General Psychopatology Vol I - K. J. (1997)

KARL JASPERS
GENERAL
PSYCHOPATHOLOGY
Volume One
Trans/ated from the German by
J. HOENIG
and
MARIAN W. HAMILTON
With a new foreword by

PAUL R. McHUGH, M.D.
THE JOHNS HOPKINS UNIVERSITY PRESS

Baltimore and London
FOREWORD TO THE 1997 EDITION

GENIUS IN A TIME, PLACE, AND PERSON
For those who would understand psychiatry, this book is indispensable.

Although it draws from the clinical thought and practices of the late nineteenth and early twentieth centuries, its delineation of the methods for
comprehending mental disorders remains unmatched to this day. It is, in fact,
a product of a special time, place, and person.
Originally published in German as Allgemeine Psychopathologic, by Karl Jaspers
Copyright Springer-Verlag Berlin Heidelberg 1959
Copyright in the English translation 1963 Manchester University Press
Foreword, by Paul R McHugh, M.D., 1997 The Johns Hopkins University Press
All rights reserved
Printed in the United States of America on acid-free paper
Johns Hopkins Paperbacks edition, 1997
9 8 7 6 543 21
The Johns Hopkins University Press
2715 North Charles Street
Baltimore, Maryland 21218-4319
The Johns Hopkins Press Ltd., London
Library of Congress Cataloging-in-Publication Data
Jaspers, Karl, 1883-1969.
[Allgemeine Psychopathologie. English]
General psychopathology / Karl Jaspers; translated from the German by]. Hoenig and
Marian W. Hamilton; with a new foreword by Paul R McHugh. - Johns Hopkins pbk. ed.
p.
cm.
Originally published: Chicago: University of Chicago Press, 1968.
Includes bibliographical references and indexes.
ISBN 0-8018-5775-9 (pbk. : v. I: alk. paper). - ISBN 0-8018-5815-1 (pbk. : v. 2: alk.
paper)
I. Psychiatry. 2. Psychology, Pathological. 3. Phenomenological psychology. I. Title.
IDNLM: I. Mental Disorders. 2. Psychology. WM 140 J39a 1968aJ
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The Time
Consider first its time. The year General Psychopathology was publishedI9I3-was pivotal in the history of psychiatry. It was the culmination of the
most productive decade of this century. It was also the last year before the
great German tradition of university-based empirical psychiatry was drowned
by the chaos of war, economic depression, Nazi barbarism, and the Cold War's
division of East and West Germany.
In the ten years from I903 to I9I3, the investment of fifty years of
preparation and prior work bore fruit. In that decade, Emil Kraepelin
published the eighth and definitive edition of his textbook (I909), Eugen
Bleuler introduced the term schizophrenia (I906), and Alois Alzheimer described the condition that now bears his name (I907). These outstanding
contributions to empirical psychiatry, though, were matched in the same
decade by a maturing interpretive psychiatry. Sigmund Freud's fledgling
movement, "psychoanalysis," gained international reputation through its
spread among neurologists, private practitioners, and the sophisticated middle
classes of Europe, through the interest of American physicians and society
prompted by Freud's I909 visit to Clark University, and through the revisionism and generation of alternative ideas provided by the breakaway in this
decade of former students of Freud-Alfred Adler and Carl Gustav lung.
Freud, lung, and Adler did more than propose explanations for psychiatric
disorder; they generated a movement of thought about human mental life,
well enough advanced by I9I3 for any perspicacious student to predict its
eventual power and claims.
As is obvious from this mere sketch, the initial collision between empirical
and interpretive psychiatry occurred in this decade and originated in two
linear Teutonic thinkers (Kraepelin and Freud). Their contention demanded
resolution, but-with the exception of this great book-no such effort was
made, in part because of the social chaos that enveloped the original
champions and their followers. Enervating as it is to teaching and practice, this
rCl'Ord for this hook is availahle from the British Lihrary.
VB
psychiatric conflict festers to the present day, with empiric and interpretive
psychiatry retitled "biologic" and "dynamic." The monolithic tyrannies of the
originators persist.
try, not even a common observational method for identifying the manifestations of psychiatric disorders.
The problem was not just in the library. In the clinics as well, psychiatrists
on one day seemed to work to a Kraepelinian diagnostic formula, but on the
next proposed some theoretical explanation that took nothing from the
previous day's ideas. It seemed to Jaspers that psychiatrists struggled to make
sense of their discipline. They were aware of concepts and facts, but were
unsure of when particular explanations for disorder might apply, and adopted
treatments and research programs almost on impulse. Coincidentally Jaspers
also appreciated why many of his more gifted contemporaries restricted their
work to brain studies. At least they could get their hands around the brain,
even if the problem of importance to the patient lay somewhere else.
"To make real progress psychiatrists must learn to think," he said during
one discussion with colleagues. "Jaspers ought to be spanked," replied his
contemporaries.
Jaspers sensed that psychiatry inhabited a middle ground between science, where laws of nature are discerned, and history, where fateful events are
conceived as emerging from human choices and actions. That is, Jaspers knew
that some mental disorders derive from brain diseases, and therefore psychiatrists should be close allies with neurologists. But he also knew that mental
distress could emerge as consequences of some conflict between an individual's
wishes and actual life circumstances, so psychiatrists should naturally share
interests with students in the social and cultural disciplines. In fact, Jaspers
saw more coherence and conceptual development among neurologists and
social scientists than among most psychiatrists. The students in the disciplines
surrounding psychiatry tended to reflect on the methods behind their opinions and thus learned to judge them.
Jaspers turned to three prominent social scientists to organize his thought:
the philosopher Edmund Husserl, the historian Wilhelm Dilthey, and the
political scientist Max Weber. Husserl comes first because Jaspers took from
Husserl an approach to examining patients. Husserl taught that the contents
of the conscious mind of others could be accessed and described by what he
called at first "descriptive psychology" and later "phenomenology." Jaspers
followed Husserl's lead and, with modifications for the clinical setting,
defined a phenomenological approach to interviewing and examining psychiatric patients.
The phenomenological method hinges on the human capacity for selfexpression-a means of communicating one's experiences to another. This
capacity makes it possible for patients to describe the contents of their minds
and for psychiatrists listening to these descriptions to enter the mental life of
such patients. Through this process psychiatrists can empathically penctrutc
(almost co-experience) their patients' thoughts, perceptions, and feelings und
note the similarities and differences among the "phenomena" they find.
The phenomenologically inspired interaction between psychiatrists lind
VI
The Place
If 1913 was a propitious year for someone to identify and resolve the
warring concepts of psychiatry, then the place where this book was written was
itself ideal. The Psychiatric Clinic of the University of Heidelberg, the
preeminent German university and academic center, was under the direction
of Franz Nissl, he of the Nissl stain in neurohistology. Nissl was an intense,
hardworking, odd character who started on the wrong side in the battle of the
neuron theory and learned from his mistakes. He was the perfect chief for
such a clinical research institution: a methodical scientist himself who had
learned about the difficulties of discovery.
A man of integrity without envy, Nissl could get others to join him in the
enterprise of clinical and investigative psychiatry. He emphasized his colleagues' strengths rather than harping on their weaknesses. With these traits,
combined with a passionate interest in scientific effort and achievement, he
created an atmosphere of vigorous and free discussion among his faculty. For
all that his own creativity was modest, his choices of colleagues, his enthusiasm for new enterprises, and his lack of autocratic tyrannies helped to create
an environment in which inventiveness of all kinds flourished.
Nissl was not initially enthusiastic about this work of Karl Jaspers,
wondering whether it was merely philosophical hairsplitting or "monkey
business," as he called abstract treatises. Once he had read it, however
(carrying the galley sheets around in the pocket of his white coat for weeks),
he became its champion. Jaspers noted that Franz Nissl in Heidelberg in 1913
was just the right leader to produce a "genius of place."
The Person
The time and place inspired a special person to write this book. Karl
Jaspers came to Heidelberg right from medical school in 1908. He brought
with him a unique set of qualities. Although initially interested in philosophy,
he had turned to study medicine, which, he believed, best illuminated life
itself and the challenges of human existence. However, he was chronically ill
with bronchiectasis and could not assume heavy clinical duties. Jaspers won
Nissl's begrudging permission to work in the library rather than the clinic or
laboratory. His skills as an open-minded, critical, indeed often skeptical,
thinker about psychiatric opinions and practices came to the fore. Jaspers soon
realized, and as promptly said, that the library volumes (and the psychiatric
periOllicll literature) were filled with "unfounded chatter." This "chatter"
derived from the mushrooming of independent self-referential schools of
thollght ahollt patients-each with its own terminology. Jaspers discerned that
there was no commonly accepted, science-based, logical approach to psychia-
VIII
patients calls for efforts that go beyond the definition and cataloging of
disordered mental events such as delusions and hallucinations. The psychiatrist attempts to grasp these events as experiences within the consciousness of
the patient-a kind of "living with" the events as the patient recounts them.
jaspers, following Husserl, proposed that psychiatrists could achieve such
an understanding of their patients' mental life if they approached the task of
inquiry without prejudice of theory but rather by attempting to gain from a
patient a full description of his or her mental experience. The process is not
some secret seeking but rather a true "meeting of minds." In this book jaspers
lays out a treasury of characteristic disruptive experiences within human
consciousness accessible to psychiatrists prepared to take up such a "walk in
your shoes" stance with their patients.
Once he clarified the "phenomenologic" approach and described the
characteristic features of disordered thoughts, perceptions, and emotions,
jaspers's next issue was to differentiate the several prevailing explanations for
mental disorders. Again he had little help from the psychiatric literature,
where he found a muddle of conflicting schools of thought. Here he turned to
Dilthey and Weber. These social scientists taught that drawing explanatory
"connections" between events-as, for example, concluding that the loss of a
parent in childhood produced a revengeful character in the adult-was a
hazardous business if not done methodically and systematically.
The social scientists had two methods at hand. An empirical, statistical
demonstration of the regular co-occurrences of certain events in a population
might provide evidence for the "connection" between them, but an empathic
assertion that a particular experience had special meaning in the life story of
an individual might suggest even more powerfully the link between an
experience and a later behavior. jaspers's goal became the appropriation and
practical differentiation of these two social science methods of explanation so
as to make them available to psychiatric teaching, investigation, and practice.
Thus, he could support Kraepelin's opinions on heredity and mental
illness based on the statistical study of hundreds of patients and their families.
And, as well, he could identify what Freud and Adler were claiming for
"connections" between early life experience and the development of a
disorder such as hysteria or anxiety. jaspers, taking the terminology from
Dilthey, distinguished these two modes of work by speaking of Kraepelin's
method as "explanation" (erkliiren). "Explanation," jaspers noted, was the
attempt to discern nature's laws acting impersonally, through "causal connections," to produce a mental disorder.
jaspers identified Freud's method as "understanding" (verstehen). "Understanding," jaspers taught, grasped for "meaningful connections" in an attempt
to demonstrate that disorder emerged because of a conflict between experience and a specific individual's hopes and desires-a conflict and its emotional consequences that could be empathically appreciated for the person
even though not statistically demonstrable.
By differentiating "explanation" and "understanding," jaspers emphasized that there was a critical epistemological divide within the field of
psychiatry and that psychiatrists could bridge this divide only by appreciating
these different methods at their disposal. But woe to the psychiatrist who
confused "understanding" with "explanation" (as jaspers believed Freud to
have done), because then false claims and misdirected hypotheses would once
again muddle this field.
Thus, from each method jaspers identified contributions to psychiatry.
But he emphasized those contributions as having limits implicit in the method
itself. For example, he noted that Kraepelinian labels might slight the
personal suffering of an individual, whereas Freudian interpretations might
overlook a neurobiologic process.
jaspers also emphasized those limits because he held that neither provided full views of human mental life and its potentials. He believed and
emphasized in his phenomenological studies that the individual human
being--even affiicted by mental disorder-was always more than we can
know. In essence, jaspers's object was to show psychiatrists exactly what they
know, how they know it, and what they do not know and cannot claim. He
wrote this book with these aims in mind.
IX
Aftermath
General Psychopathology was a splendid achievement for anyone but amazing for a man of barely thirty years of age. A fascinating fact, though, is that it
culminated the psychiatric productivity of its author, who, with the exception
of revising the text (with some expansion) for subsequent editions (this is the
seventh), left psychiatric work forever. He became a distinguished leader in
twentieth-century existential philosophy. He was also a voice of reason in the
catastrophic events that overcame his university and his country. He was a
prodigy in many ways, but as a physician, who led a philosophical movement
and denounced tyranny when others were silent, he was most special.
jaspers always claimed that the work in General Psychopathology was his
avenue to understanding human nature. An open, unblinkered view of mental
illness gave him a comprehension of mental health. As well, his dedication to
identifying limits to imperious claims about human beings protected him from
the huge ideological errors of this century. His emphasis on the phenomena of
human consciousness helped him grasp an essential characteristic of human
mental life-its promise. His commitment to this promise provoked his
enmity to the totalitarian systems that sprang up in the West (Fascism,
National Socialism, Marxism/Leninism).
From the same allegiance to promise he also opposed physician/scientists
who, emphasizing a fragmentary knowledge of human biology, slighted the
value and grounds for hope in the lives of their patients. Thus. right from
1913. Jaspers attacked the growing power of the eugenics movement. which
engaged psychiatrists around the world seeking "racial hygiene." Ilis stronj(
and persisting enmity toward racism in all its forms came from the same source
and was based on his recognition of the fundamental unity of human mental
experiences played out in individual lives and purposes.
His quarrels with psychoanalysis grew over time and increased with each
edition of General Psychopathology. (They can also be reviewed in his philosophical works, such as Man in the Modern Age.) The quarrel began in the first
edition, in which he challenged the views of Freud and his followers that they
had a scientific-that is, "causal" or "explanatory" rather than a "meaningful" -approach to mental disorders. Later, when the requirement for a
training analysis became psychoanalytic policy, Jaspers attacked the movement both for its indoctrinating methods toward its students and for its
fundamental nihilism (deriving even what is best in a person from base origins
that only psychoanalysis can unveil).
At the very heart of all his teaching is Jaspers's radical commitment to two
great themes, freedom and responsibility. These two themes must interrelate
either for a person to reach his or her innate promise or for all of us to build a
society worthy of mankind. The first of the two themes declares that the
essence of human beings is freedom. Unlike all other creatures, men and
women face an unpredictable future and have unlimited opportunities for
progress. Jaspers's sense of human freedom aroused his hatred for simplistic
notions about our nature and for coercive forces that would restrict our
development to certain paths. He foresaw situations in which thinking about
human beings as animals would eventually lead to treating them as suchculling them as if they were a flock or a herd.
The second theme-responsibility-reflects his appreciation that the way
things are formed-families forged, societies built, cities sustained, and the
future realized-depends in the last analysis on the decisions and deeds of
individuals. "Each individual-by his way of life, his daily small deeds, by his
great decisions, testifies to himself as to what is possible. By this, his present
actuality, he contributes unknowingly toward the future." This idea-that
there is no law of nature or law of history which determines what is and what
will be, but rather it is the many and repeated choices of free individuals
which make or break this world-was fundamental to Jaspers's thought as a
psychiatrist and as a philosopher. It made him inspect the choices suggested to
and imposed on people by authorities of all kinds-scientific authorities as
much as political authorities-and ultimately set him at odds with tyranniesboth the tyrannies of governments and the tyrannies of the crowd.
. I'he central problem of modernity is how to tie freedom to self-government. In General Psychopathology, Jaspers addresses this issue as he describes
the conceptual foundations of psychotherapy. He discloses that order in
mental life is a consequence of enlightened freedom, not an imposition on it.
llere Jaspers voices opinions that he derives from that quintessential modern
SOllf{'C, psydlOtherapy, but that have had earlier advocates and other derivations (Thucydidcs from war, Augustine from the ruins of an impcrial civiliza-
tion, Jefferson from revolution). The main point of these advocates-and the
essence of Jaspers's thought-is that people are free but can learn that they
are responsible for the consequences of their actions.
These ideas, the promise in human nature and its realization through the
interplay of freedom and responsibility, with all their implications for both
psychiatric practice and a democratic society, are not found in the clinical
writings of Jaspers's contemporaries, Kraepelin or Freud. This is another
seldom-noted, distinguishing feature of his work in both psychiatry and
philosophy. Thus Jaspers alone advances the wisdom about patients needed to
dispel the contemporary agitations around psychiatry that characteristically
clamor for rights and disregard implications. These include the antipsychiatry
of Michel Foucault and Thomas Szasz, the demand for physician-assisted
suicide in the Netherlands, and the subtle forms of eugenics that the Human
Genome Project has in store.
Xl
Conclusion
I call this book indispensable even though it was written eighty-four years
ago-before the discovery of the EEG, DNA, or norepinephrine. I hold this
view because, despite these many scientific advances, most of the problems
that Jaspers noted in 1913 remain as problems to psychiatry today. We have
more information than Jaspers found crowding the shelves in Heidelberg, but
we still disagree about how best to order this information so as to encourage its
steady progress and to read its fundamental messages.
Jaspers noted that psychiatrists must "develop and order knowledge
guided by the methods through which it is gained-to learn the process of
knowing and thereby to clarify the material." The twentieth century brought
more facts to us. But a systematic appreciation of the methods of observation
and interpretation that psychiatrists employ is essential to transform these
facts into knowledge and its ultimate implications. No one since Jaspers has
done it better.
PAUL R. McHUGH, M.D.
Henry Phipps Professor and Director
Department of Psychiatry and Behavioral Sciences
Johns Hopkins Medical Institutions
I{EFERENCES
Jaspers, K. The Phenomenological Approach in Psychopathology. British Jou,

nfl/ oj Psychiatry 114:1313-1323,1968.
Jaspers, K. Philosophical Autobiography. In Paul A. Schilpp (ed.), The Phi/osopkv oj Karl Jaspers. La Salle: Open Court Publishing Company, 1981.
Shepherd, M. Karl Jaspers: General Psychopathology. British .I()urn(l14/\Vf'hifltry 141:JI0-JI2, 1982.
xii
Shepherd, M. The Sciences and General Psychopathology. In M. Shepherd

and O. L. Zangwill (eds.), Handbook of Psychiatry, Vol. I. Cambridge: Cambridge University Press, 1982.
Slavney, P. R., and McHugh, P. R. Psychiatric Polarities (Chapter 3, Explanation
and Understanding). Baltimore: Johns Hopkihs University Press, 1987.
Wiggins, O. P., and Schwartz, M. A. Chris Walker's Interpretation of Karl Jaspers' Phenomenology: A Critique. Philosophy, Psychiatry, and Psychology
2:319-343, 199 6 .
Wiggins, O. P., and Schwartz, M. A. Edmund Husserl's Influence on Karl Jaspers' Phenomenology. Philosophy, Psychiatry, and Psychology 4:15-36,1997.
FOREWORD
I am honoured that the task of writing a foreword to the English translation of
the seventh and latest edition of this great psychiatric classic should devolve
upon me. An English translation is long overdue. It is a source of satisfaction
to me also that this translation should emerge from the Manchester University
Department of Psychiatry. Karl Jaspers has worldwide eminence as a philosopher; his outstanding contribution to psychiatric thought is less well-known,
at least amongst psychiatrists in England and America. The first edition of the
Allgemeine Psychopathologie appeared nearly fifty years ago, in 1913, when
the author was barely thirty years of age. Before this, in 1910, Jaspers had
created a stir in the world of German psychiatry by the publication of his
seminal article on morbid jealousy in which he first brought to the light of day
his method and fundamental principles. As one of his biographers has remarked, Jaspers showed in this momentous contribution his sure eye for
psychopathological detail and it was in this article that he first introduced his
concept of 'process' versus 'personality development'. This laid the basis of socalled psychopathological phenomenology which, through the work of
Jaspers and a brilliant group of colleagues, amongst whom may be mentioned
Hans Gruhle, Kurt Schneider, the late Professor Mayer-Gross, well-known to
us in this country, and several others, became the particular decoration of the
Heidelberg school of psychiatry. The importance of this development in
psychiatric thought has been on the whole insufficiently recognised, even in
the land of its origin. In recent years, however, there has been an evident increase of interest in and attention to the teachings of this school. The Heidelberg school, until recently under the leadership of Professor Kurt Schneider,
whose own contributions over the last fifty years have been outstanding, has
stimulated a large number of younger men who have broken fresh ground. It
may, I think, be fairly said that the school of phenomenology with its developmental offshoots is at the moment the most significant school in present-day
German psychiatry. That this school should have been insufficiently recognised in England is perhaps hardly suprising. Many reasons can be adduced
for this, first and foremost of which is the linguistic barrier. Secondly, even for
those familiar with the German language, Jaspers' thought and style are difficult, due no doubt to his training as a philosopher, and his consequent use at
times of terms specially devised to express some nuance of meaning not easily,
if at all, to be translated intelligibly. To the English with their ingrained empiricism such an approach might well repel at first sight as academic and theoretical. Yet this would be a superficial valuation. In fact, the whole basis of Jaspers'
work is strongly empirical and, as he is at pains to affirm, strictly within the
framework of the inductive method of the natural sciences as far as the often
XIII
xiv
FOREWORD
intangible subject matter of this difficult field allows. By a remarkable paradox,

however, our supp~sedly empirical countrymen have accepted readily enough,
and on the whole w1th an astonishing lack of criticism, the often unproved and
unprovable assertions of the so-called psychodynamic schools. To those to
w?om such teachings form an acceptable psychopathology, the work of Jaspers
mlght well appear static and ari~. Static it is certainly not, arid it may be to
those for whom the still sparse and inconvenient facts of mental illness must
be circumvented by romantic fancies. This statement implies no facile derision
of psychoanalytic teaching, it reflects rather an unvoiced Utopian regret that,
due no doubt to the nature of the subject, psychoanalytic teaching, often
enough characterised by profound insight into human behaviour could not
have been limited to the thoughtful and critical few. On the oth:r hand the
phenomenological approach involves painstaking, detailed and laborious study
of facts observed in the individual patient at the conscious level. It is the
method which forms the basis of the clinical practice and teaching of the Manchester Department of Psychiatry and one which I believe is fundamental to
s~u?d clinical. w~rk. Moreover, I believe that whatever other paths the young
c.hmcal psychlatrist may come ultimately to tread, whatever particular orientatlon he may come later to adopt, a knowledge of the principles stated in this
book is indispensable to him. For whilst one of the great merits of the book lies
in its tentative formulations and the resolute determination of the author to go
no further t?an the facts, and whilst some of Jaspers' interpretations and analyses of morbid phenomena have been subjected to searching criticism, and some
are now not widely accepted, the principles remain and with these the continuing influence of the work.
. As long as psychiatric diagnosis and treatment rest on psychopathological
mvestigation, the continuing improvement and sharpening of this tool of investigation n:ust re~ai.n a prime concern to psychiatrists. This book is a guide
to that techmque, stllllrreplaceable, much of it is still as fresh as the day it was
written and still a lively stimulus to others yet to come.
The world of English-speaking psychiatry stands in debt to the translators,
my two colleagues Dr. J. Hoenig and Miss M. W. Hamilton. It had been for
long my earnest desire that this key work should be translated into En<Ylish.
When Dr. Hoenig joined my staff I was gratified to learn that he had al~eady
contemplated doing so. Miss Hamilton, who had had already some considerable experience in translating from the German other works of this particular
s~hool, seemed ~n obvious collaborator. I wish therefore to thank them partlcularly for havmg undertaken this immensely difficult task. If here and there
the translation may seem to have faltered, this can, I am sure, be charged for the
most part to the difficulty and at times impossibility of rendering the author's
subtle thought into concise and comprehensible English.
E. W. ANDERSON
TRANSLATORS' PREFACE
Being concerned with the teaching of psychiatry, we have felt as keenly as
others the lack of a fundamental textbook in psychopathology. The existing
difficulties of psychiatry as a subject are many but they seem rooted in two
major shortcomings:
I. Although modern clinical psychiatry is still largely based on the achievements of continental psychiatrists, particularly of those French and German
workers, who wrote in the first quarter of this century, much of what has been
written remains inaccessible to the English-speaking psychiatrist who is unfamiliar with these languages. This often results in a very superficial understanding of the concepts, which are either used out of their proper context or
put into a wrong one. The confusion which follows is suffocating.
2. As a consequence of this confusion, but also going beyond it, there is an
absence of common terminology. Identical expressions tend to be used for
entirely different entities, and one and the same entity is often given two, three
or more different names as if it were so many different things.
It is said that the development of psychiatry has at present reached a stage
where a unification of viewpoints is impossible. This is true; more than that,
a unification is not even desirable. Thought and research must be free to explore in many directions and within many different theoretical frameworks.
But conceptual confusion and the lack of a common, basic terminology far
from safeguarding this freedom constitute a major threat to it. It is precisely
because there are now so many different interpretations of the few known facts
that the need for improved communication within the profession has become
paramount. We need to know better what psychiatry has already achieved and
discipline ourselves more, to use a shared terminology within clearly defined
theoretical frameworks.
Though none, perhaps, are better placed to further such an aim than the
editors of the psychiatric journals themselves, professional education remains
the function of the University Departments. With this in mind we decided to
translate Karl Jaspers' General Psychopathology. To make the book available
in English had been a firm objective with one of us (J.H.) since 1951, but
hitherto the scale of the work had failed to attract a publisher. However the
University Department in Manchester seemed to offer an excellent opportunity for a fresh endeavour since the climate of this Department under
Professor Anderson's teaching was very favourable to the Heidelberg School
and one of us (M.W.H.) had already had experience in translating other
psychiatric texts from the German. l No other work better meets the need for
1 K. Schneider, P.,ychopathic Personalities (Cassell, 1958); Clinical Psychopathology (Grune &
Stratton, 1959)'
xv
xvi
xvii
a critical introduction to continental psychiatry and for the creation of a

terminology which would be commonly acceptable. The translation therefore
was begun in I9S8 but, as we were only able to work in our own time, it was
not completed until 1962. The task has proved exacting but very instructive
and always enjoyable.
One of Jaspers' explicit aims was to systematise the main methods of
approach in psychopathology and thus facilitate the building of a common
terminology. To do justice to this latter has presented us with some formidable
difficulties. We have tackled these in several different ways:
I. We retain the original German or French term (e.g. 'Gestalt', 'Anlage',
'Querulant', 'Milieu', 'Absences'), where the words have already become part
of English usage. Where a possible translation has suggested itself, but we
have felt doubtful, we have given the German term in brackets with a crossreference in the index, e.g. Thought-resonance (Gedankenlautwerden),
Thrust (Schub) of the schizophrenic process, Talking past the point (Vorbeireden), Inhibition on becoming (Werdenshemmung), etc.
2. Where the obvious English translation is already in technical usage but
represents quite a different concept from its German step-brother, e.g.
'Psychopathy' for 'Psychopathie', we have avoided it, since its use would give
rise to confusion. We have, therefore, translated 'Psychopathie' as 'personality disorder', which is a term relatively free from any other specific
meaning and appears to express quite adequately what is meant by the term
'Psychopathie' in continental psychiatry. But we have retained 'neurosis' for
'Neurose' since here the term has retained the same sense in both languages,
namely, a psychogenic disorder of behaviour and thought.
3. The term 'paranoid' presented us with special difficulties. We have used
it in keeping with the Oxford Dictionary definition of Paranoia (n. Mental
derangement, esp. when marked by delusions, of grandeur, etc. [Gk. -noia f.
para (noos-mind), distracted]. The German usage is also in line with this
definition and implies a 'wrong notion', synonymous with 'delusional'. In
English, however, 'paranoid' is often used to mean 'Persecutory' both in
technical psychiatry and in general usage. This has led to a: good deal of confusion with such expressions as 'paranoid schizophrenia' (i.e. a schizophrenic
picture in which delusions predominate), since the content of the delusions
can have other than persecutory content, e.g. messianic, hypochondriacal,
magical, etc. Thus the expression 'paranoid features' does not properly mean
'ideas of persecution' but merely the 'presence of delusions'. As there does not
seem any philological justification for the use of this word in the narrower
sense of 'persecutory', we have retained the broader meaning in accordance
with the dictionary definition.
4. We have translated the philosophical terms as best we could. We were
not able to get much help from translations of Jaspers' philosophical works
nor from other writings. These translations have not been consistent nor particularly happy, and, on advice from our colleagues in the University Depart-
ment of Philosophy, we decided to go our own way, keeping the other

translations in mind as much as possible. Terms such as 'Existenz' (Existence
itself), 'Dasein' (Existence as such; existence in a world; human existence),
'Sein' (Being), 'So-Sein' (Being-Thus), 'Das Umgreifende' (that which encompasses, the Encompassing) or 'Geist' presented some of our greatest
difficulties. The latter we found impossible to render by any single English
word. It appears as 'mind', 'spirit', 'culture', according to the context.
S. Certain words in common German usage have been 'coined' by Jaspers
and given specific meanings. The two most important 'Verstehen' (understanding) and 'Erklaren' (explanation) run through the whole book and are
related to his central theme, the dichotomy of psychic phenomena into
'psychogenic development' versus 'organic process'. Both these orders of
psychic phenomena occur in all the conditions encountered in psychiatric
practice, are usually inextricably intertwined and must be separated out for
complete comprehension of the mental state. Jaspers uses 'Verstehen and
'Erklaren' to describe the methods of their respective exploration. Words
which would fully convey his exact meaning do not exist in either German or
English and even for the German reader lengthy comment was needed (p. 301,
footnote). We therefore thought it best to retain the literal translation throughout the book, wherever possible. However, for clarity's sake we have been
forced to 'coin' certain phrases, especially in respect of 'Verstehen' and its
adjectival use 'verstehende' (e.g. 'verstehende Psychologie' -'the psychology
of meaningful connections, meaningful psychology, psychology of meaning'),
Where 'understanding' is non-specific in Jaspers' sense, the term 'comprehend'
-'Begreifen' has been used.
Finally, we are aware that in trying to be faithful to the text and preserve
in some measure the author's style, our translation may at times leave the
reader, as it has us, dissatisfied, but we hope that in all major matters the intention of this great work has been served truly by its English rendering.
We were greatly helped by many; we would like to acknowledge the
sympathetic support accorded by Professor E. W. Anderson and the unceasing
encouragement offered us in particular by Sir Aubrey Lewis and the late
Professor Mayer-Gross. A number of colleagues have helped in preparing the
scripts and proofs in their various stages. We wish to thank particularly
Mr. J. C. Kenna and Dr. N. L. Gittleson. We are also indebted to colleagues
and friends who have helped in the compilation and paging of the index, in
particular Mr. Harold Smith, Dr. Uma Sreenivasan and Mrs Meti Abraham.
Last but not least we wish to thank Mr. T. L. Jones, Secretary of the
Manchester University Press, for his constant help and the patience he has
brought to bear on the many problems involved.
Manchester, 1962
J.H.
M.W.II.
AUTHOR'S PREFACES
AUTHOR'S PREFACES
To th.eftrst edition (19 13)
This book sets out to survey the entire field of general psychopathology
and the facts and viewpoints of this science. It also sets out to be a guide to the
literature for all those who are interested.
Instead of presenting dogmatic statements of results, it prefers to introduce
the reader to problems; approaches and methods, and instead of a system based
on a theory, it would like to achieve some kind of order based on a deliberate
methodology.
There are in psychopathology a number of viewpoints, a number of
parallel approaches which in themselves are quite justifiable and complement
rather than oppose each other. My efforts have been directed towards sorting
these approaches out, separating them clearly and at the same time demonstrating the many-sided nature of our science. An attempt has been made to
include every empirically-based approach and every field of psychopathological interest, so that as far as possible the reader may gain a really comprehensive view of psychopathology as a whole and not merely be presented with
a personal opinion, a particular school or a set of ideas that happens to be
in vogue.
In many parts of the book we have had simply to record and enumerate
facts so far available, data still lacking in context and experiments that are as
yet tentative. But in psychopathology it is dangerous merely to learn the
matter, our task is not to 'learn psychopathology' but to learn to observe, ask
questions, analyse and think in psychopathological terms. I would like to help
the student to acquire a well-ordered body of knowledge, which will offer a
point of departure for new observations and enable him to set freshly acquired
knowledge in its proper place.
"
To the second and third editions (extracts, 1919 and 19 22 )
... We trail around with us a great number of vague generalities. I have

tried to clarify them as far as possible. But the deep intentions, which sometimes
find expression through them, should not simply be put aside and let fall,
because full clarification has not been attained. . . . The opinion has been
expressed in medical quarters that this book is too hard for students, because
it attempts to tackle extremely difficult and ultimate problems. As far as that
is concerned, I am convinced that either one grasps a science entirely, that
means in its central problems, or not at all. I consider it fatal simply to adjust
at a low level. One should be guided by the better students who are interested
xviii
XIX
in the subject for its own sake, even though they may be in a minority. Those
who teach should compel their students to rise to a scientific level. But this
is made impossible if 'compendia' are used, which give students fragmentary,
superficial pseudo-knowledge 'for practical purposes', and which sometimes
is more subversive for practice than total ignorance. One should not show a
fa~ade of science. There is a decline in culture and intellectual effort in our
days and it is the duty of everyone not to compromise. This book has, as a
matter of fact, found its way to students; I feel justified in hoping that it will
remain in the hands of students.
. .. In general, the methodological climate of the book remains important.
In the midst of all the psychopathological talk, we have to learn to know what
we know and do not know, to know how and in what sense and within what
limits we know something, by what means that knowledge was gained and on
what it was founded. This is so because knowledge is not a smooth expanse
of uniform and equivalent truths but an ordered structure of quite diverse
kinds of validity, importance and essence.
To the fourth edition (1942)
The intention of this book has remained unchanged. Its working-out

however has called for a complete re-writing. This was so because of the
extensive research done in psychopathology during the last two decades and
because of the deepening of my own basic knowledge.
The book aims very high. It would like, as far as the subject matter is
concerned, to satisfy the universal demand for knowledge. It wishes to be of
service to physicians and all those who make mankind their theme.
I have attempted to get to know all the material provided by research,
obtain an over-all picture and present it vividly. Everything, which has been
contributed to the knowledge of the sick human psyche by psychiatrists in
the main, but also by general physicians, psychologists, psychotherapists,
biologists and philosophers, has needed to be analysed in respect of its basic
features and also found a place within a realistic classification. The illumination brought by analysis of methods has provided me with the means. Such
a task, in all its width, can only be achieved for the time being and then only
incompletely. I hope that now I have succeeded better than in my previous
attempt.
I want to thank Professor Kurt Schneider! of Munich. Not only has he
stimulated me with penetrating criticism and valuable suggestions but he
has greatly encouraged my work through his positive and exacting attitudes.
I am also grateful to Professor Oehlkers of Freiburg for information on
biological questions and for clarifying them in discussion. He read through
the chapter on Heredity and made improvements.
1
Now ([946) in Heidelberg.
xx
AUTHOR'S PREFACES
I wish to thank my publisher Dr. Ferdinand Springer. My impulse to rewrite was aroused through his expressed wish in the spring of 1941 that I
should again work over the book which Springer and Wilmanns stimulated me
to write thirty years before, and through the generosity with which he left
it entirely to me to determine the scope and time in which to write it. After
the first hesitation I became wholly absorbed by the task and instead of making
minor adjustments set myself once more to reconstruct the whole.
Professor Carl Schneider made my work much easier by admitting me to
the free use of the Library at the Heidelberg Clinic for Neuro-psychiatry and
by being always ready, even at the cost of considerable trouble, to obtain
books for me, for which I am most grateful.
To the seventh edition (1959)
Along time ago this book came into being in the Heidelberg Clinic. Under
Nissl's leadership, Wilmanns, Gruhle, Wetzel, Homburger, Mayer-Gross and
others created a community of living research. (See my brief description in
Philosophie und Welt, 1958, pp. 286-92. Regarding Franz Nissl, there is an
excellent essay by Hugo Spatz in the Grosse Nervenar{te, vol. 2, 1959, ed.
K. Kolle). Within the framework ofWundt's brain-research and accompanied
by much fierce discussicm, phenomenology and the psychology of meaningful
connections came into being. At the same time as they appeared, they were
established methodologically. The psychology of meaningful connection has
become an undisputed part of psychiatry, drawing today from other sources,
some of which are productive, others highly confused. When my book has
been on occasion described as representative of the phenomenological trend,
or of the trend of meaningful psychology, this has been only partly correct. It
reaches into a far wider sphere: the clarification of psychiatric methods in
general, modes of comprehension and ways of research. The aim has been to
work through all the available empirical knowledge critically, by reflecting
on the methods whereby it was gained, and then give it a general presentation.
To bring the book up to date on the basis of the psychiatric research
of the last two decades, would have necessitated my living for a while as an
observer in a clinic in order to refresh and extend my own experience. Even
if this had been possible, nowadays I would not be able to manage it. The
book however rouses a steady interest and does not seem to be out of date.
Considerable extensions in its material might be necessary, particularly as
regards researches into the brain and somatic research in general, but the
methodological principles remain largely unaffected by the increased material.
It would certainly be possible nowadays to write a better book even on the
methodological side. Such a task must fall to a younger scientist who might
well succeed if he would appropriate the methodological clarification of this
AUTHOR'S PREFACES
xxi
book, expand it and put it perhaps into a different context. I would gladly
welcome such a book. Until it appears this present old one is well suited to
help the physician who wants to learn how to 'think' in psychopathological
terms.
KAru. JASPERS
SUMMARY OF CONTENTS
xxm
Volume Two
SUMMARY OF CONTENTS
Part Three: The Causal Connections of Psychic Life
Volume One.
Foreword to the 1997 Edition by Paul R. McHugh, M.D.
Foreword by E. W. Anderson, M.D., F.R.C.P., D.P.M.
Translators' Preface
Author's Prefaces
Detailed Analysis of Contents
Introduction
(Erklarende Psychologie)
IX. EFFECTS OF ENVIRONMENT AND OF THE BODY ON PSYCHIC LIFE
X. HEREDITY
XI. THE EXPLANATORY THEORIES-THEIR MEANING AND VALUE
Part Four: The Conception of the Psychic Life as a Whole

XII. THE SYNTHESIS OF DISEASE ENTITIES (NOSOLOGIE)
Part One: Individual Psychic Phenomena

Chapter
I.
XIV. BIOGRAPHICAL STUDY (BIOGRAPHIK)
SUBJECTIVE PHENOMENA OF MORBID PSYCHIC LIFE (PHENOMENOLOGIE)
Section I: Abnormal psychic phenomena

Section 2: The momentary whole-the state of consciousness
II.
XIII. THE HUMAN SPECIES (EIDOLOGIE)
Part Five: The Abnormal Psyche in Society and History

(Social and historical aspects of the psychoses and
the personality-disorders)
THE OBJECTIVE PERFORMANCES OF PSYCHIC LIFE (LJ:iISTUNGSPSYCHOLOGIE)
Section I: Individual performances

Section 2: The total performance
III. SOMATIC ACCOMPANIMENTS AND EFFECTS AS SYMPTOMS OF PSYCHIC
ACTIVITY (SOMATOPSYCHOLOGIE)
IV. MEANINGFUL OBJECTIVE PHENOMENA
Section
Expression of the psyche through body and movement(Ausdruckspsychologie)

.
Section 2: The individual's personal world-(Weltpsychologle)
Section 3: The psyche objectified in knowledge and achievement(Werkpsychologie)
I:
Part Two: Meaningful Psychic Connections

(Verstehende Psychologie)
V. MEANINGFUL CONNECTIONS
VI. MEANINGFUL CONNECTIONS AND THEIR SPECIFIC MECHANISMS
Section I: Normal mechanisms

Section 2: Abnormal mechanisms
VII. THE PATIENT'S ATTITUDE TO HIS ILLNESS
VIII. THE TOTALITY OF THE MEANINGFUL CONNECTIONS (CHARAKTERO'
LOGIE)
xxii
Part Six: The Human Being as a Whole

Appendix
I
2
3
4
Examination of patients
The function of therapy
Prognosis
The history of psychopathology as a science
Name Index
General Index
xxv
DETAILED ANALYSIS OF CONTENTS
s. What a general psychopathology has to do: a survey of this
PAGE
book
VOLUME ONE
PAGE
Introduction
I. The boundaries of general psychopathology

(a)
(h)
(c)
(d)
Psychiatry as clinical practice and psychopathology as a science

Psychopathology and psychology .
Psychopathology and physical medicine .
Methodology-the contribution of philosophy
2.. Some basic concepts
(a) Conscious critique of methods in place of dogmatism.

(h) Classification according to methods
.
.
.
(c) The idea of the whole.
.
.
.
(d) The objective validity of the classifications
(e) The plan of the book .
.
.
(I) Comments on the plan of the book
(I) Empiricism and philosophy .
(2) Overlapping of chapters
.
(3) Specific methods and the total picture
(g) Technical lay-out

(I) Illustration by example
(2.) The form of presentation
(3) References to the literature
Man and animal.

Objective manifestations of psychic life
Consciousness and the unconscious.
Inner and outer world.
Differentiation of psychic life.
(f) Recapitulation
(a)
(h)
(c)
(d)
(e)
7
9
9
(A) Psychopathology and culture
Part One: Individual Psychic Phenomena
[[
13
Introduction
53
IS
CHAPTER I
3. Prejudice and presupposition
16
(a) Prejudice .
16
(I) Philosophical prejudice

(2.) Theoretical prejudice .
(3) Somatic prejudice

.
.
.
(4) 'Psychologising' and 'intellectualising'
(S) Use offalse analogy.
.
.
(6) Medical prejudice relating to quantitative assessment, objectivity and
diagnostics
(h) Presupposition
16
17
18
Introduction
19
19
20
20
4. Methods
SUBJECTIVE PHENOMENA OF MORBID PSYCHIC LIFE

(PHENOMENOLOGY)
:12
(a) Techniques
SECTION ONE: ABNORMAL PSYCHIC PHENOMENA
(a)
(h)
(c)
(d)
The dissection of the total relational context

Form and content of phenomena
Transitions between phenomena
Classification of groups of phenomena
I. Awareness of objects
(I) Case study

(2) Statistics
Anomalies of perception
.
.
Abnormal characteristics of perception
Splitting of perception.
False perceptions
.
.
.
(e) Abnormal imagery-false memory.
(f) Vivid physical awarenesses
(I) Collection of individual phenomena .

(2) Enquiry into connections
(3) Grasp of complex unities
(I) The slide into endlessness

.
(2) The impasse created by absolutes
.
(J) Pseudo-insight through terminology.
31
JI
34
35
(d) The relatedness of psychopathological methods to other scientific
studies
.
..
.
(e) The demands of a satisfactory methodology: a critique of methods in
contrast to methods that mislead
XXIV
60
(a)
(h)
(c)
(d)
(h) The practical logic of research
(c) Inevitable mistakes in formal logic that have to be constantly

overcome.
60
60
Psychological Preface
(3) Experiments
57
58
S9
35
37
2.. Experience of space and time

(a) Space (micropsy and macropsy, experience of infinite space, emotional

space)
(h) Time
(I) Momentary awareness of time.
.
.
(2.) Awareness of time-span of the immediate past
79
79
80
IIJ
8)
Hot
XXVI
PAGE
PAGE
(3) Awareness of time-present in relation to time-past and future

(4) Awareness of the future
.
.
.
.
.
.
.
(S) Schizophrenic experience of time standing still, flowing together, and
stopping
(c) Movement.
3. Awareness of the body

(a) Amputated limbs
(0) Neurological disturbances
....
(c) Bodily sensations, perception of bodily shape, hallucinations of the
bodily senses, etc.
(d) The "double" or heautoscopy
4. Delusion and Awareness of reality

Awareness of Reality; logical and psychological comment
(a) The concept of delusion
(0) Primary delusions
(c) Incorrigibility of delusion
(d) Elaboration of the delusion
(e) Delusion proper and delusion-like idea
(f) The problem of metaphysical delusions
5 Feelings and affective states

(a) Changes in bodily feeling
(0) Changes in feelings of capacity
(c) Apathy
(d) The feeling of having lost feeling
(e) Change in the feeling-tone of perception
(f) Unattached feelings (free-floating feeling)
.
(g) The growth of private worlds from unattached feelings
6. Urge, Drive and Will

(a) Impulsive acts
(0) Awareness of inhibition of will
.
( c) Awareness ofloss of will or access of power
7. Awareness of the self

(a) Activity of the self
(0) The unity of the self
(c) Identity of the self
(d) Awareness of self as distinct from the outside world
(e) Awareness of one's personality
.
.
(f) Multiple personalities: dissociated personality
8. Phenomena of self-reflection
(a) Psychic life-mediated and unmediated by thought
8S
86
XXVll
(0) Disturbance of instinct and bodily function

(c) Compulsive phenomena
13%
133
86
87
88
88
89
90
90
91
93
93
9S
98
104
106
106
107
SECTION Two: THE MOMENTARY WHOLE-THE STATE OF CONSCIOUSNESS
Techniques of enquiry
I. Attention and fluctuations in consciousness

(a) Attention .
(0) Fluctuations in consciousness.
(c) Clouding of consciousness
(d) Heightening of consciousness
2. Sleep and hypnosis.

(a) Dreams
(h) Falling asleep and waking
(c) Hypnosis .
3. Psychotic alterations in consciousness
147
4. Forms of complex fantasy experience
loS
CHAPTER II
108
110
III
OBJECTIVE PERFORMANCES OF PSYCHIC LIFE(PERFORMANCE PSYCHOLOGY-LEISTUNGSPSYCHOLOGIE)
III
III
III
113
liS
117
117
117
u8
119
III
UI
III
114
IlS
u6
u7
u8
13 1
13 1
13 1
(a) Subjective and objective psychology

(0) The basic neurological schema of the reflex arc and basic psychological schema of task and performance
(c) The antagonism between the two basic schemata
(d) Association-, Act- and Gestalt-Psychology
(e) The hierarchy of complex unities.
.
(f) Experimental work in psychopathology
155
155
IS8
160
164
I6S
SECTION ONE: INDIVIDUAL PERFORMANCES
F. Perception
2. Apperception and orientation
171
3. Memory
I73
It>?
173
(a) Amnesias .
174
175
178
(0) Disturbances of recall (reproduction), retention and registration

(c) Falsifications of memory
4. Motor activity
(a) Neurological disturbances of motility
(0) Apraxias .
(c) Psychotic disturbances of motor activity
179
179
180
180
XXVIJI
PAGE
PAGE
5. Speech
18 5
(a) Disorders of articulation
(6) Aphasias .
(c) Speech disorders in psychoses
6. Thought and judgment
18 5
186
187
19 1
194
3 Somatic findings in psychosis

(a)
(6)
(c)
(d)
Body-weight
Cessation of menses
Endocrine disturbances.
.
Systematic physiological investigations to find clinical pictures with
typical somatic pathology
SECTION Two: THE TOTAL PERFORMANCE
I. The psychophysical basis for performance.

(6) Work-performance
(c) Individual variations in performance
2.05
2.07
2. The actual flow of psychic life .
2.08
(a) Flight of ideas and retardation
2.09
2.13
2.14
(a) Analysis of Intelligence (preconditions, store of knowledge, intelli-
gence proper)
(6) Types of dementia
2.14
2.I6
(I) Fluctuations in output.

(2.) Congenital subnormality
(3) 'Relative mental defect'
(4) Organic dementia
.
.
.
(5) Schizophrenic 'dementia' (deterioration)
(6) Cultural subnormality .
.
.
(7) Emotional stupidity and pseudo-dementia
(c) Examination of intelligence (life history, clinical exploration, tests)
2.16
2.17
217
218
2.18
22.0
2.20
22.0
CHAPTER III
I. The basic psychosomatic facts .

(a) Body-sensations.
(6) Constant somatic accompaniments

(c) Sleep
(d) Somatic effects in hypnosis
2. Somatic disturbances dependent on the psyche

(a) Main categories of psychically determined somatic disturbances
(I)
(2)
(3)
(4)
Faints and fits.

.
Organic dysfunctions.
.
.
.
.
Dependence of primary somatic disorders on the psyche
Functional disturbance of complex instinctive behaviour
(6) The origin of somatic disturbances.
2.48
2.48
Introduction
SECTION ONE: EXPRESSION OF THE PSYCHE THROUGH BODY AND MOVEMENT

(THE PSYCHOLOGY OF EXPRESSION-AuSDRUCKSPSYCHOLOGIE)
(a) Somatic accompaniments and psychic expression
(6) Understanding the expression
(c) Techniques of investigation
(d) Summary .
I. The study of physiognomy
2. Involuntary gesture (Mimik)

(a) Types of bodily movement
(6) Understanding involuntary gesture-general principles
(c) Psychopathological observations
3. Handwriting
2.73
SECTION Two: THE INDIVIDUAL'S PERSONAL WORLD (THE PSYCHOLOGY OF

THE PERSONAL WORLD-\VELTPSYCHOLOGIE)
I. Analysis of conduct
SOMATIC ACCOMPANIMENTS AND EFFECTS AS SYMPTOMS OF

PSYCHIC ACTIVITY (SOMATOPSYCHOLOGY)
Body-psyche relationship
2.47
2.48
MEANINGFUL OBJECTIVE PHENOMENA
198
199
3. Intelligence
2.46
CHAPTER IV
(a) Basic psychophysical functions
(6) Confusion.
xxix
2.2.2
(a) Behaviour.
(6) The shape given to the environment

(c) . The whole way of life .
(d) Overt actions
2. Transformation of the personal world
280
(a) The worlds of schizophrenic patients
(6) The worlds of obsessional patients .

(c) The worlds of patients with 'flight ofideas'
SECTION THREE: THE PSYCHE OBJECTIFIED IN KNOWLEDGE

AND J\.CHIEVEMENT (THE PSYCHOLOGY OF CREATIVITY-WERKPSYCHOLOGIE)
I. Individual instances of creative work

(a) Speech
(6) Patients' written productions.

(c) Drawing, art and handicraft .
xxx
PAGE
2. The total mental achievement-the patients' general outlook(,Weltanschauung')
293
(a) Realisation of extremes.

(b) Patients' specific outlooks (Weltanschauurtgen) . .
(c) Patients' own observations of a philosophical character
294
294
296
Part Two: Meaningful Psychic Connections

(The Psychology of Meaning-Verstehende Psychologie)
(a) Understanding and explaining
.
.
.
.
.
.
(b) Concrete reality and the self-evidence of understanding (Understanding and Interpretation)
(c) Rational and empathic understanding
.
.
(d) Understanding is limited and explanation unlimited
(e) Understanding and unconscious events
(f) Pseudo-understanding .
(g) Modes of comprehensive understanding (cultural, existential and
metaphysical).
.
.
.
.
.
.
.
.
(II) How what can be understood psychologically moves midway between
meaningful objectivity and what cannot be understood
(i) The function of understanding in psychopathology
30 3
30 4
30 ;
306
340
(I) Logical, biological, psychological and intellectual opposites

(2) Dialectical modes
.
.
.
.
.
.
.
(3) Application of the dialectic of opposites to psychopathological understanding

.
.
.
.
.
..
(4) Fixation of psychopathological concepts as opposing absolutes
340
341
4. Self-reflection
(a)
(b)
(c)
(d)
30 7
310
31 )
MEANINGFUL CONNECTIONS
I. The sources of our ability to understand and the task of the

2. Connections with a meaningful content
31 4
Concept of drive
.
Classification of drives.
Abnormal drives
.
.
.
.
.
Psychic developments due to transformation of drive
(b) The individual in the world

(I)
(2)
(3)
(4)
(;)
(6)
The concept of situation

Concrete reality
Self-sufficiency and dependency
.
.
.
Typical blsic relationships of the individual to reality
Denial of reality through self-deception
Marginal situations
(c) Symbols as the content of ultimate knowledge
343
344
345
347
Reflection and the unconscious

Self-reflection as a spur to the psychic dialectic
The structure of self-reflection
Examples of the effect of self-reflection
347
349
349
3;1
(I) The connection between intended and unintended events

(2) Awareness of personality
(3) Ultimate (basic) knowledge
351
353
354
5. The basic laws of psychological understanding and of

meaningfulness
(a)
(b)
(c)
(d)
(e)
(f)
(g)
Empirical understanding is an interpretation

.
Understanding follows 'the hermeneutic round' .
Opposites are equally meaningful
Understanding is inconclusive
Unlimited interpretation
To understand is to illuminate and expose
Excursus into psychoanalysis.
3 17
(a) Instinctual drives, their psychic manifestations and transformations

(I)
(2)
(3)
(4)
340
(a) Opposing tendencies in the psyche and the dialectic of its movement
306
CHAPTER V
psychopathology of meaningful connections
PAGE
3. Basic patterns of meaning
(b) The reciprocity of Life and Meaning

302
XXXI
CHAPTER VI
3 7
1
MEANINGFUL CONNECTIONS AND THEIR

SPECIFIC MECHANISMS
318
320
32 4
325
32 ;
)26
326
32 7
328
(a) The concept of the extra-conscious mechanism .
364
(b) Meaningful content and mechanisms

.
.
.
.
.
(c) Mechanisms that are universal and constantly in action and those that
are specifically evoked by psychic experiences
(d) Normal and abnormal mechanisms .
36S
33 0
33 0
(I) Ultimate knowledge.

.
.
.
.
(2) Concept of the symbol and its significance in real life
33 0
(3) The possibility of understanding symbols

.
(4) The historical study of symbols
(s) The possible function of symbol-exploration
333
33 1
33 2
334
SECTION ONE: NORMAL MECHANISMS
(a)
(b)
(c)
(d)
(e)
Psychogenic reactions (Erlebnisreaktionen)

After-effects of previous experience.
Dream-contents
Suggestion
Hypnosis .
36 5
366
xxxii

SECTION
Two:
ABNORMAL MECHANISMS

PAGE
I. Pathological psychogenic reactions .
2.. Methods of Personality-analysis
(a) Reaction as distinct from Phase and Thrust (Schub).
.
(h) The three different ways in which reactions become meaningful
(c) Classification of reactive states
.
(d) The curative effect of emotional trauma
(a) Awareness of the possibilities of verbal description
.
(h) The concepts of personality-study are those of the psychology of
meaningful connection
.
.
(c) Typology as a method.
2.. Abnormal after-effects of previous experience

Abnormal habits.
The effects of complexes
Compensation.
.
.
.
Disintegrating and Integrating Tendencies
3. Abnormal Dreams.
3. Attempts at Basic Classification of Character
399
(a) Dreams during physical illness

(h) Abnormal psychotic dreams .
(c) The content of abnormal dreams
4. Hysteria
399
399
400
401
5. Meaningful content in the psychoses

(a)
(b)
(c)
(d)
Delusion-like ideas
Delusions in schizophrenia
Incorrigibility
Classification of delusional content.
PAGE
(h) How personality comes into being .

.
.
(c) The understandable personality and its opposite.
Characteristics of the abnormality of the mechanisms
(a)
(h)
(c)
(d)
(a)
(h)
(c)
(d)
I.
(I) Basic dispositions of temperament

(2.) Basic will-power
(3) Basic dispositions of feeling and drive
(h) Variations in psychic energy .

(I) The neurasthenic syndrome
(2) The psychasthenic syndrome
(c) Refiective personalities.

(I) Hysterics
(2.) Hypochondriacs
.
.
(3) The self-insecure personalities .
THE PATIENT'S ATTITUDE TO HIS ILLNESS

(a) Understandable attitudes to the sudden onset of acute psychosis
(perplexity, awareness of change)
(b) Working through the effects of acute psychoses.
(c) Working through the illness in chronic states
(d) The patient's judgment of his illness
Self-observation and awareness of one's own state
Attitudes in acute psychoses.
.
Attitude to psychosis after recovery .
Attitudes in chronic psychoses
(e) The determination to fall ill.

.
to one's own illness: its meaning and possible implications
414
416
416
419
4:to
4U
4u
II. Personality-change due to a Process

(a) Dementia due to organic cerebral processes
(h) Epileptic dementia
(c) 'Dementia' in schizophrenia .
VOLUME TWO
42.3
Part Three: The Causal Connections of Psychic Life

(Explanatory Psychology-Erklirende Psychologie)
4:t4
(f) The attitude
4:t5
CHAPTER VIII
THE TOTALITY OF THE MEANINGFUL CONNECTIONS
(CHARACTEROLOGY)
I.
Defining the Concept

(a) What personality really is
Variations of Human Nature.
(a) Variations in the basic personality-dispositions
410
4 10
411
Single, individual forms

Ideal types.
Personality-structure in general
Real types.
4. Normal and Abnormal Personalities.
409
CHAPTER VII
(I)
(:t)
(3)
(4)
xxxiii
(a)
(h)
(c)
(d)
Simple causality and its difficulty

Mechanism and organism
Endogenous and exogenous causes
Causal events are extra-conscious events
(I) Signs and symptoms
(2) 'Organic-functional'
42.8
(e) Causal knowledge must not be made an absolute
42.8
(f) Review of our causal knowledge
42.9
43 0
43 1
433
434
431
43S
43 6
43 6
43 8
439
439
440
440
440
440
PAGE
CHAPTER IX
EFFECTS OF ENVIRONMENT AND OF THE BODY
ON PSYCHIC LIFE
PAGE
I. Environmental effects
463
(a) Time of day, season, weather, climate

(b) Fatigue and exhaustion.
2.. Poisons
3. Physical illnesses
xxxv
XXXIV
(c) Investigation into the heredity of psychoses

(d) Investigations into the heredity of psychic phenomena.
(e) The idea of hereditary groupings
518
SI9
(f) Twin-research
(g) Injury to the genu-cell.
.
(II) The importance of applying genetics in psychopathology in spite of
S24
negative results up to the present
46 4
46S
466
4. Return to empirical statistics of a temporary character
pI
p6
P7
p8
469
(a) General medical illnesses
4 69
470
47S
477
(h) Endocrine disorders

(c) Symptomatic psychoses
(d) Dying
4. Cerebral processes .
47 8
Organic cerebral diseases

General and specific symptoms
.
The history of the theory of localisation.
.
.
.
.
Relevant facts for the localisation theory: clinical data, the structure
of the brain, pathological-anatomical findings .
(e) Basic questions raised by the theory of localisation
.
(f) The questionable aspect of localising psychic material .
(a)
(h)
(c)
(d)
478
479
4 80
4 83
49:1
495
CHAPTER XI
EXPLANATORY THEORIES-THEIR MEANING AND VALUE
I. Characteristics of explanatory theories
53 0
HI
2.. Examples of theory formation in psychopathology
S34
(a) Wernicke.
(h) Freud
(c) Constructive-genetic psychopathology
(d) Comparison of the above theories .
3. Critique of theorising in general

(a)
(h)
(c)
(d)
(e)
CHAPTER X
HEREDITY
I. The old basic concepts and their genealogical and statistical

clarifications .
(a) The basic fact of heredity
(h) The genealogical point of view
(c) Statistics .
(d) Constant and inconstant heredity
(e) The cause for the first or fresh appearance of mental illnesses
(I) Harmful effects of inbreeding or hybridisation
(2) Degeneration .
2.. The new impact of biological theories on heredity (Genetics)

Statistics of variations .
The Genotype and Phenotype
Mendelian Laws.
Hereditary substance lies in the cells
Mutation .
(f) Critical limitations
(g) R6sume of the most important basic concepts
(a)
(h)
(c)
(d)
(e)
3. Application of Genetics to psychopathology

(a) The basic guiding ideas
(h) Methodological difficulties
BO
(a) The nature of theories.

(h) Basic theoretical concepts in psychopathology
Natural scientific theories as models.

The spirit of theorising
Fundamental errors of theorising
The necessity for theories in psychopathology
Methodological attitude to theorising
534
H7
HO
S46
S47
H7
S47
S49
HO
HI
497
497
49 8
499
SOl
S0 3
S03
50S
S07
S07
Part Four: The Conception of the Psychic Life as a Whole

(a) The main objective
Threefold division of the objective .

What can and cannot be achieved in trying to reach this objective
Enthusiasm for the whole and its power to mislead
Knowledge of Man as a way into the openness of being human
(f) Investigation guided by ideas
(g) Methods of typology .
(II) The psychic profile (the psychogram)
(h)
(c)
(d)
(e)
H6
H6
SS7
SS8
SS9
S60
S60
S6:1
s08
s08
510
511
51:1
sa
513
fI3
fIG
CHAPTER XII
THE SYNTHESIS OF DISEASE ENTITIES (NOSOLOGY)
1. Investigation guided by the idea of disease entities
S64
Unitary psychosis or series of definable disease entities

Entities from the point of view of:
psychic structure
the causal factor
564
,6,
,6!
xxxvi
XXXVll
PAGE
PAGE
anatomical findings.
.
.
.
.
the course of the illness.

The unification of all points of view in the idea of Disease entity (Kahlbaum and
Kraepelin)
.
.
Results of their investigations.
.
.
.
.
.
No disease entities except those of purely neurological cerebral processes
Significance of the idea of disease entity for type-formation in special psychiatry
Objections to Kraepelin's ideas.
.
.
.
.
.
Concrete field of enquiry opened up by these ideas
Research into the Brain .
Research into Types.
.
The task for special psychiatry .
2.. Basic classifications in the total field of psychic illness.

I.
II.
(a)
(b)
(c)
(d)
Differentation according to the clinical state

Acute and chronic psychoses
Differentation according to the nature of the illness
Defects in performance and disorders of personality
Neuroses and Psychoses
.
.
.
.
Organic cerebral diseases and endogenous psychoses.
.
Affective and Mental illness (natural and schizophrenic psychic life)
56 5
566
566
567
56 7
568
568
570
570
571
572.
573
574
574
574
574
575
576
577
3. Symptom-complexes (syndromes)
(a) Mental state and symptom-complex.
.
.
.
(b) Points of view governing the formulation of symptom-complexes
(c) The significance in reality of symptom-complexes
(d) Carl Schneider's theory of schizophrenic symptom-complexes
2.. Constitution .
62.8
62.8
62.8
630
633
The concept and idea of constitution

History of the idea of a constitution
Personality and psychosis
Kretschmer's theory of constitution.
Critique of Kretschmer's researches into constitution..
(f) Conrad's reformulation of psychiatric teaching on constitution
(g) The positive value of theories of constitution
(a)
(b)
(c)
(d)
(e)
633
636
639
641
645
656
666
3. Race .
668
I. Biographical Methods
(c) Explanation of the schema

606
610
61 I
612.
6I 3
61 4
Collection, arrangement and presentation of the material

Case-record and biographical study
The present as the starting-point
The idea of the individual life as a unity
The basic biographical categories
(f) Comments on literary biography
(g) Pathographies
(h) The art of publishing case-histories
(a)
(b)
(c)
(d)
(e)
2.. The individual life as a biological event

CHAPTER XIII
(a) Age epochs (biological age, biological relation between age epoch
.
and mental illness)
(b) Typical course of an illness (attack, phase, period, process) .
THE HUMAN SPECIES (EIDOLOGY)

(b) Sex, constitution, Race.
(c) Methods of Eidology
(d) Gathering the facts
62.3
62.4
62.5
62.6
62.7
633
(a) The biographical material

(b) The use of the biography to apprehend the individual.
(c) The limits of the individual life and its history .
(d) Investigation guided by the idea of the individual
(a) Requirements for a diagnostic schema.

(b) Outline of a diagnostic schema
.
(a) The idea of the Eidos .
62.3
62.3
BIOGRAPHICAL STUDY (BIOGRAPHIK)
4. Classification of illnesses (Diagnostic schema)
(d) Statistical investigations with the help of diagnostic schemata
Biological and psychological preface.

(a) The primary phenomenon of sex
(b) Biological factors in sex-differences.
(c) Somatic and psychological sex-differences.
(d) Sexual drive
(e) Historical aspect of research into sexuality
Sex-linked anomalies
(a) Different incidence of psychic illness in the two sexes
(b) Sexual epochs and reproduction
(c) Sexual disorders.
(d) Effects of castration
CHAPTER XIV
Particular complexes
(a) Organic-symptom-complexes.
.
.
(b) Symptom-complexes of altered consciousness
(c) Symptom-complexes of abnormal affective states
(d) Symptom-complexes of 'delusional states'
Characteristics of the three groups
.
The meaning of the diagnosis in the three groups
Diagnostic hierarchy of symptoms in the three groups
Psychoses in combination (mixed psychoses)
F rui tful significance of the discrepancies
I. Sex
61 7
618
3. The individual life in terms of its history
62.0
(a) The basic categories for the life-history (clements of the development
6:&2.
as a whole, specific categories of development, consciousness as a
671
671
672.
674
674
674
675
675
677
678
678
679
680
681
681
687
694
xxxviii
PAGE
means of acquiring new automatisms, the creation of personal worlds

and works, sudden change and adaptation, the first experience,
critical situations, intellectual development)
.
.
.
.
(b) Some special problems (importance of infancy and early childhood,
relationship of the psyche to its own age-epochs, development as an
experience)
.
.
.
(c) The basic problem of psychopathology: is it personality development or process.
.
....
(c) The extension of psychopathology from a social anamnesis to the
exploration of historical material
(d) The meaning of socio-historical facts
(e) Methods .
701.
709
7 10
711
713
713
747
The problem of the nature of man

(a) The basic philosophic position
(b) The image of man
(c) Philosophical construct of ourselves as that which encompasses
(d) The eternal incompleteness of man.
(e) Summary: Basic principles of the human being, and the significance
and potentiality of our knowing him
75 6
Psychiatry and Philosophy
7 68
768
768
76 9
Modes of scientific knowledge in psychopathology

Philosophy in psychopathology
Basic philosophical positions.
Philosophical confusion
(f) Ways of looking at the world (Weltanschauung) passing for
scientific knowledge
(g) Existential philosophy and psychopathology
(h) Metaphysical interpretation of illness
(b)
(c)
(d)
(e)
(a) Causal effects of the civilised milieu.
(c) Times of security, revolution, war

(d) Accident-neuroses
(e) Work-situation .
(f) Educational situation
2.. Investigations into population, occupation, class, urban, rural
747
748
75 0
7P
7S 6
75 8
759
760
76 5
770
77 1
771.
77S
77 8
722.
4. The concept of health and illness
3. Asocial and antisocial conduct
(a)
(0)
(c)
(d)
(a) Asocial conduct .

(b) Antisocial conduct (the psychology of crime)
4. Psychopathology of Mind
The doubtful nature of the concept of illness

Value norms and statistical norms
Concept of illness in somatic medicine
Concept of illness in psychiatry
The application of value-norms and statistical norms
Speculations regarding illness and health .
Structuring the psychiatric concept of illness
5. The meaning of medical practice

71.9
73 1
5. Historical aspects
(a) The determination of morbid psychic content by the culture and the
historical situation
.
(b) The history of hysteria: possession, psychic epidemics, witchcraft,
orgiastic cults, spiritualism
(c) Mass-psychology
(d) Archaic psychic states .
Psychopathology in retrospect .
(a) Objections to my system of psychopathology
(b) The obligation to integrate our knowledge of Man with the picture
given by psychopathology
.
(c) The complex unities in retrospect and the problem of a unified whole
(d) The concrete enigmata in retrospect
(a) What scientific knowledge is .
(b) Typical situations for the individual
(a) Empirical investigation: pathography

Meditative exercises
(b) General problems: significance of illness for creativity, connection
between the form of illness and the cosmic content, cultural assessment of sick individuals
(c) Psychopathy and religion
740
740
Part Six: The Human Being as a Whole

699
I. The significance of the social situation for the illness
and other groups
PAGE
(e) Psychopathological elements in different cultures

(f) The modem world and the problem of degeneration
694
Part Five: The Abnormal Psyche in Society and History

(Social and Historical Aspects of the Psychoses and the
Personality-disorders)
(a) Heredity and tradition.
(0) The community .
XXXIX
732
734
737
737
The relation of knowledge to practice

The contingent nature of all therapy
Legal steps, expert opinion and psychotherapy
The link with different levels of general medical therapy
Types of inner obstacle-the patient's decision to undergo therapy
(f) The aims and limits of psychotherapy
(g) The personal role of the doctor
(Jz) Different psychiatric attitudes
(i) Harmful psychological atmospheres
(k) The public aspect of psychotherapy
(a)
(b)
(c)
(d)
(e)
790
79 1
79:&
793
79'
800
ROI
Ro,
806
809
'Ira
xl
Appendix
PAGE
I. Examination of patients .
(a) General poipts
(6) Methods of examination
(c) Aims of the examination
(d) Viewpoints for evaluating the results of the examination
2. The function of therapy .

(a) Therapy and eugenics
(6) Physical treatments
(c) Psychotherapy
Methods of suggestion
Cathartic methods
Practice and training
Methods of re-education.
.
.
.
Methods that address themselves to the personality
(d) Hospital admission and treatment
3. Prognosis
(a) Danger to life
(6) Curable or incurable
4. The history of psychopathology as a scienc.e

(a) Scientific knowledge and practice
Psychiatry in mental hospitals and University clinics
Psychotherapy .
(6) From Esquirol to Kraepelin (19th century)
Esquirol
.
The describers and the analysers .
The somatic and psychic approach
Wernicke and Kraepelin.
.
Independent individual contributions
German and French psychiatry
(c) Modem psychiatry

.
.
.
(d) The drive to advance science and the forms it takes

Drives and goals.
The origin of scientific movements

Contemporary scientific trends
Medicine and philosophy
825
825
826
827
828
GENERAL PSYCHOPATHOLOGY
Volume One
INTRODUCTION
The aim of this introduction is to remind the reader of the wide, unrestricted field in which the science of psychopathology has to make its way.
Since each chapter provides the necessary basis for its subject-matter there is
no need to lay any general foundation in these opening remarks. We shall
simply centre discussion on the modes of human experience and the meaning
of psychopathology. Patients' actual experiences will be reported on later.
I.
THE BOUNDARIES OF GENERAL PSYCHOPATHOLOGY
(a) Psychiatry as clinical practice and psychopathology as a science

The psychiatrist as a practitioner deals with individuals, with the human
being as a whole. These individuals may be patients in his care or under
treatment, he may give testimony on their behalf in a Court of Law or to
other authorities, or a personal opinion on them to historians, or may just
see them in his consulting-room. Every case is entirely 'unique' but to deal
with it competently the psychiatristhas to look to psychopathology to provide
him with certain general concepts and laws. Psychiatrists function primarily
as living, comprehending and acting persons, to whom science is only one
resource among many; for psychopathologists, however, science is the sole
and ultimate aim of their work. Their interest is not the individual human being.
Their aim is to know, recognise, describe and analyse general principles rather
than particular individuals. Their major concern is not the usefulness of science
(this comes automatically as progress is made) but what the real, distinguishable
phenomena are, what truths can be discovered about them and how they can
be tested and demonstrated. Empathy and observation bring complex material,
indispensable for study, but psychopathologists want more than this; they
want communicable concepts for this material which can then be formulated
into laws and principles and demonstrable relationships. This being so, they
have to accept certain limitations so as not to transgress but on the other hand
they gain freedom and power to explore the wide field which is left to them.
Psychopathology is limited in that there can be no final analysis of human
beings as such, since the more we reduce them to what is typical and normative
the more we realise there is something hidden in every human individual which
defies recognition. We have to be content with partial knowledge of an infinlt y
which we cannot exhaust. As a person, not as a psychopathologist, one mlly
well see more; and, if others see more which is exceptional and unique, we
should refrain from letting this interfere with our psychopathology. Ethlcll),
aesthetic and metaphysical values are established independently from psychopathological assessment and analysis.
INTRODUCTION
Apart from this field of values, which has nothing to do with psychiatry,
instinctive attitudes and personal intuitions, which are usually quite incommunicable, are essential nevertheless for clinical practice. It has often been
emphasised that psychiatry is still an 'expertise' apd has not yet reached the
status of a science. Science calls for systematic, conceptual thinking which can
be communicated to others. Only in so far as psychopathology does this can
it claim to be regarded as a science. What in psychiatry is just expertise and
art can never be accurately formulated and can at best be mutually sensed by
another colleague. It is therefore hardly a matter for textbooks and we should
not expect to find it there. Training students in psychiatry is always more than
a communication of concepts, more than mere scientific teaching. A textbook
of psychopathology, however, must be scientific and is valuable only for this
reason, so that we are deliberately confining ourselves in this book to what
can be understood in scientific terms, while we fully recognise the. practical
importance of clinical art in the examination of the individual case.
~
Psyclwpathology is concerned with every psychic reality which we can render
intelligible by a concept of constant significance. The phenomenon studied
may also be a matter of aesthetic, ethical or historical interest, but we can still
examine it psychopathologically. Different frames of reference are involved.
Further, there is no sharp line of demarcation between the art and science of
psychiatry. Science is continually extending into the field of clinical art but the
latter always remains indispensable in its own right and reaches out on its own
into ever new territory, but scientific practice is to be preferred in principle,
even if it is not always possible. When it is attainable, we should always
deprecate the use of our own personal intuitions which by their very nature are
unreliable.
Psychopathology has, as its subject-matter, actual conscious psychic events.
Although the main concern is with pathological phenomena, it is also necessary
to know what people experience in general and how they experience it; in
short, to take the full range of psychic reality. It is necessary not only to
examine the actual experience but also the causes and conditions at work, as
well as the relationships and the modes in which the experience comes to
expression. We can make an analogy with somatic medicine, where in individual cases physiology and pathology seem equally concerned. We find the
two are really interdependent. They work with the same principles and there
is no clear, dividing line between the two disciplines. In the same way psychologyand psychopathology belong to each other and learn from one another.
There is no sharp division and many mutual problems are tackled by psychologists and psychopathologists alike. There is no unitary concept of what is
morbid, but rather a number of concepts which in principle can all be differentiated but in practice have to allow for borderline cases and transitional states.
We are not insisting here on any precise definition of mental illness, and our
selection of material will be seen to follow conventional lines. We do not
think it so important if in somebody's view this or that material should be
INTRODUCTION
included as morbid or some other material excluded as not morbid. A full

discussion on the concept.of illness has been left to the last part of this book.
We must admit that we have demarcated our field of psychopathology from
the larger field of psychology in what may seem rather an arbitrary manner,
and it should be remembered that they really belong together, just as physiology
and pathology belong to each other.
. (b) Psychopathology and psychology

Psychology studies what has been called normal psychic life. Theoretically
psychology is as necessary for the psychopathologist as physiology for the
pathologist, l but in fact we find many instances to the contrary. This is due to
the fact that psychopathologists are concerned with much material of which
the normal counterpart has not yet been studied by psychologists and they
often have to provide their own psychology, since the psychologist can give
no counsel. Academic psychology seems to be too preoccupied with those
primary processes that are affected by neurological disorders and organic
lesions but rarely suffer any disturbance in psychic illnesses proper. Psychiatrists, therefore, need some wider psychology which will give them better
provision from the thousand-year-old stores of psychological thinking. Such
a psychology seems to be finding a place for itself in academic circles recently.
(c) Psychopathology and physical medicine
We said earlier that psychic events, their conditioning factors, causes and
consequences all provide the subject-matter for psychopathology. Any enquiry
.into the connections between them must bring us to the theory of extraconscious mechanisms and ultimately in many cases to definite, somatic events
as the remote causes of psychic phenomena.
In every individual event soma and psyche form an inseparable unity. The
two stand in a mutual reciprocity which shows itself much more directly in
psychopathology than it does in normal psychology. There are somatic
phenomena, universally accepted as such, which are in part dependent on
1 We cannot quote anyone text on psychology which would serve as a complement to the
study of psychopathology. Psychology is divided into as many different camps as psychopathology.
We have to get to know the schools and their teachings one by one if we are to learn anything
about psychology. The Physiologische Psych%gie of Wundt is the main text on psychic problems
connected with the physiology of the senses and somatic phenomena but in many respects it is out
of date. Ebbinghaus, Lehrhuch in Buhler's new edition is preferable so far as it goes. No new principle but a new thoroughness in the old method is offered by Husser! in his phenomenological basis
for psychological enquiry. Contributions from the school of Kiilpe follow the same line. Messer
provides a short popular exposition of this type of enquiry in Empfindung u. Kenken. As an introduction to certain sections of modern psychology, there is the well-written and realistic text by
Bumke, Psych%gische Ver/esungen (Wiesbaden: Bergmann, 1919). More recent texts can only be
recommended with some reserve. For an overall picture of the literature we might mention S. J.
Frobes, Lehrhuch der experiment.llen Psych%gi. (Fl'eiburg, 1917, vol. I; 1910, vol. :l). A. Mt8lcr.
Psych%gie, 7 bis 9 Tausend (Stuttgart, 1911). Th. Eisenhaus, Lthrhuch d., P.~ychO/ORi,. lrd edn.
(Giese, Gruhle and Dorsch, T(lbingcn, 1937).
INTRODUCTION
INTRODUCTION
psychic events: for example, duration of menstrual flow, .the nut~itional state
and perhaps in certain circumstances anyone of the somatic functions. On ~e
other hand, the most complex psychic events originate in part f~om somatic
sources. These relationships are responsible for the close connection between
psychopathology and medicine. Quite apart from the fact that the actual treatment of human beings calls for thorough medical training, insight into the
aetiology of psychic events cannot be achieved at all without some knowledge
of somatic function, more particularly the physiology of the nervous system.
Thus psychopathology finds in neurology, internal medicine and physiology
its most valuable auxiliary sciences.
Investigation of somatic function, including the most complex c~rtical
activity, is bound up with investigation of psychic function, and the. umty. of
soma and psyche seems indisputable. Yet we must remember that ne1ther l~ne
of enquiry encounters the other so directly that we can speak of some spec1fic
psychic event as directly associated with some spe~ific somatic eve~t or of an
actual parallelism. The situation is analogous W1th the exploration of an
unknown continent from opposite directions, where the explorers never meet
- ~ause of impenetrable country that intervenes. We only know the end links
i"u 1:he chain of causation from soma to psyche and vice versa and from both
these terminal points we endeavour to advance. Neurology has disco~ered t~at
the cortex with the brain-stem provides the organ most closely assoc1ated w1th
psychic function and its researches have reached their highest p~ak so far in
the theory of aphasia, agnosia and apraxia. It seems, however, as 1f the further
neurology advances, the further the psyche recedes; psychopathology on the
other hand explores the psyche to the limits of consciousness but finds at ~hese
limits no somatic process directly associated with such phenomena as deluslOnal
ideas, spontaneous affects and hallucinations. In many cases, wh~ch increa~e
in number as we gain in knowledge, the primary source of psych1c chang: 1S
found to lie in some cerebral disorder. Yet we always find that no one spec1fic
psychic change is characteristic for anyone of these disorders. Th~ facts see~
to be that cerebral disorders may be responsible for almost all poss1ble psych1c
changes though the frequency with which they appear may vary in different
.
disorders (for example, in General Paralysis of the Insane):
From these observations we may conclude that it is vital for us when mvestigating somatic changes to bear possible psychic causation in m~nd and
vice versa. Since every psychopathologist has to study neurology and mternal
medicine independently, we shall not try to deal here with matters of neurology
and internal medicine best learned from the many textbooks available (such
as neurological methods of examination, pupillary changes, abnormal reflexes,
sensory or motor disturbances). Furthermore, the principle of this book is to
present a psychopathology which, in its concept-building, its method.s. of
investigation and general outlook, is not enslaved to neurology and med1cme
on the dogmatic grounds that 'psychic disorder is cerebral disorder'. Our particular scientific contribution is not to imitate neurology and construct a system
wi~ constant cross-reference to the brain-this always seems unreal and superfic1al-but to develop a standpoint from which to investigate the various
problem~, concepts and relationships within the framework of the psychopatholog1cal phenomena themselves. This is the special task of psychopathology, but time and again and at many points we shall of course find
ourselves close to associated problems of neurology (e.g. the dependence of
particular defects of psychic function on focal brain injury as in aphasia, etc.;
the finding that some mental disorders are based upon cerebral disorders as
with General Paralysis, arteriosclerosis, etc.; the conjecture that this is also
the case with a number of others such as dementia praecox).
Cd) Methodology-the contribution ofphilosophy

. Psychology and medicine are the scientific disciplines most closely linked
W1th psychopathology but the latter, of course, like any other science, has remoter connections with all other branches of human enquiry, one of which
should have a special mention here-the discipline of philosophy with its
accent on methodology.
Ir: psych~logy as in psychopathology there are very few, perhaps no,
assertions wh1ch are not somewhere and at some time under dispute. If we
wish to raise our statements and discoveries to firm ground, above the daily
flood of psychological notions, we shall almost always be forced to reflect on
our methodology. Not only assertions but methods themselves come under
dispute and it is quite an achievement if two investigators will agree upon
method and only argue over their actual findings. Compared with this situation
in psychopathology, somatic investigations in psychiatry at present pursue a
relatively firm and smooth traditional path. There is, for instance, a wide
community of aim in such fields of research as the histology of the central
nervous system, serology, etc., whereas even the mere possibility of a scientific
psychopathology will be questioned. Voices are raised asserting that no progress has been made in this field for a long time, nor could any be made since
psychopathology, it is said, is involved with that 'popular psychology' familiar
to psychiatrists of an earlier date, which has already provided all that is really
n~eded for psych~atric purposes. We also find a tendency to cling to newly
d1scovered somatic phenomena as a means of gaining better knowledge of the
psyche. Salvation is thought to lie in experiments where results are either
expressed in figures or are objectively demonstrated or plotted as a curve.
The upholders of such views are guilty of one omission. They fail to train
themselves in psychological methods and therefore may be charged with
uncritical thinking. Observation is not enough. If we are to obtain some clear,
communicable concepts and if we are to reach an adequate differentation of
our field, valid thinking in addition is essential, otherwise no advance in our
knowledge will take place.
It is not surprising, therefore, that every psychopathologist is driven to
concern himself with his methods. For the same reasons some discussion of
INTRODUCTION
INTRODUCTION
methodology is necessary in this book. In the face of outside criticism we are

forced to defend ourselves and clarify our own position. A science in dispute
must first of all show its merits by factual results but, particularly when these
are not so readily accessible, we must anticipate some criticism of the methods
we employ.l
So far as concrete research is concerned, a thorough study of philosophy is
not of any positive value to psychopathologists, apart from the importance
of methodology. There is nothing that we can, so to speak, take over 'readymade', but philosophical studies undoubtedly exercise a certain restraining
influence of their own. They can protect us from putting the wrong question,
indulging in irrelevant discussions and deploying our prejudices, all of which
activities appear only too often in the psychopathological field among individual workers bereft of any such training. In the second place the study of
philosophy makes a positive contribution to the human quality of the psychopathologist himself and with its help he can clarify his motives.
4. The psyche is not a thing but 'being in one's own world'. What do 'inner'
and 'outer' world mean?
5. The psyche is not an end state but becoming, developing, unfolding.
What does psychic differentiation mean?
2..
SOME BASIC CONCEPTS
Psychopathology is concerned with the ill person as a whole, in so far as

he suffers from a psychic illness or one that is psychically determined.
If we knew the elements that constituted the human psyche and all the
forces at work we could begin with a broad outline of the psyche and leave
details to be filled in later. But we need no such blue-print, since we conceive
the psyche as an unending effort at comprehension, an effort which can never be
concluded wholly, though we are always advancing through the many methods
of research. We have no basic concept in terms of which we could define man
nor any theory that would wholly cover his actual, objective existence. We
must, therefore, as scientists, keep an open mind for all the empirical possibilities and guard against the temptation to reduce human existence to one
common denominator. We have no psychic master-plan, but we shall simply
discuss a number of horizons within which our psychic realities present
themselves.
I. We are going to discuss Man. Does the fact that man is not an animal
have any bearing on human illness?
2.. We are going to discuss the human psyche. How is this actually objectified?
3. The psyche is consciousness. What do 'conscious' and 'unconscious'
mean?
1 Among psychiatrists writing on methodology, we would recommend Gaupp, 'Ober die
Gren7.en psychiatrischer Erkenntnis', Zhl. Nervenlch., etc. (1903). Wege and Ziele, Psychiatrischer
Forschung (Tubingen, 1907)' Professional philosophers who generalise have less to offer than
papers on methodology written by research workers who have in their possession a wealth of
concrete observations. Max Weber's book, for instance, Gesammelte Beitrag. {ur WissenschaftsI,h" (TObingen, Mohr, 19U), is of value, dealing in part with problems closely touching on
psychopathology.
(a) Man and animal

Medicine draws little distinction somatically between man and animal.
Both are studied in anatomy, physiology, pharmacology, pathology and
somatic therapeutics. In psychopathology, however, human existence is, so to
speak, a constant problem since the human mind and spirit are involved in
every psychic illness.
It is altogether doubtful whether animals suffer from psychic illness. They
can it is true suffer from diseases of the brain and nerves. We may, for instance,
study the heredity of syringomyelia in rabbits. Then there are such phenomena
as restiveness in horses, so-called hypnosis in animals (a different matter from
the hypnosis of humans) and panic reactions. Animals can also suffer 'symptomatic psychoses' due to organic brain diseases. They show disorders of senseperception, of stance, movement and changes in their 'personality', such as
running in circles, biting, apathy and so on.
The following illustrates this: Dogs and cats in a state of experimental hypoparathyroidism sometimes behave in such a way that Blum,l who has reported on
such observations, speaks of a borderland between motor and psychic symptoms.
He noticed attacks of savagery in which a cat rushed round its pen as if possessed,
tried to jump up the smooth walls, attacked another friendly cat and bit it, until it
finally collapsed with exhaustion. With dogs and cats he also noticed the adoption of
unusual and uncomfortable postures, sudden jerky movements or a gait never seen
with normal animals, such as parading or prancing like a show-horse. The head
might be held consistently low as with an attacking bull, or the animal might stagger
to the extent of falling or run or try to creep backwards in spite of a wall behind it,
which it was bound to feel. A dog in a state of hallucination and delusion would
sniff around and stare when there was nothing to see, and without the slightest
apparent cause. He would scratch on the tin floor of his cage or try to burrow with his
muzzle in an empty corner. From time to time he would bark but pay no attention to
the environment. The cats obviously saw visions, striking out into emptiness and
slowly retracting their paws.
'Functional psychoses proper' in animals have not been described (hysteria
in animals is far from proven). Schizophrenia and the cyclic psychoses are
found in every human race but not in animals. 'There is indeed no evidence
for any specific animal psychoses and certainly none for any hereditary ones,'
1 F. Blum, Arch. Psychiatr. (D), vo!' 96 (1932), p. 215. Covering the whole subject: Dexler,
'Ober die psychotischen Erkrankungen der Tiere', Mschr. Psychiatr., va!. 16, Erg. H.99. Dexler,
'Die Erkrankungen des Zentralnervensystems der Tiere'. Hdbuch. der normalen u. pathologischen
Physiologis von Bethe, Bergmann, etc. (1927), va!. X, p. 1232.. R. Sommer, Tierpsychologie (Leipzig, 192.5). K. Lorenz, 'Durch Domestikation verursachte Storungen arteigenen Verhaltens',
Z. ang,w. Psychol., vo!' 59 (1940).
INTRODUCTION
INTRODUCTION
states Luxenburger, who quite rightly attacks anthropomorphic attitudes

which tend to attribute human motives to animal behaviour. There is a striking
contrast here between somatic medicine and psychopathology. Our quest for
the particular human factor in psychic illness constrains us to view the latter
as a specific human, rather than a universal natural, phenomenon. In so far as
man exhibits his specific human nature, there can be no analogy with animals.
Man holds a unique position. He brought into the world an element alien
to the animals but what this is still remains a problem. Although man can be
classified somatically with the zoological species even his body remains unique,
not only because of its erect gait and other characteristics but because his
specific constitution sets him apart since, if we take the whole range of living
forms into account, the human form preserves within itself more possibilities
and less specialisation than any other. In addition man differs from all the
animals in the expressive use he makes of his body. Psychologically there is a
complete break. Animals do not laugh or cry as men do nor is the intelligence
of apes mind or genuine thought but a sharp attentiveness which in man is a
pre-condition of thought and not thinking itself. Freedom of action, conscious
reflection and qualities of intellect and spirit have been considered the fundamentals of our humanity from time immemorial. The animal is bound to a
natural fate which automatically fulfils itself in accordance with natural laws.
Man is likewise bound but in addition he has a destiny the fulfilment of which
lies in his own hands. Nowhere, however, do we find man as a completely
rational being; he is borne along by natural-necessity, which reaches into the
furthest ramifications of his reason. In earlier centuries the imagination of men
conceived of angels as pure intelligences. Man, however, is himself neither
animal nor angel; he shares the condition of both but the existence of neither.
A further question is how man's special position influences the nature of
human illness. In physical illness we so resemble the animals that experiments
on the latter can be used to reach an understanding of vital bodily function in
humans, though the application may be neither simple or direct. But the concept of human psychic illness introduces a completely new dimension. Here
the incompleteness and vulnerability of human beings and their freedom and
infinite possibilities are themselves a cause of illness. In contrast with animals,
man lacks an inborn, perfected pattern of adaptation. He has to acquire a way
of life as he goes along. Man is not merely pattern, he patterns himsel In so
far as he is merely pattern, he is nearer to the animals.
In psychopathology the human being has himself become the object of
scientific study and thus observations on animals do not contribute anything
essential and there is a qualification of another kind. Not everything that
happens in a psychic illness can be explained by using the criteria of science.
Human beings are creators of culture, they develop beliefs and moral standards
and constantly transcend their own empirical human self which is the only
self that scientific research can recognise and grasp.
Animal psychology and psychopathology-so far as they can be said to
exist-are not without some interest for our study. Firstly, we learn from
them the basic phenomena of life, which may be discerned in humans also, but
can be evaluated more objectively in this wider context-phenomena such as
habits, learning abilities, conditioned reflexes, automatisms, trial-and-error
behaviour and specific kinds of intelligent behaviour (e.g. W. Kohler,
InteUigenzpruefungen an Anthropoiden). Secondly we learn what are the idiosyncracies of animal life itself, and we see that none of the animal forms were
the predecessors of man but are all like him branches of the great tree of life.
From such contrasts we learn to understand the exact implications of specific
human existence.
(h) Ohjective manifestations ofpsychic life
We can grasp and investigate only what has become an object to us.
Psychic life as such is not an object. It becomes an object to us through that
which makes it perceptible in the world, the accompanying somatic phenomena,
meaningful gestures, behaviour and actions. It is further manifested through
communication in the form of speech. It says what it means and thinks and it
produces works. These demonstrable phenomena present us with the effects
of the psyche. We either perceive it in these pher10mena directly or at least
deduce its existence from them; the psyche itself does not become an object. We
are aware of it as conscious experience in ourselves and we represent the experience of others to ourselves as similar, whether the related phenomena are
objectively observed by us or reported by others. But this experience too is
a phenomenon. We can try to objectify the psychic life through symbol and
analogy but it remains simply the encompassing of existence; a comprehension
which in itself can never he comprehended as an ohject, yet it remains the framework of all the individual objective phenomena which we encounter.
We must emphasise once again that the psyche is not a thing. Even talking
of 'the psyche' as an object is misleading. (I) Psyche means consciousness, but
just as much and from certain points of view it can even, in particular, mean
'the unconscious'. (2) Psyche is not to he regarded as an object with given
qualities but as 'heing in one's own world', the integrating of an inner and outer
world. (3) Psyche is a becoming, an unfolding and a differentiating, it is
nothing final nor is it ever fully accomplished.
(c) Consciousness and the unconscious
The term 'consciousness' has acquired a threefold significance: it implies

awareness of experience and as such is distinct from loss of consciousness and
from what is extra-conscious; secondly, it implies awareness of an object
knowing something, and as such is distinct from unconscious subjective ex:

perience, in which 'I' and 'object' are as yet undifferentiated; thirdly, it implies
self-reflection, awareness of one's self and as such is distinct from the unconscious experience where I experience the self and the object as separate
entities but am not explicitly aware of this differentiation.
10
INTRODUCTION
Consciousness is indispensable for the manifestation of the psyche, provided by consciousness we mean every mode of inner experience, even where
there is no differentiation into 'I' and 'object' and even where all that takes place
is simply a feeling, devoid of object or any discrete self. There is no psyche
where there is no consciousness of this order.
Psychic life, however, cannot be fully understood in terms of consciousness,
nor is it to be grasped by consciousness alone. To reach a full and satisfactory
explanation we must add to the actual psychic experience a theoretical extraconscious construct that goes beyond it. Phenomenology and objective observation are founded in the actual phenomena of psychic experience and need no
theory. They are only concerned with what is given, but once we look for
explanation, this requires a theoretical framework and the assumption of
certain extra-conscious mechanisms and apparatuses. Direct, accessible psychic
experiences are like the foam on the sea's surface. The depths are inaccessible
and can only be explored in an indirect and theoretical way. But the test of
theoretical assumptions is in their effects. Their value never lies solely in their
self-consistency but rather in how well they explain the actual experience and
how capable they are of refining our observation. In order to explain psychic
life we have to work with extra-conscious mechanisms and unconscious
events, which of course can never be visualised as such but can only be
conceived in simile and symbol, whether physical or psychic.
In contrast to century-old tradition a dislike for speculative theory has
been asserting itself for some time. This seems a move in the right direction
since theories are so easily thought up and lead to irreparable confusion,
particularly when they are mingled with facts. We shall make it a principle to
be as economical as possible with our theoretical concepts and use them in the
full consciousness of their hypothetical character and consequent limitations.
It has often been debated whether unconscious psychic events exist. First,
we must differentiate between psychic events which though they have been
actually experienced go unnoticed by the individual and those events which
are in fact extra-conscious and have never actually been experienced. The
unnoticed psychic events can be brought to notice given certain favourable
circumstances, and their reality can thus be established. Extra-conscious events,
however, can by definition never be brought to notice.
Psychology and psychopathology have the important task of extending
knowledge into wide areas of the unnoticed psychic life and they illuminate
this life for consciousness (= knowledge). To do this within one's self is a
necessary pre-condition in the quest for truth and in the achievement of
individual development; to enhance this latter is one type of psychotherapy.
Extra-conscious events can never be directly demonstrated unless they
happen to appear as perceivable somatic events. It is undeniable, however, that
conscious psychic phenomena can be explained very plausibly and usefully
in this way by adding extra-consious events as cause and effect. They are
therefore theoretical constructs and their aptness and consistency are debatable,
INTRODUCTION
II
but we cannot establish their actual reality, nor need we. The extra-conscious
facto,rs appe~r in man~ different forms, such as acquired memory patterns,
acqutred habits and attitudes and one's intellectual and temperamental endowment, It is not uncommon for a person to be aware that he is faced or even
perhaps being overwhelmed by an experience which has emerged from extraconscious depths within him.
The numerous meanings which have become attached to the term 'unconscious' are shown by the following:
(a) The 'unconscious' is thought to be a derivative ofconsciousness. As such
it may be (I) automatic behaviour (e.g. a past conscious activity is now carried
o~t automatically and hence unconsciously), e,g. walking, writing, riding a
bicycle; (2) forgotten experience that is still ejfective, e.g. the so-called complexes,
after-affects of previous experience; (3) memories in reach of recall.
(b) The 'unconscious' is thought of in relation to inattentiveness. As such
it is (I) unnoticed, yet lived through; (2) unwilled, unintended yet performed;
(3) ,unremem,bered (it has been in consciousness but was straightway forgotten;
sen des, for lOstance, often no longer know what was their clear intention a
m?ment before-'I go into another room-what did I want there?'); (4) somethlOg that has never become objective and is not definable in speech.
(c) The 'unconscious' is thought of as a power, an original source. As such
it is (I) the creative, vital element; (2) haven, shelter,first cause and final end.
That is, everything essential comes to us from the unconscious our passionate
aspirations and inspirations, every impulse, every idea, every ~hape and form
of our creative imagination, all the grandeur and the desolation of life. Fulfilment becomes the unconscious into which we return.
(d) ~h~ 'unconscious' is thought of as 'Being'-the very sense of being.
As sU,ch It IS thought to, be (I) psychic reality (but we can no more explain
con~clOusness as somethlOg mechanically and accidentally added to psychic
realIty than we can equate what is psychic with mere consciousness rooted
as the psyche is in the unconscious, influenced by it and influencing it in tum).
Psychic reality has been variously conceived: as the spontaneous play of basic
elements (Herbart), of which conscious psychic life is the manifestation' as a
series of deepening unconscious levels (Kohnstamm, Freud); as that pe:sonal
unconscious which every individual gathers to himself in the course of his life'
as the collective unconscious (Jung) which operates in each individual as a sub~
stratum of universal human experience. In all these instances the unconscious
is conceived as 'being for its own sake', the reality which gives us our existence.
(2) 'Absolute being.' (TIlis is a metaphysical concept: the 'unconscious'-like
Being, Non-Being, Becoming, Substance, Form and almost all categories-is
used as an analogy for this in an effort to make the unthinkable thinkable'
,
'absolute being' is not however a concept that belongs to psychol~gy.)
(d) Inner and outer world
There are certain categories of thought valid for the apprehension of all
INTRODUCTION
living things, even of the psyche in its highest flights, though we have then
to exchange exact meaning for analogy. Among these categories is that of life
as 'an existence in its own world' since all life reveals itself as a continuous interchange between an inner and an outer world (v. Uexktill). To live in its own
world is a fundamental phenomenon of life. Even physical existence cannot be
adequately explored as if it were merely a matter of anatomical structure and
physiological function, arbitrarily located in space. It has to be regarded as a
living engagement with the world around it, whereby it achieves form and
reality through constant adaptation to stimuli, which it receives in part and in
part creates. This primal, integrative process of life as an existence in and along
with its own world is exemplified in human life too, but human beings take
the process even further through conscious discrimination and an active influence on their own world and then through their generalised knowledge of it. By
such means life transcends itself and moves on into other possible worlds and
beyond the concept of \Vorld itself. Empirical research must turn to certain
particular manifestations of this basic inter-relatedness and thereby to certain
isolated aspects of the relation between inner and outer world. For instance:
(1) In physiological thinking we find stimulus related to response; in
phenomenological thinking we find the 'intentional' relationship of the'!, to
'what confronts it' ('subject' v. 'object').
(2) Individual life develops out of constitution (Anlage) and environment
(milieu); it springs from innate potentialities which may be stimulated and
moulded by the environment or left dormant to wither away. Constitution
and environment operate at first through biological events that lie outside
consciousness and we try to understand causal relationships at this level. Next,
in our conscious life they function in a psychologically comprehensible way,
when environmental factors, our birth, for instance, and changing life-situation,
pattern our existence and are in turn challenged and patterned by us. Because
of a natural self-development, the individual with his constitution confronts
the environment and enters into effective exchange with it. From this springs
all experience of human destiny, deed, effort and pain.
(3) Above all, environment fosters situations. 1 These provide the individual
with opportunities which he may make use of or waste or in which he may
reach decisions. He can contrive situations himself, letting them arise or not
arise in some meaningful pattern. He submits to the ordered regularity and
conventions of a world and at the same time he can convert them into means
of escape. In the end, however, he comes upon frontier-situations, the final
frontiers of existence--death, chance, suffering, guilt. These may awaken in
him something we have called Existence itself-a reality of selfhood.
(4) Everyone has his own private world2 but an objective world also exists
1 The concept of 'the situation' is discussed in my Geistige Situation der Zeit (Berlin, 1931),
pp. 19 fr.
I See my book Philosophie (Berlin, I93~), vol. I, pp. 61 fr., on concepts of the world. Also
my Psychologie der Weltanschauungen (Berlin), pp. IU fr.; 3rd edn. (Berlin, 1919), pp. 141 fr.
INTRODUCTION
13
-a general world common to all. This general world exists for 'common
consciousness' (or 'consciousness-as-such') and participation in this ensures
a criterion for accuracy of thinking and its objective validity. Individual
consciousness is but a portion of what is universal and generally possible, for
which it provides a concrete historical framework, and so sets the stage for
misapprehension and mistake.
(5) The psyche discovers itselfin its own world and with that creates a world.
In the world it becomes intelligible to others and the world brings it to
creativity.
Thus the meaning of the fundamental relation between inner and outer
is so often transposed that we may suddenly find ourselves confronted with
what seem to be completely heterogeneous entities. But the general analogy
holds good; there is a basic relatedness between what is within and what is
without; we are in a world common to all living things and to all psychic life
and to every human being in his separate reality.
(e) The differentiation ofpsychic life

Psychic reality erHightens our understanding best when it is most highly
developed. The furthest evolved and the most complex illumines the simple
and the primitive, not vice versa. For research purposes, therefore, we look
to those who have the best cultural endowment and a rich psychic life, but
the very highly differentiated is something rare. Yet it is just the rare case
which gives orientation to knowledge, in so far as it is not a freak but the full
development of a classical extreme. Exceptional not ordinary cases are the
psychologically illuminating ones and through them we gain a firmer grasp of
the great company of more commonplace instances. The degree of psychic
differentiation is a fundamental factor which exerts a constant influence on all
phenomena.
To be able to distinguish the unusual is very important from a clinical
point of view. What happens most often is most often reported on or complained of, but the mere fact of frequency does not mean that the phenomenon
is fully understood nor that it is more akin to natural law, nor that somehow
it has more reality. We may ask why one thing occurs rarely and another
frequently. Why are the paranoics as defined by Kraepelin so rare, yet when
they do occur they are so typical? Why should the classic types of hysteria
be so common in the environment of Charcot's world but so rare nowadays?
Psychic life offers us enormous variety right up to the elaborate developments of genius. Hashish will produce in one person a dull, animal glow,
uproariousness in another, in another a rich fabulous bliss. The same illness,
dementia praecox for example, may be characterised in one individual by
simple delusions of jealousy and persecution, while in another, Strindberg for
instance, the same ideas can develop to an extraordinary degree of richness and
the changed experience of life turn into a fountain of originality and poetic
INTRODUCTION
INTRODUCTION
creativity. The symptomatology of every psychic disturbance will correspond

with the degree of psychic development attained by the patient.
Psychic phenomena are generally only possible where there is some psychic
differentiation. This applies both to the complexity of content and to the
actual form the psychic event takes. For instance, compulsive ideas and the
phenomena of depersonalisation only appear when there is a relatively advanced degree of differentiation; compulsive ideas, which call for a high degree
of self-awareness, are not observed in young children, but are common in
generally well-differentiated persons. The same applies to that large group
of subjective inhibitions, specific to vulnerable people who are given to selfscrutiny.
The concept of differentiation can be further analysed: in the first place, it
means a numerical increase in qualitative modes of experience. Secondly, it
means the breaking up of vague experiences into several well-defined ones,
thus giving richness and depth to the total experience. Low-level individual
phenomena differentiate into higher ones; the vague instinctive life gains in
content. Increased differentiation brings increased clarity and awareness. Undefined intuitions and feelings give place to clear, definite ideas. From an
undifferentiated state of innocence emerge the innumerable contradictions and
conflicts of our psychic life. Thirdly, it implies analysis and synthesis of objectconsciousness, whereby we increase the possibilities for thought, comprehension, attitude, discrimination and comparison. Fourthly, it means a
growing consciousness of self through the process of self-reflection. We have
to distinguish here differentiation as a subjective experience which need not be
conscious from conscious differentiation which takes the form of self-observation. Someone may have a compulsive idea without attempting to understand
what he is undergoing. Usually, however, differentiation and self-awareness go
together. Sometimes the mere registering of all kinds of unimportant feelings
may create the false impression of a growth in differentiation. Fifthly, we
should know at what level of development the differentiation takes place; this
is decisive for understanding the personality. The whole force and vigour of
the individual need to be taken into account besides the actual degree of differentiation, so that we come across different levels of the personality as a
whole (Klages' concept of levels of development-'Formniveau'). Here we
are at one of the limits of what we can conceive. Yet if we wish to understand
personality we must try to find our way confidently beyond this point.
Individuals can really be compared only when they have the same degree of
differentiation and are at the same level of development (have the same
'Formniveau'), and this applies as much to the comparison of personal bearing
and conduct as to comparison in the narrower field of handwriting, etc.
These distinctions are not really enough to give us any clear definitive
point of view on the psyche as a whole. At present, so far as psychopathological phenomena are concerned, we have no satisfactory basis for estimating
degrees of differentiation nor of the direction taken, and the same applies to
degrees of disintegration and the direction they take. The general point of
view which we have outlined will therefore have to suffice.
We can, however, distinguish two fundamental causes of differentiation.
One is rooted in the individual disposition (Veranlagung); the other springs
from the cultural milieu.
In mental defectives! psychosis exhibits a relatively poor symptomatology,
the disturbances seem fewer in number and more primitive; delusions are
hardly systematised and below a certain level of intelligence certain types of
delusion (such as delusions of profound guilt) are never encountered. Excitement manifests itself invariably as loud, monotonous shouting or screaming;
apathy appears as general, dull torpidity.
The cultural milieu in which a human being grows up and lives merely
furthers or retards the unfolding of the individual constitution (Anlage). Man
lives by participating in the collective cultural achievements of history and
only reaches his own individual development through them. Untaught deafmutes remain at the level of idiots. What from the external social point of view
seems to emerge by stages is actually already there in the totality of the psyche.
Manifestations of mental illness obviously attain far more richness and variety
when they occur at higher cultural levels. For this reason the advance of
psychopathology gains nothing from the study of animals and is largely
dependent on the study of people who come from the higher levels of culture.
Doctors in private clinics possess incomparably valuable case-material in their
educated patients, whereas public clinics know only too well the monotony of
hysteria in the simpler type of patient.
Both differentiated and undifferentiated psychic phenomena, however, call
for our attention. Analysis of highly differentiated psychic life throws light on
the lower levels of development so that typically our interest finds itself swinging to and fro in both directions. For the natural sciences the proper object of
investigation is the average phenomenon or that which most commonly
appears. Other studies, equally partisan, maintain that the only proper object
for examination is the rare and highly differentiated psyche. In the realm of
'belles lettres', we may find an analogy in the early French novel of manners
and morals and the psychological novel of modern times. 2
14
(f) Recapitulation
From the above selected points of view we have visualised a number of
horizons within which psychic phenomena appear. The only common factor
is the shift in meaning, so that any contrast takes on manifold form. But discussion of the above five points of view should give us some preliminary feel- .
ing for the extent of the realities with which we have to deal, and make it quite
Luther, Z. Neur., vol. 16, p. 386. Plaskuda, Z. Neur, vol. 19, p. 596.
Bourget, commenting on the 'psychological novel' in contrast to the novel of manners and
morals, says 'il devra choisir les personnages chez lesquelles cette vie interieure soit Ie plus ample'
(i.e. choice needs to be made of characters whose inner life is rich and ample).
1
16
INTRODUCTION
INTRODUCTION
clear how little can be said in general terms. When it comes to individual
application, we need a firm grasp of the particular meaning in relation to the
concrete issue. Discussion in general terms is usually meaningless in view of
their indefinite nature.
nineteenth century, completely annihilated such 'philosophising in the wrong

place'. Science indeed has no room for philosophies of this sort, however important they may be as expressions of human attitudes to the world. Philosophies in conflict are commonly a mere battle for power, but in an exchange of
scientific views there is always some chance for sensible discussion and a
rational conclusion. All the same, it is difficult to keep psychology and psychopathology wholly free from value-judgments, which often prove to be an
expression of some background philosophy. The simple separation ofobservation and value-judgment is something that must be required from every psychopathologist in his work, not so that all human values must be relinquished but
that, on the contrary, we shall possess truer, clearer and profounder values the
more we observe before we judge. What is needed is a quiet absorption into
the facts of psychic life without the adoption of any specific attitude to them.
Human beings have to be approached in an unbiased fashion with lively
interest and without any kind of appraisal. This principle of keeping simple
observation and value-judgment apart is easy to accept in theory but in practice it calls for such a high degree of self-discipline and real objectivity that we
can never take it for granted at any time.
(2) Theoretical prejudice. The natural sciences rest on comprehensive and
well-founded theories which provide us with a uniform background for individual observations. The atom-theory and the cell-theory are cases in point.
We find nothing similar in psychology or psychopathology, where no uniform
theoretical framework is attainable, except perhaps as the speculative construct
of an individual. Our methods do not lead us to discover any ultimate elements,
mechanisms or laws, in terms of which psychic life becomes explicable or will
eventually do so; they merely introduce us by certain paths to various aspects
of it. In our view psychic life is an infinite whole, a totality that resists l:ny
consistent attempt to systematise it; much like the sea, we may coast along the
shore, go far out into the deeps but still only traverse the surface waters.
If we try to reduce psychic life to a few universal principles and seek comprehensive laws, we beg a question that cannot be answered. Where our
theories may seem to have some kinship with the natural sciences, it is 1n the
forming of tentative hypotheses, which we make for limited research ends
only and which have no application to the psyche as a whole. Wherever we
prejudge because of a theory, the appreciation of facts is curtailed. Findings
are viewed from the angle of that particular theory; anything that supports it
or seems relevant is found interesting; anything that has no relevance is
ignored; anything that contradicts the theory is blanketed or misinterpreted.
Reality is constantly seen through the spectacles of one theory or another. We
have, therefore, to make a continual effort to discount the theoretical prejudices
ever present in our minds and train ourselves to pure appreciation of the facts.
We can only appreciate these latter in terms of category and method, and we
have therefore to be fully aware of the presuppositions lying in every discovery
according to the nature of its subject-matter--'theory lurks in every fact'. We
3.
PREJUDICE AND PRESUPPOSITION
Whenever we apperceive, we have already brought into the situation that

which renders apperception possible and gives it form. If what we bring falsifies our view we call it 'prejudice' but if on the contrary our apperception has
been enabled and enhanced, we speak of 'presupposition'.
(a) Prejudice
It is an enlightening process of self-criticism to make ourselves realise how
much we have taken unconsciously for granted. There are many reasons for
this, e.g. the urge to get some unified picture of the whole, or the wish to
arrive at a few primary concepts that are simple and definitive. As a result we
tend to generalise isolated points of view, specific methods and categories.
Or, what happens more commonly, we confuse what is definitely knowable
with what we believe.
Prejudices of this sort weigh on us unconsciously but with paralysing
effect and we shall have to try and free ourselves from them in every chapter
of this book. At this point we will only look at one or two very pronounced
examples, and if we can recognise them in these extreme forms we shall be
ready for the disguises which they more often assume.
(I) Philosophical prejudice. There have been periods in which great value
has been placed on speculative and deductive thin1cing, based on principles that
sought to comprehend and explain everything without the test of experience.
Such thinking was more highly valued then than the irksome examination of
particulars. These were periods in which philosophy tried to create from
'above' what only experience could bring from 'below'. Nowadays we seem to
have abandoned this orientation but it reappears here and there in the form of
abstruse theories. Behind our accepted systems of general psychopathology
the old spirit hovers and can be identified. Our rejection of purely deductive
and barren philosophical theorising is justified but it is often linked regrettably
with the opposite misconception, that the only useful approach is to go on
with the collection of particular experiences. It is thought better to amass data
blindly than sit down and think. From this follows a contempt for the activity
of thinking, which alone gives a place to facts, a plan to work to, a standpoint
for observation and the passionate drive for rewarding scientific goals.
Deductive philosophies were generally associated with value-judgments
and displayed moralistic and theological tendencies. Sins and passions were
ascribed as the causes of mental illness and human qualities divided categorically into bad and good. Maximilian Jakobi, writing in the first half of the
17
18
INTRODUCTION
INTRODUCTION
can thus learn to look at reality in the clear knowledge that what we see is
never reality itself nor ever the whole reality.
(3) Somatic prejudice. Tacit assumptions are made that, like everything else
biological, the actual reality of human existence is a somatic event. Man is only
comprehensible when he is understood in somatic terms; should the psyche be
mentioned, this is in the nature of a theoretical stop-gap of no real scientific
value. A tendency arises to discuss all psychic events as if their essence were
something somatic, already in one's grasp, or as if such a concept merely
pointed the way to discoveries of a somatic nature. Genuine research provides
hypotheses which stimulate investigation, verification or refutation of experiential facts through somatic findings, but where this somatic prejudice is
operative an imaginary 'soma' receives great emphasis as a heuristic presupposition, when in fact it is nothing but the unconscious expression of an
unscientific prejudice. The attitudes of resignation sometimes shown when
psychological matters are under consideration reflect the same prejudice; we
can see it, for instance, in the statement that all psychological interest in
schizophrenia will vanish when once the morbid somatic process that underlies
it is discovered.
This somatic prejudice comes up again and again in the disguise of physiology, anatomy or vague biology. At the beginning of the century we would
find it expressed as follows: there is no need to investigate the psyche as such;
it is purely subjective. If it is to be discussed scientifically, it must be presented
anatomically, somatically-as a physical function. Even provisional anatomical
constructs are preferable to mere psychological investigation. These anatomical constructions, however, became quite fantastic (e.g. Meynert, Wernicke) and have rightly been called 'Brain Mythologies'. Unrelated things
were forcibly related, e.g. cortical cells were related to memory, nerve fibres
to association of ideas. Such somatic constructions have no real basis. Not one
specific cerebral process is known which parallels a specific psychic phenomenon. Localisation of various sensory areas in the cerebral cortex and of the
aphasias in the left hemisphere only means that these organs must be intact for
a specific psychic event to be possible. There is no difference in principle here
from the equal necessity of having intact function of the eye or of the motor
mechanism, etc., which are also essential 'tools'. With regard to the neurological mechanisms, the position is more advanced, but we are still infinitely
far removed from finding exact parallels to psychic events. It was entirely
erroneous to suppose that the discovery of the aphasias and apraxias would
lead us into psychic territory, and empirically we cannot decide whether
psychic and somatic phenomena are parallel or interacting. There is not a
single instance where we could demonstrate this. Psychic and somatic phenomena, in so far as we can have some scientific understanding of them, appear
separated by a measureless expanse of intermediary events, of which at present
we are ignorant. In practice we can speak of parallelism or of interactionusually of the latter. We can do this all the more easily in that it is always
possible to convert the one set of terms into the other. As regards this tendency to translate psychic into somatic terms (imaginary or real), we may
refer to Janet who said: 'if we are always to think anatomically where psychiatry is concerned, we might as well resign ourselves to think nothing'.
(4) 'Psyclwlogising' and 'intellectualising'. Empathy is often itself responsible for 'psychologising'. There is a desire to 'understand' everything
and all critical awareness of the limits of psychological understanding is lost.
This happens whenever 'psychological understanding' is turned into 'causal
explanation' under the misconception that in every case there is a meaningful
determinant of experience to be found. People ignorant of psychology and
with a somatic orientation are most prone to fall into this trap. Too much is
a.ttributed to ill-will or malingering but this is due perhaps not so much to
actual psychologising as to moralising. Some physicians have a definite dislike
for hysterics and they suffer profound irritation if they cannot find any of the
physical signs with which they are familiar. In their heart of hearts they think
it all plain naughtiness, and when the situation is out of hand, only then do
they pass the case on to the psychiatrist. Crude, naive psychologising is
found precisely in those medical men who do not want to have anything to do
with psychology, nor to know anything about it.
Psychic life provides many contexts where people seem to act purposefully and out of rational motives, and there is a very widespread inclination to
assume 'conscious reasons' behind all human activity. In actual fact rational
behaviour plays a very small part in human affairs. Irrational drives and
emotional states usually prevail, even when the individual wishes to convince
himself that he is acting on purely logical grounds. Exaggerated search for
rational connections gives rise to intellectualising, which obstructs any hope
of reaching a true and penetrating understanding of human behaviour.
Reasoning is then over-rated as against the forces of suggestion. When the
patient appears irrational, there is a hasty resort to a diagnosis of 'dementia'
and all the complex richness of human experience is ignored.
(5) Use ofFalse Analogy. Psychic life is objectified through expression and
through creative impact, through behaviour and through action, through
somatic events and speech. But the psyche itself cannot be observed; we can
only see it through metaphor and simile. It is something we experience and
implement, something we realise in ourselves but never actually see. In discussing the psyche we always have to fall back on imagery, usually of a threedimensional kind, and in psychological thinking analogies for the psyche
abound, e.g. the psyche is a stream of consciousness; consciousness is like a
space where individual psychic phenomena come and go as figures on a stage;
it is a space that recedes infinitely into the unconscious; the psyche is constituted of layers-layers of consciousness, of experience, function and personality; the psyche is made up of elements in various combinations; it is
moved by fundamental forces, the factors and components of which we can
analyse; it has attributes that can be described as with any other thing. Such
2.1
INTRODUCTION
INTRODUCTION
three-dimensional analogies are invaluable to us. We could not do without

them and they do no harm as long as we do not try to prove anything by
them, but merely use them descriptively. It is not uncommon, however, for
the original analogy to be taken as a valid construct and become established as
one of our prejudices. Vivid and comprehensible analogies readily dominate
our minds so that from time to time we no longer see them as analogies but as
valid concepts of the thing itself. For instance, the psyche is broken down into
atom-like elements or psychic events are seen as mechanical movements
(mechanistic theory) or psychic connections as a series of combinations
analogous to a chemical compound (psychic chemistry). In any case there is
a constant human tendency to let imagery and metaphor become the preferred
mode of thought and work in our minds prejudicially.
empirical sciences every investigator is driven on to find reality, so that as

regards the somatic aspects of psychiatry the psychiatrist will ask for histological, serological and neurological facts and will discard anatomical constructs and speculations. In psychopathology the basic reality for research is
psychic life as it is presented to us through observed behaviour and through
what can be understood from the patient's remarks. We have to feel, grasp and
contemplate all that is really happening in the human psyche. The reality we
are driven to look for is the reality of psychic life and we want to know it in a
context that to some extent is open to scientific observation. It is the understanding of psychic reality which alone gives body and richness to our concepts, and we refuse to have this reality dissolved away in empty theoretical
prejudice and anatomical or other constructs taking its place. Indeed, we
cannot practise psychopathology at all if we lack the capacity and the desire to
bring the psyche home to ourselves in all its rich complexity.
The investigator, however, is more than a vessel into which knowledge
can be poured. He is a living being and as such an indispensable instrument of
his own research. The presuppositions without which his enquiry will remain
sterile are contained within his own person. Clarification may free us from
prejudice, but presuppositions are a necessary part of understanding. They
appear as tentative ideas which we then take as experimental hypotheses; they
are certain basic attitudes in ourselves, derivations of our own being, without
which we cannot comprehend the essence of anything. Presuppositions provide guiding ideas, and form the mental life of those engaged in research; they
need to be strengthened and cultivated and they should be acknowledged.
They do not prove the correctness of an insight but are the source of any truth
or relevance it attains.
Prejudices (that are false) are rigid, circumscribed presuppositions which
are wrongly taken as absolutes. They are hardly realised by those who hold
them; they do not reach consciousness and when clarified can be dissolved.
Presuppositions (that are true) are rooted in the investigator himself and are the
ground of his ability to see and understand. Once elucidated, they will be well
and truly grasped.
The most vital part of the psychopathologist's knowledge is drawn from
his contact with people. What he gains from this depends upon the particular
way he gives himself and as therapist partakes in events, whether he illuminates himself as well as his patients. The process is not only one of simple
observation, like reading off a measurement, but the exercise of a self-involving
vision in which the psyche itself is glimpsed.
It is possible to partake in the inner life of another person through a
tentative exchange of roles; a certain dramatic play, as it were, which nevertheless is no play but real. There is a natural way of empathic listening to
others in which we simultaneously keep touch with ourselves. Every psychopathologist depends on his power to see and experience and on the range,
receptivity and complexity of such power. There is an immense difference
2.0
(6) Medical prejudice relating to quantitative assessment, objectivity and

diagnostics. The prejudice in favour of quantitative findings derives from the
exact sciences. Examination of qualitative changes is regarded as arbitrary,

subjective and not scientific. Statistical and experimental methods, which by
their use of measurement, calculation and graphs seem so valuable for the investigation of certain problems, are held to be the one and only scientific
method. Even when this sort of investigation is no longer possible, quantitative
concepts are often still applied, though in the context they are meaningless.
Sometimes we find it put forward quite seriously that the 'intensity' of ideas is
the primary cause of compulsive thinking, hysterical phenomena, delusions and
hallucinations-ideas are projected outward simply because of their intensity.
The only suitable object for investigation then becomes that which can be
perceived through the senses. The examination of physical phenomena, of performance and productivity is indeed very valuable but all the same we can
only penetrate to what is psychic if we let the psyche confront us directly and
the psyche, as we shall find, is always qualitatively singular. Psychic events
can never be directly perceived, only indirectly in the way they express themselves. This self-evident point explains why a psychopathology which simply
confines itself to what can be directly perceived through the senses becomes
inevitably a psychopathology without a psyche.
In the psychiatric assessment of a case, diagnosis is left to the last but in
practice, except in the case of well-known cerebral changes, diagnosis is the
least relevant factor. If it is made the main issue, it will prejudge what ideally
should emerge from the investigation. What matters is the process of analysis.
The chaos of phenomena should not be blotted out with some diagnostic
label but bring illumination through the way it is systematically ordered and
related. Psychiatric diagnosis is too often a sterile running round in circles so
that only a few phenomena are brought into the orbit of conscious knowledge.
(b) Presupposition
The opposite of prejudging our investigations is to try and make every

possible approach to psychic reality, using all the means in our power. In the
22
INTRODUCTION
INTRODUCTION
between those who blunder about among the sick and those who take an
unhesitating course in the light of their sensitive perceptions.
This sympathetic tremulation of one psyche with the experiences of
another means that if we are to be scientific, we must objectify such experience critically. 'Sympathy is not the. same as knowle~ge,. bu.t from it
springs that vision of things which prOVIdes knowledge WIth 1ndlspen~able
material. Completely dispassionate observation misses the essence .of th1ng~.
Detachment and sympathy belong together and should not be seen 1n OppOSItion. If we are to gain in scientific knowledge, the interplay of both is needed.
The psychopathologist with this genuine vision has a psychic life vibrant
with experiences which he is constantly subduing to a ratio~al or?er.
The critique of his own basic reason, when confronted WIth objects, forces
him to ask: what state of mind is governing my perception of these objects?
Have I got their correct relevance and importance as an observed reality?
What construction am I putting on them? How do they affect my own conscious reality? In order to appreciate facts properly we must always work on
ourselves as well as on our material. Only that knowledge is a full knowledge
which leads to growth of the self and as such it can move into new dimensions
beyond the level of mere confirmatory practice.
Research workers and clinicians should create in themselves a universe of
different approaches. Memories of things seen, concrete clinical pictures, biological insights, important encounters-in brief, all their personal past experience should be readily available for constant comparison. They also need
a set of well-differentiated concepts, so that the interpretation of what they
perceive can be made clear to others.
4.
METHODS
In psychiatric literature there is much discussion of mere possibilities and

a great deal of subjective and speculative comment that lacks the subst~ce of
authentic experience. In studying the contributions of others as well as 1n our
own researches, therefore, we should always ask: 'What are the facts?''What am I being shown?'-'What are the original findings and what are the
present ones?'-'What interpretation has been put upon them?'-'How much
is pure speculation?'-'What experience do I need to follow these ideas up
properly?' When the ideas presented are not based on experience, we should
ask whether we might not discard them as immaterial. Ideas should lead to
new findings or enrich those findings that already exist by making them more
tangible or giving them a fuller context. It is a pity to waste time on tortuous,
meaningless argument or on imaginary models, however much they clamour
for attention. If we are to apperceive essentials with certainty, our guide
should be a clearly grasped methodology. This helps us to draw a line between
genuine, empirical research, pointless experiment and compilations that are
uninformative, poorly designed and repetitive.
23
Every advance in factual knowledge means an advance in method. The

latter is often adopted consciously, but by no means always so. Not all great
scientific advances begin with complete methodological insight, though when
this is present it always clarifies and establishes the factual knowledge gained.
Research methods define their objects by the method chosen. The
object is therefore never reality as a whole but always something in particular,
an aspect or a perspective, never the happening in its totality.
(a) Techniques
Psychopathology finds its objects for study in clinics, consulting rooms,

institutions, in collected papers, reports, in research laboratories, etc. We are
dependent in the beginning on such facts as can be found, and on the way they
have been tackled. Discovery often enough consists in simply drawing attention to observed facts. The first person to count suicides and list other comparable figures (population-statistics, seasons of the year) discovered something, even if only in the first instance a routine technique. The important
thing is to see the significance of something hitherto ignored and to watch the
chance of winning fresh facts through the use of a number of techniques.
I. Case-study. Research in psychopathology is based on verbal exploration
of the patient and on an intimate acquaintance with his behaviour, gestures and
attempts at communication. We also try to get material information on his
present condition and on his earlier personal history, so far as it can be obtained. We use the patient's own description of himself, the history as given
by him or his relatives, official documents when he has been in the hands of
authority, personal papers, information from acquaintances, superiors, etc.
The individual case remains the basic source for all that counts as experience in psychopathology. The description of cases and case-historieswhich may range from a description of individual phenomena to a comprehensive biography-is called case-study. This method provides the foundation
for our particular science and orientates our approach.
Besides this commonly used and readily grasped method, psychopathology has also developed certain special methods which are not so well
suited for routine enquiries, but are appropriate for the exploration of correlates. These are the statistical and experimental methods.
2. Statistics. Statisticsl first appeared in psychopathology as a method of
social research, e.g. criminal statistics, suicide rates, etc. Then came the statistical handling of certain specific psychiatric problems: duration of paralysis,
interval between luetic infection and onset of paralysis, ages of patients and
onset of their respective psychoses; annual distribution curve of admissions,
etc. Finally, statistics gained a prominent place in genetics, in correlationfinding in personality studies, in intelligence testing and in somatotyping.
The pull towards precision, so characteristic of the natural sciences, operates
1 F. W. Hagen, Statistische Untersud.ungen aher Geisteslcranlcheiten (Erlangen, 1876). Also later
works such as Roemer, Allg. Z. Psychiatr., vol. 70, p. 804.
INTRODUCTION
INTRODUCTION
no less in the field of psychopathology and spurs us on to try to measure and

enumerate everything we can.
Statistical methods present a particular problem of their own. We would
comment briefly as follows:
point of view. The brilliant investigations of Kraepelin in regard to the workcurve, his measurements of memory, his association experiments, etc., constitute a most valuable contribution but comparing the results of psychopathological enquiry in general with the results of experimental psychology,
Mobius1 seems to state the truth when he writes of the latter 'they are, to put
it crudely, very small beer'.
The main problem is to find those methods that will extract some definite
realities from the endless and confusing flood of life; methods that will help us
to construct models, find measurable data, draw graphs, schemata and likenesses-in brief create the configurations whereby reality can be properly
structured and comprehended. Discovery of a way to make certain facts comprehensible, so that they can be re-identified by others, is the beginning of all
research.
Technical methods, such as experiments, calculations, measurements, very
often result in accidental observations on the patient which may be extremely
useful, though within their own term of reference these methods may yield
little. Intelligence tests, for instance, can produce situations in which the
patient offers an interesting piece of behaviour which the objective clinical
examination did not bring to light. Somatotyping induces a scrutiny of the
body from all possible angles, although the actual measurements may be
without significance. Thus it is easy to make false evaluations, once we confuse
a method's objective findings with what comes to light incidentally in the
course of its application.
(aa) Statistical findings never show anything conclusive, when applied to the
individual case. They can only work with probabilities (usually to the most modest
degree). Individual cases can never be subsumed under a statistical finding. For
instance, if I know the percentage mortality for an operation, I still do not know
what will happen in the individual case. Or if I know the correlation between
somato-type and psychosis, I cannot assess the significance of the somatotype in
the individual. Anyone case may be t?tally unaffected by the statistical findings.
(bh) A clear definition of the original data is of decisive importance. If it is not
unequivocally defined and identifiable by any other research worker at any time,
calculation becomes meaningless. Exact method based on inexact data can lead to the
most remarkable mistakes.
(cc) Whenever simple enumeration gives place to mathematical manipulation a
high degree of mathematical and critical ability is required in evaluating results.
All the different steps must be kept in mind as well as the sense of the findings; it is
only too easy to get lost in a nightmare world of pseudo-mathematical abstractions.
(dd) Statistical findings lead to correlations but not to causal connections. They hint
at possibilities and stimulate us to interpret. Causal interpretation demands hypotheses which we can test out. This leads to the danger of numerous ad hoc hypotheses multiplying in support. The limits of interpretation must be realised. We
should be aware when the point has been reached of artificial hypotheses explaining
every correlation. No one case can be contradictory because the supposed factors in
all their possible combinations have become all-inclusive and by the application of
mathematics every finding can be turned into a confirmation. Friess' theory of the
periodicity of biographical events provides an instance. But even with relatively
simple numerical comparisons, misinterpretation is quite a risk and often not easily
perceived as such. Figures are convincing and we must see they do not smother the
useful overstatement 'figures can prove anything'.
3. Experiments. Experiment has occupied a prominent position in psychopathology. Experimental psychopathology, as it was called, was separated off
from the rest of the subject and regarded as a special field, i.e. scientific psychopathology proper. Such a division seems to us a mistake. Under certain
circumstances experiments can be most valuable auxiliaries but the ultimate
goal of a science cannot be merely to obtain experimental results. Valid experiment in this field can only be carried out by a psychopathologist who has
psychological training, and who knows what questions to ask and how to
evaluate the answers. Practice in experiment may give technical skill but it does
not in itself constitute the ability for psychological work. Hence the many
pseudo-scientific experiments carried out by experimental psychopathologists.
Complicated experiments are performed and figures produced but they tell us
nothing. There is no supporting theory at the back of them nor any guiding
(h) The practical logic of research

In the actual course of acquiring knowledge we find ourselves using
several methods simultaneously. For theoretical purposes we can discriminate
between them and along with them the main types of material gained from
their use. There are three major groups: the collection of individualphenomena,
the enquiry into the connections and the grasping of complex unities.
I. Collection of individual phenomena. Individual facts emerge out of the
living flow of psychic reality. Their infinite number fall into various groupings
determined by the method of their collection.
(aa) The first step towards a scientific knowledge of the psyche is the
selection, delimitation, differentiation and description of particular phenomena of experience which then, through the use of the allotted term, become
defined and capable of identification time and again. Thus we shall presently
describe the different kinds of hallucinations, delusions, compulsive phenomena and the different modes of personal awareness, drives, etc. So far there
is no concern with the sources of such phenomena nor with the emergence of
one psychic phenomenon from another, nor yet with any theories about underlying causes. The only concern is with the actual experience. This representation of psychic experiences and psychic states, this delimitation and definition
1 P.
J.
Mobius, Die HoJfmmgslo.,iglceit aller Psychologie, lnd edn. (Halle, 1907).
INTRODUCTION
27
INTRODUCTION
of them, so that we can be sure the same term means the same thing, is the
express function of phenomenology.
(hh) The descriptions of phenomenology only help us to get to know our
material indirectly. We depend on patients' self-descriptions, which we can
only grasp by analogy with our own modes ot experience. Phenomena of this
sort may be called suhjective as opposed to those ohjective phenomena which
can be directly demonstrated as they occur, which they do in a number of
fundamentally different ways, e.g. as somatic accompaniments (the pulse rate
during excitement, dilatation of pupils during fear), or as expression (facial
expressions of happiness or gloom), as measurable performance (work-output,
memory performance), or in the shape of actions, behaviour or literary or
artistic creation. All such objective phenomena help to elucidate the question
-what are the basic types of objective psychic facts?
Differentiation is very often made between subjective (the patient's immediate
experience, which can only be indirectly grasped by the observer) and objective (that
which can be directly demonstrated in the external world). But such differentiation is
not unequivocal. 'Objective' has various meanings; it is not identical in the case of
pulse rate, memory performance or meaningful gesture. The following shows the
different meanings which this dichotomy into 'subjective' and 'objective' can produce :
I.
OhjectiYe means everything that can be perceived hy the senses: reflexes,
recordable movements, actions, conduct, etc.; every measurable performance,

work-output, memory-span. Subjective then means everything that can be
comprehended by empathy into psychic events, or by some realisation of
psychic content.
2.. Rational content, e.g. of delusions, can be called objective, in so far as this can
be understood in a purely intellectual way, i.e. without empathy. Subjective
then is applied to the actual events in the psyche which can only be grasped by,
sympathetic insight, i.e. the original delusional experience.
3. Objective can be used ultimately for a part of what was up to then subjective,
for the outward sign of some psychic content directly understood by empathy,
e.g. the fear shown by a patient. In this context, suhjectiye becomes what we
get to know indirectly through the patient's own statements, e.g. when a patient
with no outward signs of fear tells us he is afraid.
4. It is a remarkable fact that one can have psychic experience without knowing
the exact manner of it. For instance, patients may be retarded, which we can
either note objectively in the slowing down of their reactions or detect as an
objective fact through the exercise of our own empathy. They themselves,
however, need not be subjectively aware of this at all. The less psychic differentiation there is, the less is the subjective awareness. In this context, therefore,
we can find objective retardation as opposed to suhjectiye retardation or an objective flight of ideas as opposed to a subjectively experienced 'pressure of
thought' (the feeling of a disjointed, restless and shifting flow of ideas).
5. So far all the phenomena, whether objective or subjective, provide matter for
scientific investigation but there is one last aspect of the dichotomy into subjective and objective under which ohjectiye phenomena become those which can
he tested and discussed, while subjective phenomena are those that remain
vague matters, untestable, cannot be discussed, seeming to rest on inexplicable
impressions and purely personal judgments.

2. Enquiry into connections (' Understanding' or 'perception of meaning' Verstehen; 'Explanation' or 'perception of causal connection'-Erklaren).
Phenomenology presents us with a series of isolated fragments broken out
from a person's total psychic experience. Other studies present us with data of
a different order, e.g. psychological performances, somato-psychic events,
expressive gestures, psychotic actions and inner worlds. How are all these
various data to be related? In some cases the meaning is clear and we understand directly how one psychic event emerges from another. This mode of understanding is only possible with psychic events. In this way we can be said to
understand the anger of someone attacked, the jealousy of the man made
cuckold, the acts and decisions that spring from motive. In phenomenology
we scrutinise a number of qualities or states and the understanding that
accompanies this has a static quality. But in this question of connectedness,
we grasp a psychic perturbation, a psyche in motion, a psychic connection,
the actual emergence of one thing from another. Here our understanding has a
genetic quality. (A psychopathology of meaningful phenomena.) Not only do
we understand subjectively-experienced phenomena in this way, but all the
other phenomena which are directly visible to us in their objective manifestations, e.g. actual performances and the works and personal worlds of our
patients, which may all have provided us with the material for our static
observation.
Broadly speaking, however, 'understanding' has two different meanings,
according to whether it is termed static or genetic. The static mode denotes the
presentation to oneself of psychic states, the objectifying to oneself of psychic
qualities, and we shall exercise this kind of understanding when we come to the
chapters on phenomenology and the psychology of expression, etc. In the
second part of the book we shall occupy ourselves with the genetic mode, that
of empathy, of perceiving the meaning of psychic connections and the emergence of one psychic phenomenon from another. The qualification of 'static'
or 'genetic' will only be added to 'understanding' (Verstehen) where there
might be some confusion. Otherwise we shall use the term 'understanding'
according to context, implying in one chapter the static mode, in another the
genetic.
In psychopathology our genetic understanding (or perception of meaningful connection) soon reaches its limits. (We can call this process 'psychological explanation' if we like, but then we must keep it clearly distinct, as of a
different order from objective causal explanation, which is the perception of
causal connection in the strict sense.) In psychopathology psychic phenomena
appear suddenly as something entirely new, in a way we cannot understand at
all. One psychic event follows another quite incomprehensibly; it seems to
follow arbitrarily rather than emerge. Stages of psychic development in
28
INTRODUCTION
INTRODUCTION
normal people, psychic phases and episodes in abnormal people are all incomprehensible events and appear as purely temporal sequences. It is equally
difficult to understand the whole range of a person's psychic development and
its full meaning in genetic terms. We can only resort to causal explanation, as
with phenomena in the natural sciences, which, as distinct from psychological phenomena, are never seen 'from within' but 'from the outside'
only.
In order to be clear we shall keep the expression 'understanding' (Verstehen)
solely for the understanding of psychic events 'from within'. The expression
will never be used for the appreciation of objective causal connections, which
as we have said can only be seen 'from without'. For these we shall reserve the
expression 'explanation' (Erklaren). These two different expressions denote
something very specific which will grow clearer as the reader proceeds and the
number of examples increases. In questionable cases where one or the other
expression could be used interchangeably we shall use the term 'comprehend'
(Begreifen). The very possibility of any systematic study or clear-sighted
research in psychopathology depends on grasping the fact that we are dealing
here with polar opposites, static understanding as opposed to external senseperception and genetic understanding as opposed to causal explanation of
objective connections. These represent totally different, ultimate sources of
knowledge.
Some scientists tend to deny the validity of any psychological source of
scientific knowledge. They only accept what can be perceived objectively by
the senses, not what can be meaningfully understood through the senses. Their
viewpoint cannot be refuted since there is no proof of the validity of any
ultimate source of knowledge. But at least we might look for consistency.
Such scientists should abstain from talking of the psyche or even thinking in
terms of psychic events. They should give up psychopathology and confine
themselves to the study of cerebral processes and general physiology. They
should not appear as expert witnesses in Court, since on their own showing
they know nothing about the subject-matter; they can give no expert opinion
on the psyche, only on the brain. They can only help expertly with reference to
physical phenomena and they should give up any pretence to history-taking.
Such consistency would gain one's respect and we might think it worthy of
the name of science. More commonly we find, however, denials and doubts
expressed in interjections such as 'this is only subjective', etc. This seems a
sterile nihilism shown by people who would persuade themselves that their
incompetence is due to their subject-matter, not to themselves.
3. Grasp ofcomplex unities. All research differentiates, separates and studies
individual particulars in which it tries to discover certain general laws. Yet all
these individual particulars are taken out from what is in reality a complex
unity. In grasping particulars we make a mistake if we forget the comprehensive
whole in which and through which they exist. This never becomes the direct
object of our study but only does so via the particulars. It is never examined
in itself but only in the form of some schema of its essence. In itself it remains
an idea.
We can state the following in relation to it: the whole comes before its
parts; the whole is not the sum of its parts, it is more than them; it is an independent and original source; it is form; the whole cannot therefore be grasped
from its elements alone. The whole can persist in its totality even when its
parts are lost or changed. It is impossible to derive the whole from its parts
(mechanistic philosophy) nor can the parts be derived from the whole (Hegelianism). We have rather to conceive a polarity. The whole must be seen
through its parts and the parts from the aspect of the whole; there can be no
comprehensive synthesis of the whole from its parts nor any deduction of the
parts from the whole; there is only something that encompasses. The infinite
whole comprises a mutual interplay of parts and wholes. We have to enter
upon an infinite analysis and relate everything analysed to its appropriate
whole. In biology, for instance, all the particular causal connections obtain
their coherence through mutual interaction within a living whole. Genetic
understanding (the perception of psychic connection) enlarges the 'hermeneutic round'; we have to understand the whole from the particular facts
and this whole in turn preconditions our understanding of the facts.
The same question arises in somatic medicine. In the old days when illnesses were thought to be demons in possession, a man was held to be either
sick or not; he had a devil in him or he had not. He was thought to be wholly
possessed, sick as a person. Then came one of the greatest advances in scientific
knowledge, when it was found that the body was not sick as a whole at all, but
that the trouble could be localised in certain anatomical organs or biological
processes, from which point it exercised more or less far-reaching effects on
other organs, functions or even on the whole body. Reactive and compensatory processes were observed between the morbid development and the body
as a whole, which was seen as a life-process making for health. It was now
possible to distinguish purely local and limited diseases, which had no effect
on the rest of the body and were of slight importance-what we might, using
other criteria, call a blemish-from those other disorders which became vitally
important because of their effect on the body as a whole, which then began to
react to these effects. Instead of the numerous ills which had been supposed
rather vaguely to affect the whole body, it was now possible to describe a
number of well-defined diseases which could be the cause of widespread
symptoms but did not spring from the living body as a whole. There remained a by no means unimportant group of somatic disorders which seemed
to be grounded in the total constitution of the body. In the last resort, however, we find that with all individual disturbances once they have been identified there is always some relation to the 'constitution', that complex unity of
the living individual.
The same polarity of whole and part will be found to exist in our study of
the psyche. But in this case from the point of view of methodology everything
INTRODUCTION
INTRODUCTION
is much less clear scientifically, with many more dimensions and much more
complex. The relationship between part and whole enters into every chapter of
this book. At critical points the meaning of wholeness will be explored in
some detail, but it becomes the main theme in the fourth part, as the empirical
whole, and in the sixth part as that all-encompassing whole which is beyond empirical investigation. The following are a few general preliminary
remarks:
Though we speak of 'a human being as a whole' we mean something
infinite and as a whole unrealisable. A vast number of individual psychic
functions go to its construction. Let us take for example some extremely
circumscribed particular, such as colour-blindness, tone-deafness or outstanding memory for digits; these are so to speak deviant parts of the psyche
which may eventually-sometimes during a lifetime--exert an influence on
the total personality. Similarly we can think of many other particulars as
isolated functions of the psyche which provide the varied equipment of personality and we can contrast abnormalities arising in these functions, in
memory for instance, with abnormalities of a quite different kind, which are
rooted in the whole individual right from the start and do not seem to originate in any individual part of the psyche. For instance, there are patients in
whom brain injury has produced severe memory defects, speech disorders and
motor paralyses which seem destructive to the total personality. If we observe
closely, however, under certain favourable conditions, the original unchanged
personality becomes apparent; it is only 'put out of action' for a time or made
incapable of expressing itself. It remains potentially intact. In contrast with
this we find patients whose 'equipment' seems all in order but who appear
deviant in their personality as a whole, sometimes in a way which defies
definition. It was this which led the older psychiatrists to call mental illnesses
'illness of personality'.
This general polarity of the human being as a whole and his individual
psychic parts does not provide the sole dimension for our analysis. There are
many kinds of wholes and parts in psychological research. Phenomenological
elements are contrasted with the totality of the momentary state of consciousness; an individual's particular performance with his over-all performance;
the individual symptom with the typical syndrome. As to more comprehensive
and complex unities, we find these in the constitution, in the disease entity and
in the person's whole history. Yet even these ultimate empirical wholes remain relative and cannot be taken as the whole of the human being as such.
This encompasses all these things and springs from an unconfined freedom
which lies beyond the reach of empirical enquiry into Man.
Scientific endeavour makes progress only by analysis and by relating one
particular to another, but if it does no more than this, it dies in failing to discern the essential; it simply slips into the comfort of bare enumeration.
Science must always be carried along by the idea of some unifying whole,
without being seduced by facile anticipation into tackling any such whole
directly. When this happens we tend to get drunk with phrases and narrow
our horizons through a presumed mastery of the whole and through an
apparent elucidation of the psychic forces which encompass us all. In our
research we need to keep as our farthest horizon the consciousness of this
encompassing quality of the human being, which reduces every object of our
enquiry to a part or an aspect, to something relative, however comprehensive
it may seem in its empirical wholeness.
What Man actually is remains the great question that stands at the margins
of all our knowledge.
(c) Inevitahle mistakes informal logic tllat have to be constantly overcome
I. The slide into endlessness. Facts and thinking are 'correct' but yet do not
bring knowledge. Every research worker has the experience of being on the
wrong track and baffled, without knowing why. We have to learn to meet this
hazard consciously, having grasped wherein it lies. I now try to point out a
number of these hazards.
(aa) If I write my case-histories on the principle that I must lay judgment aside
and describe everything, put down all that the patient says, collect everything that
can be known, my case-histories will soon become nothing but endless description
and if! am too conscientious, they will grow into fat tomes which nobody reads. The
mass of irrelevant data cannot be justified by saying that later research workers may
look at it from some fresh point of view. Very few facts can be well described without
there being some intuitive awareness of their possible meaning. We can only avoid
pointless activity of this sort if we start with a vision of what is essential and if we
formulate some ideas to govern the collection of our data and its presentation. It is
no help to cut the process short with some schema of popular appeal.
(bb) One of the surest ways to establish facts is to count what can be counted. But
we can count ad infinitum. Figures may now and then command interest, particularly
for a beginner, but they make sense only when such figures can be compared from
different points of view. Yet even that lacks point. The important thing is to make the
whole counting operation into an instrument for some exploratory idea which will
penetrate reality and not merely re-present itself in a string of endless figures. Thus
we find complex investigations which produce certain figures but teach us nothing;
there is no basic idea to check diffusiveness and give the work methodical shape.
(cc) It has become popular to calculate the correlation between two sets of facts,
and this may vary from certainty (coefficient = I) to complete independence (coefficient = 0). Personality traits, individual abilities, genetic factors, test-results, are
all examined statistically for degrees of correlation. Such correlations appear very
satisfying; there seems to have been a conclusive demonstration of real connections.
If however such correlations are multiplied endlessly and are only of moderate significance in any case, they begin to lose their value. Correlations are after all only
superficial facts, an end effect which cannot inform us of the real relationships obscured by such mass statistics. In this world almost everything is related to everything
else. The facts will attain to meaning and the endless correlation stop only if we can
introduce some standpoint to give significance. This should derive from a theory
based upon other sciences and be itself illumined with a fresh idea. As with everything
else, the mere beauty of the presentation must not blind one. Diffusiveness of this
30
31
33
INTRODUCTION
INTRODUCTION
sort can be checked only with the help of some methodological principle to which we
must adhere.
(dJ) Another protracted, yet sterile, undertaking is the enumeration of all the
parts of a reality and the explanation of it by the comhination and permutation of these
same parts. Even if, judging by methods of pure lQgic, this were quite correct, our
knowledge of fresh, essential matters is advanced not at all. The important thing is to
possess the formula whereby all the real possibilities may be deduced as required, not
to make ad hoc use of the play of permutations without any over-riding notion of
what it is all about.
(ee) In studying the physiology of reflexes, because the reality of mutual conditioning of elementary reflexes is so complicated, we may quickly get caught in an
endless maze, while trying to establish all the possible combinations of certain conditioned reflexes. But knowledge of the integration of reflexes will overcome this
endless interchange by helping us to grasp the principle of such an integration, which
we can test by a number of well-designed experiments. Such knowledge illuminates
for us the endless process and informs it with a principle.
(if) Generally speaking in all fields of research we find the same enumerative
process at work. Clinical syndromes are described and combined endlessly, phenomenological descriptions accumulate and tests of performance multiply.
Unlimited 'ad hoc' hypotlteses. We need working hypotheses for the interpretation of our facts. They have no value p.er se but ?nly as a means of
widening experience, so that we can pose the right questions an~ develop. a
line of research. It is usual to endow these working hypotheses W1th a certam
significance, often quite unconsciously. We keep on ma.king more and more
far-reaching concepts, develop our theoretical construct~o~s and employ one
concept after another simply for the sake of concept-bulldmg. We ?:ed only
to consider the psychiatric literature attentively to see how much wrltmg consists of un objective thinking without foundation in experience. We can see
how easily this happens. Theoretical possi.bilit.ies are end.less in them~elv.es.
To develop them is an intellectual game, d1ffermg, accordmg to tast~, 10 h~e
and pattern and in persuasive power. But for th~u?ht to ha~e. meanmg, th1s
endless game has to be controlled. We can set a .hmlt by requmng eve.ry co~
cept so to justify itself in the reality of experience that our experience 1S
furthered. This cannot be done by unproductive play with the experiences
already available. Thought that leads us away from living experience without
again returning to it builds a fable. We must, therefore, ask of every method
whether it increases our knowledge and gives it depth and shape, and whether
it makes it more possible to identify phenomena as the~ arise. Does ~t widen
our experience and increase skill? Or does it lead to a vOld of abstractions and
so entangle us with ideas and paper-schemes that we suddenly find ourselves
in a world remote from what we see and do, and ourselves moving from one
vacuum into another?
Acceptance of endless possihility. If our. theoretical e~planati.ons are such
that a combination and variation of the ava1lable facts w1ll explam every possible instance in such a way that no case remains to contradict the theory, we
have fallen into the trap of another endless activity-one that tries to explain
everything and therefore explains nothing. An initially c~arifying ~eory ,;ill
encounter contradiction at some time or other. There wlll be reahtles wh1ch
will oppose it. 'Ad hoc' theories may then be formed t? explain these new
facts and finally a point is reached where so many premises have been made
that all thinkable eventualities are provided for. Probably all successful
theories that have held sway from time to time have fallen into the practice of
this magical, confusing play. Such theories 'exp~ain eve~~ing' and thereby
nothing and can offer the faithful only an un~nd~ng apphcatl~n of the the~ry
and the all-embracing possibilities of combmatlon. Every time explanation
becomes too complex, scientists should be on their guard against being dr~wn
into an acceptance of endless possibilities, which at on~ str~ke tur~s them mto
omniscient individuals, whose only means of progress1On m fact IS to revolve
in tautologous circles.
Unlimited use ofreferences. Anyone who does research wants to know what
has been discovered previously. In describing a given field of knowledge, o~e
must know the literature referring to it, but too exacting a thoroughness m
this comprehensive occupation may go on for ever. We may then consider
In research we have to go through the same experiences again and again.

We first have to commit ourselves and then embark on a long journey. After
coundess attempts we have so to feel the impact of our efforts that-saturated
with what we have gathered on the way-we at last gain the idea which will
bring order, create categories and differentiate between what matters and what
does not. Every true discovery is a conquest over endlessness. It is a prime
mistake for a scientist, however industrious, to lose sight of this and work
away in sterile repetition. We should retain the capacity to be starded and to
stop, to feel the challenge of our work and discover in this experience of endlessness the beginning of new possibilities. For a time, it is true, the slide into
endlessness is always necessary. Every piece of original work is followed by
analogous studies, by repetition of the same experiments on other material,
by work which serves the purpose of confirming or enlarging upon the previous findings, until the unending nature of the repetition becomes obvious.
But the forward march, the beat in the real rhythm of research, springs from
the periodic fertilisation of our consciousness with a new idea which solves
the endless riddle that has baffled us so far. In putting the clear question, we
already have our reply.
This discussion on the danger of diffuse effort rests on the principle that all
concrete reality is infinite. Knowledge lies in discovering concepts whereby we
can master this unendingness and bring it under the control of discerning insights
which, though limited, are nonetheless well fitted to help us grasp the essence
of their matter, in so far as they grow organically out of it and are not forcibly
imposed upon it.
There are many ways in which we can lose the point of our efforts, and
we will now describe a few that are typical:
34
INTRODUCTION
important only the collection of ideas, opinions and individual differences as

such, the matching and selecting of them. This activity will grow endless once
we fail to recognise certain areas of agreement because different terms and
phrases have been employed. It will be equally endless if we do not see the
indefiniteness of certain aspects because we believe that the whole has already
been explained; or if, for lack of proper scrutiny, the author's ideas have overgrown the actual argument; or if the literature has not been extracted on
:elevant lines and according to the factual value of its contents, there being
lnstead a wholesale collection of it, as if everything described were of equal importance. In the face of the enormous psychiatric literature that has accumulated,
we have to acquire a power of discrimination which will protect us from confusing what are only 'efforts of Sisyphus' with the accumulation of knowledge.
(2) The impasse created hy absolutes. Almost all the methods and material
of research come to be regarded as necessary, of central importance and
absolute. Once we feel we are on the right course, we are eager to subordinate
all our findings to the one point of view which now is no longer seen simply
as our method of working, but takes on an ontological value in itself. We
believe we have now grasped reality, instead of remembering that we are in
fact usin? a large variety of methods and our enquiry must be kept in a proper
perspective. We have come to regard what is only partial knowledge as if it
were an absolute, whereas all knowledge is partial and of the particular. To
safeguard against this pitfall, we should have a clear idea of the different
methods and points of view and weigh them one against the other those of
biology, for instance, as against those of the social sciences, or vice'versa; or
the psyche against the brain, or nosology against phenomenology. By regarding our own point of view as an absolute we create nothing but prejudice.
In psychopathology and in psychology, theories have grown up from a far
too readily satisfied urge to explain the whole in some one particular way by
means of a limited number of elements. This has resulted in the construction
of 'systems', certain all-embracing frameworks, broad classifications and
apparently final, totally comprehensive structures, which need only further
perfecting in their details. In all these efforts, theories of the nervous system
have always been the model. We, on the contrary, are asking for a systematic
grasp of all the existing methods and viewpoints and insist that there should
be no confusion of them, and no generalisation beyond certain well-defined
limits, and within these limits methods should be systematically used and
carefully applied.
~rom its inception this book has been averse from every kind of fanatical teaching,
which creates absolutes so readily out of the human desire for attention. In the course
of an enquiry and in following up all its consequences, absolutes may be necessary
and even meaningful to an enthusiastic investigator, caught up in some phase of his
work. When however we are trying to construct some comprehensive picture such
practices should be discarded. The first requisite is to fight fanaticism-and ':ho is
there without it? Only so will theory spring from an appreciation of the whole rather
INTRODUCTION
35
than from some partial truth that has been raised arbitrarily to the status of an absolute. The unifying whole which we look for is always incomplete. In contrast to the
totality of closed and would-be universal systems, my own over-all point of view
starts, not from an apparently known, factually demonstrable principle of things, but
rather points down many perspectives and in many directions. It suggests movement in various planes and constrains us to remain alert and look far afield, while at
the same time we try to keep a firm grasp on all the systematised knowledge we have
won so far.
But it is a delicate matter to unify the manifold findings of research. Every investigator is apt to consider the facts in his own field misrepresented by others. He
will resent that anybody who has not worked in this same field should interfere with
his judgments and he will lightly dispose of arguments which arise from an objective
interpretation of the whole field, treating them as purely theoretical. Any such
unification would indeed be a distortion, if it were built on ontological principles,
but, as it is, our attempt does not take the form of a universal theory bent on explaining everything. It takes the form only of a comprehensive methodology, in which all
possible knowledge can be accommodated. Such a methodology must be so constructed that it is an open one which constantly allows for new methods.
The basic attitude expressed in this book is that of fighting against all attempts to
create absolutes, of exposing the various forms of endlessness and of doing away
with obscurities, but we hope at the same time to recognise every genuine experience
and comprehend it in its own way. We want to understand and accommodate all
the knowledge that is possible and find a natural place for it within the framework
of our method.
(3) Pseudo-insight through terminology. Precise knowledge always lends
itself to clear formulation. Happy or unhappy formulations have exceptional
importance for the effective dissemination and general intelligibility of our discoveries. But only where the knowledge gained is itself clear will the resulting
terminology be both factual and of intrinsic value. There is a recurrent demand
for some unified terminology in psychology and psychopathology and the
difficulty lies not in the words so much as in the actual concepts themselves. If
only our concepts were clear, there would be no problem of terminology. As
it is, to create a scientific terminology at this juncture by setting up some committee or other appears quite impracticable. We have not yet arrived at any
universal acceptance of the necessary concepts. We can expect only that everyone who publishes any work in psychopathology will be familiar with the
concepts which outstanding investigators have associated with certain terms
and that he himself will deliberately associate precise concepts with the words
he himself uses. At present people do not hesitate to introduce new words into
scientific publications and discussions, words which carry manifold meanings
in general usage. Frequently, too, fruitless attempts are made to suggest a
whole number of new words rather than do any real research.
Cd) The relatedness ofpsyclwparhological methods to other scient~jic studies

Medicine is only one of the roots of psychopathology. Psychopathological
37
INTRODUCTION
INTRODUCTION
phenomena may also be reinterpreted as biological events against a general

ground of biological theory, e.g. genetics, where human existence and mental
illness can be studied from this point of view. Only when the biological aspects
have been clearly distinguished can we proceed to discuss what essentially
.
belongs to Man.
Whenever the object studied is Man and not man as a species of animal,
we find that psychopathology comes to be not only a kind of biology but also
one of the Humanities. With psychiatry the doctor enters a world which lies
outside the other disciplines with which he is already familiar. The fundamentals of his education generally consist of chemistry, physics and physiology, but here he is in need of a different basic training. This situation is
responsible for the fact that psychiatry, in so far as it is practised by doctors
without training in the Humanities, lacks any consistency in its scientific
standing. Young doctors study their psychiatry more or less haphazardly and
some psychiatrists can show little more than a dilettante learning.
is true that methods taken over from elsewhere may lose thereby and are often
misapplied, thus producing a pseudo-methodology, and this is a weakness.
Yet psychopathology is impelled to make use of methods that have been perfected elsewhere in order to improve the status of its subject-matter, which is
unique and irreplaceable for our apprehension of the world and humanity, and
to bring it to a level where it can be properly grasped and its significance fully
comprehended.
The channels provided by society for psychopathological enquiry are
the hospital practice, the outpatient departments, the institutions, the medical
and psychotherapeutic consulting-rooms. Scientific knowledge emerges first
as the consequence of 'practical necessity' and most often remains within these
confines. More rarely, but then all the more effectively, the thirst for fundamental knowledge has led great personalities within these fields to break new
grounds.
Psychopathology requires us to study specially, not only to understand the

work of others, but to do so methodically and with a reasonable certainty, as well
as to make further progress ourselves.1 The literature is pervaded by inadequate
contributions in this respect. The average psychiatrist is officially recognised as an
expert only in so far as cerebral pathology, somatic, forensic, nursing and administrative problems are concerned.
According to Kant2 expert opinion in the Courts on mental states should
fall within the competence of the philosophical faculty. From a purely logical
point of view perhaps this is correct but in practice of course it will not do. No
one but a doctor can treat mental patients because somatic medicine is indispensable for this. Consequently only a doctor should be concerned with
the collection of factual data necessary for the Court. Kant's dictum stands,
however, in that the psychiatrist's competence is really commensurate with
how far his education and knowledge would qualify him to belong to the
philosophic faculty. This goal is not served where (as has occurred in the
history of psychiatry) he learns a certain philosophical system by heart and
applies it automatically. This is worse than if he had learnt nothing at all. But
he should acquire some of the viewpoints and methods that belong to the
world of the Humanities and Social Studies.
In fact the methods of almost all the Arts and Sciences converge on
psychopathology. Biology and morphology, mensuration, calculation,
statistics, mathematics, the Humanities, sociology, all have their application.
This dependence on other branches of learning and the proper taking over of
their methods and concepts are both matters of some importance to the
psychopathologist, who is concerned with the human being as a whole and
more especially the human being in times of sickness. The essence of psychopathology as a study can only emerge clearly from a composite framework. It
1 Ktilpe, 'Medizin ll. Psychologie.', Z. Pathopsych., vol. 1 (1912).
I Kant, Anthropologie, 51.
(e) Th.e demands ofa satisfactory methodology: a critique of methods in contrast

to methods that mislead
What can we expect from our methods? They should help us to gain new
ground and enrich our knowledge in depth while they widen our experience.
They should enable us to understand cause and effect and they should indicate
to us comprehensible relationships, the verification of which is tied to our
presuppositions. They should not involve us with what are mere logical
possibilities divorced from observation and experience, and their value should
show itself in the extent to which we can assess and influence events that arise
from our contact with persons.
Criticism of methods is of value in testing the foundations of our knowledge from time to time. We can then detect pseudo-knowledge due to wrong
method. Such a critique also helps us to grasp the inner organisation of our
knowledge. It refines our methods of enquiry, making them more practicable
and better understood.
Every scientific approach has its pitfalls and methodology is no exception.
It can degenerate into an empty, logistic checking and rechecking. Such superficial juggling with figures or shuffiing of concepts is merely destructive. The
true source of all our knowledge is always the contemplative gaze. It may well
happen that a writer who has seen something new cannot formulate what he
has seen into an unexceptionable theory; although he is right, formal logic
may apparently demonstrate contradiction and error. Constructive criticism,
however, will grasp the essential and valuable part of what he wants to
say and only improve formulation and clarify method. This necessary, if only
formal, correction will be dangerous only if the real significance of the new
insight is overlooked. We may find also that clear, correct concepts have been
fatal for a particular problem at a certain time, inasmuch as they were premature and as yet unsubstantiated.
Discussion of method makes sense only when there is a concrete case to
INTRODUCTION
INTRODUCTION
consider and when the particular effects can be shown. Discussion of method
in the abstract is painful. Only a concrete logic is valid in the empirical
sciences. Without factual investigations and concrete material, arguments
become suspended in mid-air. There is little point in thinking up methods
which are not put into practice and perhaps can never be.
Finally there is a type of methodological approach which works quite
categorically and negates 'de facto' every positive attempt at fresh knowledge.
It works on purely logical grounds and the result is entirely unproductive.
For example, there is the typical objection against any attempt at precise
differentiation, which is said to be 'breaking down' what is properly a 'unit'
(e.g. body and soul, knowing and living, personality development and morbid process, perceiving and conceiving, etc.). Another such argument is that
'transitions' between the separated elements make differentiation illusory.
However broadly true this 'unit' thesis may be, its application to the processes
of research is generally untrue. Knowledge can be gained only by differentiation. True unity precedes knowledge in the form of an unconscious comprehension that pervades in the form of Idea, creating clear perspectives that
once more unify what has been separated. Knowledge itself cannot anticipate
this unity, which can be achieved only through actual practice, through the
reality of the live human being. To know is to differentiate; knowledge is
always concrete and structured, pregnant with opposites and unlimited in its
movement towards unity. The discussion over 'transitions' is usually nothing
but a retreat from observation and thinking. It is a negative quibbling and
such pseudo-methodology does nothing to strengthen genuine unity; it only
makes for greater confusion. An amorphous enthusiasm for unity produces
chaos and obscurity instead of knowledge which should have a wide mastery
over its means.
understanding ofmankind. It thus specifically assumes the function of furthering
Certain standards should be expected from publications in psychopathology.

Arguing until domesday should be impermissible. Before communicating any research, writers should live themselves into the major observations of the past,
familiarise themselves with the essential differences and be clear about their methods.
This is the only way to ensure that ancient matter is not being presented again as
something new and perhaps even in inferior form. It is the only way to avoid abstract
theorising, a lapse into endlessness and the charge that a great deal of hard-won
knowledge has got lost in surmise.
5.
WHAT A GENERAL PSYCHOPATHOLOGY HAS TO DO:

A SURVEY OF THIS BOOK
General psychopathology is not called upon to collect individual discoveries but to create a context for them. Its achievement should be to clarify,
systematise and shape. It should clarify our knowledge of the fundamental
facts and the numerous methods used; it should systematise this knowledge
into comprehensible form and finally shape it so that it enriches the self
39
knowledge, a function which far exceeds the simple process of fact-finding.

A mere didactic classification that can be of practical use and committed to
memory is not enough; only that didactic matter suffices which coincides with
a grasp of the essential facts.
General psychopathology takes its place within a stream of earlier attempts
to comprehend the whole. It takes its orientation from them and in turn
becomes the starting-point for fresh attempts which contradict, elaborate or
advance them yet further. Let us turn to some of these earlier contributions:
When my Psychopathology appeared for the first time (1913) there were books
by Emminghaus and Storrmg; later we had those by Kretschmer and GruMe. 1 All
these works were written with different intentions and it would not be fair to class
them all on the same level as to aim and value. Each, however, was the expression of
a comprehensive theory, an attempt to mould material of unlimited extent.
General psychopathology is far from being a didactic presentation of available
facts; it tries consciously to fit the whole together. Every psychiatrist is characterised
by the way he formulates his complex material into some over-all pattern, flexible or
rigid as the case may be. Every book on psychopathology wants to contribute to this
total picture and find some mode of thinking which will give meaning and definition
to the individual methods used. Books which aim at a total presentation gain relative
importance from the way in which they take a comprehensive view and represent this
throughout the whole of their methodology and line of reasoning. In comparing and
characterising the following works I hope to draw an illuminating contrast with what
I have tried to do in my own General Psychopathology.
Emminghaus. (1878). He chose a medical classification, analogous to other
clinical specialities. His book treats 'seriatim' nosology (symptomatology, diagnostic
criteria, course, duration and outcome of psychiatric illness), aetiology (predisposition, precipitating factors, etc.) and lastly, pathological anatomy and physiology. His
method is purely descriptive and displays the untested general attitudes of medicine
based on the natural sciences of his day. In his detailed psychology he makes use of
very diverse points of view and there is little conscious criticism or development of
ideas. The standard is little more than that of everyday psychology which is obscured
by an apparently scientific terminology and the contemporary interest in externals.
The advantage of the book is its orderly comprehensive character, but its very comprehensiveness obscures the gulf which always exists between psychiatry and other
clinical specialities. (We can make a real synthesis only after a conscious effort to
clarify the partly heterogeneous principles and methods involved.) Presentation is
attractive and vivid throughout and the extensive bibliography makes the book an
excellent reference book even today, for the older literature in particular. A wide
perspective (the interest, for instance, in ethnic psychology), which is maintained
along with the general medical interest, derives from the psychiatric education of
earlier times. The medical classification of earlier times, which Emminghaus employed, continues in use in the general psychiatric textbooks.
1 Emminghaus, Allgemeine Psychopathologie {ur Einfuhrung ill das Studium des GcistcsstorungclI
(Leipzig, 1878). Storring, Vorlesungen iiber Psychopathologic (Leipzig, 1900): Kretschmer,
Medi{inischc Psychologic (Leipzig, 1911, 5th edn., 1949). Gruhle, 'Psychologic des Abnormen',
lId/JU,-h der vergleichenden Psychologic, Kafka, vol. }, sect. 1 (MUnchen, 1911).
40
INTRODUCTION
INTRODUCTION
Starring (1900): aimed at a different target. He wanted to discuss the importance

of psychopathology for normal psychology and stressed the theoretical issues from the
beginning, taking Wundt's theories as a standard. He devotes much space to discussions on the genesis of phenomena, using W undt' s methods, which nowadays strike
us as rather out of date. Classification follows the old schema: cognition, emotion
and volition. He uses 400 pages for cognition, 35 pages for emotion and only 15
pages for volitional phenomena. The trend of thought is consistent throughout and
this lends a particular value to the book. Interesting points emerge but the net contribution is so meagre that though the title is attractive one puts the book down with
some disappointment. The theoretical approach brings much more shape into the
material than the traditional medical classifications used by Emminghaus, but in view
of the enormous range of psychic reality, Storring's work offers very limited solutions.
Kretschmer (1922). This book cannot be compared with the other two. Its aim
is didactic and it deals with that part of psychology which is supposed to be of real
importance to the doctor, but without-as we think quite justifiably-differentiating
in principle between normal and pathological. Kretschmer also constructs his over-all
picture with the help of a theory and this gives his thought a particular configuration.
He conceives a number of psychic levels, which appear as stages of development in
history, phylogeny and ontogeny and are simultaneously present in the mature
individual. To this he adds a second idea which concerns types of personality and
modes of reaction. Both notions are then rigidly schematised. He stresses the value of
simplification into a small number of formulae and he refers to the natural sciences
which have found this method fruitful in gaining control over subject-matter. He
wants to show how, using exact methods, he can reduce the multifarious richness
of real life to a few basic biological mechanisms, universally recurrent. In doing this,
however, he meets his own confusion. In the natural sciences there is a constant
interplay between theory and observation, which then either confirms or disproves
the theory so that exact hypotheses emerge which can get exact answers. Science
progresses in a generally connected way, step by step, or with the leap of a new formulation. But in psychiatry, and this applies to Kretschmer, theory always has to
have the character of a tentative approach which will allow for varied classifications
and further observations.
Kretschmer supplies us with an original example of the 'psychology of meaningful phenomena' disguising it as one of the natural sciences to suit the climate of the
medical faculty, but in fact he manages to do this only by misusing the logic of the
natural sciences and their exact methods. His simplifications were 'to bring life into
dry bones'. 'Sometimes I have tried to startle people with the barest of formulae', he
says. So much compression of his material, however, and so much theoretical simplification produce an air of omniscience, with which we are only too familiar in the
history of psychological medicine. His omniscience rushes to classify and pigeonhole such phenomena as 'expressionism' or 'historical personality' and the book is
pervaded by that incredible delusion adhered to by many psychiatrists that the
'psychology of the neuroses is nothing else but the psychology of the human heart''to understand neurosis is, "eo ipso", to understand human nature'. It is perhaps
typical that the book should be written in a literary style. It has little respect for the
infinite possibilities of the human individual, or for the eternal problem of the psyche.
There is no sense of wonder. Instead we are offered a number of cliches, the use of
which gives us a satisfactory feeling of penetrating human understanding. But
Kretschmer creates no real concept of the totality of psychic life. He gets as far as an
initial selection of problems. His language is figuratively telling rather than conceptually sharp and we are more impressed by the slickness of the expression than by the
genuine force of his ideas.
Gruhle (1922): This work seems in perfect contrast to Kretschmer's. The externals of careful work and dry style already point to this. Gruhle tries to find an
unbiased classification. He does not theorise schematically but deals with his material
as to the whole. He distinguishes quantitative, qualitative and functional abnormalities,
the latter to include intentional acts and motivated behaviour. He comments on
abnormal relationships between physical and psychic events and on abnormal
psychic development. By using broad concepts, such as quality and quantity, he is
able to classify all his material and find accommodation for all observed phenomena.
No underlying concept or fresh idea is developed. There is no systematic exploration
of the inner organisation of phenomena. As he said, he simply sets up a number
of boundary-stones, to contain everything that seems of psychopathological importance. His superficially wide-reaching sys>em gives us a number of broad concepts but no creative picture of the whole. He has a passion for formal clarity and
this forces him to avoid everything in the way of creative construction. In the end he
is left surrounded by his innumerable facts but unable to differentiate the important
from the unimportant. This indeed is something which formal classifications cannot
achieve; it can be done only by the use of ideas and Gruhle therefore misses the substance of the problem. He does not try to impress and one has the feeling that there is
not one inaccurate sentence in the whole book. Yet the writing has a certain charm in
spite of the dryness of style. The author is a man of culture and keeps a certain
distance from the things he writes about. He would have had no difficulty in cultivating a literary style but he feared nothing more than the confusion of 'belles lettres'
with science. If we accept the book for what it purports to be, a careful collection of
existing material, we shall find it most useful. A wide literature is referred to, and old,
forgotten work has been put to much good use.
My own book (1913) intends something quite different from all the publications
both before Gruhle and after. As the author I cannot of course characterise this intention unfavourably. But I want to make it clear from the start that what I intend to
do in no way invalidates what others have attempted so far. On the contrary I would
recommend everybody who wants to penetrate into the problems of psychopathology to read all these texts and compare them. Only by correcting the one by the
other can we hope to gain a proper grasp of this complex subject.
41
The following are some observations on the purpose and format of this
book:
(a) Conscious critique ofmethods in place of dogmatism

In 19IJ I described my methodology as follows: 'Instead of forcing the
subject-matter into a strait-jacket of systematic theory, I try to discriminate
between the different research methods, points of view and various approaches,
so as to bring them into clearer focus and show the diversity of psychopathological studies. No theory or viewpoint is ignored. I try to grasp each
difTercnt view of the whole and give it place according to its significance and
limitations. The all-embracing factor will be the mental search. Every theory
INTRODUCTION
INTRODUCTION
that aims at completeness will be taken as valid for that particular standpoint
only. I then try to master the sum of all such views in their entirety. But in the
end no more can be done than to order them according to the methods and
categories by which they have been individually constructed. I indicate how we
come to perceive the various aspects of the psyche and each chapter presents
one such aspect. There is no system of elements and functions to be applied
generally in psychopathological analysis (as one might apply knowledge of
atoms and the laws of chemical combination); we must simply be satisfied
with a number of different methods of approach. The data are ordered not in
terms of anyone consistent theory, but simply in terms of the methods used.'
The above statement reflects a common conflict of scientific opinion that
cannot be overestimated in its importance. Either we think every piece of
knowledge gives us the thing itself, reality as such, Being in its totality, or we
think that there can be no more than an approximate appreciation of context,
which implies that our knowledge is rooted in our methods and limited by
them. We may thus rest content with a knowledge of 'what is' or know ourselves constantly on the move against expanding hori'{ons; we may simply
emphasise some theory of reality as sufficiently explanatory or prefer the
systematic approach to methods used, hoping this will throw light on what is
after all an unlimited obscurity. We may discard our methods as temporary
but necessary tools, to'be dropped when we supposedly grasp at the thing itself,
or things in themselves may become temporary though necessary myths attending our incessant efforts to know; they are theoretical realities which we discard as incomplete, but which keep the doors open for further experience and
research.
A conscious critique of methods will keep us prepared in the face of enigmatic reality. Dogmatic theories of reality shut us up in a kind of knowledge
that muffies against all fresh experience. Our methodological approach, therefore, is in full opposition to the attitude that would establish absolutes. We
represent searching in opposition to finding.
We have to remember that methods become creative only when we use
them, not when we theorise about them. Early investigators who widened
knowledge by their methods sometimes did not understand what was happening. (They paid for their lack of understanding by becoming dogmatic about
their discoveries.) The conscious study of methods as such is not creative; it
only clarifies, but in doing so it creates the conditions under which discoveries
can arise, whereas all forms of dogmatism inhibit fresh findings.
In a naive thirst for knowledge people want to grasp the whole at once and
grope after seductive theories which seem to point in this direction. Critical
enquiry, however, would rather know the limitations and possibilities. It
wants a clear understanding of the boundaries and implications of each viewpoint and fact, as well as a continuous exploration of hard-won, ever-expanding
possibili ties.
It seems to me that only through the use of some systematic methodology
can we obtain the widest extension of our limits and the greatest clarity about
what it is possible to know.
42
43
(b) Classification according to methods
. B~ reducing our methods to some order we become fully aware of the

differing modes of apprehension, the various kinds of observation, forms of
thought, ways of research and basic scientific attitudes, which we can then test
out on appropriate objects of investigation. In this way differentiation between
individual entities becomes sharper and our organs of apprehension and enquiry are refined. On each several occasion limits can be clearly drawn and
we can test out possible concepts of the whole and put them in some kind of
perspective. This training in methodological order provides a reliable critique
of the meaning and limits in every piece of knowledge, and enhances our
unprejudiced apprehension of facts.
To the psychopathologist, reality displays itself as an individual whole in
the form of a living human being. As we get to know, we analyse, and by ~ne
metho~ or another we secure our facts. It follows that (1) all our knowledge is
of particulars; we have never seen the whole before our analysis starts; we
have already made analysis in the act of seeing. (2) the observable facts and
o~r methods. of observation are closely related. We obtain our facts only by
usmg a parttcular method. Between fact and method no sharp line can be
drawn. The one exists through the other. Therefore a classification according
to the method used is also a factual classification of that which is, as it is for us.
It is the ever-moving function of knowledge through which empirical being
reveals itself to us. By classification of method and the indication of what is
revealed thereby, we gradually come to see the basic varieties of existing fact.
Only so can we arrive at any well-defined statement about observed facts and
grasp the possible range of definable fact. Classification of method introduces
an order into observed facts which is in accordance with the order of these
same facts.
Where work develops successfully, object and method coincide. A classification
according to the one is at the same time in accord with the other. This may seem to
contradict the statement that 'every object should be examined by a number of different
me~ho~s'. This maxim is correct but mea.'1S that what is only superficially one single
obJe.ctlve fact (what we call an individual person) has to be investigated by a number
different methods, as an illness, an alteration in consciousness, as memory etc. The
bJect obecomes in this sense something ill-defined and inexhaustible, a crude fact
indefinable in its totality. What it really is as an object reveals itself only through th~
methods we use. Whether and to what extent the object which we tackle by so many
methods really is a single object and what kind of entity this may finally prove to be
can be determined only by methods specific to it.
0:
. If on the other hand we have some theory of reality to go by, the classificatIOn of our knowledge appears much easier. A few principles and basic factors
will then afford us a comprehensible whole- 'we grasp reality itself'. Hence
INTRODUCTION
INTRODUCTION
understanding. In the second part our enquiry calls for some knowledge of
the Humanities; in the third part, we need a knowledge of biology.
In the fourth part, the predominantly analytical procedures of the previous
sections are followed by what is in chief an effort at synthesis. We are now
concerned with the way in which we can apprehend the individual psychic lifo
as a whole. We present the comprehensive approach of the clinician, who has
before him the individual man as a whole and thinks, in diagnosis, in terms of
a personal history, which in its entirety provides the essential setting for every
individual life.
The fifth part considers ahnormal psychic lifo in its social setting and in
history. Psychiatry differs from the rest of medicine amongst other things
because its subject-matter, the human psyche, is not only a product of nature
but also of culture. Morbid psychic events depend in their content and in their
form on the cultural milieu which is affected by them in turn. The fifth part
trains the appreciation of the scientist for the historical aspects of human reality.
In the sixth part we finally discuss human lifo as a whole. We are no longer
making empirical observations but present a philosophical reflection. The
specific frames of reference, which as complex unities contributed a guiding
principle to every previous chapter, are in the end all relative. Even the comprehensive approach of the clinician cannot grasp empirically the human life
as a whole. The individual is always more than what is known of him. The
final discussion, therefore, no longer adds to our knowledge but tries to
clarify our philosophical position, into which we can gather all that we know
and understand of Man.
The book, therefore, sets out to show us what we know. Practical questions of clinical work are outlined in the appendi.r: and there is a short survey of
the history of psychopathology asa science.
does not need philosophy because the latter can teach it anything about its own
field, but because philosophy can help the psychopathologist so to organise
his thought that he can perceive the true possibilities of his knowledge.
2. Overlapping of chapters. In describing the phenomena of experience we
sometimes hint at their causal and meaningful connections and vice-versa. So
in most of the other chapters we shall encounter phenomenology in one way
or another. Thus we review delusional ideas, phenomenologically, as a
psychological performance and in their meaningful connections. So with
suicide-outwardly it is a straightforward fact the incidence of which can
be counted; it can also be investigated by a number of methods, directed
towards motive, or in accordance with age, sex and time of year, or with
regard to its connection with psychosis, or with social conditions, etc~ Thus
we shall find the same facts appearing in different chapters and it will become
progressively apparent what it is that remains 'the same'. Different schools of
thought (psychoanalysis, for instance, or Kretschmer's 'theory of bodybuild') also appear in several places, wherever they happen to include different
methodological aspects (be it consistently or otherwise). The different chapters therefore do overlap but it should be understood that this is necessary
and we should be clear in what sense it is permissible.
In each chapter there is only one method that is paramount, and the
reader's gaze is directed to all that it reveals. But each of these methods is
already using other methods and allows an echo to be heard of what is the
master-principle of another chapter, though not yet, or no longer, the prevailing principle (for instance, the phenomenology of some memory-failure can
be rendered precise only if the facts are also comprehended from the point of
view of the psychological performance, while functional defects of memory
can be analysed only along with the phenomenology of the experience in
question). Or, to express this differently, every method is related to its own
subject-matter, but what becomes apparent through it has at the same time
some relation to other subject-matter which is duly comprehended by other
methods that point towards it. What we therefore regard as the same set of
facts has to appear in several chapters which are in fact complementing each
other; yet seen severally from these different perspectives the facts are not the
same. One method in isolation can always go only so far and no farther. No
one method can allow its subject-matter to segregate itself aloofly within it.
rt is therefore quite natural that in writing one chapter we should relate it,
either with facts or references, to one of the others. All divisions are unnatural at some point. The coherence of things themselves demands that the
various methods should remain tangible in their relatedness.
There is also the basic fact that every human being is in some sense one,
and this brings a universality into all the possible relationships between the
t~lcts that can be found out about him. We need the viewpoints of all the different chapters in order to apprehend one man. No single chapter by itself
!l;ives us sufficient understanding.
(f) Comments on the plan of the hook

I. Empiricism and Philosophy. In the first five parts I hope I am a thoroughgoing empiricist and that I am successful in my fight against platitudinous
speculation, dogmatic theorising and absolutism in every form. But in the
sixth part, and here in this introduction, I have discussed philosophical questions, where these seem to me essential, if as psychopathologists we are to
achieve any real degree of clarity. Not only does unprejudiced empiricism
bring us to the real boundary where philosophy begins but conversely only
philosophical clarity can make reliable, empirical research possible. Philosophy
is not so related to science that philosophic studies can find application in the
sciences and it has always been a fruitless, though often repeated, undertaking
to recast empirical findings into some philosophical terminology. Philosophy
can only help towards an inner attitude of mind, which will enhance science
by delineating its boundaries, giving it inner direction and stimulating an insatiable thirst for knowledge. Philosophical logic has to grow indirectly into
a concrete logic by the conceptual organisation of facts. Psychopathology
47
INTRODUCTION
INTRODUCTION
Division into chapters is necessary for clarity but to reach truth and comprehension they must all be reunited. The themes of the different chapters are
related to each other and do not lie mechanically side by side. In every chapter
however a specific method of approach will be seen to prevail, a particular
mode of observation of presentation and explanation.
3. Specific methods and the total picture. In every chapter-to put it rather
grandly-the whole field of psychopathology is touched upon, but only from
one, single point of view. There is no complete set of facts, ready-made,
which are being considered merely from diverse points of view. Through the
application of each method, something becomes apparent that belongs only to
it, as well as something rather vaguely defined which does not belong. Similarly, the totality that becomes apparent through all our methods is not any
consistent total reality nor is there anyone universal method which will
reveal everything that is. All we can do is to try and apprehend individual
realities clearly and unequivocally with the help of individual methods.
Hence enquiry will always be limited by the fact that only one way can be
traversed at any given time. Yet there are still many other ways to tread,
essential conditions for critical knowledge. In so far as the total picture can
remain only a collection of methods and categories, it must stay for ever unfinished; the circle is never closed. The question remains open, not only what
will emerge as future additional data, but also what at a later time will appear
as new methods of thinking and new perspectives. Therefore the book is
probably lacking in that individual chapters may still be insufficiently clarified,
with something hiding there that derives from some different principle of
which we are not yet aware and which at a later date will have to be extracted.
Each chapter tries to give a complete viewpoint but there is no guaranteed
completeness; other chapters are possible and to this extent the whole book is
incomplete. There is a challenge to develop further chapters, not as simple
additions but as part of the connected series of methods. Only so would we
keep that total picture of infinite extent which cannot be attained as a concrete
reality but only as a system of methods.
It is wrong to call this book 'the principal text of phenomenology'. The
phenomenological attitude is one point of view and one chapter has been
devoted to it in some detail as the viewpoint is a new one. But the whole book
is directed to showing that it is only one point of view among many and holds
a subordinate position at that.
others better, imagine them and use them for our own understanding. Written
descriptions cannot substitute for the actual experience, but some account of
concrete examples helps us to grasp further possibilities. My book offers many
such examples. All my own experience is here and I have added certain striking
and characteristic examples from the work of other investigators.
These should help the reader to build up a store of experiences. Though
this can be properly achieved only through experiences of his own, he will
find good preparation and confirmation in the reports and interpretations set
out in the literature.
The essential requirement stands that every speculation should find fulfilment in experience. No experience should be without its theoretical explanation nor should we find theories unsupported by experience. We need
plastic views on life, clearly structured and containing neither too much nor
too little. They should be the 'fixed lights' to give our thoughts inner direction
when the way is uncharted. So it becomes possible for us while we observe
and theorise always to know and say what it is we mean.
2. The form of presentation. A comprehensive presentation needs to be
readable. It should not be simply a reference book. This involves us in maintaining a line of thought throughout and in concentrating on what is essential.
Concise definition is desirable even to the point of what might seem a legalistic
brevity.
But every idea we formulate has to be lifted out of an endless host of facts
and accidental events. Enumeration of these ought to be minimal but they have
to be mentioned and their presence felt. The danger of making endless enquiry is always with us but in presenting our material we have always to
remember those ever-present, as yet unmastered elements which are important and must be given a place. Interesting accidentals are among our data
also, though perhaps as yet nothing much more can come of them than the
evocation of a surprised 'well, that is how it is . .'. We must not forget that
undetermined, unmastered elements and surprising happenings are always
marks of failing comprehension; we recognise these things but as yet we do not
know them.
Every chapter has a prevailing point of view. The reader would do well to
familiarise himself with the whole series. In the individual chapters however
he may want to leave out this or that, depending on his own particular
interests and he will then find the table of contents a useful guide.
3 References to the literature. It is always a problem to know how to cope
with the continUOl.lS stream of publication. The extent of the literature is vast
even if we discount all the many repetitions, the muddle of happy ideas, the
noisy arguments and indifferent reporting. To get at the factors of value, we
must go for the following: first and foremost, the facts themselves, cases, personal histories, self-portrayals, reports and every other kind of material eyidence; secondly, any really new insight; thirdly, the concrete observations made,
the images, forms and types adopted, the pregnant formulations: fourthly, the
(g) Technical lay-out

I. Illustration hyexample. Experience must in the last resort remain a personal matter. A book can enhance our experience but cannot be a substitute
for it. What is seen at a glance, the actual experience of human intercourse and
conversation, the confirmation that comes from factual investigation, none of
this can be transmitted by a text, even with the most circumstantial presentation. If we have had our own personal experiences we can understand those of
49
so
INTRODUCTION
hasic attitude behind the new discoveries, their 'atmosphere', shown in the
style of the work and the kind of criteria used. There may be an unconscious
grasp of the whole, some hidden philosophy, or an attitude determined by the
worker's social status, calling or occupation, or it may be a practical attitude
founded in the need for action and the wish to help. What publications should
be mentioned? It is impossible to give them all. Recently reference books have
grown to an unwieldy size,! and our aim is something different. We are not
after the compilation of facts but what characterises them, so our use of the
literature must be selective: First we include epoch-making contributions
which have led to the foundation of new schools of research, the classic
original papers. Secondly, we mention the most recent summaries, where the
bibliographies introduce us to a particular field. Thirdly, we take representative
samples from various lines of research, which can stand for much other
analogous work. Selection in this case is haphazard and does not imply any
value-judgment.
The immense task of a real survey of the literature has hardly begun. In
the individual sciences the problem is the same as in the great libraries. A
hierarchy of importance is sorely needed, so that really valuable material can
be recognised and not tend to get lost among the rabble. Inessentials could well
be dispensed with, yet they have to be categorised somehow, for the use of
specialists. At present there seems no hope of any final evaluation nor of any
formal purge by some scientific court. At a later date investigators may well
find something of value among the discards; so far as psychopathology goes,
we have at present only an unselective set of references.
(h) Psychopathology and culture
A comprehensive presentation aims at more than mere knowing; it tries to

cultivate. It would like to see psychopathologists exercise their thinking,
differentiate their knowledge, discipline their observations and introduce
method into their -experiences. While preserving a great tradition, we also
wish to serve it by re-shaping it. Knowledge as such is only relevant when it
contributes to the further cultivation of sight and thought.
I would like my book to give the reader a wide education in psychopathology. It is indeed much simpler to learn up formulae and technical
terms and appear to have the answer to everything. An educated attitude has
to grow slowly from a grasp of limits within a framework of well-differentiated
knowledge. It lies in the ability to think objectively in any direction. An
educated attitude in psychiatry depends on our own experiences and on the
constant use of our powers of observation-no book can give us that-but it
also depends on the clarity of the concepts we use and the width and subtlety
of our comprehension, and it is these which I hope my book will enhance.
1 The following texts cover the literature: the specialist journals and original contributions:
Aschalfenburg, Handhuch der Psychiatrie. Bumke, Handhuch der Geisteskrankheiten, Zentralblatt
fUr Neurologie u. Psychiatrie (Berlin, 1910, onwards); Fortschritte der Neurologie (Leipzig, 1929,
onwards); the reference section of many journals.
PART I
INDIVIDUAL PSYCHIC PHENOMENA
PART I
Introduction
Phenomena form the groundwork of our knowledge. Empirical research
depends on our seeking out as many phenomena as possible, since it is through
them alone that our ideas receive verification.
The collection of phenomena always means collection of individual
phenomena. These are far from uniform and the need for clarification forces
us to group them according to certain basic types. Such classification is sometimes of a superficial character only, that is according to the source material,
e.g. case histories, Court records, patients' own writings, photographs, departmental files, school reports, statistics, experimental test results. But a real
classification must work on the principle that its basic phenomena are of an
observable nature. We shall, therefore, classify our phenomena into four main
groups: the patients' subjective experiences, objective performances, somatic
accompaniments and meaningful objective phenomena (Le. expression, actions
and productions).
Group 1. The psyche experiences life-and experience is a psychic phenomenon. Metaphorically we call it the stream of consciousness, a unique flow of
indivisible occurrences which, however many people we take, never seems
to flow in quite the same way. How then is it best apprehended? Experiences
crystallise out for us in their course into a number of objective phenomena
and take relatively fixed forms. We can speak of an hallucination, an affect,
a thought, as if we were dealing with some definite object; it at least maintains
a certain span of existence in our mind. Phenomenology is the study which
describes patients' subjective experiences and everything else that exists or
comes to be within the field of their awareness. These subjective data of experience are in contrast with other objective phenomena, obtained by methods of
performance-testing, observation of the somatic state or assessment of what
the patients' expressions, actions and various productions may mean.
Group 2. Psychic performances (for instance, those of apperception,
memory, work-capacity, or intelligence) provide the material for what we call
the study of psychological performance (Leistungspsychologie). Performance
can be measured as to quality and quantity. The common factor is the use of
set tasks in an attempt to answer specific enquiries or meet the accidental
problems posed by some given situation.
Group 3. Somatic accompaniments ofpsychic events provide the material for
what we call somatopsychology, the study of bodily events (Somato psychologic). Here somatic events are observed which are not psychol(l~iclll In
53
character and in no way express the psyche nor are they meaningful. Psychologically they are incomprehensible and have only a factual relationship with
psychic events or happen to coincide with them.
Group 4. Meaningful ohjective phenomena are perceivable phenomena that
show their psychic origin only because we understand their meaning. They
fall into three categories: bodily appearance and movements that we directly
understand (giving rise to a psychology of expression-Ausdruckspsychologie); personal worlds of meaningful activity and behaviour (giving rise
to a psychology of the personal environment-Weltpsychologie); and
meaningful literary, artistic and technical productions (giving rise to a
psychology of creativity-:-Werkpsychologie).
These four main groups of phenomena will be set out in the four following
chapters. From these we shall see that (a) every datum described raises the
immediate question-why is it as it is, how is it so and to what end? The answer
to these questions will be discussed in the latter part of this book. We continually experience dissatisfaction in the face of mere facts, though we also
experience a very special satisfaction in establishing facts as such, 'This is a
facti' 'We have found something!', but in the end we find this field of pure
fact is infinitely wider than the field where such facts stand properly related
and fully understood. (b) Apparently identical phenomena can be aetiologically
different from each other; so that the realisation of meaningful relationships can
throw light on the facts themselves and show differences between them which
at first sight had gone unobserved. External facts, such as murder, suicide,
hallucination, delusion etc., mask a heterogeneous reality. Therefore even
during the stage of fact-finding we are always going beyond the facts themselves. (c) All individual phenomena derive their specific quality from a whole
to which they currently belong: for instance, the phenomena of experience arise
within a consciousness; somatic symptoms arise within a body-mind unit;
individual performances within a unified intelligence and expression, actions
and productions within what is sometimes called the level of development
(Formniveau), the psychic totality or some such name.
CHAPTER I
SUBJECTIVE PHENOMENA OF MORBID

PSYCHIC LIFE
(PHENOMENOLOGY-PHENOMENOLOGIE)
Introduction
Phenomenology! sets out on a number of tasks: it gives a concrete description
of the psychic states which patients actually experience and presents them for
observation. It reviews the inter-relations of these, delineates them as sharply as
possible, differentiates them and creates a suitable terminology. Since we never
can perceive the psychic experiences of others in any direct fashion, as with
physical phenomena, we can only make some kind of representation of them.
There has to be an act of empathy, of understanding, to which may be added
as the case demands an enumeration of the external characteristics of the
psychic state or of the conditions under which the phenomena occur, or we
may make sharp comparisons or resort to the use of symbols or fall back on a
kind of suggestive handling of the data. Our chief help in all this comes from
the patients' own self-descriptions, which can be evoked and tested out in the
course of personal conversation. From this we get out best-defined and clearest
data. Written descriptions by the patient may have a richer content but in this
form we can do nothing else but accept them. An experience is best described
by the person who has undergone it. Detached psychiatric observation with its
own formulation of what the patient is suffering is not any substitute for this.
So we always have to fall back on the 'psychological judgment' of the patient
himself. It is only in this way that we get to know the most vital and graphic pathological phenomena. The patients themselves are the observers and we can only test
their credibility and judgment. At times we have accepted patients' communications
too readily and at times on the contrary we have doubted them too radically. Psychotics' self-descriptions are not only unique but yield reliable results and through
1 Cf. my paper, 'Die phanomenologische Forschungsrichtung in cler Psychopathologic',
1.': Neur., vol. 9 (1912.), p. 391. The term phenomelWlogy was used by Hegel for the whole field
(~f mental phenomena as revealed in consciousness, history and conceptual thought. We usc it only
for the much narrower field of int/iyidual psychic experience. Husser! used the term initially in Ihe
"('nse of 'a descriptive psychology' in connection with the phenomenon of consciousness; in thiM
,ense it holds for our own investigations also, but later on he used it in the sense of 'the appear.nce'
()f thin?~' (Wesensschau) ~hich is not a term we use in this book. Phenomenology is till' 110 punly
;In tmpmcal method of enqutry maintained solely by the fact of patients' communication. II iN nhv\ou.
Ihat in these psychological investigations descriptive efforts are quite different from thoM'- in II..,
natural sciences. The object of study is non-existent for the senses and we can expcd"""r only"
n'presentation of it. Y ct the same logical principles arc in operation. Descriptiol1 ,h-m,lIul. Ilu'
<'fe.uion of systematic categories, as well as a demonstration of relationships and or<h'l'Iy ."'1l1l'n,,-.
Oil the one hand and of sporadic appearances, unheralded and unforeseen, on th., othrr.
55
SUBJECTIVE PHENOMENA OF PSYCHIC LIFE
ABNORMAL PSYCHIC PHENOMENA
them we have discovered many of our basic concepts. If we compare what patients say
we find much that is similar. Some individuals are very reliable and also very gifted.
On the other hand with hysterical patients and psychopaths (those suffering from
personality disorder) there is very little one can trust. Most of their extensive selfdescription has to be taken very critically. Patients.will report on experiences in
order to oblige and please. They will say what is expected of them and often if they
realise that they have aroused our interest, they will more than rise to the occasion.
fruitful scrutiny of what the patient's immediate experiences are, so that we

come to recognise what is identical in all the manifold manifestations. We need
to collect a rich store of observed phenomena in the form of concrete examples
and in this way provide ourselves with some measuring-rod and frame of
reference when we come to the examination of any new case. 1
There is value too in the description of unusual and unexpected phenomena
and the ability to recognise them for what they are, i.e. fundamental phenomena of conscious existence. Normal phenomena are also often better understood following some study of the abnormal, but there is little point in a
purely logical differentiation without concrete examples.
We shall now proceed to deal with (x) individual phenomena, isolated for
purposes of study, e.g. hallucinations, emotional states, instinctual drives,
and (2) a clarification of the properties of the conscious state, which in its own
way influences the phenomena studied and lends them different meanings
according to the different psychic contexts in which they appear. 2
The first step, then, is to make some representation of what is really

happening in our patients, what they are actually going through, how it
strikes them, how they feel. We are not concerned at this stage with connections nor with the patients' experience as a whole and certainly not with any
subsidiary speculations, fundamental theory or basic postulates. We confine
description solely to the things that are present to the patients' consciousness.
Anything which is not a conscious datum is for the present non-existent. Conventional theories, psychological constructions, interpretations and evaluations
must be left aside. We simply attend to what exists before us, in so far as we
can apprehend, discriminate and describe it. Experience shows us that this is
by no means easy to do. We refuse to prejudge when studying our phenomena,
and this openmindedness, so characteristic of phenomenology, is not something which one just has, but it has to be acquired painfully through much
critical effort and frequent failure. When we were children we drew things not
as we saw them but as we imagined them, so, as psychopathologists, we go
through a phase in which we have our own notions about the psyche and only
gradually emerge into a direct, unprejudiced apprehension of psychic phenomena as they are. Phenomenological orientation is something we have to
attain to again and again and involves a continual onslaught on our prejudices.
Close contemplation of an individual case often teaches us of phenomena
common to countless others. What we have once grasped in this way is
usually encountered again. It is not so much the number of cases seen that
matters in phenomenology but the extent of the inner exploration of the
individual case, which needs to be carried to the furthest possible limit.
In histology, when we examine the cerebral cortex, we expect to account
for every fibre and every cell. So in phenomenology we expect to account for
every psychic phenomenon, every experience met with in our investigation of
the patient and in his own self-description. In no circumstances should we rest
satisfied with a general impression or a set of details collected ad hoc, but we
should know how to appreciate every single particular. If we persevere in this
way we shall cease to marvel at the phenomena we see so frequently but which
those who are satisfied with general impressions either miss or find extraordinary according to how they feel at the time and how impressionable they
are. On the other hand this method draws attention to what is really out of the
ordinary and therefore justifies our wonder. There is no danger that wonder
will ever be exhausted.
In phenomenology, therefore, the main thing is to train ourscIves in a
57
SECTION ONE
(a) The dissection of the total relational context of the phenomena
In all developed psychic life we find the confrontation of a subject with an

object and the orientation of a self towards a content as an absolutely basic
phenomenon. In this respect awareness of an object may be contrasted with
self-awareness. This first distinction enables us to give an independent description of objective abnormalities (e.g. altered perceptions, hallucinations) and
then ask in what ways awareness of the self may have changed. But the state
1 The following are good self-descriptions: Baudelaire, Paradis artificiels. Beringer and MayerGross, Z. Neur., vol. 96 (192.5), p. 2.09. J. J. David, 'Halluzinationen', Die neue Rundschau, vol. 17.
p. 874. Engelken, AIIg. Z. Psychiatr., vol. 6, p. 586. Fehrlin, Die Schi{op/zrenie (Selbstverlag, 1910)
Fr. Fischer, Z. Neur., vol. 12.1, p. 544; vol. 12.4, p. 2.41. Forel, Allg. Z. Psychiatr., vol. 34, p. 960.
Fraenkel and Joel, Z. Neur., vol. I l l , p. 84. Gruhle, Z. Neur., vol. 2.8 (1915), p. 148. Ideler, Der
Wahnsinn (Bremen, 1848), pp. 32.2. If., 365 If. Religioser Wahnsinn (Halle, 1848), vol. I, p. 392. If.
Jakobi, Annalen der Irrenanstalt {u Sieghurg (Koln, 1837), p. 2.56 James, Die religiose Erfahrung in
ihrer M annigfaltigkeit (Leipzig, 197). Janet, Les ohsessions et la psychasthenie. Jaspers, Z. Neur., vol.
'4, pp. 158 If. Kandinsky, Arch. Psychiatr. (D), vol. II, p. 453. Kritische u. klinische Betrachtungen
im Cehiet der Sinnestiiuschungen (Berlin, 1885). Kieser, AI/g. Z. Psychiatr., vol. 10, p. 42.3. Klinke,
J. Psychiatr., vol. 9. Kronfeld, Mschr. Psychiatr., vol. 35 (1914), p. 2.75. Mayer-Gross, Z. Neur.,
vol. 62., p. 2.22.. Mayer-Gross and Steiner, Z. Neur., vol. 73, p. 2.83. Meinert, Alkoholwahnsinn
(Dresden, 1907). Nerval, Aurelia (Milnchen, 1910). Quincey, Bekenntnisse eines Opiumessers
(Stuttgart, 1886). Rychlinski, Arch. Psychiatr. (D), vol. 2.8, p. 62.5. Gerhard Schmidt, Z. Neur.,
vol. 14', p. 570. Kurt Schneider, 'Patbopsychologie im Grundriss', Handworterhuch der psychischen
Hygiene (Berlin, 1931). Schreber, Denkwiirdigkeiten eines Neryenkranken (Leipzig, 1903). Schwab,
Z. Neur., vol. 44. Serko,j. Psychiatr., vol. 34 (1913), p. 355. Z. Neur., vol. 44, p. 21. Staudcnmaier,
Die Magie als experimentelle Naturwissenschaft (Leipzig, 1912.). Wollny, Erkliirungen der Tollheit
yon Haslam (Leipzig, 1889).
~ Regular annual reports on phenomenological research appear in Fortschritte der Neurologie,
P~y('hi"trie u. ihrer Crefl{gehiete (Leipzig, 192.9 If.). Initial reports by Kurt Schneider; since 1934
by K. F. Scheid; since 1939 by Weitbrecht.
~8
of self-awareness and the objective aspects of that 'other', to which the self
directs itself, interlock in a mutual movement whereby the 'self' is caught up
by what is given externally and is at the same time driven internally to grasp
at what is there. Description of what is objective leads on to the meaning of
this for the self and a description of the states of the self (emotional states,
moods, drives) turns into a description of the objective aspects under which
these states become apparent.
Subjective orientation towards an object is certainly a constant and basic
factor in all meaningful psychic life but we cannot achieve differentiation of
the phenomena by this alone. Immediate experience is always within a total
relational context which we have to dissect if the phenomena are to be described.
This total relational context is founded in the way we experience space and
time, in the mode of hody-awareness and the awareness ofreality; it is moreover
self-divided through the opposition of feeling-states and drives, and these
create further self-divisions in their tum.
The division of phenomena into direct and indirect cuts across all these
other divisions. Every phenomenon has the character of direct experience but
for analytical and purposive thought it is essential for the psyche to stand outside this immediate experience. The basic phenomenon that renders such
thinking and purpose possible may be called reflection, the turning-back of
experience on itself and on its content. Hence indirect phenomena come into
being and indeed all human psychic life shows the pervasiveness of this reflective activity. Conscious psychic life is not just an agglomeration of separable
and isolated phenomena, but presents a total relational context which is in
constant flux and from it we isolate our particular data in the very act of describing them. This total relational context changes with the conscious state in which
the psyche may be at the time. All differentiations that we make are transient
and must grow obsolete at some point, if we do not discard them altogether.
According to this broad principle of a total relational context it follows
that (I) phenomena can only be partially delimited and defined, simply to the
extent that they can again be identified. Isolation of phenomena makes them
clearer and sharper than they really are. However, we have to accept this
limitation if we are to aim at any fruitful points of view, precise observation
or accurate presentation of the facts. (2) Phenomena can reappear in our
descriptions repeatedly according to the particular aspect stressed (e.g. qualitative phenomena of perception may appear in respect of object-awareness or in
respect of feelings).
(h) Form and content ofphenomena
The following points are of general application for all the phenomena to
be described: Form must be kept distinct from content which may change from
time to time, e.g. the fact of a hallucination is to be distinguished from its
content, whether this is a man or a tree, threatening figures or peaceful landscapes. Perceptions, ideas, judgments, feelings, drives, self-awareness, are all
59
forms of psychic phenomena; they denote the particular mode of existence in
which content is presented to us. It is true in describing concrete psychic
events we take into account the particular contents of the individual psyche,
but from the phenomenological point of view it is only the form that interests
us. According to whether we have the content or the form of the phenomenon
in mind, we can disregard for the time being the one or the other-the phenomenological investigation or the examination of content. For patients content
is usually the one important thing. Often they are quite unaware of the manner
in which they experience it and they muddle up hallucinations, pseudohallucinations, delusional awarenesses, etc., because they have never had to
differentiate what seems to them so unimportant a matter.
Content, however, modifies the mode in which the phenomena are experienced; it gives them their weight in relation to the total psychic life and
points to the way in which they are conceived and interpreted.
Excursus into form and content. All knowledge involves a distinction between
form and content, and throughout psychopathology from the simplest of psychic
events right up to the most complex wholes this distinction is in constant use. For
example:
I. In all psychic experience there is a subject and object. This objective element
conceived in its widest sense we call psychic content and the mode in which the
subject is presented with the object (be it as a perception, a mental image or thought)
we call the form. Thus, hypochondriacal contents, whether provided by voices,
compulsive ideas, overvalued ideas or delusional ideas, remain identifiable as content.
In the same way we can talk of the content of anxiety and other such emotional
states.
2. The form ofthe psychoses is contrasted with their particular content: e.g. periodic
phases of dysphoria are to be contrasted as a form of illness with the particular type of
behaviour that furnishes the content (e.g. dipsomania, wandering, suicide).
3 Certain very general psychic changes, which can only carry a psychological
interpretation, may also be formally conceived, e.g. the schizophrenic or hysteric
experience. Every variety of human drive and desire, every variety of thought and
phantasy,can appear as content in such forms and find a mode of realisation (schizophrenic, for instance, or hysteric) in them.
Phenomenology finds its major interest in form; content seems to have a more
accidental character, but the psychologist who looks for meaning will find content
essential and the form at times unimportant.
(c) Transitions hetween phenomena
Many patients seem mentally able to view the same content in quick
sllccession in a number of widely varied phenomenological forms. Thus in an
aCLIte psychosis the same jealous content may come up in the most diverse
shapes (as an emotional state, a hallucination or as a delusion). We might well
talk of 'transition' between these several different forms but this would be a
mistake. 'Transition' as a general term is simply a cloak for insufficient analysis.
The truth is that the fabric of the individual momentary experience is woven
60
from a number of phenomena which we can separately discern by description.

For instance, a hallucinatory experience is pervaded by delusional conviction;
the perceptual elements gradually disappear, and in a given case we can often
be no longer sure whether they ever existed or, if so, in what form. There are,
therefore, clear differences between phenomena; real phenomenological gulfs
(as for instance between physical and imaginary events) which remain in
contrast to phenomenological transitions (from awarenesses, for example, to
hallucinations). Psychopathology should reach a clear understanding of these
differences and should deepen, extend and classify them since only this will
help us in the analysis of our cases.
can be abstractly aware of something, there can be a mere knowing of it (e.g. in

rapid reading). We are clearly aware of the meaning of the words without actually
conjuring up the precise image of what is alluded to. This abstract representation of
content is termed an awareness. Depending on the type of perception this awareness
may be physical, e.g. awareness of ' someone's presence' without actually seeing him
and with no mental image of him (colloquially a 'feeling that someone is there') or
. may be a pureIy ideational awareness, which is by far the most common.
'
It
61
The following are certain first-hand accounts of how objects may be

experienced in an abnormal way:
(a) Anomalies ofperception

(d) Classification ofgroups ofphenomena.
The following paragraphs give a description seriatim of abnormal phenomena. We proceed from concrete experiences to the experience of space and
time, then to body-awareness, to the awareness of reality and to delusion.
Next we deal with emotional states, drives and will and so on to the awareness
of sel Finally we present the phenomena of self-reflection. The paragraphs
are determined by the distinctness and singularity of the relative phenomena.
They are not arranged according to any preconceived scheme, since at present
it is not possible to classify our phenomenological data in any satisfactory
manner. Phenomenology, though one of the foundation-stones of psychopathology, is still very crude. Our present effort at description does not hide
this fact, but we have to classify somehow, even if tentatively. This is best
done by a classification which gives some plastic impression of what the facts
will naturally yield. The inevitable discrepancies will at the same time stimulate
us to try and grasp the full significance of the phenomena, not on the basis of
some purely theoretical order but by trying to master them repeatedly from
more comprehensive and profounder points of view.
I. AWARENESS OF OBJECTS
Psychological preface. We give the name 'object' in its widest sense to anything
which confronts us; anything which we look at, apprehend, think about or recognise
with our inner eye or with our sense-organs. In short anything to which we give our
inner attention, whether it be real or unreal, concrete or abstract, dim or distinct.
Objects exist for us in the form of perceptions or ideas. As perceptions the objects
stand bodily before us (as 'tangibly present', 'vividly felt' and 'apperceived' or 'with a
quality of objectivity'). As ideas they stand before us imaginatively (as 'not actually
there', 'with a quality of subjectivity'). In any of our perceptions or ideas we can discern three elements: the qualitatiye aspect ofsensation (red, blue, pitch of sound, etc.),
the spatial and temporal arrangement and the purposeful act ofperception (apperception and objectification). The purely sensory factors are, so to speak, brought to life
by the purposeful act and only gain objective meaning through it. We can term this
act 'thought' or 'awareness of meaning'. There is the further phenomenological fact
that these purposeful acts need not always be founded in sense-data. For instance, we
(I) Changes in intensity. Sounds are heard louder, colours seem brighter,
a red roof is like a flame, a closing door thunders like a cannonade, crackling
in the bushes sounds like a shot, wind like a storm (in deliria, in the initial
stages of narcosis, in poisoning, before epileptic seizures, in acute psychoses).
A patient who had suffered for some years from a non-penetrating shot-wound in
the head wrote: 'Since my head-injury I feel from time to time that my hearing has
become extraordinarily sharp. This is so at intervals of 4-8 weeks, not in the day but
at night when I am in bed. The change is sudden and surprising. Noises which, when
I am normal, are almost inaudible strike me with a shattering intensity and are uncannily clear and loud. I am forced to try and lie perfectly still as even the slight
crackling of sheets and pillows causes me a lot of discomfort. The watch on the bedside-table seems to have become a church clock; the noise of passing cars and trains to
which I am accustomed and which normally never bothers me now roars over me
like an avalanche. I lie drenched in sweat and instinctively assume a rigid posture until
I suddenly find normal conditions have returned. It lasts about 5 minutes but it seems
absolutely interminable' (Kurt Schneider).
On the other hand a diminution of intensity may also occur. The environment seems dimmed, taste is flat or everything tastes almost the same
(melancholia). A schizophrenic gave the following description:
'The sunshine pales when I face it directly and talk loudly. I can then look quietly
into the sun and am only dazzled moderately. On the days when I am well looking
Intu the sun for several minutes would be quite impossible for me as it must be for
anyune else' (Schreber).
Absence or reduction of pain (analgesia and hypalgesia) may occur in local
(l1'~cneralised form. The local kind is usually neurological in origin, sometimes
psychogenic (Hysteria). The generalised form occurs as a hysterical or hypnotic
phenomenon or as the result of strong affect (soldiers in battle). It also occurs
as the sign of a particular constitution (hypalgesia only). Hyperalgesia shows
I he same diversity of conditions.
(2) Shifts in quality. While one is reading, the white paper suddenly appears
I"t"ll Olnd the letters green. The faces of others take on a peculiar brown tint,
people look like Chinese or Red Indians.
Serko observed himself in the early stages of mescalin intoxication and noted that
everything he perceived took on an infinite riclmess of colouring so that he was
actually intoxicated wit" colours: 'The most inconspicuous objects outside one's
normal attention suddenly lit up in a host of brilliant colours difficult to describe.
Objects like cigarette-ends, and half-burned matc;hes on the ash-trays, coloured
glass on a distant rubbish heap, ink-blots on the desk, monotonous rows of books,
etc. In particular, certain indirectly viewed objects attracted my attention almost
irresistibly through their vivid colouring-even the fine shadows on the ceiling and
on the walls and the dim shadows which the furniture cast on the floor had a rare and
delicate colour which gave the room a fairy-tale magic.'
reality they can see, hear and feel sharply and distinctly. We are dealing, therefore, with a disturbance in the actual process of perception, not in its material
elements nor in the apprehension of meaning nor in judgment. Thus in every
normal perception there must be yet another factor which would elude us had
these patients not presented us with these peculiar complaints. Where there is a
severer degree of disturbance the descriptions become more noteworthy:
(3) Ahnormal concomitant perceptions. A schizophrenic gives the following

description:
'With every word spoken to me or near me, with every slight noise, I feel a blow
on my head, producing a certain pain. The pain-sensation feels like an intermittent
pulling in my head, probably linked with a rending of part of the skull-bone'
(Schreber).
In such cases, which are fairly common in schizophrenia but which may
also appear quite independently of it, we are dealing with genuine concomitant
perceptions and not with the well-known association of sound and colour
images. (Audition coloree, synopsia.)l
(h) Ahnormal characteristics ofperception

Perception has a number of characteristics, it may seem familiar or strange,
or have an emotional quality or seem imbued with a certain atmosphere. The
following appear to be abnormal characteristics:
(I) Alienation from the perceptual worlJ2-Derealisation

'Everything appears as through a veil; as if I heard everything through a wall' ...
'The voices of people seem to come from far away. Things do not look as before,
they are somehow altered, they seem strange, two-dimensional. My own voice
sounds strange. Everything seems extraordinarily new as ifI had not seen it for a long
time' ... 'I feel as if I had a fur over me ... I touch myself to convince myself that I
exist.'
These are complaints of patients who have this disturbance in a relatively
mild form. Such patients are never tired of describing how strangely their
perceptions have altered. Their experience is so odd, peculiar, eerie. Description always proceeds by metaphor as it is impossible to express the experiences
directly. Patients do not think that the world has really changed but only feel
as if everything were different to them. We should always remember that in
IOn the theory of synaethesia cpo Bleuler, Z. Psychol., vol. 65 (1913), p. 1. Wehofer, Z. angew.
Psychol., vol. 7 (1913), p. 1. Hennig, Z. Psychother., vol. 4 (1912), p. 22. Georg Anschuetz, Das
Farhe-Ton-Prohlem in psychischen Gesamthereich (Halle, 1929). (Deutsche Psychologie, Bd. V,
vol. 5) (careful investigation of a rare and interesting case).
Oesterreich, J. Psychiatr., vol. 8. Janet, Les Ohsessiolls et la psychasthenie, 2nd edn. (Paris,
1908).
'All objects appear so new and startling I say their names over to myself and touch
them several times to convince myself they are real. I stamp on the floor and still have
a feeling of unreality' ... Patients will feel lost and think they cannot find their way
about though they can do this as well as ever. In really unknown surroundings this
feeling of strangeness will increase. 'I held on to my friend's arm in panic; I felt I was
lost if he left me for one moment'-'All objects seemed to retreat into infinity.'
(This is not to be confused with physical illusions of distance.) 'One's own voice
seems to die away into infinity.' Patients often think they can no longer be heard any
more; they feel as if they have floated away from reality, away into outer space in a
frightening isolation-'Everything is like a dream. Space is infinite, time no longer
exists; the moment endures for ever, infinite expanses of time roll by'-'I am entombed, totally isolated, no human is by me. I only see black; even when the sun is
shining, it is still all black'. Yet we find such patients see everything and have no
disturbance in the sensory part of their perception.
With these more severe grades of disturbance (if we explore the patients
carefully) actual judgment does not seem disturbed at first but the feelings are
so forceful that they cannot entirely be suppressed. Patients have to handle
things to make sure they are really still there, have to convince themselves of
the existence of the ground by stamping on it. In the end, however, the psychic
disturbance becomes so serious that we can no longer speak of patients having
any judgment at all. Other severe disturbances usually appear as well. Terrified
and restless, the patients begin to experience their feelings as the reality itself
and are then inaccessible to reason. Now the world has escaped them. Nothing
remains. They are alone in terrible isolation, suspended between infinities. They
have to live for ever because time no longer exists. They themselves no longer
exist; their body is dead. Only this fake-existence remains as their horrible fate.
( 2) Just as the perceptual world may be experienced as something strange
or dead, so it can be experienced as something entirely fresh and of overpowering
heauty:
'Everything looked different-I saw in everything the touch of a divine magniwas as if I had come into a new world, a new existence. Every object
wore a bright halo, my inner vision was so enhanced I saw the beauty of the universe
in everything. The woods rang with celestial music.' (James.)
fin~nce' -'It
(3) These descriptions have shown that objects are not only perceived in a
purdy sensory manner but are accompanied by an emotional atmosphere.
Empatkr ill to other people is an important instance of this, in that we no longer
have pure sense-perception but the latter has now become an occasion for
psychic understanding. The pathological phenomena consist either in afailure
6;
of empathy-other people seem dead, patients feel they only see the outside
and are no longer conscious of the psychic life of others, or in an unpleasantly
flrcefol empathy-the psychic life of others impinges with a fierce vividness
on the defenceless victim, or finally in afantastically mistaken empathy-where
this is entirely unwarranted:
ceptions; here external sensory stimuli unite with certain transposing (or distorting) elements so that in the end we cannot differentiate the one from the
other. Hallucinations are perceptions that spring into being in a primary way
and are not transpositions or distortions, of any genuine perception.
(aa) There are three types of illusions (illusions due to inattentiveness,
illusions due to affect and pareidolia):
I. Illusions due to inattentiveness. Experimental investigation into perception
shows that almost every perception collects some elements of reproduction
that tend to transpose or distort it. When attention is scanty and therefore
external sensory stimuli are meagre, the latter are nearly always filled out in
some way or other. For instance, in listening to a lecture we constantly piece
out the meaning and only notice we are doing this when occasionally we make
a mistake. We overlook misprints in a book and complete the meaning correctly
according to the context. Illusions of this sort can be corrected immediately
once our attention is drawn to them. Errors in identification and inexact, faulty
perceptions that arise in General Paralysis and deliria, etc., belong to some extent to this category. Illusions of this sort (failure to identify) playa part in
these patients' mistakes in reading and hearing and in the way they recast their
visual impressions.
2. Illusions due to affect. When walking alone in the woods at night we may
become frightened and mistake a tree-trunk or a rock for a human figure. A
melancholic patient beset by fears of being killed may take the clothes hanging
on the wall for a corpse, or some trivial noise may strike him as the clang of
prison chains. Illusions of this sort are mostly rather fleeting and always
comprehensible in terms of the affect prevailing at the time.
3. Pareidolia. Imagination can create illusionary forms from ill-defined
sense-impressions, such as clouds, old patchy walls, etc. No particular affect
is involved nor any reality-judgment, but the imaginary creation need not
disappear when attention is directed upon it. Johann Mueller gives us the
following description:
A patient with encephalitis lethargica reported: 'During that time I had an incredibly fine feeling for imponderables, atmospheres etc. For instance I would feel
immediately the minutest misunderstanding among two of my student friends'.
The patient also reported that he did not really share in these feelings, he only
registered them. 'It was not a natural participation' (Mayer-Gross and Steiner).
Increased empathy into highly differentiated psychic states is found among other
signs at the beginning of process-disorders. A patient many years before the onset of
an acute psychosis experienced an increased sharpening of his feeling-sensitivity,
which he himself regarded as abnormal. Works of art appeared to him profound,
rich, impressive, like ravishing music. People appeared much more complex than
before and he felt that he had a much more intricate understanding of women.
Reading gave him sleepless nights.
There is one particular mode of misunderstanding the psychic life of others
which may be found in the initial stages of process-disorders. Other people
appear so curious and baffiing to the patient that he considers these healthy
people as mentally ill rather than himself (Wernicke-Transitivismus).
(c) Splitting ofperception
This term covers phenomena described by schizophrenic patients and
patients in toxic states:
'A bird chirrups in the garden. I hear it and know that it is chirruping but that it is
a bird and that it is chirruping are two things which are poles apart. There is a gulf
between them and I am afraid I shall not be able to bring them together. It is as if the
bird and the chirruping have nothing at all to do with each other' (Fr. Fischer).
In mescalin intoxication: 'When I opened my eyes I looked towards the window
without actually appreciating it as a window and I saw a number of colours or green
and light blue blotches; I knew they were the leaves of a tree and the sky which
could be seen through them, but it was impossible to relate these perceptions of
different things with any definite location in space.' (Mayer-Gross and Steiner).
(d) False perceptions
We have now described all abnormal perceptions in which no fresh set of
unreal objects is perceived, but only a set of real objects which somehow
appear to be different. Now we turn to false perceptions as such, in which fresh,
unreal objects seem to be perceived. l Since the time of Esquirol a discrimina-
tion has been made between illusions and hallucinations. Illusion is the term
for perceptions which in fact are transpositions (or distortions) of real perl Johannes MUller, Ober die phantastischen Gesichtserscheinungen (Koblenz, 1826). Hagen, Allg.
Z. Psychiatr., vol. 25, p. I. Kahlbaum, Allg. Z. Psychiatr., vol. 2.3. Kandinsky, Kritische u. klinische
Betrachtungen im Gehiete der Sinnestiiuschungen (Berlin, 1885). I myself have written a detailed
Ilccount of false perception in Z. Neur. (Referaten-teil), vol. 4 (19II), p. 2.89. See my further work
'As a child I was often teased by this vivid gift of imagination. I remember one
fantasy particularly. From the living-room I could see a house opposite, old and
shabby with blackened plaster and patches of various shape through which the colours
of older plaster could be seen. As I looked through the window at this dark, dilapidated wall I made out a number of faces in the contours of the peeling plaster. As time
went on they became more and more expressive. When I tried to draw other people's
attention to these faces in the dilapidated plaster no one would agree with me. All the
same I saw them distinctly. In later years I could still remember them clearly though I
could not recreate them again in the contours which had given them birth.'
Similar illusions can be observed in patients. They appear to the onlooker
as something alien; only the patients observe them and see them constantly
'Zur Analyse cler Trugwahrnehmungen', Z. Neur., vol. G, p. 4(,00 Mon' r~c('nt work" IIr.. W. Mllyra
Gross and Johannes Stein, 'Pathologie der Wahrnehmunp;' in IIll1nk,,. 1I.IIIJhlld, ./., (;.i,II',IAr,IIIA
heit.n (Berlin, 19,,8), vol. I.
o
66
coming and going, whereas with the other two types of illusion they either
vanish when attention is drawn to them or when the affect from which they
sprang undergoes a change.
Tuzcek of Marburg: 'I had been gathering apples for the greater part of the
day without a break. 1 had been standing on a ladder to work the apple-picker
and had been gazing continuously up into the branches as 1 pulled away at the
long stick of the 'picker'. As 1 walked back through the dark streets to the
station, 1 was painfully hindered by the fact that 1 kept on seeing apple-hung
branches before my eyes. The image was so powerful that 1 could not stop
myself from waving my stick in front of me as I walked. The state persisted
for several hours until at last 1 went to bed and fell asleep.'
The following is an extract from the self-observations made by Johannes
Mueller on fantastic visual phenomena:
A patient in the clinic at Heidelberg, while fully collected, saw animal and human
heads 'as if embroidered' on the counterpane and on the wall. She also saw grimacing
faces in the spots of sunlight on the wall. She knew they were deceptions and said:
'My eye evokes faces in the unevenness of the wall'. Another patient reported with
surprise: 'Things shape themselves; the round holes in the window-frames [the
fastenings] become heads and seem to be biting at me'.
Another patient described the following illusions while he was out hunting:
'On all the trees and bushes I saw, instead of the usual crows, dim outlines of pantomime figures, pot-bellied fellows with thin bow-legs and long thick noses, or at
another time elephants with long trunks swinging. The ground seemed to swarm
with lizards, frogs and toads; sometimes of portentous size. All kinds of animal forms
and evil shapes seemed to surround me. Trees and bushes took on wild, provoking
shapes. At other times a girl's figure rode on every bush, and on the trees and reeds.
Girls' faces smiled from the clouds, enticing me and when the wind moved the
branches, they waved at me. The rustle of the wind was their whispering' (Staudmaier).
Illusions which are a matter of sensory experience must be clearly differentiated from misinterpretations, or wrong deductions. If shining metal is
mistaken for gold or a doctor for a public prosecutor, this does not imply any
alteration in the actual sense-perception. The perceived object remains exactly
the same but a wrong interpretation has been put upon it. Illusions must also
be differentiated from the so-called functional hallucinations; a patient, for
instance, hears voices while the water is running but they stop when the tap
is turned off. He hears the running water and the voices simultaneously. While
illusions contain an element of genuine perception with functional hallucination we have simultaneous hallucinations running alongside with a constant
element of genuine sense-perception and disappearing at the same time as the
sense-perception.
ebb) Hallucinations proper are actual false perceptions which are not in any
way distortions of real perceptions but spring up on their own as something
quite new and occur simultaneously with and alongside real perceptions. This
latter characteristic makes them a different phenomenon from dreamhallucination. There are a number of normal phenomena comparable to hallucinations proper. For instance, the after-images which arise in the retina, the
rarer phenomenon of sense-memory (the subsequent, deceptive yet real hearing
of words already heard, and the seeing of microscopic objects at the end of a
heavy day of microscope work, all phenomena particularly common when one
is tired). Lastly there are the fantastic visual phenomena classically described by
Johannes Mueller and the now well-known phenomenon, the subjective eidetic
image.
An example of sense-memory has been given me personally by Geheimrat
'I would shorten my sleepless nights by wandering as it were among my own

visual creations. If I want to watch these bright images, I relax my eye-muscles,
close my eyes and look into the darkness of the visual field. With a feeling of complete
relaxation in my eye-muscles I let myself down into the sensuous stillness of my eyes
or into the darkness of the visual field. I ward off any thought or judgment ... at
first the dark field shows patches of light here and there, hazy clouds, shifting and
moving colours; these are soon replaced by well-defined pictures of all sorts of objects, at first dim, then increasingly clear. There is no doubt that they are really
luminous and sometimes coloured as well. They move and change. Sometimes they
arise at the margin of the visual field with a vividness and distinctness which ordinarily never occurs in that area. With the slightest movement of the eye they are usually
gone. Reflection too will chase them away. They rarely represent known figures;
usually they are strange people and animals I have never seen, or an illuminated room
in which I have never been ... I can conjure up these visions not only at night but at
any time during the day. At night I have spent many sleepless hours watching them
with my eyes closed. I have only to sit down, shut my eyes, abstract myself from
everything and watch the automatic arrival of these images which I have known and
loved from my childhood ... Bright pictures frequently appear in the dark visual
field but equally often the dark field brightens into a kind of mild, inner daylight
before the actual picture appears, which it then does immediately. The gradual
brightening of the visual field seems to me as remarkable as the actual appearance of
the luminous images. It is astonishing to sit as a spectator, in the daytime, with eyes
closed and see the 'daylight' entering gradually from inside and in the daylight of
one's eyes to witness luminous moving figures, produced apparently by the private
life of the senses, and all this happening in a waking state, a state of quiet reflection,
with nothing magical about it nor any sentimental fancy. I can determine with the
greatest precision the exact moment when the images will become luminous. I sit
with my eyes closed for a long time. If I try to imagine anything deliberately it
remains a mere idea, which does not shine or move within the dark visual field; but
suddenly there is a congruence between the fantasy and the light-nerve, suddenly
there appear luminous forms, quite apart from the train of ideas. These arc suddell
apparitions not forms imagined in the first place and then growing hun/nOUN. t do
not see what I make up my mind to see. I simply have to accept whllt lip;h'N lip In
front of me without any effort on my part. The short-sighted objection thllt thrIll IIl'r
the same as luminous dream-images or 'merely fancied' CIlII cerllllllly btl clIMclIl'dr.cl. I
can weave fancies for hours but what I imagine nevel' bCClllIIClM lIvln" IIlId vivid In
68
this way. There must be a disposition to experience these luminous phenomena.

Something bright suddenly appears which has not previously been imagined, is
unwilled and has no recognisable associations. This phenomenon which I see in my
waking state shines as brightly as the flashes which we can create in the visual field by
pressing on the eyeballs'.
Suhjective eidetic images are sensory phenomena found in 50 per cent of all adolescents and among a certain number of adults (the so-called eidetics). If pictures of
flowers, fruit or other objects are laid on grey paper and then removed, these people
will see the objects again in full detail on the paper, sometimes in front or behind the
plane of the paper. Such images are distinct from after-images since they are not
complementary. They can also shift and change and they are not exact copies but
modifiable by reflection. They can be recalled even after some considerable time.
According to Jaensch, before an examination an eidetic person could read out extensive texts from such a visual image alone. l
case, the visual sense]. Where the spontaneous pseudo-hallucination is actively appreciated, it is possible to retain this for a little in the focus of awareness and longer
than one could do without such active effort. Direction of attention to another senseactivity (for instance from vision to hearing) whether in part or wholly will interrupt
the pseudo-hallucination that first appeared. Interruption also will take place when
attention is focused on the black visual field of the closed eyes or on real objects in
the environment when the eyes are open; also when there is any onset of spontaneous
or deliberate abstract thinking." , (Kandinsky).
(cc) A certain class of phenomena were for a long time confused with
hallucinations. Looked at closely these proved to be not really perceptions but
a special kind of imagery. Kandinslcy has described these phenomena very fully
under the title of Pseudo-hallucinations. The following is an example:
The first thing one notices about this description is that the phenomena in
question are seen by an 'inner eye'; they are not within the black visual field,
like the previous fantastic visual phenomena nor do they possess the reality of
perception (the character of objectivity-Kandinsky). If we are to get our
orientation among these many phenomena of our imagination, of which
Dolinin furnishes only one example, it would be as well to arrange the varying
characteristics in some order whereby normal perception and normal imagery
can be phenomenologically distinguished. Thus:
Sense-perception (Wahrnehmung)
Image or Idea (Vorstellung)
Perceptions are of concrete reality.

They have a character of objectivity.
2.. Perceptions appear in external ohject-
Images are figurative. They have a

character of subjectivity.
Images appear in inner suhjective space.
I.
'During the evening of August 18th, 1882., Dolinin took 2.5 drops of tincture opii
simplicis and wertt on working at his desk. One hour later he observed great facilitation in the way his imagination worked. He stopped what he was doing and still
conscious and with no inclination for sleep he noticed in the course of one hour while
his eyes were closed a number of faces and figures seen during the day, faces of old
friends not seen for a long time and faces of unknown people. Now and then there
appeared white pages with different kinds of writing; then repeatedly a yellow rose
and finally-pictures of people in various costumes standing in all sorts of positions
but quite motionless. These pictures appeared for a moment then vanished. They
were followed at once by a fresh set, not logically connected. They were projected
outward distinctly and seemed to stand there in front of his eyes. They were in no
relation whatever with the dark visualfield of his closed eyes. It was necessary to divert
his gaze away from this field if he was to see the pictures. Fixing on the visual field
interrupted the visual phenomena. In spite of many attempts he failed to make the
subjective picture part of the dark background. In spite of the sharp outlines and
vivid colours and the fact that the pictures seemed to stand out in front of the subject's
gaze they lacked the character of ohjectivity. Dolinin felt that though he saw these
things with his eyes, they were not his outward, physical eyes, which only saw a
black visual field flecked with patches of foggy light; they were "inner eyes" located
somewhere behind the outer ones. The distance of the pictures from these "inner
eyes" varied from 0'4-6'0 metres. Usually it was that of clearest vision which in his
case was very small, because of his short-sightedness The human figures varied
in size from normal to that of a photograph. Optimal conditions for the pictures to
appear were as follows: "An attempt must be made to make the mind blank as far as
possible and direct one's attention idly to the sense-activity concerned [in Dolinin's
1 Urbantschitsch, Oher suhjektive optische Anschauungshilder (Vienna, 1907), Silberer, 'Bericht
tiber eine Methode gewisse symbolische Halluzinationserscheinungen hervorzurufen', Jh. Psychoanal., vol. I (199), p. SI3. E. R. Jaensch, Oher den Aufhau der Wahrnehmungswelt u. ihre Struktur
im Jugendalter.
ive space.
3. Perceptions are clearly delineated and

stand before us in a detailed fashion.
4. The sensory elements are full, fresh.
Colours, for instance, are bright.
5. Perceptions are constant and can

easily be retained unaltered.
6. Perceptions are independent of our
will. They cannot be voluntarily recalled or changed, and are accepted
with a feeling of passivity.
Images are not clearly delineated, and

come before us incomplete, only individual details evident.
Though occasionally sensory elements
are individually the equal of those in
perception, most are relatively insufficient.
The majority of people's visual images
are neutral-toned.
Images dissipate and have always to be
recreated.
Images are dependent on our will. They

can be conjured up or deliberately
altered. They are produced with a
feeling of activity.
With regard to point 2., we must add that objective space and subjective
space can appear to coincide, for instance, when 1 form the visual image of
something behind me. I can also imagine something standing between certain
objects in front of me but I do not see it there (in that case it would be a
hallucil1ation). Both spaces only seem to coincide; there is always a jump from
the one to the other and they are widely separated in fact.
From the above table we may now be able to derive the specific characteristics of pseudo-hallucinations. The only absolute difference from senseperception appears in points I and 2. (i.e. pseudo-hallucinations are figurative,
not concretely real and occur in inner subjective space, not in external objective
70
space). These two opposing characteristics divide perception sharply from

imagery, as by a gulf, and there are no transitions. With the other characteristics,
as shown in points 3 and 4, the differences are not so clear-cut. Images which
always remain configurations of our inner space may progressively assume
certain characteristics ascribed to perceptions. Thus we find an infinite variety
of image-phenomena ranging from normal imagery to fully developed pseudohallucinations. We may now characterise these as follows: pseudo-hallucinations lack concrete reality and appear in inner subjective space. To the 'inner
eye' however they seem to have definite contours and are fully detailed (point
3); in their sensory elements they have all the sufficiency of normal perception
(point 4). We may be fully conscious and find ourselves suddenly confronted
with them, sharply articulated and with a wealth of vivid detail. They.do not
dissipate at once but may be retained as constant phenomena untll they
abruptly take their departure (point 5). Lastly, they cannot be deliberately
altered or evoked. The subject is receptive and passive (point 6) in regard to
them.
Such fully developed phenomena are, however, by no means the most
common. The phenomena are generally rather more imprecise and show only
one or two of the above characteristics. We may get pale, vague images which
appear involuntarily, or detailed, constant phenomena that have been deliberately invoked. Thus a patient recovering from an acute psychosis could
imagine things most vividly for a time. He inwardly visualised a chessboard
with all the men on it but he soon lost this capacity. Pseudo-hallucinations
have so far been found only in the visual and auditory field in the form of
inner pictures and voices.
In describing sense-experience in false perception, we distinguished
illusions from hallucinations and similarly we draw a clear distinction between
sense-phenomena and the phenomena of imagery (i.e. between hallucination
and pseudo-hallucination). This does not prevent us from finding actual
'transitions' in that pseudo-hallucination can change over into hallucination
and there may be a florid sensory pathology in which all the phenomena
comhine. We cannot reach any analysis, however, unless we attempt sharp
distinctions of this sort which provide us with some kind of standard.
been observed that take the form of whole scenic panoramas. Here are some examples:
(aa) In inner subjective space: A schizophrenic patient, while awake, saw ghastly
pictures, she did not know how. They were inner pictures; she knew they were
really nothing. But the pictures crowded in on her. She saw a graveyard with halfopen graves; figures walking about without heads; the pictures were agonising. By
diverting her attention to external objects, she could make them go.
(hO) Wit" open eyes: Figures appear in the whole visual field, but there is no
integration with objective space: 'The figures grouped themselves round me 3-6
metres away. Grotesque human figures, who made some kind of noise like a jumble
of voices. The figures were there in space, but as if they had their own private space,
peculiar to themselves. The more my senses were diverted from their usual objects,
the more distinct grew this new space with its inhabitants. I could give the exact
distance but the figures were never dependent on the objects in the room nor were
they hidden by them; they could never be perceived simultaneously with the wall or
the window etc.'
'I could not accept the objection that I had only imagined these things; I could not
find anything in common between these perceptions and my own imagination nor
can I do so to this day. I feel the figures of my imagination are not in space but
remain faint pictures in my brain or behind my eyes while with these phenomena I
experienced a world which had nothing to do with the world of the senses. Everything was "real", the forms were full of life. Later on the ordinary world still contained this other one with its own separate space and my consciousness was gliding
between the two as it chose. The two worlds and their perceptions are utterly
dissimilar' (Schwab).
Serko described false-perceptions during mescalin intoxication as follows:
'They appear in the one constant, disc-like and microscopic visual field and are
greatly diminished in size; they are not integrated with the real surroundings but form
a miniature theatre of their own; they do not touch on the immediate content of
consciousness and are always subjective . they are chiselled to the finest particular,
and vividly coloured. They appear in sharp relief and change constantly .. when
my eye moves, they do not change position in space.' The content of these false
perceptions is 'in continuous movement' ... 'Patterns dissolve into bouquets,
whirls, domes, Gothic doorways .. and so on; there is an everlasting coming and
going and this restless moving to and fro seems to be their hallmark'.
(cc) Wit" eyes closed. A schizophrenic counterpart to Johann Mueller's description is as follows:
'With closed eyes I would perceive a diffused, milky-white light out of which
appeared exotic forms of plants and animals in relief and often in shining colours. I
thought the pale light lay in the eye itself but the shapes were like an experience and
seemed to come from another world. The perception of light was not always the
same. When my mental state was better the light was brighter but after some trivial
social set-back (annoyance, excitement) or some physical discomfort (e.g. after overeating) it would get darker and sometimes it was pitch-black night. Light appeared
about 1-2 minutes after my eyes were shut. When I travelled by train through a
tunnel and shut my eyes it would become bright and I thought wrongly that the
train was in the open again but when I opened my eyes suddenly there was nothing
but the pitch black of the tunnel. The light vanished not only because I opened my
Illusions, hallucinations and pseudo-hallucinations are extremely varied and

range from elementary phenomena, such as sparks, flames, rushing sounds, bangs and
cracks, to the perception of shapes and forms, heard voices, and visions of figures
and landscapes. If we review the different sense-fields we will get a certain over-all
picture:
Vision: 1 Real objects are seen enlarged or diminished or distorted or in motion.
Pictures jump about on the walls, the furniture comes to life. Optical hallucinations
in alcoholic delirium are myriad and changing, in epilepsy their colouring is vivid
(red, blue) and they tend to be overpowering. In acute psychoses hallucinations have
1 For illustrations of vi~ual hallucinations see Serko, Z. Neur., vol. 44, and Morgenthalre,
Z. N,ur., vol. 45.
71
72.
eyes but because I tried to look and see. As soon as I stopped looking fixedly I could
see the light with my eyes open even during the day, but less clear. The shapes did
not appear every time. The plants were beyond imagination; I was astounded by their
loveliness and grace; there was something magnificent about them as if the plants I
ordinarily know were only their degenerate descendants. The animals were prehistoric; they had something benign about them. Occasionally some one part became
extremely prominent, but I was surprised how harmoniously the rest of the form was
adapted to these peculiarities so that a certain type emerged. There was no movement
among them, they seemed three-dimensional and after a few minutes disappeared'
(Schwab).
(dd) Integration witk outer ohjective space: Kandinsky described his own psychotic
experiences thus: 'Some of my hallucinations were relatively pale and indistinct.
Others were bright with all sorts of colours, like real objects. They obscured real
objects. For a whole week I saw on one and the same wall, which was covered with a
smooth, plain wallpaper, a series of gilt-framed frescoes, landscapes, seascapes, and
sometimes portraits.'
Uhthoffl described the following:
'The patient suffered from an old chorioiditis. Central positive scotoma. Had it
for 2.0 years without particular symptoms; one day, a dull feeling in the head and
tiredness. The patient looked out of the window and suddenly noticed a "vine"
moving and growing in size on the pavement of the courtyard. The appearance of
leaves persisted for six days and then it became a tree with buds. Walking along the
street she saw the tree as in a fog between the real bushes. On closer observation real
leaves could be distinguished from the fictitious ones; the latter were 'as if painted'the colour was bluer and greyer "as if shaded"; the "fantasy leaves" were as if "pasted
on" while the natural ones "stand out from the wall". After a time the patient also
saw "exquisite flowers, of every possible colour, little stars, sprays, bou.quets". On
closer scrutiny this intelligent patient gave the following description: "The leaves,
bushes, etc., seemed localised in the positive, central visual field defect and the size
changed with distance. At 10 cm. the phenomena had a diameter of 2. cm." If projected on to a house across the street they were so big as to cover the whole window.
When the eyes were moved, the phenomena moved too. This was the criterion by
which the patient realised that they were not real objects. When the eyes were closed,
the phenomena disappeared and gave way to patterns (golden star on a black background-and round it often a concentric blue and red ring). The hallucinatory objects hid the background and were opaque.'
A patient suffering from a schizophrenic process gave the following description:
'Once I was visited for a few days by a pretty young woman. A few days later I
was lying in bed at night and turning over on to the other side I saw to my great
surprise on the right beside me the girl's head protruding from the bedclothes as if
she was lying by me. It looked magical, beautiful, ethereally transparent and softly
gleaming in the dark room. I was completely dumbfounded for a moment but the
next moment I knew what I was dealing with, all the more as at the same time a
rough, unkind voice whispered sarcastically inside me. I turned crossly on to the left
side and swore without paying any more attention to the phantom. Later a friendly
inner voice said-The girl has gone' (Staudenmaier).
A schizophrenic girl reported:

'At first I was very busy catching the "Holy Ghost" with my eyes; by this I mean
those little white transparent flecks which jump in the air or out of the eyes of those
around me and look like dead, cold light. I also saw people's skins emitting fine
black and yellow rays; the air too became pervaded with other strange rays and
layers .. All day I have been afraid of wild animals which race through the closed
doors; they steal, slow and black, along the wall to hide under the couch and watch
me from there, with bright eyes. I have been frightened by headless men who walk
about the passages and by soul-less bodies of murdered people that lie in the middle
of the parquet floor; when I look at them they vanish at once; I "catch them away"
with my eyes' (Gruhle).
Hearing: In acute psychoses patients hear tunes, confused noises, whistling and
the rattling of machines, a racket which appears to them louder than guns. Here as in
the chronic states we often find 'voices' as well, the 'invisible' people who shout all
kinds of things at the patient, ask him questions and abuse him or order him about.
As to content, this may consist of single words or whole sentences; there may be a
single voice or a whole jumble of voices; it may be an orderly conversation between
the voices themselves or between them and the patient. They may be women's,
children's or men's voices, the voices of acquaintances or unknown people, or quite
indefinable human voices. Curses may be uttered, actions of the patient may be commented on or there may be meaningless words, empty repetitions. Sometimes the
patient hears his own thoughts spoken aloud. (Voiced tkougkts-Gedankenlautwerden.)
Here is a self-description (Kieser):
'It is amazing, horrible and for me humiliating, to think what acoustic exercises
and experiments-musical ones too-have been conducted with my ears and body
for nearly 2.0 years. Sometimes I could hear one and the same word repeated without
interruption for two to three hours. I had to listen to long continuous speeches about
me; frequently the content was insulting and there was often an imitation of wellknown persons. These lectures, however, had little truth about them, usually they
were infamous lies and slanders about my person, sometimes also of others. it
was often proclaimed that "I" said all these things .. the scoundrels wanted to pass
the time with onomatopoeia, paronomasia and other figures of speech and kept up a
perpetuum mobile of speech. Sometimes one could only just hear these incessant,
uninterrupted sounds but sometimes one could hear them a half or full mile away.
They were being catapulted out of my body and the most varied sounds and noises
got slung about, especially when I entered some house or village or town. This is the
reason I have been living like a hermit for the last few years. All the time my ears keep
ringing and sometimes so loudly that it can be heard far and wide. When I am
among woods or bushes and the weather is stormy, some horrible, demoniacal poltergeist is aroused; when it is quiet, each tree starts rustling and uttering words and
phrases when I approach. So with water-all the elements are being used to torture
mc.'
Another patient had been hearing voices for months, on the street, in the shops, in
trains and restaurants. The voices talked and called out quietly but clearly and distinctly. 'Do you know him, he is crazy Hagemann'. 'He is looking at his hands
again.' 'Lie down, now, your spinal cord is diseased.' 'He is a man without character',
etc.
1 Uhthoff, 'Beitrage zu den Gesichtstaeuschungen bei Erkrankungen des Sehorgans'. Mschr.

Psychiatr., vol. 5, pp. 241, 370.
73
75
Schreber gives a description of those Junctional hallucinations that are heard at the
same time as a real noise. They can be heard only then, not when it is quiet:
'I should remark on the circumstance that all the noises I hear, specially those
that last rather long, like the rattle of trains, the throbbing of a steamer, the music at
concerts, all seem to speak. It is a subjective feeling, of course, not like the speech of
the sun or of the miraculous birds. The sound of words spoken or developed by me
links up with my sense-impressions of train, steamer, squeaking boots etc. I would
not think of saying that the train, steamer etc. are really speaking as in the case of the
sun and the birds'.-Schizophrenic patients often hear the voices localised inside, in
the body-trunk, head, eyes, etc.
We have to differentiate 'inner voices' ('voices of the mind') that is 'pseudohallucinations' from 'voices proper':
Perewalow, a chronic paranoic, distinguished voices that talked directly from the
outside, through walls and pipes, from those voices brought by a current which his
persecutors used to force him sometimes to hear inwardly. These inward voices were
neither localised outside nor were they physical; he distinguished them from 'made
thoughts' unaccompanied by any inner hearing and directly conducted into his head.
(Kandinsky). Mrs. K. reported she had two memories; with one she could recall at
will like anyone else; with the other, voices and inner pictures would appear before
her involuntarily.
'Voices' are of particular importance with schizophrenic patients. Many different
names and interpretations are given to them; for instance (Gruhle), communications,
rapport, magical talk, secret language, voices in uproar etc.
Taste and smell: These senses have no objective pattern. In principle and sometimes in practice we can differentiate spontaneous hallucinations from those false
perceptions in which objective smells and tastes are sensed as smelling and tasting
somehow differently: A patient gives the following description-'It is odd about
taste .. food may taste just anyhow; sprouts like honey or the soup so unsalty I
want to salt it heavily but, just before I do, it seems to me over-salted' (Koppe).
Other patients complain about coal-dust, sulphur, air that stinks, etc.
also visual perceptions, zig-zag, angular, like oriental ornamentation ... all this is not
only thought by me, but felt, smelt, seen by me and seem to be my own movements as
well . all is clear and definite . in the face of this actual experience of the impossible, criticism becomes nonsensical' (Beringer).
74
Simultaneous activity of several senses. In actual sense-perception we deal

ultimately not with one single sense, but with an object. This object seems to
us as one and the same through the operation of several senses. So with hallucination, one sense supplements the other.
But there is a melee of the senses, a different matter altogether, which
makes clarity impossible. Experiences have been observed where the object
is never exhibited to the patient in any clearly defined way by anyone sense
but is mixed up in a whirling confusion of shifting sense-data in which
consciousness vainly tries to establish some meaning. We are not dealing here
with a co-ordinated hallucination of several senses but with real synaesthesias
that have become the dominant mode of perception. Genuine perceptions are
now one with hallucinatory and illusory ones. Bleuler describes how he 'tasted'
juice on his finger-tips. Under mescalin intoxication it is reported:
'One thinks one hears noises and sees faces and yet everything is still one and the
same ... what I see, I hear; what I smell, I think ... I am music, a grating, everything is one and the same ... then there are the auditory hallucinations which are
(e) Ahnormal Imagery-False Memory

The phenomena of abnormal perception have now been described and
our account of pseudo-hallucinations brings us to the phenomenology of
abnormal imagery.
Abnormal imagery has some cOt1'espondence with alienation from the perceptual world. The anomaly is not so much of the image itself but only of
certain aspects which we might call the 'character of the image'. Some patients
complain they are quite unable to imagine anything; such images as they can
summon up are pale, shadowy, dead and do not seem to appear in consciousness.
One of Foerster's patients complained: 'I cannot even imagine how I look, how
my husband and children look ... when I look at an object, I know what it is but as
soon as I close my eyes afterwards it has gone completely. It is as if one tried to
imagine what air looked like. Surely, doctor,you can hold an object in your mind, but
I can't keep an idea of it at all. I feel as if my thought had gone black.' Foerster found
on examination that this patient could describe things perfectly from memory and
that she was in fact extremely sensitive to colours, etc.
We are not dealing, therefore, with real inability to imagine but rather with
something like derealisation in perception. The sensory elements and the mere
direction of attention to an object are not all there is to a perception nor to an
image. There are certain accessory characters which are of even greater importance for imagery than for perception, as with imagery the sensory elements
tend in any case to be few, slight and fleeting. As a result we seem far more
dependent upon these 'accessory' characters. If they are in abeyance we can
well understand the patient when he says that he cannot imagine anything at
all.
In the discussion of imagery a special place must be assigned to memories,
that is the images which occur with the conscious knowledge that they constitute a previous perception of ours, that we have experienced their content
before and that the object they represent is or was real. False perceptions mislead our judgment and false memories can do the same. Later on, when we discuss theories of memory, we shall see how nearly all memories are slightly
falsified and become a mixture of truth and fantasy. It is necessary to differentiate Kahlhaum's hallucinatory memory from simple falsification of memory. For
example:
A patient suffering from a process schizophrenia reports during the final stage of
an acute phase of paranoid anxiety: 'For the past few weeks so many things have
suddenly occurred to me over what happened with Emil [her lover] ... just as if
someone had told me'. She had completely forgotten these things. Later she even
talked of the time 'when I suddenly remembered so many things'. The things she
remembered were of this sort: 'Emil had, I'm sure, hypnotised me, because I was
sometimes in such a state that I surprised myself; I had to kneel down on the floor of
the kitchen and eat out of the pig-bucket. Afterwards he told it all triumphantly to
his wife . I once had to go into the pig's sty. How long I was there and how I got
there I don't know; I only came to as I was coming out of the sty on my hands and
feet . Emil also nailed a couple of boards together and I had to say I wanted to
be crucified after which I had to lie face downwards .. once it seemed to me as if I
had been riding a broomstick .. once I felt as if Emil had me in his arms and there
was a terrible wind .. once I stood in the muck and was being pulled out .. .'
Sometime before she had to go for a walk with Emil, and she knew exactly what
happened under the lamp but did not know how she got home again.
definite enough to support any conclusion. However the phenomena as described

by Alter suggest that he really went through this experience. There was a gradual
illumination of memory through the help of a number of individual facts which could
have aroused associations, and there was no sign that he felt he had been a passive
tool, or subject to alien influences, etc.
Three criteria distinguish these cases which have often been observed.l
The patients know for certain that what comes to their mind is something they
have forgotten. They have the feeling that at the time they were in an abnormal
state of consciousness. They talk of doped states, attacks of faintness, being
half-asleep or half-awake, being in some peculiar state, a state of hypnosis, etc.
Lastly there are indications that the patients feel that they must have been the
passive tools of someone or something at the time and could not do anything
about it. They were just made to do things. The mode of description in such
cases is suggestive of false memory but in certain individual cases it has been
shown (Oetiker) that the behaviour of the patient was actually disturbed
during the period to which the false memory referred.
With the phenomena of false memories the patient gets a sudden image of
a previous experience that has all the vivid feeling of a memory, but in actual
fact nothing, not even a slender basis for it, is really remembered. Everything
is freshly created. There are however apparently similar phenomena where
everything is not freshly created but there is a distortion of actual scenes, for
instance an innocuous scene in a public-house is distorted into an experience of
being poisoned or hypnotised. There are, lastly, false memories that seem to
have a neutral content: the patient announces that an hour ago he had a visitor
when actually he was alone in bed. The only feature left here sometimes to
differentiate such phenomena subjectively from normal falsifications of memory
is the 'sudden coming to mind', which gives us an impression of primary
phenomena.
This 'sudden coming to mind' of supposed 'forgotten' experiences can be difficult
to distinguish from a progressive illumination of memory regarding real experiences
which have been undergone during a twilight state. 2 Alter described the case of a highranking civil servant, who recalled step by step the details of a sexual murder he
thought he had committed some time previously. Some circumstantial evidence
indicated this. After his death, a detailed self-accusation was found among his papers,
but neither the patient'S other psychopathic symptoms nor the objective data were
lOetiker, Allg. P.<ychiatr. Z., vol. S4. Cpo Schneider's case, Z. Neur., vol. 2.8, p. 90. Cpo
Blume, Z. Neur., vol. 42., p. 2.06, regarding a possible relation between falsification of memory
and dreams.
a Alter, 'Ein Fall von Selbstbeschuldigung', Z. Neur., vol. 15, p. 470.
77
Another false-memory phenomenon looks rather like a deja vu, but here
the patient consciously accepts everything as real. For example:
A dementia praecox patient reported that she couldn't help noticing that she saw
faces in the clinic which she had seen at home a few weeks before; a witch-like form,
for instance, that walked through the ward during the night as an attendant; she said
that she had also seen the Matron some time ago in Pforzheim dressed in black.
'There was my recent experience in the garden when Dr. G. asked why didn't I
work ... I had already told this to my landlady four weeks ago. It struck me as very
funny and I asked him with surprise what he had in mind.' When conversing in the
clinic, she thought it had been like this before; she believed in any case that she had
been in a mental hospital before. l
The patients accept these phenomena as real and because of this they should
be distinguished from deja-vu experiences proper, which are never thought to
be real. Moreoever, the total experience itself leaves one with a different impression. This certainty of having seen or experienced something before may
only refer to certain aspects of the present, sometimes it may refer to the whole
situation; sometimes it occurs for only a brief period, a few minutes at the most,
and sometimes it accompanies psychic events for weeks on end. It is not an
uncommon phenomenon in schizophrenia.
The above examples of hallucinatory memory and this latter special form of deja
vu are phenomenologically all of the same character. The following group of falsifications of the past are not strictly speaking false memories and do not have this same
phenomenological character:
(a) Pathological lying. Stories about the past which are pure fantasy are eventually believed by their inventor himself. Such falsifications range from harmless tall
stories to a complete falsification of the whole past.
(b) Reinterpretation of the past. Insignificant past scenes suddenly acquire new
meaning as the patient looks back at them. 'A meeting with an officer of high rank
means the patient was of noble origin etc.'
(c) Confobulations. We use this term for a shifting series of false memories,
briefly retained or immediately lost. They can appear in a number of forms: Confabulation out of embarrassment, which involves filling in the gaps of a severely
impaired memory, e.g. in senile patients. With these and in cases with severe head
injuries we find productive confabulations as part of the Korsakow syndrome.
Patients will tell long stories about accidents they have had, a walk they have taken
and other activities when they have been quietly in bed all the time. Lastly we have
the well-characterised phenomena of the fantastic confabulations common in paranoid processes: A patient had lived through the Great War when he was about 7
1
Other instances are given by Pick, Fschr. Psycho/., vol. 2. (1914), pp. 2.04 If.
79
years old; in Mannheim he had seen large armies fighting; he had a special decoration
because of his noble descent; he made a journey to Berlin with a big entourage to
visit his father, the Kaiser; all that happened a long time ago; he was changed into a
lion and so it goes on, endlessly. One patient called his whole fantastic world 'the
novel'. The content of these confabulations can be influenced by the investigator.
One can sometimes bring completely new stories to light. On the other hand, we can
observe individual cases, for instance after head injury, where one of the confabulatory contents is tenaciously and continuously held.
There are transitions to primary delusions as well: patients feel they are
'being observed' or 'watched' without anyone near them. A patient said, 'I
did not feel free any longer, tkat wall in particular kept me.'
(f) Vivid pkysical awarenesses

In discussing false perception, false memory and pseudo-hallucinations,
etc., emphasis was laid on the concrete vividness. We can now add to these
phenomena one which is not vivid in the concrete sense but is for all that an
equally forcible deception. This is the phenomenon of a false awareness. 1
A patient felt someone was always walking next to him or rather obliquely
behind him. When the patient got up, this one got up too; when he went, the other
went with him; when he turned round, the other kept behind him so that the patient
could never see him. He always remained in the same position though sometimes he
came a little nearer or moved a little further away. The patient had never seen or
heard him and had never felt him nor touched him and yet he experienced with an
extraordinary certainty the feeling that somebody was there. In spite of the keenness
of the experience and though he sometimes let himself be deceived, he concluded in
the end that in reality no one was there.
If we compare phenomena such as this with normal experiences of a similar
character, the following points emerge: For instance, we know when we are at
a concert that someone is sitting behind us; we have just seen him; while walking in a dark room we suddenly stop because we think a wall is in front of us,
etc. In such cases we are aware tkat sometking is present which at that moment
is not based on any obvious sensory sign. Nevertheless these normal phenomena are either based on previous perceptions or on fine momentary ones
which can be demonstrated if one will examine the situation more carefully
(such as changes in sound, or density of atmosphere as in the case of the awareness of a wall), but with pathologically vivid awarenesses, the experience
appears as a completely primary phenomenon and has the character of urgency,
certainty and vividness. We have termed phenomena of this sort vivid physical
awarenesses in contrast to other vaguer awarenesses which bring something
abstract or fantastic before the psyche (e.g. awarenesses of thoughts or
delusional awarenesses).
There are transitions from vivid physical awareness to hallucination
proper:
'One thing is always with me. I feel and see a wall around me about 3-4 metres
away; it is made of some wavy and hostile substance and under certain conditions
devils keep on breaking out from it' (Schwab).
1 Cpo my article on 'Concrete Awareness', Z. Pathopsychol., vol.
2.
(1913)'
2.
EXPERIENCE OF SPACE AND TIME
Psychological prefoce. Space and Time are always present in sensory processes.
They are not primary objects themselves but they invest all objectivity. Kant calls
them 'forms of intuition'. They are universal. No sensation, no sensible object, no
image is exempt from them. Everything in the world that is presented to us comes to
us in space and time and we experience it only in these terms. Our senses cannot
transcend the space-time experience of existence nor can we escape from it but are
always confined within it. We do not perceive space and time as such, as we do other
objects, but we perceive them along with these objects, and even in experience barren
of any object we are still within time. Space and time do not exist on their own
account; even where they are empty, we have them only in conjunction with objects
that inform and define them.
Space and Time, underivative and primary, are always present in abnormal as
well as in normal life. They can never vanish. Only the way in which they are present,
how they appear to us, our mode of experiencing them, our estimate of their extent
and duration, only these may be modified.
Space and Time are real for us only through their content. It is true we conceive
them as a void, although we try to picture this emptiness to ourselves in vain. As
voids, they share a hasic characteristic of a quantitative kind: we find dimensions,
homogeneity, continuity, infinity. The parts so constituted are not, however,
instances of a universal called space or time, but parts of a perceptual whole. Informed
with content, they immediately become qualitative. Although space and time are inseparable, they are radically different from each other; space being a homogeneous
manifold and time a spaceless occurrence. If we want to bring these primary things
home to ourselves in some neat phraseology we may say that they both represent the
sundered existence of Being, separated from itself. Space is extended being (the sideby-side) and time is sequential being (the-one-after-the-other).
We can sometimes do without space and enjoy a kind of inner objectless experience, but time is always there. Or can we also break through time? The mystics say
we can. In breaking through time, eternity is experienced as time standing still, an
everlasting now, a 'nunc stans'. Past and future become one lucid present.
If space and time only become real for us through the objects that give them
content the question arises what can we regard as the essence of space and time? Their
universality has misled us in the past to take them as the very basis of Being. But it is
a mistake to consider space and time as absolutes of Being itself and the experience of
them as an absolutely basic one. Although everything that exists for us is spatial and
temporal, whether real or symbolic, we should not impute to space and time th~t
which gives them their content and intrinsic value. Though we all fulfil our fate 10
space and time in such a way that both gain substance for us in the all-embracing
present, they are both nothing but the outer covering of events, with no significance
but that which comes from our attitude towards them. It is the significance, not the
specific experience, which turns them both into a psychic language, a psychic form,
80
which should be kept out of the discussion when space and time are themselves the
theme. In this chapter we are concerned only with space and time as they are actually
experienced. It is altogether another matter that this experience, if it suffers any
change, will modify all the psychic contents and be itself altered by the psychic
contents-that is, the awareness of the significance ofspace and time may be changed.
Both space and time exist for us in a numher of hasic configurations, though what
they have in common is not always immediately clear. In regard to space we have to
distinguish: (I) the space I perceive as a qualitative structure, when I view it from my
present orientation within the centre of my body, e.g. left to right, up and down, far
and near. This is the space I contact around me as I live and move, which my eye
grasps, the place where I am. (2) objective three-dimensional space, the space through
which I move, which I constantly have with me as my immediate space of orientation.
(J) theoretical space, including the non-euclidean space of mathematics-the space
which is simply a theoretical construct. What significance I feel may lie in the configurations of space, in the spatial experience itself and in spatial change is another
matter. As to Time, we have to distinguish: the time-experience, clock-time, chronological and historical time and time as the historical aspect of the individual's Existence.
For phenomenological purposes there is no point in psychopathology taking
these philosophical problems as a starting-point, however relevant they may be for
philosophy itself. It will be better to work out the actual abnormal phenomena and,
as the case may be, see whether this theorising about space and time may not contribute something towards a clearer comprehension of the phenomena.
(a) Spacel
Appreciation of space can be assessed quantitatively as a performance,
but there may be a very poor performance and yet the experience of space may
still be normal. On the other hand space as a phenomenon may be being experienced quite differently. Where this experience is unconscious, we can only
see it through its effects, i.e. through faulty performance. Where it is conscious,
the patient can himself compare his present changed experience of space with
what he remembers of his normal experience or with what normal spatial
perception still remains to him.
I. Objects may seem smaller (micropsia) or larger (macropsia) or aslant,
larger on one side than the other (dysmegalopsia). We also know of double
vision or multiple vision up to a sevenfold vision. (All these phenomena may
occur in deliria, epilepsy, and in acute schizophrenic psychoses, but we can
also find them in psychasthenic conditions.)
EXhaustion neuroses. An overworked student sometimes saw letters and music,
sometimes the wall and door as small and distant. The room became a long corridor.
At other times his movements appeared to take on enormous dimensions and a mad
speed. He thought he made enormous strides. 2
Lubarsch (quoted by Binswanger) reported fatigue experiences when in bed in
1 L. Binswanger, 'Das Raumproblem in cler Psychopathologie', Z. Neur., vol. 14S (1933),
p. 59 8
I Veraguth, 'Ober Mikropsie u. Makropsie', Duch. J. NerY,nheilk., vol. :14 (1903).
81
the evening at the age of 11-13 years. 'My bed became longer, wider and so did the
room, stretching into infinity. The ticking of the clock and my heartbeats thudded
like huge hammers. A passing fly seemed like a sparrow.'
A presumably schizophrenic patient reported: 'There were times when everything I saw around me assumed enormous proportions. Men seemed gigantic, everything near and far seemed to me as if seen through the end of a telescope. I
always seem when looking outside, for instance, to see everything through fieldglasses; so much perspective, depth and clearness in everything' (Ruemke).
2.
Experience of infinite space. This occurs as an alteration of the whole
spatial experience:
A schizophrenic reported: 'I still saw the room. Space seemed to stretch and go on
into infinity, completely empty. I felt lost, abandoned to the infinities of space, which
in spite of my insignificance somehow threatened me. It seemed the complement of
my own emptiness ... the old physical space seemed to be apart from this other
space, like a phantom' (Fr. Fischer).
Serko described the feeling ofinfinite space under mescalin. The depth dimension
of space seemed to enlarge. The wall moved away and space diffused itself everywhere.'
3. As with the contents of perception, so it is with the appreciation of
space, which also takes on an affective character. L. Binswanger called it 'space
with an atmosphere' (or emotionally-coloured space). Space can have something
of a psychic character so that it can exist as a threatening or a pleasing reality.
Even in the previous examples it is difficult to distinguish sharply what are the
actual changes in perception and what are merely alterations in the affective
components of perception, although conceptually it is important to keep these
two situations apart.
A schizophrenic patient of Carl Schneider said: 'I see everything as through a
telescope, smaller and at a very great distance, yet not smaller in reality but more in
the mind ... less related to each other and to myself as it were ... colours are dimmer and so is the significance .. everything is far away ... it is more a mental
remoteness . .'
Here the described alterations in perception are clearly already in essence
affective changes. In the following example of schizophrenic experience, the
fact of a reality experience seems to be in the forgeround, although perception
itself seems altered:
A schizophrenic reported: 'Suddenly the landscape was removed from me by a
strange power. In my mind's eye I thought I saw below the pale blue evening sky a
black sky of horrible intensity. Everything became limitless, engulfing ... I knew
that the autumn landscape was pervaded by a second space, so fine, so invisible,
though it was dark, empty and ghastly. Sometimes one spac;:e seemed to move,
sometimes both got mixed up... It is wrong to speak only of space because something took place in myself; it was a continuous questioning of myself' (Fr. Fischer).
Another schizophrenic reported: 'when he looked at objects, things often seemed
so empty, sometimes there, sometimes here. The air was still there between things,
. .
but the things themselves were not there.'
Another patient said: He only saw the space between thmgs; the thmgs were
there in a fashion but not so clear; the completely empty space was what struck him.
(Fr. Fischer).
which we perceive? Do we perceive something concrete or are we experiencing

something that is basically ourselves, or do both these things happen? We can ask all
these questions but so far we are left without answer. Carrell is still circling round
the riddle when he writes: 'Time is told in the tissues of our body. Possibly when
this reaches the threshold of consciousness, it explains our deep-rooted, indefinable
feeling of the flow of silent waters on which our conscious states waver like searchlights on some great, dark river. We realise we are changing and are no longer one
with our previous self and yet we realise our identity.' We cannot explain the experience of time nor can we derive it from anything else; we can only describe it. We
cannot avoid asking what are the causes of abnormal experience of time but so far
demonstrable answers do not exist.
The following points are material when we come to discuss the phenomena of the
experience of time: Knowledge oftime (and actual orientation in time) takes place on
the basis of our experience of time but it is not the experience of time itself. Our
experience of time involves a basic awareness of the constancy of our existence;
without this constancy in time there can be no consciousness of time passing.
Consciousness of time passing is an experience of hasic continuity (Bergson's duree,
Minkowski's temps vecu). Experience of time is also an experience of kaying a direction, a growing forward, in which the awareness of the present stands as a reality
between the past as memory and the future as planned. Finally there is tke experience
in time of timelessness, of Being as the eternal present, as the transcendence of all
becoming. 1
(b) Time
Preliminary remarks. We have to make three distinctions:
I. Knowledge of time. This relates to objective time and the
perfo:man~e of
judging time-intervals rightly or wrongly: It also.relates to wrong ~r delu.slOn~lldeas
on the nature of time (e.g. a patient says hiS head IS a clock, that he IS makmg ttme; or
another patient says: 'new time is being produced so they must be turning the blackwhite knob' (Fr. Fischer).
2. Experience of time. The subjective experience of .time .is not the estima~on of
any particular span of time but a total awareness of Dme, m res~ec~ of which the
ability to assess the time-span is only one of many othe~ characten~ttcs.
3. Handling of time. Everyone has to handle the basiC fact of ttme. We ~~y or
may not be able to wait, to allow something to mature; we have to make de~ls10ns;
we have to handle time in the context of our over-all awareness of our past life and
our whole existence.
Knowledge of time concerns the study of psychological performance; kandling of
time is a matter for the psychology of meaningful phenomena (Verstehende Psychologie); in the following paragraphs we shall deal with the experiem:e of time only.
We are merely describing phenomena and there is no need to explam or grasp the
.
.
meaning of these immediately.
In addition to the three above lines of enquiry, we are left finally With the blOlogical problem of tke time-hound nature oflife, including psychic life. E~ery life ~as
its own time, peculiar to it, whether it be the mayfly or man; each has Its own hfespan, its own life-curve and periodicity. This vital time is an ~bjectiv~, bio.logical and
qualitatively differentiated time. Time always plays a pan: m p~yslOlogtcal e:ents.
(For instance, the beginning of the hormonal impulse which bnngs about a .tlmely
puberty.) It also plays a part in all forms of regulation; not only. those which are
merely chemical, varying in rate according to the temperature, for mstance, but also
those which show a rhythmic build-up, as interplay of stimuli, harmoniously ordered
in their time-relationships. Finally, time plays a part in that extraordinary 'inner
time-keeping' which can accurately determine any time interval (for instance, during
sleep after a resolve to wake at a certain h~ur or ~ter hypn?tic sugges~on).l .
The reality of this vital time raises certam quemons: Do ttme-events, If they differ
for different species, also vary within the species in power, impetus, increase or decrease of tempo? Can time-events be disturbed as a whole, not only in one or other of
their constituent factors? Is our experience of time, experience of events as such and
therefore disturbed by any disturbance of these events? What kind of perception is
implied in our experience of time? Do we perceive some kind of objective, every-day
event, such as the objects of ordinary sense-perception or is it the vital bodily event
Ehrenwald (Z. Neur., vol. 134, p. 5u) reports two cases of Ko~ow syndrome; ~e ~me
sense was severely disturbed and he induced the patients by hypnOSIs to wake at certain umes
with some accuracy; conscious awareness was lost but a primitive, unconscious time-sense seemed
there.
1
(x) Momentary awareness of time. Normal experience of the momentary

passage of time varies understandably. Interesting and changing occupation
makes us aware how rapidly time passes; idleness, lack of events and waiting,
all make us feel how slowly the time goes and generally bring about a state
of boredom, though not always. Mental patients do nothing for years on end
without suffering from boredom. Exhausted and tired people can have the
feeling of vacuity without boredom. These are all understandable variations,
but there is an abnormal experience of the time-lapse found in seizures,
psychoses and poisoning. The manner of the experience is altogether different
and rooted in the vital events themselves:
(aa) Time hurrying or slowed. Klien 2 reports a boy who had attacks during
which he would be frightened and run to his mother, saying:
'It's starting again, mother, what is it? Everything starts going so quickly again.
Am I talking faster or are you?' He also thought the people on the street were walking
faster.
In mescalin intoxication, Serko had the feeling that the immediate future
was rushing on at chaotic speed:
'At first you have the peculiar feeling that you have lost control over time, as if
it were slipping through your fingers; as if you were no longer capable of holding on
1 Re abnormal experience of time see E. Straus, Mschr. Psychiatr., vol. 68, p. :1.40. v. Gebsattel,
Nervenar{t, vol. I, p. :1.75. Also Roggenbau, Die Storungen des Werdens u. Zeiterlehens (Stuttgart,
1939) Fr. Fischer, Z. Neur., vol. 1:1.1, p. 544; vol. 13:1., p. :1.41. G. Kloos, Nervenar,t., vol. II
(193 8), p. :1.:1.5 (Storungen des Zeiterlebens in der endogen Depression).
Klien, Z. Psychopath., vol. 3 (1917), p. 307.
84

to the present in order to live it out; you try to cling on to it but it escapes you and
streams away .. :
(bb) Lost awareness of time. As long as there is some aware.ness the fe.eling
of time cannot be lost altogether but it can be reduced to a mimrr:um. Patients,
for instance if severely exhausted, may say that they do not feel time any more
at all. If activity is lost, there is also a corresponding loss in the awareness of
the passage of time:
In mescalin intoxication, when the chaotically racing moments of time are streaming away when the intoxication is at its height, time vanishes al~og~ther'f Ser~o:
'Particul:rly when there is a wealth of hallucination, you have the ee ~g 0 sWI~i
min in a boundless stream of time, somewhere, so~ehow '.' y?U .ave to. pu
g If up repeatedly and make a real effort to appreciate the time situation
yourse
1 fi actively
0
so as to escape from the chaotic flight of time, if only for .a moment; ~n y or ~ m as soon
sl'nce
ment, ho w e
ve
r , .as you rel~ boundlessfi time ' returns. As Bennger
commented, it is life 'for the moment only, no past or uture.
( ) Loss ofreality in the time-experience. Consciousness of time is primarily
of immediacy, of something being present
absent,
feelings of reality. With the disappearance of a time-sense~ the pr~sent disappears
and with it reality. Reality is felt purely as a temporallmmedlacy; or, to p~t
it another way, we feel as if nothing were timelessly there. S~me psychas~h~n~c
or depressive patients describe this experience as follows: It f~els ~ ~f I.t IS
always the same moment, it is like a timeless v~id.' They do not hve t elr time
any more, although in some way they know It.
linke~ with feelings
o~
A depressed patient feels as if time did not want to go on. ~is exp~encefhas
not ot the elementary character of the previous cases but ~ere IS some . ng 0 an
character in this particular feeling, which symbolises
and time .locked
th ry 'The hands of the clock: move blankly, the clock ticks emptily ...
iost hours of the years when I could not work' ...
patient sees that the hands move forward but, for her, actual time IS no;
on with them but is standing still. 'The world is all. of a piece and cannot go orwar
or backward' this is my great anxiety. I have lost time, the hands of the clock are so
r ht ' O~ looking back on recovery, the patient said: 'It seems to me that Jan~
'February passed
like a blank, all of a piece, at a
1
;
believe time really went on. As 1 kept working and working and n~~mg ca~e 0d It, ,
had the feeling that everything was going backwards and 1 wou never e one
(Kloos).
elem~nta
~~:e ar~th~
Th~
:~ a~d
sel~
Time.goe~ backwa~ds.
gom~
j~st
stan~still; cou:~n
(dd) TAe experience of time standing still. A schizophrenic patient reported:
'1 was suddenly caught up in a peculiar state; my arms and legs seeme~ to .swell.
A f 'ghtful pain shot through my head and time stood still. At the s.ame time It was
on me in an almost superhuman way how vitally
moment was.
Then time resumed its previous course, but the time which stood still stayed there
like a gate'. (Fr. Fischer).
for:~d
2..
i~portant thl~
Awareness of the time-span of the immediate past. After a hard day and
many experiences we are understandably conscious of having had a long day,

while an empty, slowly passing day is felt in retrospect to have been short. The
livelier our memory of past events, the shorter seems the time-span that has
passed, but the more experiences intervene, the longer does this time-span
appear. There is, however, a mode of recalling the time-span which is of a
different order and has something new and primary at its root:
Following an acute and florid psychosis a paranoid patient reported: 'My own
memory gives me the impression that this time-span, 3-4 months by ordinary
reckoning, was an immensely long time for me, as if every night had the length of
centuries.'
Serko experienced an enormous subjective over-estimation of the length of time
during mescalin intoxication. 'Time seemed stretched out', 'Recent experiences
seemed far away'.
Frequent reports are made of an overwhelming richness of experience packed
into seconds, for instance during a crash or in a dream. A French investigator of
dreams (quoting from Winterstein) reported as follows: 'He dreamed of the terror
regime of the Revolution, of scenes of death, tribunals, condemnation, of a journey
to the guillotine, of the guillotine itself; he felt his head severed from his trunk and
then he woke up; the head of the bed had collapsed and hit him on the back of the
neck: 'The end of the dream was its source:
The authenticity of similar reports cannot be doubted. But in one second of time
we do not experience as a sequence what has become a series in our memory. There
has to be some concerted act of intense momentary representation which gathers up
together all those things that our memory has interpreted as a sequence in time.
Psychasthenic and schizophrenic patients report ecstatic experiences lasting in
fact a few minutes as if they might have lasted for ever.
With the epileptic aura, a second in time is experienced as timeless or as eternity
itself (Dostoievski).
3 Awareness oftime-present in relation to time-past andfUture. A number of
remarkable but very varied phenomena have been described:
(aa) Deja vu andjamais vu. Patients are seized at moments by an awareness that everything they see has been seen before in exactly the same way.
The moment has been clearly experienced before, down to the last detail.
Objects, persons, postures and movements, words, even the tone of the voice,
are all surprisingly the same, everything has been like this before. Conversely
the 'jamais vu' experience consists in the awareness that everything is seen
for the very first time, everything strikes as unfamiliar, fresh and incomprehensible.
(bb) Discontinuity of time. Individual schizophrenic patients report, for
example, that one has fallen from heaven between one moment and the next:
that time appears void, that awareness of the flow of time is lost (Minkowski);
a patient of Bouman's (Korsakow) suddenly felt (during transfer from one
institution to another) as if he were abruptly transplanted from one place to
another; the two moments stood side by side; no time-span intervened.
(cc) Months and years fly by with excessive speed. 'The world races on and
when it is autumn, spring is here already. It never used to be as fast as that in

the old days' (A schizophrenic woman-Fr. Fischer).
(dd) The shrinking of the past: Bouman's patient felt a past of twenty-nine
years had lasted only four years at most and the smaller time-spans within this
period were correspondingly shortened.
emptiness, non-existence, time standing still and the return of the past: 'Life is now a
running conveyor-belt with nothing on it. It runs on but is still the same .. I did
n~t know. death looked like this .. I am now living in eternity .. outside everytlung carnes on ... leaves move, others go through the ward but for me time does not
pass . . . when they run around in the garden and the leaves fly about in the wind I
w,ish I could r~n too so that t~e might again he on the move but then I stay stuck. '..
t~me stands still ... one swmgs .between past and future . it is a boring, endless
time. It would be fine to start agam from the beginning and find myselfswinging along
with the proper time, but I can't ... I get pulled hack, where to ? .. there where it
comes from, where it has been before .. it goes into the past-that is what is so
dusive ... time slips into the past ... the walls which used to stand firm have all
fallen down ... do I know where I am, oh yes-but the elusive thing is there is no
time and how can one get hold of it? Time is in collapse' (Fr. Fischer).
Another schizophrenic described his attack: 'One evening during a walk in a
busy stree~, I had a sudden feeling of nausea . . . afterwards a small patch before my
r.ycs, no bIgger than a hand. The patch glimmered inwardly and there was a to and
fro of dark threads ... the web grew more pronounced .. I felt drawn into it. It
was really an interplay of movements which had replaced my own person. Time had
failed and stood still-no, it was rather that time re-appeared just as it disappeared.
Tnis new time was infinitely manifold and intricate and could hardly be compared
with what we ordinarily call time. Suddenly the idea shot through my head that time
did not lie before or after me but in every direction. It came to me from looking at
the play of colours . but the disturbance was soon forgotten'.
This patient also reported: Thinking stood still; everything stood still as if there
were no more time. I seemed to myself as a timeless creature, clear and transparent, as if
I could see right down into myself ... at the same time I heard quiet music far away
IUld saw dimly lit sculptures ... it all seemed a never-ceasing flow of movement
very different from my own state. These distant movements were, it seemed, a "folie"
of my condition.'
Yet another experience of the same patient was as follows: 'I was cut offfrom my
own past, as if it had never been like that, so full of shadows .. as if life had started
just now ... then the past turned round ... everything got intermingled but in no
wmprehensible way; everything shrank, fell together, packed up, like a wooden
"hack which has collapsed, or as if a well-perspectived painting became two-dimen"ional and everything flicked together' (Fr. Fischer).
86
4. Awareness of the future. The future vanishes:

A depressed patient, suffering from 'terrible emptiness' and a feeling of 'having
lost all feeling' reported-'I cannot see the future, just as if there were none. I think
everything is going to stop now and tomorrow there will be nothing at all'. Patients
know there is another day tomorrow but this awareness has changed from what it
was like before. Even the next five minutes do not lie ahead as they used to do. Such
patients have no decisions, no worries, no hopes for the future. They have also lost
the feeling for past stretches of time. 'I know the exact number of years, but I have
no real appreciation of how long it was' (Kloos).
This is not an elementary experience of time. Changes in the emotional
atmosphere of the patient's perception and in his awareness of things also
make themseives noticeable in the experience of time. What is lostis the feeling
of immediate content. Things are there but the patient can only know them,
not feel them, so the future disappears like everything else. The concept of
time is there and the correct knowledge of time but not the actual timeexperience.
s. Schi'{ophrenic experience of time standing still, flowing together, and

stopping. Schizophrenic patients report that sometimes during transient, brief
attacks, they have remarkable, elementary yet somehow significant experiences,
sensorily keen but of a supernatural strangeness. They report these experiences
as some kind of transformation of their time-experience:
A schizophrenic described one attack thus: 'Yesterday I looked at the clock ... I
felt as if! was put back, as if something past was coming to me ... I felt as if at I 1.30
a.m. it was II.O a.m. again but not only the time went back but what had happened
to me during it. Suddenly it was not just I 1.0 o'clock but a time long past was there
too . midway in time I came towards myself out of the past. It was terrible. I
thought perhaps the clock was put back; the attendants had played a stupid trick ...
then I had a feeling of frightful expectation that I could be drawn into the past ..
the play with time was so uncanny .. an alien time seemed to dawn. Everything
blended with everything else and I said in a strained way to myself: I must bold on
to everything ... then lunch came and everything was as usual .. .' (Fr. Fischer).
A schizophrenic woman said: 'There is no more present, only a backward reference to the past; the future goes on shrinking-the past is so intrusive, it envelops
me, it pulls me hack. I am like a machine which stands in one place and works by itself.
It is worked to breaking-point but it still stands ... I am living much faster than before .. It is the contact with old things. I feel this sustains me. I let myself be carried
away, so that at least one can reach an end and be at peace ... if! were to hang on to
all this speed I would get swept away with it ... time chases me and ravenously eats
itself away and I am in the middle of it all' (Fr. Fischer).
Another schizophrenic woman described the painful admixture she suffered of
(c) Movement
Perception of movement involves space and time simultaneously. Dislurbances in the perception of movement are principally reported as disturbances of function following neurological lesions. So far as abnormal experi(,Ilees go, our description of the time-experience has already covered movement,
Ihus, there is discontinuity; movement is not perceived, but the object or
p('rson is now here, now there, without any time intervening. There is also
I he speeding up or slowing down of visible movements etc.
Perceptions of movement in an object have been noted even though this
has made no actual change of position:
Under the influence of scopolamine: 'I suddenly saw how the pen-apparently
88
surrounded by a kind of fog-crawled towards me like a caterpillar with fine wavy

movements. It seemed to get nearer. At the same time I realised that the distance
between the end nearest me and the line of the cover on the desk never got any
smaller' (Mannheim-quoted from C. Schneider), (Z. Neur., vol. 131).
less well in the sensations contributed by the heart and circulatory system and least of
all in the vegetative changes. Specific feelings of one's bodily existence arise from the
fol~owing: movement and posture, the style, ease and grace of our motor-activity
or Its heavy and clumsy nature, the impression we think our physical presence makes
on others, our general weakness or strength and any alteration in our normal feelingstate. All the above are factors of our vital self. There are wide variations in the extent
to which we feel our oneness as well as in the amount of distance we establish between
ourselves and our body. This may reach a maximal distance in medical self-observation when we see our pains only as symptoms and consider the body as some alien
object, consisting of anatomical findings, or as a kind of garment, something in the
last resort quite different from ourselves and in no way identical, though our unity
with it in fact is inseparable.
Aw~reness ofour hody need not he confined to the actual houndaries ofour hody. We
may still feel at the end of the stick which guides us in the dark. Our proper space,
the space of our anatomical body, may be extended by the feeling of something at
one with ourselves. So the car I drive, if I am a good driver, becomes part of my
body-schema or image and is like an extended body which I invest fully with my own
senses. External space begins where my senses and I come up against objects that
emerge from it.
My bodily awareness is able to detach itself from objective, organised space, that
is from the realities of space, in two directions: either negatively, in giddiness (as loss
of vital feeling and certainty) or positively, in dancing (as an access of vital feeling
and sense of freedom).l
The experience of one's body as one's own is phenomenologically closely linked
with the experience of feeling, drive and awareness of self.
We should distinguish between phenomenological description of actual hodily
experiences and any discussion of the significance for the individual of his own body,
in terms of the effective meaningful connections, where there are hypochondriacal,
narcissistic or symbol-forming tendencies influencing the self-awareness.
3.
AWARENESS OF THE BODY
Psychological preface. I am aware of my body as my existence. I also see it and

touchit. The body is the only part of the world that is both felt from within and-so
far as its surface goes-at the same time perceived. The body provides me with an
object and I am also that body. There is a difference, it is true, between what I feel
about myself as a body and how I perceive myself as an object, yet the two are inextricably interwoven. Bodily sensations whereby a certain object builds itself up for
me and sensations which remain as a feeling of my bodily state are the same and indivisible, though one can differentiate between them: Sensations that give rise to flelings blend into an awareness ofour physical state. Awareness of our body's existence,
normally an unnoticed, neutral background for consciousness-neither a disturbing nor an influential factor, may undergo a number of exceptional changes as a
whole: states of sexual excitement, anxiety or pain may involve the body profoundly, absorbing the individual and compelling him to further effort or destroying
him completely.
Our body becomes an object to us because we are aware of our own body, which
follows our every movement not as a clear-cut, isolated object but as an intuition of
our three-dimensional self. Head and Schilderl have clarified this phenomenon.
According to Head the impressions relating to space-kinaesthetic, tactile, opticalbuild up organised models of ourselves which may be termed hody-schemata. What
we make of our bodily sensations and how we execute our movements are both
maintained through the relationship these sensations and movements have with
previous bodily impressions that have found their way unconsciously into the bodyschema.
The awareness of our physical state and the three-dimensional body-schema combine as a whole to form what Wernicke called the somato-psyche. Awareness of the
physical state has to be analysed physiologically according to the specific senseperceptions which go to build it up. All the senses play some part in this, those of the
eye and ear to the smallest degree, only reaching such a level if the external content is
accompanied by intensive stimuli which give rise to a bodily sensation. Taste and
smell playa larger part and the bodily sensations continuously so. These latter can be
classified into three groups: those of the body-surface (thermic, haptic, hygric etc.);
those belonging to movement and posture (kinaesthetic, vestibular); and those
belonging to the organs (which intimate the condition of the inner organs). The
physiological basis for these sensations lies in the histologically well-known nerveendings. Whether this list exhausts all the sensations we receive may be questioned.
Awareness of the body has to be clarified phenomenologically by relating it to our
experience of the body as a whole. The close relationship of the hody to awareness of
selfis best exemplified in the experience of muscular activity and movement, rather
Paul Schildf'r, Dal Karperschema. Ein Beitrag {ur Lehre Yom Bewusstsein des eigenen Karpers
(Berlin, 19~ 3)
1
(a) Amputated limhs

It is remarkable how amputated limbs may be sensed as a result ofhabituation to the body-schema, which remains a reality after the amputation has
taken place. The body-schema is not a mere free-floating concept of one's own
body but a mode of apprehending oneself that has been deeply imprinted
throughout all one's life, a mode in which at anyone time all the body sensations are unified into a whole. Just as we think we can see within the normal
blind spot in the visual field, so we still sense the lost limb as real and fill out
the gap that has been rent in the body-schema. These sensations must be
localised in the cerebral cortex. Head saw such a phantom limb disappear
following a focal cortical lesion.
Riese 2 describes a healthy leg-amputee thus: in all his body movements the lost
leg was still sensed. When he got up, the knee extended; it bent again when he sat
1 E. Straus, 'Die Formen des Riiumlichen', Neryenar{t., vol. 3 (1930)'
Riese, 'Neue Beobachtungen am Phantomglied', Desch. Z. Nereynkh. (193~), p. U7. D. Katz.
Zur Psychologi, der Amputierten (Leipzig, 19U).
down; he could stretch the leg luxuriously along with all the other limbs; when
asked whether he really believed all this, the patient knew the leg was no longer
there, but it somehow still kept its own peculiar reality for him.
can be in part conceived as hallucinations of this sort but some of them must
be interpreted as hallucinations of the vestibular apparatus.
2. Vital sensations. These give rise to feelings which make us aware of our
vital bodily state. Reports from patients about their bodily sensations are
inexhaustible. They feel turned into stone, dried up, shrunk, tired, empty,
hollow or blocked. Sensations such as these cannot but alter the feeling of
bodily existence. The patient feels he is a soap-bubble, or that his limbs are
made of glass or describes himself in one or other of the countless ways in
which patients try to depict their feelings. We have a host of reports on these
puzzling sensations, particularly from schizophrenic patients. It is difficult to
separate the actual sense experience from the delusion-like interpretation and
in the latter case to clarify the underlying sensory events.
3 Passivity experiences in the form ofbodily sensation. Bodily sensations may
be accompanied by the vivid experience that they have been contrived from
outside. In such cases the patients are not merely interpreting various abnormal
organic sensations in one way or another but have an immediate perception of
this 'coming from outside'. We observe that patients will correctly perceive
pain and other sensations such as may be caused by physical illness (angina,
rheumatoid arthritis), but they will experience these specific sensations as
something externally contrived. Schizophrenic patients know the experience
of being made to be sexually excited, of being raped and of being made to have
sexual intercourse without any person being present. They may feel that wires
are pulling at their hair and their toes.
4 Experience of bodily distortion. The body enlarges, gets stronger, becomes coarse and heavy and along with this the pillows and bed grow bigger
and bigger. 1 Head and limbs get thick and swollen, parts are twisted, limbs
become alternatively larger or smaller.
90
(b) Neurological disturbances
With localised cerebral lesions orientation in relation to one's own body

is disturbed in a number of ways. For instance (taking psychological performance) the ability to recognise an irritable place on the body-surface or the
position of a limb is partially or wholly absent. Patients can no longer touch
nose, mouth or eyes or the orientation for the left and right side of the body
may be disturbed. Patients can no longer say on which side of their body the
stimulus is applied etc. In these states we do not know how the bodily
awareness itself is altered phenomenologically.l
Giddiness may be either (I) vertigo (2) a sensation of falling (3) general
unsystematised dizziness, experienced as an uncertain awareness, without
rotation of objects or any sensation of falling. Here we are dealing with three
heterogeneous phenomena. They have in common a total uncertainty as to
posture and position.
This uncertainty normally occurs at the critical point of transition from one state
to another, whether due to one's physical surroundings or some psychological
reason. It arises neurologically from somatic causes, particularly in the vestibular
apparatus. It may arise neurotically in connection with the upset of psychic conflict.
Giddiness is the experience of an existence which as a whole has lost its ground; as
such it is a symbol for everything that is on the verge but not yet brought within the
orderly clarity of immediate being. This is the reason why philosophers could adopt
the expression 'giddiness' for the original experience from which their basic insights
into Being as a whole derived.
(c) Bodily sensations, perception of bodily shape, hallucinations of the bodily
senses, etc.
These may be classified and grouped as follows:

(I) Hallucinations of the bodily senses. We may distinguish between thermic
hallucinations (the floor is burning hot, unbearable feelings of heat) and
haptic ones (cold wind blows on the patient, insects creep under the skin, the
patient is being stung all over). Within the latter category, hygric hallucinations
have been further differentiated (perceptions of wetness and fluids). The
hallucinations of muscle sense (Cramer)2 are interesting. The floor rises and
sinks, the bed is raised, patients sink, fly, feel they are light as a feather, an
object in the hands feels very light or heavy, patients feel they are making
movements, although motionless themselves; they think they are speaking,
when actually they are silent (hallucinations of the speech apparatus). 'Voices'
1 Cf. Schilder, Das Korperschema. Ein Beitrag {ur Lehre Yom Bewusstsein des eigenen Korpers
(Berlin, [92 J).
I Craner, Die Haltu{inationen im Muskelsinn (Freiburg, 1889).
Serko describes himself during mescalin intoxication (the picture presents us

with a vivid analogy to some psychotic experiences): '1 feel my body is exceptionally
three-dimensional and highly detailed ... 1 suddenly have a sensation that my foot
has left my leg; I feel it lying apart from my body below the truncated leg. (N.B.it is not just the sensation that the foot is missing but rather that there are two positive
sensations-that of the foot and that of the truncated leg with the hallucinatory
sensation of a lateral shift in position) ... then I have the sensation that my head is
being turned right round, 180, that my abdomen is becoming a soft fluid mass, my
face growing to gigantic dimensions, my lips swelling, my arms becoming peculiarly
wooden and serrated in outline, like the Nurnberg puppets, or growing long and apelike, while the lower jaw hangs down heavily. Among many other things 1 have the
hallucination that my head has become separated from my body and is floating free
in the air half a mile behind me. I really feel it floating and yet still belonging to me.
To control myself! say a few words aloud and even the voice seems to come from n
<.:crtain distance behind me. More peculiar still ,Ire the tl'ansformaliollHj for IIlMtlltll't',
1 R. Klein, 'Ober Halluzinationen der K6rpervcrgr6sscrung', MilAr. 1'.ry,AI"".,
p. 78 (cases of head-injury and encephalitis).
VIII.
"7 (Iyall),
my feet become key-shaped and tum into spirals, while my lower jaw twists into the
curls of a section-mark; my chest seems to melt away .. .'
state, the mind's eye and the satisfaction derived from the meaning of the apparitionhe was riding in the opposite direction back to Sesenheim-he will return.
2. A schizophrenic patient of Menninger-Lerchenthal complained that 'she sees
herself from behind,naked; she has the feeling that she is not dressed and sees herself naked and feels cold too; it is her mind's eye that sees'.
3. A schizophrenic patient (Staudenmaier) said: 'During the night while I walked
up and down in the garden I imagined as vividly as possible that there were three
other people present besides me. Gradually the corresponding visual hallucination
took shape. There appeared before me three identically clothed Staudenmaiers who
walked along in step with me; they stopped when I did and stretched out their hands
when I stretched out mine.'
4. A patient of Poetzl with a hemiplegia and diminished self-perception felt the
hemiplegic side did not belong to him. While looking at his paralysed left hand he
explained it by saying that it probably belonged to the patient in the next bed; during
nocturnal delirium he affirmed that another person lay on his left side in the same bed
and wanted to push him out.
In states of altered consciousness, the integration of bodily awareness with

the space in which the body senses its objects may take on grotesque forms. A
patient feels 'he is the water-mark on the paper which is being written upon'.
Serko again describes his mescalin intoxication:
'Haptic hallucinations sometimes fuse with visual ones in an odd way difficult to
describe. In a vaguely illuminated visual field there form certain strips of light with a
lively movement, turning into spirals which move to and fro in the visual field while
rapidly rotating. There is at the same time a transformation in the haptic field whereby
my leg assumes a spiral form too. The light spirals and the haptic spirals fuse together
in consciousness so that the same spiral that is visually hallucinated is also perceived
haptically ... one feels a complete bodily and visual unity . .'
Under hashish intoxication the proband states: 'my body feels like a husk, a
coffin in which the soul is suspended, as something delicate, transparent, like spunglass and floating free within the confines of the shell. Arms and legs can see, all the
senses are one; the shell is heavy and immobile; but the kernel thinks, feels, and experiences.' All this was not just imagined but actually felt to be real. The proband was
afraid of being damaged by others (Fraenkel and Joel).
A schizophrenic patient said: 'I saw my new "self" like a new-born baby; power
came from it but it could not fully pervade my body; it was too big and I wanted
them to take a leg or an arm off so that it could be filled completely. Things got better
later and at last I felt my "self" sticking out of my body into space.' (Schwab).
The phenomena recounted above show a good deal of variety but it is
difficult to sort them out any more clearly than this. For the most part these
abnormal experiences of the body-schema have no analogy with normal experience of the body. Vital sensations, experience of symbolic meanings,
neurological disturbances, all merge into each other. Awareness of self permits
each to represent itself in the other.
Cd) The 'Double' or Heautoscopy

Heautoscopy is the term used for the phenomenon when someone vividly
perceives his own body as a double in the outer world, whether as an actual
perception or as an imaginary form, as a delusion or as a vivid physical awareness. There have been patients who will actually speak with their doubles. The
phenomenon is not at all uniform.l
I. Goethe (in Drang und Verwirrung) had seen Frederika for the last time and was
riding to Drusenheim when the following happened: 'In my mind's eye, not with my
physical eyes, I saw myself distinctly on the same road riding towards myself. I was
dressed as I had never been before in grey and gold. Immediately I shook myself out
of this dream, the figure went' ... 'The strange phantom gave me a certain peace of
mind at that moment of parting.' What is noteworthy in the episode is the dreamy
1 Menninger-Lerchenthal, 'Eine Halluzination Goethes', Z. Neur., vol. 140 (193~), p. 486.
93
We can see that we are dealing with phenomena that are really not the
same although they are superficially similar. They may occur in organic brain
lesions, in deliria, in schizophrenia and in dream-like states, never at least
without a mild alteration in consciousness; day-dreaming, intoxication, dreamsleep or delirium. The similarity consists in the fact that the body-schema gains
an actuality of its own out in external space.
4.
DELUSION AND AWARENESS OF REALITY
Since time immemorial delusion has been taken as the basic characteristic
of madness. To be mad was to be deluded and indeed what constitutes a
delusion is one of the basic problems of psychopathology. To say simply that
a delusion is a mistaken idea which is firmly held by the patient and which
cannot be corrected gives only a superficial and incorrect answer to the problem.
Definition will not dispose of the matter. Delusion is a primary phenomenon
and the first thing we have to do is to get it into a proper focus. The experience
within which defusion takes place is that of experiencing and thinking that
something is real.
Awareness of reality-logical and psychological comment. Things that are for the
moment most self-evident are also the most enigmatic. Thus it is with Time, the Self
and Reality. If we have to say what we think reality is we find ourselves answering
something like this: it means things in themselves as compared with how they appear
to us; it means what is ohjective in the sense of something generally valid as oppoKcd to
subjective error; it means underlying essence as distinct from masking effects. (>r- WI.'
may call reality that which is in time and space, if we want to differentiate it f!'olll thc
theoretically valid objectivity of ideal Being- -that for instance of lIlutht'III,lIkM.
These are the answers of our reason and through them Wt~ ddine to otlrMt'lv('" II
wncept of reality. But we need something more thull thiN plIJ'l'ly lo"k"1 rOlln'pl of
reality; there is also the reality we experience. Com;cptulil r,,"l1ly \:111'1'1". ClIl1vktiulI
94
only if a kind ot presence is experienced, provided by reality itself. As Kant says, 100
imaginary dollars cannot be distinguished from a 100 real dollars so far as the actual
concept goes; the difference is only noted in practice.
What the experience of reality is in itself can hardly be deduced nor can we. compare it asa phenomenon with other related phenome~a.. We have to regar~ It as a
primary phenomenon which can be conveyed o?ly mdlrectly. Our atte~t1on ge~
drawn to it because it can be disturbed pathologically and so we appreciate that It
exists. If we want to describe it as a phenomenon, we shall have to take the following
. '
., .
points into account:
I. What is real is what we concretely percetve. In contrast With our Imagmmgs,
perception has a quality not determined by ~e particular ~ens~-organ, ~.g. the eye or
ear but rooted in the actual mode of what IS sensed, which IS somethmg absolutely
pri:nary and constitutes sensory reality (normally connec.ted with external stimuli~.
We can talk about this primary event, name and rename It, but we cannot reduce It
any further. 1
. '
.
2. Reality lies in the simple awareness of Demg. Awareness of reahty may fad us,
even when we concretely perceive. For instance it is lost in 'derealisation' and 'depersonalisation'. Awareness of reality must therefore be a primary experience of
existence and as such Janet called it a 'fonction de reel'. Descartes' 'cogito ergo sum'
holds even for the person in a state of derealisation who says paradoxically: 'I am not
but have to go on being nothing for ever'. Descartes' phrase therefore cannot convince us by logic alone; in addition it requires the primary awareness of Bei?g a~d
the awareness of one's own existence in particular. 'I exist and thereby the things m
the world outside me are experienced as equally existent.'
3. What is real is what resists us. Whatever may inhibit our bodily movements or
prevent the immediate realisation of our aims and wish~s is a r:sis~ance. The ~chieve
ment of a goal against resistance or defeat thereby bnngs With It an expenence of
reality; all experience of reality, therefore, has a root in the practice of living..But the
reality itself which we meet in practice is always an interpretations, a meanmg, the
meaning of things, events or situations. When I grasp the meaning, I g~sp reality.
The resistance we meet in the world gives us the wide field of the real which extends
from the concreteness of tangible objects to perceived meanings in things, behaviour
and human reaction. This brings to us awareness of the reality with which in practice
we have to reckon and deal, to which we have to accommodate every moment,
which fills us with expectation and which we believe in as something which is.
Awareness of this reality pervades us all more or less clearly as a knowledge of the
reality with which we are individually most concerned. This individu~l reality is
embedded in a more general reality that has been structured and amphfied for us
through the traditional culture in which we have grown up and been educated. What
is real for us in all this has many grades of certainty and usually we are not completely
clear about it. We only-need to test how much we would risk in our ordinary judgments of what is real or not for us to see the measure of this certainty.
We have to distinguish between immediate certainty of reality and reality-judgment. A vivid false perception may be recognised as a deception and judged as such
1 Gerhard Kloos Das Realitiitshewusstsein in der Wahrneltmung und Trugwahrneltmung (Leipzig, 1938). This is ~ excellent survey of all the ~fforts ma?~ at definitio~ hitherto and make~ its
own fresh contribution, but an unsuccessful one m my OpIniOn, though It helps us to apprecIate
the primary nature of the phenomenon.
9S
and yet continue to be what it is, as happens with simple after-images and sometimes
in the case of hallucinated mental patients. Even when the deception is recognised
the patient may still act unawares as if the content were real. For instance, an amputee
has a phantom limb, steps on it and falls; or there was the case of the famous botanist
Naegeli who wanted to put a glass of water on a hallucinated table. Reality-judgment is the result of a thoughtful digestion of direct experiences. These are tested
out against each other; only that which stands the test and is confirmed in this way is
accepted as real; and hence only that is real which is commonly identifiable and accessible to others and not merely a private and subjective matter. A judgment of reality
can itself be transformed into a new direct experience. We live continuously with a
knowledge of reality acquired in this way but not always made fully explicit in the
form of a judgment. The characteristics of this reality as evinced by our judgments
(implicit or explicit) are: that reality is not a single experience 'per se' but only as it is
there in the context of the experience and ultimately in the experience as a whole;
reality is relative in so far as it is recognised only up to the point at which it has disclosed itself; it can alter; reality discloses itself; it rests on insight and how certain
this is; it does not depend on concreteness nor on an immediate experience of reality
as such; the latter are only supporting features for the whole, they are indispensable
but have constantly to be checked. Hence, the reality of our reality-judgments is a
flexible reality-a movement of our reason.
If now we want to characterise the field of delusion, we shall have to make

some distinctions. There is first diminished awareness ofBeing and ofone's own
existence, which\Jiere discussed under derealisation of perception and which
we shall meet again among the disturbances of self-awareness. Then there is
hallucinatory vividness, which was discussed under false perceptions. Delusion
proper, however, implies a transformation in our total awareness of reality
(including that secondary awareness which appears in the form of realityjudgments). This builds itself up on judgmental experiences as well as on the
world of practical activity, resistance and meanings, in which, however,
hallucinatory vividness plays only an accidental and relatively minor part beside the transformation of basic experience which we have such great difficulty
in grasping. 1
(a) The concept of delusion
Delusion manifests itself in judgments; delusion can only arise in the process
of thinking and judging. To this extent pathologically falsified judgments are
termed delusions. The content of such judgments may be rudimentary but
take a no less effective form as mere awareness. This is usually spoken of as
a 'feeling' that is also an obscure certainty.
The term delusion is vaguely applied to all false judgments that share the
following external characteristics to a marked, though undefined, degree: (I)
they are held with an extraordinary conviction, with an incomparable, suhjective
certainty; (2) there is an imperviousness to other experiences and to compelling
I Gerhard Schmidt, 'Der Wahn im deutschsprachigen Schrifttum cler letzten 25 Jahre' (19141\1), Zhl. N6ur., vol. 97, p. 115.
96
SUBJECTIVE PHENOMENA Oli' PSYCHIC LIFE
counter-argument; (3) their content is impossihle. If ~e want to get be~ind
these mere external characteristics into the psychological nature of del~sl~n,
we must distinguish the original experience from the judgm~nt based on ~t, 1.~.
the delusional contents as presented data from the fixed Judgment which IS
then merely reproduced, disputed, dissimulated as occasion dem~nds .. "'!e can
then distinguish two large groups of delusion according to their ~rzgtn: o~e
group emerges understandahly from preceding affects, from shatter1Og, ~ortl
fying, guilt-provoking or othe~ su~h experiences, from fa~se-perceptlon or
from the experience of derealisatlon 10 states of altered conscl0usne~s etc. !~e
other group is for us psychologically irreducihle; phenomenologically It IS
something final. We give the term 'delusion-like ideas' to the first group; the
latter we term 'delusions proper'. In their case we must now try and get close~ to
the facts of the delusional experience itself, even though a clear presentatlon
is hardly possible with so alien a happening.
With every hallucination proper, a need is experien~ed to regard the .hallucinated
object as real. The need remains even when the false Judgment of realtty has been
d the light of the total context of perception and subsequent knowledge.
correcte 10
r bl
. h [; I . dg
But should the patient, although such a correction is.leasl e, re~am IS a.se JU ment of reality in spite of the known objections, in spite of reflection and With absolute certainty-overcoming indeed any initial doubts he may have had-~hen we are
dealing with delusion proper: such a bel~ef is no lon~e~ understandable .10 t~rms of
hallucination alone. With delusion-like Ideas that onglOate f~om hall~clOat1on~ we
only find a tendency towards false judgment of reality (or a qUite .translent certamty)
but with delusion proper all doubt has ceased. Some other psychiC factors than mere
hallucinations must be at work and these we will now try to explore.
The content of the delusions which the patient may disclose to us i~ the
course of an interview is always a secondary product. We are faced ~1th a
customary formulation of a judgment, which simply differs from other Judgments perhaps in having a different con~ent. When. investi~ating, there.fore,
we are always confronted with the questlOn-what IS ~e pnmar~ expenence
traceable to the illness and what in the formulation of the Judgment 1~ s~cond~ry
and understandable in terms of that experience? There are three exz:ung pornts
of view: the first denies that there is any experience at all of delUSion proper;
all delusions are understandable in themselves and secondary. The ~econd
believes that lack of critical capacity due to poor intelligence allows delUSion to
emerge from any kind of experience; the third requires ~e singular ~henomenon
of delusional experience, which it regards as the essentlal pathol?glcal el~ment.
The first point of view is represented by Westpha}.l Accord1Og to. him the
first step is an awareness of change in one's personalit~, much as one ml~ht feel,
f::>r instance, if one had put on a uniform for the first t~me and felt conSpICU?US.
So paranoics think that the change in themselves, which they alone appreCiate,
is also noticed by their environment. From this delusion that one has beco~e
noticeable arises the delusion that one is watched and from that the deluslOn
1
Westphul, Allg. Z. Psychiatr., vol. 34, pp. 252 fT.
97
that one is being persecuted. It is true such understandable connections do

playa part, particularly in paranoid developments of personality, and in
psychoses so far as content is concerned. We can thus understand over-valued
ideas and secondary delusions in general, but we are still without an explanation of the essential nature of delusion. The same may be said for the attempt
to derive delusion from preceding affects, the affect of distrust, for instance.
There is no clear delineation here of the specific phenomenon, the actual
delusional experience; we are only offered an understandable context for the
emergence of certain stubborn misconceptions. If these misconceptions tum
into delusion, something new has to arrive, which as an experience can also
he grasped phenomenologically. The second point of view holds that the
cause-or perhaps more modestly the precondition-for delusion lies in weakness ofintelligence. We always tend to look for the logical errors and blunders
in the paranoid patient's thought in order to prove some such weakness. Sandberg, I however, pointed out quite rightly that paranoics have by no means a
poorer intelligence quotient than healthy persons and in any case the mentally
ill person surely has as much right to be illogical as the healthy one. It is
wrong to consider the failure in reasoning a morbid symptom in one case but
normal in the other. Actually we find every degree of mental defect without
delusions of any kind and the most fantastic and incredible delusions in the
case of people of superior intelligence. The critical faculty is not obliterated
but put into the service of the delusion. The patient thinks, tests arguments and
counter-arguments in the same way as ifhe were well. A highly critical attitude
is as rare in paranoics as in healthy people, but if it does occur it naturally
colours the formal expression of the delusional content. For any true grasp of
delusion, it is most important to free ourselves from this prejudice that there
has to be some poverty of intelligence at the root of it. Any dependence on the
latter is purely formal. We have to assume some specific alteration in psychic
function, not a failure of intelligence, if after some delusional experience an
individual, who is fully conscious and-as occasionally happens-quite free
from any other morbid symptom, maintains a delusion that everyone else
recognises as such, and if he simply declares: 'Well, that is how it is; I have
no doubts about it, I know it is so'. With delusion proper there is material
falsification while formal thinking remains intact. Where there is formal
thought disturbance, then misapprehensions, confused association and (in acute
conditions) the wildest notions may follow, which as such do not have the
character of delusion proper. The third point of view, that there is some
phenomenologically peculiar delusional experience, sets out to find what this
basic primary delusional experience may be.
Methodologically delusion can be viewed from a number of standpoints: phenomenologically it is an experience; from the point of view of psychological performance it is
a disturbance of thinking; as a psychological product, it is a mental creation: from the
1
Sandberg, AI/g. Z. Psychiatr., vol. p.
98
point of view of meaningful connections, it is motivated, dynamic content; and in the

framework of nosological-hiographical study we may ask whether we are to. comprehend it as a break in the normal life-curve or simply as a part of the contmuum of
personality development.
(b) Primary delusions

If we try to get some closer understanding of these primary experiences of
delusion we soon find we cannot really appreciate these quite alien modes of
experien~e. They remain largely incomprehensible, unreal and beyond o.ur
understanding. Yet some attempts have been made. 1 We find that there anse
in the patient certain primary sensations, vital feelings, moods, awarenes~es:
'Something is going on; do tell me what on earth is going on', as one pat1~nt
of Sandberg said to her husband. When he asked what she tho~gh~ wa~ gom~
on, the patient said, 'How do I know, but I'~ certai~ :omethzng zs gozng ~n.
Patients feel uncanny and that there is somethmg SUSpIClOUS afoot. Everythmg
gets a new meaning. The environmen.t is somehow di~erent-not to a gr?ss
degree-perception is unaltered in itself but there IS some ch~ge. whIch
envelops everything with a subtle, pervasive and strangely uncertam 11ght. A
living-room which formerly was felt as neutral or friendly. now ~eco~es
dominated by some indefinable atmosphere. Something seems 10 the aIr wh~ch
the patient cannot account for, a distrustful, uncomfortable, uncanny tensIon
invades him (Sandberg). The use of the word 'atmosphere' might .suggest
chasthenic moods and feelings perhaps and be a source of confuslOn; but
Psy
h"
th
with this delusional atmosphere we always find an 'b"
0 Jecttve so~et . 109 . e~e,
even though quite vague, a something which lays the s:ed of ~bJecttve va11dlty
and meaning. This general delusional at~osphere WJth ~1l Its vagu~ness of
content must be unbearable. Patients obvlOusly suffer terrtbly under It and to
reach some definite idea at last is like being relieved from some enormous
burden. Patients feel 'as if they have lost grip on things, they feel gro~s uncertainty which drives them instinctively to. loo~ for some fixed pomt to
which they can cling. The achievement of thIS bnngs stren~th and comfort,
and it is brought about only by forming an idea, as happens WIth healthy people
in analogous circumstances. Whenever we find ourselves depressed, fearful or
at a loss the sudden clear consciousness of something, whether false or t:ue,
immedi;tely has a soothing effect. As .iudgme~t gai?s in .clarity, the feeItngs
loosed by the situation will (ceteris panbus) dwmdle 10 their force. Conversely
no dread is worse than that of danger unknown' (Hagen). Expe~iences ~uch as
these give rise to convictions of persecution, of having commltte~ cnme, ~f
being accused or, by contrast, of some golden age, transfiguration, sanCtification, etc.
.,
.
It is doubtful whether the foregoing analYSIS wtll hold 10 all cases: Content
sometimes seems immediately present, vividly clear. In the former 1Ostances,
1 Hagen, Fixe Ideen in: StuJien auf dem Gebiete der iirt,lichen Seelenlcunde (Erlangen, 18 70)'
Sandberg, AI/g. Z. Psychiatr., vol. 51
99
however, it is certainly possible to wonder whether the patients have found

any content adequate for their actual experience. We will try therefore to
explore the original experience further, with its feelings and sensations rather
than the content itself, though it is true our exploration can only be a limited
one. The content in these cases is perhaps accidental; it is certainly not meant
literally and is quite differently experienced from similar content in the case
of a person whom we can fully understand.
Let us now try to imagine what the psychological significance is of this
delusional experience of reality in which the environment offers a world ofnew
meanings. All thinking is a thinking about meanings. If the meaning is perceived
directly with the senses, if it is directly present in imagination and memory,
the meaning has the character of reality. Perceptions are never mechanical
responses to sense-stimuli; there is always at the same time a perception of
meaning. A house is there for people to inhabit; people in the streets are
following their own pursuits. If I see a knife, I see a tool for cutting. If I look
at an unfamiliar tool from another culture, I may not see its precise meaning
but I can appreciate it as a meaningfully shaped object. We may not be explicitly conscious of the interpretations we make when we perceive but nevertheless they are always present. Now, the experiences ofprimary delusion arc
analogous to this seeing of meaning, but the awareness of meaning undergoes
a radical transformation. There is an immediate, intrusive knowledge of the
meaning and it is this which is itself the delusional experience. If we distinguish the different sense-data in which meaning of this sort can be experienced,
we can speak of delusional perception, delusional ideas, delusional memories,
delusional awarenesses etc. In fact there is no kind of experience with a known
object which we could not link with the word 'delusion' provided that at the
level of meaning, awareness of meaning has become this experience of primary
delusion (Kurt Schneider, G. Schmidt).1
We will now look more closely at delusional perceptions, delusional ideas,
and delusional awarenesses:
(aa) Delusional perceptions. These may range from an experience of some
vague meaning to clear, delusional observation and express delusions of
reference.
Suddenly things seem to mean something quite different. The patient sees people
in uniform in the street; they are Spanish soldiers. There are other uniforms; they are
Turkish soldiers. Soldiers of all kinds are being concentrated here. There is a world
war (this was before 1914). Then a man in a brown jacket is seen a few steps away.
He is the dead Archduke who has resurrected. Two people in raincoats are Schiller
and Goethe. There are scaffoldings up on some houses; the whole town is going to
be demolished. Another patient sees a man in the street; she knows at once he is an
old lover of hers; he looks quite different it is true; he has disguised himself with :1
1 Kurt Schneider, 'Einc Schwierigkeit im Wahnproblem', Nuv,,,ar,l., vol. II (1938), p ... 62,
He recognises only delusional perception as a two-stage phenomenon and .pceifically distinp;uishel
this from other sources of delusion, the 'delusional notions'.
wig and there are other changes. It is all a bit queer. A male patient says of such
experiences-'everything is so dead certain that no amount of seeing to the contrary
will make it doubtful'.
went on working, while finding throughout the day all sorts of imaginary
connections among otherwise quite real perceptions:
100
These are not considered interpretations but direct experiences of meaning

while perception itself remains normal and unchanged. In other cases, particularly at the beginning of process disorders, no clear, definite meaning
accompanies the perceptions. Objects, persons and events are simply eerie,
horrifying, peculiar, or they seem remarkable, mystifying, transcendental.
Objects and events signify something but nothing definite. Delusional significance of this sort appears in the folowing examples:
A patient noticed the waiter in the coffee-house; he skipped past him so quickly
and uncannily. He noticed odd behaviour in an acquaintance which made him feel
strange; everything in the street was so different, something was bound to be happening. A passer-by gave such a penetrating glance, he could be a detective. Then there
was a dog who seemed hypnotised, a kind of mechanical dog made of rubber. There
were such a lot of people walking about, something must surely be starting up against
the patient. All the umbrellas were rattling as if some apparatus was hidden inside
them.
In other cases patients have noticed transfigured faces, unusual beauty of landscape, brilliant golden hair, overpowering glory of the sunlight. Something must be
going on; the world is changing, a new era is starting. Lights are bewitched and will
not bum; something is behind it. A child is like a monkey; people are mixed up, they
are imposters all, they all look unnatural. The house-signs are crooked, the streets
look suspicious; everything happens so quickly. The dog scratches oddly at the door.
'I noticed particularly' is the constant remark these patients make, though they cannot say why they take such particular note of things nor what it is they suspect. First
they want to get it clear to themselves.
The patients arrive at defining the meaning more clearly when there are
delusions of reference. Here the objects and events perceived are experienced as
having some obvious relation to the patient himself:
Gestures, ambiguous words provide 'tacit intimations'. All sorts of things are
being conveyed to the patient. People imply quite different things in such harmless
remarks as 'the carnations are lovely' or 'the blouse fits all right' and understand these
meanings very well among themselves. People look at the patient as if they had something special to say to him.-'It was as if everything was being done to spite me;
everything that happened in Mannheim happened in order to take it out of me.'
People in the street are obviously discussing the patient. Odd words picked up in
passing refer to him. In the papers, books, everywhere there are things which are
specially meant for the patient, concern his own personal life and carry warnings or
insults. Patients resist any attempt to explain these things as coincidence. These
'devilish incidents' are most certainly not coincidences. Collisions in the street are
obviously intentional. The fact that the soap is now on the table and was not there
before is obviously an insult.
The following is an account extracted from the report of a patient who
101
'I was hardly out of the house when somebody prowled round me, stared at me
and tried to put a cyclist in the way. A few steps on, a schoolgirl smiled at me encouragingly.' He then arrived at his office and noticed leg-pulling and ragging by his
colleagues .. 'at 12 o'clock there were further insults, the time when the girls came
from school; I tried hard to confine myself to just looking at them; I simply wanted to
see a bevy of girls, not to make any gesture . but the lads wanted to make out I
was after something immoral and they wanted to distort the facts against me but
nothing could be further from my mind than to be a nuisance staring and frightening
: .. in the middle of the street they imitated me and laughed straight in my face and
10 a hateful way they pushed humorous drawings my way. I was supposed to read
likenesses to third persons from the faces .. '. the lads talked about me afterwards
at the police station ... they fraternised with the workers .. the nuisance of being
stared at and pointed at went on during meals ... before I entered my flat somebody
always had to annoy me with some meaningless glance but the names of the police
and the private people involved I did not know . .' The patient objected to 'eyelanguage' used even by the judge who examined him. In the street 'the police tried to
stalk me several times but I drove them away by my looks ... they became a kind of
hostile militia ... all I could do was to stay on the defensive and never take the
offensive with anybody.'
A fine example of delusional reference is provided by a I7-year-old patient
reported by G. Schmidt. 1 She was suffering from a schizophrenic psychosis
and recovered after a few months. There is a mass of detailed self-reference:
.'My illness first showed itself in loss of appetite and a disgust for "serum". My
perIods s~opped and there came a kind of sullenness. I didn't speak freely any more; I
had lost Interest; I felt sad, distraught and was startled when anyone spoke to me.
My father, who owned a restaurant, said to me the cookery examination (which
was to take place next day) was only a trifle; he laughed in such an odd tone that I
felt he was laughing at me. The customers were looking oddly at me too as if they
had guessed something of my suicidal thoughts. I was sitting next to the cash desk,
the customers were looking at me and then I thought perhaps I had taken something.
For the last five weeks I had had the feeling that I had done something wrong; my
mother had been looking at me sometimes in a funny, piercing way.
It was about 9.30 in the evening (she had seen people whom she feared would
take her away). I got undressed after all. I lay in bed rigidly and made no move so
they wouldn't hear me; I was listening hard for the least noise; I believed the three
would get together again and tie me up.
In the morning I ran away; as I went across the square the clock was suddenly
upside down; it had stopped upside down. I thought it was working on the other
side; just then I thought the world was going to end; on the last day everything stops;
then I saw a lot of soldiers on the street; when I came close, one always moved away;
ah, I thought, they are going to make a report; they know when you are a 'wanted'
person; they kept looking at me; I really thought the world was turning round me.
In the afternoon the sun did not seem to be shining when my thoughts were bad
1 Gerhard Schmidt, Z. N,ur" vol. 171 (1941), p. S70
but came back when they were good. Then I thought cars were going the wrong way;
when a car passed me I did not hear it. I thought there must be rubber underneath;
large lorries did not rattle along any more; as soon as a car approa.ched, I seemed t?
send out something that brought it to a halt .. I referred everythmg to myself as If
it were made for me people did not look at me, as if they wanted to say I was
altogether too awful to look at.
, . .
At the police station I had the impression that I wasn t at the station but m the
Other World; one official looked like death himself. I thought he was dead and had to
write on his typeWriter until he had expiated his sins. Every time the bell rang I
believed mey were fetching away someone whose lifetime had ended. ~Later I r~al
ised the ringing came from the ty~ter as it reac~ the: en~ of the lme.) I w~tted
for them to fetch me also. A young pohceman had a pistol m hiS hand; I was af~ld he
wanted to kill me. I refused to drink the tea they brought me as I thought It was
poisoned. 1 was waiting and longing to die . it ~ as on a stage, ~nd marionettes
are not human. 1 thought they were mere empty skins . the typeWnter seemed upside down; there were no letters on it, only signs which I thought came from the
Other World.
When I went to bed I thought someone else was in it already because the eiderdown was so bumpy; the bed felt as if people were lying in it already; 1 thought
everybody was bewitched; I mistook the curtain for Aunt Helena; I found the black
furniture uncanny' the lampshade over the bed moved continuously, figures kept on
swirling round; to~ds moming Jran out of the bedroom and shouted 'What am I?
I am the devil I' '.' I wanted to take my nightdress off and run out into the street, but
my mother just caught me
The illuminated signs of the town were very scanty-for the. moment I did ?ot
think of the blackout due to the war; it seemed to me extraordmary; the glow~ng
cigarette-ends of people were uncanny .somc:thing must ~.the matter, everythmg
was looking at me; I felt I was brightly lliummated and VISible when others were
"Iwping at me". One constantly sees menacing faces, one senses traps, hears allu.Ions. New powers seem to grow under the intoxication, and ideas of reference
.pr('ud to the inflated ego (Fraenkel and Joel). What then happens, happens because
of oneself, not to one's detriment, but purely for one's benefit:
10%
not...
Ii
At the clinic I found everything unnatural; I thought I was going to be used or
something special; I felt like a guinea-pig; I thought the doctor was .a murde~er,
because he had such black hair and a hook nose. Another man outside pushmg
an apple-cart seemed like a puppet. He was walking so hurriedly, just like in the
pictures. .
.
Later at home things were changed, partly they were smaller; It was not so hamel?,
as before it had become cold and strange. My father had got me a book; I thought It
had been'written specially for me; I did not think I had lived through all the scenes it
described but it was more that they seemed meant for me. I was annoyed that now
they knew all this.
Today I can see clearly how things really are; but then I always thought something unusual was up, even on the most trivial occasion. It was a real illness.'
Ideas of reference can also be experienced during hashish intoxication,
and in a remote way resemble schizophrenic ideas of reference:
'Feelings of uncertainty spread; things lose their self-evident nature. The intoxicated person feels defeated and finds himself in ~ si~ation o~ dist.r~~t and defence.
Even the most banal question sounds like an exammatIon or an mqulsltlon, and harmless laughter sounds like derision. An accidental glance leads to the reaction-"stop
r03
(66) Delusional ideas. These give new colour and meaning to memory or
may appear in the form of a sudden notion-'J could be King Ludwig's son'which is then confirmed by a vivid memory of how when attending a parade
the Kaiser rode by on his horse and looked straight at the patient.
A patient wrote: 'It suddenly occurred to me one night, quite naturally, selfevidently but insistently, that Miss L. was probably the cause of all the terrible things
through which I have had to go these last few years (telepathic influences, etc.). I
cln't of course stand by all that I have written here, but if you examine it fairly you
will see there is very little reflection about it; rather everything thrust itself on me,
Muddenly, and totally unexpectedly, though quite naturally. I felt as if scales had fallen
from my eyes and I saw why life had been precisely as it was through these last
years .. .'
(cc) Delusional awarenesses. These constitute a frequent element particularly

in florid and acute psychoses. Patients possess a knowledge of immense and
universal happenings, sometimes without any trace of clear perceptual experience of them, and when there is sensory experience, pure awarenesses will
often intermingle among the forms in which the actual content is given. When
there is delusional experience of some emotional depth, content will usually
appear for the most part in the form of awareness. For example:
A girl was reading the Bible. She read about the waking of Lazarus from the dead.
She immediately felt herself to be Mary. Martha was her sister, Lazarus a sick cousin.
She vividly experienced the events about which she read just as if they were her own
(oxperience. (The vividness was a feeling rather than a sensory vividness) (Klinke).
From the phenomenological point of view the delusional experience is
always the same: besides sensory experience of illusory, hallucinatory or
pseudo-hallucinatory contents, there is a kind of experience where sensory
richness is not essentially changed, but the recognition of certain objects is
linked with an experience totally different from normal. The mere thinking
about things gives them a special reality-which does not have to become a
sensory experience. The new and special significance may be associated as
much with thoughts as with things perceived.
All primary experience of delusion is an experience of meaning, and simple,
'one-stage' delusional notions do not exist. For example, a patient suddenly
has the notion that a fire has broken out in a far-away town (Swedenborg).
This surely happens only through the meaning he draws from inner visions
that crowd in on him with the character of reality?
A basic feature of the first experience of delusional meaning is 'the establishment of an unfounded reference' (Gruhle). Significance appears unaccountably,
suddenly intruding into the psychic life. Later the identical experience of
104
significance is repeated, though in other contexts. The trail is blazed and the
preparedness for the significant experience then permeates almost all perceived
contents. The now dominant delusion motivates the apperceptive schema for
all future percepts (G. Schmidt).
(c) Incorrigibility of delusion

Delusional experiences proper, false perceptions and all the other primary
experiences we have so far described give rise to errors of judgment. They
are the source for the great variety of delusional syndromes which we encounter
in individual patients. After the creation of the primary delusion from his
experiences, the patient often takes a further step, and holds on to his delusion as
truth. He will maintain it as such in the face of all other experiences to the
contrary and against all argument. He does this with a conviction far beyond
normal, even perhaps stamping down on any occasional, initial doubt he may
have himself.
Psychological digression. Normal convictions are formed in a context of social
living and common knowledge. Immediate experience of reality survives only if it
can fit into the frame of what is socially valid or can be critically tested. Experience
of reality leads us to judgments of reality. Individual experience can always be corrected but the total context of experience is something stable and can hardly be corrected at all. The source for incorrigibility therefore is not to be found in any single
phenomenon by itself but in the human situation as a whole, which nobody would
surrender lightly. If socially accepted reality totters, people become adrift. What is
left to them? A set of habits, survivals, chance events? Reality becomes reduced to
an immediate and shifting present.
Incorrigibility however has another source as well. The fanaticism with which
opinions are held in a discussion or over long periods of time does not always prove
that their content is really believed in, but only that in the holder's judgment such
opinions will have some desired effect, sometimes no more than his personal advantage, to which his instinctive drives unconsciously direct him. It is the behaviour
which will show clearly enough what is held to be reality; since only the reality that is
actually believed will compel to action. Fanatic opinions that are not believed in can
be dropped at any time and in this sense they become corrigible. But genuine reality
judgments which are the expression of a believed-in reality and according to which
people in fact conduct themselves (e.g. belief in hell) are extremely difficult to correct.
Should they be so, it will mean a revolution in the individual's whole conception of
life.
Normal mistakes are also very largely incorrigible. It is astonishing how most
people tend to maintain the realities they believe in during a discussion, although the
mistakes they are making seem to the knowledgeable person little else but 'sheer
delusion'. 'Delusions' on a national scale,as commonly discussed,are not ;.oeally delusions but mass-beliefs that change with the times and are typical illusions. Only those
that reach the highest ranks of absurdi ty deserve the term delusion-belief in witches,
for example-and even that need not be a delusion in the psychopathological sense.
Speaking methodologically, the concept of incorrigibility does not belong
to phenomenology but to the study of psychological performance and the
lOS
psychology of meaningful connections. Phenomenologically, we have only to

decide whether there is more than one kind of incorrigibility which may
indicate different phenomena as the source.
We may sum up the position briefly as follows: i:!.rrors in normal people
are the errors common to their social group. Conviction has a root in the fact
that all believe. Correction of belief comes about not on the ground of any
logical argument but through historical change. Delusion-like errors on the
part of individuals always imply some segregation from what all believe
(i.e. 'what one believes') and in this case the incorrigibility cannot be distinguished psychologically from the unwavering force of a true insight, asserting
Itself against a whole world. Delusion proper is incorrigible because of an
alteration in the personality, the nature of which we are so far unable to describe,
let alone formulate into a concept, though we are driven to make some such
presupposition. The decisive criterion seems to be not the 'intensity' of the
direct evidence, but the maintaining of what is evident to the patient in the
face of subsequent reflection and external criticism. Delusion cannot be grasped
as a change in one of the thought processes nor as an alteration in anyone of
our activities, nor as mere confusion, nor is it the same as the normal fanaticism
of dogmatic people. One need try only to suppose an ideal case of a paranoic
with a high level of critical insight-a born scientist, perhaps-who shows
incorrigibility as a pure phenomenon in the midst of his general scepticismwell, he would no longer be a paranoic! Patients are in a state of clear consciousness and have continual possibilities for testing their ideas but correction
of their delusion does not come. We cannot say the patient's whole world has
changed, because to a very large extent he can conduct himself like a healthy
person in thinking and behaving. But his world has changed to the extent that
a changed knowledge of reality so rules and pervades it that any correction
would mean a collapse of Being itself, in so far as it is for him his actual
awareness of existence. Man cannot believe something that negates his existence.
Such formulations, however, are only trying to make us understand what in its
essence cannot be understood-i.e. the specific schizophrenic incorrigibility.
We can only hold on to the fact that it is found where formal thinking is
maintained, the capacity for thought undamaged and where there is not the
slightest clouding of consciousness.
On the other hand we should look at what it is that is actually incorrigible.
The patient's behaviour will show this more readily than any conversation
with him. Reality for him does not always carry the same meaning as that of
normal reality. With these patients persecution does not always appear quite
like the experience of people who are in fact being persecuted; nor does their
jealousy seem like that of some justifiably jealous person, although there is
often some similarity of behaviour. Hence the attitude of the patient to the
content of his delusion is peculiarly inconsequent at times. The content of the
delusion strikes one as a symbol for something quite different; sometimes
content changes constantly though the delusional meaning remains the same.
106
Belief in reality can range through all degrees, from a mere play with possibilities via a double reality-the empirical and the delusional---to unequivocal
attitudes in which the delusional content reigns as the sale and absolute reality.
During the play of possibilities, each individual content may perhaps be
corrected but not the attitude as a whole and once the delusional reality has
become absolute, incorrigibility is also absolute.
Once we are clear that the criteria for delusion proper lie in the primary
experience of delusion and in the change of the personality, we can see that a delusion may be correct in content without ceasing to be a delusion, for instance
-that there is a world-war. Such correctness is accidental and uncommonmostly it appears in delusiOnS of jealousy. A correct thought ordinarily arises
from normal experience and is therefore valid for others. Delusion however
arises from a primary experience not accessible to others and it cannot be
substantiated. We can recognise it only by the way in which the patient
subsequently tries to give it ground. A delusion of jealousy, for instance, may
be recognised by its typical characteristics without our needing to know
whether the person has genuine ground for his jealousy or not. The delusion
does not cease to be a delusion although the spouse of the patient is in fact
unfaithful-sometimes only as the result of the delusion.
(d) Elahoration of the delusion

Thinking accompanies the first step which brings delusion about. This
may be no more than the unsystematic, blurred thinking of the acute psychoses
and states of chronic defect, yet even here patients look for some kind of
connection. Or the thinking may be more systematic as in the case of betterpreserved chronic conditions. Here the thought works over the delusion on
the basis of the primary experiences, trying to link them harmoniously with
real perceptions and the patient's actual knowledge. To do this sometimes
calls for the full strength of an intelligent personality. In this way a delusional
system is constructed which in its own context is comprehensible, sometimes
extremely closely argued and unintelligible only in its ultimate origins, the
primary experience. 1 These delusional systems are objective meaningful structures and methodologically we can assign them to the psychology of creativity.
(Werkpsychologie).
(e) Delusion proper and delusion-like idea

The term delusion should properly only be given to those delusions which
go back to primary pathological experiences as their source, and which demand
for their explanation a change in the personality. As such, they constitute
a group of primary symptoms. The term delusion-like ideas is reserved by
us for those so-called 'delusions' that emerge comprehensibly from other
1 Examples of closely argued delusional systems may be found in Wollay, Erkliirungen der
Tollheiten von Haslam (Leipzig, 1889), pp. 14 ff. Schreber, Denlcwiirdigkeiten eines Nuvenlcranktn
(Leipzig, 1903).
107
psychic events and which can be traced back psychologically to certain affects
drives, desires and fears. We have no need here to invoke some personalit;
change but on the contrary can fully understand the phenomenon on the basis
of the permanent constitution of the personality (Anlage) or of some transient
emotional state. Among these delusion-like ideas we put the transient deceptions due to false perception, etc.; the 'delusions' of mania and depression
(' delusions' of sin, destitution, nihilistic 'delusion', etc.)1 and over-valued ideas.
Over-valued ideas are what we term those convictions that are strongly
toned by affect which is understandable in terms of the personality and its
history. Because of this strong affect the personality identifies itself with ideas
which are then wrongly taken to be true. Psychologically there is no difference
between scientific adherence to truth, passionate political or ethical conviction and the retention of over-valued ideas. The contrast between these
phenomena lies in the falsity of the over-valued idea. This latter occurs in
psychopathic and even in healthy people; it may also appear as so-called
'delusion'-'delusions' of invention, jealousy, or of querulant behaviour etc.
Such over-valued ideas must be clearly differentiated from delusion proper.
They are isolated notions that develop comprehensibly out of a given personality and situation. Delusions proper are the vague crystallisations of blurred
delusional experiences and diffuse, perplexing self-references which cannot be
sufficiently understood in terms of the personality or the situation; they are
much more the symptoms of a disease process that can be identified by the
presence of other symptoms as well.
(f) The problem ofmetaphysical delusions

Patients may display their delusions in some supra-natural mode and such
experiences cannot be adjudged true or untrue, correct or false. Even when
empirical reality is concerned it is difficult enough to be decisive, though some
evaluation can usually be made. We can study the metaphysical experience
in its schizophrenic manifestations as it is conditioned by the morbid process
and yet realise that the metaphysical intuitions (the images themselves, the
symbols) that have arisen in the course of these experiences have acquired
cultural significance in the minds of normal people for quite different reasons.
For us reality is the reality of time and space. Past, present and future are real for
normal people in the form of 'no longer', 'not yet' and 'now' but the constant flux of
time makes everything seem unreal, the past is no longer, the future is not yet and
the present disappears irresistibly. Temporal reality is not reality itself. This reality
lies athwart time and all metaphysical awareness is experience and affirmation of this
reality. Where it is truly felt, we call it faith. When it is externalised into something
tangibly existing in this world (where it becomes mere reality again) we talk of superstition. We can tell how much people need this absolute hold on the reality of the
world when we see the abysmal despair into which they fall should they lose it.
1 Depressive delusions can only be attributed to affect comprehensibly if we presuppoiie in
severe melancholia a temporary change in the psychic life as a whole.
108
Superstition we might say is the 'delusion' of n.o~mal p:o?le. Only f~ith, transcending
in the world, can by virtue of its own unconditioned hVIng and actIng be sure ?f the
Being which all our existence symbolises. Only faith can hover above both Without
fear of falling into bottomless confusion.
The shattering of the self is said to be mirrore~ in the sc.h~zophren~c
experience of the end of the world. This is not suffiCiently exphc,t. E~~er'
eneing the end of the world and all that this implies inv~lves a deep rehgl0us
experience-of a symbolic truth that has served human eXistence for thousands
of years. We have to regard this experienc~ as such and not. merely as some
perverted psychological or psychopathologl.cal phen~~enon If we ~eally wa~t
to understand it. Religious experience remams what It IS, whether It occurs In
saint or psychotic or whether the person in whom it occurs is bot~ at once.
Delusion is the morbid manifestation of knowledge and error In regard
to empirical reality, as it is of faith and superstition in regard to metaphysical
reality.
S.
FEELINGS AND AFFECTIVE STATES
Psychological Prefoce. There is fairly general agreement as to what w~ m~an by

sensation, perception, image, thought, also perhaps what we mean by InstInctual
urge and act of will. But confusion still r~i~ns re~ar~i~g the word and concept
'feeling'. We may still ask what is meant by It m any IndiVidual case. Commonly the
term 'feeling' is given to any psychic event that does. nO.t clearly bel~~g to the phenomena of object-awareness, nor to instinctual excitation and vO}ltlO?al, acts. ~ll
undeveloped, undefined psychic mani~estations te?d to get ~alled feehng. That IS,
everything intangible, analytically elUSive, everythmg for ~hlch w~ can find no other
name. Someone feels he does not care, or that something IS not right. ~e f~e1s that
the room is too small or that everything is clear or he feels uneasy, etc. Th,s d,verse set
ofphenomena which we term 'feelings' has never been satisfactorily analysed from the
psychological point of view. We do not know what ~onstitute~ the basic .element or
elements nor do we know how to classify, whereas With sensation the baSIC elements
have been both well examined and classified. There are very few scientific investigations into feeling and we will mention them when necessary. On the other hand there
is an extensive literature on the pathological phenomena of object-awareness as well
as on the perversion of instinct.
l
It is difficult to know how we should set about it. However, psychologists have
laid some foundations for the analysis of feelings and we can get an orientation from
the leading schools of thought, a methodol.ogical approach w~ich will ~elp us to
evaluate more precisely what has been estabhshed so far. E~t~ns.l~e a~al~sls of every
different kind of feeling would only end in a vast array of trtvlalttle~. First therefore
we will review the different ways in which feelings have been classified:
1 Geiger 'Das Bewusstsein von Gefiihlen', Munch. phil. Ah. (Th. Lipps zum 60 Geburtstag
gewidmet). !Ober Stimmungseinfuhlung', Z. Asth. (1911). Kulpe, 'Zur psychologie der Gefilhle',
6 Psycho!. Kongr. Genf. (1909)

. '
For psychological discussion on feelings generally, at a supe~ficlallevel, see .Ho/fdmg ~nd
Jodi; Nahlowsky, Dos Gefiihlslehen, 3rd edn. (Leipzig, 1907); Ribot: Psychologle der Gefuhl,
(Paris, 1896) (in German, 1903)

I. Phenomenologically, according to the different modes in which they appear:
(a) Feelings that are an aspect of conscious personality, and define the self; these
nl'(~ broadly contrasted with feelings that lend colour to object-awateness, e.g. my own
Madness in contrast to the sadness of a landscape (Geiger).

(h) Feelings that can to some extent be grouped in opposites; Wundt, for instance,
clbtinguished pleasure and displeasure, tension and relaxation, excitement and calm.
'~'here are a number of such opposites: e.g. profound and shallow feelings (Lipps);
feelings of shatterment, deep pain on the one hand and feelings of petulance or for
tlte comic on the other.
(c) Feelings may be without an object and contentless (i.e. how one feels) or they
Illay be directed upon some object and classified accordingly.
2. According to their object (Meinong, Witasek). Here the contrast is between
phantasy feelings directed on to suppositions and reality feelings directed upon actual
tl/.jects. Feelings of value may be directed on the subject himself or on to someone
C'lse; they may be positive or negative (pride-submissiveness, love-hate). Any classification by content, e.g. social feelings, patriotic feelings, family or religious feelings
etc., leads not so much to a classification of feelings as to a classification of the innumerable contents, to which feelings of value may be attached. Language has unl'Ounted resources at its disposal for this end but these are better suited for concrete
description than for the purpose of a general phenomenological analysis.
3. According to source. The classification is made in accordance with different
/,vels of psychic life, i.e. a distinction is made between localised feeling-sensations,
vital feelings involving the whole body, psychic feelings (e.g. sadness, joy), and
Hpiritual feelings (a state of grace) (Scheler, Kurt Schneider).
4. According to the hiological purpose, the vital significance of the feelings, e.g.
pleasurable feelings express the advancement of biological purposes, displeasurable
feelings their frustration.
5. Particular feelings directed on specific objects or partial aspects of the whole
.Ire distinguished from all-inclusive feelings, where the separate elements are fused
illto some temporary whole, which is then called the feeling-state. Such feeling-states
arc characterised in various ways; for instance, there are irritable feeling-states, states
of sensibility and of diminished or increased excitability. A 'feeling of being alive'
'Irises on the basis of organic sensations as an expression of the vital state, of drives,
needs, tendencies and of the organism as a whole.
6. The old and useful classification into feeling, affect and mood is based on the
difference of intensity and duration of feeling. Feelings are individual, unique, and
radical commotions of the psyche. Affects are momentary and complex emotional
processes of great intensity with conspicuous bodily accompaniments and sequelae.
Moods are states of feeling or frames of mind that come about with prolonged emoI ion which while it lasts colours the whole psychic life.
7. Feelings are distinguished from sensations. Feelings are states of the self (sad or
cheerful); sensations are elements in the perception of the environment and of one's
own body (colour, pitch, temperature, organic sensations). Sensations, however,
show a whole scale of differences; they range from those that are purely objectbound to subjective bodily states. Vision and hearing are purely object-bound while
organic sensations, vital sensations, sensations of stance and balance all predominantly
refer to subjective bodily states. Between these two poles we find sensations referable
to bodily states at the same time as they are object-bound, e.g. sensations of skin,
taste, smell. Hunger, thirst, fatigue, and sexual excitation are simultaneously sensations (elements in bodily perception) as weII as feelings (in the form of pleasure and
displeasure). Hence we can talk of feeling-sensations (Stumpf). Bodily sensations as
feelings are at the same time aspects of instinctual drive, as with hunger, which impels
to food, fatigue, which impels to rest, and sexual sensations, which impel to contact.
Thus sensation, feeling, affect and drive show themselves an integrated whole.
(6) Changes in feelings of capacity

We always have some feeling of our capacity; this gives us confidence in
ourselves without any explicit awareness of the underlying feeling. In depression, patients get a feeling ofinsufficiency, one of their most common complaints. In part these feelings are an awareness of real insufficiency and in part
Ihey are unfounded, primary feelings. Awareness of being useless for the real
world, of being incompetent and incapable of action, of being unable to make
1\ decision, of wavering, of being clumsy, of not being able to think or underNland any more, all these are the burden of many abnormal states, though real
Inefficiency need not exist; it can, however, be present in a moderate degree.
Such complaints often appear with symptoms of an objective retardation, and
lire experienced as subjective retardation.
IIO
In classifying abnormal feeling-states we need to make a preliminary distinction as follows: (I) those affective states which emerge in understandable
fashion from some experience, even though they appear abnormally exaggerated
and heavily coloured; (2) those affective states which defeat understanding and
arise endogenously as a psychological irreducible. Explanation can only point
to sources beyond consciousness (physical events, phases, periods, etc.). This
helps us to distinguish normal homesickness, for instance, from excessive hut
understandahle homesickness (sometimes leading to violent behaviour in young
girls away from home), and both of these from depression without external
cause, which is then subjectively interpreted as homesickness.
Ahnormal feeling-states of an all-emhracing character are represented by a
rich terminology, e.g. grief, melancholy, cheerfulness, merriment, accidie, etc.
Certain typical states can also be recognised: natural cheerfulness, bubbling hypomanic merriment, the gloomy mood of depression, the euphoria of General
Paralysis with its contented complacency and the silly, awkward blandness
of hebephrenia. Out of all the host of trivial feeling-states our aim is to mark
down only those which are the more typical and noteworthy.
(a) Changes in hodily feeling

In physical illness bodily feeling is bound up with all the innumerable sensations which general medicine recognises as symptoms: e.g. the fear of the
cardiac patient, the suffocation of the asthmatic attack, the sleepiness of encephalitis, the general malaise of an initial infection.
Bodily feelings are basic to the feeling-state as a whole. In the psychoses
and personality disorders there is often a change in feelings for which it is
difficult to have empathy, particularly with schizophrenia. Self-description,
however, gives us only a little information about the great variety of these
vital and organic feelings.
Kurt Schneider sees a change in vital feeling as the core of cyclothymic
depression. The misery of these vital depressions is located specifically in the
limbs, forehead, chest or stomach:
A patient said: 'I always have an oppression in my stomach and neck; it feels as if
it would never go away, it seems fixed; it makes me feel as ifI would burst, there is so
much pain in my chest.' Another patient described fee~ings, of pressure in the chest
and abdomen and said 'it is more a sadness'; another, speaking of her chest, said 'I
have such a terrible misery there'. Besides this very physical sadness one will usually
find other complaints of vital distress (Kurt Schneider).
III
(c) Apathy
This is the
. term given to absence of feeling. If this absence is complete, as
can happen 10 acute psychoses, the patient is fully conscious and orientated,
Nces, hears, observes and remembers, but he lets everything pass him by with
the same total indifference; happiness, pleasure, something positive in which
he is involved, danger, sorrow, annihilation are all the same. He remains 'dead
with wakeful eyes'. In this condition there is no incentive to act; apathy brings
about aboulia. It seems as if that one aspect of psychic life we call objectawareness has become isolated; there is only the mere grasp of reason on the
world as an object. We can compare it to a photographic plate. Reason can
portray its environment but cannot appreciate it. This absence of feeling shows
ilself objectively in the patient not taking food, in a passive indifference to
being hurt, burnt, etc. The patient would die if we did not keep him alive
with feeding and nursing care. The apathy of these acute states must be dislinguished from the dullness of certain abnormal personalities who are
wnstantly at the mercy of innumerable feelings, only crude in quality.
(d) The feeling of having lost feeling
This feeling of having no feeling is a remarkable phenomenon. It appears
in certain personality disorders (psychopaths), in depressives and in the
initial stages of all processes. It is not exactly apathy but a distressful feeling
ofnot having any feeling. Patients complain that they no longer feel gladness or
pain, they no longer love their relatives, they feel indifferent to everything.
Food does not gratify: if food is bad they do not notice. They feel empty,
devastated, dead. All 'joie de vivre' has left them. They complain they cannot
participate in things, they have no interest. A schizophrenic patient said.
'There is nothing left; I am cold as a block of ice and as stiff; I am frozen hard'
(Fr. Fischer). Patients suffer very much from this subjectively felt void. But
the very fear which they imagine they do not feel can be recognised objectively
in their bodily symptoms. Mild cases will complain about numbness of feeling,
feelings that have got damped down, feelings of estrangement.
112
113
(e) Changes in the feeling-tone ofperception

First there is a simple increase in the feeling-tone:
Ihl~ III the beginning of a psychosis.) Or we may find the patients feel the
(Iblrl'ts they perceive are ghastly, spookish, thrilling or horrific.
'Thoughts that otherwise I would have felt as merely unpleasant and brushed
aside now brought a distressing, almost physical feeling of fear. The smallest pang of
conscience grew into a near-physical fear, felt as a pressure in the head' '(Encephalitis lethargica,' Mayer-Gross and Steiner).
'Nature seemed infinitely more beautiful than before, warmer, grander and
..Ilnrl'. There was a more brilliant light in the air, the blue of the sky was deeper,
doud-play more impressive, the contrast of light and shadow was much sharper.
Tltl' 1"lldscape was all so clear, so brightly coloured and so full of depth .. .' (Rumke).
The following description of an early phase in an acute psychosis shows

increased feeling-tone towards normal objects:
Rmpathic feelings towards other people must be classed as a special type

among these feelings ascribed to objects. We may observe how patients either
aufTer from abnormally strong empathy or complain that people appear to
them like automata or soul-less machines.
'The covered bath made a weird impression on me ... the keys on the attendant's
key-ring with their double hooks could, I felt, be used to pry out the eyes. I waited
for the heavy key-ring to fall from the attendant's belt on to my head and when it
kept clattering on the ground I couldn't bear it. The cells to which I was hastily
consigned every evening and where I was left to my own devices were I felt deeply
insulting in their emptiness and absence of every comfort and decoration .. most
painful of all were the feelings aroused by the wild, swearing talk of the patients. I
really suffered from this far more than I would have done had I been well' (Forel).
There are also alterations in the characteristic feeling-tone ofperceived ohjects.
Similar changes may occur with mere sensations and appear as abnormal
feeling-sensations .'The feeling of touch has become most unpleasant. When I touch wood (they
have given me poisoned pencils), wool or paper, I feel a burning sensation run
through all my limbs. I get the same burning feeling in front of the mirror. It "throws
out something" which rinses me with an acid feeling (that is why I avoid the mirror).
The best things to touch are china, metal, small silver spoons, fine linen or my own
body in certain places... .' 'In addition the obtrusive luminosity of a group of
colours (flowers at a distance) strikes my senses as devilish and poisonous. They have
a painful emanation, for instance, red, brown, green or black (printer's ink, deep
shadows, black flies). Lilac, on the other hand, yellow and white are all pleasant to
look at' (Gruhle).
'All my senses enjoy things more. Taste is different and much more intense than
before' (Rumke).
All the contents of our object-awareness, forms, figures, nature, landscape

and other people, have these characteristic feeling-tones for us. We can speak
of a 'physiognomy of things' which expresses their psychic essence. We only
have a very summary knowledge of the changes that may take place. In one
instance the patient spoke of the outer world as having grown cold and strange.
'I can see the sun shining, but I do not feel as if it is'. In other cases a positive
feeling for objects is present. A patient has a great feeling of tranquillity and
his view of the environment is clear and full of feeling. Everything is pregnant
with meaning, solemn and wonderful. He enjoys unthinkingly the impression
of a world divine and far-removed (as in light fever, in 'periodic states', under
opium, etc.). Nature is marvellous; the golden age is here; the landscape might
b&,a picture by Thoma or H. von Marees. The sun is incomparably beautiful. (All
,'ul
en Unattached feelings (free-floating feeling)

The elementary break-through of experiences, which are not understand-
ahle in their genesis, is manifested in unattached feelings. If they are to become

mt'"llingful to the subject, these feelings must first search for an object or try
I" create one. The feelings simply arise in the first place and remain in force
though they may never find an object. For instance, unattached anxiety is very
common in depressive states, so is a con tentless euphoria in manic states, so
hi obscure erotic excitement in early puberty, so are the feelings roused at the
.1I1ft of a pregnancy and in the early stages of a psychosis. Driven by an almost
Inescapable need to give some content to such feelings, patients will often
IIlIpply some such content on their own. It is a sign of critical insight if feelings
life actually described as lacking in content. Some of these contentless feelings
life as follows:
J. Anxiety is both common and painful. Whereas fear is directed towards
Nomcthing, anxiety is free-floating and unattached. We can differentiate a vital
IInxiety as a specific feeling-sensation in the heart, the anxiety of angina pectoris,
(II' as an anxiety of suffocation (e.g. the breathlessness in decompensated circulatory conditions). But anxiety may also be a primary psychic state, all-pervasive
"!lei dominating, analogous to vital anxiety and involving existence as a whole.
There is every degree from contentless, powerful anxiety that leads to a
clouding of consciousness and ruthless acts of violence against oneself or others,
down to a slight, anxious tension where the anxiety is experienced as alien to
I he self and inexplicable. Anxiety is linked with physical sensations such as
pressure, suffocation, tightness. It is often localised-precordial anxiety, for
instance; sometimes too in the head. A patient felt the urge to poke into it
physically as he might poke a painful tooth with a toothpick. But the existential
,lI1xiety, which is a fundamental of our human life as it manifests itself in
llI(1rginal situations and which is a source of Existence itself, can no longer be
I!,I'(Ispeci phenomenologically.
2. Anxiety is usually linked with a strong feeling of restlessness but this
(lTlotional state of inward excitement can occur on its own without anxiety.
Hctrospectively patients will call this feeling a 'nervous excitement' or 'fever'.
114
In a mild degree the state may occur in the form of a feeling that one has to do
something or that one has not finished something; or it may be a feeling that
one has to look for something or that one has to come into the clear about
something. In florid psychoses this feeling of restlessness may be heightened
to tension and a sense of oppression. Patients feel they cannot stand the
massive weight of impressions any longer and want only distraction and peace.
A schizophrenic patient in the early phases of his illness distinguished three

'Yl'rs of happiness: (I) 'intuitive happiness'-in which he is productive; it is for him a
f"lIblown and continual jubilation; symbolically he sees it as a sphere out of which
mhrr spheres emerge as a single solid mass; (2) 'bliss'-which is on a different level.
It 1M like ~oating; awareness of the body is faint, he stands above it; (3) while 'intuitlv" happmess' comes often and 'bliss' is rare, he has once had an attack of happiness
fill th~ ~ame level as. the ~t type but this is better expressed symbolically as an
IIvrr-nsmg wa:e, which S?lralS upwards while imposing masses pile up one on the
"Ihrr. Thefeehng ofhappmesscrescendoes .. bliss,on the other hand, is a contrastInK pe~ce. It remain~ quite ~ndependent and con tentless. Physical happiness is there
lI\unJ1;slde the psychiC happmess but the physical remains more on the surface' ..
III! f~lt as if the v.:ave of happiness was at once dark on the outside, bright and empty
wlrl~ln, a mere skm. I~ seemed so~ethi~g always s.training higher and higher, existing
fur Itself alone and With no relationship to anythmg. It faded out quickly in the end
lind left a state of psychic exhaustion. The feeling of happiness was con tentless but
briJ1;ht; the other ~periences of happiness were not so fine-spun, but much more
IIrlkulate. The patient felt he could not stand this state again; he said it would be
unh;arable be~use it c:une from within and would destroy him bodily.
fhe followmg case Illustrates how feelings of happiness link up with 'delusions of
N'ference' and become a source for such phenomena: 'It seemed as if everyone could
IWe .how happy I was and as if seeing me made others happy. I seemed something
diVine; older people at the station kept looking into my compartment; each did his
best to catch my eye; officers, officials, families with their children all ran in front of
me hoping I would look at them. That is all very fine, I said .. but I must know who
lind what I am : .. am I no longe: my~elf, am I altered? Then I cried because I always
hlld to be movmg on, yet I felt mfinttely happy. Even the animals were glad when
they saw me; swans stretched their wings out in honour of me .. .' (Rumke).
A schizophrenic patient in an initial phase described his restlessness as new and

different from the usual sort in which one cannot work, has to get up often or go for a
walk. He said it was more tangible, so to speak; it pervaded his whole being and
swallowed it up. He ran up and down in the room; he felt he could not escape. Going
for a walk was quite out of the question in this state. 'It tortures me more than anything else in the world; 1 can't get out of its reach; 1 want to tear myself away but 1
can't; it only gets worse; an urge comes to smash everything to bits but 1 can't trust
myself to start with something small; everything else would follow. I would start to
lash around; if I only threw a glass on the floor, everything else would come on its
own; the power of stopping myself is wholly undermined; I find it so hard to hold
back I wish sometimes "if only it were all over":
3. Abnormal feelings of happiness1 are complicated by dimly experienced
meanings which do not become objectively clear to the patient. They may
range from purely sensuous feelings of pleasure to mystical ecstasies of a
religious character. Feelings of sublimity2 occur as phases in psychasthenics
and as states of ecstatic intoxication in schizophrenic patients. Patients become
filled with a remarkable enthusiasm; are touched deeply by everything; find
everything moving and meaningful. During convalescence from illness, in
mild feverish conditions, tuberculosis, etc., soft, world-embracing, sentimental
states may occur. Schizophrenic experiences are described as follows:
'I woke up one morning with the most blissful feeling that I had risen from the
dead or was newly born. I felt supernatural delight, an overflowing feeling of freedom from everything earthly ... brilliant feelings of happiness made me ask "am I
the sun? Who am I?" ... "I must be a shining child of God" ... "Uncle A. changed
into God will fetch me ... we shall fly straight into the sun, the home of all those
risen from the dead ... in my blissful state I sang and shouted; I refused to eat and
no longer needed to eat; I was waiting for Paradise and to feast on its fruits' (GruhIe).
'Light clouds lifted me ... it was as if every moment more and more the spirit
was unwound from its bonds; a nameless delight and gratitude took hold of my
heart ... an entirely new and heavenly life began in me ... I was enormously
cheerful, I looked transfigured . . I felt extraordinarily well and delighted with
myself ... my condition at that time was to be envied ... I had a true foretaste of
heaven in myself ... my voice became clear and bright and I was always singing . :
(Engelken).
Another patient called his rare feelings a 'lust of the soul'. He felt it to be divine
and the content of eternal bliss. Such patients enjoy an entirelY;'lelf-contained state of
invincible delight, though bodily sensations appear to playa larger part than usual.
1
H. C. Riimke, Zur Phiinomenologie u. Klini1c des Gliic1csgefiihle (Berlin, 192.4).

Janet, Psyc1lasthenie, vol. I, pp. 388 If.
II)
(1/) The growth ofpriyate worlds from unattached feelings

. These new and unfamiliar feelings press for some understanding on the part
0/ the person who experiences them. Countless possibilities are contained in
them which can be realised only when reflection, imagination and formative
thought h~ve created some kind of coherent world. There is therefore always
1I path which leads from these unimaginable experiences of happiness towards
al~ attempt to ren~er the~ precise. The experience of blissful feelings starts
with a crystal clarIty of Sight though there is no real, clear content to communicate; the patients delightedly believe that they have grasped the profoundest of meanings; concepts such as timelessness, world, god and death
become enormous revelations which when the state has subsided cannot
he reproduced or described in any way-they were after all nothing but
feelings.
Nerval gives a self-description which shows this feeling of crystal-clear sight of
profou~d penetration into the essence of things: 'It struck me I knew everything;
C'vcrythmg was revealed to me, all the secrets of the world were mine during those
NI~a~ious ho~rs' .... A patient wrote: 'I seemed to see everything so clearly and
dIstinctly as If! had a new and remarkable understanding' (Gruhle). Another patient
II7
said: 'It was as if I had some special sense like second-sight; as if I could perceive
what I and others had never before been able to perceive'. (K. Schneider).
The patient of mine who described his three types of hap~iness whil~ he was still
critical and able to view his experiences without any delUSion formation, later on
developed other mystical and religious experiences f~om ~ese. He sensed th~ att~c~s
as 'metaphysical experiences' in so far as they contamed a character of t~e mfinlte
He also had certain objective experiences (vivid awarenesses, etc.) and said of them:
'I see something of infinite greatness, something that makes me shiver.' One day he
said he had 'experienced God' and that this was the 'climax of his life'. He had 'obtained his meaning'. It had lasted a good hour. Em~ations came from him and '~is
soul expanded'. Excitement was incredibly strong. Fmally there ~ peace and .bhss
with God and God poured into him. Comparing his form~r expen~nces of hap~mess
with this he put the experiences of God alongside the .happmess which seemed hke an
ever-rising wave, only now the crest had deta~ed I~self and be~ome a .sphere, expanding into the infinite. The experience had a co~mlc cha~acter . He sal~ the symbolic significance was different from that of the earher expenences of happmess. God
was the obvious content but only as a form that could be felt. The patient said
everything was quite incomparable, unimaginable, and had nothing in common with
his ordinary percepts .. He made other formulations such as 'I come to God, not
He to me. I am streaming forth .. it seems as if I might embrace the whole world
but stay outside myself as if my spirit stepped forth to embrace God'.
The awakening of new worlds in the schizophrenic transformation of the

Individual goes along with an alienation of the natural world. Patients feel they
hllve lost contact with things. They feel distant and lonely. 'What is there
In the world? I don't seem to belong to it any more' (Fr. Fischer).
II6
Feelings ofabsolution are often linked with these f~elings of ha~piness, this
clarity of vision and this experience of God; the pat1en~ then .quickly p~sses
from this sphere of feeling down into concrete delUSional Ideas. Pat~ents
feel freed from sin; they feel holy, children of God and eventually MeSSiahs,
prophets and madonnas.
. '
These feeling-states are found not only in the early experiences of schiZOphrenia. They also occur in toxic states (due to opium, mes~lin, .etc.~ and they
make a classic appearance in the brief moments before an eptleptlc seizure; nor
can they be wholly banned from the fields of normal experience, that is, no
other specific symptom seems present. We cannot class all the elaborate
descriptions of mystic ecstasies as psychiatric states.
Dostoevski gave repeated descriptions of his epileptic auras: 'And I felt that
heaven came down to earth and engulfed me; I experienced God as a deep and lofty
truth; I felt invaded by Him. "Yes, there is a God,"lshouted; after that I do not know
what happened. You can have no idea of the marvellous feelings that pervade an
epileptic a second before his attack. I do not know whether they last seconds or hours
but believe me I would not exchange them for all the lovely things that life can give.'
'Yes one such moment is worth a lifetime .. in these few moments I understand th~ profound and wonderful saying: "there should be Time no longer" '.
'There are seconds when suddenly you feel the one eternal harmony that fills all
existence. It is as if you suddenly feel the whole of nature within your~lf and s~y:
yes, this is the truth .. it is not only love, it is more than love; the clartty ?f feel~ng
and the overwhelmingness of the joy are terrifying. In these five seconds.I h~e a ltfetime and would give my whole life for them .. development has no pomt smce the
goal is reached ... .'
6.
URGE, DRIVE AND WILL
Psychological prefoce. Here, as before, we shall deal only with the phenomena of
IIctual experience, and not with any mechanisms outside consciousness. Such mechanIMIllS, e.g. motor mechanisms, carry into effect the instinctual impulses and volitions
which we experience and help them to outward expression; they give these experiences
Ilmple effectiveness. Volitional impulses that come into being outside consciousness
are either inwardly effective (as well-defined memory images) or externally effective
(11M motor performances). We will deal with the latter when we come to the chapter
on objective phenomena. Here we are concerned only with the direct subjective
oxperience as such.
In regard to the experience of instinctual drive and volitionl psychology only
lives us a few elementary concepts. From an over-all picture of the phenomenology
of these experiences, we can visualise them as arranged in a progressive series, subject
to Interruption by the appearance of qualitatively new elements. Thus we can distinguish the different experiences of primary, contentless, non-directional urge; of
Ililtural instinctual drive unconsciously directed towards some target; and of the
w,/itional act itself which has a consciously conceived goal and is accompanied with
In Awareness of the necessary means and consequences.
Urges, instinctual activity, purposeful ideas compete with each other as motiva,irlfl,l; distinct from these motivations which provide the material as it were, we find
',ei,rion which comes after weighing-up, wavering and conflict. This is the personal
'I will' or 'I will not'. This volitional awareness is an irreducible phenomenon, found
.Iongside the experience of instinctual activity and the experience of being at variance
III' in opposition. We speak of will or volitional acts only when there is some experif'III:C of choice and decision. When such experience is absent, the instinctual drive
"OI'N into action uninhibited by any volitional act. We then speak of instinctual he""V;OUf. Ifin the background there lies a possible volition, we experience a sense of
hrlng 'driven' or of being 'overpowered'. Without this, simple non-volitional,
1,IIlIogicai necessity asserts itself.
Bcsides these phenomena of urge, instinctual activity, conflict and volition,
Ihrrr. is the awareness of drive and will as they operate through motor discharges or
pNYl'hic effects. These effects are then experienced as willed or as due to a special kind of
impulse, i.e. as coming from me, belonging to me, and different from other sponIIIIII'OLIS phenomena such as muscle cramp. A special kind of inner volitional phent'lIIl'lIon is the voluntary or involuntary giving ofattention which increases the clarity
II,\(I Nignificance of the content.
(") Impulsive acts
When instinctual activity takes place directly without conflict or the
I I.(),ze, M,d. Psychologic, pp. ~87-32.5. Th. Lipps, Vom FiiMen, Wollen u. Denken,
\1 ~IP/.iI(, '97), Else Wentschcr, Dc, Wille (Leipzig, 1910).
~nd
edn.
II8
making of any decision, but still within the hidden control of personality, as
it were, we use the term instinctual act. But if the manifestation is uninhibited,
cannot be inhibited and is totally uncontrolled, we use the term impulsive act'!
We speak of an abnormal impulsive act whe~ no matter how much empathy
we exercise, the possibility of its suppression remains inconceivable. Such acts
are common in the acute psychoses, in states of clouded consciousness and in
states of retarded development. Instinctual acts but not pathological impulsive
acts are some of the commonest acts of our everyday life.
A schizophrenic patient in the first stages of his illness reported impulsive behaviour in the following terms: 'We had had a party. On the way home I was seized by
an idea out of the blue-swim across the river in your clothes. It was not so much a
compulsion to be reckoned with but simply one, colossal, powerful impulse. I did
not think for a minute but jumped straight in .. only when I felt the water did I
realise it was most extraordinary conduct and I climbed out again. The whole incident gave me a lot to think about. For the first time something inexplicable, something quite sporadic and alien, had happened to me' (Kronfeld).
With acute psychoses and certain transient conditions, we often find a
number of unintelligible instinctual activities. Motor discharge is usually
reached very quickly. A patient who seemed stuporous will jump out of bed,
thrash about, bite, run against the wall; on the next day, he is accessible and
knows what happened; he will say the impulse had been irresistible. Another
patient suddenly hit the doctor in the chest in the middle ofa quiet conversation;
a little later he apologised; he said the impulse came suddenly and irresistibly
with the feeling that the doctor was hostile. The simple urge to move (instinctual
discharge through pleasure in aimless movement) and the urge to do something
(discharge through a definite activity, handwork, etc.) are both common in
acute conditions. The urge to move may appear on its own and be circumscribed, e.g. an urge to talk when otherwise perfectly still.
In encephalitis lethargica, particularly with young people in the acute stage
and immediately thereafter, impulsive acts may be observed in the form of
sudden aggressiveness and cruelty. Thiele2 investigated these primitive urges
in detail and described them as elementary, aimless and undirected tendencies
to discharge which arise out of an unpleasant restlessness and tension. The
urge takes shape only in its effects, according to situation and opportunity and
turns into an action with a definite content. Such urges, like frustrated instincts, simply find an object; instincts always seek their object, whereas
volition determines the wanted object.
los~ ?f inter~st, lack of desire, absence of motive, etc.), or as an inhibition of

volttlQ~al drive (complaints of incompetence, inability to make a decision).
(b) Awareness of inhibition of will

Awareneness of inhibition is a characteristic disturbance,. which is experienced suhiectively as an inhibition of instinctual activity (complaints about
1 See Forster and Aschaffenburg, 'Impulsive Insanity', Z. NerY~k. (1908), p. 350. Ziehen,
Mx"r. Psychiatr., vol.. II, pp. 5), 393. Rauschke, C"arite-Ann., vol. 30, p. 251.
3 R. Thiele, 'Zur Kenntnis dec psychischen Residuarzustande nach Encephalitis epidemica',
Mse"r. Psycltiatr. (1926), Bcih. 36.
119
AlongSide this subjective inhibition we usually find objective inhibition but

not necessarily to a corresponding degree. The former can however b; experienced intensively, without any objective inhibition at all.
(c) Awareness ofloss of will or access ofpower

. The experien.ce of total loss o~ will-power is a remarkable phenomenon.
With ac~te! flond psychoses feeltngs of passivity and subjection are quite
character;tsoc. ~~ten we cannot decide whether we have here an experience
of defecove volioon or an awareness of an actual objective ineffectiveness of
the will. The following is an illustration:
'
The. patient is in bed. She hears a thumping at the door. 'Something enters' and
comes nght up t? her bed. She feels it and cannot move. It comes up her body righ[
up to the neck h~e a hand. She is terrified and all the time is fully awake but she
cannot cry out, raise herself up or sit up. She is utterly stricken.
It also happens to patients that without experiencing any content and
though. they are f.ully ~onscious, they cannot move nor can they talk. P~ople
may think the patient IS drunk and laugh at him. He may get annoyed but
ca~not answer back. Afte.rwards he remembers everything all right and shows
quite clearly that all the orne he was quite conscious. Such states have been in
part described as narcoleptic. Frie~mannl has described them thus: 'The eyes
are upturne? a~d fixed, the pupds are somewhat dilated and reacting; the
pow~r to ~nk IS arrested but consciousness is preserved. Posture is relaxed
and Immobde but more rarely there may be an automatic continuation of the
im~ediat:ly precedi,ng activity. The patient usually awakes without any
resldu~l dlstur.bance. We also find reports of similar paralysing attacks among
hyste~lcal pat1~nts and particularly in the schizophrenic group. Complete
conSCIOusness IS preserved. Suddenly-as if from a shock-the body fails to
respond to the volitional impulse, either as a whole or only in a circumscribed
are~. T~e body is experienced as rigid and stiff, heavy, powerless, lifeless. The
patient IS usually overtaken by this condition when lying down but sometimes
when he sits or stands; it differs from a paralysis in its transi:oriness.
KI 2 '
.,
oos gives some patients reports as follows: 'She tries hard to speak; it won't
work; she can't get up from the chair, give any sign or communicate, as if she was
gagged and bound; all the time she is frightened'-'She could not move mouth or
limbs while praying~ it was as if she were dying; she was not afraid; she thought she
woul~ wake up again; she went on praying in her mind; then it was all over. The
I~ext tI~e, ?owever, she felt ~eal fear of death. On both occasions the whole body felt
hfeless. - She felt she was tied; she could not lift her feet from the floor and had to
stay just where she was (but only for a few seconds).'
1
p.
Friedmann, Dtse". Z. Nervenhk., vol. 30
s~.Gerhard Kloos, 'Ober kataplektische Zustande bei Schizophrenen', NerYenar{t, vol. 9 (193 6),
Here we are not dealing with motor paralysis nor with a psychogenic
disturbance but with an elementary event during which the volitional drive fails
to get translated into physical movement. We do not know where the disturbance
lies. Phenomenologically, when we move, the last thing we experience is the
actual effort together with the image of the goal to which our movement is
directed. Pikler has analysed the situation. 1 If we exercise our will on some
particular bodily part in order to move it, the conscious point of attack is not
on the nerves and muscles but rather on the surface of that part of the body
which will be most engaged during the movement (e.g. on the surface of the
fingers, when grasping). The will has no dynamic impact itself but it impinges
at the point where the movement is conceived. We are in the dark as to where
this actual point of impact lies and where exactly we shall find the relationship
between the psychological experience and the entirely heterogeneous and
complex nerve/muscle process. It is only in pathological states that we see
thus dramatically demonstrated the disappearance of something we have always
accepted as a matter of course. There is no paralysis either to account for it.
A failure of motor-impulse is being experienced; there is an absence of the
normal, magical effect of the will on our physical movements.
This experience of utter powerlessness or ineffectiveness may also occur in
respect of controlling our own processes of thought and imagination, which we
normally take as a matter of course. Patients feel that something has taken
possession of their head; they cannot concentrate on their work; thoughts
disappear just when needed; inappropriate thoughts intervene. They feel
sleepy and absent-minded. In addition to an inability to work, they have no
wish to work. But they can be successful with mechanical activities and will
often undertake these gladly; in this they differ from patients in states of inhibition and fatigue. Such phenomena are common in the initial stages of the
process; intelligent patients will themselves say their condition is different
from ordinary fatigue, with which they are quite familiar.
With some acute psychoses patients experience the very opposite of what
we have so far described. They get an immense feeling ofpower. It is as if they
could indeed do anything. Physically they feel giants in strength; a hundred
people could not master them. Their power, they feel, has a remote extension.
Linked with this sometimes are certain feelings of immense responsibility;
an awareness that they are to perform world-shaking deeds:
In their own words. I have an indescribable influence on my surroundings. I think
12.0
Nerval described the following: 'I had an idea that I had become enormous, and
through a flood of electrical power I would throw everything near me to the ground.
There was something comical in the extreme care I took to hold my powers under
control, to save the life of the soldiers who had captured me... :
A schizophrenic patient wrote: 'All the people I speak to believe in me wholly
and do what I tell them. No one tries to lie to me; most of them have ceased to believe
1
Julius Pikler, 'Ober die Angriffspunkte des Willens am Korper', Z. Psychol., vol.
p.288.
110
(1929),
12.1
Illy look beautifies other people and I try this magic out on my nurses; the whole
world depends on me for all its weal and woe. I will improve and rescue it' (Gruhle).
Other patients will be surprised to find at the beginning of their psychosis

that they have an unusual power and clarity ofthought. Thoughts flow into their
mind just as they want them with a facility they have hitherto never had and
with a surprising copiousness. Now they feel capable of solving every possible
problem as if it were child's play. Their mental powers have been multiplied a
thousandfold.
7.
AWARENESS OF THE SELF
Psychological preface. Self-awareness is contrasted with object-awareness. As we

have had to differentiate a number of modes of object-awareness, so we have to do
the same for self-awareness, since the modes in which the selfhecomes aware ofitselfdo
not present any single or simple phenomenon. Self-awareness has four formal
claaracteristics: (1) the feeling of activity-an awareness of being active; (2) an awareness of unity-I am aware at any given moment that I am a unity; (3) awareness of
Identity-I am aware I have been the same person all the time; (4) awareness of the
IIClf as distinct from an outer world and all that is not the self. Within these four
formal characteristics, self-awareness displays a range of developmental levels from a
plain, bare existence to a full life with a conscious wealth of sensitive experience. In
the course of such development, the self grows aware of itself as a personality. Abnormalities of self-awareness show themselves typically as a lack of one or other of
these formal characteristics. In the end we come to abnormalities in the awareness of
personality, at which we will briefly glance.
(a) Activity of the self

Self-awareness is present in every psychic event. In the form of ' I think' it
Accompanies all perceptions, ideas and thoughts, while feelings are passive,
And instinctual drives are impelling states of the self. All psychic life involves
the experience of a unique and fundamental activity. Every psychic manifestation, whether perception, bodily sensation, memory, idea, thought or feeling
rarries this particular aspect of'heing mine' of having an'!, -quality, of 'personAlly belonging', ofit being one's own doing. We have termed this 'personalisalion'. If these psychic manifestations occur with the awareness of their not
being mine, of being alien, automatic, independent, arriving from elsewhere,
we term them phenomena of depersonalisation.
I. Alteration in awareness of existence. A group of phenomena which
represent defective awareness of one's own activity may be seen in what we
nln depersonalisation and derealisation, in the cessation of normal sensory
experience of one's body, in the subjective inability to imagine and remember,
In complaints of inhibited feeling and in the awareness of one's behaviour
becoming automatic. This whole group of phenomena are obviously related
to each other. Here we shall quote only the descriptions of patients l who are
aware of dleir existence as an awareness ofhaving lost the sense of self:
own thoughts and in addition he feels in the power of some incomprehensible

('x ternal force.
Patients showing a mild degree of this phenomenon feel they are estranged from
themselves; they feel they have changed, become mechanical; they will speak figux:atively of a twilight state, they say they are no longer their natural sel.ves. A~lel
records the following in his diaries: 'I feel nameless, impersonal; my gaze IS fixed llke
a corpse; my mind has become vague and general; like a nothing or the absolute; 1
am floating; I am as if 1 were not.' Patients also say: 'I am only an automaton, a
machine; it is not I who senses, speaks, eats, suffers, sleeps; 1 exist no longer; I do not
exist 1 am dead; I feel I am absolutely nothing.'
patient said: 'I am not alive, I cannot move; I have no mind, and no feelings; I
have never existed, people only thought 1 did.' Another patient said: 'T~e ;vor~t
thing is that 1 do not exist.' 'I am so non-existent I can neither wash nor dnnk. It IS
not that she is nothing but she just does not exist; she only acts as if she did; she
speaks of ,swirling'-doing something 'out of not-being'; nothing she did was out of
a sense of 'I am' (Kurt Schneider).
'Some artificial influence plays on me; the feeling suggests that somebody has
"Ilached himself to my mind and feeling, just as in a game of cards someone looking
over one's shoulder may interfere in the game (a schizophrenic patient).
12.2.
The remarkable thing about this particular phenomenon is that dIe individual, though he exists, is no longer able to feel he exists. Descartes'
'cogito ergo sum' (I think therefore I am) may still be superficially cogitated
but it is no longer a valid experience.
2.. Alteration in the awareness of one's Own performance. Loss of the sense of
existence can also be conceived as a reduction in one's awareness of performing one's own actions, an :),wareness which normally accompanies every
psychic event. In the natural course of our activities we do not notice how
essential this experience of unified performance is. We take it for granted that
when we think, it is we who think, a thought is our thought and the notions
that strike us-and perhaps make us say not 'I think' but 'it occurs to me'are still at the same time our thoughts, executed by us.
This general awareness of one's own performance can alter in a number of
directions which are quite incomprehensible, difficult to imagine and not
open to e~pamy. With compulsive phenomena, where the patient cannot rid
himself of haunting tunes, ideas or phrases, we can still find some measure of
comprehension. The patient takes the distressing part of the .experien~e ~s
part of his own thoughts. But the thought-phenomena of schlzophremcs l~
something quite different in that they talk about 'thoughts made by others
(passivity-thinking) and 'thought-withdrawal', using words coined by themselves, which psychopathology has had to take over. Patients think some~hing
and yet feel that someone else has thought it and in some way forced lt on
them. The thought arises and with it a direct awareness that it is not the
patient but some external agent that thinks it. The patient does not know wh!
he has this thought nor did he intend to have it. He does not feel master ofhls
1 Janet, Les olmssions et /a psychasthenie. 2.nd edn. (Paris, 1908). Osterreich, Die Phiinomen%gie deslch (Leipzig, 1910).
12.3
Just as the patients find their thoughts are 'made' for them so they feel that
these are being withdrawn. A thought vanishes and there arises the feeling that
Ihis has come about from outside action. A new thought then appears without
context. That too is made from outside.
A patient tells us: 'When she wants to think about something-a business matter
for instance-all her thoughts are suddenly withdrawn, just like a curtain. The more
.he tries the more painful it is-(a string seems pulling away from her head). Still
Mhe succeeds in holding on to them or regaining them.'
It is extremely difficult to imagine what the actual experience is with these
'made thoughts' (passivity thinking) and these 'thought withdrawals'. We
IUllt have to accept the account as outsiders, relying on me descriptions we are
~Iven of these otherwise easily recognisable phenomena, which are not to be
confused with unusual thought-content, poorly grounded notions or compulsive phenomena.
There is still another abnormal mode in which dloughts are presented. No
one speaks them to the patient nor are the thoughts 'made' nor does the patient
oppose them in any way. Nevertheless the thoughts are not his own, not those
which he usually thinks; they are suddenly implanted, coming like an in.piration from elsewhere:
'I have never read nor heard them; they come unasked; 1 don't dare to think 1
source but 1 am happy to know of them without thinking them. They come at
lilly moment like a gift and I do not dare to impart them as if they were my own'
(C ;ruhlc).
11111 I he
Any mode of activity may acquire this sense of being 'artificially made'.
Not only thinking is affected, but walking, speaking and behaving. These are
nil phenomena that exhibit influences upon the will. They are not the same as
those of which people complain who suffer from personality disorders and
clrpression and who declare it is as if they themselves were no longer acting
1)111 have become mere automata. What we are discussing here is something
I'Ildically different, an elementary experience of heing actually influenced.
I'al ients feel themselves inhibited and retarded from outside; they cannot do
what they want; when they want to lift something, their hand is held; some
pllychic power is at work. They feel as if they were pulled from be4ind, immohilised, made of stone. They suddenly find they cannot go on, as if they
wrn~ paralysed and then suddenly it has all gone again. Their speech is sudtlrllly arrested. They may have to make involuntary movements; they are
124
surprised to find their hand is led to their forehead or that they have attacked
someone else. They did not intend it. This is all felt as some alien, incomprehensible power at work. A patient of Berte said: 'I never shouted, it was the
vocal chords that shouted out of me: 'The hands turn this way and that, I do
not guide them nor can I stop them: Here are phenomena which seem to lie,
outside our imagination. There is still some similarity with a volitional act,
yet it seems to be an autistic, reflex movement which we have merely observed.
Its performance is 'criticised' not executed by a self. The following passages
from a self-description will make the matter clearer:
patients who interpret their compulsive ideas as a doubling of personality or

ullllounce that they conclude they have a double self for one reason or another
(rK heautoscopic hallucination). Nor is the experience in question to be confused with the so-called 'double personality' which appears objectively in
"It~rnating states of consciousness. The real experience of heing in two, of
~"mg douhled occurs when both chains of psychic events so develop together
Iilul we can talk of separate personalities, each with their own peculiar exI~rl'icnces and specific feeling-associations, and each perfectly alien and apart
from the other. The old autobiographical sketch of Father Surinl gives a very
vivid description, if we allow for the religious language in which it is cast:
'The "shouting miracle" is an extraordinary occurrence; the respiratory muscles

are put into motion, so that I am forced to shout out, unless I make an enormous effort
at suppression, which is not always possible in view of the suddenness of the impulse,
or rather I have to concentrate relentlessly on it ... At times the shouting is so
repetitive that my state gets unbearable ... since words are shouted my will is of
course not altogether uninvolved . It is only the inarticulate shouting which is
really like a compulsion and automatic .. my muscles are subject to certain influences
which can be ascribed only to some external force ... The difficulties too, which
get in my way when I want to play the piano, defy description-paralysis of my
fingers, alteration of my gaze, misdirection of my fingers on the keys, quickening of
tempo through premature movement of the finger muscles... .' We also find in this
patient analogous experiences in the field of inner volition-'passivity thinking'
(made thoughts) and 'thought-withdrawal', etc. (Schreber).
We also find that instinctual activities are experienced as 'made' in this
, sense, sexual drives in particular:
A schizophrenic patient describes suprasensual enjoyment with young girls
with no physical contact ... 'a pretty girl flirts in passing .. attention is roused ...
one gets acquainted rather like a pair of lovers ... after a little while she makes
gestures towards her lap ... she wants to arouse sexual stimulation from a distance
telepathically without physical contact and bring about an ejaculation as with a real
embrace'.
Another patient said: 'My character is not mine, it has been "made".'
(h) The unity of the self

The experience of the basic unity of the self can undergo some notable
changes. Sometimes, for instance, while talking we may notice that we are
talking rather like an automaton, quite correctly may be, but we can observe
ourselves and listen to ourselves. Should this dissociation last any length of
time, disturbances will occur in the flow of thought, but for a short time we
can ourselves experience without any disturbance that 'doubling' of personality which patients describe to us in much more elaborate terms. l This is
not the old familiar situation in which we say 'two beings live within my
breast' or where reason struggles with passion. Nor must we be misled by
I Janet, Les obsessions et /a psyehasthenie., 2nd edn. (Paris, 1908), pp. 319-:1.2. Osterreich, Di.
PI.dnom,n%gi, des leI. (Leipzig, 1910), pp. 4U-s09.
'Matters have got so far that I believe God, because of my sins, allows something
unique to happen in Church (the Father was practising exorcism). The devil leaves
the body of the possessed person and rushes into mine, throws me on the ground
Illd beats me violently for some hours. I cannot really describe what goes on; the
Iplrit unites with my own and robs me of consciousness and the freedom of my own
mind. It reigns in me as another self, as if! have two minds, one dispossessed of the
Ulll of its body and pushed into a comer, while the other intruder ranges round unchrcked. Both spirits fight within the same body and my mind is divided, as it were.
Onc part is subject to this devil, the other obeys its own motives or those which God
vc it. I feel at the same time a deep peace and that I am in accord with God without
knowing whence comes the raving and hate of Him which I feel inside me, a raging
dC'Nlre to tear myself away from Him that astonishes everyone; but I also feel a great
Illd mellow joy which cries out as the devil does; I feel damned and afraid; as if my
tlnr. mind is pierced with thorns of despair, my own despair, while my other mind
Indulges in derision and cursing against the author of my distress. My shouts come
(!'01Il both sides and I cannot decide whether pleasure or fury prevails. Violent trembItll~ seizes me on approaching the Sacrament; it seems due both to distress at its
IJft"NCnCe and to adoration of it; I cannot stop it. One mind bids me make the sign of
,IIr cross on my mouth, the other mind stops me and makes me bite my fingers
fllrlously. During such attacks I can pray with greater ease; my body rolls on the
I!'lOlind and priests curse me as if I were Satan; I feel joyfully that I have become
SllIall, not in revolt but because of my own miserable sins'. (The Father seems to
IhlVe fallen ill in due course with a schizophrenic process.)
Jt is rare to get a description of these remarkable experiences of a double

_rlf, where the self is really one, yet experiences itself as two and lives disnrlcly in both sets of feeling-associations, and knows them both. The fact of
litis double existence cannot be denied and every formulation of the experience
IIlw<lys carries this contradictory quality.
(.. ) Identity of the self
The third characteristic of self-awareness is the awareness of one's identity
11I1'O\lgh the passage of time. We need only think of statements made by cer111111 schizophrenic patients. They will speak of their previous life before the
12.6
onset of their psychosis and say this was not their own self, but somebody else.
A patient said:
'When telling my story I am aware that only part of my present self experienced
all this. Up to 2 Jrd December 1901, I cannot call myself my ~rese~t self; the past ~lf
seems now like a little dwarf inside me. It is an unpleasant feelmg; It upsets my feeltng
of existence if I describe my previous experiences in the first person. I can do it if I
use an image and recall that the dwarf reigned up to that date, but since then his part
has ended' (Schwab).
(d) Awareness of self as distinct from the outside world

The fourth characteristic of self-awareness is the clear sense of the self
confronting an outside world. According to rather obscure utterances of
schizophrenics patients seem to identify themselves with the objects of the
outer world; they suffer from what others do. If someone is spinning, they
say 'why are you spinning me?' or, when a carpet is beaten, say 'why are ~ou
beating me?' (Kahlbaum). A schizophrenic patient said: 'I saw a vortex whlrling before me-or rather I felt myself whirling outside in a narrow space'
(Fr. Fischer). During mescalin intoxication one re.port reads: 'I felt the ~og's
bark painfully touching on my body; the dog was 10 the bark and 1 was 10 the
pain' (Mayer-Gross and Stein). During hashish intoxication: 'Just now 1 was
a piece of apple' (FraeDkel and Joel, S.102). In this sa~e c~tegory we ca~ place
patients who for brief moments think they are vamsh1Og; they are hke a
mathematical point' or they continue to live only in the objects around them.
Baudelaire describes something of this sort in hashish intoxication:
'Sometimes one's personality disappears and objective reali~, as with t~e pantheistic poets, springs up in its place, but in such abnormal fashtOn that the ~lgh.t oC
external things makes you forget your own existence and soon you ~re flowmg mto
them. You look at a tree bending in the wind. As a poet you see It as a perfectly
natural symbol of yourself, but in a few seconds it ha.s b.ecome reall~ you. You
ascribe to it your passion, longing and melancholy. Its slghmg and wavmg ~ome
yours and soon you are the tree. So with the bird sailing about in the blue sky; It may
first only symbolise the eternal longing to soar above human concerns but ~uddenly
you have become the bird itself. Let us imagine you are sitting th~re smokmg your
pipe; you let your attention linger a little too long on the blue .plpe-smoke ...by
some peculiar equation you feel yourself wreathing up, you wl.11 become th.e pipe
(into which you feel yourself pressed like the tobacco) and credit yourself with the
strange ability to smoke yourself.'
. .
A schizophrenic patient said: 'The sense of self had dwmdled so that It was necessary to complement it with another person-rather like the wish for stronger selves
to be near and protective .. I felt as if! were only a little piece of a person' (Schwab),
We now add a few reports from patients about similar experiences, the
basis of which must be some cancellation of the distinction we normally draw
between the self and the outside world. It is a frequent remark of schizo-
phrenics that tke whole world knows their thougkts. Patients answer all questions
hy saying, 'Why do you ask me-you know it already':

Patients notice that other people know their thoughts as soon as they have them.
Or, in a way similar to passivity-thinking and thought-withdrawal, they experience
the feeling of being exposed to everybody. 'I believe I can no longer hide anything; I
have experienced this over the last few years; all my thoughts have been guessed. I
realise I can no longer keep my thoughts to myself.'
() Awareness of one's personality

Once the merely formal awareness of self acquires content, we can speak
of awareness of personality. This, in its totality of content, provides subjectmatter for the psychology of understandable connections. So far as phenomenology is concerned, the basic characteristics are as follows:
I. The individual can have two distinctive relationships to his own experience.
Many instinctual activities are sensed by the personality as a natural expression
of itself and its momentary state. They are felt to be entirely understandable
In terms of the personality and experienced as its own instinctual drives. This
IN so for quite abnormal, sado-masochistic drives, urges to suffer, etc. There
lire other instinctual drives, however, which the personality experiences as
ulien, unnatural, not understandable, not as its own. They are felt as something
Imposed. The phenomenological opposites of subjectively understandable
lind ununderstandable drives can be contrasted with drives that are objectively
understandable and ununderstandable to the observer. The two sets need not,
however, tally. Perverse sexual drives which may occur at the beginning of a
process (for instance, in senility) can be subjectively experienced and recognised as the patient's own, whereas objectively they may be seen as something
quite new, not understandable, and due entirely to the morbid process itsel
On the other hand, instinctual drives which have become an irresistible habit
may be subjectively experienced as something alien, whereas objectively they
lire regarded as quite understandable.
2. The feeling of change in one's own personality is a normal experience,
particularly at the time of puberty. Then many different and stormy impulses
arise in the psyche, and new experiences emerge from obscure depths. There
is a strong awareness-sometimes painful, sometimes delightful, sometimes
nippling, sometimes lending wings-that one has become another and a new
person. The awareness of patients in the early stages of their illness comes very
close to this. They are conscious of something new and puzzling; they feel
I hey are different. They feel that their awareness of their own personality has
I)("come uncertain, that there is something alien against which they have to
Ii~ht. At last there comes the awareness of being wholly overpowered. Some
patients will say that they think differently, feel and sense differently from
what they did before. Some profound transformation has taken place. Others
'J;IY that after an acute psychosis the change which they feel is something subje"l:tiveiy pleasurable; they are more indifferent, less excited, not so easily
12.8
'moved to their depths'; at the same time, they talk more easily, they have less
reticence and are more certain in their conduct. A patient wrote:
into veritable personifications, a name aptly given to them by a patient (Staudenmaier):
'I was in a state of great physical weakness for several years; because of this
morbid physical state, I turned gradually into a passionless, calm and reflective person. This was the opposite of what one might have expected, in view of the influences
at work (telepathic effects).'
A patient complained: 'She longs for herself but cannot find herself; she has to
look for the person inside her'-'Two years ago I started to wither'-'I have lost
myself-I am changed and without defence' (Gruhle).
S taudenmaier, Professor of Chemistry, described these personifications among his

pathological experiences. He did not regard them (as the other schizophrenic patients
did) as strange beings, but as 'emancipated parts of his unconscious' . We will follow
his account, which has certain affinities with that of Father Surin quoted above:
'Single hallucinations gradually emerged more definitely and returned more often.
At last they formed into personifications; for instance, the more important visual
images regularly combined with the corresponding auditory images, so that the
emerging figures began to speak to me, gave me advice and criticised my actions. A
characteristic defect of these personifications is that they really think they are what
they represent or imitate and therefore they talk and act in earnest. For a long time I
tried to elaborate them further.' Here are some examples:
A few years ago I was watching some military exercises. I chanced to see one of
the Court personages at close quarters repeatedly and heard her speak. Later I had a
vivid hallucination-as if! heard her speak again. At first I paid no attention to this
frequently recurring voice and for a time it disappeared. At length I had the feeling
more and more often and clearly that this personage was near me and the visual image,
by constantly forcing itself on me along with the inner voice, became clearer too
without at first becoming a true hallucination. As time went on personifications of
other Court people appeared, particularly the personification of the Kaiser, then the
dead Napoleon 1. Gradually I was overcome by the feeling, a peculiarly exalted
feeling, that I was dictator and ruler of a great nation; my chest s,welled on its own,
my whole posture became stiff and military-proof that the respective personification had gained considerable influence over me. For instance, I heard the inner voice
speak in grandiose terms: I am the German Kaiser. After a time I grew tired; other
images forced themselves on me and I relaxed. Out of all the royal personages who
ltppeared to me, a concept of 'Majesty' gradually developed. My majesty greatly
desired to be a foremost, or rather royal and ruling personage at least, and-as I
became more enlightened about these personages-to see and imitate them. Majesty
interests itself in military displays, cultivated living, good manners, rich food and
drink, order and elegance in my home, distinguished attire, fine, erect military bearing, exercise, hunting and other sports and tries to influence my mode of life accordingly with advice, warnings, orders and threats. Majesty, however, is an enemy of
children, of quaint little things, of jokes and making merry, seemingly because it
knows the royal personages from their dignified appearance in public or from pictures
of them. Majesty is also an enemy of comic papers and magazines with caricatures,
lind of water-drinking, etc. Physically I am myself somewhat too short for 'Majesty'.
The personification 'child' plays a similar role to that of 'Majesty'; there is the childish
voice, childish needs and pleasures; there is also the personification 'roundhead' who
('njoys jokes and jolly things. All have distinctive voices and one can speak with them
as if with different people, 'except that one has to remain within the special field they
rl'present and keep everything else out. As soon as one starts with anything diametrically opposite, the whole idyll vanishes'. The clearly defined personifications
were preceded in time by less well-defined and rather hazy ones. 'Sometimes devils
~l'cmed let loose. I saw devilish faces repeatedly for quite a long time all perfectly
dear and sharp. Once when I was in bed I positively felt someone putting chains
3. Lability in awareness of the personality is experienced in all sorts of ways

in the acute, florid psychoses. The following self-description illustrates this
phenomenon clearly, and the patients themselves sometimes call it 'taking
part in the play'. The example shows well the awareness of lability at the same
time as this is being experienced:
'I was in a state bordering on actual delusion, yet still clearly distinguishable from
it. It was a state that recurred frequently in the course of my illness, when, half-driven
by inspiration, half-knowing and wanting it, I created a part for myself which I
played out like an actor, declaiming it; I lived myself into it and acted according to it,
without considering myself entirely identical with the character.' Among the parts
played were 'the personification of a wave', 'the prancing of a fiery young horse', 'a
young sister of Queen Sulamith in the noble song', 'the daughter of Alfred Eschers',
'a young French woman' or 'agriculture'-in which the hospital courtyard was the
estate (Forel).
In similar psychoses patients experience themselves as Messiahs, divine
personages, witches, or as historical characters. In the paranoid psychoses (in
which Bonhoeffer 1 has described the lability of this personality-awareness),
we can see the patient elaborate the role-say that of some world-famous
inventor-and maintain it tenaciously over a long period of time. During
these fantastic transformations it may happen that the patients remain aware of
their previous identity; they are still the same but are now Messiahs, etc.
(f) Multiple personalities: dissociated personality

Such a doubling or multiplication of the self can take place that patients
find themselves confronted by entirely alien forces, which behave as if the.v had
a personality. They not only use devious means, with certain obvious purposes,
but they have a definite character, friendly or hostile. At the most elementary
level in the formation of these entities we find the so-called simultaneous
hallucination of several senses. The personality which the patient visually
hallucinates also talks. 2 Voices, visual hallucinations, delusions of influence,
doubling of body-awareness, may all combine and shape themselves eventually
1 Bonhoeffer, 'Klinische Beitrage zur Lehre von den Degenerationspsychosen', Alt's Samml.,
vol. 7 (Halle, 1907).
8 Specht, Z. Psych,'path., vol. 2.
13
round my neck; then I smelt sulphur, and an eerie inner voice said, "You are now my
prisoner-I shall not let you go-lam the devil himself". Threats were often launched
at me. I have really experienced it all in myself. Those tales about evil spirits which
modem people present as the horror fables of the middle ages and those reports of
spiritualists about poltergeists have not been dreamt up out of nothing. The personifications work without relation to the conscious personality but each one of them
tries to gain complete control over it. A lengthy battle goes on with them and also
between them, since some seek to help the conscious personality. I often observe
quite clearly how one or two personifications will help and support each other or
how they will secretly conspire to fight against me, the old man-which is the nickname they always use-and annoy me (rather like the situation when telegraphists
in a number of stations in a complicated network conspire together without letting
the others know). But how they fight against each other and abuse each other.'
'Because of the far-reaching and sometimes pathological influences of certain centres
and personifications I could observe how vigorously they fought and how powerfully they tried to force out the feelings and ideas they found unpleasant and assert
their own wishes and ideas, so as to improve their position in the organism and make
it more influential.' All personifications have something one-sided about them. They
are not wholes, only parts which are able to exist as dissociated parts of the unconscious side by side with the conscious personality.
These descriptions show us the attitude which Staudenmaier took towards these
phenomena. This becomes clearer, as follows: 'Inexperienced in these things, one
certainly gets the impression that a mysterious invisible and alien personality is
playing a game. This "inner voice" has been acknowledged from time immemorial,
has been regarded as divine or devilish.' Staudenmaier, however, felt this to be false;
he did feel possessed in the same way as the Saints in the Middle Ages, but not by
alien powers, only by split-off parts of his own unconscious. 'I considered them as
entities that had still got a certain independence of existence, although they were
developed for certain partial purposes and were confined once and for all to a definite
place in the organism. Because of their one-sided position and purpose, they have
certain separate memories and separate interests which do not necessarily coincide
with those of the conscious self. With nervous people particularly they often gain an
extraordinary ascendancy over the affect and over the whole mode of life of the conscious self, since they are themselves capable of such diverse affects. If they are capable
of learning, they can eventually develop, as with me, into very intelligent partexistences with whom one has then to reckon seriously.' Normal people get to know
of the influence of their unconscious from the obscure feelings they experience; but
Staudenmaier made contact with his dissociated personalities in articulate conversation and thus experienced his unconscious more vividly than is otherwise possible.
He does not believe that these dissociated entities are in principle different from what
is contained in the normal unconscious. 'There are a number of intermediary stages
starting from the complete and autocratic psychic unity of normal people down to a
pathological splitting-up and far-reaching emancipation of individual parts of the
brain.' Staudenmaier 'took as evident that the human being represented a single
psychic entity. We should not forget that we have been dealing herewith a state that
passed directly into the pathological. Still the fact that such phenomena are possible
remains of the utmost importance for any evaluation whic1z we may make of the human
psyche and its nature.'
8.
13 1
PHENOMENA OF SELF-REFLECTION
Psychological preface. I am not only conscious in the sense of having certain

inner experiences, but I am turned back on myself-reflected back-in consciousness
of self. In the course of this reflection I not only come to know myself, but I also
influence myself. There is not only something happening within me, but I instigate,
arouse and shape a happening within me. I can, as it were, draw reality into me as well
as evoke and guide it.
Human development in the individual and in history is not only a passive transformation as with all other biological happenings, but it is an inward effort of mind
and spirit working on its own, driving itself forward in the universal dialectic of
opposition and transformation.
For this reason, there is no longer any such thing as unmediated psychic life.
Thinking and volition beget reflection and with the reflective process begins the
indirect alteration of all direct experience. Once, however, direct experience ceases to
be the sole determining factor, we not only find expansion, a general unfolding, and
new dimensions of experience, but also interferences of an entirely new character.
For instance, to take the simplest, basic immediacies, the instincts, not only can they
be assisted by reflective purpose, but they can be thoroughly confused and obliterated by it.
Interference of this sort arises when the mechanisms that realise and co-ordinate
reflection with immediacy do not take their natural course, which remains obscure
but maintains all that is self-evident, beneficial and unproblematical in our lives,
reflect how we may.
Human psychic life can no longer be an immediate experience such as that of
animals or idiots. Should it become a purely elementary process, we should have to
consider it disturbed; equally so if it were nothing but pure reflection.
The fact that the immediate phenomena we experience do not remain immediate
but are constantly being transformed by reflection does not obliterate for most of us
their immediate character, as indeed we have tried to describe it in all its great variety.
But the fact of alteration remains a basic one and while we investigate phenomena we
should keep our eye carefully on the possible changes wrought by reflection. In
particular it may be the source for new psychopathological phenomena which we will
illustrate by three examples: Firstly, purposeful reflection may lead to disingenuousness; in hysterical persons it may deceive us with what appear to be real experiences.
Secondly, it may throw instinctual activity, including the bodily functions, into confusion and, thirdly, it may lead to compulsive phenomena, unique psychic experiences
that are possible only on the basis of reflection and volition. In all these three instances
purposeful reflection is indispensable for the production of the phenomena which
clearly did not intend themselves.
The immense importance of reflection when it has contents to work on will be
discussed when we come to the chapter on meaningful psychic connections. All the
pathological manifestations which we review here as phenomena will find a natural
place there. They are but moments in a person's life and their content needs to be
understood in the context of that life. Here however we are concerned only with the
phenomena of experience as such, and the various types and forms. We are not dealing with their content or their meaning.
(a) Psychic life-mediated and unmediated Dy thought

Normal, everyday psychic life is always in some way rooted in reflection.
In this it contrasts with psychotic, elementary experience. For instance, if we
contrast delusion proper with an ordinary mistake, a vivid awareness with an
'as if' experience, melancholia with a neurotic depression after an unpleasant
occurrence, hallucination with projected fantasy, the experience of a double
self with the feeling of a 'divided self', an instinctual drive with a simple wish,
or motor agitation with a meaningful motor discharge of emotion, we see a
number of elementary, immediate and irreducible experiences on the one hand,
and on the other something that has evolved and grown, something that is
rooted in ideas and in living into these ideas with some intensity, something
that is perhaps a little faint and secondary by comparison, though the momentary affect and visible passion may be striking. What is elementary and immediate cannot be influenced by psychological means, though the latter may
influence anything that is mediated by thought. What is elementary is primarily without content and gains this only secondarily, but whatever has been
evolved conceptually starts from content and operates in reverse. All that is
understandable and has developed understandably stands contrasted with
phenomena that are obscure in their causes, exist incomprehensibly and break
into the psyche with an elementary force. Whatever is purely elementary in
this way belongs to a morbid process.
Where the understandable development is a healthy one, there is nothing
disingenuous or deceptive about it but it is the undistorted reality of psychic
development following its proper course. Yet whatever is mediated through
concepts may become a distorting factor. Deception, difficult to detect, can
intrude subtly along hidden connections. The smooth, well-adapted existence
of the animal ceases once immediacy is at an end. Animals live beyond truth
and untruth, but I, the human being, experience life and cannot simply leave it
at that. I believe I am myself but I develop intentions and grow disingenuous
in imitation. People with pronounced hysterical endowment can reach extraordinary lengths in this respect so that their psychic life which is entirely
derived and thought up, totally artificial and treacherous, can become for the
time being an elementary experience, gripping and immediate. For instance,
a young man suffering from schizophrenia lived with a woman hysteric who
shared many of his hallucinations and anxieties. The patient said of her, 'If
one gets caught up, one is nervous; once one has the actual experience, one is
not at all nervous; in my case the whole thing is much quieter and clearer.'
and the acquisitions of our personal history fuse into one. But reflection,
which is indispensable for the development and stability of both, may in itself
create a disturbance.
132
(D) DisturDance of instinct and Dodily fonction

So far as our bodily functions are concerned, we live successfully because
we rely all the time upon the unconscious guidance of our instincts. But these
in their turn are developed by exercise, and refashioned and enriched by our
consciously inspired activity. The details of this process are extremely complicated and we can never wholly disentangle them. Our biological inheritance
133
Such functions as urination, walking, writing, sexual intercourse can no longer

he carried out. The affected person feels he is losing contact as well as becoming
ddiculous. He wants to be able to do these things but directing his attention to them
only makes it worse. Fear of failure makes it worse still.
Anxious attention to health brings about hypochondriacal complaints. As the
"('sult of constant reflection on the body and its functions, subjective syndromes
dcvelop with partly objective effects. Finally, expectations and fears drive consciousness into a life which concerns itself chiefly with the body and which in the process of
looking for itself, actually loses itself.
(c) Compulsive phenomenal

I. Psychic compulsions. Experience of psychic compulsion is an ultimate
phenomenon. I may feel under quite normal conditions that I am being driven,
Impelled or overpowered not only by outer forces and other people but by my
Jwn psychic life. We have to keep this normal phenomenon well in mind and
r~alise that it is strangely possible for us to oppose ourselves, want to follow
1111 instinctual drive, yet fight it, want and yet not want. Otherwise we shall
not properly understand the phenomena described in psychopathology as
compulsive ideas, compulsive drives, etc.
Normally the self lives freely in its perceptions, anxieties, memories and dreams.
This is so whether it surrenders itself to them instinctively or whether it deliberately
l'huoses what it will attend to, what it will make the object of its affections. Now
Nhould the self be no longer master of its choice, should it lose all influence over the
IH'lcction of what shall fill its consciousness, and should the immediate content ofconu;ollsness remain irremovahle, unchosen, unwanted, the self finds itself in conflict faced
with a content which it wants to suppress but cannot. This content then acquires the
dmracter of a psychic compulsion. This is not the kind of compulsion we feel when
we are suddenly distracted by something catching our attention, but it is a compulNion from within. Instead of the normal consciousness of controlling the sequence of
('vI'nts (Kurt Schneider) there arises a consciousness of compulsion, the person cannot
1'1'('(' his consciousness if he would.
We do not speak of a psychic compulsion when in the course of ordinary inhlinctual experience our attention is drawn to one thing or another or some desire is
ilwakened. Psychic compulsion is possible only where there is a psychic life suhject to a
I'Ufa;n degree of volitional control. Psychic events can become compulsive events only
1 Compulsive ideas: see Friedmann, Mschr. Psychiatr., vol. 2.I. Compulsive phenomena: see
I."wcllfeld, Die psychischen Zwangserscheinungen (Wiesbaden, I904); also Bumke, Alt's Samml.
(llull.., 1906) (he defines and restricts the old concept created by Westphal). Kurt Schneider,
/.. N,lIr. (Ref.) (1919). Critical bibliography, also 'Die psychopathische Personlichkeiten',
,til ..dn. (1942.), pp. 65-75. H. Binder, Zur Psychologie der Zwangsvorgiinge (Berlin, 1936). Straus,
M,I(h,. Psychi:ur., vol. 98 (1938), p. 6I If. Freiherr v. Gebsattel, 'Die Welt des Zwangskranken',
M,,'/". P.sych,atr., vol. 99 (1938), pp. IO If.
134
when they contain an experience of self-activity. There is, therefore, no psychic

compulsion where there is no volitional control and no choice, as with idiots and
very young children.
All psychic events that contain an element of deliberation can become characterised by compulsion, and we use the prefix 'compulsive' when we wish to emphasise anyone of them. Where the self tries but is unable to withdraw its attention
from some hallucination, sensation or anxiety, we may speak of compulsive hallucinations, compulsive sensations, compulsive anxiety, etc. Compulsion is co-extensive with the range ofthe individual's volition. Perception retains a compulsive character
only as long as I cannot divert my sense-organs or close them against the stimulus.
Compulsion as so far described refers only to the form in which psychic events
appear. As to content, this may be meaningful and integrated with the personality;
for instance, the fear of confinement which a woman experiences not for the moment
only but with her whole personality as ajustifiahle anxiety. However, in so far as she
may try in vain to think of something else, she experiences this anxiety as a compulsion. Yet she may realise that her fear is in fact unjustified and refuse to identify herself
with it, considering it groundless and silly, not her fear. The anxiety is compulsive in
character, related in content to the self, a possible anxiety but essentially alien to the
self. In other cases the content of ideas is entirely nonsensical, the alien quality comes
forward in a drastic manner (the individual cannot take a walk without having injured someone behind him in the eye, unnoticed, with his umbrella). In the strict
sense of the term, compulsive thoughts, impulses etc., should be confined to anxieties
or impulses which can be experienced by the individual as an incessant preoccupation,
though he is convinced of the groundlessness of the anxiety, the senselessness of the
impulse and the impossibility of the notion. Thus compulsive events, strictly speaking,
are all such events, the existence of which is strongly resisted by the individual in the
first place and the content of which appears to him as groundless, meaningless or
relatively incomprehensible.
We can gather these compulsive phenomena into two groups if we want to get
some comprehensive picture of them. Firstly: compulsive phenomena in the wider sense,
where the main characteristic is the feeling of subjective compulsion and the content
is indifferent (formal compulsive thinking). An image, thought, memory or question
may intrude into consciousness repeatedly. One is haunted by a tune, for example,
but it need not be such an isolated content only; there may be an intrusive re-orientation of one's thinking; one has to count, for example, spell names, ponder insoluble
and silly problems (rumination) etc. Secondly: compulsive phenomena in the narrower
sense, where the further characteristic of ,something alien' is added and the contents
acquire strong affective tone. This group may be subdivided:
(I) Compulsive affects-strange, unmotivated feelings, against which the affected
person struggles without success. (2) Compulsive heliefs-the patient is compelled to
consider something true although he is convinced it is not. (3) Compulsive urgessenseless urges out of keeping with the personality-e.g. to kill one's own child.
Where these urges tend to recur repeatedly in groups we can speak of compulsive
states, compulsive excesses, for instance, of which compulsive cleanliness would be
an example.
2. Compulsive helief. The characteristic of compulsive ideas is that the
individual believes what is often a meaningful content yet knows the content
13S
is false. A struggle ensues between conviction and knowing the opposite to be

t rue. We must distinguish this phenomenon from ordinary doubt and from
firm conviction. To give an example:
Emma A. had been through many phases of an affective disorder. Each time she
recovered completely. For some weeks she had again been ill, homesick and depressed
and she was in hospital. Two men were teasing her, tickling under her armpits and
touching her on the head. She objected to this: 'I am not going to flirt around in the
hospital'. Then the thought occurred to her that the men might have assaulted her
and she might be expecting a baby. This idea, which was quite baseless, came to dominate her more and more. Here are some of her comments: 'I put the idea away sometimes but it keeps on coming back.' Her thoughts revolve round the topic. 'All day
long I turn over in my mind how it all happened; they wouldn't have had the nerve.'
She is certain she is having a child but immediately afterwards she says: 'I am not
quite certain, there is always a bit of doubt'. She tells the story to her sister and they
laugh about it. She had to go to the doctor to be examined and resisted this because
the doctor might laugh at her about it, 'such a stupid idea'. The doctor found nothing. This reassured her for a day but then she ceased to believe him, perhaps he only
wanted to reassure her. 'I simply don't believe people any more.' She expected to
miss her periods; when menstruation started she was reassured for the time but she
was not convinced. 'I try to sort it all out for myself; I sit down and think .. it can't
be true, I haven't been a bad lass and then I think again ... and yet 1 tell myself, one
line day it'll tum out to be true .. .' 'I go on like this all day ... there is always a
wrangle going on inside me. It may have been like this or like that, it's always to and
fro.' She was extremely restless. She was always thinking she was big with child and
that everyone noticed it-'I keep on thinking it will be terrible when it comes'.
Sometimes the patient laughs about all this nonsense which she thinks. Asked about
her illness, she denies she is ill but says, 'I know that it has always gone away before.'
We may say in conclusion that the patient's ideas all group round one central
idea which keeps recurring in her consciousness involuntarily (compulsive thinking);
the validity of these ideas forces itself on the patient in the face of her conviction to
the contrary (compulsive belief).
These compulsive beliefs need to be distinguished from three other
phenomena, that is from delusion, from over-valued ideas and from normal
doubt. In the case of delusion a judgment is made which is held on to with full
conviction, not only with a consciousness of validity but with a sense of
absolute certainty. In compulsive belief, there is no question of absolute certainty. With over-valued ideas belief is strong, the topic itself is the only thing
t hat matters and the psychic life is normal and unchanged so far as the individual himself is concerned, whereas in compulsive belief he considers his
belief to be morbid. In the case of ordinary doubt a judicious weighing of the
pros and cons leads to an indecision, experienced as a psychologically unified
judgment on the situation. In the case of compulsive belief, however, conviction is felt simultaneously with a knowledge of the very opposite. As an
illustration, we might take the competing visual fields in the stereoscope
(Friedmann). There is " ('.onstant contest going on between a consciousness
MOMENTARY WHOLE-STATE OF CONSCIOUSNESS
of validity and of non-validity. Both push this way and that, but neithe:r can
gain the upper hand. In normal doubt, there is not this experience of right and
wrong, but as far as the subject himself is concerned, a single, unified act of
judgment establishes the matter as undecided.
3; Compulsive urges and behaviour. When urges arise in us and the consequences of acting them out are of some importance, there may arise a conflict of motive. Decision is reached in two ways, either there is a feeling of
self-assertion, conscious freedom or defeat, a consciousness of having to submit. This is a normal and universal phenomenon. In the latter case, however,
there may be the added awareness of an alien urge which does not arise as one's
own, foreign to one's nature, apparently meaningless, incomprehensible. In
these circumstances if action follows, we speak of compulsive behaviour. If the
urge is suppressed and does not issue in behaviour, we speak of compulsive
urge. Often individuals who are experiencing such phenomena will comply
with these urges, when they are harmless (e.g. move chairs, swear, etc.), but
they will successfully resist criminal urges or those with distressful consequences, e.g. murder of a child, suicide (e.g. throwing oneself from a great
height).
palpitations, a sense of freezing, of being hot in the head, of perspiring, of being

clamped to the ground, and a paralysing weakness in the extremities and a fear of
falling. 1
Compulsive urges can be partly understood as secondary compulsive behaviour

emerging from other compulsive events, e.g. a man who has the compulsive belief
that he has given some promise which he cannot fulfil may ask for a written certificate
that he has not done so. This secondary behaviour includes many defensive acts
taking place on the basis of other compulsive events, e.g. washing through fear of
contamination. The behaviour develops into a ritual and is expected to serve as a
defence against disaster, one magic against another; the performance grows all the
more irksome because it never brings fulfilment. Performance becomes scrupulously
exact, distractions must be excluded and there is an engagement of the whole mind.
Every possibility of error arouses doubt as to the effectiveness of the ritual and increases the demand for further acts to make certain, and, if there is further doubt,
there must be a full repetition from the start; in this way any definite result in the
form of a successful completion of the whole behaviour becomes impossible. When
the compulsive urges are surrendered to, there is, as in impulsive action, a vivid feeling of relief. If, however, they are resisted, severe anxiety arises or other symptoms
such as motor discharges. To get rid of the anxiety, patients must once more carry
out the meaningless ritual of harmless acts. Fear of suffering this anxiety is enough to
arouse it, and within this vicious circle the phenomenon pursues its increasingly
painful and self-aggravating course.
4. Phobias. Patients are beset by an irresistible and terrifying fear of perfectly natural situations and performances: for instance, fear of closed spaces
or of crossing open places (agoraphobia). The phenomenon has been described as follows:
Patients suffer an enormous anxiety, real fear of death together with terror, when
they want to cross an open space, find themselves in empty streets, or stand outside
tall houses or in other similar circumstances. They feel oppression in the chest,
137
SECTION TWO
THE MOMENTARY WHOLE-THE STATE OF
CONSCIOUSNESS
For the first time in our study of the phenomena of experience, we come
to the idea of something complete, something as a whole, and we find it in a
form par excellence, that is in the immediate experience of the total psychic
state.
Phenomena do not originate in discrete fashion, and causes which give
rise to single phenomena are rare. There is always a total state of consciousness which makes it possible for individual phenomena to arise. We have
isolated phenomena by description and we have begun to arrange them in
certain groups and in a certain order. This has to be done because it is only by
making these clear distinctions that viewpoints on the whole are reached,
which are productive, because well structured. But by themselves all these
distinctions are incomplete.
When speaking of individual phenomenological data, we have temporarily
pre-supposed that the total state of the psyche within which these data occur
remains the same; we call this the normal state of awareness and clear consciousness. But in actuality the total state of psychic life is extremely variable
and the phenomenological elements are by no means always the same but have
individual permutations according to what all the other elements are and to
what the total state may be. We see, therefore, that an analysis of an individual
I:ase cannot consist simply in breaking up the situation into its elements, but
that there has to be constant referral to the psychic state as a whole. In psychic
life, everything is connected with everything else and each element is coloured
by the state and context within which it occurs. Traditionally this fundamental
fact has been emphasised by distinguishing the content of consciousness
(broadly speaking all the elements so far described have belonged to content)
from the activity ofconsciousness itself. Each single element, every perception,
image or feeling differs according to whether it occurs in a state of clear or
douded consciousness. The more the state of consciousness differs in its
dmracteristics from the one we are used to, the more difficult it becomes to get
adequate understanding of it as a whole as well as of the individual phenomena. Psychic life taking place in deep clouding of consciousness is generally
inaccessible for phenomenological examination, or can be made accessible only
with the greatest difficulty.
1 Westphal, Arch. Psychiatr., vol. 3 (1872.), pp. 138, 2.19; vol. 7 (1877), p. 377.
139
It will therefore be of decisive significance in the assessment of all subjective phenomena to determine whether they are occurring in a state of clear
consciousness or not. Hallucinations, pseudo-hallucinations, delusional experiences and delusions which occur in clear consciousness cannot be taken as
part-symptoms of some transient alteration of consciousness; they have to be
regarded as symptoms of much more profound processes within the psychic life.
We can properly speak of hallucinations and delusions only when there is this
clear state of consciousness.
There are many altered states of consciousness (like sleep and .dream)
which are quite normal and accessible to everyone; others depend on certain
conditions. In trying to visualise the psychotic states we seek comparison with
our own experiences (in dreams, while falling asleep, in states of fatigue) and
some psychiatrists have collected experiences during self-induced toxic states
(mescalin, hashish, etc.), so as to get first-hand experiences by means of
'model' psychoses of states that may be closely related to that of some mental
patients.
I'nce when it consists rather in being drawn towards something or being fascinated by
It. This creates the distinction between voluntary and involuntary attention. (2.) The
,/,.wee ofclarity and distinctness of the conscious content is termed the degree of attentilln. This relates to the preferential selection of content. Liepmann spoke of this
IIwtaphorically as the energy of attention and Lipps conceived it as the application of
psychic power to a psychic event. This clarity or distinctness of content is usually
linked with the experience of turning towards something or being fascinated by it.
lIut in pathological states there may not be this accompanying experience and these
qualities therefore come and go and vacillate independently. ()) The effects of these
two first phenomena on the further course of psychic life have also been included
under attention. The clarity of the conscious content is chiefly responsible for rousing
further associations, since such content is retained in memory with particular ease.
(;lIiding notions, set tasks, target ideas or whatever we choose to call them, if grasped
with attention in the first two senses of the word, undoubtedly have such an effect
1111 the appearance of other ideas that appropriate and useful associations are autolIIatically selected (determining tendencies).
It will be seen, therefore, that our momentary state of consciousness is not an
rVl'n one throughout. Around the focal point of consciousness a field of attention
."reads, dimming in clarity towards the periphery. There is only one point in clearest
(,!lllsciousness. From then on a whole series of less conscious phenomena extends in
rvery direction. Usually these phenomena go unregarded but taken as a whole they
create an atmosphere and contribute to the total state of consciousness, the whole
lIlood, meaning and potentiality of the given situation. From the brightly lit centre
of consciousness there is a general shadowing down to the obscure area where no
drllr demarcation remains between consciousness and the unconscious. Trained selfohservation makes it possible to investigate the degree of consciousness ( = degree
.,1' attention, the level of awareness).1
1. The state ofconsciousness as a whole, our total psychic life at any given moment,
lIIay have different degrees of awareness from clearest consciousness through various
Map;es of clouding to complete loss of consciousness. Consciousness may be pictured
",r " wave on its way to the unconscious. Clear consciousness is the crest, the crest
ht'wmes lower, the wave flatter, until it completely disappears. It is not however a
~llIIple matter of the one following the other. We are dealing with a changing maniIe ,lei. We may find constriction of the field of awareness, diminished differentiation
ht't ween subject and object and a failure to disentangle the encompassing feeling_t.lles that are obscuring the thoughts, images and symbols.
13 8
Psychological prefoce. The term 'consciousness' denotes first of all the actual inner
awareness of experience (as contrasted with the externality of events that are the
subject of biological enquiry); secondly, it denotes a suhject-object dichotomy (i.e. a
subject intentionally directs itself to objects which it perceives, imagines or thinks),
thirdly, it denotes the knowledge ofa conscious self (self-awareness). Correspondingly
unconscious means firstly something that is not an inner existence and does not occur
as an experience; secondly, something that is not thought of as an object and has gone
unregarded (it may have been perceived and therefore can be recalled later); thirdly,
it is something which has not reached any knowledge of itself.
The whole of psychic life at any given moment is called consciousness; and contains the above three aspects. Loss ofconsciousness occurs when the inwardness of an
experience vanishes and with it, therefore, goes consciousness, as happens in fainting,
narcosis, deep and dreamless sleep, coma and epileptic seizures. But if some degree of
inner experience is present we still speak of consciousness, even though our awareness
of objects has become clouded and there is only a weak self-awareness, if it has not
been obliterated. Clear consciousness demands that what I think is clearly before me
and I know what I do and wish to do it; that what I experience is my experience,
linked to a self and held together in a context of memory. Before psychic phenomena
can be called conscious they must be remarked by the individual at some stage so
that they can be lifted into clear consciousness.
We imagine consciousness as a stage on which individual psychic phenomena come
and go or as a medium in which they move. As something psychic it naturally belongs
to all psychic phenomena and has a number of modes. To keep our metaphor we may
say for instance that the stage can shrink (narrowing of consciousness) or the medium
can grow dense (clouding of consciousness), etc.
J. The field of clear consciousness within the total conscious state is termed the
field of attention. This covers three closely connected but conceptually distinct
phenomena: (I) attention as the experience of turning oneself towards an object may
show itself as a predominantly active experience when accompanied by awareness of
its own inner determinants. Or it may show itself as a predominantly passive ex peri-
Alterations in consciousness and disturbances of the conscious state are not

ulliform. They spring from a number of different causes, and may be brought
.,I)(lllt by concussion, physical illnesses that lead to psychoses, toxic states and
"hnormal psychic reactions. But they also can occur in healthy people, during
.I,ep, in dreams and in hypnotic states. In the same way, altered consciousness
has many modes. The one common factor is the negative one that all these
.,Iterations in consciousness represent some departure from the state of normal
,I,lrity, continuity and conscious linkage with the self. The normal state of
I Cpo Westphal, Arch. Psychol., vol.
Wumlts Phil. Stua., vol. :1.0, p. 487.
:U.
'Ober den Umfang des Bewusstseins': Wirth in
consciousness, which is itself capable of very varied degrees of clarity and

comprehensiveness and can be of the most heterogeneous content, remains as
the focal point and round it in all directions we find that deviations, alterations, expansions and restrictions can take place.
phenomenon was experienced. Otherwise we shall not reach a full understanding. If he has nothing special to say, we may assume the experience took
place in a state of clear consciousness.
Sense-deceptions may occur along with the fullest attention or with complete inattention. For instance, some sense-deceptions can take place only at a
low level of attention and will disappear if full attention is directed upon them.
Patients complain that 'the voices cannot be caught' or that it is a 'hellish
dazzle' (Binswanger). Other sense-deceptions-particularly in subsiding
psychoses-are experienced only in a state of acute attention, and disappear if
the attention is directed elsewhere. 'Saying a prayer makes the voices go.'
Observing an object brings the visual pseudo-hallucination to an end. The
importance of the degree of attention in the case of sense-deceptions is beautifully illustrated by patients suffering from alcoholic deliria, as investigated by
Bonhoeffer.1 If the examiner keeps attention up to a moderate degree by
making the patient talk and reply, few sense-deceptions occur, but if attention lapses-a tendency of the patients when left to themselves-massive
illusions and scenic hallucinations reappear. However, when the examiner
forcibly directs attention to visual stimuli, numerous discrete illusions
appear in this field. With psychic 'passivity' phenomena, we sometimes find
a noteworthy low degree of consciousness. When the patient is occupied
he feels nothing of this, but if he sits around with nothing to do 'passivity'
phenomena appear-attacks of giddiness, compression in the head, attacks
of rage, whispers-which he can subdue only by a terrific effort of willsometimes shaking his fists. This is why such troubled patients seek company,
conversation, something to do or some other means of distraction (praying,
mumbling meaningless phrases), through which they hope to free themselves
from the 'influence' of the voices. Schreber experienced ideas as put into his
head when he sat around doing nothing, and called them his 'non-thinking
thoughts'. The following self-description illustrates the dependence of schizophrenic phenomena on attention, and on arbitrary encouragement or discouragement:
Techniques ofenquiry. There are always two ways of trying to understand patients
and gain some insight into the psychic events taking place within them. We can try
conversation and make every attempt to establish a psychic relationship between the
patient and ourselves; we can endeavour to empathise with their inner experiences.
Alternatively, we can ask them to write down afterwards what went on in their minds,
and make use of these self-descriptions when they have recovered from their
psychoses. The more the total psychic state has suffered al teration, the more we
depend on these subsequent self-descriptions.
If the total state of mind is on the whole intact-though even so the most severe
psychic disturbances may be present, such as delusion, hallucination, or change of
personality, we say the patient is sensible. Sensihle is the term we give to the state of
consciousness in which intense affect is absent, the conscious contents have an average clarity and definition and the psychic life runs in orderly fashion determined by
foreseen goals. An objective sign of this sensible state is orientation (the individual's
present awareness of the orderly structure of his world as a whole); another sign is
the ability to collect thoughts in response to questions and to remember things. This
is the most suitable state of consciousness in which to reach a mutual understanding.
As the total state alters, it becomes increasingly more difficult to get in touch with
the patient. One condition for keeping some mental rapport with him is that we
should be able to pin him down in some way, and get him to react to questions and
set problems, so that we can judge from his reaction whether he has grasped them or
not. Normal people can concentrate on any task which is set them, but with alteration
in the total psychic state, this capacity steadily decreases. Patients may no longer
respond to a question in any intelligible way, but repeated questioning may possibly
elicit some reaction. One can then still pin them down on easy and neutral points,
such as the place of birth, the name of a place, etc., but they may no longer respond
to the more difficult questions and tasks, such as what do they think, etc. We may
then be able to get them with visual situations and stimuli, but they will no longer
react to verbal stimuli. To the extent to which we can pin patients down in one way
or another, we can hope to embark with some degree of success on the path of direct
understanding. If, however, they are deeply preoccupied with themselves, the sparse
fragments of information divulged are rarely sufficient for us to arrive at any convincing view of their inner experiences.
I. ATTENTION AND FLUCTUATIONS IN CONSCIOUSNESS
(a) Attention
This determines the clarity of our experience. If we take the second of the
above discussed concepts of attention-the clearness and precision of the
psychic phenomena, the degree of consciousness, the level of awareness, we
can see that, with each psychic phenomenon we discover in our patient, we
need to know how much attention he gave and at what level of awareness the
141
'I felt as if! were continually among criminals or devils. As soon as my strained
altention wandered off from things around me, I saw and heard them, but I didn't
always have the power to deflect my attention from them to other tangible objects.
Every effort to do that was like rolling a millstone uphill. For instance, the attempt
10 listen to a friend's conversation that lasted more than a few sentences resulted in
,~uch restlessness (because these threatening figures towered over us) that I had to
lake my quick departure. It was extremely hard to attend to an object for any length
of time. My thoughts would wander off at once to far-away places where demons
would at once attack me, as if provoked. At first this shift of thought, this giving way,
happened voluntarily and was sought by me, but now it happens on its own. It was a
sort of weakness; I felt driven to it irresistibly. In the evening when trying to sleep I
d()~ed my eyes and would enter the vortex willy-nilly. In the daytime, however, I
1 Donhoelfer, Die akuten Geisteskrankheiten Jer Gewohnheitstrinker Gena, 1901), pp. 19 If.
managed to keep out of it. It was a feeling of being spun round until figures appeared.
I had to lie in bed awake and watchful until after many hours the enemy withdrew a
little. All I could do was to try not to encourage the thing by letting myself go.' At a
later phase the patient reports: 'Every time I wanted to I saw these figures and was
able to draw conclusions about my own state. To keep control I had to utter words
for inner protection; this was to make me more aware of the new self which seemed
trying to hide behind a veil. I would say "I am" (trying to feel the new self, not the
old); "I am the absolute" (I meantthis in relation to physical matters, I did not want
to be God). "I am spirit, not flesh" . "I am the one in everything" .. "I am what
lasts" (as compared with the fluctuations of physical and mental life .) or I would
use single words like "power" or "life".'
These protective words had always to be at hand. In the course of 10 years, they
became a feeling. The sensations which they aroused had so to speak accumulated so
that he did not have to think afresh every time but at times of particular instability
they had to be used then as now, in a somewhat altered form. The patient could see
the figures at any time he wanted and could study them, but he did not have to see
them. (However, after specific physical disturbances they came on their own and
once more became dangerous) (Schwab).
Fluctuations of consciousness down to the loss of it may be observed in

personality disorders (psychopaths) and in many acute and chronic psychoses.
The patients themselves complain that they lose their thoughts momentarily.
'The works have stopped.' Janet describes these as 'eclipses mentales'.
A proband describes such an experience under hashish:
'It feels as if! am always emerging from unconsciousness only to fall back into it
.tfter a time ... meanwhile my consciousness has altered ... instead of completely
empty "absences", I now have something else like a second consciousness. This is
experienced as a period of time on its own. Subjectively it is as if there are two separtlte sequences of experience each running its own course. The experimental situation
seems unaltered; but there follows the experience of a long-drawn-out, undifferentiated
existence in which I cannot keep myself separate from the experienced world. In spite
of this, I experience this second state not as in a dream but in complete wakefulness.
This alternating consciousness may explain my over-estimation of time, which is
excessive. I feel as if hours must have elapsed since the beginning of the intoxication;
Ihe thinking process is extremely difficult and every sequence of ideas gets cut off
when the next change in consciousness occurs.' 1
(b) Fluctuations in consciousness
(c) Clouding of consciousness
Mild degrees of fluctuation in consciousness may be observed in the

perioaze waxing or WaTUng of attention (Wundt). The crest of the wave of
psychic life never remains at the same height from moment to moment, but
changes all the time, however slightly. We may observe more noticeable
changes during fatigue, and more noticeable changes still and to a pathological
degree in those periodic fluctuations ofconsciousness1 which sometimes dwindle
down to a complete absence of it. We have observed a patient in whom this
occurred within the course of one minute. In epileptic patients normal conscious attention, as measured by reaction to hardly perceptible stimuli,
fluctuates much more than in the case of healthy persons.a
Lowering, clouding or narrowing of consciousness occurs variously as the

accompaniment and consequence of single experiences. On a long train journey
we may doze and experience a low ebb of the wave-crest, an emptiness of
consciousness, which we can interrupt at will. When there are violent affects, as
in anxiety states and deep melancholia as well as in manic states, it becomes
much more difficult to concentrate on anything external, contemplate anything, reach a judgment, or even think of anything. Answers to simple
questions can only be given after a number of unsuccessful attempts and
visible exertion on the part of the patient. For this reason, i.e. difficulty of
nlncentration, the contents of delusion-like ideas go unscrutinised by the
patient and there is no reality-judgment concerning possible sense-deceptions.
(:onsciousness is completely filled by the affect, and judgment and attitude
bt~come very disturbed in an understandable way. This is even more the case
in depressive states when primary inhibition of function is added. All the
above states, however, deserve the name of abnormal consciousness, which
lIIay become a persisting emptiness of consciousness in the last-named instance.
Fluctuations of consciousness must be differentiated from petit mal attacks,

absences, etc., which lead to irregular interruptions of consciousness, accompanied by
slight motor phenomena. Nor should they be confused with the interruptions ofconcentration and reactivity frequently observed in schizophrenic patients (so-called
Mocking). They suddenly cease to reply, stare in front, and do not seem to understand
anything. After a time (minutes or seconds) this ceases, only to recur again a little
later. Subsequently one can often find that the patients have been perfectly attentive
during the time they were inaccessible and remember the occasion. These interruptions occur for no apparent reason as an expression of the disease process or they may
be attributable to affect-laden complexes, which the examiner's questions have triggered off, or they may be understood as distraction by voices and other hallucinations.
In the last case, we may observe that the patients have grasped only poorly what the
examiner said.
1 Stertz, Arch. Psychiatr., vol. 48, p. I99. Janet, Neyroses et idees fixes, pp. 69-I08. Psychastheni., pp. 37I-7.
a Wiersma, 'The psychology of epilepsy', J. Ment. Sci., vol. 69 (I9~3), p. 48~.
143
(,/) Heightening of consciousness
We may wonder whether heightening of consciousness really is a fact; do

we find abnormal alertness, abnormal clarity, and other abnormal phenomena
(If this order? Kurt Schneider considers heightened clarity of consciousness a
1I('cessary prelude for the development of certain compulsive states. 'This ex['('ptional clarity of consciousness is well marked in cases of encephalitis with
(Iuscssional symptoms.' Of another sort are those numerous self-c1escrjptioll~
I
Beringer, N,rY'fllJr{t, vol. S, p. 341.
144
145
of a mystic retreat into contemplation, which suggest a state of overwakefulness. Different again are the unusual brilliant states of narrowed consciousness
occurring as an aura in epileptic attacks and described by Weber and Jung.
One patient described it as if 'thinking became absolutely clear'. The authors
point to Dostoievsky's own description of his aura 'as if there was a flare-up
in the brain', so that 'the sense of life and self was increased ten-fold'.
Zuttl describes phenomena after the taking of Pervitin: overwakefulness,
vivid interest, shortening of performance, shorter reaction-time and the conquest of masses of material by apperception. At the same time he points out
diminished powers of concentration, crowding of thoughts, diminution in the
ability to order impressions or meditate deeply and a restless interest of an
aimless character with an equally aimless drive to activity. This overwakefulness means a reduction in the precision and clarity of the external world, since
the external world tends to retreat for tired and over-wakeful people. Zutt,
therefore, constructs a polarity of consciousness between sleepiness and overwakefulness, so that the peak of clarity lies in the middle. The above phenomena once more show the ambiguity and enigmatic character of what we call
a state of consciousness.
2.
SLEEP AND HYPNOSIS
(a) Dreams
Hacker2 has tried to clarify dream life phenomenologically for the first
time by taking notes on his dreams for a whole year. He did this immediately
on waking up, noting how his dream experiences appeared to him. The
specific character of dream life showed itself in three ways: (I) Elements which
are alwaY3 present in waking life are now in abeyance. There is no true awareness of one's personality, so that acts take place which would be foreign to the
individual in his waking state without this being noticed at all in the dream.
There is no awareness of the past, no awareness of self-evident relationships
between things, so that the dreamer may, for instance, talk to a doctor about
his leg-muscles while the latter dissects him anatomically, or he may look at his
own abdominal cavity without seeing anything queer about such a situation.
There are, therefore, no volitional acts, with the consciousness of 'I really
will .. .', if for no other reason but that the feeling of personality is absent and
there is only a momentary self-awareness. The dream may become completely
rudimentary and all that is left consists of a number of psychic fragments.
Thus Hacker once found that at the moment of waking a few incomprehensible
words remained in the dream, which he could understand only when he woke
Zutt, 'Ober die polare Struktur des Bewusstseins', Neryenar,t., vol. 16 (1943), p, 145,
Hacker, 'Systematische Traumbeobachtungen mit besonderer Beriicksichtigung der Gedanken', Arch, Psychol, (D), vol. 21, Kohler, Arch, Psychol CD), vol. 23, Hache, Das tral.mende len
(Jena, 19 2 7)' E, Kraepelin, 'Die Sprachstorungen im Traum', Psycho!. Arb" vol. 5, p. I,
1
up. There was not only no awareness of meaning but no awareness that they
were words, ~nd no sense o~ any object versus the self. It was so to speak
sensor~ materla,lleft over,wh,lch had not become fully objectified. (2) Psychic
connections. vamsh. PsychiC lIfe so to speak goes into dissolution, gestaltconfiguratIOns, the linking tendencies of volition, all disintegrate. There is no
representation in the present of past and future; the dream lives only in the
moment, one scene ,follows a?other, and often the previous one is completely
forgotten. Contradictory thmgs are experienced without surprise consecuti~e~y or simult~neously. From such elements as are apprehended, no determmmg t.endencles :merge, but the most heterogeneous things follow one
a~other, In a changIn~, haphazard flow of association. Among the general
dissolution, of connectIOns the most surprising was the misapprehension of
senso~y objects. Hacker drea~t, for instance, that he was looking for some
chemical substance for analYSIS; some one gave him his big toe which seemed
quite naturally a chemical substance. On waking up he could' recall both the
sense~experience of seeing the big toe, and the being aware that this was a
chemical substance. This dissolution of connection between sensory material
and awareness of appropriate meaning is a common phenomenon in dreams.
(3) Fresh elements appear. These are the dream-images which we cannot call
hallucinations, delusions or false memories. On the other hand these contents
ha.ve a vi,vid,ness which they would not have if they were mere images. New
dungs arISe In the form of remarkable identifications and condense and separate in an astonishing way.
Apparently Hacker never dreamt of coherent situations and events such
as others have experienced in dreams with great vividness. He belonged to
those who completely forget their dreams if immediately on waking they do
not record the few remembered fragments which they can retain. Other
pe,ople, however, ca~ be haunted all day by dreams and remain vividly conS~I~US of ~hem. But In general the sensory richness, the actual experience of
vlv~dness IS apt to be over-rated. This is shown by the following example in
which the dreamer looks on and observes his experiences while dreaming:
A friend of mi~e, who had no psychological training and was not interested in
psychology, sometimes thought to himself: 'it really seems that one sees things in a
dream which one has never seen before. Perhaps one can learn in a dream of things
which waking reality never shows. I want to look out for this in my dreams.' One
day he, reco~nted a rec~nt dream: 'I must have slept a long time, when I realised I was
dreammg WIthout havmg to wake up because of this idea. I thought in my dream that
I was, dreaming and could wake up when I wanted to, but immediately I became
conscIous of the thought-No, I wiII go on dreaming-1 want to see how this ends' I
was, clearl~ aware of the question-will I see something in my dream never seen ~()
far 111 realIty! I went on dreaming and seemed to take up a book to sec the kth'r~
dearly; as soon as I brought the book near to my eyes the letters became blum'd' I
l'Ould not read anyt~ing; I took other objects to look at closely but TSilW ('vnyrhi:w,
a~ ()n~ sees them ordllla~ily when one is in a room, with a general illl/Hessioll f ."-""rail.
II I tned to see the detaIls properly, they became blurred. After a wliill' I r('ully wokl'
146
up and looked at the clock. It was 3.0 a.m. It surprised me to find that one could dream
and yet be an observer at the same time.'
The changes in consciousness which occur during sleep, hypnosis and

certain hysterical states are in some way inter-related but they can be fully
grasped only if we know in what way precisely they differ.
(b) Falling asleep and waking

These allow for intermediary states to be experienced. Carl Schneider!
describes the experience of falling asleep; everything grows fleeting, vague
and loses its structure; thoughts, feelings, perceptions, images merge in confusion, glide away, slip about and get derailed, while at the same time ~e ~ay
have exotic experiences, sense deep mean~ngs or the ?re~ence o~ ~e m~mte.
One's own activity merges into an acceptmg and a Yle~dmg until, m spite. of
the unity of consciousness, self-awareness completely dissolves away. Durmg
the phases of falling asleep, healthy people will often have what are, therefore,
. .
called hypnagogic hallucinations..
Certain hallucinations at the time of waktng are very charactenstically
dependent on the state of consciousness. Patients have a fee~ing that they have
been wakened by the hallucination, but once they are qUlte awake the hallucination has gone.
Miss M. clearly felt during the night that she was pulled suddenly by the hair at
the back of the neck on the left, pulled with great force. At the same time, she saw a
great flame flare up for a moment from the depths and then die down. She awo~e
immediately and once awake there was nothing more to be seen, but she knew this
had not been a dream. It had been real and it had wakened her. It happened between
sleeping and waking and it had disappeared altogether onc~ s~e was c.o~pletely
awake. Similarly on two occasions at night when she was staymg ~n the chm.c something was done to her genital organs; certain movements were carned out qUlckly, as
if she were having sexual intercourse. The moment she opened. her eyes~ she saw no
one was there but she was certain it was not a dream and that It was bemg done by
some evil force. On another occasion she saw the bedcovers lifting just when she
woke up. Fehrlin reports: 'I suddenly woke up at midnight:md felt myself em~raced
by a woman whose hair fell over my face. Quickly, s?e crIed, y~u have to dIe....
then it was all over.' With some patients this sort of thing repeats Itself several tImes
during the night and they are tired and unrefreshed the next day. The content ~f
these phenomena proves to be manifold ~ut ~ey ~hemselves always have thiS
element of suddenness, something happens lIke IIghtmng.
(c) Hypnosis
Hypnosis is related to sleep and is identical in character. During. hypnosis
a particular kind of productivity arises; pictures are seen and. memones are relived. There is no known principle on which we can grasp thiS state, as to what
it really is. We can delineate it only by distinguishin~ it..It is n~t a? u~der
standable psychic change but a vital event of a peculiar kmd which IS ~m~ed
with effective suggestion. It is a primary phenomenon of somato-psychic hfe,
manifesting itself as an alteration of the conscious state.
1 Carl Schneider, Psychologie der Schirophrenen, p.
Mayer-Gross in Bumke's Handbuch, vol. I, pp. 433- 8.
12
u.a. 'Ober das Einschlaferleben vgl.',
3.
147
PSYCHOTIC ALTERATIONS IN CONSCIOUSNESS
The alteration of consciousness in acute psychoses, in deliria and in

twilight-states is certainly very different in each case. We need only to compare the reduced consciousness of organic processes with the dreamy perplexity of the acute psychoses, the confusions of deliria or the relatively
well-ordered, coherent behaviour in some twilight states to get the impression
that we are not dealing with one single type of disturbed consciousness. At the
present time, however, we cannot formulate the differences comprehensibly.
We will only describe the following types: reduced consciousness (torpor),
clouded consciousness and altered consciousness.
(a) By 'reduced consciousness or torpor' we mean those states that lie between
consciousness and unconsciousness; no fresh psychic events are being experienced, only fewer. Perceptions remain as dim as the memories. Very few
associations appear and the act of thought can no longer be performed. All
psychic events are slowed down and much more difficult. As a result patients
take no part in things, are apathetic, apt to doze and show no spontaneity;
when talked to, their attention is hard to rouse and cannot be sustained; they
cannot concentrate and are easily tired but in pure cases appear perfectly
orientated. There is a tendency to fall into a dreamless sleep or sink into a state
of coma or sopor from which they cannot be roused.
(h) Clouded consciousness. Florid events are taking place and hallucinations,
affects and partly coherent fantasy experiences are occurring to the extent that
there is no longer any consistent, connected flow of psychic events. Psychic
life breaks up, so to speak, and fragmented experiences take place disconnectedly. Only single, completely isolated acts remain and there is an entire
splintering of consciousness. Contents become highly self-contradictory (there
are, for instance, rapidly changing and opposing 'delusions') so that nothing
can be remembered.
(c) Altered consciousness. The state is usually clearly demarcated from
normal psychic life and relatively coherent so that patients possibly remain
quite normal. Consciousness is restricted to certain areas only and nothing
else is allowed to intrude that does not fit the inner set. Westphal gave the
following description: 'There are states which may last a few minutes or hours
in which consciousness is so deeply disturbed that the individual moves in a
circle of ideas that appear quite detached from his normal ones. On the basis
of these ideas and the feelings and wishes which are linked with them, he may
carry out acts which are entirely foreign to the usual content of his thoughts
and are unconnected with them. But the ability is not abolished to act coherently and to a certain extent logically.' The span of altered consciousness
is different and split off in the memory from normal consciousness. Not Qnly
hysterical twilight states but also apparently elementary phenomena such as
epilepsy belong to this group.
(d) The state of consciousness during an aura before an epileptic seizure1
is an uncommonly brief alteration in consciousness before it merges into unconsciousness. During it the outer world disappears; the inner experiences
become overpowering, consciousness narrows and in this restricted state it
can yet have a moment of high illumination. Out of initial anxiety, and with
full clarity of consciousness, ecstasy may rise to a pitch of unbearable terror
during which unconsciousness and the fall of the seizure begin:
One set of experiences comes during clouded consciousness; the othermore rarely-may fill the psyche in states of altered consciousness, which do
not exclude complete wakefulness. In the former, clouding is recognised in the
general lowering of the mental activity, in the loosening of context and in the
hazy memory which remains. Wakeful experiences on the other hand are of
extreme clarity; they demonstrate a pervading connectedness of phenomena
which brings the psychotic experience close to real experiences and they tend
to be remembered vividly. Even incoherent experiences during wakefulness
are well remembered.
2. One set of experiences occurs in complete isolation from the real environment. The psyche is in another world altogether and is without relation!lhip to the real situation. The other set of experiences intertwines in a peculiar
way with. real perceptions and with the real environment, which is then misinterpreted and bears a different meaning as related to the particular psychotic
experience.
3. In relation to the subjective attitude of patients towards their psychotic
experiences, we find two contrasting extremes: Either the patient is nothing
but a spectator. He is quite detached, passive, even indifferent. He sees everything clearly and faces the contents calmly as they emerge or pass before him
Ilt! impressive visions, with complex elaborations in all the sensory fields.
Alternatively, he is actively engaged. He stands in the mid-stream of the events;
he is in the grip of powerful entities which, sometimes painfully, sometimes
delightfully, toss his mind to and fro. He may be thrown from heights of bliss
to depths of hell. He becomes a world-redeeming person and then the devil
himself in most evil form. Whereas the first group of experiences have a pronouncedly scenic character, the latter are much more dramatic. To use
Nietzsche's words, the former have more the character of dreams and dreamobjects, while the latter are more like an intoxication.
4. As far as the connectedness of the particular content is concerned, this
may vary from completely isolated, individual, false perceptions or awareness,
etc.-hardly to be included among experiences in the sense in which we use
the word-to a continuous, progressive occurrence, with definite circumscribed
rvents, that denote phases and crises in the history of the psychosis. In rare,
fully developed cases, we may see over long periods a sequence of phases in
which the patient passes, rather like Dante, through hell, purgatory and paradise. Such connection as there is will either predominate in the concrete,
rational content of the experience or in the confusion-like subjective state.
Either we observe isolated experiences of fragmented situations occurring in a
I:onfused sequence or we see over a period one scene emerging organically
out of another. Usually the patient seems completely submerged in the
psychotic experience, in which he lives with all his senses to the full, but sometimes a particular sense, usually the visual one, seems more predominant.
5. Contents are either sensorily vivid and complex or in spite of the intensity
of the experience they may be little more than awarenesses or pale images. As
There are a number of ohjective symptoms for all kinds of clouding of consciousness in psychotic states, though they may not be present in every individual case.
They are: (I) Turning away from the real world: Patients comprehend poorly, cannot
fix their attention and act without regard to the situation. (2) Disorientation: This is
closely linked with (I). (3) Loss of coherence: which makes the behaviour un-understandable. (4) Disturhance in registration and memory: along with difficulties in
reflection and subsequent amnesia.
4.
FORMS OF COMPLEX FANTASY EXPERIENCE
Alterations in the conscious state are frequently the soil for pathological
experiences. At any time of day these states may appear briefly as a kind of
sleep or, if of longer duration, as psychotic states which last several days or
weeks. Hallucinatory experience is especially common (a differentiation
between hallucination proper, pseudo-hallucination and mere awarenesses no
longer becomes possible). While the patient is in this half-sleep, someone may
approach his bed; he feels the actual approach, he feels the hand around his
neck, feels suffocated. Or he lives among a series of vivid scenes, landscapes,
crowds, mortuaries, graves. Very often the patients can feel this alteration of
consciousness when it happens. They may feel it from the start, at the point
where it overcomes them and also at the end, when they come round again:
'just now, as I dreamt it'. In mild cases they may be able to observe themselves
in this altered state: they are peculiarly puzzled; they feel they cannot think,
they have to remind themselves where they are and what they wanted to do.
Hysterical people can more or less put themselves into a twilight state through
an abnormal kind of day-dreaming.
These unreal contents of psychotic experience have their own context;
they build up as it were a continuous world and fate for the patient. This context splits off from the world of real experience and becomes a transitory event,
limited to a certain period of time (days, months or years). We will try to
bring some order into these diverse and numerous experiences, and if we want
to understand the peculiarities of an individual case, we shall first have to be
clear about certain basic differences of a purely descriptive character:
1
Weber and Jung, Z. Neur., vol.
170,
p.
UI.
I.
149
to their significance, contents are either ordinary and simply relate to everyday
experience (the patient, for instance, is concerned with his experiences at work
and its possible irritations) or the contents may proveJantastic, such as never
occur in reality. The patient stands at the crossroads of world events. He
feels the world's axis at his side; tremendous cosmic movements are connected
with his fate; mighty tasks await him; everything depends on him; he can do
anything, even the impossible, thanks to his magnificent powers.
6. The experiences may be unified-the patients have only one reality, the
psychotic one; or the experiences-particularly the fantastic ones-may occur
while the patient lives in two worlds simultaneously, the real one which he
can see and judge for himself and his psychotic one. He acquires a certain
double orientation and can move among live realities more or less correctly, in
spite of his cosmic experiences, but the psychotic reality is the real world for
him. The actual external world has become an illusion which he can conveniently ignore to the extent that he knows: these are doctors, I am in the
cells, they say I am religiously deluded. It happens that the patient in an
acute psychosis is completely filled for a time with his psychotic experiences
and forgets who he was, where he is, etc., but he is apt to be pulled out of this
illusionary world by harsh events or certain profound impressions (admission
to an institution, visits by relatives). An emphatic word may lead the patient
back to reality for a moment. Then the double orientation reasserts itself;
everything acquires double motivation, he himself is double or manifold.
'I have thought of an enormous number of things from many spheres altogether at once', said a patient. In typical cases the patient comes into collision
with reality when he experiences supernatural processes which he expects to
change something in the external world. Reality is to disappear and so on.
Then occurs 'the experience of the catastrophe that fails' and this is followed
by indifference which later on makes room for new contents to arise.
Differentiations such as these are very general and are mere viewpoints
for analysis. We have no factually based order for the various forms of
psychotic experience. Out of the immense variety that presents itself to us, we
will limit ourselves to the description of a few selected types: l
I. Daydreaming can be found associated with other abnormalities. A
man in prison imagines himself into the situation of fabulous wealth; he builds
castles and lays the foundations of cities. He fantasies to such an extent that he
cannot now differentiate clearly between reality and unreality. He draws large
plans on waste paper and has vivid experiences of how he would behave in his
new situation; how he acts and delights people. Fantasy such as this may
start from an accidental notion but be carried on subsequently with an awareness that it is full reality. The individual buys a good deal he cannot pay for,
for an imaginary mistress perhaps; he lives through the part of an inspector of
schools and behaves so naturally during the school visit that he is not noticed
until some all too obvious contradiction arises and puts an end to his fantasy.
(Pseudologia phantastica.) With hysterical patients a certain alteration of consciousness may occur in the course of such daydreaming. The patients live
through imaginary situations which they experience in the form of vivid
hallucinations. The fantasies occurring during febrile illnesses, as described by
1I0epffner,I are probably closely allied to such experiences.
2. Delirious experiences. 2 These are characterised particularly during
alcoholic delirium by a strong sensory vividness, a low level of consciousness
and therefore a lack of coherence. Content is quite natural and possible and
corresponds to accustomed reality; it is almost always tinged with anxiety and
consists in persecutions, maltreatments and often unpleasant and hurtful
experiences.
3. Illusory experiences full of blissful tranquility that come to some people
during hashish and opium intoxication have a peculiar character of their own:
1 Further material on these phantasy experiences can be found in W. Mayer-Gross, Sellmsehi!derungen der Verwirrtheit (die oneiroide Erlebnisform) (Berlin, 1924).
Baudelaire reports the following description given by a woman: After taking

llilshish she found herself in an exquisitely panelled and furnished room (it had a
p;olden ceiling with a geometrical grille). The moon was shining. She said: 'At first I
was surprised; I saw enormous plains stretching in front of me and all around; there
were clear rivers and green landscapes reflected in the quiet waters. (You may guess
the effect of the panelling-reflected in the mirrors). As I raised my eyes, I saw a
Netting sun, like molten metal as it cools. This was the gold of the ceiling. The grille
led me to think I was in some kind of cage or in a house open on all sides, separated
from all these wonderful things only by the bars of my imposing prison. At first I
Illughed about the deception, but the longer I looked, the stranger the enchantment,
the more liying it grew, in all its clear and deceptive reality. Now the image of being
locked in dominated my mind, without I must confess diminishing the pleasure I
derived from the spectacle surrounding me. I considered myself imprisoned in this
handsome cage for thousands of years among these enchanting landscapes and wonderful horizons. I dreamt as follows: The Beauty who sleeps in the forest is making
I'xpiation. I dreamt of her liberation. Brilliant tropical birds flew over my head and
II" my ears picked up the ringing of the horses' bells in the street, the impressions of
tlte two senses fused into a single idea. I ascribed the wonderful tinkling sounds to
the birds and I believed they were singing through their metallic beaks. They were
I hatting about me and glad I was a prisoner. Monkeys were playing and satyrs
I ilpered about delightfully and all of them seemed to be amused over the prisoner
lying there condemned to immobility. However, all the gods of myth gave me a
frit'lldly smile as if they wanted to encourage me to bear the "spookery" patiently. All
fytS were turned into one corner as if they wanted to touch each other with their
I!;.ll.e ... I must confess the pleasure which I felt in looking at all these forms and
III illiant colours and considering myself the centre of some fantastic dream; this took
lip .111 my thoughts. It lasted a long time. Did it go on till morning? I do not know.
... I suddenly saw the morning sun in the room; I felt vivid surprise, and in spite of
II ~lIruggle with my memory I could not tell whether I had been asleep or whether I
h.ltl survived an ecstatic sleeplessness. A moment before it had been night; now it was
I IIorpffner, Z. Neur., vol. 4 (1911), p. 678.
U"pmann, Arch. Psyehiatr. (D), vol. 27. Bonhoeffer, Msehr. Psyehiatr., vol. t.
day .. in that moment I had lived a long time, a very long time. My knowledge of
time was in abeyance . so the whole night could be measured by me only in terms
of the thoughts which filled it. Long as this seemed, I still felt it had all only lasted a
few seconds; alternatively, it was so long it could not even find room in eternity.'
Serlco's self-description during mescalin intoxication is as follows: 'Seeing masses
of colours, visual hallucinations with no connection in objective space; haptic hallucinations; disturbances of time-sense, a sentimental state of bliss, an enchanting
fairy-tale atmosphere, due to the colours, the hallucinations, the disturbed timesense, and with all this, a complete clarity of judgment and a correct reality-judgment.'
was wondering how she could sing, something she had never done before. She had the
idea of counting the points in the window. Then she was overcome by what seemed
another power; she had to count up to 12,000; she kept hearing a knocking; there was
always something happening. The letters in the Bible turned blue; her faith was being
tested and they were making her into a Catholic. Mter sunset the sun changed to
blood. The following night she remained standing at the window till she was frozen;
she must remain standing because of her faith which they wanted to take from her.
She saw a moving hand on the street; it was a devil. As she stood there she felt a
power from above on her right; at this she always looked to the left; she had an idea
that the power came from the right, there was also more warmth there and from above
there was pressure on her chest. This was spiritual power not physical; she felt quite
closed in; she could tum neither to right nor left nor look up. Many more peculiar and
puzzling things happened, until after seven days it was all over.
4. Surpassing all the forms of experience so far enumerated are the schizophrenic psychoses,l the acute experiences of which offer a continuity, richness
and importance of content, which overshadow the rest. We have selected two
cases of such experiences, which of course by no means exhaust the matter.
(a) The common schizophrenic experience at the beginning of the process
is not a very connected one, but it is full of uncanny import, vague riddles and
shifting contents, as follows:
Mrs. Kolb had been having delusions of reference for some time connected with
her work as a seamstress. In September she felt different: 'I feel as if I am veiled, I
believe I shall soon get to know something I don't know yet.' -She falsely believed
that Mr. A. was going to marry her. She constantly thought something was being
done in the shop for someone whom she was not supposed to know-perhaps it was
a dowry for herself; she found more and more things .. when she came home on
Sunday she thought someone had been in the room and disarranged a few things. On
Monday certain things at work did not tally; she had the impression that the cutter
had been giving her wrong orders . . everyone seemed conspicuous, but she did
not know why .. she was surprised about everything ... the fact that her brother
was fetching her made her pleasurably excited ... she thought it odd that people
greeted her in such a friendly way ... she was surprised to see so many people passing in the street. At home she had an overpowering feeling of compulsion-'you
have to stand still; you must stay put; do something special'. In spite of the warning
by her sister-in-law that she ought to come and eat and not talk too much, she never
budged. Finally, towards evening, she was taken to hospital. She felt this was a game.
When she saw the barred windows she got frightened; she got an injection because
of her excitement. Lots of girls were looking through a little window in her door
when she was sitting in her room in the hospital; they were winking. Someone called
from the ceiling 'you rascal'. In the garden she saw white figures in the dark; she
stayed up all night because she felt she had sworn right at the beginning 'My God I
am not going to bed'. On Tuesday, she was reading in the Bible. All afternoon she
saw people in the garden going to a funeral; she thought it was a television show with
her lover (some months before she had really seen a television show). Finally she
herself played in it. Sister was giving some signal to the people in the yard. So the
game ended. She suddenly saw a stove in the ceiling and a flat cross. She found the
light of the lamp wonderful; in the middle were three stars; she felt in heaven; she
1 Cpo my write-up of Dr. Mendel in Z. Neur., vol. 14 (1913), pp. 2.10-39: a case with rich
symptomatology.
(b) The following case offers a much richer experience. We see vividly the
new significance of the perceptions and thoughts; the bliss experienced, the
feelings of power, the magic connections, the unusual tension and excitement
coupled with the inability to hold an idea, and the eventual transition into
confusion.
The patient (Engelken) had had a love relation with William X. She had slowly
Hlid down through degrees of depression and mania into her psychosis. After she was
cured of the acute phase she described the further course of her illness as follows: 'I
was crying terribly; I was quite beside myself; I called for people dear to me. It
N('cmed to me I had everything collected round me. Then everything was forgotten; a
Nparkling cheerfulness appeared. The whole world was turning round in my head. I
I/:0t mixed up ... the dead and the living. Everything turned round me; I used to
hear the voices of dead people distinctly, sometimes William's voice. I had indeNl'ribable happiness when I thought of bringing my mother a new live William; I had
lost a brother of that name but the puzzle was too much for me; it was too great a
Illllddle-I was terribly excited; I had an incredible longing for peace-my brother
l"<lme towards me, frightened, looking like a skeleton, he seemed quite unaware of the
things that were filling me-I cannot describe it better than by comparing it to
Intoxication with champagne ... I saw other figures-a wonderful lady-I then felt
like the Maid of Orleans, as if! had to fight for my lover, had to conquer him; I was
tnribly tired, but I still had inhuman force. They couldn't hold me down, not three
of them. I thought at the time he was fighting in a different way, he was influencing
Iwople. I didn't want to be idle. The effective circle of my mental strength was shut,
NO 1 wanted to exercise my physical powers. Mterwards I was supposed to have
nicd but I cannot remember this .. I wanted to make the world happy through
n.lcrifice ... to dissolve every misunderstanding .. 1832. was prophesied as imp( .rtant ... I wanted to make it important. If only everyone was pervaded by the
II"IIIC sort of feeling as myself, the whole world would be a paradise. I thought I was a
,wl'Ond Messiah; I thought I had to make the world happy and important through my
lovI'. I wanted to pray for sinners, to cure the patients, to awaken the dead. I wanted
10 dry their tears; when this was done and not before, I wanted to be happy with what
I had. I called the dead as often as I could. I felt as if I was in the vaults among
IIIl1mmies whom I was to awaken with my voice. The picture of the Redeemer and
154
his melted into one . so pure and mild he stood before me. Then he was the murderer of my father and like a distracted person for whom I should pray. I worked
fearfully hard and my only recreation was to sing . every idea had first to be given
order and sequence and then I was looking for a new one. My hair seemed to be the
tie between us .. I wanted to throw it at him so my inner voice would give me new
thoughts for which I had to work. The smallest details had deep meaning for me...
The last French I did had been "Napoleon in Egypt". I seemed to experience everything I had learnt, heard or read. I thought Napoleon had returned from Egypt but
not died of cancer of the stomach. I was the remarkable girl in whose eyes his name
was written. My father returned with him too. He was a great admirer of him .
and so it went on day and night until I was brought here [to the hospital]. I have
made my escorts suffer terribly; they didn't want to leave me to myself and that I
couldn't bear. I tore everything off to meet him unadorned. I tore my bows off, they
were called butterflies, I did not want to beat my wings and declare myself a prisoner. Suddenly it was as if! were among strangers but you [to the doctor] seemed
like a well-known good genius, I treated you as if you were my brother. Here I
thought my fate is going to be decided . the people seem wonderful, the house
looks like a fairy palace, but the joke went on too long everything seemed cool
and feelingless. I had to get to know more about this .. I continually kept in
contact with William X ... he would give me a sign on the window or door telling
me what to do and encouraging me to be patient ... A lady from R whom I loved
also spoke to me, I replied to her and I was firmly convinced she was here I cannot tell everything that went on but it was a lively, active life .. I would count it as
the happiest time of my life .. you saw what my condition was later on .. It has
remained a bit of a puzzle ever since .. it took a good deal to tear myself away from
this beautiful dream and come back to reason once more . The whole illness has
left certain traces on my mind I have to admit a certain loss of power; I might
say my nerves were rather exhausted. I don't have any pleasure in mixing with
people, no excitability nor any desire to do anything nor any power of reflexion.
I remember my condition too vividly not to see how much is needed for me to
makeup.
CHAPTER II
THE OBJECTIVE PERFORMANCES OF

PSYCHIC LIFE
(PERFORMANCE-PSYCHOLOGY-LEISTUNGSPSYCI!0LOGIE)
(II) Subjective and objective pSYChology
Chapter one dealt with psychic experiences and, we were not concerned
wI! h those perceivable objective facts which, in an individual case, give us
1I\'n$5 to the other person's psyche. We have so far seen the psyche only 'from
IIl~ide' but in this chapter we shall examine it, as it were, 'from the outside'. In
the previous chapter we were engaged with subjective psychology and we now
IlIl'I1 to what may be termed objective psychology.
The external objective phenomena of psychic life may be assessed in a
IIlImber of different ways. They may be assessed as performances (Performancepllychology) or recorded as physical accompaniments or consequences of
p"ychic events (Somato-psychology) or they may be understood as meaning1'111 somatic or motor expressions of the psyche (Psychology of Expression),
III' as the observable facts of personal existence and conduct in the world (PsydlOlogy of the Personal World) or as perceived facts of human creativity
(Psychology of Creative Work). Each of these psychological studies provides
1111 with certain appropriate methods whereby we may gain access to different
lirlds of psychically relevant facts.
In the present chapter our concern is with psychic performances. For the
_like of methodological clarity, we shall keep 'performance' as our guiding
principle in grasping the objective material of our investigation. Performance
iI~ such arises from the application of some general category; for instance, the
,orrectness of a perception (e.g. spatial perception, estimation of time, an idea),
"I' the correctness of memory, speech or thought, etc. Or it may be the type
"f perception that is assessed (e.g. whether predominantly of shape or of
I (110m) or the type of apperception, etc. Or a quantitative standard may be
,,(tthe extent of memory, the amount of work done, the amount of fatigue.
(,.) TIle basic neurological schema of the reflex arc and the basic pSYChological
schema of task and performance
'[he traditional schema of neurology is the concept of an organism into

which stimuli are fed. After inner elaboration (excitation) it reacts to these with
IllOvements and other objectively perceivable phenomena. This physiological
""citation is of infinite complexity. The concept is of reflexes superimposed
'III rcllexes in a system of interacting functions, ranging all the way from the
155
OBJECTIVE PERFORMANCES OF PSYCHIC LIFE
patellar reflex to instinctive behaviour. The basic concept of the nervous

system is that of the reflex arc underlying all psychic events and it contains the
triparti te concept of centripetal (sensory) performance of the sense-organ, central event, and centrifugal (motor) performance to the end-organ. In the concept of the 'psychic reflex are' this schema is transferred into the psychic life.
Thought processes are considered to belong to the central events. In the place
of sensory stimulation there is a memory image, for example, and in the place
of motor excitation, an image of movement. Here objective psychology has the
closest contact with neurology because of the physiology of the sense-organs
and of motor phenomena. Neurology teaches the complexity of the apparatus
which underlies psychic life. Perception and memory depend on the intactness
of this apparatus, and so does externalisation of the inner drives. The investigation of the higher levels of this apparatus takes us into the borderland
between psychology and neurology, and its disorders are both neurologically
and psychologically analysed in the agnosias, apraxias and aphasias. It is
characteristic of such investigations into the psychic reflex arc that they always
lead us to physically tangible and at the same time localisable functions as its
groundwork.
In contrast to this schema of the reflex arc psychologists have long viewed
living activity in quite a different light. There is a radical difference between the
facts that appear when simple stimuli arouse somatic reactions and those which
are deemed to be performances that fulfil certain 'tasks'. In the latter case the
object of investigation is no longer a physically tangible occurrence but a
performance in an environment, a meaningful act, a reaction not to stimuli but
to a situation. In such investigations we no longer introduce simple stimuli
but set certain tasks, e.g. the recognition of briefly exposed objects, the memorising of syllables, adding up, etc.; we no longer register mere movements but
evaluate performance according to duration, correctness and incorrectness.
Task! and performance are the basic concepts, and the experiment of setting a
task is the basic experiment of objective psychology.
The reflex apparatus and the apparatus of performance represent two
different methodological viewpoints. Of neither can we say that they are
life itself. On the contrary they are both artificially isolated, whether in the
one case we think of the mechanism of an automatic event or in the other of a
performance as a whole. In life they are both inseparable.
The psycllOlogical point of view of task and performance has therefore
repercussions on the neurological investigations. It has been recognised that
reflexes are artificial, isolated events of the experimental situation and that
reactions in their normal context in real life cannot be explained in terms of
reflexes. It is true there are reflexes, but only those people who are carried
away by the concept of reflex activity will try to comprehend real life reactions
in these terms. As life adapts itself, as it acts purposefully for its own preservation and extension, as it unwittingly trains itself, learns, and takes on shape
.md form and as it keeps itself in constant movement, so must we conceive it,
as if it were motivated by meaning, in terms of what has been called the teleoI()~ical principle or the function of 'Gestalt' or 'integrative action' (SherringtIIll). The muscle movements are not a summation of reflexes but the meaningful
hehaviour of a live organism in an environment or a situation. 'Our psychophysical performances (as opposed to physiological functions) should not be
I'('presented as part of the schema of neurophysiological excitation but within
1\ sl:hema of relationships between an organic subject and its environment.
Every act carried out is an adaptive performance of my body to my environIlwnt ... for example, sensory stimuli on the vestibular organ act in such a
Wily that orientation to a given situation is possible ... so that coherence in
behaviour is maintained' (v. Weizsacker). The same author wrote as follows:
'When we analyse going up and down hills, the real performances occur in a
continuous cycle of connectedness between organism and environment-environment and organism, but not in the way that we can put the two together
II~ two parts of one whole, because the organism itself always determines what
purl of the environment will act on it and so with the environment, it detrrmines what part of the organism will be excited. Every stimulus has already
hrl~n selected and is thus not just given but fashioned. Every excitation is
"Ircady an alteration of set and once more not just given but fashioned. We
I\lay term this cyclic interaction a Gestalt-circle' (Gestaltkreis),1
On the other hand the neurophysiological viewpoint of the reflex arc has
I'('percussions on the psychology of performance. The basic concepts of
Ilt'lirology are translated into psychopathological theory and they offer a model
111111 sometimes a very apt analogy. We will illustrate with some of the basic
nmcepts of neurophysiology:
1 Re the concept and significance of the set task see Watt, Arch. PsycllOl. (D), vo!' 4, PP. 289 fT.
Ach, Ober die Willenstatigkeit u. das Denken (190). Knipe, Gottinger geMma An{eigen (1907),
pp. 595 fT.
157
(J) Fatigue: reduction of function by constant exercise in time is something

which may be observed in an analogous way from the highest levels of psychic life
lie Iwn to the lowest level of function of the nervous system. (2). Practice: is con!'I'jvc'd to be a factor in the mnestic formation of the nervous system in general.
1,'IIIll:tions released by stimuli produce after-effects which facilitate the function and
plTl1Iit it to take place in response to other stimuli or in response to partial or weak
olilllllii. (3). Excitation and suppression: are the opposite poles in all nervous funcII .. n. (4). Inhihition: is the name given to the weakening or suppressing effect on
1C'lIt'xes produced by the higher centres or other simultaneous stimuli. If we omit
IIlI'sl' other stimuli or exclude the higher centres, the reflex will immediately appear in
Itdl strength. Facilitation is the term used when no reaction appears following either
"I I wo stimuli but will do so only when both stimuli act together or within a short
1IIIt'rvai of each other. Each single stimulus is too weak but several similar weak
'it ill\uli summate in their effect. 5. Shock: is the term used when there is cessation of
111'1 VI IllS function brought on by injury of all kinds (including very strong stimuli)
I
Neryenar{t., vol. 4, p. 529. v. Weizsacker Der Gestaltkrus (Leipzig, 1940).
without destruction. After some time the ability to function returns spontaneously to
the parts which have been affected by the shock.
we get involved in endless complexities and the whole always remains more
Ihan the sum of its parts. We scrutinise things as wholes and, by the clearest
n'presentation of them, we see them more concretely, but in this manner we
do not learn anything of their origin or function. Analysis therefore finally
Irnds towards the grasping of original complex wholes from which the moveIIlcnt of the parts is derived while the perception of complex wholes tends
finally towards analysis in order to comprehend them. The interaction of these
Iwo tendencies is founded in the nature of all living things which as we study
It becomes capable of infinite exploration under these two aspects. This interIIction calls for clear distinctions and clear relationships and does not allow
lilr any confused mingling in which the one tendency substitutes for the other.
I.l[ us take a physiological example:
All these neurophysiological concepts have found application in psychology, but so far with undoubted justification only the concepts of fatigue
and practice, excitation and inhibition. The psychic factor is already important
for reflexes; for instance, Pavlov's dogs. These were fed after a bell had been
sounded and later on produced gastric juices in response to the bell alone (no
food present). It is impossible to discern how far we are using mere analogies
and how far the phenomena are identical. Are we to conceive the effect of
upbringing as an inhibition or facilitation of reflexes; or are we to regard the
increasing complexity of psychic performances such as memory or speechin which complex performances clearly presuppose simple ones-as levels of
integration in the morphology of the nervous system or as linked with the
physiology of reflexes (their integrative action)? Are we to think of a depression as being brought about by the summation of all the little stimuli rising
from a painful situation or are we to explain as shock! the violent emotional
upheavals that are followed by complete flattening of all emotions.
This consideration of the nervous system helps us to draw a necessary
distinction when we are enquiring into psychic life and trying to find causal
explanations. The distinction lies between phenomena (which are experienced
or visible as a performance) and Junctions (which are not themselves visible
but manifest in the phenomena). Functions are not mere theoretical additions
but actual facts of the performances and experiences. As such they are not
in consciousness. The effect of a volitional act on the organs' of movement,
the effect of attention on the sequences of thought and of the act of thought
itself on the play of language cannot be comprehended simply in terms of
awareness. Complex functions take place when the simplest direct experiences
and performances appear. The reverse is also true: simple functions, 'basic
functions', are the condition for a far-reaching range of phenomena.
(c) The antagonism hetween the two hasic schemata
The clearer our analysis is, the more our knowledge improves and the
more we comprehend events as mechanically constructed by the elements of
our analysis. We see reality, however, more distinctly, the more concretely
we can perceive its complex unities, groupings and configurations. Both
tendencies have their own specific point. Each fails should it try to be the sole
foundation of our knowledge or aim at finding the complete answer. We
analyse but in fact are never able to know the whole apart from its elements;
A. Pick has done much work to make psychological phenomena comprehensible through
analogy with the nervous system. He has collected a wealth of minute observations and has reported his views and methods in Die neurologische Forschungsrichtung in der Psychopathologie
(Berlin, Karger, 1921). His numerous writings, highly detailed, are scattered all over and contain
valuable things which are unfortunately embedded in a highly circumstantial presentation. It
would be desirable to try to get at what is of real value by bringing some order into this work.
1
IS9
Integration of the reflexes. Reflexes exist in isolation only in the physiological

~lhema,
not in the nervous system in reality. Through mutual inhibition and facilitalion the reflexes even in the lower levels of the spinal cord are integrated to a funcIional tissue within which they act in consonance, superimposed or antagonistically.
Tlwy build themselves up into a hierarchy of functions which plays together as a
whole. Sherrington demonstrated how complicated even peripheral reflexes, such as
tlw patellar reflex, are in their relationships. Changes in posture of the leg or even that
III' the other leg exert an influence. Sherrington termed this manifold interaction of
till' reflexes 'integration'; the action may be inhibiting, facilitating or regulating and
"xists right up into the highest levels of the nervous system.1 This integrative action
lit' the nervous system makes reflex responses to stimuli appear extremely variable.
(:Il-ordination of reflexes may be disturbed and illness may bring about a reduction
III the hierarchy of functions.
With this kind of presentation there is a constant interweaving of the
lIlt'chanism of mutual influence and modification of all the reflexes with the
IlIdcpendent, original source of the whole complex pattern. For a moment it
~rcms as if the whole might be comprehended from its parts yet, without the
~lIpport of the entirely opposite viewpoint of a whole in its own right, such
UII explanation could only lead us into endless and astronomical complications.
\lIeh investigations make us feel that there is a primary independent source of
.111 the complex unities and that this needs some method for its formulation.
A~ a mechanism reflexes are parts of the totality of reflexes; from the point of
virw of a complex unity, they are members and the membership cannot be
I ,.mprehended simply through the fact of being a part.
There are some noteworthy facts that dramatically demonstrate the
nistence of complex unities:
(;ood performance may be maintained in 'complicated' life situations and certain
can demonstrate this experimentally, although isolated, artificial laboratory tests
"h,.w serious defects of elementary functions of perception (for instance, in cerebral
IlIjllry). A patient suffering from agnosia (psychic or 'soul' blindness) who cannot
1I'l'IIl1:nise shapes during a test may still be able to move quite correctly according to
1"'lls
I (:. S. Sherrington, The Integrative Ac tion of the Nervous System (Cambridge, 1906).
the situation, in his flat or in the street. There are people with encephalitis who cannot go forward but can go backward and even dance (E. Straus) or someone suffering
from the rigidity of Parkinsonism may suddenly show a good performance during
some ball-game, with a graceful pattern of movement (L. Binswanger). The defects
are there in a hidden way and will show themselves up as failure in certain tests, but
the ability of the whole is more than the sum of the individual performances.
the form of psychic performances. The schools of thought which have developed one after the other (as the psychology of association, of intentional
thought, or as gestalt-psychology) and which have all attacked each other,
can in fact be brought together. We can make use of all of them, each one
within its own limitations, as a means of describing phenomena and posing
new questions for analysis. None of these psychologies can claim to explain
everything or provide an all-embracing theory of psychic life as it really is.
They fall down entirely as an explanation of the psyche, but show their value
nonetheless if one employs them for a clear presentation of the relevant psychic
facts. They cohere, they can be combined and do not have to contradict each
other.
160
Some exact experiment in biological research may often make us feel that
we have grasped life in its original wholeness and that we have at last penetrated it through and through and yet in the end we find it is still only a
widening of mechanistic insight, a widening which in comparison with the
preceding simplicities may be truly magnificent but which is yet no penetration
of life itself, only of its apparatus. Thus we have the 'co-ordinating factors' of
Spemann or the genes of genetics. In the end we have comprehended only
elements and the problem of the whole appears again in new form. The
elements however may be complex unities themselves compared with other
elements while at the same time they are also elements in a mechanistic style
of thinking. This mutual interplay is a characteristic of all that we know in
biology and psychology. We can keep things clear only if we know exactly
what we are doing.
We should make ourselves conscious of the antagonism of these two
tendencies and not forget them in our investigations. Only so can we protect
ourselves from contradictory and futile polemics, which follow current fashion
and playoff one method against the other. There is a dislike for complex
unities, for anything 'gestalt-like', since they defy reason, and we prefer to
leave the arts and the poets to deal with matters unscientific. On the other hand
there is also a dislike of elements and mechanisms and a desire to do away
with these remote and artificial abstractions. One party despises interpretations
derived from the whole, the other any interpretation of the whole from its
parts. With many people today holistic and gestalt theories have the upper
hand; there is a certain fear of still using such concepts as belonged to the old,
mechanistic psychology of reflexes and association. It all seems so dull and
retrograde. Yet in fact we still abide by these constructions and use them
unwittingly. The old tendency to make them absolutes was false just as is the
present tendency to make a fresh absolute. Neither way is wrong in itself,
but we have to move in both paths deliberately, otherwise we shall not reach
the real margins of our understanding nor the ultimate possibilities they imply.
(d) Association-, Act- and Gestalt-psychology

The antagonism between mechanism and integrating unity, between automatic happening and creative shaping, between analysis into elements and
discernment of things as a whole, has dominated biological and therefore neurophysiological thinking and turns up again within the sphere of psychological
study. There is a vast psychological literature which discusses the various
schemata of apprehension, by means of which we interpret psychic events in
161
I. Basic concepts. The flow of psychic life is thought to be an association of elements, which group into complexes and as time proceeds call each other up into consciousness. These elements are called 'ideas'. Our perception of the external world
provides the content for these inner images. The psyche can turn to the external
world through perceptions or it can surrender itself to an inner sequence of ideas.
The ideas or images-the elements of this psychic flow-are built up into units by
the act which intends an object in them. In these acts we apperceive certain conHtantly forming, structured units (Gestalten-configurations of perceived objects)
und we experience intra-psychically similar structures among our own psychic
('vcnts.
2. The automatic mechanism ofassociation. We may investigate the flow of psychic
life from two aspects. On the one hand we can understand how drives give rise to
lIlotive, how motives give rise to decision and deed; and we can understand how
thought and thought-content arise from the purposeful consciousness of the person
who is thinking. On the other hand we may try to give some objective explanation of
how one element of consciousness 'follows' another automatically; how a mere
"('qllcnce of psychic events rolls along mechanicalIy. This automatic happening is the
basis for the rest of psychic life, which it makes possible, and we can study it in isoI.lt ion. Objective explanation of the existence and sequence of psychic elements can
proceed either by referring to concrete physical events-the mechanism of perception,
1I('lIrological localisation-or by the use of psychological concepts such as those
which combine into a theory of association mechanisms.
We conceive the psyche as if it were broken down into innumerable elements,
wIi ich move through consciousness one after the other as in a chain, and leave behind
11"'111 certain extra-conscious dispositions, through which they may again become
I IllIsciuus. All psychic events appear either through external stimuli or through the
.11 tllalisation or revitalisation of those dispositions that have been acquired through
I''''vious stimuli. The dispositions are thought to be linked among themselves. They
III'V('I" appear by themselves (independently arising images) but almost always
IIlrIllIgh a stimulation of these linkages. The latter are of two kinds: primary, the
',.IIIlC in all of us (association by similarity, or associations of a general character in
VillllC of some objective context), or they are acquired and dependent on specific
,1I11I'cedent experiences, they are individually different (association by experience or
.(('cording to the particular subjective context). Thus a psychic event may appear by
II'm( ,ciations of similarity, e.g. I see a red colour and I think of another colour, or by
the situation, in his flat or in the street. There are people with encephalitis who cannot go forward but can go backward and even dance (E. Straus) or someone suffering
from the rigidity of Parkinsonism may suddenly show a good performance during
some ball-game, with a graceful pattern of movement (L. Binswanger). The defects
are there in a hidden way and will show themselves up as failure in certain tests, but
the ability of the whole is more than the sum of the individual performances.
the form of psychic performances. The schools of thought which have developed one after the other (as the psychology of association, of intentional
thought, or as gestalt-psychology) and which have all attacked each other,
can in fact be brought together. We can make use of all of them, each one
within its own limitations, as a means of describing phenomena and posing
new questions for analysis. None of these psychologies can claim to explain
everything or provide an all-embracing theory of psychic life as it really is.
They fall down entirely as an explanation of the psyche, but show their value
nonetheless if one employs them for a clear presentation of the relevant psychic
facts. They cohere, they can be combined and do not have to contradict each
other.
J60
Some exact experiment in biological research may often make us feel that
we have grasped life in its original wholeness and that we have at last penetrated it through and through and yet in the end we find it is still only a
widening of mechanistic insight, a widening which in comparison with the
preceding simplicities may be truly magnificent but which is yet no penetration
of life itself, only of its apparatus. Thus we have the 'co-ordinating factors' of
Spemann or the genes of genetics. In the end we have comprehended only
elements and the problem of the whole appears again in new form. The
elements however may be complex unities themselves compared with other
elements while at the same time they are also elements in a mechanistic style
of thinking. This mutual interplay is a characteristic of all that we know in
biology and psychology. We can keep things clear only if we know exactly
what we are doing.
We should make ourselves conscious of the antagonism of these two
tendencies and not forget them in our investigations. Only so can we protect
ourselves from contradictory and futile polemics, which follow current fashion
and playoff one method against the other. There is a dislike for complex
unities, for anything 'gestalt-like', since they defy reason, and we prefer to
leave the arts and the poets to deal with matters unscientific. On the other hand
there is also a dislike of elements and mechanisms and a desire to do away
with these remote and artificial abstractions. One party despises interpretations
derived from the whole, the other any interpretation of the whole from its
parts. With many people today holistic and gestalt theories have the upper
hand; there is a certain fear of still using such concepts as belonged to the old,
mechanistic psychology of reflexes and association. It all seems so dull and
retrograde. Yet in fact we still abide by these constructions and use them
unwittingly. The old tendency to make them absolutes was false just as is the
present tendency to make a fresh absolute. Neither way is wrong in itself,
but we have to move in both paths deliberately, otherwise we shall not reach
the real margins of our understanding nor the ultimate possibilities they imply.
(d) Association-, Act- and Gestalt-psychology
The antagonism between mechanism and integrating unity, between automatic happening and creative shaping, between analysis into elements and
discernment of things as a whole, has dominated biological and therefore neurophysiological thinking and turns up again within the sphere of psychological
study. There is a vast psychological literature which discusses the various
schemata of apprehension, by means of which we interpret psychic events in
J61
I. Basic concepts. The flow of psychic life is thought to be an association of elements, which group into complexes and as time proceeds call each other up into consciousness. These elements are called 'ideas'. Our perception of the external world
provides the content for these inner images. The psyche can turn to the external
world through perceptions or it can surrender itself to an inner sequence of ideas.
The ideas or images-the elements of this psychic flow-are built up into units by
the act which intends an object in them. In these acts we apperceive certain constantly forming, structured units (Gestalten-configurations of perceived objects)
and we experience intra-psychically similar structures among our own psychic
events.
2. The automatic mechanism ofassociation. We may investigate the flow of psychic
life from two aspects. On the one hand we can understand how drives give rise to
motive, how motives give rise to decision and deed; and we can understand how
thought and thought-content arise from the purposeful consciousness of the person
who is thinking. On the other hand we may try to give some objective explanation of
how one element of consciousness 'follows' another automatically; how a mere
sequence of psychic events rolls along mechanically. This automatic happening is the
basis for the rest of psychic life, which it makes possible, and we can study it in isolation. Objective explanation of the existence and sequence of psychic elements can
proceed either by referring to concrete physical eyents-the mechanism of perception,
neurological localisation-or by the use of psychological concepts such as those
which combine into a theory of association mechanisms.
We conceive the psyche as if it were broken down into innumerable elements,
which move through consciousness one after the other as in a chain, and leave behind
them certain extra-conscious dispositions, through which they may again become
conscious. All psychic events appear either through external stimuli or through the
actualisation or revitalisation of those dispositions that have been acquired through
previous stimuli. The dispositions are thought to be linked among themselves. They
never appear by themselves (independently arising images) but almost always
through a stimulation of these linkages. The latter are of two kinds: primary, the
same in all of us (association by similarity, or associations of a general character in
virtue of some objective context), or they are acquired and dependent on specific
antecedent experiences, they are individually different (association by experience or
,Iccording to the particular subjective context). Thus a psychic event may appear by
associations of similarity, e.g. I see a red colour and I think of another colour, or by
associations of experience, e.g. I perceive a smell and think of the house in Rome
where I experienced a similar smell and feelings are aroused in me similar to those I
felt then. The extra-conscious association-links which theoretically are considered
to be causal remain by definition always unconscious; moreover, when a new image
emerges we are by no means always conscious of the connecting link of objective
similarity or of chance subjective experience. We have feelings and thoughts the
origins of which we cannot discover even by thinking hard about them. Sometimes
we are successful when some time has elapsed,as,in the example, we may explain the
appearance of certain feelings by that earlier experience and the present olfactory
sensation. Thus it is with most explanations of psychic phenomena in the case of
patients. We find the associations. The patients are not aware and do not need to be
(for instance, in the speech of aphasic patients and the flow of images during a flight
of ideas, etc.).
This rather crude picture of elements and association-linlcs will have to suffice. We
try to explain what appears new in the flow of ideas by the principle of association
but it is not only new things that are constantly appearing. Ideas that have been aroused
tend to stay and after brief intervals will return by themselves. Perseyeration is the
term given to this tendency of psychic elements to linger on. From what has been
said it will be clear that not only ideas but feelings, thoughts, aims and modes of
reaction 'perseverate' as well.
3. Constellations and determining tendencies. This flow of ideas holds momentarily
immense possibilities for the association-process. But only few of these possibilities
come to pass. How does the selection of them take place? It is certainly not brought
about simply by the latest idea but by the whole complex of antecedent experiences,
through the influence of ideas which are far removed from the centre of consciousness, and of which we are only dimly aware, and even through ideas which are too
weakly stimulated outside consciousness to reach it. The term 'constellation' is given
to all these very complex conditions that determine the eventual direction of the
associations. The various individual conditioning factors are said 'to constellate'.
Besides this constellation of associations we find another quite different factor which
is responsible for the selection of certain associations out of all the infinite number
possible. Certain aims (master-ideas)-the awareness that the flow of ideas is to lead
to a certain goal and satisfy the requirements of a particular task-bring about a
preference for the relevant ideas if the individual has the necessary association-links.
We can demonstrate this effect experimentally. The extra-conscious causal factors
that are linked with this target-awareness are called the determining tendencies (Ach).
We have to make a threefold distinction: (I) the awareness of the target, (2) the
selection of suitable ideas-as can be shown objectively, (3) the determining
tendencies which provide the theoretical explanation for this selection of ideas as
demonstrated and which are thought to be linked with the target-awareness. Determining tendencies do not originate only from a rational awareness of the target. They
arise from all kinds of ideas, from aesthetic images of some complex unity, from
moments of mood etc.
4. The chain of associations and the linlc by Act. We are now acquainted with that
objective explanation of the psychic flow of ideas which is based on the principles of
modes of association (similarity or experience), the constellation of ideas and determining tendencies. Elements are linked by association and are called up in clusters or
constellations under the influence of determining tendencies. To make any meaning-
ful use of these explanatory principles we need to know what are the elements that
are being called up and between which links exist and are being created. When we
begin to think of examples we immediately find that there are a number of extremely
diverse elements: sensations as such, percepts and ideas, ideas as such, ideas and
thoughts, ideas and feelings, feelings and entire thought-complexes etc. In psychic
life everything can be associated with everything else. One might be inclined to the
opinion, as many psychologists are, that all psychic life could be reduced in the last
resort to a number of simple elements, sensations and simple feelings. All more
complex functions are then built up from associative links. All associations at this
level would be traced in the last resort to the links between the primary elements.
This is a mistake due to the confusion of two quite different connections, the associatiye linlc and the intentional linlc. We must be clear about the difference because
otherwise we cannot apply the concept of association correctly. With idiots and
parrots we can establish an association between words and the perception of objects;
on seeing the object, the word is said, without knowing that the two are linked by any
meaningful association. Here the associative link causes one element to be aroused by
the appearance of the other (i.e. perception and word). But if an individual grasps that
a word means an object, we have here the experience of an intentional link. Word
and object form a new unit now for him, whereas when mere associative links are in
operation the context of the connection is present only to the observer, not to the
individual who associates (in whose consciousness one element is following the other
automatically). Speaking quite generally, we may say that innumerable psychic
clements are grouped within one intentional act and are grasped as one comprehensive whole, and this, in contrast to the individual elements, gives rise to something
new. One thought builds on another, on ideas and perceptions, and these all become
unified for the subject eventually in his thought. This experience of unity seen from
the point of view of association-psychology is again another element. Everything
which is grasped in one intentional act and experienced as a whole is an element.
We are now approaching the answer to the question what an element means for
association-psychology. We can design a visual schema to give us a proper view of
the matter (see accompanying diagram, Fig. I). The elements lie in horizontal layers,
one on top of the other, in such a way that several elements of the lower layers can
meet again at a higher level by means of the intentional Act; for instance, at the
bottom there are elements of sensation, at the higher level, thoughts of relationship.
162.

--0---0
FIG.
Element
/\ Intentional link by Act
- - - - Association link
In the diagram, the intentional links have been drawn from above down; the association links are presented horizontally. Every intentional act in the higher layer is
an element which associates, and at the highest levels most complicated intentional
Acts are being associated together.
completion of a task which has meaning only as a whole. But every individual
performance is once again a particular.
Beyond the individual performance lies the total performance. This complex
unity influences the single performances of every individual. It may correct
or modify them. Only the performance that is in harmony with the total performance will obtain full realisation. The total performance can be conceived
from several points of view: as the psychophysical ground for the performance of basic functions; as the present state of the individual within tke flow
ofhis psychic life, or as that persisting capacity for performance, which we call
intelligence.
However, this total performance is not the final thing. As a whole it is a
tool for understandable personality. Although the personality itself lives
in it, it always still remains a tool. If we talk of tasks to be performed, we may
ask what tasks? for what end are they posed and by whom? The psychological
study of performance presupposes the existence of meaningful tasks; but we
have to turn to sources in human beings themselves when it comes to whether
the tasks are grasped and assented to, whether the performance is seen as a
means, and why these means are used. Hence the psychological study of performance never grasps the human being as a whole but only the apparatus
which lies at his disposal. The psychophysical apparatus in all its developed
thought-performances provides the basic structure for intelligible personality.
One could construct the theoretical borderline case where the personality as
a potentiality remains intact although there is every kind of disturbance in the
performances of the psycho-physical apparatus and there is no further
possibility of self-expression.
If we look at the contents objectively realised by human beings through
the medium of task and performance, we see that mere performance is something extremely limited yet necessary. The machinery must function if the
human nature which it serves is to reach realisation. The aspect of performance links the psyche most closely with the neurological apparatus. From
this point right up to thinking proper there is a hierarchy of connected
function, providing the tools with which man works.
Schema
Association linlc
I. Associations occur mechanically in
sequence and stand side by side.
Associations occur unconsciously; an
association-link is not an object of
experience for the individual associating.
3. The lower the level of intentional
acts, the more frequent are the
association-links, as observed, occurring in speech and conduct.
2.
Intentionallinlc
Intentional links build up one on
another to higher wholes, which are
again experienced as units. 1
Intentional links occur consciously;
the link is an object for the individual
who experiences it.
The higher the level of intentional
acts, the more conspicuous to the observer are the meaningful connections
of conscious psychic life.
5. Elements and configurations (Gestalten). The unity of anything that has been
comprehended by an intentional act and which has been carried out as a whole by
means of its movement has been termed a configuration (Gestalt). We do not perceive sensations but all our perceptions, images and thought-contents appear to us as
configurations. We do not carry out muscle contractions but a configuration of
movements. The simple act of unitary object-perception would be impossible if the
miraculous interweaving of all that has preceded it in our psychic life did not supply
the influence which brings order into the scatter of individual facts. Sensations in the
course of perception become members of a whole, muscle contractions become
governed by ideo-motor schemata. We talk of word-pictures or movement-patterns
in order to differentiate these configurations from sensations and contractions. The
psychological study of perception and movement has examined these configurations
in some detail, particularly with reference to disturbances in this field in the form of
agnosias and apraxias. The function of configuration is, so to speak, the architectonic
association of sensory and motor elements to make a meaningful unit of the perceived
object and in the movement pattern; to make a meaningful unity also of sensory and
motor patterns in general, wherever there is perception and motor activity, understanding of speech or the act of speech. According to this conception, configurations
become the elements of every psychic event.
The concept ofelements in psychic life never denotes 'ultimate' units but only units
as they are seen to function according to some particular point of view. We shall,
therefore, work with different units as elements according to the point of view we
have for the moment adopted, so that what is an exceedingly complex construction
from one point of view will become a single element for another.
(e) The hierarchy of complex unities
Beyond the reflexes, which only appear as isolated units under experimental
conditions, lies the first complex unity-performance. Performance is the
1
Beringer, Spannweite Jes intentionalen Bogens.
(f) Experimental work in psychopathology!

The psychological study of performance is also the main field for experimental psychopathology. At this point we can appropriately include some
remarks on psychological experiment:
I. The set task. The basic structure of every experiment consists in the
1
On experimental psychology see Kraepelin, 'Der psychologische Versuch in der Psychiatrie',
Psychol. Arh., vol. 1 (1896). Sommer, Lehrhuch Jer psychopathologiscnen UntersuchungsmetlwJen

(1809).-For a survey, see Gregor, LeitfaJen Jer experimentelles ps:;-:lwpatlwlogie (Berlin, 19(0).
More recently Ernst Schneider, PsychoJiagnostisches Pralctikum (Leipzig, (936). Papers in Z. Neur.,
vol. 161, pp. 444, SII. Ober Psychotechnik u. Eignungspriifungen; Miinsterberg, GrunJ:r;iige Jer
Psychotechnik; F. Giese, Handbuch Jer psychotechnischen Eignungspriifungen (Halle, 192.5). W.
I'oppelreuter, 'Psycho. Begutachtung der Erwerbsbeschriinkten in Abderhalden', HanJhuchJer bioI.
Arb.itsmethoJ,n, Abt. 6.
166
setting of tasks and the observing of performance, reaction and the general
mode of behaviour. Set tasks are of the following kind:
the techniques for examining aphasias, apraxias, and agnosias. There are a
series of carefully graded tasks in a number of situations, to bring out clearly
and objectively the actual performance and the failures, which are kept circumscribed in relation to specific factors. (This has been subtly developed by
Head.)
(hO) Precise measurements. The results are characterised by being in the
precise form of figures and measurements. There are experiments with a series
of tasks, learning experiments, experiments with the tachistoscope. In these
there is always a quantitative assessment; experimental conditions are systematically varied and correlations between factors are established.
(cc) Techniques for presenting the phenomena. An attempt is made to write
down everything the patient says during the experiment; behaviour is described, and performance recorded, the way the patient writes, how he moves.
Here belong also the mechanical recordings of movement for 'objective'
presentation, speech-recording and the use of film and gramophone.
(dd) Selfohseryation under experimental conditions. The purely objective
tests ask for co-operation, accessibility and understanding of the task on the
part of the patient or subject, but they need no particular psychological ability
on his part nor any self-observation. Tests that require self-observation call for
individuals who have this latter ability and who are able to carry out selfobservations in an unbiased way. The results of such experiments belong as
much to the study of objective performance as to phenomenology, e.g. in the
explanation of failures in performance noted by phenomenological observation. I These experiments simply create suitable conditions under which
through the patient's self-observation it is possible to become aware of certain
psychic phenomena of a particular nature. Patients are asked what they experience when carrying out the tests. An effort is made to relate these phenomenological reports to the failures in performance, so that they may be interpreted
psychologically; this applies especially to disturbances of perception and
movement.
(ee) Ohseryations made during the experiment, hut not as part of it. Testing
in psychopathology derives much of its value from the observations made
during the actual tests. These are not like the experiments made in the natural
sciences during which one simply registers and measures. The patient is placed
in conditions under which he tends to disclose himself more quickly and more
clearly than he will do in ordinary interview. The unexpected observations
areespeciaUy stimulating for the examiner. Moreover, they are essential for the
correct interpretation of the measurements obtained. It is only through observation that we can detect schizophrenic thought-blocking, whether affective
pauses prolong the test, and whether the behaviour is due to laziness or
stolidity. Purely mechanical test-results are useless here.
I. Recognising an object which is exposed for a very short time (use of the
tachistoscope): test of apperception. 2. saying the first word that comes to mind in
response to a stimulus-word;-test of association: 3. taking in and retaining certain
test material-test ofattention, test oflearning: 4. looking at a picture and then giving
a spontaneous description of it, followed by an examination on individual points, or
reading a story instead: test ofpowers of reproduction: 5. adding up, making measurable movements. The performance is calculated and the many determining factors are
investigated: test of working capacity.
Example. Test ofassociations. Association experiments! are often used because of
the technical ease with which they can be arranged. Stimulus words are called out and
the instruction given to react as quickly as possible with a single word, the first that
occurs to one. Or the task is set to surrender oneself to ideas as they come and speak
them out without thinking. The extremely simple procedure of the association test
has shown itself to be fruitful, not so much through its exactness as in what it reveals
objectively to the observer.
In association tests we observe: I. the length of time of the individual reaction
(measured with a stop-watch). 2. the correct or incorrect reproduction of the individual association when the test is over. 3. the number of associations faIling into
certain categories e.g. clang-associations, associated content etc. The classification of
associations is made according to a number of schemata the value of which can only
be assessed according to their particular purpose. 4. reactions with associations which
are qualitatively dijforent; e.g. egocentric reactions, whole sentence completions,
definitions, verbal similarities, marked emotional colouring etc. The test reveals the
wealth of associations at the disposal of an individual, though the conclusions gained
by the test are not very reliable; the emotionally toned complexes that dominate
the patient's life (shown by increased reaction-time, poor powers of reproduction,
marked accompanying phenomena-a convincing but unreliable clue); odd types
of ideational processes, e.g. flight of ideas, catatonic incoherence. These will occur
spontaneously during the test as in conversation.
2. The manifold nature of experimental ohserYations. Experiments abound
in great variety. They range from simple aids to examination to complicated
and costly techniques, from a simple recording of performance to the endless
possibilities of accidental observations, from the sole observation of the experimenter to self-observation of the proband.
(aa) Aids to examination. There are some very simple experiments, such as
having pictures described, or observing false perceptions that arise when there
is pressure on the eyeball, having a story retold, having inkblots described
(Rorschach) etc. Here we are not dealing so much with actual experiments as
with technical aids to examination, which have proved to be valuable techniques for complementing the ordinary interview. 2 Rather more complex are
1 Aschalfenburg, Psychologische Arheiten von Kraepelin, vols. I, 2, 4. lung, J. Psychiatr.
vols. 3,4, 5. Isserlin, Mschr. Psyc!Uatr., vol. 22, pp. 419, 509. Munch. med. Wschr., vol. 2 (1907).
I Such technical tests exist in great numbers, especially intelligence tests; for the examination
of inaccessible patients see Liepmann, 'Kleine Hilfsmittel', etc., Dtsch. med. Wschr., vol. 2. (1905).
1 The school of Kulpe (Buhler, Messer, Selz) has developed this kind of test. Cf. Arch.
P.(ychol. (D). For criticism see E. Muller, Zur Analyse der Gediichtnistiitig1r.eit (Leipzig, 1911),
1'1" 61 If. Wundt, 'Ober Ausfragexperimente', Psy. Stud., vol. 3 (1907).
168
OBJEC'rIVE PERFORMANCES OF PSYCHIC LIFE
INDIVIDUAL PERFORMANCES
(If) The aim of experimental testing. This is to measure individual performance, basic JUnction, intelligence, personality or constitution. Whatever the
test many functions must be intact for performance to be possible. We can only
test certain psychic functions if the other functions are intact. This is why, for
example, association experiments, reproduction experiments, tests of working
capacity are equally applicable to the investigation of single functions as to the
characterisation of the total personality, whether it be in its constitutional
features (psychic tempo, sensory type, etc.) or as an individual form of personal
expression.
(gg) Several tests attempt to penetrate the unconscious, and illuminate hidden
aspects of the life-history, i.e. association-tests and the Rorschach.
3. The value ofexperiments. Experimental psychology is not equally valued
by everyone. Some think it sterile and empty; others see it as the only scientific
method we have. To a balanced observer it must appear irreplaceable as an
experimental method in its own field, but we cannot concede it the right to
consider itself as the only method. The main thing is to formulate our problems clearly and this needs an all-round psychological education. We should
certainly try experiment where questions can be suitably answered in this way;
otherwise we should look oUt for other methods, such as simple observation
and the study of the patient's life-history and the use of cases, statistical
methods, and methods of sociology.
Experiment creates objective facts which convince. Other methods do not
do this as easily nor as quickly nor as obviously. Many psychic phenomena
only become apparent when their relation to the patient is shown in this objective way. The distance created by the experimental situation may reveal
quietly and impersonally what had been hidden during actual interview.
Furthermore the experiments of normal psychology as of sense-physiology
have important results. They make us keenly aware how even the simplest
phenomenological process contains extremely complex factors, not only in its
somatic genesis but in the function and correlation of the phenomena brought
out by the experiment but not yet explicable in somatic terms. PsychopatllOlogical experiments also confirm this. We always need to distinguish what the
experiment really shows from the theoretical explanations we give of what is
happening. Where no direct link with a physiological-somatic base appears
possible, we would still like to find a psycho-physical apparatus functioning.
This is achieved when the conceptual schemata of neurology become translated
into psychology and concepts are formed such as those in the above-discussed
schools of Association-, Act- and Gestalt-psychology.
a performance of some kind will fall naturally into one of the groups which we
are about to discuss. These are perception, apperception and orientation,
memory, movement, speech and thought. Our concern is with particular
failures of performance which can be directly observed. Description of these
will always give us the performance-profile of an individual. First, however,
we must make an inventory of the separate types of performance.
I.
Not all the stimuli that impinge on sensory nerve-endings reach consciousness.
There are many centripetal nerves which elicit complex reflex responses without
anything becoming conscious. The whole process remains automatic. As surgeons
have found, the stomach and intestines are almost entirely devoid of sensation and
yet within their numerous nerves reflex mechanisms of a most complicated kind
occur. Maintenance of equilibrium, the performance of many movements (ind~vi
dual muscle contractions as well as complex synergies) happen without our awa'reness but we cannot draw any sharp dividing line between purely physical mechanisms and psychically conditioned events. Mere reflexes, as for instance breathing,
become conscious and conscious events can become automatic (for instance, the
movements learned in riding a bicycle).
When we come to perception it is obvious that disturbances in the nervous
system will affect perception in so far as the latter is based on the former. Thus, for
example, we get anaesthesias, parasthesias, disturbances caused by morbid processes
in the visual apparatus (hemianopsia, disturbance of visual perception through lesions
in the choroidea etc.) and all the other anomalies described in neurology. These
disturbances are subdivided physiologically according to their predominantly peripheral or central nature. The higher the level of nervous integration in which they are
situated, the nearer we come to psychic events. It is true there seems no end to it, an
infinite progression. Every new neurophysiological discovery, instead of setting foot
within the psyche, simply enters a yet higher level of the neuro-mechanisms that
underlie psychic life. However, when describing psychopathological disturbances in
perception, we usually include the neurophysiological anomalies that affect the highest levels. Sensory disturhances helong here, a few of the false perceptions and above all
can
the agnosias.
SECTION ONE
Performances are classified according to the form in which they materialise.

Everything that can be observed objectively, tested, investigated and called
PERCEPTION
(a) We find simple sense-deficiency-congenital deafness, colour-blindness,

anosmia-where sometimes no physical cause for the deficiency is known.
We can find full descriptions in the textbooks of neurology, ophthalmology
and otology of the manifold perceptual disturbances arising from local diseases
of the sense-organs and of the nerve tracts up to the projection-area of the
cerebral cortex.
(b) With the majority of hallucinations we do not know what causes or
conditIons their appearance. With some hallucinations, however, we do know
some if not all the contributing causes (cp. pp. 377-89). Hallucinations follow
diseases of sense-organs and certain localised conditions of the sensory cortex
(peculiar elementary light and sound phenomena). We have also observed
vertigo in diseases of the vestibular apparatus and hemianoptic hallucinations

in particular with localised lesions in the occipital lobe. With other hallucinations we have noticed a certain dependence on external stimuli; in organs which
are so disposed and can hallucinate almost spontaneously, it is possible to
bring hallucination about by any kind of stimulus. With delirious and other
patients visions can be elicited by pressure on the closed eye, as we all know.
But all these effects are far too crude for us to penetrate to the extra-conscious
mechanisms that underlie the hallucinations.
(c) Agnosias. 1 This is the term given to disturbances of recognition while
sense-perception is intact. After a head-injury, the patient may be able to see
the room and its furniture but cannot recognise the objects as furniture; she
is perplexed, does not know what objects they are and of course does not know
that they are her furniture.
She can therefore perceive but cannot make out the meaning of her perceptions. In agnosia, perceptions take place, with sensations present in the act
itself, but what is then perceived is not perceived as a definite object, nor can
it be recognised. Reproduction, which links up previous experiences and makes
recognition possible in all perceptions, is absent here. Goldstein and Gelb have
to some extent clarified what is actually present in consciousness in such cases.
They have given us a description of a patient of theirs with a gunshot wound
in the head: 2
Visual agnosia (,soul'- or psychic-blindness) occurs with the destruction

of both occipital lobes. Actual facts do not support a relationship between
these specific disorders of performance and any fine, localised cerebral lesions.
Visual agnosias, auditory agnosias and tactile agnosias (stereoagnosias) are
differentiated according to the sense-areas.
(d) Some of these perceptual anomalies which so far have only been
treated phenomenologically can be recognised by objective tests and measurements, and can be explained as defective performances; for instance, some disturbances of the time sense. We have to distinguish between disturbances in
the perception of time, which we can test, and disturbances in the experience
of time (which so far we have only studied phenomenologically). So with
perception of space, in a few cases it is possible to link this up with testable
alterations in performance; for instance, a reduction of the visual field, l explicable in terms of a fatigue-phenomenon or a disturbance of attention and
increased distractibility.
170
The patient has coloured and colourless blotches in a certain part of his visual
field. He can see whether a certain blotch is higher or lower, to the right or left of
another one, whether it is narrow or wide, large or small, short or long, nearer or
further, but that is all, because the various blotches together create a confused impression and there is not, as with normal people, any impression of a specific, weIlcharacterised whole. The patient could not recognise any shapes, neither straight nor
crooked ones. When, however, he followed the shape with his hand, he could recognise it. Nor could he see movements properly. He reported: 'When I saw the train
coming, I saw it about 5 metres away.' After that, usually, he saw nothing until it
was suddenly standing in front of him. A moving train which 'he clearly recognised'
he did not see moving; he concluded it was moving only from the noise; when he
wanted to go for a walk with his sister-in-law, she went in front of him, and he followed her at a distance of 20 metres; he then thought his sister-in-law had stopped
and was standing still and was 'very surprised that he did not overtake her'. The
distance did not get any shorter ... What he saw was only a 'now-here', 'nowthere'; he never had the impression of movement as a normal person has it, that is, as
something specifically different from individual, static position. In the tactile field,
however, the patient had distinct perception of movement.
1 Wilbrand, Die Seelenblindheit (1887). Lissauer, Arch. Psychiatr. (D), vol. 2.1, pp. 2.2.2. If.
MUller, Arch. Psychiatr. (D), vol. 2.4, pp. 856 If. Liepmann, Neur. Zbl., vol. 2.7 (1910), p. 609.
KUlpe, Z. Pathopsycho!., vol. I, pp. 2.2.4 If.
! Goldstein and Gelb, 'Zur psychologie des optischen Wahrnehmungs und Erkennungsvorgangs', Z. Neur., vol. 41 (1918), p. I. Fruitful translation of Gestaltpsychology into psychopathology is continued in Z. Psychol., vols. 83, 84, 86 (1919-2.0), and in the continuous series of
'Psychological analyses of brain-pathology cases'.
2.
171
ApPERCEPTION AND ORIENTATION
Agnosias are disturbances of recognition, that is they are properly disturbances of

apperception, but because they are confined to particular sense-areas, we have grouped
them with disturbances of the perception mechanism. If we now discuss disturbances
of apperception 2 in the narrower sense, we cannot make a very shat p distinction.
What we mean now is a disturbance in all the senses at the same time, in so far as
they are related to the psychic life as a whole. We can, therefore, differentiate disturbances of this sort from those agnosias which, similarly to disturbances in the
sense-organs, occur as more peripheral anomalies in a normal person and attack only
one of the mechanisms underlying psychic life. Whereas phenomenologically perception and apperception form a single whole, an objective analysis of the performance can differentiate the mechanism of perception, as the process whereby nervous
mechanisms can lead to awareness of objective content, and apperception, as the
process which brings about the absorption of such content into the body of our
experience.
Apperception can be slowed down, or remain in abeyance in the face of
difficult objects or lead to false results. These facts can be crudely observed in
any interview, through reading a sample of short stories to the patient, or
showing him a number of pictures. 3 The time required for apperception can,
however, be measured in much finer detail, and so in cases of false apperception
can the dependence on the constellation of the preceding inner associations.
For this we can use experiments with the tachistoscope, an apparatus which exposes picture3, letters, words for very brief measurable periods. Investigations
1 Klien, Arch. Psychiatr. (D), vol. 42, p. 359. Rehm, Z. Neur., vol. )5, p. 154 Heilbronner, Mschr. Psychiatr., vol. 17, pp. 441 If. Kronfeld, Arch. Psycho!. (D), vol.
p. 543. (Summaries), Gregor, 4 Vorlesung.
'lIeilbronner, Mschr. Psych;"tr. (D), vol. 17, p. 10j.
22,
173
such as these lead to a tentative classification of disturbances of apperception

into three groups, according to the source of the disturbance:
but they are not wrongly orientated. 4. Clouding ofconsciousness. The patients only
grasp details. Apperception of the real environment is replaced by the changing experiences of the disturbed consciousness, which cause a wealth of fantastic disorientations, analogous to dreams.
I. Level of intelligence. Apperception fails with the more difficult objects because
of the persisting defective state. There is no body of knowledge with which the perception can be linked.
2. Apperception can be affected owing to disturbances in registration (e.g. in
senility, in Korsakow-syndrome). Everything that comes into consciousness is
immediately forgotten. Before anything more complex can be apperceived, however,
what has been perceived must also have been retained. In this case this is already forgotten when the next part of what is to be apperceived appears.
3. Apperception depends upon the state of consciousness and on changes in the
mode of psychic activity. In states of clouded consciousness there is an indistinct,
often illusory, apperception, sometimes clear in detail but never clear as a whole. In
manic states apperception is most changeable, following the flitting interest and the
marked distractibility through chance constellations of ideas which may lead to
falsifications. In depressive states apperception is inhibited and does not reach its
goal though efforts are made, sometimes intensively. With the use of the tachistoscope and by exposing a series ofletters, we can count the omissions and mistakes in
apperception and measure reliability and distractibility. objectively.
Orientation is a highly complex apperceptive performance. We can easily

verify it in respect to the environment in the current real situation or else in
respect to one's own person. We distinguish orientation in space and orientation in time, orientation in relation to the self and orientation in relation to
others. Orientation in one direction may be intact when there is disturbance in
others. For instance there is the characteristic symptom of delirium tremens,
complete disorientation in place, time and environment but correct orientation
in relation to one's own person. Disorientation, however, is not a particularly
pathognomic symptom. It can come about in very different ways and its significance therefore may vary greatly. It is only the last, easily detectable,
objective failure in performance in a chain of manifold acts of apperception.
The following schema covers the different modes of disorientation:
I. Amnestic. Where there is a severe degree of disturbance in registration, there is
a disturbance of apperception as a result of immediately forgetting what has just
been experienced. Senile patients, for instance, think they are twenty years old.
Women take their maiden name again, write the wrong year, think they are at school
or at home when they are in the clinic, think the doctor, whom they never recognise,
is a teacher, some official or the mayor etc. 2. Delusion-like. The patients are fully
conscious but have delusions and therefore conclude, for example, that the date is
three days out although they know everyone else finds the date different. They may
conclude they are in prison, though everyone else considers the place is a hospital
etc. Double orientation as it is called is connected with this. The patients are correctly
and incorrectly orientated at the same time. They know, for instance, where they are,
what time it is and that they are having a mental illness. At the same time this is only
an appearance, the golden age has arrived and time no longer matters. 3. Apathy. The
patients do not know where they are, what time it is, because they do not think of it,
Disturbances in orientation occur in acute psychoses and many chronic

states. They are easily recognisable and important for the assessment of the
case. In each case it is necessary to make sure about all four dimensions of
orientation. The finding that the patient is orientated or in which direction
this is so will influence the whole of the further examination.
The disturbances of apperception have been differentiated and investigated
according to their content-the failure to recognise people, for instance. 1 This
phenomenon is an objective disorder of performance but it may be of very
different kinds and origins.
Failure to recognise persons occurs where there is alteration of consciousness
(deliria), where there is confabulation in amnestic syndromes, fooling about in
manic states, altered perception (illusion), acute psychosis, or delusional perception
in schizophrenia. The mode of experience is as heterogeneous as the cause.
3.
MEMORy2
Psychological prefoce. A threefold distinction is necessary.

(I) Registration. The ability to add new material to the store of memory. We
then differentiate into learning ability (repeated presentation of material) and registration in the narrower sense (single presentation of material). (2) Retention. The big
reservoir of lasting depositions, which can enter consciousness on appropriate occasions. (3) Recall. The ability to bring into consciousness particular remembered
material at a particular moment under particular circumstances. Registration and
powers of recall are actual functions; memory itself is a possession of lasting depositions. We can find pathological disturbances in anyone of these three fields. They
can all be described as 'disturbances of memory' but in fact they are each different in
character. Normally, memory may be faulty with constant limitations and fluctuations as regards fidelity (reliability), duration, readiness and serviceability. Extensive
psychological experiment has established certain laws which are of interest; there are
laws of memorising (e.g. the dependence on attention, interest, whether one learns
the whole or part, impairment by simultaneous evocation of other associations,
generative inhibition). There are also laws of recall or reproduction (impairment by
other simultaneous psychic processes, inhibition by associations which try to enter
consciousness at the same time; effectual inhibition). We have to realise that there is
Werner Scheid, 'Ober Personenverkennung', Z. Neur., vol. IS7 (1936), p. I.
Ribot, Das Gulachtnis und seine Storungen (D), (I88~). The following summarise the great
experiments of Ebbinghaus and G. E. Muller: Offner, Das Gedachtnis (Berlin, 1909)' G. E. Muller,
'Zur Analyse der Gedachtnistatigkeit und des Vorstellungsablaufs', Erg-Bd.d.Z.Psychol., vol. 3
(19 I I ff).
As regards psychopathology see Ranschburg, Das kranke Gediichtnis (Leipzig, 191 I). K.
Schneider, 'Die Storungen des Gedachtnisses', Bumke's Handbuch der Geisteskrankheiten, vol. I
(19~8), p. s08.
1
I
174
no such thing as memory in the form of a general ability to remember, but that
memory consists in a number of special memory factors. We can sometimes find, for
instance, an otherwise feebleminded person possessing an outstanding memory for
time.
So far in this discussion of memory we have had in mind a mechanism, a machine
which we can work well or badly. Memory, however, is also subject to meaningful
connection with affect, significance, the desire to forget. Nietzsche once said: 'Memory
declares that I did this; I could not have done this, says my pride; and memory loses
the day.' It is one thing to deal with memory in respect of things learned (knowledge);
it is quite another to deal with memories in respect of personal experience (recollection) and the latter may differ greatly in relation to the personality. Memories may be
fresh, effective, significant, not at all remote, or may have become objective, a matter
of history, a sort of knowledge, at one remove from the present personality. A
number of these meaningful connections have been investigated experimentally: e.g.
the relationship between the pleasantness or unpleasantness of an experience and
retaining it correctly or forgetting it.i Pleasant experiences are retained better than
unpleasant ones and the latter better than indifferent ones. It is an old saying that pain
is soon forgotten. Memory is optimistic in that we tend to remember the pleasant
parts most of all. Memories of severe pain after operation, during confinement or of
violent affects soon fade. We only know finally that what we suffered at the time was
very powerful, painful and unusual, but we do not keep any real memory of the
experience itself. Are unpleasant experiences not so well memorised from the start or
do we only recall them with greater difficulty? Or is it that we think of them less
frequently and so forget them more quickly? We have to distinguish the forgetting of
obligations, of unpleasant tasks, of embarrassing scenes, by simply not thinking of
them, and that unintentional repression of unpleasant things, which may lead to an
actual splitting off of the content (with impossibility of recall).
In discussing memory disturbances we must distinguish between those
which result from abnormal states of awareness (Amnesias) and those which
occur in normal states.
(a) Amnesias
These are disturbances of memory which last over a definite and limited time,
when nothing or only little (partial amnesia) can be remembered; the term also
covers experiences not so well defined as to time. The following different situations should be noted: (I) there may be no disturbance of memory at all.
There is a state of deeply disturbed consciousness in which nothing could he
apperceived and therefore nothing could be registered. Nothing has come into
the memory and nothing can therefore be recalled. (2) Apperception may have
been possible for a while but registration was seriously disturbed so nothing
was retained. (3) Transitory registration may have been possible during an
abnormal state, but the memory depositions have been destroyed by an organic
process. The clearest example of this is what happens with retrograde amnesias,
1
Peters, 'Gefiihl und Erinnerung', Psychol. Ar"., vol. 6 (19II), p. 197. Peters and Nemecek,
2 (1914), p. 226.
Fschr. Psycho/. vol.
17S
after head injury, when everything experienced during the last hours or days
hefore the injury is totally extinguished. (4) There may only be disturbance
of the power to recall (reproduce). The memory contains the whole content
but cannot evoke it. Under hypnosis, however, successful recall occurs. Such
amnesias have been investigated by Janet.I His padents were unable to remember certain experiences (systematic amnesia), or some particular period of
their lives (localised amnesia) or their life as a whole (generalised amnesia). If
we observe such behaviour in our own patients we shall see that memory does
playa conspicuous part. They do not behave as if they had really lost the
memory depositions. They do not appear subjectively disturbed by the amnesia.
Their attitude towards it is one of indifference and is full of contradictions.
Finally the amnesia may lift, spontaneously, periodically or with the help of
hypnosis.
Several of these four types of amnesia may app'ear in one case, but usually
one or other predominates. Particularly characteristic is the way in which
something belonging to the amnestic period tends to be preserved. An amnesia
is very rarely complete and this or that particular can be evoked. We find two
types of spontaneous memory:2 (I) Summary recollection: the recollection of
the essential points in a vague, undetailed way. (2) The recollection of a mass
4 detail, of small, unimportant points which stand unconnected, alongside
each other. Sometimes the memory consists of these detailed small irrelevancies,
hut neither the relationships in time nor in context ever become clear. The
above two types correspond to what can be evoked by stimulation or by the
lise of certain props to the memory: e.g. (I) by appropriate means, and most
strikingly of all by hypnosis, we find we can evoke a whole systematic context,
a whole complex, a whole set of experiences; (2) we can also sometimes evoke
a large number of particulars, by arousing detailed images via the most diverse
associative paths. The proper time order and the context can only be evoked
with the utmost difficulty or not at <ill. Speaking categorically, we might say
that the former method is appropriate for hysterical amnesias and amnesia
after powerful affects, while the latter is more applicable for amnesias in
epileptic and organic states, disturbances of consciousness etc.
The fact is worth noting that even organically caused amnesias can sometimes be lifted with the use of hypnosis. This has happened repeatedly in the
case of epileptic amnesias3 , and also with a person who had had a retrograde
amnesia due to hanging and who was revived. 4
(II) Disturhances of recall (reproduction), retention and registration
Besides the more circumscribed amnesias we commonly deal with

I Janet, Der Geistes{ustand der Hysterischen (Vienna, 1894), pp. 65 fr.
Heilbronner, Mschr. Psychiatr., vol. 17, p. 450.
Ricklin, 'Hebung epileptischer Amnesien durch Hypnose' (Diss., Zurich, 1903), j. Psychiatr.,
vol. 1, p. 200. v. Muralt, Z. Hypnotism usw., vol. ro (1900), p. 86. H. Ruffin, Dtsch. Z. Nervenhlr.,
vol. 107 ('929), p. 27 1
Schilder, Med. Klill., vol. 192), p. 604
disturbances of memory in the simple form of an exaggeration of everyday forgetting, of ordinary poverty of registration, etc. Here too we make the usual
subdivision into the ability to recall (reproduction), the reservoir of memorydepositions (retention) and the ability to grasp (registration).
I. Disturhances of recall (reproduction). Hebephrenics sometimes give a
deceptive impression of poor memory when they talk past the point or suffer
from thought-blocking; melancholics do the same when retarded and preoccupied with their own distress, and so do manics who show flight of ideas
and lack of concentration'! In all such cases recall may perhaps be transiently
diminished but the memory is there and after the disturbance has passed will
appear unaltered. The patients have only been temporarily unreflective. We
also find these disturbances in recall among psychasthenics. They know everything quite well, but the moment they want to use what they know nothing
comes to them-e.g. during an examination. As to the hysterical inability to
recall, we mentioned this among the amnesias. It is always related to a number
of complexes and is not so much a question of momentary lapse of memory
as the dissociation or splitting-off of some definite, circumscribed memorycomplex.
2. Disturhances of memory proper (retention). Our memory capacity is
increased or fortified by our powers of registration, but at the same time it
tends to disintegrate continually. As time goes on, the memories that have
been laid down fade from us and we forget. In old age particularly and in
organic processes, memory may undergo excessive disintegration. Beginning
with more recent events, the patient finds himself robbed of the memory of his
own past and his vocabulary suffers as well. Concrete terms disappear first,
abstract terms and conjunctions etc. are preserved longer. Generalities and
broad categories linger on, whereas everything that is directly observed and
individual vanishes. Of personal memories, the most recently acquired disappear first, the more remote ones are engulfed more slowly. The memories of
childhood and youth are retained the longest and sometimes are particularly
vivid.
3. Disturbances of Registration. Patients no longer register though their
previous memories are at their disposal. These disturbances have been investigated experimentally. In particular there is the test in which pairs of words are
learned-be they nonsensical or meaningful-and the assessment of such performance has proved fruitful. A quantitative assessment of the memory
disturbance becomes possible.
G. E. Storring2 observed the case of an isolated, total loss of registration
with no other disturbances than those consequent on this disastrous loss. The
case has been excellently described and it is unique as well as uncommonly

instructive:
1 J. Schultz, 'Ober psychologische Leistungspriifungen an nervosen Kriegsteilnehmern',

Z. Neur., vol. 68, p. 326-of relevance to the failure of grasp and recall in depressions and
neurasthenia.
2 G. E. Storring, 'Ober den ersten reinen Fall eines Menschen mit voJligem isolierten Verlust
der Merkf~higkeit', Arch. Psychol. CD), vol. 8r (r93 r), p. 257. For an earlier report on the same
case see Griinthal and Storring, Mschr. Psychiatr., vols. 74 and 77.
177
A 24-year-old locksmith sustained gas-poisoning on May 31St, 1926. In 1930 he

was examined. Memories dating from before May 31st were preserved. From ".hen on
nothing new had been added. Every impression vanished after two seconds. Any
long question was forgotten by the time the questioner had reached the end of his
sentence. Only brief questions could be answered. Yesterday for the patient was for
ever May 30th, 1926; whatever seemed to contradict this, puzzled him for the
moment but the contradiction was immediately forgotten. After his accident his
fiancee married him. He did not know this had happened and therefore when asked
'are you married?' would say 'no, but I want to marry soon'. He said the last word of
the sentence hesitatingly; he no longer knew why he was actually saying it. Looking
through the window at the winter landscape, he could call the time of year 'winter',
but ifhe covered his eyes he would say it was 'summer'-'it was so warm'. The next
moment, looking at the fire he would say 'it is winter, because there is afire'. During
the usual examination of the skin with the use of painful stimuli, pinprick etc., each
prick was immediately forgotten, though unpleasant sensation persisted. Thus he
offered his hand unsuspectingly again and again but the unpleasant feeling summated
until finally a sudden elementary fear and flight reaction ensued.
In so far as the whole experience of his former life was at his disposal, he apperceived correctly, recognised things correctly, judged correctly everything at the
moment of apperception. He recognised people whom he had known before 1926.
Those he met later, his doctors, for instance, struck him every time as strange, new
people, in spite of his frequent meetings with them. He was not dull or 'dopey' but
wide awake and attentive. He was fully there, observing, enjoying himself, SPVHtaneous in movement and talk. His emotional life had remained the same; his personality, his reactions, values, likes and dislikes had not changed. Compared with the
previous period there was a stronger intensity of feeling (his wife said he felt more
deeply than before). Every situation was held isolated in his mind without incorporating past or future and every experience was sudden and therefore sharper. His feelings were less complicated than before, conditioned by the immediate past. He lived
entirely in the present but not in time. Central feelings closely linked with his
personality were more to the fore than peripheral, indifferent ones. His personality
was strongly felt by those around him and he was found to be very likeable ... He
had been a tranquil man but his actions were now abrupt and hasty. He became
outwardly restless before beginning; the feeling-drives had to reach an adequate
intensity by summation before they suddenly triggered off. The patient was unaware
of his memory disturbance and did not notice it. If he had noticed it, he would have
forgotten it immediately but he did not even notice it, because every impression
vanished by the time he wanted to reflect on it. Instead he became puzzled and restless
in certain situations, not because he realised his forgetfulness but because he had a
feeling that he intended to do something, while he no longer knew what he was to do
or wanted to do, unless he was told again and again from second to second. The constant perplexity became set in his facial expression. Starring compared this situation
with a wax tablet suddenly turned to stone; the old impressions were still readable but
IlO more new impressions could be made.
The failure of memory-performance often affects registration and recall
179
at the same time as it extinguishes the already existing depositions. The

picture will get clearer if we describe the memory-performance as a whole and
how particular behaviour is affected. W. Scheidl, for example, gives us an
excellent description of memory-defect in an alcoholic-Korsakow. Innumerable islands of memory appear, a random scatter of defects and an equally
random scatter of successful efforts at registration. We may also note a complete loss of memory after some severely upsetting experience, though memory
for small details may be retained. In every memory-performance the situation
and the individual attitude are always important.
events, and as preceding and following definite points in time. Some confabulations may possibly be experienced as memories of this sort, but generally they
have much less degree of certainty; they are memories without any real back~round and lack temporal or causal connection with memory as a whole. It is
true we can remember something without placing it in time and without a
I:ontext, but then we are not sure whether it might not have been a dream,
unless we can link it up with some other memories. So with the Korsakow
patient. The lack of connections made him feel that his real memories had only
been dreams.
(c) Falsifications of memory
So far we have described memory-lapses in respect of general knowledge

and personal experience. We now come to a fundamentally different order of
phenomena, which we have termed falsification of memory. This occurs universally and in healthy persons as well as the sick. Investigations into powers
of reproduction or of giving evidence2 have brought to light the surprising
extent of these falsifications. These experiments, which, like most experiments,
involve some kind of 'task', give a cross-section of the person's mental life
and show many phenomena more clearly than the ordinary clinic examination
can do, and can demonstrate it quantitatively.3
Falsification of memory plays a considerable part in mental illness. 4 We
find boastful tales in paralytic patients, random spun-out fantasies in certain
paranoid dements, who bring them forward as memories and tell them to others
as such; we find falsifications of memory analogous to hallucinations (p. 64).
With some conditions we feel we can well understand how patients after some
serious disturbances in registration with simultaneous loss of old memories
try to fill in the gaps witn anything that springs to mind (confabulation). They
still retain their intelligence, think and judge. They comprehend the situation
but they cannot come to any proper conclusion as they lack the vital associations. They unwittingly invent what seems to fit the moment and although
they may have been in bed a week, they will say they were in the market this
morning or have been working in the kitchen etc.
W. Scheid observed real memories in the patient who was suffering from
an alcoholic-Korsakow syndrome. (They arose in distorted fashion as in
confabulation.) He experienced them, however, as if they were dreammemories, yet he doubted whether it was a dream or real after all: 'Did I dream
that?'-Scheid describes the actual experience of rememhering. Normally we
remember the past as having happened at a certain time continuous with other
1 W. Scheid, 'Zur PathopsychoJogie des Korsakow-syndroms', Z. Neuf., vol. 51 (1934),
P346.
2 RodenwaJd, 'Ober Soldatenaussagen', Beitf. Psycho!. Aussage 2. Baerwald, Z. Ungew.
Psycho/., vol. 2.. W. Stem, Beitf. Psychol. AlIssage 1. Stohr, Psych%gio der Aussage (Berlin, 1911).
3 Roemer, Klin. psych. u. nerv. Kranlch., vol. 3. Eppelbaum, Allg. Z. Psychiatr., vol. 68, p. 763.
Kraepelin, 'Ober ErinerungsfiiJschungen', Arch. Psychiatr. (0), voL 17 (1886), p. 830;
vDL 18 ( 188 7). pp. 199, 39S.
4.
MOTOR ACTIVITY
From the point of view of the 'psychic reflex are' all psychic events merge
at last into motor phenomena, which assist the final inner elaboration of
stimuli into the external world. From the point of view of inner meaning,
subjective awareness of Will translates itself into movement. This volitional
act is associated with an extra-conscious motor mechanism, on which the act
depends for its effectiveness.
We can, therefore, examine the many, often grotesque, movements of
mental patients from two points of view. Either we try to acquaint ourselves
with the disturbances of the motor mechanism itself, which can sometimes
show disturbances independently of any psychic anomaly and this is the
approach adopted by neurology. Or we try to get to know the abnormal
psychic life and the patient's volitional awareness, which these conspicuous
movements exhibit. In so far as we know the meaningful connections, the
movements become behaviour we can understand, for instance, the delight
in activity shown by manic patients in their exuberance, or the increased urge
10 move shown by patients who are desperately anxious. Somewhere between
the neurological phenomena, seen as disturbances of the motor-apparatus, and
the psychological phenomena, seen as sequelae of psychic abnormality with the
motor-apparatus intact, lie the psychotic motor-phenomena, which we register
without being able to comprehend them satisfactorily one way or the other.
Neurological phenomena are termed disturbances of motility; the psychotic
phenomena are termed disturbances of motor activity. Psychological phenomena
are not conceived to be primary motor phenomena but are to be seen as actions
and modes of expression which have to be understood.
(a) Neurological disturhances of motility
Motility and its regulation depend on three systems: the pyramidal system
(if diseased, there is simple paralysis); the extrapyramidal system of the basal
)!;anglia and brain stem (if diseased, there are changes in tonus, expressive
movement, gesture and co-ordination -for instance, a disappearance of the
automatic pendulum arm-movement when walking, choreic and athetotic
movements); the spinal cord and cerebellar system (if diseased, there is ataxia,
lSI
a disturbance in motor-co-ordination due to impairment of sensory factors). In

psychopathology we must be familiar with these disturbances of motility so
that we are not tempted to understand them psychologically. For instance,
automatic movements such as forced laughter in bulbar paralysis are in no way
expressions of psychic factors but the results of localised irritation in the brain.
resistance. Tensions such as these are basic for the term catatonia. However, at
present catatonic symptoms denote rather more than these tensions alone, and
include all the incomprehensible motor phenomena which we shall now proceed to describe. (h) Flexihilitas cerea. There is a slight, easily surmountable
tension; the limbs can be put into various postures, like wax, and they will
remain like this. This phenomenon is termed catalepsy. There is apparently
a transition from this point to a meaningful phenomenon; patients will retain
postures of an accidental nature or into which they have been put. They do
not resist these movements, but permit them co-operatively. (c) Limp immohility. The patients lie immobile as in the previous descriptions; we can
move all their limbs, sometimes with surprising ease. Afterwards they will
flop down following the law of gravity. (d) Bi,{arre, statuesque postures.
Kahlbaum compared some patients with Egyptian statues. They remain totally
inexpressive, as if turned to stone; one will pose himself on the window sill,
another stand rigid in a corner etc.
Hyperkinetic states. In states of motor-excitement, we speak of the pressure
of movement. However, we usually know nothing about this 'pressure' and
we would do better to resort to the more neutral expression 'motor-excitement'.
Old writers would speak of 'furor' (Bewegungstollheit). Movements of this
sort appear manifold, aimless and there seems to be no happy or anxious
affect accompanying them or any other appropriate psychic change. If our
immobile patients sometimes give the impression of Egyptian statues, these
patients seem like soulless machines. When one investigates individual cases
one gets the repeated impression that sometimes we are dealing with neuronal
phenomena and sometimes with meaningful actions. At other times both
seem to apply in that neuronal activity seems supplemented by expressive
movements (Wernicke: complementary movements). But no general statement
can be made of any validity. For the present we can only content ourselves
with description of the movements we observe, and their different types.
ISO
(h) Apraxias
Neurology climbs up from level to level in the nervous system as if it must

come closer and closer to the centre of volitional awareness, the psyche itself.
The apraxias are the disturbances at the highest level yet described. l Apraxia
consists in the patient's inability to make the right movement in relation to his
target-image, although his psychic life is intact and his motor-ability from
cortex to periphery is undisturbed, that is, there is no ataxia or paralysis. He
wants, for instance, to light a match; instead of doing this, he puts a matchbox
behind his ear. The pattern of movement which would co-ordinate this gesture
is not available to him. Liepmann localised this disturbance in the brain and
has even observed it to occur unilaterally. The patient could carry out movements successfully with one arm but was apractic with the other.
The neurological disturbances in these apraxias have something in
common with psychotic movements and normal activity. We can only recognise them as pure disturbances of the motor-mechanism when they occur in
an otherwise !tealthy individual and when we can localise them anatomically
in the brain. It is very likely that a whole series of extra-conscious functions
are superimposed one on the other betw~en these mechanisms of apraxia and
the conscious volitional impulse. Our knowledge here has grown from below
upwards but at present once we are beyond the boundary of the motor
apraxias we find ourselves floundering about in an entirely unknown country.
(c) Psychotic disturhances of motor activity
If for the moment we leave aside purely neurological motor-phenomena

in mental patients, as well as other phenomena which seem to be expressive
of psychic events and can be understood as normally motivated, we are still
left with a large number of surprising phenomena which at present we can
only register and describe and interpret hypothetically. 2 Wernicke distinguished
akinetic and hyperkinetic disturbances of motor activity, and added the parakinetic disturhances as a contrast, meaning by this unsuccessful, inept activity.
I. Description: Akinetic states. (a) Muscle tonus. The jaws are firmly
pressed together, the hands are clenched, the eyes tightly shut, the head kept
rigidly just above the pillow. When one tries to move a limb, one meets with
1 Liepmann, Die Storungen des Handelns hei Gehirnkranken. Das Krankheitshild der Apraxie.
Drei Aujsiit{e aus dem Apraxiegehiet (Samciich, Karger, Berlin).
2 Kleist, Untersuchungen <ur Kenntnis der psychomotorischen BeweglllZgsstorungen hei Geisteskrankheiten (Leipzig, 1908-9)' Homburger, 'Motorik', in Bumke's Handhuch deT Geisteskrankheiten,
vol. 9, pp. :l.II-64
Externally many of these movements remind us of athetotic, choreic or involuntary

movements as we find them in patients with lesions of the cerebellum and cerebellar
tracts. Patients make peculiar writhing movements of the body, roll around, stretch
their backs, distort the fingers in bizarre fashion, fling their limbs about. Other
movements give more the impression that they are reactions to bodily sensation.f.
While the patients are writhing and contorting themselves, they put their hllntiK
suddenly on one side of their abdomen, press their hands on their genitals, pick Iheir
noses, open their mouth wide and grope in it, shut their eyes tight, lean over 01' lutlll(
un to something, as if they wanted to avoid falling over. Other lll()vl~l11!'nl~j ul1,uill v,ivl'
more the impression of being expressive. All kinds of grimadlll( hdolll1, h!'I'!', Ihoqr
grotesque gestures which have been long regarded as characlt"ri~lk~ of 1111111111'._,
the faces of rapture and terror, or silly, childish faceti()usnes~. Pllllrlll~ 11111 Ih!'l.
head against the wall, gesticulate, assume animal postures, or llIl rl'r1r"I;,~' 1t"II lilt;
most of these movements are quickly interrupted and fresh (lll~' IItk~ Ih!'11' plllrr;
or again certain movements are endlessly repeated over week8 IIne\ 11I11111hN. DAlil"
ing, hopping about, tripping around, affected little skips lind jumpN, KYIIIIIANIIl'N,
innumerable rhythmic movements, can all be included here. A further group of movements might be subsumed under the category of sterotypies linked in some way with
sensory impressions. The patients touch everything; tum things this way and that;
outline contours with their fingers; imitate movements seen (echopraxia) or repeat
everything they hear (echolalia) parrot-fashion. They say the names of all the objects
they see. All these movements have in common that they are done uninterruptedly,
in stereotyped repetition. Finally there is a group of movements which is characterised by complexity and similarity to purposeful acts. A patient jumps up and knocks
someone's hat off. Another carries out a military drill. A third suddenly shouts out
swear-words. We talk here of impulsive acts. They are extremely conspicuous when
the patient has been immobile for days. He suddenly carries out such an act, only to
relapse into complete immobility immediately afterwards.
We can occasionally make the observation for all the disorders of
movement so far described that they are apparently restricted to certain areas.
Patients may talk incessantly and senselessly but may otherwise be quite quiet
in their movements or, inversely, there are other patients who are entirely mute
when carrying out their peculiar movements. Increased muscle tonus is often
localised to specific groups of muscles, for instance, eyelids and jaws are firmly
shut while the arms can be moved quite easily.
One other observation is worth mentioning. In the akinetic states there is a
great difference between spontaneous movements and those made on request
(Wernicke: self-initiated and responsive movements). The otherwise immobile
patient sees to his own toilet, will swallow his food, feed himself. When these
spontaneous movements are present, the patient does not respond to any
request at all. During testing, when one tries to get the patient to carry out
some movement by request or perform a 'task', the patient may begin a movement and one has the impression that he has understood and has formed an
appropriate target but the movement does not proceed. It is suddenly interrupted by another movement, or is simply suspended, or is replaced by widespread
tension, or by some entirely contrary movement (negativism), or after prolonged hesitation, with much muscle tension and jerking, some small attempt
is made at the requested movement and it is finally carried out perfectly
correctly. We can observe all this if we simply ask the patient to raise his hand.
During such tests, the patient seems to exert himself greatly, he flushes,
perspiration breaks out; his eyes are turned on the examiner with a peculiar
suddenness and with an inscrutable expression. In catatonic patients one can
often see a last-minute reaction (Kleist). One has been at the bedside a long
time. The moment one walks away, patients will say something; as soon as
one turns back nothing further can be elicited. It is therefore an old practice
with catatonic patients to keep one's ears open just as one walks away, so that
one may at least catch the solitary piece of information that emerges. The
patient who never speaks may write down the answer to some question, or
an immobile patient may say he cannot move. But we get no more than an
impression in these cases that we are dealing with mechanical motor-dis-
turbances like motor apraxia, and manifestations of this sort are rare among
all the many phenomena which still puzzle us and which for the time being
we simply call 'motor' phenomena.
The original more circumscribed concept of 'catatonic' has been substantially
enlarged to include all these incomprehensible phenomena of movement. The latter
arc very common in the large group of schizophrenic processes. The same phenomena are apparently found in low-grade idiots, as described by Plaskuda. 1 In the case
of idiots, the commonest finding is a rhythmic movement to and fro of ,the trunk,
torsion movements of the head, grimacing, clicking of the tongue, rattlIng movemcnts of the lower jaw, whirling the arms, tapping, plucking, twiddling the legs,
rhythmical jumping up and down, running in circles. Catalepsies with clouding of
l'Unsciousness have been observed in physically sick children. 2
2. Interpretation. We have already emphasised sufficiently that interpretation of all these phenomena is not yet possible. Wernicke's neurological interpretations as given in his teaching on the motility psychoses were applied
by Kleist in the new teaching on apraxia, but despite excellent descriptive work
he was not very successful. In some catatonic disturbances of motility it is
possible, indeed probable, that neurological disturbances may constitute one
factor. Here there would be nothing psychic but rather the disturbance of a
mechanism with which volition is then confronted, but it could be linked with
a disturbance in the pysche and in volition. There are anomalies of movement
in genuine neurological diseases of the subcortical ganglia (corpus striatum)
which are linked with certain psychic anomalies (lack of initiative) and comparison has been made with catatonia. But it is precisely the psychological
differences that are conspicuous. Comparison can only be fruitful through a
better description of what may be neurological, so that this can be used as a
contrast for the clearer comprehension of catatonic psychic disturbance. 3 Disturbances of movement in post-encephalitics are externally very similar to
catatonia and are very remarkable:
We find rigidity of muscles, lack of spontaneous movement. The clinical picture

initially looks like a catatonic state: 'lying on the back with head bent forward; the
head not touching the pillow. Lengthy retention of passively received postures
whether uncomfortable or not; fixation of the final posture after action or the freezing
of a movement in the middle of an action; when a spoon is taken to the mouth, the
kmd stops halfway, or the arms are kept rigid during walking. 'The inner state,
however, is quite different from catatonia. Patients see their disturbance objectively;
Plaskuda, Z. Neur., vo!. 19, p. 597
Schneider, Z. Neur., vol. :&2 (1914), p. 486, reviews the literature and discusses the onset of
,"tatonic symptoms.
3 Frankel, 'Ober die psychiatrische Bedeutung der Erkrankungen der subkortikalen Ganglien
lind ihrer Beziehungen zur Katatonie', Z. Neur., vol. 70, p. 31:1. O. Foerster, 'Zur Analyse und
I'athophysiologie der strHiren Bewegungstorungen', Z. Neur., vol. 73, p. I. The latter work
instructs us on the purely neurological nature of these disturbances of motility due to lesions of
'he subcortical ganglia and how different they are from the genuine catatonic disturbances known
,<I psychiatry.
1
though spontaneous movement is extremely difficult for them, they can carry out the
same movements by request from someone else. Hence the patients try out psychological devices on themselves; they work themselves up, make themselves furious, or
enthusiastic, to keep the movements up. Once their attention is distracted the tonus
increases and movement becomes more difficult. The increase in muscle tonus is
very disturbing when they want to fall asleep. When attention is directed towards the
intended movement by someone else's will, relaxation and easing takes place. Reiterative phenomena are frequent; rhythmic distention of the cheeks, clicking of the
fingers, rhythmical protruding and withdrawing of the tongue. The patients experience this inability to stop as a compulsion. The patients remain aware and thinking is
orderly. They are orientated and not psychotic; there is no negativism, resistance or
contrariness.
Severe cases of encephalitis are described in phrases very reminiscent of catatonia.
'Physically these people are almost completely blocked'-'Expression is immobile,
they have staring looks'-'silent, speechless people, motionless as statues'. Many
attacks of fury are reported, sudden apparently unmotivated shouting, crying without apparent cause, even spontaneous attempts to strangle someone near-by, especially in young encephalitics (Dorer).
Further descriptions deal with the interweaving of intended movements and
those which are neuronally determined. Movements which patients will make after
encephalitis epidemica seem to bring the limbs into positions which one sees in
choreic or athetotic types of movement or in torsion spasms. l
Psychological interpretation has been offered by KraepeIin. The observations of restricted and interrupted movements, oflast-minute responses, negativism, are particularly suggestive of possible understanding on the basis of
the psychic mechanisms of idea and counter-idea, effort and counter-effort;
with patients it seems as if every idea not only evokes a 'counter-idea', every
effort a counter-effort, but the one actually encourages the other and lets it
assert itsel The patient who wants to raise his hand, does not want to, for that
very reason. Kraepelin called this state of affairs 'blocking'. Many of the disturbances of movement described were then explained in terms of such
'blocking of volition'. He interpreted other movements as an expression of
the alteration in personality. Every person exhibits his nature through his
movements and the sick person shows his nature in his manneristic and bizarre
movements, in a 'loss of grace'. Wernicke interpreted yet other movements
as the sudden appearance of 'autochthonous' target-images, psychologically
unmotivated, and he supposed an impulse to realise them. Others he interpreted
as automatic innervations, complemented by psychologically motivated movements (Complementary movements). Thus a jerk of the arm is complemented
by some groping movement. Patients' self-descriptions sometimes give us insight into their own experience of these disorders of movement. We see that
even the most surprising mOVements may have a psychologically understandable motivation, which of course does not exclude their having an organic
basic as well:
1
Rothfeld, Z. Neur., vol.
114,
p.
281.
A patient in an acute psychosis in which she was almost inaccessible kept tearing
lip her underwear and making countless incomprehensible movements. After .the
acute phase had disappeared, the patient wrote this about herself (Gruhle). 'I was m a
dream-like state and had the idea that "if you are not ashamed to tear up your underclothes in the presence of a man, all people will get to Paradise. The man will m~e
you his Heavenly Bride and you will be Queen of Heaven." T~a: then ;-ras the mouve
for tearing up my underwear. Another idea I h.ad ,;as that as a dlvl~e bel~g I must not
wear any clothes, just as I must not eat anythmg. Movements which might cause ~e
onlooker some frightening moments meant for the patient harmless amuseme~t (I.e.
jumping around). 'As to my desire to fall, this had a variety ofreason~. Sometimes I
obeyed voices: "Fall down, Claudia" (her christian name). At other umes the world
would only be saved by my fall, because I would fall to my death by foiling forward
vertically on to my face. I never had the courage t~ do ~his and always l~nded on my
knees or on my seat' .. 'I forgot to explain my up-toemg. I had lost weight and had
a wonderful feeling of being light as a spirit, so that floating along on tiptoe gave me
great pleasure.'
5.
SPEECH
Psychological Preface. From the viewpoint of the 'psychic reflex arc' lang~age is
only a particularly well-developed part of the total reflex arc. Understandmg of
language is a part of perception and apperception, speech a part of the motor ~hen
omena. This viewpoint clarifies only a few aspects of language, not language Itself.
Speaking should be differentiated from uttering noises that are audible. !he .latter
may be involuntary expressions but as such are not sp:ech .. They. are cries, mte~
jections, whistles, etc., but not words, sentences. There IS ~o mtentlOn to co~mu~l
l:ate. Speech only exists if meaning attaches itself to articulate words. Objective
speech is a system of symbols, sanctioned by traditional usage, and used as a tool by
anyone who grows up within the system.
.
We should also differentiate speaking from expresszve movements. These are
involuntary manifestations of the psychic self through gesture, voice and posture.
Speaking, on the other hand, is a willed communication of an objecti:e content,
whether by gesture-language or voiced speech. If! speak, I have somethmg to communicate to a listener which he will understand.
We also have to separate speech and speaking. Speech, as language, is an objective
symbolic structure in which the individual who belongs to that language-group
partakes to a greater or lesser extent. Speaking is an accomplishment of ~he psychzc
reality of the individual. Our concern here is with speaking as a psychological occurrence and not, as later, with language or speech as cultural products..
.
Speaking and understanding are closely linked. They take place m group mterl:ourse. They occur as a communication of meaning and it is the meaning as such,
not the language or the words, which is in the field of attention for both the speaker
and the understanding recipient.
Man , when isolated, uses speech in order to make himself understand his own
h
thoughts and wishes. Although speaking and thinking are not identical, ~very tho~g t
nevertheless develops in conjunction with speech. In the manual handlmg of objects
and during the actual execution of meaningful work, our thinking is speechless, but
in the objects themselves we find symbols and signs of an activity analogous to speech.
No thoughts can exist without roots in something concrete; abstract ideas are linked
with symbols, the concrete meaning of which is not immediately present although it
is with these that we think. The symbol is then a concrete minimum.
Abnormalities of verhal production whether spoken or written may be due to two
quite different reasons. The verbal production may be abnormal because although
the speech apparatus is normal something ahnormal is heing expressed. We see in the
verbal products elementary disturbances of thinking, feeling and awareness which
make use of normal language and tum its content and character into expressive
phenomena. In spite of the intact speech we can recognise in the verbal product the
striking manifestation of underlying psychic disturbance. In the second place, the
verbal production may be ahnormal because the mechanism of the speech apparatus itselfhas changed. Only when this is so should we speak of speech-disorders. These are
not meaningful changes, because they are extra-conscious events. But we can psychologically understand and try to interpret all abnormal verbal products that are secondary to abnormal psychic life; their content and expressive character have some meaning for us. Apart from these neurologically and psychologically explicable products
of speech we find, thirdly, certain inexplicable ones the analysis of which helps us
to learn what are the speech disorders proper.
can hear; these are feebleminded persons who do not speak though they can
186
We differentiate disorders of articulation from aphasias and speech-disordfi's

in psychosis:
(a) Disorders of articulation
Speaking is a co-ordinated process of muscle movement. Disturbances in

this field are termed disorders of articulation, in contrast to disturbances of the
central speech-process that precedes the muscle movement. Disorders of
articulation are neurologically conceived and are possible without any psychic
disturhance. The actual word is malformed owing to the paralysis of individual
muscles or some disturbance of innervation. It therefore comes out distorted
(where disorders of articulation are not immediately observable, the patient
can be tested by being asked to repeat difficultword-combinations-(e.g. Royal
Irish Artillery, the swimming swan etc.) We find, for instance, syllables are
bungled; speech is slurred; there is dysarthria; laIling in paralytics, scanning in
multiple sclerotics. In addition there is stuttering which belongs to this group
although it arises from quite different causes and may be psychologically
conditioned. We use the term 'stuttering' for those clonic movements of the
speech-muscles whereby consonants and vowels at the beginning of a word
fall prey to constant repetition instead of becoming incorporated into the
spoken word. 1 Corresponding to these disorders of articulation on the motor
side are certain sensory disorders; for instance the failure of a deaf person to
understand. Those who are deaf and dumb for congenital reasons or through
early acquired deafness need to be differentiated from those who are dumh hut
1 Hoepfner, 'Vom gegenwartigen Stande der Stotternforschung', Z. Psychother., vol. 4 (19u),
p. 55 Gutzmann, Die dysarthrischen Sprachstorungen (1911). E. Froschels, Z. Neur., vol. 33
(19 16), p. 317. E. Froschels, Lehrbuch der Sprachheilkunde (Leipzig and Vienna, 1931, 3rd cdn.).
(This not only deals with stammering but with aphasia.)
hear and there is no speech disorder.

(h) Aphasias
We find patients who no longer speak (cases of apoplexy, brain injury,

cerebral tumour). In the old days they were often thought to be demented but
one can see they would like to speak when one addresses them. They try to
speak and torture themselves in trying to do so. Their whole demeanour shows
their personality is still there. Other patients will speak but cannot understand.
it was a great discovery to find that in these cases one was dealing with a speech
disorder, a circumscribed disorder of the apparatus, not of the personality or
the intelligence (though such disorders hardly ever appear without some
change in the total state). Another great discovery was that in right-handed
persons symptoms of this sort were due to destruction of the left lower frontal
convolution or of the temporal area. These speech disorders are incredibly and
most confusingly varied. Attempts have been made to reduce them to some
order by endeavouring to erect a large-scale basic psychology of language
(Wernicke). Speech was broken down into speaking and understanding, repeated speech and spontaneous speech, naming, reading, writing etc. Each of
these elements were then ascribed a definite place on the left frontal cortex, so
that these psychological structures became physically embedded in the brainstructures. From this emerged the 'classical teaching on aphasia'.
The aphasias are similar to agnosia and apraxia but related to speech. Patients
hear but do not understand what is said (sensory aphasia). We may differentiate here
Il(tween understanding the sound-pattern and understanding its meaning. Other
Jl<ttients can move all their speech muscles and can use them for purposes other than
speech but cannot pronounce words (motor aphasia). Here too we should differenti.lle between inability to pronounce from inability to find the words (amnestic aphasia).
III the first case the patient cannot repeat words, in the latter he can. Sensory aphasia
depends predominantly on destruction in the temporal lobes; motor aphasia on
destruction in the posterior part of the third frontal convolution. In both cases this is
1
I III the left side with right-handed persons.
We need to differentiate the psychic processes which occur in speaking and
I/Ilderstanding. On the side of understanding we need to distinguish: (I) merely
hearing a noise, such as a cough, or some inarticulate sound; (2) hearing a word,,<utern without understanding it, e.g. a foreign language which we do not under;tand. So also with written material, which we may be able to read but need not
IIllderstand. Or a word-series, which we can learn by repeating but it remains meanill~less to us; (3) understanding the meaning of words and sentences.
The following schema devised hy Liepmann (slightly modified) gives us a tentative
,.IIrVCY of the different aphasias:
He analyses the aphasias and differentiates components that are psychic phenomena
I The best exposition is that of Liepmann in Curschmann's Lehrbuch der Neurologie. Von
M,,"akow surveys the literature in the Ergebnisse der Physiologie. A new, critical and excellent
"'I'"sition of the subject is given by Thiele in Bumke's Handbllch der Geisteskrankheiten (1928,
v,,\. 2).
188
(shown in the diagram as blank circles) and psychic connections (shown as dotted or
interrupted lines), from the non-psychic components that are linked to anatomical
cortical areas (shown in the diagram as solid circles) and the anatomical fibre tracts
(shown by lines). Making use of this diagram we may conceive the connections (left
ascending, sensory; right descending, motor) as interrupted, or the circles as either
destroyed or cut off. In this way we can construct possible types of aphasia in great
variety. Thus (see Fig. 2):
,~
".".
,1'''
......
'....
"
"'-"
.......
----------------..... - ..
..........
Ear
Eye
Hand Tongue
FIG.
Anatomical components:
a. acoustic projection area of the cortex.

m. motor
"
" " "
"
o. optic
"
"""
"
gr. graphic part of the motor projection area of the
cortex (innervating the hand).
2. Psychological components: A. acoustic component (word sound-pattern-Wortsinnverstandnis).
M. motor-speech components.
O. optic components.
Gr. graphic-motor components.
C. meaning of words ('conceptual' components).
The test performance (sometimes called functioning) of aphasic patients becomes
comprehensible only if the following paths are intact:
...-....
Spontaneous speech:
C-A-M-m-Tongue.
Spontaneous writing:
C- ~O-Gr-Hand.
A""
Speech-comprehension: Ear-A-C
/A-C
Reading-comprehension: Eye-O",~
Repeating:
Ear-A-M-Tongue.
Copying:
Eye-O-Gr-Hand.
Writing to dictation:
Ear-A-O-Gr-Hand.
Reading aloud:
Eye-O-A-M--Tongue.
/t1
...-....
From gr and m downwards destruction is responsible not for aphasic but

articulatory disturbances (dysarthria, anarthria). Destruction from a to 0 upwards
is responsible for deafness, tone-deafness, partial deafness and so with weak vision,
blindness.
The following types can be elicited from the manifold and individually varying
aphasias:
~Ja...
~"
I.
Pure motor aphasia: M is destroyed or isolated. Understanding of speech is

preserved, so are reading and writing. But spontaneous speech is destroyed and the
power to repeat and read aloud. This is a rare type and we more commonly get
'complete motor aphasia'. Through the involvement of M through O-M in all
functions which require the pathway O-C, reading and writing are also disturbed,
whereas copying (without M) is preserved. Such patients tend to be taciturn; at
other times they are explosive; they try to speak but quickly break off.
Pure sensory aphasia: A is destroyed or isolated. Spontaneous speech is preserved, but comprehension of speech and powers of repetition etc. are destroyed.
This form is rather rare; complete sensory aphasia is more common. Normally,
spontaneous speech requires the pathway via A, hence the present disturbance of it,
not in the form of word-dumbness as in the motor aphasias but as paraphasia. Paraphasia consists in a distortion of words so great that we can no longer recognise any
meaning from the series of syllables heard. This is because the word-sound-pattern
(A) cannot be aroused in the usual way while the simultaneous free-floating soundpatterns (Mehringer and Mayer) which occur associatively lead to a number of
distortions, switchings, reversals, anticipations etc. These patients are paraphasically
talkative with neologisms. If they lose control, they appear manic. They are surprised
and dismayed to find that no one understands them.
Transcortical aphasias: With these we have the pathway: Ear-A-M-Tongue
preserved; powers of repetition of what has been heard are therefore preserved.
With transcortical motor aphasia the pathway C-M is blocked. The patients cannot
find words, the concepts of which they possess, but yet they recognise and pronounce the word when the name is given to them. In mild degrees we term this
condition amnestic aphasia. With transcortical sensory aphasia patients can repeat
everything, but the meaning of the words escapes them.
Important objections have been raised against the total picture as presented
by this classical theory of aphasia. The psychology used is exclusively that of
association-psychology, which is hardly adequate and according to which
discrete elements are only linked into units by virtue of association. The nature
of speech, however, cannot be understood in terms of such a psychology,
since the essence of speech is awareness of meaning. The unity of verbal
meaning is shattered hy a division into sensory, optic, acoustic, kinaesthetic
and motor elements. Speech takes place at a fundamentally higher level of

functioning in the form of impulse to movement and reception of sensations.
This accounts for the fact that the clinical picture presented by aphasia cannot
be classified into acoustic and motor speech-disturbances, as alexia, agraphia
etc. There are a few cases it is true which with the help of the diagram may be
very satisfactorily described. Most cases, however, would have to be forced
within the framework. The theoretical schema is a deductive one and the individual clinical pictures are so constructed. The fruitfulness of the construction
has shown itself up to a certain point-as happens in the natural sciences-but
then we come to a halt. The discrepancy between clinical cases and what is
presupposed grows noticeable. The construction here-in contrast to the
theories of natural science-is of limited heuristic value and has utterly
exhausted itself. Initially a small clearing has been made in the phenomenological
confusion and there is some intelligible description of phenomena not properly
understood in their nature. There can be no further elaboration or fruitful
application and it is necessary to discard the theory as a whole and in principle
to m~ke room for a new and better comprehension growing out of other
premIsses.
The new approach has its origins in Wernicke himself who formulated
th e term ' verbal concept' to express the basic function within 'which his sensory
and motor elements were inseparably linked into unity. These unitary 'images
of speech' were later seen as functions of a cortical speech area without any
specific localisation of the motor, sensory and other elements.
meaning his particular categories have, and how far they will help us towards firm,
realistic and meaningful concepts. Head's success can only be judged by specialists
with large numbers of cases at their disposal. The cases reported in the literature are
insufficient. No one has yet succeeded in giving so seductive and lucid a picture as the
old classical theory-deceptive though that lucidity seems to be.
Headl went furthest of all. He discarded the whole schema. Classification of

speech disorders into disorders of speech, reading, writing, and understanding,
hardly corresponds to the clinical facts. There are no basic psychic functions which
~re localised and correspond to these performances. Head himself started by improv1I1g. the method~ of exa~ination, and in many decades of experience he enlarged and
enriched these 1I1to an Imposing and intelligible schema of investigation. His new
interpretation of the findings avoids any dogmatic theory. He takes the disturbances
of sy~bolic.fo~u.lation. or ~f any behaviour in which verbal or other symbols playa
par: 111 medIating 1I1tentIO? 1I1to execution. Even though one cannot break language
up 1I1to elementary functIOns (sensory, motor, etc.) we cannot really do without
some typical syndromes which will present us with a meaningful picture. Head
therefore develops four groups of aphasias: verbal, syntactic, nominal and semantic.
He limited himself to this field, and remained closer to reality than the classic theory.
Yet ?e pays for this by not giving us the impression of any simple or radical comprehenSIOn of the whole. He does not sketch psychological theories in the brain-space
but presents clinical syndromes without theory. The question has to be left open
whether these are just clinical pictures or whether behind them lies some really relevant function,. wai~ing to be discovered. Head helps us to come closer to the reality of
language and Its disturbances than we have ever done before. He is not obsessed with
untried psychological presuppositions or brain-mythology. We have yet to see what
lt is of general psychopathological interest to find that in the examination

of some aphasias we come across great fluctuations in performance within
very brief spaces of time: l
Performance decreases as the patient grows tired with the examination. Somelimes a low ebb is reached and then after a brief interval this is overcome. The fluctualinns may be related to the concentrated attention which the patients give to the tasks.
I\s is the case with all impairment of function, speech in this case can only reach
performance if there is a high level of attention. We should also expect aphasic
patients to be considerably disturbed by affects, such as embarrassment, surprise etc.
1\ situation which makes clear demands can interest and stimulate them and they can
have remarkable success. Quite apart from this we cannot rule out the possibility of
occasional spontaneous 'fluctuations in brain-function' (see above, p. 142).
(c) Speech disorders in psychoses 2
These disorders include certain verbal performances which at present

cannot be explained in terms of neurological mechanisms; nor can they be
simply understood as a form of expression or as the communication of abnormal psychic contents. We have to deal with a territory of interest to both sides.
For the moment we only need to record the actual psychotic speech phenomena.
They form a group of 'objective' symptoms on their own:
r. Mutism and pressure of talk. From the purely formal point of view,
content apart, these phenomena correspond to immobility and excitement in
the motor field. Mutism may be intelligible as a deliberate silence, or as an
expression of psychic inhibition, or as the effect of some hysterical mechanism,
hut in many cases none of these interpretations seem to apply and we have to
accept the phenomenon as incomprehensible for the time being.
Motor excitement in the speech apparatus, which we term pressure of talk,
gives rise to most varied phenomena. Irrespective of their affective state,
patients keep on talking about all sorts of senseless things without bothering
really to communicate. They keep on all day long, uninterruptedly, and for
several days or weeks the talk runs on; sometimes they speak quietly and the
voice never rises above an indistinct murmur; sometimes they perform incredibly by shouting until they become hoarse, though this does not impede
them. Some seem to address themselves, and talk themselves into it; others
talk quite mechanically. There is frequently a tendency to rhythmical emphasis.
In most cases we do not know what is the subjective experience during
Stertz, Mschr. Psychiatr., vol. 32, p. 363.
Hcilbronner, 'Sprachstorungen bei funktionellen Psychoscn mit Ausschluss aphasischer
Stiirungen', ZM. Nenenhk., vol. 1906, pp. 472 If. Liebmann and Edel, Die Sprache der Gtiflt.fkra"k." (fhlle ,1903) a shorthand record of verbal productions.
1
1 Head, Aphasia and kindred disorders of speech (Cambridge, 1926). Last, Nervenar,t, vol. 3
(1930), p. 222.
192.
these motor-speech discharges. Self-descriptions, however, do tell us of two

different types of experience: (I) There is the experience of a real pressure of
talk, like an instinctual drive; it is of varying degree; some patients can suppress
it altogether; others have to give in and feel it an unpleasant and morbid
experience. Other patients give way without any inhibition. (2.) Others experience what seems to them spontaneous activity of the speech-apparatus; and
look on the performance as a spectator. For instance, the case described on
p. 12.4 will give us an example. Here is another described by Kandinsky:
We must distinguish between these apparently automatic verbigerations

and those which are affectively toned and in particular due to anxiety. In states
of gross anxiety patients repeat the same matters over and over again in a
puzzled way 'God, God, what a disaster ... God, God, what a disaster . .'
and so on. (3) If unproductive patients look around for material for their pressure of talk they can obtain this from external sense stimuli, if they do not get
it from automatisms of the speech-apparatus or from perseveration. Acoustic
impressions are simply repeated (echolalia), a senseless name given to every
object. (4) We should distinguish flight ofideas from all three previous sources,
because of its sheer productivity. The pressure of talk that flows from this is
marked by rich content and extremely varied associations, sometimes by its
wit and apt turns of phrase. Flight of ideas and distractibility both need
pressure of talk if they are to manifest themselves objectively; otherwise they
will remain purely subjective feelings (an inner flight of ideas, an inner distractibility). Conversely, flight ofideas is by no means a condition for pressure
of talk. The latter is often similtaneously present with an inhibition of talk,
and in patients suffering from dementia, pressure of thought without any flight
of ideas is particularly common. (5) The term 'confused speech' covers many
different modes of speech. The form may seem coherent and yet no meaning
may be communicated or understandable, l as the sentences, or interrupted
fragments of them, are being uttered. Some of these constructions certainly
have no meaning for the patients themselves; others are only unintelligible for
the observer. The following extract from the letter of a catatonic patient
suffering from this confusion of speech shows a relatively high degree of
in telligibili ty:
Dolinin suddenly felt his tongue starting to pronounce loudly and very fast a
number of things that should not have been said; this was not only involuntarily but
definitely against his will. At first the patient was startled and worried by this unusual
event. It is hardly pleasant to feel some concrete, wound-up automatism inside oneself. When he began to realise what his tongue was saying, he became horrified; he
found himself admitting to guilt as a political criminal, ascribing to himself plans he
had never had. Yet he had no power to curb the utterances of his suddenly automatised tongue.
These are apparently clear-cut casesancl there is a whole series of such
phenomena ranging in clarity down to cases where the phenomena are the
same but there is no such dichotomy between the self and the actual flow of
talk.
2.. Where does this pressure of talk get its content from?1 (I) The speechapparatus itself may function on its own with a stream of repetitive phrases
senselessly reproduced, Bible-quotations, verses, numbers, months of the year,
tunes, meaningless phrases in grammatical form, agrammatical constructions,
clang-associations, word-compounds, inarticulate sounds. (2.) There may be
perseveration, which we now know to be a deficiency symptom, a 'getting
entangled or stuck'. We can see this happen with aphasic patients in certain
situations which we can predict. Pressure of talk which draws its material
from perseverating content is bound to 'get stuck' in the end. In this case we
speak of verhigeration (Kahlbaum). The patient is apparently talking and making
a conversation but repeats separate words, fragments of words and phrases,
meaningless phrases, in a monotonous tone; nothing significant is ever said
nor does there seem any relation to the patient's experience. Kandinsky remarked that patients often feel vividly the compulsive character of this impulse
to verbigerate, analogous to the states of shouting, mentioned above, and the
automatic speaking of Dolinin.
193
For analogous and natural reasons I am disclosing to you the fact that I have
passed various examinations, which rest upon fresh advances of the time and relate
to all the natural rights to freedom. Self-help is always the best and cheapest. We
know what national pride is, and I know the honour concerned, and what knowledge
is, is my secret. Respect for my cause, which is related to the above. 'Eye and hand
for the Fatherland' ... My affairs must be taken roundly. With this I would inform
you that I am already known here as the first public prosecutor ... (Otto).
With confused speech we can compare incoherent productions, which no
longer show any sentence-formation. Although the content can be understood,
the following letter of a catatonic patient to his wife well illustrates this
phenomenon:
One of his patients used the phrases 'involuntary speech', 'parleying with myself'
or 'rriy self-parleys'. Even when he wanted to ask for something, he had to express
himself in this particular form: 'selbstparlage, selbstparliere, excuse me . . . selbstparlage, selbstparliere, excuse me... selbstparlage . . . excuse me a Papiros . . .
must not smoke oneself ... I want to smoke myself ... but by selbstparlage ...
selbstparlieren ... I selbstparliere to you ... give me a smoke .. .'
In the house there, is he lying at home ill? yet ... [untranslatable] 'anspruchlos,
inderesenlos von dem was gekommen? doch was to geslagen an den? Ich. der Muller.
Nachts unruig gewesen. Stimmen horen traurige. Ja Schwager da in F. Wir bilden
cine kurze underdung von der Achmrika. Frau Kinder sesund. ja nun alen da. wie
geth. gut mir auch sehr gut. das freuet mich.'
1 Heilbronner, 'Sprachstorungen bei funktionellen Psychosen mit Ausschluss aphasischer

Storungcn', Zbl. Nervenhk., vol. 1906, pp. 472. fr.
lOtto, Ein seltener Fall yon Verwirrtheit (Diss., Miinchen, 1889)' He gives a detailed description of an exceptional case of confused speech.
194
3. Disturhance of .:onversational speech. Description so far has been concerned with phenomena exhibited by the patient on his own. Another picture
arises if we look at the play ofquestion and answer in the conversational situation
between examiner and patient. This is the occasion for the symptom 'talking
past the point' (Vorbeireden). With aphasic speech disturbances (particularly
with the sensory aphasias) patients spontaneously utter garbled sounds with
an awareness on their part that they mean something (Paraphasia). Here
however the paralogia has intelligible content and is manifestly related to the
question and answer, but although the intellectual competence may be there,
answers are incorrect and there is no proper solution of the tasks set. The patient
performs all the multiplications, for instance, except that he adds one digit
more: 3 X 3 = 10,6 X 7 = 43, and so on. How many legs has a cow-5,
etc.'l There seems no single psychological interpretation for this phenomenon.
It arises as a symptom of 'pseudodementia' in hysterical states, when illness
fulfils the patient's wish (in prison, for example) or it appears as a form of
negativism or an expression of the silly joking of hebephrenia.
4. Psychological interpretation. Attempts are made to explain psychotic
speech psychologically, particularly the phenomenon of confused speech. The
principle of association is invoked with recourse to sensory and ideational
material, the one stemming from the apprehension of sensory stimuli, the
other from the actualising of memory-dispositions. 2 The problem is whether
all the verbal constructions can be explained in terms of association; or do
'freshly arising' structures occur? Elements link through similarity (e.g. clangassociations), through being experienced, through their related content etc.,
and perseveration adds itself to the initial elements. Syllables, words, bits of
sentences, an intended 'meaning', etc., all function as 'elements' in this respect.
Contamination is one of the concepts specially belonging to associationpsychology and is used for the classification of abnormal speech-structures.
This denotes the fusing of one word-element from two other such elements
(e.g. sur-stonished, for surprised and astonished). In the same way, words and
syllables suffer permutation, some are tacked on as affixes, others as suffixes.
6.
THOUGHT AND JUDGMENT
Thought is contained in all our performances from the act of perception

to speech itself. Judgment is said to be disturbed only when perception,
orientation, memory, movement and speech are otherwise in order or when
we can distinguish between specific disturbances in these and what has
occasioned the false judgment.
1 Julius Hey, J)as Gansersche Symptom (Berlin, 1904). Ganser, Arch. Psychiatr. (D), voIs. 30-8.
Raecke, Allg. Z. Psychiatr., vol. 58. Henneberg, Allg. Z. Psychiatr., vol. 61.Pick, Mschr. Psych.iatr.,
vol. 4~, p. 197 (Vorbeidenken-Vorbeireden).
I Kraepelin, 'Ober Sprachstorungen in Traume', Psycho!. Arb., vol. 5. Pfersdorff, Zbl Neurol.,
vol. 1908, Z. Neur., vol. 3 (1910), etc. Mehringer and Meyer, Versprechen und Verlesen (Stuttgart,
1895).
The performance of judgment is measured against objective truth. Where

the judgments of an individual deviate from what is generally held as valid
and he holds obstinately to their content although it interferes with adaptation, the question arises whether among other things there is a morbid cause
affecting the judgments themselves. There is a difficulty here because the same
characteristics might apply to the judgments of exceptional people who
creatively open new ways of thought. If, therefore, a disorder is suspected
merely because the judgment runs counter to current beliefs, this clearly will
not suffice and we have to try and assess the situation in some other context
before we can decide that a disorder of judgment is really there. Judgments
that deviate from generally held opinions provide us with objective, if superficial phenomena, disregarding for the moment whether they may be false or
true. The problem is what characteristics must judgments have for us to say
that they are examples of disordered performance. We have to distinguish
disorders of intelligence and thought-disorders from delusion. We shall deal with
the first two in the next section and will discuss the latter here.
Delusion presents us with one of those great riddles which can be solved
only if we define our facts clearly. If incorrigible wrong judgments are termed
'delusion', who will there be without delusion, since we are all capable of
having convictions and it is a universal human characteristic to hold on to our
own mistaken judgments? Nor can the prolific illusions of entire peoples and
persons be given the title of 'delusion', since this would mean treating a basic
human characteristic as if it were an illness. We should rather address ourselves
to the problem of what it is that occasions the incorrigibility and causes us to
recognise certain modes of wrong judgment as delusion.
As a psychopathological concept, delusion can be considered in four ways:
as a psychological performance, in its actual phenomenology, with an understanding of how it comes about and with an understanding of it as a meaningful
whole.
(a) As a psychological performance, it is delusion only where intelligence
is undisturbed and there is no disturbance in the immediate state of consciousness either, so as to occasion the wrong judgment. The patient's thinkingapparatus and power of judgment are in order but there is a factor in his
thinking which affords him unshakeable evidence when other people, even
other patients, can see the mistake. Since thinking is in order in delusion and
even used ingeniously to serve it, we can hardly speak of delusion as a thoughtdisturbance. To consider it from the point of view of psychological performance may be the first step, but it leaves us simply with the negative result that
delusion is not really a disturbance of performance. It springs rather from
some deeper source, which is manifested in the delusional judgment hut hIt,.
none of the characteristics of a judgment in itself.
The following is an example of the elaborating thought-perfurlmUlcc which IilkelM
place in delusion: a schizophrenic patient (a factory-hand, who lallell' baclllllt' IIl,olica
man) experiences typical 'passivity' phenomena; there are movcmant. uf hi. 11mb,
o
197
and he hears voices. He thinks of remote hypnosis and telepathy. He suspects and
reports someone to the police. He arranges for a private detective to make enquiries
and finally convinces himself that his suspicions are unfounded. He writes: 'Since no
one can have been influencing me and I am sure I am not suffering from any falseperception, I have to ask who can it be? The way in which I am plagued and tortured
and the hidden meaning in all these conversations and bodily movements suggest
that there is some malicious supernatural being at work. He influences and plagues
me continually and hopes to destroy me. Are my experiences of the same order as
those of mental patients or are they unique? For humanity's sake I feel I should state
my conviction that if they are of the same order, then the doctor must be wrong in
thinking that the voices which patients hear are hallucinations. Whatever it is in my
own case, whether it is the same experience as that of a mental patient or something
exceptional, the conclusion is in either case that life goes on after death' (Wildermuth).
In whatever way we consider delusion we are presented with the external

fact that delusion is a defective performance when measured up against objective
truth-provided we have this measure. As a defective performance in this
sense, we can consider it from the point of view of content: delusional ideas
may be either of a personal relevance or of an impersonal, ohjective nature. In
the former case they will concern the individual himself; they are the delusions
of spite, persecution, inferiority, sin, poverty, etc; in the latter case, the delusional ideas are of more general interest; they may be revelations, delusions
of invention, theses in defence of theories (e.g. the identity of Bacon and
Shakespeare), so-called fixed ideas, objective enough in their content but completely monopolising the individual. Patients behave as if the whole meaning
of their life rested on this one idea and superficially they in no way differ in
this from great creative personalities who expend themselves on their own
ends, but the difference lies in the extreme narrowness of idea and the atmosphere ofslavish confinement. Both types of delusional content are linked together in that the objective content tends to become an extremely personal
affair, e.g.: defence of justice becomes for the querulant the defence of his own
particular rights. Any classification of delusional content would have to include all the interests that life can offer and all the contents of our minds. It
seems as if everything in our human world can be remoulded into delusionlike forms, which (as distinct from delusion proper) may pass over into 'normality' at any point, so that as the mind pursues its course, these delusion-like
creations pursue their own, a sort of parody of it, as it were. In psychopathology therefore we must be careful not to put all incorrigible mi?takes
under the heading of delusion proper. But when faced with actual delusional
worlds, we need to think afresh about the meaning of truth, so that in any
given case our assessment of reality can be justified.
(h) Phenomenologically, we observe in delusion an experience that is radically

alien to the healthy person, something basic and primary, which comes before
thought, although it becomes clear to itself only in thought. This primary
experience, moreover, is not limited to a single experience which breaks
through into consciousness simply as one phenomenon among others, otherwise the patient could criticise and master it. The primary event has to be
related to some radical change of personality since, otherwise, the insurmountable character of the delusion and its essentially distinctive incorrigibility
would be quite incomprehensible.
(c) We may well understand froin the context how a delusional belief
liberates an individual from something unbearable, seems to deliver him from
reality and lends a peculiar satisfaction which may well be the ground for why
it is so tenaciously held. But should we also try to make the actual formation
of the delusion, as well as its content, understandable, any diagnosis of delusion becomes impossible, for what we have grasped in this case is ordinary
human error, not delusion proper. Philosophy is always trying to reach that
state of mind where all mistakes can stand corrected, and to exercise that unprejudiced, large and perceptive affection for the world, that openness of
reason, which can tolerate what is real and true and, when no decisive answer
is possible, can endure doubt, and which always remains ready to communicate
and prevent the rigidity of fixed opinion. But we are still far from that ideal
state and are tied to the interests of our existence and to all that makes it
bearable; here is the root of all our common mistakes to which, in their
exaggerated form, we give the term 'delusion-like' mistake, although we are
not really dealing here with delusion proper.
(d) Delusion proper shows itself as a whole primarily in the fact that it
creates a new world for the deluded person. It expresses itself through its style
but a living being is revealed as well. Delusion draws its content from the world
which it shapes so pervasively for the patient, and, as it grows more elaborate,
it becomes a cultural creation.
Delusion is a word that is commonly used for a numher ofquite different phenomena.
It is, however, a mistaken judgment, and a judgment by externals only, that allows
the same term 'delusion' to be applied to such completely different phenomena as the
so-called 'delusions' of primitive peoples and the 'delusions' of demented persons
(paralytics) and ofparanoics. Primitive peoples have a psychic life that is differentiated
to only a slight degree. We characterise this in relation to their beliefs, and we say
that they have not yet learnt to distinguish perception and fantasy as arising from
different sources. A number of diverse logical processes all possess for them the same
evidential quality; for instance, they will conclude by analogy, on the basis of purely
external criteria. With the demented, paralytic patient, psychic life has disintegrated in
ways characteristic for the organic, cerebral disorders and these cannot be compared
with the undifferentiated state of primitive man. In paralytic changes every illlap;e
obtains reality, every idea seems correct without regard to wish or purpose, oftt'll
without effect and consequence. Every content appears real. This p;ivc~ riRC to 1111restricted delusions of grandeur which shift constantly and t'<lnl'Vl'Ill'1"IIlI(t' into tht'lr
opposite. In thecase ofparanoics, we arc ag<lin dC~lling wilh :illlll{'t1lillf~ qllill' dilli'n'lll.
The individual shows a high degree of differentiation, sh;lrp pOWl'nl of l"I"ilid~1II iU1l1
an ability to think, but none of this interferes with hi~ belief in the ~(}lItVJlt Ill' hl~
THE TOTAL PERFORMANCE
delusional ideas. He has had certain experiences and for him they carry as much if not
more, weight than anyone else's. He integrates these experiences with others ~nd he
builds up his delusional system quite seriously and with deep involvement and holds
unshakeably to it. Contrary ideas do occur to him, but he brushes them aside disparagin.gl~. He doe.s not lack power to differentiate the discrete sources of knowledge
but he 1OS1Sts on hiS own source, whether supernatural or material.
but without success. We still ask questions, however, and it appears that we
can dimly discern some all-embracing foundation for our biological existence.
Areas of questioning are as follows: defective performance in brain disorders,
the facts that emerge from the establishment of a work-curve, and individual
variations within the countless types of performance. In all these cases research
is constantly directed to what may lie at the root of these manifold appearances
and what may be considered the vital, foundation occurrence.
SECTION TWO
Disturbance in each individualperformance affects the individual's total state.

The effect may be quite catastrophic, although the disturbance need be limited
to only one function as we have described. It may be a disturbance of registration, a severe aphasia, a motor disturbance etc. The individual's total state is
changed but this can be fully grasped in terms of the demonstrable, separate
disturbance. Inversely,each individual performance may change in quality and
meaning through its dependence on the sum-total of the performances. If we
consider this, each individual performance then becomes the symptom of a
total event, which we cannot directly perceive. We no longer simply register
a series of defective performances but the defects are formed into a group. This
is done in various ways, depending on how we ourselves regard the total event.
We may see this either as the psycho-physiological hasis of the individual performance manifesting itself in the defects as a whole, or as the actual mode of
psychic heing which prevails at the time, or as the individual's permanent
capacity for performance, which we call the intelligence. All these several
totalities are phenomena that occur in states of clear consciousness and when
there is no clouding or alteration of awareness. 1
If individual performances are not the products of an isolated apparatus
but already parts of a total apparatus ofperformance, this latter itself is not an
independent closed unit either, but an instrument of the individual whose
mind shapes the instrument it uses, while in its tum it remains dependent on
the instruments given and their potentialities for its realisation. All mental
performances have this in common that they can be measured against a norm
of 'common awareness'.2 This confines them to one area of human existence
which is clearly enough defined, but never exhibits the whole human person'
~~as~
,
I.
THE PSYCHOPHYSICAL BASIS FOR PERFORMANCE
We have no insight into the basic function of vital, psychic life. Our urge
to premature comprehension has often driven us to conceive some such whole,
1 K. F. Scheid, 'Die Psychologie des erworbenes Schwachsinns (1919-1932.)', ZM. Neur.,
vol. 67, p. I.
I Cpo my lectures: Vernunft u. Existen;. (Groningen, 1935), pp. J 1 If.
199
(a) Basic psychophysical Junctions

Investigations of defective performance following organic brain lesions
have shown that-even if the lesion is localised in the brain-the disturbances
of performance are often characterised by more than one, single defective
performance. This tempts us to look for some comprehensive psychophysical
basic function which manifests itself not only in one single type of performance
but in indirect fashion in a whole number of defective performances. We would
like to see what is common to them all, on what does this great variety of
disturbances rest, what pervades them all. It is a comprehensive whole since
we find it appearing in many phenomena and it is also something elementary,
a basic function, one basic function among others.
Basic functions, however, cannot be directly demonstrated as can single
defects of performance. Our method is to try and penetrate into the context of
the disturbance by first using the self-descriptions of patients, brought out
systematically by talking to them, and then by observing the paths of the still
intact performances. If one knows where and how the patient experiences his
difficulties, the disturbance lays itself open to us, even though objectively the
performance is still intact. Objective observation and patients' self-descriptions
together help us to get to know the paths and detours of their performance
and we can compare it with the normal. In this way we can get to the central,
essential point of the disturbance. We then compare the manifold performances
of the patient, and hope that if there is something common to them all, we
shall find it. Research. of th.is type-followed by Gelb and Goldstein, Hochheimer, Benary, and so on-brings results. We will quote as an example a
famous case of psychic blindness (soul-blindness) using the actual report of
the authors:1
At 23 years of age the patient was wounded at the back of the head by splinters
from a mine. He could no longer recognise shapes and movements in space (cp.
p. 170 the descriptions of the same patient). Close examination showed that, even
after performance had improved, the defects as a whole could not be wholly understood in terms of the visual agnosia.
One could talk freely with the patient and not notice anything conspicuous. He
1 W. Hochheimer, 'Analyse eines "Seelenblinden'" from PsyclwL Forseh., vol. 16 (19)1),
p. I. On the same case Gelb and Goldstein, Psyehologisehe Analyse hirnpathologisch" FIJI/, (Lelp
zig, 19:10), vol. I. Benary, Psyehol. Forseh., vol. :I (19:11.), p. 1.09. Goldstein, Mschr. Psyt!tig'r.
(19 1 3), vol. s...
201
had a letter read to him which he had written himself a short time ago to the doctor.
He listened but did not recognise his own letter. The letter was then shown to him
and he did not recognise his own handwriting, except when he read the signature...
'Well, that is my signature!' ... 'I would never have recognised itl' ... Throughout
long conversations with the patient, behaviour was quite inconspicuous, until some
task came up, like the recognition of the letter, and the behaviour changed. The defect in performance was startling, and the man who usually talked cheerfully and unruffled became taciturn and tense.
In one investigation there were a number of listeners sitting around. After one
hour the patient was asked: 'Do you see the others over there?' Reply: 'Now, yes!'
The patient's attention is limited strictly to what it is directed to; no two elements
exist for him simultaneously in his environment. To the question 'How did you get
on in the winter?' he replies: 'I can't say that right now, I can only say what takes
place now.' Past and future are not accessible to him and he cannot imagine them. He
does not imagine at all and it is the same with everything that is not immediately
present to him. 'I can name something but not imagine it.'
What is a frog? ... 'Frog .. a frog? .. what is a frog .. frog .. quak,
quak, it jumps!' ... What is its colour? 'Frog .. frog ... a tree-frog ... oh,
colour ... tree-green ... the tree-frog is green. Well!' The patient is not able to
invoke mental images himself in contrast to images emerging involuntarily. In place
of inner representation he uses talking towards it to invoke his reply.
Tell us something! ... 'I can't manage that, someone has to say what do you
know of that and that .. .' When greeting: Any news? ... 'What for instance?' or
if you ask 'What happened last timer' . . . 'When, where . . oh a lot of things, I
don't know' .. Can you remember anything we have done here? 'There was so
much' ... 'for instance?' This 'for instancer' was a favourite stereotype response of
the patient. There was no point in directing him to indefinite matters; he could only
be aware of something concrete; he could not answer general questions.
The conversation was about stealing: 'At any rate nobody stole from me' ..
The investigator recounted the theft of a watch from someone at the railway-station.
When he says 'railway-station' the patient starts and interrupts.... 'Yes, railwaystation, stolen at the station, that's right'. 'Something was stolen from me there ...
my big trunk.' Memory traces are not at his disposal, he always needs a stimulusword. Unless a word fits like a latchkey, the past experience remains inaccessible.
The patient does not know that he knows and he cannot dispose of what he has.
The patient depends on things cropping up within him spontaneously. He only
manages with what occurs to him unwittingly; he cannot will things to appear and
cannot spontaneously tum his attention to the contents of his own mind. Instead he
has to be helped out by the spoken word and what accompanies it. The ego-impulse
is supplanted by a word that rouses impulse and this replaces the acts of self-recall.
The patient's speech is therefore like an automatically released gramophone
record. There is nothing there but mere words: memory images have given place to
verbal memory.
Questions only rouse him to performance when he speaks them himself. The
words then either start off an automatic progress to the target or bring the patient
into some vivid concrete situation in which further things occur to him. Action
becomes acting with the help of arbitrary words. However,not only words stimulate
the patient, but also perceptually concrete things, e.g. a magnet put before him. He does
not speak spontaneously; his speech consists only of replies to definite questions
directly concerned with some object, or of responses to an object directly laid before
him.
This patient knows of his disturbance. He isnot just at its mercy and hefinds ways
of substitute performance. He recites Schiller's 'Glocke'; he is asked the meaning of it
and whether he can imagine the content of the poem. He replies: 'But that's just it ..
I can't take part in my thinking ... when I want to tell something, it just comes into
my brain ... it happens haphazardly ... the words come just like that ... but if one
is asked the meaning ... that is the difficulty.' The meaning? ... 'No, it Rows off;
it's all right, one grasps it ... then it is gone .. .' He tells us of his dependence on
various 'props' ... 'a word or a few words to help me hang on .. .'
We are struck by his intelligence in spite of this exceptional and primary disturbance; he is very clever in formulating and surprises us with the promptness and
crispness of his phrases.
200
v-,'e record here only a fraction of the findings. The sum of them should
lead us to the common factor. The basis of the disturbance is still obscure but
the investigators had the compelling impression that it was something unitary.
They tried to formulate the basic disturbance, using concepts which have unavoidably a more restricted meaning than they carry nowadays:
I. The patient cannot 'visualise'. Something is lacking which is equally
necessary for recognition and for evoking previous perceptions in his imagination. It has as much to do with the structure of perception as with the recovery
of memories. The patient with visual agnosia, it is true, appears to have the
obvious disturbance in one sense-area only, but underlying this is some
general factor. He was asked if he could imagine some music; he said 'No;
with opera for instance, I am only in it again when the music has started.' If
the patient is to live in it the situation must always be a concrete one.
2. The patient cannot perform by apperceiving a number of things simultaneously; he can only proceed by taking them in successively, in particular by
talking himself into them. He fails when it is necessary to constellate a situation
simultaneously as a structured whole, but he achieves fair, even good, results
when all that is needed is to deal successively with the material. We may condude from this that there is a basic function which appears when there are
'simultaneous configurations' (Simultangestalten); that is, the function of
'simultaneously beholding a totality of processes'.
The taking-in of a situation plays a predominant role in visual activity so
any disturbance there becomes dramatically obvious. However, the unifying
character of the structural organisation of sight is but one instance of the unity
of simultaneous structures in space, or even in the spacelessness of our minds.
Everywhere this unification is of the same character and it leads us to suppose
it as the basic function which manifests itself in perception, imagination and
thought. The concept of what is visual in this context should not be overstretched.
3. The patient can perform only what he can represent to himself through his
202
own movements. Hence the constant movement he makes when he is r t .

h d'
th'nki
dh
IS enmg,
com?re en mg, 1 ng an ence the talking which becomes his means of
~olV1ng a task. There is a ere-organisation of the total performance'. He succeeds
If ~~ target can. be re~ched by means of talking or moving about, but, when
thIS IS not p~sslble, hlS failure is complete. What seems ohjectiyely the same
performance IS actually the performance of a radically different function th
path to the performance. is d~fferent. In healthy people there are a num~r o~
paths to performance, WIth SIck people these are limited. In this case th
I
. , d'
, eon y
means at ou~ patient s Isposal was movement. His high level of intelligence is
s~own bYthhl~ resourcefulness in finding substitute performances. At the same
time one mks one can descry a basic function which strikes Our notice
o~ly when people are ill: the close connectedness ofall psychic life with motility,
WIth actual movement an~ with images of movement (Ribot, Kleist); we could
compare here the central Importance of movement in the cosmolog f
h'l
h
(A'
I
yo many
p 1 osop ers
nstot e, for example, or in more modern times the system of
A. T rendelenburg).
. 4 The inabili~ t? visualise, the inability to hold simultaneous configurations, and the restr1CtiOn to continuous movement are three formulations which
all must .conve~e o~ the same basic function. The general disturbance created,
~hen tlus function 1S upset, is termed 'reduction to the concrete'. Patients cannot
mwardly comprehend what is possible, what is abstract or merely thought
nor can they use these generalisations in order to reach some performance~
ta~et. Henc~ they find a detour for the performance by making a connection
W1th somethmg concrete, actual objects, real situations, spoken words and
formulae. They tend to avoid life-situations which they cannot meet adequately.
they try to preserve an automatic conduct and in spite of profound defect~
they may get on reaso?ably well provided they are intelligent.
In the ab?ve-de~cr1bed cases (so-called agnosia) there has been a disturbance of a b~s1c functton; many other basic functions may of course be disturbed.
The followmg are some examples of this:
I . In the aphasic patient the central disturbance is that of speech. In the abovedescnbed case of psychic blindness speech had proved to be the last effective aid
towards performance.
2.
There are possible defects at a vital level where the instinctual regulation of
~unger, ~hirst, satisfaction and all the rest of the bodily rhythms is indispensabl
h~ed .wIth the whole course of Our consciousness. W. Scheid remarks in connectio~
With. his K~rsak~w case: 'such vital regulation obviously plays an important part in
the tlme~onentatlOn, by subdividing the day'.l

3 Dlsturban~es in conation (see p. 485)2 form another different group.
4 Perse~eratlon3 or '.gettin~ sr,uck' is a phenomenon we observe in organic defect
states, aphaSias, dementlas. This IS perhaps a pointer to yet another basic function.
; Cpo Borger-Prinz an? Kaila, Z. Neur., vol. 24 (1930), p. 553.
a ~P:lt Hauptmann, Der M~ngel an Antrieb', Arch. Psychiat:r:. (D), vol. 66 (19 U ).
Ph' el ranter, Mschr Psychlatr., vol. 17, pp. 429 tf., vol. 18, pp. 293 If. Brodmann
syc latr., va. 3, p. 2S. R oenan, Z. Neur., vol. 162, p. p.
'
J.
20 3
Constellations of ideas remain long after the normal span of appropriateness. This
shows particularly in the set tasks, when there is inappropriate reaction. For instance,
a word continues to stick and is given as answer repeatedly when quite out of context; or the word 'swan' may be a correct response to the picture shown but will then
be said for all the others; or again, it can happen that after the first time a clock is
never read again correctly but the patient gets lost in details though the actual ability
to tell the time is unimpaired. Such leit-motifs will dominate all reactions for days on
end. In many cases perseveration is a secondary phenomenon and when psychic life is
defective it takes the place of the correct performance. Heilbronner found that perseveration increased as set tasks grew harder. In other cases we can understand the
perseveration in terms of interest, emotional complexes etc. Yet in other cases it
appears to be an independent phenomenon. Certain contents almost persecute the person
and dominate him in such a way that it is difficult to dismiss the idea of spontaneous
excitation (e.g. during fatigue).
5. The ruinous disorder of thought appearing in Huntington's Choreal points to
another basic function. With choreic patients, although the motor apparatus can
function normally, it becomes impossible for them to hold on to what they intend,
nor can they keep to their goal, conscious or unconscious. Just as their movements
deviate, derail, and spontaneously occur so it is with their thought processes, which
get side-tracked, derailed, interrupted by other thoughts and generally confused. 'It
has simply vanished!'-'I think of something else, nothing at all to do with it'; 'I
knew it was different, I have just messed it up' ... 'I make so many slips of the tongue,
I speak so much nonsense, don't I?-things that have nothing to do with it, is that
not so?' .. 'Now I've jumped again .. .' In brief, all performances requiring controlled motor-behaviour, e.g. body-movements, speech, thought, etc., are disturbed
by involuntary impulses interfering with them. Impulses never reach their goal, they
are always breaking off and renewing, but many break off for good. At the same time
choreic patients in the beginning do not show any loss of intelligence level nor any
inability to think-it is only at the end that dementia sets in. It is the steering that has
failed; they do not find the things they look for, nor can they keep steadily to what
they think and wish.
6. Zuckerll applied the method of functional analysis to schizophrenics. He gave
performance tests and linked these with the patients' self-descriptions. He investigated the modes of their imagination (by asking them to imagine things or stories; by
comparing the two different experiences of having spontaneous hallucinations and of
imagining somewhat similar contents; by observing the relationship between hallucinations and the deliberate reconstruction of them in the imagination, etc.). He
found the imaginary creations were not very successful, became more difficult to
produce, arrived more slowly, alternated between clarity and indistinctness and tended
to break off and vanish. He thought one could detect here various degrees of disturbance of function, leading to the experience of thought-withdrawal, and from that
to the breaking off of thoughts on the one hand and talking past the point and incoherence on the other.
1 Hochheimer, 'Zur Psychologie des Choreatikers', J. Psychiatr., vol. 47 (1936), p. 49.
'Kritsches zur medizinischen Psychologie dargestellt an Chorea', Literatur. Fschr. Neur., vol. 8
(193 6), p. 455
I Konrad Zucker, 'Funktionsanalyse in der Schizophrenie', ArCh. Psychiatr. (D), vol. 110
(1939), p. 46S
In all these investigations we find the presupposition of a threefold differentiation: I. phenomena that can be experienced (Phenomenology); 2. certain
well-defined performances (study of psychological performance); 3. basic
functions. All these three categories are inter-related in such a way that the
two first spring from the third, the basic function, which can be recognised
as such only by means of the particular performances and experiences. Performance itself is clarified by the experience.
In the search for basic functions a tendency grows of simply not accepting
mere concrete failures of performance as such; e.g. disturbance of registration
is no longer just this but a disturbance in set or flexibility of set, which results in a disturbance of reproduction that looks like a defect in registration. 1
This method however becomes questionable once we begin to make explanations with the help of hypothetical basic functions. The analysis of performance
then becomes a theoretical practice. We do not reach any clearer comprehension
of grouped performances so that we apprehend the structure of our facts more
clearly, but well-known facts are simply used to stimulate our interest in
thinking out what may underlie them. The method loses all its fruitfulness if
we merely stay satisfied with a most general concept of basic Junction, as, for
instance, gestalt-formation. Disturbance of gestalt is always there, a concept
general to all performance, as general as the concept of intelligence and valid
thinking. Description of the gestalt-changes in the psychic structure is always
a good method, but deductions from gestalt-formation as a basic function are
meaningless, because far too general. The broad formulation of a disturbance
in the mental attitude that ohjectifies and predicates seems to he absolutely correct
hut unfruitful in its application. The investigator then only goes on saying the
same thing once more.
The search for basic functions must be distinguished from (I) the examination of
particular, concrete deficts in performance and their consequences, e.g. disturbances in
registration. We should not stretch the general rule too far, that all disturbances of
performance are disturbances of the whole. Precisely by contrast to this the search for
specific disturbances and consequences remains alive. (2) Speculative analysis of some
yitally important basic eYent, glimpsed in its metaphysical setting and seen as the source
of understandable psychic experience and behaviour (v. Gebsattel,Straus, cpo pp. 453
ff). In the case of the basic functions under discussion, we observe the path followed
by the performance and, combining analysis of performance with phenomenology,
we investigate methodically until the basic function itself becomes self-evident in the
separate phenomena.
We cannot doubt the importance of this approach for research. It is the only
method which offers insight into the way performances are related to each other. It
involves the use of phenomenology for the analysis of performance, an analysis of
performance itself according to the path it takes, the proper fathoming of the reorganisation and the comprehension of defects in the context of intact performance or
of what may be left of the total functioning. This stands out all the more strikingly
in virtue of the defects themselves. The investigators concerned have extravagant
1
Griinthal Mschr. Psychiatr., vol. 35 (1923).
hopes and tend to look down on all that has gone before. It is a mistake, they think,
to presuppose isolated performances and handle them like building-bricks. Defects
are only crude findings; a host of failures may be noted but tell us nothing. Measurement of defects may be the beginning of some rough orientation but, if nothing more
is done there will be no understanding of the altered psychic structure of the individual. 'To ascertain the actual performance that has become difficult or impossible
for the patient is only the first step. It is much more interesting to find out what the
patient experiences as difficult. Only the analysis of experience by self-description
will reveal the essential nature of defective performance. Progress in psychology is
blocked by the use of such generalised terms as intelligence, attention, memo,/"
Disturbances of intelligence (dementia), attention and memory as terms do not dISclose the unique basic disturbance nor the basic mode of behaviour.
Now there is a good deal of exaggeration in all this. Investigation on these
lines has not brought the findings one might reasonably expect, on which a
theory could be constructed that would make 'crude' descriptions and attempts
at classification superfluous. These interesting studies show a peculiar lack. In
spite of much subtlety and skill investigation has on the whole got lost in the
sand. Much has been seen in passing, but no really conclusive result has been
achieved. A genuine beginning has been made, a method established and the
techniques of enquiry once gained can never be lost. But so far the investigatory
work has got a certain pointlessness and there is a lack of any clear, concentrated
effort to end this. In research of this type decisiveness is in abeyance and
vacillation is taken as satisfactory in the guise of caution, but it may just as
well reflect the many possible interpretations of the individual results.
Furthermore for the time being the whole approach is limited to defective
performance in ;ases of organic brain lesions. Here it has been of great significance in helping us to see that circumscribed brain lesions rarely lead to equally
circumscribed psychic failures; at most a number of performances are more or
less affected. We cannot yet see clearly to what extent we may find basic
psychological functions, over and above the organic functions disclosed by
the cerebral disorders so far defined.
(h) Work-performance
Performance turns into 'work' when it is carried out as a steady effort for
a practical purp~se, absorbs the person as a whole, depends on his getting
tired and refreshed, and is generally subject to quantitative measurement. The
psychophysical organism with all its powers en~ages .in a g~eat c~~plexity of
work-performance and thereby manifests certam of Its hastc qua/meso
Work-performance may be objectively observed, quantitatively assessed
and the effect of varying conditions noted. In this way we are beginning to
uncover the factors responsible for the essentially mechanical element in
work-performance. l
1 The experimental basis was laid by the work of Kraepelin and his scho~l: Kraepeli.n~ 'Die
Arbeitskurvp.' in Wundt's Philosophische Studien, vol. 19 (1902), p. 459. A cnttcal exposltlon as
to the impor:ance of the findings for assessment of work-performance in life-situations. Max
206
The kind of work asked for in experimental investigation is nearly always

the addition of single digits. We seem to know very little about the differences
due to differences in occupation, e.g. work that is predominantly mental in
contrast to work that is predominantly physical.
In our analysis of work-performance we should differentiate clearly
between subjective phenomena, such as feelings of weariness and pleasure in
the work, from objective phenomena, such as fatigue and suitability for the
work. Objective work-performance is well illustrated by the work-curve in
which the abscissa show the time and the ordinates the quantity of the w'ork
unit. From this we can observe certain components such as thefotigue-curve
which at first goes down and then, after intervals of recreation, mounts agai~
quickly; we can also read another important curve, the practice-curve which
at first rises quickly, later more slowly and then, after intervals, falls ~ff.l In
addition there is the incentive-curve, which shows a rise at the beginning which
can be interpreted as the initial effort of will; we also find peaks at the end as
well as at the beginning of the performance. Then there is the habituationcurve which shows reaction to distracting stimuli. At first it rises steeply but
then flattens out and remains fairly level. 2 Fatigue and practice seem the most
important components.
3
Fatigue is contrasted with recuperation, and these are aspects of the psychophysical apparatus of fatiguability and recuperability. In the latter case the
period for recovery is of very varying duration. It will depend on whether we
are dealing with simple fatigue, explained by the effect of certain toxins, or
with exhaustion, explained by the using up of substance. We also distinguish
between muscle-fatigue and nerve-fatigue. It is an open question whether there
is such a thing as general fatigue or only partial fatigue for certain workperformances. Kraepelin believes there is only general fatigue.
p'r~tice', i~ ~e inc:ease in ease, speed and evenness of performance by
repetlt1on. 1 hiS IS achieved partly through a mechanisation of psychic performances which at first are more deliberate but gradually become more
reflex-like and mechanical. This means that we must assume there are changes
i? th~ ph~siological mechanism that effect practice. Capacity to become practised In thiS way and to make use of such practice varies with different people.
Kraepelin therefore differentiated between what he called practice-ability and
~nabili~y. Whereas fatigue is a fleeting and transitory phenomenon, training-practice always leaves lasting residual effects.
The dispositions which have been enumerated as fatiguability, recuperability" practice-ability, trainability, distractibility, habituation and responsiveWeber,. 'Zur psychophysik der industriellen Arbeit', Arch. So,ialw. u. So:rJaipol., vols. 27-9'
Kraepehn reports on further trials in 'Arbeitspsychologische Untersuchungen', Z. Neur., vol. 70
(19 21 ), p. 23
1 O. Gra~, 'Die Arbeitspause in Theorie u. Praxis', Psychol. Arh., vol. 9 (19 ), p. 460.
28
: Kraepehn, 'D!e A~b~itskurve', in Wundt's Philosophische StuJien, vol. 19 (1902).
M. Offner, D,e gelsttge Ermiidung (Berlin, 1928), 2nd cdn.
'B. Kern, Wirkungsformen der Uhung (Miinster, 19)0).
207
ness to stimuli, are all to be conceived as basic qualities of the psychophysical

mechanism (Kraepelin says of the personality).
Under morbid conditions all these qualities may suffer change. Kraepelin
has examined their dependency on food-intake, sleep, intoxication (alcohol,
coffee). With cerebral lesions we find an enormous slowing-down of the workperformance along with great fatiguability.1 One finds other cases in which
there is very little ability for performance, or practice-ability, and little fatiguability because there is virtually no effort; in this case the insufficiency is
psychologically conditioned. With the neuroses (particularly after accidents)
analyses of the work-curve have been made by Specht and Plaut.- It is possible
to differentiate between the quick fatiguability of neurotic patients, the lack of
determination in hysterics and the intentional poverty of performance shown
by determined simulators. Usually with neurotics we have to confine ourselves to subjective analyses. The two main components are, on the one hand,
adverse sensations and unpleasant feelings during effort, which tend to increase with the difficulty of the task, and on the other the feeling of 'not
wanting', of weakness and of not being able to go further. Weakness of will
depends on the unwitting acceptance that compensation will be lost if there is
return to work. The excitement of the compensation proceedings tends to
increase complaints and in particular the weakness of will (Compensation
neuroses). Itis not so uncommon to find that the examination shows decreased
performance as the only objective symptom these patients. have. .
Concrete examination of work-performance together With certain currently
held beliefs has led to a certain emphasis being put on the 'basic qualities of
personality'. In this connection it must be pointed out that in fact only
mechanical, automatic, learnable 'performances' are in question here, tasks
that everyone can do and which can be quantitatively assessed, in short just
those tasks that are commonly found rather a hurden. The work-curve cannot
be applied to qualitative performances, nor to prod~ctive activity, nor .in
particular to art, science and the general conduct of !tfe. We shall .value .lts
contribution, however, as an objective demonstration of the way In which
our nervous apparatus functions, that apparatus on which our life as a whole
rests.
(c) Individual variations in performance

When Kraepelin in his analyses of the work-curve spoke of 'basic qualities
of the personality' as shown in the various degrees of fatiguability, recuperability, trainability etc., he laid the foundations for a system which was capable
of considerable elaboration. All performances which can be demonstrated experimentally reveal individual differences. These can in part be measured, and
1 Busch Z. Neur. vol. 41, p. 28). 'Work with head injuries', Lange1iiddeke; Z. N4ur., vol. 58,
p. 1I6. Erg~graph te~ts, Bappert, 'Zur Frage der korperlichen Leistungsfahigkeit bei Himverletzten', Z. Neur., vol. 7), p. 239.
Specht, Arch. Psychol. (D), vol. ) (1904), p. 245. Plaut, Munch. med. Wschr. (1906), p. 1274,
Neur. Zhl. (1906), p. 481.
in part we can arrange them in typical polarities or opposites, or they may

show a multipolarity.
life goes on (pp. 280 ff). Each mode is linked as a whole with the others but
our knowledge can only grow by making distinctions. Alterations in the
present state (of consciousness and of the biological whole) and in the person's
relevant world (of intelligible, meaningful wholes) must be kept distinct from
alterations in the psychic flow itself, which is to be discussed in what follows,
and which manifests itself particularly in the way in which thinking is connected or disconnected. We are forced, however, to analyse it as a defect in, or
reversal of, certain normal performances taken as a whole. The changes involved have some very old designations: e.g. flight of ideas, retardation, disorganised thought. In diagnosis a distinction is made between the manicdepressive changes (flight of ideas, retardation) and the schizophrenic ones
(disorganisation of thought). Yet the flight of ideas can grow into disorganisation and schizophrenic states can show a classic flight of ideas.
208
For instance, 'types of imagery' have been differentiated: there may be individual
preference for the visual, acoustic or kinaesthetic sense in imagery and memory; an
individual may be an eidetic and an eidetic of a particular type. Similarly we find
different types of memory, speech, thinking, perceiving and moving; different
speeds, different rhythms, etc.
We are dealing with very heterogeneous matters. The one thing in common
is that they all emerge from objective performance tests. Differences are looked
for with the intention of finding certain basic psychological qualities due to
what have been called constitutional variations in human beings. This does
not give us the individual whom we understand, the aspect of personality which
we call character, but the biological individual who is revealed in his
performance.
One much discussed problem is that of right- and left-handedness. Right and
left is a fundamental orientation in space for our bodies. It is a morphological
feature of the body itself. There seems a very specific problem involved in whether
a person prefers right or left in his movements. In any case left-handedness is
regarded as a constitutional characteristic which is not appreciated as a physical
sign but only becomes objective during performance. Attempts have been made to
understand this in terms of personality development and structure, while others
consider it only a chance finding.
The Jacts 1 appear to be as follows: Left-handed people are almost always

in the minority. Incidence is stated to be 4 per cent in Russia, 13 per cent in
Alsace-Lorraine, in Stuttgart 10 per cent of boys, 6.6 per cent of girls. 25 per
cent of the stone-age tools discovered are said to have been made by lefthanded people; the inhabitants of Celebes are said to be left-handed as a
majority. Argument rages as to whether left- or right-handedness is an advantage or of no importance. Leonardo da Vinci and Menzel were both lefthanded. Left-handedness shows strong hereditary trends and appears correlated to speech disorders. 61 per cent of boys and 81 per cent of girls with
severe speech disorders were found to be left-handed (Schiller). 'The dominance of one cerebral hemisphere is necessary for the development of the higher
centres, especially the speech centre', so that the effort to train both hands to
equal skill is not a desirable one.
2.
THE ACTUAL FLOW OF PSYCHIC LIFE
The total present state can be considered from a number of standpoints:

as an alteration or clouding of consciousness (pp. 137 ff.), as fatigue and exhaustion (pp. 465 ff., 206) or as the particular world in which the respective
1 Maria Schiller, 'Probleme urn die Linkshandigkeit', Z. Nellr., vol. 140 (1932), p. 496. H.
Biirger, Nervenar{t, vol. 2, p. 464, on the whole problem of 'right and left'; a research report.
20 9
(a) Flight oJideas and retardation

Below we give an illustration of what is meant by flight of ideas 1 and retardation. The examples are highly heterogeneous:
A patient produced the following in 'conversation' with his doctor in which
objectively a flight of ideas was present: She was asked whether she had changed at
all in the last year. She said 'Yes, I was dumb and numb then but not deaf, I know
Mrs. Ida Teff, she is dead, probably an appendicitis; I don't know whether she lost
her sight, sightless Hesse, His Highness of Hesse, sister Louisa, His Highness of
Baden, buried and dead on September the twenty-eighth 1907, when I get back,
red-gold-red .. .' With such patients the trend of thought is haphazardly interrupted. They start doing this and that and keep losing their target, but they are
always busy about something and have a great number of notions. They cannot
stick to the point and constantly lose themselves in side issues. They will then lose
the thread and cannot recover it. They never finish what they begin, they jump from
one thing to another, are breathless and led on by superficial connections. In contrast, the patient with retardation behaves in the opposite way in almost every respect.
He shows no initiative, never begins anything, finds it hard to utter even one word,
ponders over a question but nothing occurs to him.
What the patient subjectively experiences can sometimes be elicited by selfdescription: Patients, particularly in schizophrenia, will describe one mode of flight
of ideas as a crowding of thought: Mrs. S. complained 'I can't hold on ... it all dances
round and round inside ... I can't group anything together ... I have no will ...
oh dear, what a lot of nonsense it all is .. .' A patient of Forel said ... 'A whole
uninterrupted string of ideas ran through my head ... like clockwork ... idea
chased idea with the oddest associations ... yet some kind of connection seemed
there from link to link of the whole chain ... what ideas have not tumbled about
in my head ... and what funny associations cropped up.' 'I kept on coming back
1 Heilbronner, Msc/". Psychiatr., vol. 13, pp. 272 If.; vol. 17, pp. 436 If. Liepmann, Vber
ldeenflucht (HaIle, 1904). AschafTenburg, Psychol. Arb., vol. 4 (1904). KUlpe, Psychologie u.
Medi,in, pp. 22 fT. L. Binswanger, Vber ldeenflucht (ZUrich, 1933). By flight of ideas, we mean
here rhe disturbance in the actual flow of the total psychic life, not the mere verbal production of
someone who actually need not be caught up in a 'flight of ideas'.
to certain ideas and images ... droit de France ... tannin . . Barbara .. Rohan
... they were like milestones in the headlong chase of thoughts . I said them
quickly, like a password as it were .. the particular one which they had reached
at certain points in my daily life, on entering the hall, at the opening of the sideroom door, at mealtimes, when someone approached me and so on ... I did it so
as not to lose the trend and get a certain hold on the mad thought-sequences which
were overwhelming me.'-A schizophrenic reported: 'my thoughts increased in
speed, I could no longer grasp individual ideas, I thought I would snap at any
moment; I only felt the movement of my thoughts, I could not see their content
any longer .. in the end I was not even aware of the thoughts ... 1 was empty . .'
A 30-year-old patient with a post-encephalitic state described the inner change
in his thoughts with comparable phenomena. 'I cannot sit still for five minutes
without thinking of something; thoughts go faster than 1 can speak; I know the
answers before I say them . it is as if a film was reeling off in my mind ... it
all goes like lightning and 1 seem to get hold of every detail ... when I don't
answer at once and you think I have not understood, everything is repeating itself
. I can't answer at once . all day it is like this, when 1 think, it occurs again
and again and again' (Dorer).
The following self-descriptions show milder degrees of retardation: 'my mood
was constantly changing ... my good days were characterised by interest, carrying
out what 1 wanted to do, personal stimulation, proper judgment of things and people
and of myself, and with a certain tension; I looked for company and took pleasure
in everything. The change of mood was not so sudden but progressed a little every
day. On the other bad days, I lost inteTest,jelt stupid, indecisive about things and what
should be my attitude. 1 tried hard to hide these defects, and sometimes I could
manage to evidence something of what 1 was like on my good days. My handwriting and manner of walking changed. Latterly there was also a complete indifference, and a failure to take in anything. Theatres, concerts, made no impression on
me; I couldn't talk about them any more; 1 lost the trend in conversation and I
could not link one idea to what had gone before; 1 was insensitive to jokes and
points made in conversation; I didn't catch them.' (In the following year this patient
showed paranoid deterioration.) Other patients complain, 'I have lost my memory
and cannot follow a conversation .. .' '1 feel paralysed ... I have no mind any
more ... I am completely stupid ... I can't recall what I have read or heard ...
my will has gone ... I haven't a trace of energy or drive ... I can't make up my
mind to do anything .. it takes all I have just to move, etc.'
assoclattve, passive flow of ideas and active, purposeful thought-processes

(governing ideas, determining tendencies). Associative processes bring in
material, active processes order the thought. We see at once: on one side there
is inhibition or excitation, a wealth or poverty of associative events, and on the
other a retreat of active goal-formation along with its determining tendencies.
When determining tendencies are diminished (because no goal-awareness
exists, and therefore exercises no influence and in addition changes too fast)
the flow of ideas is only guided by the constellations of the associative elements.
Consciousness is fed by external sensory stimuli as well as images evoked by
accidental constellations following all kinds of different associative principles.
This gives us the objective picture of flight of ideas. The word 'idea' in 'flight
of ideas' does not only refer to 'images' but to everything that can be called
an 'element' in the general chaos of association. In the same way the goalforming ideas are not just ideas but all those factors which bring about a
selection and structuring of psychic content; the logical (perceived) necessities
of the situation (speech, conversation, communication, task). Making use of
this schema we can derive any number of subjective and objective types of
retardation l and flights of ideas.
2. Types of disturbed psychic flow. (aa) Classical flight of ideas. Associative
processes are excited; there is a massive flow of content into consciousness. In
itself this might only imply increased mental productivity, but there is a
crippling of determining tendency and gradually this disappears altogether;
there is no longer any constant selection among the associations and they all
get mixed up through chance conditioning, association of ideas, verbal associations, clang-associations etc.
210
Interpretation of flight of ideas and retardation. We might say these

phenomena are all characterised by the opposites of accelerated or decreased
tempo. But this does not take us to the central point of the disturbance. The
acceleration of an otherwise normal process would be a sign of health while
slowing up in what is an otherwise undisturbed psychic process appears in
epileptic personalities for example without any similarity to the phenomena of
retardation which have been described. Perhaps the opposites of excitement and
inhibition corne closer to the point, but even though these can describe one
aspect of the total process they are still indefinite. If we really want to get at
the structure here it is best to make use of the contrast between mechanical,
I.
2II
So far there is no satisfactory or complete explanation of flight of ideas. It is not

the result of some acceleration in the flow of our ideas; nor is it the result of pressure
of speech. We cannot make it intelligible as a mere quick exchange of associations
(e.g. clang-associations) nor as the predominance of inferior modes of association
(loss of conceptual modes). The source of the phenomenon seems to lie in unknown
extra-conscious processes; the performance has to be viewed as a whole, taking both
sides of the thought-process into account, that is, the processes of association and
the determining tendencies.
(bb) Classical retardation. This is the exact opposite to flight of ideas so
far as associative processes are concerned. Autonomy over psychic content
is limited. The content is not destroyed however as in dementia. No associations appear; nothing enters consciousness. There is a tendency towards a
complete blank. Should a few sparse associations appear, the determining
1 I have given the rendering of the traditional theory, although it has been sharply criticised
and dismissed (by Honigswald, L. Binswanger). Even in flight of ideas, every idea, every element,
contains an act of thought. These are not just automatic happenings; there is still an 'I' 'thinking'.
Correct as this may be, it is no objection to closer analysis. The older theory is a valuable description, not a theory as to what is happening, which in any case still remains obscure. The experience
itself lies in this opposition of thought and the material on which it works, and we do wrol1l1
to dismiss the whole thing.
213
tendency, as with flight ofideas, is extremely weak. Patients cannot concentrate.

At times a reaction may be staged after long-drawn-out effort, but often the
patients are completely mute, and linger for a long time in deep stupor.
(cc) Conjunction offlight of ideas with retardation. It seems that these two
phenomena can appear together. Flight of ideas may be rich or poor in content,
speech may be profuse (pressure of speech) or extremely scanty (mute).
Where patients are aware of this disturbance in their psychic process flight
of ideas is described by them as a pressure of thoughts, and the retardation as a
subjective inhibition. Seen as a whole it appears as thought retarded with
flight of ideas.! The patients complain that they cannot cope with the mass of
thoughts, the painful chase of images which storm through their mind; or
they may complain that they can no longer think, not another thought comes.
Should the patients also be aware of a loss in determining tendency, they will
still try hard to bring some order into their thoughts and experience the complete ineffectiveness of their attempts to form controlling ideas. They experience a simultaneous excitement, pressure of thought, brought about by increased associations, and retardation through their incapacity to keep hold of
a single, coherent thought in the middle of this hectic chase.
(dd) Distractibility.2 Where determining tendencies have failed or are insufficient, flight of ideas comes about, provided the thought-process consists
mainly of an increased production of associations. Where, however, the process
is haphazardly conditioned by external impressions we use the term distractibility. The patient will immediately notice and name and include in his talk for
.
' a
Instance,
a number of objects, something one holds in one's hands, a watch,
key, a pencil, or something one does-one knocks, plays with the watch,
jingles keys. But the next minute, he is off on something else, a spot on the
wall, the doctor's tie, anything noticeable in his environment. It is obvious that
flight of ideas and distractibility will commonly occur in conjunction, but they
do not always do so. A patient may be entirely unproductive in association,
but every external stimulus may catch his attention, and reversely with other
patients whose whole process of ideas seems to consist solely of associations
linked in a typical flight of associations that cannot be interrupted by any
external stimuli.
then not to talk of distractibility but to keep this term for those cases where we get
the impression that the patient is conscious of some change in the direction of his
attention, he observes and is then again distracted, in a way for which we can have
empathy.
212
Distraction does not occur with every stimulus. One can often notice a certain
selection of areas of interest, or of a certain coherence. This partially understandable
kind of disturbance passes over by transitions into the opposite extreme, distractibility by any stimulus whatsoeyer. Every object is named indiscriminately, every word
repeated, every movement imitated. In cases of pure distractibility, should some
understandable element appear, it seems to us an 'echo-symptom', a purely automatic event. In the former case, the stimulus picked up by the distracted attention is
still being elaborated by the patient in a way that seems abnormal, but in the latter
case all that appears left is an unchanging, automatic reaction. It would be better
1
2
Schroder, Z. Neur., vol. 2.

Heilbronner, Mschr. Psyc!.iatr., vol. 13, pp. 277 fT., vol. 17, pp. 431fT.
(b) Confusion
Schizophrenic patients complain of fatigue, a loss of concentration, of a
falling-off in their intellectual performance, poor memory. The meaning of
these manifold complaints grows better 'defined when the observer can find
objective disorganisation and actual disturbances of the thinking process.
Beringer! selected a number of cases whose thought was not so disorganised
as to make self-description impossible. He noted that the subjective reports
(unlike many of the complaints of manic-depressive patients in regard to their
retardation) were well correlated with the objective findings:
The patients complained: thoughts are so fleeting, as if cut off, connections are
lost, thoughts are so rushed. It becomes worse when patients are left to themselves
and better when they have something to do or are engaged in conversation. A
patient said: 'I forget my thoughts so quickly; if I want to write something down,
it has gone ... the thoughts fall over each other ... they are no longer clear ...
they go off like lightning ... and another comes though I had not thought of it a
moment before ... I feel absolutely muddled ... I can't control my thoughts ...
they are confused ... they glance by, though I know they were there ... there are
always side thoughts beside the main thought ... they confuse me and so one
never gets anywhere ... it gets worse ... it's all criss-cross ... everything mixed
up and meaningless ... even I have to laugh but I can't ... I feel robbed of thought
... everything I see and think seems to have lost its colour, it seems shallow,
dull .. .' 'The university has shrunk to my cupboard .. .'
Much of this painful criss-cross experience is the lot of the patient who is
passive; where he is active, he experiences the difficulties of his thoughtprocesses and their extreme poverty.
When we try tests of performance, the patient may co-operate and try to
do them, but we find a reduced power of registration, a marked deterioration
in comprehending the logical structure of a story, the failure to recognise the
nonsensical as such and greater difficulty in completing gaps in sentences, etc.
The patient who gave the above clear description could not write a simple
request to someone he knew: he had to write I4 pages, started afresh several
times, but never achieved his end.
Carl Schneider2 gives a very subtle description of such disordered schizophrenic thinking; there is 'Verschmelzung'-smelting or fusing, the bringing
together of heterogeneous elements, 'Faseln'-mixing, muddling up actual
definite but heterogeneous elements, 'Entgleiten'-snapping off, the unintentional breaking of the chain of thought, 'Entgleisen' -derailment, the
interpolation of thought-contents in place of the true chain of thought, etc.
1
Beringer, 'Beitrag zur Analyse schizophrener Denkstorungen', Z. Nellr., vol. 93 (192.4)

Carl Schneider, Psychologie der Schi{ophrenie (Leipzig, 1930 ).
In an effort to try and visualise this type of thinking-or rather this kind
of psychic flow as a whole-comparisons have been made with the kind of
thinking that occurs during fatigue or while falling asleep (Carl Schneider),
or with archaic thinking of primtiive people (Storch). But there can be no
more than comparison. During fatigue or falling asleep, the primary change is
the change in consciousness; in archaic thinking we see a stage in the historical
development of the human mind (as a product of culture not as biological
inheritance). In schizophrenic thinking however a primary disturbance of a
peculiar type is taking place in the psychic flow and this is our one empirical
fact.
3.
INTELLIGENCE
Intelligence is the term given to the individual's totality of abilities, those

instruments of performance and purpose available to him for adaptation to
life.
(a) Analysis of intelligence

We have to differentiate the preconditions for intelligence, the inventory
of actual knowledge and intelligence proper. As preconditions ofintelligence we
may assume registration and memory, degree of fatiguability, mechanisms of
motor phenomena, mechanisms of the speech apparatus etc. There often is a
confusion between these preconditions and intelligence proper. The individual
who has no memory, cannot speak, or tires very quickly, naturally cannot
display his intelligence. But the cause then lies in the disturbance of some
circumscribed function, as a result of which there is a disturbance in the manifestation of the intelligence, not in the intelligence itseli If we want to analyse
anomalies of intelligence and differentiate them, it becomes very important to
chisel out from the whole concept of intelligence those limited and basic
psychophysiological functions which we have earlier on discussed. Liepmann
speaks with pride of the advances made by 'separating out aphasia and apraxia
from the undifferentiated morass of dementia'. In the past, aphasia had often
been mistaken for dementia.
In the next place, we must not confuse all that we have in our mind, our
knowledge, with intelligence. It is true that where there is great knowledge, we
can conclude the existence of certain abilities which must be there to acquire
what is not solely a reproduction of memory. But even then, we still find a
far-reaching independence between mere learning ability and intelligence
proper (the capacity for judgment). It is possible to learn a whole host of
complicated matters, so that learning ability is again often confused with intelligence. In psychopathology, comparison between the actual store of knowledge and what is still left of ability sometimes provides us with a criterion
for assessing acquired defect as opposed to congenital mental deficiency. In
the latter case, the amount of knowledge and the ability are more appropriately
related to each other. Very slight knowledge is usually a sign of mental deficiency, and vice versa. We can therefore in extreme cases indirectly base our
judgment of mental deficiency on a test of knowledge. Such a test is of more
value to us, however, in determining those contents which provide the individual's working material. Actions, attitudes, behaviour are intelligible only
if we know the extent of this material, the picture of the world which the mind
has built; only so can we converse. The smaller the mental estate, the more we
can observe that words mean one thing for the speaker and another for us. The
words he uses go in their objective meaning beyond what he wants to say.
They may deceptively suggest that he has more knowledge than is the fact.
The size of one's mental estate depends not only on learning ability and interest
but on the milieu from which we derive and in which we live. If we know the
average level of knowledge within the different social classes, this is of considerable help when we come to assess the individual. Usually one overestimates
the average extent of knowledge. l Rodenwaldt found in a majority of soldiers
a complete lack of social orientation, ignorance of their political rights, even
of the law of the land. They did not even know the country a few miles away
from their village. There was scarcely a trace of any knowledge of history.
More than half of them did not know who Bismarck was. Usually in any test
of knowledge one must take the schooling into account, as well as the general life
experience. This latter (in the form of knowledge acquired from spontaneous
interest or in the course of work) gives us a much better criterion for intelligence. Recent investigations, however, rather surprisingly show that the
majority of people have only a most superficial acquaintance with their own
occupations.
Finally we come to the intelligence itself. It is a difficult matter to comprehend. It is almost impossible to calculate the many different criteria we use to
assess someone as intelligent. Obviously there are a great many different
abilities which can perhaps be isolated out precisely, and it seems probable that
there is not just a series of greater or lesser degrees of intelligence but a ramifying tree of many different abilities. We may doubt whether there is a general
intelligence, a general capacity to perform, a 'central factor of intelligence'
which must disclose itself in every respect. But there is always a strong inclination to assumethat such a factor exists. It is this which the older psychology
called the power of judgment.
However that may be, the phenomena of intelligence are immensely varied.
We find lively people with a quick grasp but who mislead through their very
flexibility, yet are taken for exceptionally intelligent people. On test they appear
as only average anel superficial. Then we find a level of practical intelligence
where there is quick and correct choice of many possibilities and an apt
adaptation to new demands. Then there is an abstract intelligence which in
1 Rodenwaldt, 'Aufnahmen des geistigen Inventars Gesunder als Massstab fur Defektpriifungen
bei Kranken', Mschr. Psychiatr., vol. 17 (1905). J. Lange, 'Ober Intelligenzpriifungen an Normalen', Psychol. Arh., vol. 7 (191:1).
216
2 17
moments of decision becomes almost feebleminded but can achieve great

mental feats when working quietly on its own. 'Doctors, judges, politicians
may know theoretically many beautiful principles of pathology, law and
statesmanship and can teach them, but in the application of them they may show
themselves utterly futile. There may be a natural lack of judgment; they can
see generalities in abstract but cannot decide whether the concrete case fits' or
they have never been sufficiently trained by example and actual work to m'ake
judgments of this sort' (Kant).
Clinically we have not got much beyond a few very general aspects of
intelligence. We lay much emphasis on the capacity to judge, on the ahility to
think, on a flair for the essential, on the ability to grasp viewpoints and ideas.
In a difficult test the person who says he does not know something or cannot
do it seems more intelligent than someone who goes off into irrelevant detail
or tries to talk himself out of it. As well as the capacity for judgment there is
spontaneity and initiative, which a]so count. In response to requests someone
may well show intelligence in being able to judge, but when left to himself, he
may sit around, an apathetic and very dull individual.
people have suffered a loss in productivity which may be transient or lasting.

Inversely may come phases of exceptional productivity, of the richest creativeness. In all such cases we are dealing not with changes in the intelligence as a
whole but with changes in productivity. Phases such as these are usually to be
found in depressive and hypomanic states.
2. Congenital subnormality. There is a steadily descending range of capacity,
running from the limited productivity of a concrete, reproductive intelligence,
to the lowest grade of mental subnormality. Slight degrees of this are termed
feeblemindedness, moderate degrees imbecility and severe degrees idiocy. Here
we are dealing with a psychic life that suffers impoverishment in all directions,
with a low degree of differentiation. We can conceive it as a variation of human
constitution in the direction of below average. As we get lower down, psychic
life approximates more to that of animals; although the necessary instincts are
well developed, experience does not move beyond the individual sensory experience and nothing fresh can be learned. No concepts are formed and planned,
conscious behaviour is impossible. As they have no general viewpoints,
such individuals are quite unable to form ideas, or advance ideals. Their life
is spent within the narrow horizons of accidental, daily impressions. Yet at the
lowest as at the highest level of human differentiation, we can see mental
endowment is not unitary but consists of many unevenly developed abilities.
We often see imbeciles who show special aptitudes, or even mental abilities
such as arithmetical skill or a one-sided appreciation and memory for music. 1
At present we cannot distinguish psychologically the congenital mental defect
due to organic lesions,2 from those forms of congenital mental defect appearing as an abnormal constitutional variation.
3. 'Relative mental defect'. In theory we can separate the congenital fashioning of the intelligence from that of personality but in actuality we cannot always
do so. There are odd individuals with an apparently high performance-ability,
coupled with an astonishing incapacity; BIeuler called this situation 'relative
mental defect' (Verhaltnisbiodsinn)3 because the individual's endowment is in
no recognisable relationship to the level of aspiration and there is consequent
inevitable failure. There is a disturbed relationship between the intelligence
and the aspirations. The disproportionate drive poses tasks for the intelligence
and brings the person into situations with which he cannot cope. Such people
are often equipped with an excellent mechanical and verbal memory, and
appear to superficial observation as versatile thinkers, but on closer view
they are 'masters of confusion'. They are incapable of 'finding useful directives
from experience whereby to manage their affairs'; they suffer from an incorrigible self-overestimation, and a total absence of self-criticism. In conversation
a fine flow of uprushing associations is let loose in a kind of 'drawing-room
(b) Types of dementia
The concept ofintelligence, viewed as the whole of a man's mental endowment, means that an analysis will only elicit particular features which in themselves never quite meet the intended concept. We therefore have a much better
idea of the characteristics of particular types of intelligence than of intelligence
as such. We shall now try to describe some types of disturbed intelligence, as
follows:
I. Fluctuation in output. Intelligence means for us in general a lasting disposition, and dementia a lasting defect. If we cannot get an intelligent performance from people in acute psychoses, confusional states, stupor, flight of ideas,
retardation, we do not say there is any disturbance of their intelligence. This
can only be stated if intelligent performances cannot be elicited in settled,
orderly, accessible states, that is in the absence of acute disturbance. When this
is present we do not even hazard a judgment on the patient's intelligence,
what it was before and what it will be in the future. However, it is not always
easy to make this distinction between the transitory and lasting disturbance
in every case. Disturbances such as diminution in mental output in intellectuals,
artists, scientists, or the transient, more lasting or permanent disturbances that
occur in psychasthenic persons, are by no means easily classified. Passing
phases when patients feel their inadequacy strongly are quite common.
Memory they feel has gone; they cannot think any more. These feelings of
inadequacy are justified in fact; the patients are really unable to concentrate,
they read mechanically without getting the meaning, they have to think
all the time how to set about things, and constantly watch themselves instead
of what they are doing. Thus they really lose sight of their work as a whole;
they have no spontaneous ideas and without these work comes to a halt. Such
1 Witzel, 'Ein Fall von phanomenalem Rechentalent bei einer Imbezillen', Arch. Psychol.,
vol. 38.
Sollier, Der Idiot und der Imberille (Deutsch, 1891).
" B1cul"r, AI/g. 7.. P.lychi"tr., vol. 71 (1914), p. 537. L. Buchner, Allg. Z. Psychiatr., vol. 71.
218
idiocy' (SalonbIodsinn), in an urge to be somebody and impress others. There

is an impression of a flight of ideas but this is not so really. It is an understandable self-expansion coupled with an immense number of ideas, but they
are controlled only by language facility and powers of mechanical memory.
Ideas are not developed, only a chaotic knowledge displayed. Shallow, verbal
witticisms take the place of responsible evaluations and attitudes; 'speak, rather
than think' is the guiding motto. There is an intoxication with one's own wit,
instead of any directed thinking, but the wit is only a reproduction of what
has been read. Such people can deceive through their 'belief, reminiscent of
pseudologia phantastica, that all they say is their own'. The chosen content is
usually the most high-sounding problem.
4 Organic Dementia. We have to differentiate acquired, organic dementia
in all its many forms from congenital feeblemindedness and schizophrenic
defect. The organic process usually destroys in a far-reaching manner the
preconditions ofintelligence, such as memory, powers of registration, sometimes
the apparatus of speech, so that, for instance in senile dementia, we get clinical
pictures where a person forgets his whole life, cannot speak properly any longer
and can only make himself understood with difficulty. But from his behaviour
and general conduct we can still see evidences of an educated man', he has
retained his sense for the essential and under certain circumstances some
power of judgment.
In other cases of arteriosclerosis, paralysis and gross degrees of epileptic
dementia, the process in the brain leads to progressive deterioration of the
whole intelligence. Finally the patient loses all power of judgment, any inclination to go for essentials, less indeed than a congenital mental defective.
At the same time patients, as they talk, will bandy about fragments of previously acquired experience, so that a different picture arises from congenital
mental deficiency, and one gets the picture immediately of an organic disorder.
Apperceptive power is seriously reduced. They are guided by accidental
impressions and have no effective counter-ideas; they lack all initiative and find
themselves at last in the severest states of mental devastation where they can
only vegetate physically.
All organic dementias of severe degree show characteristically a lack of
insight. Only when the organic process is essentially restricted to the preconditions of intelligence (memory, etc.) does any sharp awareness of illness
exist (e.g. in arteriosclerosis). In senile and arteriosclerotic dementia there is
at the beginning, in contrast to paralytic dementia, an acute feeling by the
patient of his own regression. 1
5 Schi{ophrenic 'dementia' (deterioration). Ifwith the organic dementias we
find it difficult to separate personality from the intelligence, the schizophrenic
deterioration or dulling of the kind from which the majority of chronic mental
hospital patients suffer presents us with an even greater problem. Perhaps the
intelligence remains quite intact in these cases and the changes are due to
alterations in personality alone. It would be of fundamental importance for our
understanding of these illnesses if it were possible to separate ttis latter type
of case-which forms the majority-from those cases where a true disturbance
of the intelligence could be demonstrated. In fact we do not find a disturbance
of memory and the other preconditions of intelligence, there is no loss of
knowledge, but there is a deterioration in thinking and behaviour which has
been described as silly, hebephrenic. We also find a lack of grasp on the
essentials, at least for what can be said to be essential in the social, objective
and empiricially real world. We have characterised schizophrenics by their lack
of contact with reality and have contrasted them with paralytics, who in spite
of severe destruction manage to maintain contact with their reality, in spite
of disorientation too and reduction in awareness (Minkowski). The complete
heterogeneity of the organic and schizophrenic 'dementias' is confirmed, the
one in all its ruin, still a natural ruin, the other a crazy distortion. With the
schizophrenias there is also in many cases a loss of spontaneity, a twilight
living, which can be interrupted only by strong stimulation, to which very
surprisingly they may respond. Instead of giving a general description we will
quote a mild case of this deterioration, to bring out the peculiarities of this
kind of loss of judgment. The remarks of the patient should not be read as
intentional witticisms( I):
1 Eliasberg and Feuchtwanger give a psychological analysis of a progressive dementia after

brain-injury. Z. Neur., vol. 75 (1922), p. 516. Patient's total attitude and the disintegration and
impoverishment of the situation is shown.
The patient, Nieber, is well orientated, in his senses, lively, chatty and jovial,
always on the alert for smart and apt remarks; he is not acutely disturbed. On
admission he implores immediate discharge; if one discharged him today he could
call at the clinic occasionally. However, he goes off to the ward without difficulty
and never brings the question up again; instead of this he speaks of his intention
in the near future of making a dissertation at Tiibingen for a doctorate in engineering
... 'I shall give in it the blueprint of my life; I shall get the doctorate for sure
unless I intentionally make some mistakes'. He wants to be employed by the clinic
as a photographer; he asks for several private rooms for himself; he wants to be
transferred to the first-class accommodation; but he never follows his requests up.
He has a number of constantly changing activities which are soon relinquished and
forgotten. He writes poetry, applications, letters to authorities, to doctors, to other
hospitals, to titled people; he writes a 'dissertation'-'The toilet-paper'--extempore
essay by H. J. Nieber. Here are some extracts from this voluminous manuscript:
'Essays have already been printed and printed about the immortality of the may-fly,
about the risks of the shot-gun, about the disputability of Darwin's theory of
descent. Why should an essay on toilet-paper not find a recognition and reward?
I think the price of 30 M. is not too high for a volume full of writing. The social
and political side of this subject will get particular attention ... I therefore enclose
a table which will offer a welcome aid to local politicians and the National Economy
when it comes to discussion .. .' The patient draws with infinite care a cheque showing all the usual ornamentation and sends it to his previous hospital in payment for
the food he had had ... 'It seems to me the sum of 1000 M. is adequate for board
220
and lodging including doctors' fees.' In conversation he always surprised one by his
peculiar phrases: 'Psychiatry is nothing else but the investigation of the rights and
benefits of the law in relation to persons .. .' 'I hold the view that mental illnesses
do not exist' ... 'Psychiatry has to offer an existence to people who are born for a
workin~ life .. .' One may feel like interpreting such talk as leg-pulling of those in
the enVironment, but in fact this is not so. The patients' whole life is like this and
is carried on in the institutions for decades without any efforts in earnest on their
part.
6. Cultural suhnormality. We distinguish between congenital mental sub-
~orma.lity. and. dementia that is acquired as the result of a morbid process,

1Oclud1Og 10 this latter category the organic and schizophrenic dementias. This
is a division according to aetiology, which coincides with differences in the
psychological characteristics. Of quite different origin, however, is the mental
'subnormality' which clinically appears due not to congenital causes or any
morbid process arising from illness, but very largely due to the abnormal cultural environment in which the patient lives. It is a socially conditioned defect:
'bad upbringing, inadequate schooling, lack of stimulation, narrowing of
interest to breadwinning, and maintenance of the vegetative self, malnutrition
irregular living-all these circumstances are liable to bring about gross defect~
in knowledge and judgment and an extremely egocentric and morally poor
attitude' (Bonhoeffer). We may find many different kinds of defect due in this
way to the ~ilieu, in tramps, for instance, in prostitutes, in wealthy people
:who from chIldhood upwards have never done or experienced anything much,
10 people who have had to live in sanatoria for various chronic illnesses and
in long-stay mental hospital patients of all types.
7 Emotional stupidity and pseudo-dementia. Defects in intelligence are confused sometimes with acute states and with the changes that take place in
d~pression, hypomania and confusional conditions. They can also be easily
mistaken for some failure in emotional reaction, emotional stupidity (Jung).
This can occur in examinations, for instance, but also during a medical investigation or any other upsetting situation in people who are so disposed.
Lastly, :we may take for a disturbance of intelligence what is really a pseudodementia, a state of prison-psychosis; this can last sometimes for a long period
with consciousness unclouded. It is due to hysterical disposition reacting to
the impact of a prison-complex, and there is always recovery.
(c) Examination of intelligence. 1
. How do we assess the intelligence of anyone? It must be based always on

hiS actual performance and on his behaviour in the test-situation when given
set tasks to do. Considering the narrow grooves in which most people pass
1 Jaspers, Z'. Neur., ref. teil. 1 (1910), p. 401. Stem, Die psychologische Methoden der IntelItgen{p:u.fung u. Ihre Anwendung hei Schulkindern (Leipzig, 1916), 2nd edn. Ober die Untersuchung
von Kmdem nach der Methode Binet-Simon. Cf. Berichte von Bobertag, Z. angew. Psychol.,
vol.
?' pp.
23 0-S9;.vol. S, pp. 10;-203; vol. 6, pp. 49;-518 (1909-17). G. Kloos is good, see his
Anlmung {ur Intelltgen{pru.fung (Jena, 1941).
221
their lives, a single lifetime is not enough to draw out the capacity of ~he
intelligence to the full. The most important source for our assessment remal~s
the personal life history and the actual performance. ~ut ,:,e cannot remal~
satisfied with that. We like to feel we have made a rehable Judgment, even If
exploration has to be brief. We explor~ as mu~h as we can? t~ough the incidental
observations of clinical practice sometimes give greater 10slght than the most
carefully planned investigation. The observations arise from the .ordinary
doctor's interview. We put certain questions as doctors and long expenence has
shown their value (asking for differences, between a mistake and a lie, knowing
and believing, etc., arithmetical problems not previously learnt, cpo PP: 140155), questions as to how the patient sees his own situati.on, how he Judges
things from his occupational life and his own personal .clrcumstances, e~c.).
Finally, complex methods have been worked out. For 1Ostance, the pauc;mt
should fill in some text meaningfully, putting in words and syNables which
have been purposefully left out (Ebbinghaus-completion test), or one .asks
the patient to describe pictures from memory (Stern-memory test). Patients
are asked to repeat stories that have been told them etc. The results are assessed
.
quantitatively, if possible (or numerically).
Up to now such investigations have yielded us the ~Oll0:WlOg: assessment
of ability in anyone field depends on the tests also belOg 10 that field. We
cannot draw definite conclusions from the completion test, or memory test
for instance, as to performance in other fields. We can indeed form some sort
of picture of a person's intelligence if we use all the available sources (pers~nal
history, conversation, tests), but we cannot assess it in relatio~ to all po~sl~le
contingencies. It would be utopian to suppose that we can ouer any oplOlon
as to what work, at any rate a young child, is best fitted for through the use of
an intelligence test, unless the concern is with some relatively simple task or
with a plain property of the psychophysical apparatus. quite ~ften some
surprising success or failure in the subsequent course of h~e wtll ~lt~r the
judgment then made. In some extreme cases it may be pOSSible to hmlt the
future possibilities for those of very poor ability; it is also practicable to select
experimentally from a large number of people those best fitted :or a c~rtain
job, if one will allow for a proportion of mistakes. The ~ethod IS certalOl! a
sure one for detecting colour-blind people; but when It comes to selectlOg
people for professions in the same way, one runs into the danger that experimentally the most intelligent individuals may well prove to be unfit. 1
In all quantitative assessments of intelligence the individual's maximum
performance at anyone time should be distinguished from how hi~ correct,
competent and worthwhile responses are related to those that are IOcorrect,
incompetent and of no value. It can happen that someone may be regarded
as not very intelligent from the latter point of view yet perform extremely
well from the former, and vice versa.
1
Cf. my Idee der Universitiit (Berlin, 1946), Achtes KapiteI.
SOMATIC ACCOMPANIMENTS OF PSYCHIC ACTIVITY
CHAPTER III
SOMATIC ACCOMPANIMENTS AND EFFECTS

AS SYMPTOMS OF PSYCHIC ACTIVITY
(SOMATOPSYCHOLOGY-SOMATOPSYCHOLOGIE)
There are a large number of physical, objective phenomena which appear

without any operation of the individual's will. There seems to be no conscious
intent. Nor can we take them for meaningful, objective 'performances' nor
for any intelligible psychic expression. They follow certain psychic events or
occur simultaneously with them. They are physical findings that have or may
have some relation to psychic events but they do not portray them nor reveal
them in any sense which we can understand. To start with they are nothing
else but non-psychic, objective, somatic facts.
Body-PSYChe relationship. In every human being we see the unity of body and
psyche appearing as a living whole. We have the fact of the individual as a unity
in the shape of a body 'which either is a psyche, or has a psyche or produces the
appearance of a psyche. On the other hand, this undoubted body-psyche unity does
not itself appear as a recognisable object. All that we see, think and comprehend is
somethi?g already separated out from this unity, something particular, and we are
faced Wlth the problem of what in fact is its relation to the unity as a whole. It
follows that if we regard all psychological and somatic analysis with suspicion, any
talk of body-psyche unity not only becomes sterile but positively cripples our
thought. The unity of body and psyche is only true as idea. As such, it keeps our
anal~sis from assuming an absolute value and helps us to maintain the findings as
relattve knowledge. At the same time it fosters the question of what is the relationship of everything to everything else in somatic and psychic life. The unity itself
remains dim and incomprehensible or beyond reach as an object of knowledge, but
",!,e should think of it as the only idea that can guide our knowledge of life, which
IS only a knowledge of particulars, and has only the limited certainty of the particular.
(a) Separation of hody and PSYChe. The separateness of body and psyche may
appear a perfectly clear and obvious notion, which needs no further explanation.
But it always leaves us with the question What is body and What is psyche?
For example, psyclze means direct inner experience (the material for phenomenology); it means whatever it is that produces meaningful function or appears
as human expressiveness; it means the unity of the '1', the self, the underlying
psychic substance, etc.
Body, for example, means the morphological shape of life; visible, purposeful
movement; the chemical, physical, biological processes; foci in the brain, etc.
~f.everything is te~ed psyche, this does not make the psychic whole any more
empmcally comprehensIble than the body would be, if we term it the vague something that embraces every spatial event. We only get an empirical object, if we chisel
2.2.2.
2.2.3
out clearly from the whole a version that is neither entirely of the body nor entirely
of the psyche.
If in some way we manage to separate what belongs to the body and what to
the psyche, we are still left with the problem of their relationship. This only becomes
a fruitful question if it takes the form of something we can objectively test. If it is
put as a general problem or a problem of principle, it reduces us to absurdities. Both
of these questions must be discussed further:
(h) Enquiry into the relationship of hody and PSYChe. The relationship of the
physical and the psychic is rooted in a number of facts which we can formulate
broadly while still using the concepts of body and psyche in a fairly undefined way:
Physical things affect the psyche (e.g. poisons, sickness, brain-injury, etc.).
Psychic things affect the body; either in the realisation of deliberate intentions
(motor activity) or in unintended physical effects-heartbeat, blood-pressure,
metabolism, etc.
Psychic things appear to be understandable in the physical phenomena (e.g. the
psyche expresses itself in the body's posture and movement).
That there is a relationship seems to be a common, empirical fact, witnessed by
all. This confirmation then leads us on to certain versions of what at any time may
be thought to be body and what to be psyche. How any relationship is possible and
what exactly happens within it eludes our observation. For instance, when I move
my hand in writing, I know what I intend and my body obeys me. We can partly
demonstrate how this happens in terms of the neurological and physiological events,
but the ultimate act of all, the translation of psychic intention into a physical event
is at present as inaccessible and incomprehensible as magic, though the magic is one
of fact not of illusion. The same things have to be said of all psychic and bodily
connections.
(c) The relationship ofhody and psyche in general. If we want to grasp the relationship of body and psyche in the form of some general principle, we shall find ourselves caught up in metaphysics in such a way that we shall get landed in absurdities.
We have to be dualists, accepting a parallelism of psycho-physical events or some
form of interaction; otherwise we have to be monistically materialist (the psyche
becoming an incidental epiphenomenon, a property of the body) or else we have to
take the path of the spiritualists (the physical being only a manifestation of some
psychic substance, which alone is real). Any of these ideas will land us in impossible
consequences. The empirical investigator can usually fall back on the category of
interaction, in so far as psyche and body are treated separately; the psyche acts on
the body and vice versa, without any need to state thereby anything as an absolute
or final principle.
There have been metaphysical difficulties ever since Descartes parted body and
psyche, as absolutes. He introduced the difference for the first time of inner and
outer, between psychic states that are experienced and the physical processes in
space. He saw these as two incommensurable realities, each one observable by itself,
describable and open to enquiry; res cogitans and res extensa. Descartes' clarifying
separation retains its value in the radical difference we make between the description
of psychic experiences (phenomenology) and the observation of somatic events. But
error began to creep in when the term 'psyche' was confined solely to the conscious
inner experience and the term 'body' to the mechanically explicable, material event
in space. It crept in too when these aspects of an extremely superficial division were
treated as if they were true substances. Reality in its abundance is essentially neither
a psychic inner experience nor a physical process in space, but it is something occurring in the medium of both, as meaningful performance or as an expression which
we understand, as behaviour, as the human world, or as mental creation. Once the
dualistic division had grown into an absolute, there was no longer any room for
such abundance. Descartes' division has indeed its application, and any analysis that
follows his methods will yield us facts, though the sphere of application is limited
and disappears altogether when we reach the encompassing nature of life itself.
Descartes wanted to surpass the old, and in its own way magnificent, conception
of life as it had been held from Aristotle to Thomas Aquinas. This involved the concept of a hierarchy contained within the unity of psychophysical being and ranging
from the vital levels of the psyche through the levels of emotion to the level of
thought. Within the one, immaterial human soul lies the 'substantial form' of the
human body. The body is, so to speak, ennobled and the psyche embodied at one
and the same time. There is no assertion in principle of any basic difference in the
nature of what is physical and what is psychic.
Today the study of the psychology of Thomas Aquinas is still rewarding. It
gives us a prototype on a grand scale and his classifications are still worth reflecting
upon. We will take one particular point: Aquinas differentiated sensual knowing
and sensual striving (which are both directly dependent on the physical) from
reasoning and spiritual striving (which are indirectly dependent on the physical). He
divided the sensual field into: (I) The external senses, touch, taste, smell, hearing and
sight. (2) The inner sense-capacities, among which we find the general sense, which
brings the individual sensations into consciousness and covers everything that belongs to the senses-movement and rest, unity and multiplicity, size and shape. It is
the mid-point where all the senses are gathered up into a unity. Then there is the
power of imagination which steers our impressions and reproduces them in image and
fantasy. There is also sensual judgment (instinctive drives, instinctive evaluations,
which transcend perception and carry their own judgment with them; they participate, as it were, in reason) and there is sensual memory (which stores all those sensual
experiences that carry a time-signal). (3) Sensual striving (the 'appetitus concupiscibilis, irascibilis') and the passions.
The basic concept of the body-psyche whole can be greatly modified but it has
never lost its fundamental feature-that of a oneness that is recognisable and absolute, whereas Descartes' newer philosophy took two substances as absolute. The
older view pictured the whole in a way that preserved the abundance of reality without abandoning the unity of body and psyche and it continued to see the physical
in everything psychic and the psychic in everything physical. For this reason, it has,
right up to the present day, often heen revived in opposition to the views of Descartes.
A recent example of this is Bleuler's use of the term 'psychoid', which was to denote
something common to somatic and psychic life alike: the function of memory, integration, the purposeful character of living structures and forces. The defect here,
as with all such schematic ideas, is that a comprehensive viewpoint of this sort may
indeed provide us with an ideal construct but this cannot be investigated nor can we
use it in order to obtain new knowledge. The one ahsolute of the substantial Being
of body-psyche unity opposes the other, that of the two absolute modes of Being,
body and p~yche. Both theoretical standpoints, that of Aquinas and that of
Descartes, have to be discarded. Truth demands that we do away with all absolutes
in favour of definite, though always partial, knowledge which has to proceed step by
step and never finds itself wholly in possession. The completeness of the whole can
never be encompassed by the time-bound nature of human knowledge. Knowledge
is only true within that part of space accessible to us. If we want to know the transcendental whole, which has both physical and psychic effects and is primarily both,
we find it has vanished from us into the clarity of particular facts which are comprehensible but which are never the whole itself.
(d) The coincidental manifestation of hody and psyche as a fact for investigation.
Everyone experiences within himself this coincidental existence of body and psyche.
This experience, in the form of bodily sensation, provides us with the material for
phenomenology and somato-psychology. We see the part played by physical sensation in the perception of our own bodily events and also in our feelings, drives and
sufferings. This experience, however, is no means for obtaining a generally valid
knowledge of body-psyche unity, but, in so far as it is an experience, it becomes
material for our knowledge of body-psyche relationships.
Again, psyche and body are one for us in expression. When we see a happy,
human face, we do not divide body and psyche, nor do we have two different things
in some relation to each other, but we are presented with a whole, which we only
separate secondarily into physical phenomena and something inward and psychic.
The fact of seeing someone's expression is a primary phenomenon of the way we
grasp our world. It is a fact of infinite richness, enigmatic in principle, but always
there, present and real. If we want to talk of the coincidence of body and psyche
as a fact for investigation, it is only in this fashion that we shall encounter it. After
we have separated body and psyche, we never find again what was once present as
a real phenomenon, both medium and material of some specific (understandable)
,u;tuality, present to us before we start to reflect.
However we differentiate the physical and psychic life, we may indeed find
empirical relationships which follow the separation, but we never think of an actual
coincidence of body and psyche or any identity between the two, let alone see it.
If we wish to inscribe psychic structures into the somatic structures and maintain
their identity, we become involved in purely theoretical notions that lack objective
reference and on closer inspection seem absurd: for instance, we may think that
llIemory images are planted in the ganglion cells and psychic associations in the
fibres; or that psychic configurations are of the nature of physical configurations in
the brain and are rooted there; or that the basis of freedom lies in what are statistically
erratic, atomic events. The assumption that what is physical and what is psychic
coincide somewhere in the brain is pure fantasy, and must always remain an untestable hypothesis, which stems from Descartes' idea of the pineal body as the seat of
the soul (which is there like a rider on his horse). It is a vague, general truth that the
psyche is tied to the body, but how and where this connection takes place fragments
into a multitude of possibilities awaiting exploration. The negative position is certainly valid, that there is no one exclusive place for psychic reality; there is only the
llIost diverse set of relationships and connections between what is psychic and what
;Irc indispensable somatic determinants. There are it is true certain very circumscribed
.Ircas in the nervous system the destruction of which will cause immediate or early
cltath. There are others the alteration of which will bring about unconsciousness or
sleep and yet others the disturbance of which alters or abolishes individual functions
(e.g. speech). There arc also relationships of another kind which pertain to the
2.2.4
functioning of the neurohormonal endocrine system; for instance, hormones have

an effect on the psychic moods and drives or psychic events may evoke the inner
secretion of certain hormones with effect on body and psyche. There are other relationships too, of a different sort, between psychic type and body-build. Still, fW
seat for the psyche is to he found, neither in a crude localised sense, nor hormonally,
nor atomically nor in ultramicroscopic events. Leibnitz's insight is still valid today,
as regards our mechanical knowledge of the body: If we could enter the machine
of the brain, as we might a factory, and could observe objectively the very smallest,
and ultimate events, we would not find anything else but physical parts in active
contact with each other, never anything like a perception or anything that might
serve to explain one. To sum up, coincidence (and that restricted to what is an
understandable manifestation) exists only at the point where in primary fashion we
see and experience the psyche in the body and the body in the psyche. If we have
separated body and psyche and are investigating their relationship, no such coincidence is to be found.
(e) Areas for research into the hody-psyche relationship. The result of the above
presentation is that only those fields of investigation present a body-psyche problem
where either the unity of the two is affirmed as a primary object or where the method
of separating them presupposes a definite form in which they are to be conceived.
Beyond this there are many areas for research where neither separation nor unity
are a problem nor do they enter the subject-matter. They are areas where human
actualities are investigated that exist in their own right without having to be related
to this problem at all. Thus in psychopathology we deal with a host of subjects in
which this question of body-psyche unity or division is altogether irrelevant for
our enquiry, as for instance, behaviour, performance, creativity, meaningful connections, personal histories, and the majority of social and historical questions.
Relationships between the body and the psyche are investigated:
(I) In the study of expression (Ausdruckspsychologie)-where physical characteristics and movements are seen by us as meaningful (pp. 253 if.).
(2) As a causal relationship-where we look for some answer to the questionwhich modes of bodily existence affect the psyche and how? (pp. 463 ff.).
(3) In the enquiry into hody-huild and constitution. How far are these a basis for
psychic characteristics? (pp. 633 ff.).
(4) In the somatic consequences ofpsychic events. We shall be dealing with this in
the present chapter (Somato-psychology). These are the most superficial of bodypsyche relationships, and compared with such matters as psychic expression, they
carry minimal meaning, but we shall see how even here under abnormal conditions
a certain meaning may be inferred from particular understandable connections.
(3) Noteworthy somatic findings in the psychoses. These cannot be explained

in terms of any known organic illnesses, though they look very like them. We
can only record them for the time being. Possibly we are dealing with symptoms
of organic illness as yet unknown responsible for the psychosis in question;
possibly the relationships here are of quite a different order.
In somato-psychology we classify our findings into three groups:

(I) General basic psychosomatic facts. Body sensations, continuous somatic
accompaniments, sleep, hypnosis. As such they exist or can be produced in
every human being. We will describe them and some of the disturbances that
arise in this field.
(2) Physical illnesses dependent on the psyche. Some illnesses arise through
the psyche, others are purely somatic disorders not wholly independent in their
course from psychic events.
I.
THE BASIC PSYCHO-SOMATIC FACTS
(a) Body-sensations
Bodily events are seen objectively by the outside observer in the form of
visible signs. The somatic facts are established by methods of clinical and
physiological examination. Everyone, however, with the help of his own
body-sensations, can become his own observer. His body becomes an object
to him. With the help of body-sensations he can observe his changing bodily
state. There is something more here than the mere sensation of an external
something; there is the feeling-sensation of one's own existence. The fact that
body-sensations make perceptible something which I can then observe as
something that confronts me gives rise to certain questions: first, whether
there is an authentic coincidence between body-sensations and actual bodyprocesses and, if so, how far does it extend; secondly, how far does the perception of one's own body reach (since the majority of organic processes are
imperceptible and take place outside consciousness); thirdly, have the somatic
complaints, descriptions, perceptions of patients any validity for our knowledge of the body?
An authentic coincidence rarely occurs. Apart from sensations due to
primary organic processes, there are sensations brought about by organic
changes which constantly accompany psychic life or arise psychogenically
in a specific way; for instance, sensations of warmth and cold with vasomotor'
effects on the skin, leaden feelings during muscular relaxation, stomach-ache
during psychogenically accelerated peristalsis. Lastly there are a host of bodysensations with no demonstrable physical cause brought about by attention,
expectation, worry, etc.
Normally the range of body-sensations is not very wide, but the extent
to which they are perceived can be enormously enlarged. Intensive direction
of concern inwards-as described by J. H. Schultz during 'autogenic' training
-leads to 'the discovery of organic experiences' which are not dependent on
suggestion nor are they an illusory elaboration of normal sensation, but
testable extensions of real bodily perception.
Patients tell us of innumerable suhjective sensations. The somatopsyche is
basically being referred to here. The 'organ-sensations', 'bodily sensations',
'pains', 'unpleaasnt sensations', 'vital feelings' of which they speak can all be
divided into three groups:
I. Hallucinations and pseudo-hallucinations. These have been discussed on
pp. 64 fr.
uS
2.. Bodily processes in the organs or in the nervous system; these are already
suhjectively felt and noted by the patients, although they cannot yet be ohjectively
confirmed by the examiner. In spite of possible deception and the uncritical
attitude of the average person, there is some point in the examiner investigating these subjective symptoms closely, taking into account the patient's
ability to be objective. He may get certain hints of organic events or uncover
the psychic source of the sensations which from the organic point of view are
illusory.
3. Most people do not view their body-sensations with detachment. Rather
they are apt to falsify their account through fear and other psychic reactions.
These falsifications are in themselves a new reality. Psychic changes are
connected with sensations which apparently have no physical basis, unless it
be in the postulated somatic substratum of psychic life. These sensations are
wholly dependent on psychic events. Hysterical and other similar sensations
provide an example. 1 Pains are of special interest. Severe pains need not be
felt. With wounded men arm-amputations can be carried out on rare occasions
in the absence of narcotics, where there is a state of battle heroism, and the
patient tells the story of his courage. Martyrs have painlessly endured torture
and death. Severe pains may arise without any organic base; we can understand them as symbols, as unconscious means, as anxiety. Attentiveness and
worry can increase pain, objective observation can diminish it, distraction can
make it vanish. 2
In general we may say that reports (especially of neurotic patients) on
bodily sensations are of the nature of clinical findings, but hard to evaluate as
a source for any knowledge of psycho-physical events. If we were to trust
them as genuine sense-perceptions, as if they were real observations, it would
mean treating the fantasies of neurotic people in the same way as observations
of fact. s
can observe physical accompaniments or can confirm them with the help of
experimental apparatus, even down to the slightest of psychic stirrings:
(h) Constant somatic accompaniments

In all normal psychic processes, particularly where there are affects, we
Samberger, 'Ober das Juckgefiihl', Z. Neur., vol. 2.4, p. 313. Oppenheim, 'Ober Dauerschwinde1', Neur. Zhl. (19II), p. 2.90.
BF. Mohr, 'Schmerz u. Schmerzbehandlung', Z. Psychother., vol. 10 (1918), p. no.
a V. v. Weizsacker, 'Korpergeschehen u. Neurose.', Internat. Z. Psychoanalyse, vol. 19 (1933),
p. 16. He tries to 'link methodically anatomical-physiological knowledge with psychoanalytical
findings'. He tries to explore the psycho-physical connections through the fantasies of a psychopath with a disturbance in micturition. He tests the 'supposition that the patient through his
experiences has told us more about the process than we could ever perceive'. The patient in his
analysis 'gives us only a picture, but in important points a very apt picture of organic events'. \Ve
should accept 'that the patient's ideas, pictures and formulations have illustrative value for something which he does not directly experience, namely the activities of his nervous system'. V. v.
Weizsacker believes that his method 'establishes the psychoanalytic method and the major part of
its theory' and that 'we can now dare to approach psychoanalytic findings from another point
of view'. I cannot accept this particular supposition of his and on reading his report and interpretation of this case of disturbance of micturition, I needs must remain unconvinced.
1
In shame or fright we find blushing and blanching. Disgust leads to vomiting,

emotional upset brings tears; fear makes the heart beat, knees tremble, the face pale;
cold sweat break out, the throat go dry, hair stand on end, pupils dilate, eyeballs
protrude. In states of anxious tension, there is diarrhoea or the increased need to
micturate.! Many other affects also increase the amount of urine. Psychic upsets
inhibit secretion of the respiratory mucosae, salivary glands and lachrymal glands
(in melancholia also).
Scientific apparatus 2 enables us to make exact observations of changes in
respiration, heartbeat, blood pressure, blood-volume (by displacing the blood
through various localised vaso-constrictions or dilatations), of fluctuations in
a galvanic current taken from the skin, of pupillary changes. The dependence
of gastric secretion on psychic influences is shown by its inhibition where there
is listlessness, or during sleep, and the increase of secretion when food or
something pleasant is imagined visually or heard. 3 When we are investigating
patients these physical accompaniments, if we watch the changes of intensity
and course, will help us very greatly as a clue to the underlying psychic events.
Thus there is an interest in learning whether during stupor consciousness is not
entirely empty or whether something may not still be going on in the patient's
mind.
Gregor' gives a thorough evaluation of psychogalvanic reflex phenomena as a
means of assessing psychic events in mental patients. If electrodes are placed at two
points on the skin, on the hands for example, and a circuit established, the body
yields a weak, galvanic current; the fluctuations of this current can be recorded as a
time-sequence and plotted as a curve. The fluctuations are partly physically, partly
physiologically and partly psychically determined. Through refinements of technique and critical observation it is possible to separate the latter fairly convincingly
from the rest. The curve is studied either as a resting-curve or in the way itjluctuates
when external stimuli are applied. Characteristic resting-curves emerge with either
1 Bergmann and Katsch, Dtsch. med. Wschr. (1913). They watched sudden blanching in the
abdominal wall and immobility of the intestines in animals, using a celluloid window. This occurred
in states of unpleasant stimulation. The mere sight of food being offered started peristalsis.
I Wundt's Physiological Psychology gives the older work. Lehmann, Die korperlichen Ausserungen psychischer Zustctnde (Leipzig, 1899). More recently E. Weber, Der Einj/uss psychischer
Vorgiinge auf den Korper (Berlin, 1910). Veraguth, 'Das psychogalvanische Reflexphanomenon',
Mschr. Psychiatr., vol. 2.1, p. 397; vol. 2.3, p. 2.04. Leschke summarises in 'Die korperlichen
Begleiterscheinungen seelischer Vorgange', Arch. Psychol. (D), vol. 2.1 (191I), p. 435; vol. 31
(1914), pp. 2.7 ff.
a Following Pavlov's discovery of this dependence, there have been many investigations, c.g.
Schrottenbach, Z. Neur., voL 69 (Bibliography), p. 2.54.
'Gregor and Gom, 'Zur psychopathologischen u. klinischen Bedeutung des psychogal.
vanischen Phanomens', Z. Neur., vol. 16 (1913), p. I. Cpo also Gregor and Zaloziecki, Klin.
psych. u. mrY. Kranich., vol. 3, p. 2.2.. Gregor, Arch. Psychol. (D), vol. 2.7 (1913), p. 241. 'Die
Reeinflussung des p8ychogalvanischen Phanomens durch Suggestion in der Hypnose stell Ie'
F. Georgi. Arch. Psychiatr. (D), vol. 6:1 (19U), p. :171.
SOMATIC ACCOMPAN'IMENTS OF PSYCHIC ACTIVITY
diminished or increased psychogalvanic reactions to stimuli. There is also a differential response according to the type of stimuli (bell, pain caused by pinching the skin,
doing sums, calling over emotive words-affective tone due to 'complexes').
Gregor confirmed the following findings:
I. The different types of resting-curve may be interpreted as expressions of
inner psychic events, though so far this is not very clear. Gregor terms the steeply
rising curve the 'affect-curve'. 2. Diminution or abolition of psychogalvanic reaction is found in chronic affective dullness (many catatonic end-states, paralyses,
epilepsies and the arterio-sclerotic dementias), in temporary states of affect-loss, i.e.
diminished affective responses during treatable melancholia, also in catatonic stupor
and finally during certain phenomena of inhibition and exhaustion of a psychasthenic kind. 3. An increase in psychogalvanic reaction is found during arithmetical
tests, which denotes greater effort in states of inhibition. 4. There are varied
reactions to different stimuli; inhibited psychasthenic persons react most strongly to
arithmetical tasks, dements (e.g. many paralytics, epileptics) will react most strongly
to physical pain.-Notable among the special findings is the fact that reactions of
normal strength are shown in congenital mental subnormality, even of low grade,
which is not the case in acquired forms of emotional dulling. There is also the fact
that with hebephrenia and paralytic excitement of a hypomanic character, all reactions are in abeyance, whereas in true hypomania they are always clearly and
vigorously present.
Pupillary movements also accompany affective psychic events; and indeed in the
absence of any outer stimuli, the pupil nearly always shows what we call pupillary
unrest (Pupillenunruhe). This accompanies psychic activity, fluctuations in consciousness, attentiveness and mental effort. It corresponds to the psychogalvanic
resting-curve. The pupils always dilate in response to psychic impressions, during
any mental effort, during affect, and particularly in response to painful stimuli.
When there is extreme fear, the pupils are maximally dilated and will not react to
light. During sleep the pupils are small. With severe dementias and particularly
with dementia praecox (Bumke's phenomenon),l pupillary unrest and reactive
dilatation of pupils both disappear.
Other accompaniments of psychic events show themselves in the hlood-pressure,2
the pulse-rate and respiration,3 in plethysmographic investigations' (where fluctuations
in blood-volume of individual body-parts, the arms for instance, are recorded).
During fear the blood-pressure rises enormously, and we also find a rise in mania
and melancholia, especially in the latter. Pulse rate increases during mental effort,
and feelings of displeasure; it shows temporarily during states of attentiveness to
stimuli, in fright and tension as well as in states of pleasure. We note an increase
in excitahility in vaso-labile 'neuropaths', Basedow's disease, exhaustion, and convalescence. Typical of catatonia are: the tense vascular system (appearing plethysmographically as volume-rigidity) the rigid iris-muscles (fixed pupils), increased tonus
of the voluntary muscles. (All these symptoms should be regarded as due to autonomic innervation and not as psychic events-de Jong.)
Weinberg l took recordings with the plethysmograph, the electrocardiograph,
ilnd noted electrogalvanic phenomena, respiration and pupil reaction. All reacted
simultaneously and persistently in response to every psychic event-e.g. the mere
ringing of a bell-so that 'the raising of the conscious level' through the stimulus
brings about phenomena which depend on increased 'sympathetic stimulation'.
2JO
1 Bumke, Die Pupillenstiirungen hei Geutes-una Nervenkrankheiten (Jena, 1911), :md edn.
a Knauer, Z. Neur., vol. 10, p. 319. Enebushe, 'Von der vasomotorischen Unruhe der Geisteskranken', Z. Neur., vol. 34, p. 449.
8 Wiersma, Z. Neur., vol. 19, p. I.
de long,
Neur., vol. 69, p. 61 (detailed literature on plethysmographic curves). H. Bickel,
Die wechselseitigen Beriehungen ,w. psychischem Geschehen u. BlutkreulauJ mit hesonderea Beriicksichtigung aer Psychosen (Leipzig, 1916) (record of blood-pressure and volume).
z.
2JI
Berger2 discovered a minute electric current emanating from the brain.

The recording of this--electroencephalogram-showed various waves, individually distinct and characteristic for the particular person. These waves are
an index of physiological events that are also closely related to psychic events.
There is a big difference in the waves during the waking state and in sleep.
Consciousness, attentiveness, indeed any activity is reflected in an alteration in
the wave forms.
Physical accompaniments of psychic events appear in great numbers and
we have only enumerated a few. They do not tell us much, except that they
illustrate the universal link of psyche and soma. The concept that all these
phenomena are consequences of psychic events is too one-sided. The relationship, as soon as it occurs, is a mutual one, acting back on the psyche itself. We
can only comprehend the details of this happening by a better understanding
of physiological relationships. These are always circular: the psychic event
causes a series of somatic phenomena which in their turn modify the psychic
event. We can scarcely see this in the swiftly moving accompaniments that
we have discussed. Investigations of inner secretion gave clearer results in the
case of events that lasted a longer time, from half an hour to a lengthy timeinterval. Psychic excitation or inhibition, for instance, travels to the smooth
muscles of the vessels relatively quickly, the effects on the endocrine glands,
are much slower. The circle is obvious-psyche, autonomic nervous system,
endocrine glands, hormone production, effects of the hormones on somatic
events and of both on the nervous system and psyche. Doubtless there are any
number of such circles. During experimental recordings we can only objectively
define one link at a time. The understanding of the whole enlarges with a
better understanding of these physiological circles; how they summate and
interact. To begin with we only know isolated samples. But often they may
~ive us a clue as regards the complex psycho-physiological interaction; there
can then follow almost exclusively animal experiments which help us to more
precise physiological theories. We find that psychic life, as much in its smallest
stirrings as in its moments of violent emotion, is in its very last ramification
ifltimately linked with somatic events.
Somatic accompaniments change in intensity and in the mode of their
Weinberg, Z. Neur., vol. 8S, p. 543; vol. 86 (19:13), p. 375; vol. 93 (192.4), p. 4:11.
H. Berger, Arch. Psychiatr. (D), vol. 87 (19:19), p. 52.7. AUg. Z. Psychiatr., vol. 108 (193 8),
p. H4. R. lung, 'Das Elektencephalogramm u. seine k1inische Anwendung', Nervenar{t, vol. u,
p. 569; vol. 14 (1941), p. p, 104
1
2)2
appearance within the one individual, and as between individuals. It is

customary to say: vegetative reactivity is not a constant. Blushing, lachrymal
and salivary secretion, dermographic phenomena, heart-reflexes, etc. vary
enormously in degree. Also toxins like adrenalin, pilocarpin, atropine vary
greatly in the strength and fashion of their effects. We may speak of a COnstltutional disposition of the autonomic nervous system and find that its reactivity
has very little to do with the psychic development of a person, or conversely
we may believe we have found a correlation between basic types of body-build
and temperament.
Detailed investigation gives us a multiplicity of findings; e.g. with some
people psychic excitement is accompanied by congestion of the nasal conchi.
There is a mutual interaction between the nasal conchi and the genitalia. One
may be lucky and succeed in intervening therapeutically-by physical or
psychological means-in this circuit of autonomic-psychic effects when it is
disturbed, but the methods are somewhat unpredictable.
sleep. The average duration of sleep in the first year of life is 18 hours; from
the 7th to the 14th year it is still 10 hours; then up to the 50th year 8 hours; o:er
60 years it falls to 3-4 hours. The depth ofsleep has been measured by a curve, wh~ch
is arrived at by measuring the intensity of the stimulus needed to waken the mdividual. Normally the greatest depth occurs one to two hours after falling asleep;
it then rises slowly and a light sleep is maintained until morning. The curve that
shows the greatest depth towards morning is an abnormal one. A connection has
been found between the sleep curve of the morning-worker (normal) and the
night-worker.
Sleep is brought about by physiological and psychological causes:
.
Objective fatigue and subjective tiredness are preparatory. Severe fatigue 111 any
one organ manifests itself in all the others. Fatigue toxins sprea~ throug~out the
body; the longer the waking state, the greater and more compellmg the tiredness
becomes until it is impossible to keep awake any longer.
If as'is usual tiredness is not so great, the main condition for sleep is a situation
that :educes sti~uli to the minimum: darkness, quiet, a peaceful mind, a relaxed
position, absence of muscle tension. The complete exclusion of.stin:"uli in.duces sleep.
A patient of Striimpell who had suffered extensive loss of sensatIOn m vartous organs,
would fall asleep at once as soon as one closed his remaining right eye, and stopped
up the one hearing ear, his left one. Und~r: n~rmal conditions.a comp~ete exclusi~n
of stimuli is impossible. The more excitablltty IS reduced by fatigue toxms, the easICr
it is to sleep but first of all there has to be the addi~ional auto-suggestion ~ade. by
consciousness: 'I want to fall asleep; I shall fall asleep. The preparatory phYSIOlogical
and suggestive psychic factors act together.
.
Among the physiological determinants of sleep, the followmg are probable from
experience:
.
The importance of an inhibition of reflexes: Pavlov observed that dogs m a state
of great attentiveness were overcome by insurm~u~t~b!e fatigue. He t~ought th~t
inhibition is a localised sleep; sleep an extended mhlbltlon. Concentration of one s
attention on one object only is possibly the cause of hypnotic sleep, and can be
related to this finding. Sleep has a relationship to the brain-stem. Animal experiments
(e.g. cats fall asleep during electrical stimulation of certain brain-stem areas), as
well as experience with encephalitis lethargica, pOi?t in this di.rect~on: I.t loo~s a~ if
certain blocking points were localised in the bram-stem which mhlblt excitation
without blocking it out entirely. These are activated when we want to fall asleep and
have brought about the appropriate situation, or else they enforce sleep upon us,
when we are very tired.
(c) Sleep
Ph.ysiological prefoce. 1 Sleep is not a universal phenomenon (it is something quite
different from the change that takes place in all biological processes as day alternates
with night). But waking and sleeping are not specifically human attributes, as a
waking consciousness is found in all warm-blooded vertebrates. Consciousness
depends on the functioning of a vital, animal state of a very primitive kind. Even
in the decerebrate dog, the sleep-waking rhythm persists. It is very probable that
the function linked with consciousness and sleep is localised in the brain stem
(perhaps in the grey matter of the third ventricle).
Sleep is necessary for life. It is a respite for the brain. Prolonged suppression of
sleep (which is scarcely possible) causes death. We spend one-third of our life sleeping. Sleep is not paralysis but rest. It is also essentially different from narcosis; the
latter does not refresh. Narcotic drugs have a refreshing effect not because they
cause loss of consciousness but because of the natural sleep which they induce. On
the other hand hypnotic sleep is a genuine sleep, differing from natural sleep only
in the rapport sustained with the hypnotist, but it is not a difference in principle as
rapport may also be made with someone dreaming in normal sleep, if one talks with
them. Sleep is a function of the nerve centres which are the source for all somatic
changes that occur during sleep: the slowing of respiration, of circulation, reduction
in metabolism and body temperature, diminution of certain glandular secretions,
reduced reaction to stimuli, immobility. During sleep, however, in contrast to
narcosis, unconsciousness, etc., the psyche remains in touch with meaningful stimuli.
The soldier who sleeps through the rattle of gunfire can be wakened by a distant
telephone or a mother by the least noise from her baby; most extraordinary of all,
but undoubtedly a fact, is punctual awakening at a certain predetermined time (our
inner clock).
A distinction is made between duration and depth of sleep. People who need
very little sleep, usually sleep deeply. Deep sleep refreshes more quickly than a light
1 U. Ebbecke, Handhuch der Physiologie (Bethe and Bergmann), vol. 17 (192.6). Potzl, D,r
&h.laf(Miinchen, 1929); H. Winterstein, Sch.lafu. Traum (Berlin, 1932.).
23)
Sleep-disturhances 1 are very various; they may affect falling asleep, waking,
the mode of sleep and may appear as insomnia.
Falling asleep i~ usually a rapid matter, taking only a few seconds. But with
people who suffer from nervous symptoms it is very often a long-drawn-out
affair. We can then observe several phases and a number of specific phenomena. 2 A state of somnolence develops with a steady increase in tiredness,
1 See Gaupp, Goldscheider and Faust, Wiesbaden (Kongr. inn. Med., 1913) for the nature
anti treatment of insomnia.
Trammer, 'Die Vurgiingc bcim Einschlafen', J. Psychiatr., vol. 17, p. 343.
then suddenly, almost traumatically, there is a transition into a state of dissociation. These sudden eclipses into sleep may recur repeatedly, with a slight reawakening into somnolence, and along with this a consciousness that wavers
between sleep and waking. During that time pseudo-hallucinations are common
and sometimes actual sense-phenomena (hypnagogic hallucinations). Visions
appear and disappear in a flash, broken phrases and words are heard or whole
scenes experienced which can no'longer be distinguished from dreaming
proper and merge into it.
Auto-suggestion is one of the factors in falling asleep and this may fail.
The intense struggle to sleep is coupled with doubt as to whether sleep will
come, and this prevents it: 'to will yourself to sleep is to stay awake'. Willing
must turn into suggestion, it must agree to wait, it must become passive in its
activity. It must not try to enforce sleep but must learn to abandon itself to it.
Normal walcing is also rapid. The person is at once clear and collected. Disturbances in waking show themselves by a prolonging of this process., so that
a state ofsleepiness (drunk with sleep) intervenes between sleeping and waking. l
This state can be so abnormal that the person can perform actions automatically
without knowing anything about it.
The quality of the sleep is sometimes abnormally deep, so that patients
sometimes feel as if they had been dead. It may however be abnormally light
and the patients never feel refreshed, but have vivid, restless and anxious
dreams, and feel as if only half of their being had been asleep, the other half
had stayed awake and watched.
Duration of sleep may be very lengthy, for instance, in some depressive
states. The patients are always wanting to sleep and sometimes sleep twelve
hours uninterruptedly. On the other hand we find sleep abnormally curtailed.
The patients go to sleep but are awake again soon after and then lie awake all
night long. Or they only manage to get off to sleep towards morning.
There are many kinds of insomnia, and also many causes for it. We do
not know whether there is a type of insomnia due to some localised lesion in
the brain-stem. The place from which excessive sleep originates may also
bring about insomnia when the pathological stimulus is of a different order.
Sleep sometimes shows unusual motor phenomena ranging from shaking,
chewing, grinding the teeth, to talking in one's sleep, and alterations in awareness similar to hypnosis, with somnambulism and surprising behaviour with
subsequent amnesia.
been brought about by suggesting that a hot coin is laid on the skin. Similarly,
fever has been produced and postponement of menstruation. There have ~n
specific alterations in gastric secretion through certai.n types of ~ood ~mg
suggested, changes in metabolism due to the suggestion of e~ot1onal sItuations, pancreatic secretion after imaginary eating und~r hypnOSIs, the ~ure of
warts.l Some of these are exceptional phenomena which only succeed In rare
cases and remain somewhat controversial, such as the blister formation and the
subsequent scarring. Others however are effects that are easily and frequently
2)4
obtained.
Identical with these hypnotic effects are the physical effects that have been
described by J. H. Schultz. He induced certain conditions through autosuggestion and called the whole practice 'autogenic training'. It is surprising
to hear that one is able in certain individual cases to increase or decrease the
pulse rate enormously from 76 to 44 and up to 144. 2 The extreme possibilities
of this procedure have not been exploited in western countries but we find
it in India. It may be that the famous 'stigmatisations' (e.g. St. Francis of
Assissi), analogous to the blisters raised under hypnotic suggestion, may be
understood as produced by auto-suggestion of this kind.
Hypnosis achieves its effect through realistic, con~te ima~es which exert
their power by dominating feeling and mood. The patient carnes out the normal reaction to the suggested situation, e.g. metabolism is increased because
it is suggested that it is cold in the snow. The autonomic nervous system takes
its cue from the experience-which is an imagined one-in spite of the quite
different actual situation with its real stimuli. It is not possible to raise temperature, increase gastric juices or metabolism by direct suggestion; we can only
do it through some suggested situation, which if real would have these effects.
Hypnotic effects can partly be comprehended as condition~.reflexes in the
Pavlovian sense (Hansen). The image of food, when. realistically present,
provokes the gastric secretion. When ~~ food is repeatedly. shown ~o the. dog
but never given to him to eat, the conditioned reflex of gastriC secretIOn fads to
appear. In the same way, somatic effects of hypnotic s~ggestion will not ap~ar
if they are repeatedly tried out during the da~ ~ut With no sub~equent realIsation. If genuine reinforcement of the condltloned response IS permanently
absent the reflex disappears. The unconditioned reflex remains the reason why
events'may be influenced by the psyche. These physiological interpretations,
however, by no means exhaust the totality of psycho-somatic relations.
We cannot assess how far psychic influences can affect the body. Up to
1 Kohnstamm and Pinner, VerI.. dtsch. derm. Ges., vol. 10 (19Q8). Heller and Schul~ MiJn&/a.
med. Wschr., vol. II (1909), p. 261Z. Schindler, Nervensystem u. Spontanhlutungen (Bt:rlm, ~9Z7)
(stigmatization). Pollak, 'Zur K1inik der Stigmatization', Z. Neur., vol. 16z (193 8), p. 606. F~ber,
Mohr MiJn&h. med. Wschr., vol. Z (1914), p. 2030. Kohnstamm, Z. Neur., vol. Z3, P379 Elcheberg,' DISCI.. Z. NervenJJc., vols. 68-9 (19zl), p. 352. Re menstruation: ~ohnstamm, ~lur.
Gegenw. (1907). Re warts: Bloch, Kim. Wschr., vol. 2 (1927), p. ZZ7 1 Metabolism: Grafe, MUn&h.
m.d. Wschr. (19zl). Gastric secretion: Heyer, Arch. Verdgskrkh., vo!. Z7, z9 (19 20/ 1). Pancreas:
Hansen, Desch. Arch. klin. Med., vol. IS7 (19 Z7)
J. Schultz, Das autogene Training (Leipzig, I93 z), p. 7S
(J) Somatic effects in hypnosis

Experience with hypnosis teaches us how widely the psyche affects the
body. The observation of the physical effects of hypnotic suggestion caused so
much surprise that at first it was all felt to be deception. However, the finding
of far-reaching physical effects due to suggestion have been established beyond
doubt. Reddening and blistering with subsequent scarring of the skin have
1
Pelz, 'Ober eine eigenartige Storung des Erwachens', Z. Neur., vol.
Z,
2)5
p. 688.
2.3 6
2.37
no:, resear~h fin.ds this field an expanding one. There is, in a complex way
wetter, The statement is often made that there is something theatrical about these
attacks, but this is frequently not the case. After five to ten minutes, the movements
diminish and gradually cease. The exhausted man, covered in sweat, passes into a long
sleep and wakes up with only a patchy memory for events.'
Gruhle describes the contrasting picture of the epileptic seizure as follows: 'The
t~pileptic seizure starts suddenly; the patient may indeed notice the signal (the"aura")
for such a seizure (sensation of a gust of air, seeing red, seeing things small or targe,
seeing sparks, frightening enlargement of objects, rushing sounds, ringing, smells)
but he is unable to speak. He may stagger forward a few steps as if pushed hard, then
the seizure overtakes him. As he falls his face contorts, the mouth is screwed, foam
forms on the lips, often blood-stained saliva comes from the mouth (from biting
the tongue), the eyes are fixed, staring, turned one side or the other, a few violent
twitches run lightning-fashion over the face, the head is turned to the side or jerks
violently a few times in this direction, there is a grinding of the teeth, various muscle
groups, sometimes all the muscles, are maximally contracted for a few seconds, a
peculiar gurgle or groan comes from the mouth, breathing is very difficult. Then the
spasm loosens. Repeated clonic jerks run through tlle musculature and the convulsion proper follows. A few 'wiping away' movements are interspersed. Perspiration covers the body, the face is blue or white as chalk; urine is voided; the
pupils are fixed, the corneal reflex has gone; the patient does not react to stimuli but
sometimes there is a certain unrest of the body after very strong and painful stimuli.
The whole thing rarely lasts longer than five minutes. Often the seizure merges
directly into deep sleep. On waking the patient is exhausted and weary. He complains of headache and is depressed; he does not remember the attack at all (there
is total amnesia).'
wh~ch rematns difficult ~~ evaluate, a psychic factor present in many physiol~glcal processes. Su~pnsmg effects can be achieved by the psyche and severe
disturbances of physical processes may be trac~d to this source.
v. Wei{iicker (Aertzliche Fragen: S 31. Leipzig, 1934) writes: 'We would do

~etter to press. research to ~ and m~e son,tething of the puzzles that lie before us,
I?stead of gazmg at the In1~cles of sngmatisation, hysteria and hypnosis as excep-
tions of the rule. As exceptIOns they release us from suspecting anything anal g
',vT'''ck'
oous
in thl . I
p~ ? ogtca symptoms. ~. vvelza er Wished to make all illness understandable.
But IS It true that all somatic i1Inesses--even the severe, organic ones-are penetrated by the psyche? Could this be shown convincingly, not only would new fields
of human knowledge ?pen up, but a radically new sort of knowledge of physical
events would be constituted. I. doubt h~wev~r, that this is possible yet suspect that
there are rather close boundanes here, 10 spite of everything. The question however, retains some justification.
'
2..
SOMATIC DISTURBANCES DEPENDENT ON THE PSYCHE
The whole body may be conceived as an organ of the psyche. When the
body ~s seriously sick,. p~ychic excitement may do damage through associated
organic stress. But thiS IS a rare and borderline case. Psychic effects usually
wo~k through mental content and determining tendencies. These are pathogemc only :whe~ the psy~he is.sick. It can then happen that if the psyche is disordered ~llS Wlll show Itself In physical effects. The physical disorders connected ~lth the psyche are extremely varied and not well understood. We will
first clarify the facts and then discuss the interpretation of them.
(a) Main categories ofpsychically determined somatic disturbances

I. Faints andfits. Both can occur as an immediate result of psychic excitemen.t. But both a~e also ~nown to be conditioned by purely organic causes. In
partt~Iar e dlfferenttate organic, epileptic seizures from psychogenic
hystencal seizures:
v:
. Gruhle describes psychogenic seizures. For instance, 'A well-built man is walking
~Ietly up and down the long corridor; he suddenly groans, grabs into the air and
s~ do,,:n (he does not fall headlong). At first he lies on the floor, breathing
heavd~; hiS hand has tom. open his jacket and shirt. Suddenly the convulsion starts,
now With one arm, now With both, he threshes fairly vigorously about him. His body
arches up and down, the legs bend and buckle or stretch out now one now the
?ther or both together. We might characterise the movements ~s kicking: The face
IS. co.nto~ted, the eyes firmly closed,.but sometimes rolling wildly. If given a pinprick,
kicking mcrea~es for the firs~ few times, then ceases; pupillary reaction is difficult to
test, as the patient throws hiS head about or shuts his eyes tight. If one manag t
control this, pupils are us~ally found ~o be widely dilated (as in anxiety or pain)~:n~
they react poorly. Sometimes the patient wets himself, usually if he has been a bed1
Gruhle, Psychiatrie [ur Ar{te. (Berlin, 1922.), p. 93, ~nd edn.
The attack is the main symptom of the epilepsies. Seizures, however, occur
not only in epilepsy but also in schizophrenia and almost all organic brain
disorders. Seizures are essentially organic.! They are, therefore, quite different
in kind from psychogenic attacks, which are very varied in appearance and
have been artificially cultivated in all clinics up and down the country, particularly in the time of Charcot, Briquet and others in Paris, and have been the
subject of elaborate description (attitudes passionelles).
2. Organic dysfonctions. Psychic events may now and then influence almost
all physiological functioning of the organs. Under certain circumstances of a
psychic nature, a particular experience or some long-lasting emotional state,
there will follow: stomach and intestinal disturbances, cardiac disturbances,
vasomotor disturbances, disturbances in secretion, disturbances of vision, hearing2, voice3 , menstruation (cessation or premature commencement). In
neurotic persons one often finds dysfunction which cannot be related to any
1 Psychopaths show a rare reaction which has been described under the name 'affective epileptic
aeizure', Bratz, 'Die affektepileptischen Anfalle der Neuropathen u. Psychopathen', Mschr.
I'syc!.iatr., vol. ~9 (1911), pp. 45, 162. Stahlmann, Allg. Z. Psychiatr., vol. 68, p. 799.
a W. Kiimmel, 'Entstehung, Erkennung, Behandlung u. Beurteilung seelisch verursachter
IIllrstorungen bei Soldaten', Beitr. Anat. usw. GAr usw. (von Passov and Schaefer), vol ~ (1918),
H.I-3
I K. Beck, 'Ober Erfahrungen mit StimmstOrungen bei Kriegsteilnehmem', Beitr. Anat.
Ohm usw. (1918).
UN.
"3 8
definite psychic event but which must have some connection with psychic
abnormality, judging from the frequency with which the two go together.1
. Many neurolo~ical phenomena belong to this group, where they appear
Without any organtc base: paralyses and senso!), disturbances (their configuration follows the imagination of the patient, not the anatomical structure) tics
. etc. 'YTh
contractures, tremor, verbgo
vv e s ould refer to the neurological "texts
for all the innumerable variations of these bodily phenomena particularly in
hysteria. 2
'
3. Dependence ofprimary somatic disorders on tke psyche. Even organic disorders are not entirely independent of the psyche in their course. There is a
general acceptance of the fact that physical disorders may be influenced by
psychic factors. It is very difficult to separate what is determine~ physically
and what is determined psychically. The psyche looks for certain prepared
channels in the body to produce its pathological effects. If, for instance, pains
in the joints have existed due to a past arthritis these pains can be psychically
continued after recovery or they can be reinvoked. In nearly all physical illnesses the psychic state during the period of convalescence is by no means unimportant. Therefore what can be influenced by the psyche is not necessarily
a psychic condition nor need it be wholly psychogenic.
Another problem is whether organic illness accompanied by anatomical
changes can have a psychogenic source. It seems this can be so:
One of ~e most striking effects of psychic commotion is the sudden greyof the hair, as reported by Montaigne; there is also the sudden appearance
of an alopecia areata. 8 Psychogenic fever was for a long time doubted, but it
must now be considered an established if rare phenomenon.'
In spite of the close psychic connection patients regard these somatic
disturbances .as something entirely alien, as if they were purely a physical illness. Hystertcal phenomena can be observed appearing by themselves or
accompanied by every kind of organic or functional disorder of the nervous
system.
.
109
Most of these somatic disturbances are called Organ-neuroses. This does

not mean that some organ can become neurotic of itself. It is the psyche that is
neurotic; it, so to speak, chooses this or that organ and manifests its disturbance through it; it may be the organ itself is a locus mitwris resistentiae and
therefore more vulnerable or it may be that in the context of psychic meaning
some particular organ appears 'symbolically' the more important. For a long
time organ-neuroses were diagnosed far too freely. It was forgotten that the
ground for such a diagnosis rested less on the positive findings but on the
negative one of an absence of somatic findings. It was therefore correct to talk
of the 'gradual reduction of the organ-neuroses' through the development of
more exact methods of medical examination. The concept needed to be limited
but not dropped entirely. 5
This res~icti~n o~ the organ-~euroses was accompanied by a development
the opposite dlrecbon: a growmg recognition of the significance of psychic
factors in disorders that were primarily somatic and organic.
.
10
1 Wilmanns, Die leichte~ F~l/S des manisch-depressiven Irreseins u. ihre Be{iehungen {u StlJrungen
~e~. Ver~auung~~rgane (L~lpzIg, ~906). Dreyfus, Nervose Dyspepsie (Jena, 1909). Homburger,
Korperbch~ Storungen bei ~kt1onellen Psychosen', Duch. med. Wschr., vol. I (1\109).
I.Cf. Bnquet, <?harcot, ~dle .de la Tourette, Richer, Mobius, Babinski and the summary given
by ~mswanger, Dee Hystene (VIenna, 1904), and by Lewandowsky, Die Hysterie (Berlin, 19 14).
Poehlmann, Muneh. med. Wschr., vol. ~ (19 1 5).

Cpo Glaser, 'Zur .Kenntnis des zerebralen Fiebers', Z. Neur., vol. 17, p. 494. Summary by
Lc;wandowsky, Hystene, pp. 63 If. 'Die Dissertation von Weinert,' O!Jer Temperatursteigerungen
!Jet gesunden Menschen (Heidelberg, 1912). This contains references from a related group of
problems.
'von Bergmann, Dtsch. med. Wschr., vol. 53 (19~7), pp. ~057 It 'An old clinician has said
~at nine o~t ,of ten gastric patients have nervous dyspepsia; nowadays not even the inverse ratio
accepted. The concept of neurosis or neurotic seems to me a comfortable way out in a vast
nu~ of cases where the full nature of the illness has not been properly understood.' 'In the
ma,onty of cases, the diagnosis of neurosis is in practice a wrong diagnosis.'
IS
"39
Glycosuria is common in states of anxiety and depression. l Diahetes can start

.
after some psychic commotion, and may be worsened through it..
Acute onset of Basedow's diseases has been observed follOWIng severe fnght.
Kohnstamm2 reports a case showing how big a part psychic complexes play in this
disorder. The onset may occur only a few hours after the fright but this is very rare.
Usually a long period of sorrow, worry or anxiety precedes the onset; the strong
psychic influences during its course have been universally accepted. 3
Colitis memhranacea (Mucous colitis) also may come on after psychiC commotion
and can be cured by psychic means.
The general view is that asthma, though facilitated by a somatic disposition,
depends on psychic factors for its manifestation, course and cure. Medical research
has shown that somatic disposition and events are decisive but the attacks and onset
of the disorder can be precipitated psychically, and psychic factors may also be
responsible for cessation of attacks. The relationship here does not mean that the
psyche itself is disordered. Asthma like other physical accompaniments may be due
to normal psychic excitation. However, as only a relatively few people suffer from
asthma, we can best conceive it as a morbid somatic disposition and not a type of
psychogenic reaction as are the majority of somatic accompaniments.'
The view has been put forward that from a purely reactive, nervous stomachdisturbance there can be a development through chronic functional anomalies into
ulcus duodenale (duodenal ulcer), so that a man who gets an ulcer as the result of
constant business strain might not have got it if he had lived a more restful life.
Alkan5 gives some examples of how somatic effects that are at first functional may lead to organic, anatomic disorder:
Lasting contraction of the smooth muscles in the attacked area create pressure
and anaemia and thereby cause necrobiotic lesions, particularly so when the secretions at this point (the gastric juices) are psychogenically reinforced (as would be the
case with ulcus ventriculi and colitis ulcerosa).-Spasm in tubular organs leads
Mita, Mschr. Psychiatr., vol. 32, p. 159.
2 Konnstamm, Z. Neur., vol. 3~, p. 357.
Rahm, Der Nervenar{t, vol. 3 (1930), p. 9.
' Hansen,. Der Nervenar{t, vol. 3, p. 5. I 3.
'Leopold Alkan, Anatomische Organer1cranlcungen aus seelischer Urstu:he (Stuttgart, Hlppokneel-Verlag, 1930)'
1
240
to muscular hypertrophy of the upper parts with dilatation (oesophageal dilatation,

hypertrophy of left ventricle in hypertension). Lasting spasm or paroxysm in
tubular organs le~ds to chemical changes in the accumulating secretions (single
~holesterol s~one 10 the gall-bladder, obstructive oesophagitis). When infection
IS added, which would not harm where the flow' is free inflammation will occur
after obstruction. Psychogenic alteration in the secretio~ of the endocrine glands
~ay lead to anatomical changes in the glands (psychogenic diabetes, and Basedow's
disease).
The psychogenesis of organic disease is established only over a small
field. We lack factual confirmation over a wide area. Latterly V. v. Weizsackerl
h~s P?sed some ~undamental questions and tries enlarging them by case
hlstones. He finds It hard to be convinced because firstly, positive and negative
cases can be found side by side. For instance, if one finds positive evidence of
psychogenicity in one case, the next case fails to show it and nothing psychic
ca~ be found of any importance. Secondly, we are ignorant of the significance
of mner organs for psychic life, whether, for instance, the liver has anything
at all to do with indignation and envy. Thirdly, the relationship between the
physical and the psychic factors seems an extremely irregular one. He thinks,
however, .that in cases of angina tonsillaris, diabetes insipidus etc., it is possible
to recogmse how the illness plays some decisive role in the crucial moments of
life. He does not intend to offer any insight which could be conceptualised
and gen~rally formulated; his subject-matter is purely biographical.
The mfluence the psyche exerts on organic illness may be very extensive.
The. subjec.tive sta~e can be improved by suggestion and hypnosis, and suggestlOn on ~t~ own IS of utmost importance in all kinds of therapy. Objectively
some surprls1~g results have been achieved. The nexus of organic and psychic
factors can strike one as grotesque. For instance Marx 2 reports a case from the
Cushing clinic:
~ 14-year~old boy is admitted with severe diabetes insipidus; he drinks up to
I I htres (22 plOtS) a day. It is found that the boy had started masturbation and felt
that ~cessive drinking cleansed him and dissolved his conflict. Through psychoanal~tlc treatment h: recovers to such an extent that he now only drinks about
15 htres. One mommg he is found dead in his bed; post-mortem findings were a
large tumour of the brain-stem. In this case the thirst, as a symptom of organic disturbance. of ~he .nen:ous system, became related to the instinctual life of the patient
and to hiS thmkmg, m so far as he struggled to gain the mastery of his masturbation.
The relationships were so tightly interwoven that because of it a therapeutic influence
could be exerted both on the thirst and the polyuria.
4:
Functio~al Jismr.bance of complex instinctiye behayiour. There are many

phYSl:at funct1o~s which can be disturbed without the patient experiencing
anythmg at the time of the disturbance other than what any patient may feel
1
2
v. v. Weizsacker, Studien {ur Pathogenese (Leipsig, 1935).

H. Marx, 'Innere Sekretion', Handhuch der inn.ren Medi{in, von Bergman et al. vol. 6
p. 4~~
'
"
241
when confronted with a bodily discomfort. There are others, however, where
complex functions are involved, and volition as well. Here the functional disturbance is in obvious relation to the psychic disturbance appearing at the
same time. Functions cannot be carried out as the patient experiences anxiety,
inhibition, sudden passivity feelings or confusion. The same thing happens
whether he is walking, writing, urinating, or having sexual intercourse, etc.
Writer's cramp, disturbance of micturition, sexual impotence or vaginismus
are the result.
Traces of such disturbances are universal. One blushes, just when one does
not want to, walks or talks awkwardly, when one thinks people are watching.
Even reflexes can be influenced. Attracting attention may increase both coughing and sneezing reflexes, particularly the latter, but they can also be suppressed
for the same reason. (Darwin's bet with his friends that snuff would no longer
make them sneeze; they. tried hard, tears came into their eyes, but Darwin won
his bet.)
(h) The origin of somatic disturbances
There is a very tangled relationship between the psyche and massive

attacks, organ disturbance, and complex behavioral functions, even if sometimes it appears relatively simple in the individual case. In spite of what
individually seems so plausible, the total relationship of body and psyche still
remains obscure and extremely complex. Extra-conscious mechanisms are
obviously numerous. Organs and physical predispositions have to meet the
psyche half-way. It looks as if the psyche chooses the organs in which to manifest itself by dysfunction, or as if it chooses the functions into which its own
disturbance can enter, like an interloper, as it were.
The several physiological links can to some extent be guessed: nowadays we view
the autonomic nervous system together with the endocrine system as the media
between the central nervous system, so closely linked with psychic events, and the
body. This neuro-hormonal system regulates the activity of the organs outside our
consciousness. Through the brain it must be accessible to the psyche and under
certain circumstances far-reaching effects are possible. Those people whose autonomic nervous system is particularly excitable and responsive to the slightest psychic
influence have been called by Bergmann 'vegetativ Stigmatisierte' (people with
autonomic stigmatisation).
Many explanations have been offered in individual cases. Thus anaemia of
the brain caused by contraction of the small cerebral arteries has been advanced
to explain fainting for psychic reasons (through terror, sight of blood, overcrowded rooms, etc.).
The ways in which somatic disturbances arise lend themselves to the
following descriptive schema:
I. A large number of organic dysfunctions occur purely automatically,
such as palpitations, tremor and others. Examples are disturbances in the
SOMATIC ACCOMPANIMENTS OF pSYCHIC ACTIVITY

~2.
:&43
a slight degree and it is termed the hysterical meckanism. In some people it is

more developed and dominates their whole life, in others it appears only when
they are ill (e.g. in organic disorder) or under duress.
digestive system after emotional upsets, abnormal subjective sensations, alteration in appetite, diarrhoea or constipation. We can only note them and record
the phenomena. as with the physical phenomena that accompany psychic
events.
2.. Somatic disturbances have a tendency to hecome fixed if they recur, and
sometimes even if they only happen once. When psychic commotion has
ceased, they linger on and the individual senses these disturbances as physical
illness which recur on the mOSt diverse occasions (habituation reactions); or
a reaction which is roused for the first time by some powerful emotional event
(localised pain, cramp) may recur later on when something of a similar kind is
experienced, lesser in degree but reminiscent of the initial event (analogous to
Pavlov's conditioned reflex).
The term 'hysterical' is used in a number of ways. Psychogenic is the broader

concept. Hysterical is used for the fundamental characteristic of phenomena into
which meaning has slipped, there is meaning but it is hidden, and there is some
distortion, displacement, self-deception or deception of others involved. These
dysfunctions are motivated by events that contain a dishonesty somewhere. The
body then becomes an organ of double speech, and like speech is used to hide or
disclose. This is done subconsciously, however, not consciously and only instinctual
purpose is at work.
We can subsume these three groups under three commonplace categories:
automatic physical effects, fixed reactions and hysterical symptoms. All three are
closely related to each other. Purely automatic physical sequelae as well as
hysterical symptoms can get fixated, and where somatic dysfunction becomes
fixed through psychic stress, the hysterical component can hardly be distinguished from the purely automatic ones.
Disturbance of function can develop and fixate in areas that by chance happen
to be active during an affect. An upsetting message comes over the telephone, the
hand holding the receiver feels as if paralysed, <writer's cramp' sets in and so on.
An actual tiredness caused by playing the piano and felt in the hands and arms
becomes connected with affects of jealousy and competition and then appears as an
independent complex of sensations which will arise on any occasion, e.g. when
simply listening to mumc, should this also give rise to feelings of envy at another's
In the individual case we usually find ourselves dealing with all three factors
which we can only separate out in theory or in the borderline case. The following
is a case of Wittkower's:l 'An eighteen-year-old girl witnessed a railway disaster in
which a worker was cut to pieces by a passing train. She felt nausea among all the
excitement and did not eat for days; she vomited every morning during the first
lesson at school. Since that time she has a railway phobia, anxiety and crying attacks.
She also has compulsive phantasies about dismemberment in which she sees herself
or a relative as the victim.'
ability.
3. In the foregoing cases there is no connection between the content of the
psychic experience and the particular somatic effects. It is only that they appear
together simultaneously. For an explanation one has to resort to increased or
abnormal irritability due to the morbid state. There are, however, a large
number of somatic phenomena, the specific quality ofwmck can he understood in
terms of tke experience, tke situation or the personal conflict. For example, unpleasant sensations and dysfunctions arise, which we term hypochondriacal,
through specific attention being directed to a particular function, through careful observation of some slight disturbance perhaps, through definite worries
and fearful anticipations. In the beginning such disturbances are only fears, in
the course of time they become real. Such somatic disturbances, where the content can be understood in terms of the preceding psychic content, may also
appear quite suddenly, e.g. paralysis of the arms after a fall, deafness after a
slap, etc. These diverse phenomena have several things in common: (I) an
un.derstandahle connection between cause and effect; (2) an effect on bodily
functions that otherwise are independent of our will and imagination, e.g. sensation, menstruation, digestion; (3) the formation of a vicious circle. It seems
that in healthy people the cycle of <body-psyche-process of living' involves
reflex increase in feeling through the somatic accompaniments of feeling, and
a fuller realisation of meaning as feelings mount. With patients, everything
(e.g. automatic and chance instinctual disturbances) can become the prey of
psychic determinants which so modify it that the slightest disturbance may
then tum into a serious illness. This mechanism is probably present in us all to
The third group-somatic phenomena which are understanJahle in a psychic

context-need fuller discussion. This does not apply so much to those that we
have just discussed: (I) physical effects of anxious scrutiny, worry, fearful
anticipation; (2) simultaneous linking of somatic events and psychic commotion on the first occasion and on repetition (analogous to Pavlov's conditioned
reflex): e.g. a psychic trauma causes diarrhoea, vomiting, asthma, which can
recur afterwards on the slightest stimulus; (3) detachment of what were
originally psychically determined somatic phenomena, and their subsequent
independent existence and development. The physiological aspect of this is
still obscure but the psychological aspect is quite simple and clear.
The dependence of vital processes on psychic mood needs no further discussion either. The whole psychic condition, whether elated or hopeless,
cheerful or depressed, tending to activity or withdrawal, plays on the somatic
state uninterruptedly. We have long experienced the fact that illness, even that
of organic origin, depends very greatly on psychic attitude, though it is hard
to prove this in detail. The will to live, hope and courage are of the greatest
importance. We can have the same experience in everyday life. Subjective
Wittkower, N"",nlJl'{t, vol. 3, p. :lO6.
tiredness is lost if the work is enjoyed. Fresh experiences and hopes can bring
about an enormous increase in strength and effectiveness. The tired hunter
springs to life when at last he sights his game.
In all these understandable phenomena we have tried to see the specific
somatic content as psychically meaningfol; we have tried to see the somatic event
as an essential in the psychic and social context of the individual. In this the
respective relationship between body and psyche has remained unconscious
yet in principle open to consciousness; if the patient gains understanding of the
connection, this reverts back with healing effect on the somatic phenomena,
always provided there is a change in the psychic attitude along with the mere
intellectual understanding. And here we have reached the field of interpretation
which is most seductive but dangerous to enter. There is no doubt that fundamental knowledge may be gained here, but nowhere else do genuine evidence
and gross deception go so closely together. A wealth of possible experience
seems to offer itself but with it come confusing ambivalences and mistaken
acceptances of the first interpretation that comes to hand.
Here are a few examples from the extensive literature which deals with these
questions:
The accepted answer is that there is some organ inferiority, either constitutional
or due to illness, that is the organ is in some way prepared, a locus minoris
resistentiae, which meets the distress half-way. A gall-bladder disorder will
channel the likelihood for breakdown.
Heyerl goes beyond this and gives quite a different answer:
I. Hysterical phenomena in the narrower sense-paralyses, sensory disturbances,

etc.-are connected with images, intentions and goals which have disappeared from
consciousness. How they do this is difficult to understand but they are not completely inaccessible to consciousness. Simulations can lapse into hysteria, and then
we should cease to talk of simulation.
2.. This psychic rearrangement has been made comprehensible as an escape of
psychic energy, e.g. the discharge of repressed sexual wishes, by means of a conversion into somatic phenomena which symbolically indicate the source. Alternatively the phenomena may serve as a displacement or substitute for direct but
forbidden gratification (Freud).
3. The psychic unconscious events are further differentiated. The patient may
punish himself by a symptom for some instinctual wish or act which is against his
conscience; he may surrender his will, grow weak and unresistive and more readily
accessible for any kind of illness to which he is exposed.
4. Organs have a language which expresses what the conscious will does not
say: kidney haemorrhage, fluor albus, eczema of the vulva, are thought to be expressions of resentment against cohabitation and when the corresponding situation
improves will vanish.
These are not objective relationships of body and psyche but have only
been deduced. They are plausible and the time of onset and cessation of the
trouble seems to indicate a possible connection and in many cases a certain one.
Yet all this is still very far away from phenomena genuinely expressing an
objective unity of body and psyche.
It has been asked why after emotional disturbances or long-lasting conflicts there seems to be some kind of organ choice: sometimes the heart and the
circulation, sometimes the intestinal tract, sometimes the organs of respiration.
Somatic states which may be psychically conditioned are:-in the intestinal

tract, nausea, swallowing of air; in the circulation, anxious tension; in the respiratory
system, asthma, phrenocardia. All these states are of symbolic significance; they are
not only experienced physically but are felt to be meaningful.
Organs are hidden speech which the psyche understands and through which it
talks. Vomiting is an expression of resentment (Napoleon is said to have vomited
when told he would be taken off to St. Helena). Air-swallowing means to swallow
down something, e.g. something humiliating, which one cannot contest. Anxiety
means one is afraid for one's own life, for its very basis, for its full realisation.
Asthma means one cannot stand the air, that is the atmosphere which has arisen
through situations, conflicts and particular people in particular places. Phrenocardia
(heart-neurosis) in which the diaphragm contracts and pain and palpitation follow,
means a fixation of inspiration, a kind of tension not followed by release. (In the
sexual act, tension and excitement are not followed by release and satisfaction.) In
all these the person expresses some actual unbearable aspect of his life symbolically
through his organs without knowing that he does so.
To try and reach clear understanding, Heyer distinguished what he called liflspheres: the vegetative sphere (digestive system); the sphere of animal lifo (life of the
blood; blood, heart and circulation)-the respiratory sphere (breathing). Each sphere
has a specific nature which is connected symbolically with psychic actualities.
J. 'The intestinal life is plant-like, peaceful and dark, deeply unconscious, the basis
of existence: Through this intestinal life movements travel in waves, much as the
waves of the seasons pass through nature. ,.. 'The life of the blood is that of hot
passions, affects, of temperament and of instinct; it is the sphere of the sexual drives:
The dominating movement here is not of waves but of contraction and expansion.
We can compare the life of the roaming and hunting animal. 3. Respiration also
has a polarised nature; there are sequences of tension and relaxation, very close to a
moment of ego-life. 'The light, easy quality of the breath, its relation to air and
ether gives us a feeling of height, freedom, limitlessness, which we receive hardly
at all from the vegetative and animal spheres of our being: The bird is a symbol for
air and breath.
The different life-spheres (organ-systems of digestion, circulation and respiration) are thus linked with certain 'basic', 'archaic' or 'universal' feelings which always
preserve their separate character. Thus conversely 'these specific psychic movements
express themselves through the corresponding organ-system'. We will confine ourselves to the main example given: In the circulation, the carrier of the animal life
of drive and passion, the basic dysfunction is anxiety, arising through the infirmity
of the elements of life (as in coronary sclerosis, anaemia, etc.) and through suppression of the blood, that is of urge and passion. Anxious tension is the person's
loss of unity with the animal in his blood, he feels anxiety lest the animal in him has
grown too weak, or anxiety lest it may be too powerful and devour him. Therefore
1
Gustav R. Heyer, D" O,ganUmus d., Sem (Munchen, 19P)'
these are 'circulation-neuroses' which occur 'not only in people who do not follow
the will of the blood (or of their sexuality) and repress it, but in those equally who
dissipate their mental self in nature'. These neuroses of circulation therefore are
fostered in 'conflicts with the untried world of earth and urge' no less than in a
neglect of 'the illuminating human mind'.
changes in the pupils, oedema, cyanosed hands and feet, strong, peculiar
smelling perspiration, the 'greasy face' ,pigmentations and trophic disturbances. All that can be directly observed has long been methodically complemented by special findings: for instance, body-weight, amenorrhea. In the last
ten years physiological investigation has been pursued with all the refinements
of modem medicine. Some of the findings are random findings accumulated
into a limitless host; others provide a clear picture of the somatic phenomena
produced by the physiological processes in psychosis. Here are a few examples:
This quotation shows how theories of this sort weave a complex web of
concepts: (I) vital, physiological relationships, such as that between the heart
and anxiety, sexuality and anxiety; (2) possible symbolic interpretations in
which organs are experienced as a symbol for what is psychic; (3) a mystical
symbolism, in which expression is given to a metaphysical interpretation of
life. The interweaving of these heterogeneous elements is not without its
charm, but from the scientific point of view it is insufferable. A vast inextricable
confusion is created from obvious empirical facts, which are extremely difficult
to isolate and grasp clearly. Patterns of possible experiences, of understandable
connections with somatic phenomena, are mixed up with speculative metaphysical and cosmic interpretations. What emerges as true is only the general,
indefinite reminder that the occurrence of a body-psyche relationship and all
the facts that demonstrate it cannot be even approximately exhausted by our
customary simple schemata and most certainly cannot be sufficiently comprehended in this way. There is no scientific value in this psychotherapeutically
nourished, fantastic configuration, justified though it may be as a negative
kind of appeal against being too satisfied with the simplicities of physiological
causation.
v. Weizsacker's far-reaching studies on the subject of psychic pathogenesis
in severe organic illness are wide open to this kind of interpretation, without
his being necessarily in full agreement with it. Sometimes he seems to adopt it
but he is careful to refrain from any too precise interpretation, being in favour
of a biological approach, in which somatic events play a part in the dramatic
unrolling of the psychic and social situation, but his study offers no universal
fixed form of understandable connection, which could be used to provide a
scientific theory of causation. His case-histories can be read with some wonder;
it seems that anything is possible, but in the end we know as little as when we
started.
3.
SOMATIC FINDINGS IN PSYCHOSIS
The final group of somatic symptoms to be observed in patients cannot up

to now be related to anything psychic whatsoever. They are rather physical
signs of morbid physical processes which are perhaps at the same time the
source of the psychic illness, or at any rate are in some relation to it. These are
not symptoms of definite physical disease (cerebral processes) but we will
class them as somatic signs, physical symptoms of psychosis, without being
able to recognise them as signs of any known disorder. Thus first and foremost
in the group of the schizophrenias we have to record certain increased reflexes,
247
(a) Body-weight
Fluctuations in body-weight can reach an extraordinary degree with

schizophrenic patients; it is a somatic symptom of varying significance. There
may be a fall into complete emaciation and deep marasmus in the acute
psychoses and a great gain in weight during convalescence from the acute
phase, so that changes in body-weight may be an important indication of which
way the illness is going. The increase in weight takes place during the return
to health as well as at the start of the lasting state of dementia which can follow
after an acute phase. (Increase in weight without any psychic improvement is
therefore an ominous symptom.) In the latter case there is sometimes a notable
over-eating, and a bloated, fat habitus. Loss of weight is seen in severe psychic
shock, in worry and in long-lasting depressive states, and in nervous disturbances of all kinds (loss of 20 lb. or more). In the particular case it is not easy
to decide how far the change in body-weight is an accompaniment of a morbid
physical process that is also responsible for the psychic disturbances, and how
far this change is a direct consequence of psychic events themselves. It seems
that both types of relationship are there. I used to observe a patient with a
traumatic neurosis who always lost several kilo. during his stays in hospital,
in spite of eating the excellent food, perhaps because the situation always
caused him extreme distress.
Reichardt 1 investigated the relationship between body-weight and cerebral
or psychotic illnesses. He found body-weight and mental state showed a farreaching independence, so that no definite correlations could be established.
For instance, he observed severe fluctuations in some acute psychoses, but in
general he found the weight-curve stationary in states of mental deficiency
and end-states; frequent endogenous increases and decreases of weight in
brain diseases, for instance, in paralyses, and a particular, excessive weight-loss
in catatonic syndromes. As distinct from those that last over long periods,
brief fluctuations in weight have been found to he due to fluctuations in water
retention.
1 Reichardt, Untersuchungen aher das Gehirn Oena, 1912.), Part 2., 'Him u. Korper'. O. Rehm,
'Ober Korpergewicht u. Menstruation bei. akuten u. chronischen Psychosen', Arch. Psychiatr. (D),
('9'9), vol. 6r, p. 385.
248
(6) Cessation of menses

This occurs frequently in psychosis. Haymann1 found it took place as
follows:
in paranoia
in hysteria, psychopathic and degenerative states
in manic-depressive insanity
in dementia praecox
in paranoid types .
in hebephrenic types
in catatonic types .
in paralysis, tumours and other organic brain disorders
of cases
"
"
"
"
"
"
"
Menstruation disappears in the majority of cases only after the psychic

symptoms have appeared. In a large number of cases cessation of menstruation
coincides with the onset of a loss in weight. When weight increases, the menses
reappear. (This is so whether there is recovery or a final defect state.)
(c) Endocrine disturhances

In scattered cases the Cushing-syndrome is found with schizophrenia. As
the latter progresses, the former tends to vanish. A hypophyseal tumour had
been excluded. This finding only shows that schizophrenic processes tend to
invade the field of hormonal activity. 2
(d) Systematic physiological investigations to find clinical pictures with typical

somatic pathology
Numerous metabolic investigations have been made, examinations of the
blood, analyses of the urine, etc., but they all so far show equivocal findings.
In some circumstances they may give valuable hints but for the most part they
tend to be interminable and barren of results. In some cases of schizophrenia,
for example, particularly with catatonia, and also in paralytic stupor, the
metabolism was found to be slowed down. Other findings have been elicited
with the help of modern metabolic studies of the pathology in such conditions
as paralysis, schizophrenia, epilepsy, circular psychosis.
The unusually painstaking and thorough work of Gjessing3 opened a new
chapter. He did not set out to collect a large amount of data in order to make
statistical comparison (such a method can only give indications, but is not any
use as a research method itself). Instead he made a series of investigations of a
few patients daily over a long period of time, so that he could observe changes
1
I
Haymann, 'Menstruationsstorungen bei Psychosen', Z. Neur. (1913), vol. IS, p. SII.

S. Voss, 'Das Cushingsche Syndrome als Initialerscheinung bei Schizophrenie', Z. Nlur.,
vol. 16S.
a R. Gjessing, 'Beitrage zur Kenntnis der Pathophysiologie des. katatonen Stupors usw.', Arcla.
Psyclaiatr. CD), (1931), vol. 96, p. 319,393; (193 6), vol. 104, p. 3SS; (1939), vol. 109, p. Ps
249
in their physical stat~ and compare these with changes in their psychosis. He
did not try to investigate a single physiological phenomenon but a composite
whole, which included examination of the blood, urine, faeces, metabolism
etc. Lastly he selected his individual cases carefully; there had to be an absolutely definite diagnosis and they had to be typical cases and show an individual
suitability for investigation. He gives exact reports on individual cases. Among
them are a few, very conspicuous, classic cases:
Catatonic stupo,: st~rts suddenly; the emergenc: from it is critical. In the prestupor state there IS sl1ght motor restlessness. Dunng the waking period he found
diminished B.M.R. and a diminished pulse rate, lowered blood-pressure reduced
blood-sugar, leucopenia, and lymphocytosis; retention of nitrogen. (This picture
occurring during the waking period Gjessing called the 'retentionsyndrome'.) As
stupor began he found: marked, autonomic fluctuations (change in size of pupils,
pulse rate, colour of face, perspiration, muscle-tone). During the stuporose period he
found: raised basic metabolic rate, raised pulse rate, blood-pressure, blood-sugar;
slight hyperleukocytosis, increased nitrogen secretion. (Gjessing called this picture
'the compensation syndrome'.) Symptoms retumed periodically alternating with the
stupor that lasted 2-3 weeks.
Gjessing fo~d similar phenomena in states of catatonic excitement. Many cases
of stupor and exCItement however follow an altogether irregular course. The author
alway~ found. that there was retention of nitrogen, autonomic changes, nitrogen
excretton-wlth the nitrogen retention occurring during the waking period.
The idea is to obtain a physiological-chemical syndrome which will show

some inner consistency and correlate with definite forms of catatonic stupor
and excitement. Gjessing refrains from causal explanation (whether the
psyche or the soma is the determining factor). He only suggests that we are
dealing with the results of periodic stimulation of the brain-stem. In abnormal
states the waking nitrogen retention is reversed; during stupor or excitement
there is as it were a recovery from nitrogen retention.
'
After this there were further investigations and new problems were demonstrated. This was all very different from the kind of disease entities usual in
general medicine but without any corresponding morbid findings of a causal
nature.
Jahn and Greving1 found concentration of the blood, increased formation
of red blood-cells (increase of erythrocytes and of early forms: the marrow of
the long bones in section showed red instead of yellow) with a reduced destruction of red blood-cells-a unique finding. They attributed this finding
along with the other somatic findings to a flooding of the blood with some
poison-a poisonous substance stemming from the albumen metabolism
which had the same effect as histamine in animal experiments. The cases concerned were the cases of fatal catatonia which had already been described at
some length.
1
or~1l
Jahn and Greving, 'Untersuchungen ilber die korperlichen Storungen bei. katatonen Stupu. der todlichen Katatollie', Arch. Psychiatr. (D), (1936), vol. lOS, p. 105.
2.S0
The classical picture of fotal catatonia was described as follows: l Unlimited

motor restlessness appears to increase without inhibition to the point of self-destruction, while the physical strength develops tremendously. There is severe acrocyanosis. The moist skin of the extremities is cold and shows many places where
pressure or knocks have caused confluent petichiae which soon tum into yellow
spots. The initially raised blood-pressure falls; the excitement settles down. The
patients lie weakly in bed with an expression of inner tension and sometimes with
clouded consciousness. Although the skin is cold, the body temperature may be
raised to 40 C. Section does not give any clear picture of the cause of death and
no changes which would point us to any important cause of the illness.
K. Scheid' describes another picture, in schizophrenia: He found marked increase
of sedimentation rate at certain periods coupled with high temperature, and the
symptom of increased rate of formation and destruction of red-blood corpuscles.
Both new formation and destruction generally kept in balance; when haemolysis was
stormy, there was a marked anaemia. There were no signs of any serious physical
disorder underlying the febrile episode.
We are always dealing with particular pictures or some narrowly circumscribed type, never with a recognition of the somato-pathology of schizophrenia as a whole. Comprehensive laws are therefore not to be found, and
we are left with the rarity of the classical case and the many current contradictions. For instance, Jahn and Greving find a lack of blood-destruction in
fatal catatonia while K. F. Scheid3 found an increased blood-destruction in
catatonic episodes; a lowering of the haemoglobin content and the appearance
of breakdown products of haemoglobin.
It is natural to think of a physical disorder which conducts itself basically
like all other physical disorders. In support of this are the severe somatic
symptoms and, on the psychological side, the similarity between schizophrenic
experiences and experiences with mescalin (and other poisons). This points to
some agent, which will be discovered eventually as the cause. Against such a
hypotheSis however are the lack of pathological anatomical findings which
would indicate the cause and, in addition, the unusual deviations in the somatic
findings, such as the type of circulatory disorder which is present. The fresh
findings are impressive. Their significance is not yet clear. A decisive factor
is whether the same disorder can in principle occur in animals or whether the
whole illness is specifically human. In any case it is a phenomenon of human
nature, a process in that substratum of human life where psyche and soma are
as yet inseparable.
1 Stauder, Arch. Psychiatr. (D), vol. 102, p. 614.
K. Scheid, Febrile Episoden bei. schi{ophrenen Psychosen (Leipzig, 1937). Cf. 'Die Somatopathologieder Schizophrenie', Z. Neur. (1938), vol. 163, p. S8S.
a K. F. Scheid, Nervenar{t., vol. 10, p. 228.
I
CHAPTER IV

Introduction. Meaningful objective phenomena are what we term the sensory phenomena which we understand as expressions of the psyche. They
consist of the human physiognomy (shape and countenance), involuntary
gestures, speech and writing, artistic productions and conscious purposeful
behaviour. These phenomena are, however, highly heterogeneous and are
scarcely comparable. Thought, art and purposeful actions have an objective
meaning which is not a psychological one as such and any understanding we
may have of it does not necessarily imply an understanding of the psyche. We
can for example understand the meaning of a sentence in a rational way without necessarily understanding the man who utters it; we need not even think
of him. There is an objective world of the mind in which we move without
thinking of the psyche at all and from this springs the spirit of enquiry into
psychological matters. Hence we divide our meaningful phenomena into
several different spheres:
I. The human psyche is expressed through the body and its movements.
This expression is involuntary. It becomes objective to the observer but not to
the individual who is thereby understood (Section I).
2.. The individual lives in his own personal world-by means of his attitudes, behaviour, actions and the shape he gives to his environment and social
relations. What he is appears in his actions and in his activity and these provide
him with a known content (Section II).
3. The individual objectifies this content for himself in speech, productive
work and ideas which form a world of the mind. He takes a firm hold on what
he has materially understood, produced, created and intends to create (Section
III).
These three spheres signify contents which concern us not only from the
psychological point of view; in fact to begin with there is no psychological
interest at all. 1 we are to study them psychologically this requires first of all
an inward appropriation of these contents and an unerring capacity to perceive
them with understanding. Apart from this there are no limits to such a study.
The highest mental creation can still be questioned as to its psychic origins;
what involuntary elements are being expressed, what is its effect on the psychic
life and what significance has it as a footing for the psyche, etc.? The realm of
the understandable is of course not exhausted by this psychic aspect of the
understandable and we should remember that from other points of view the
mind is regarded as a world of meaning divorced from the psyche and the
human individual considered a free and rational creature. However, as
:z.SI
BODY AND MOVEMENT
psychopathologists we are only interested in the understanding of objective

meaning in so far as this is a precondition for our psychological understanding
of such a meaning as it exists in the psyche of an actual individual. In the
psychology of expression indeed the direct perception of another person
through what he sees and says depends entirely on the cultural breadth of the
psychopathologist's personality. It is not surprising that many content themselves with ordinary trivialities while others feel very much the limitation of
their understanding and access to other minds. Confronted with the individual
they grasp a good deal yet they do not penetrate completely and a certain
reserve descends.
In all three spheres of meaningful objective phenomena we can observe
certain particular elements that belong essentially to a whole which is not
visible to us in the same way as a single objective fact. As regards the phenomena of expression, this whole is the unconscious Formniveau (Klages-h:vel
of development); as regards the existence of the individual in his own world,
it is the configuration or 'gestalt' of this world (Weltgestalt) and as regards the
objectification of ideas through knowledge and productivity, it is the total
consciousness of a single mind.
Each sphere has its own particular principle, but for the most part all three
go together. All three, for instance, have something of the expressive character that is the dominant principle of the first sphere. When a thoughtcontent, purpose or practical intention exists objectively in the world, we find
that from the psychological point of view there is no such thing as mere reason
or pure purpose. All psychic manifestations are pervaded by an expressive
atmosphere: thoughts are spoken in a certain way, there is the tone of voice
and the style of speech; goals are obtained in a certain way, there is a particular
kind of body-movement or a particular individual mode of behaviour matched
to the concrete situation. Further it is just this person who has this thought,
has just this or that purpose, reflecting perhaps an expression of personality or
some particular pattern of mood. 'Performance' which in itself is not expressive
takes on in the individual an expressive aspect: motility is harnessed to expressive movement, speech acquires expressive personal tone and form, the working-performance becomes a personal gesture through its rhythm and style.
I. An urge to expression in the narrow sense of involuntary, undirected

'giving vent' to psychic stirrings. The degree of expressive facility differs in
the individual and in the race.
2. An urge to present the self which brings an element of half-intention,
since the individual validates himself in the presentation either for some real
or imaginary onlooker or for himself alone. This self-presentation is a basic
human characteristic and an indispensable and positive factor in everyone's
life. But there can be self-deception; form, setting and gesture are then no
longer a direct outcome of living but take on a life of their own. As a string
of shifting immediacies or in the shape of some rigid mask they come to substitute for life itself.
3. A need for communication--human beings desire to relate themselves to
others in mutual understanding. At first there is only the need to understand
objective contents, ideas directed to objects, practical purposes and practical
theories. Later the person needs to communicate himself. Language is found
by the individual ready-made, a remarkable, enigmatic instrument of communication for him to use.
4. An urge to activity, to direct behaviour and grasp the situation and everything that is waiting to be done. But whichever direction this primary
impulsiveness takes it will always be associated with meaning and thus distinguished from the purely vital drives.
For all meaningful phenomena the rule holds that most is to be learnt
from cases that are unusual, well differentiated and complex. These illuminate
the rest and experience is enriched not so much by the number of cases we have
seen as by the depth to which we have penetrated in anyone case. Individual
cases, therefore, have a principle of importance which is essentially different
from what they have in the somatic sphere where it is always 'a case of .'
In the psychological study of expression, the single case can be of exceptional
importance simply as an example on its own.
Let us remind ourselves of the basic classifications of individual phenomena: subjective phenomena--experiences-which are studied by phefWmefWlogy; objective
phenomena, either meaningless or meaningful; if the former they are studied by
somato-psychology; if the latter, we either assess and measure them as performances
(performance-psychology) or we understand them, either as human expression (the
psychology ofexpression) or as life in a particular world (the psychology ofthe personal
world) or as mental productions (the psychology ofcreativity).
We have a psychological need to give things ohjectivity and meaning, and
in addition our intentions are always based on something unintentional and
impulsive. This primary impulsiveness can be differentiated into:
SECTION ONE
EXPRESSION OF THE PSYCHE THROUGH BODY AND
MOVEMENT
(PSYCHOLOGY OF EXPRESSION-AUSDRUCKSPSYCHOLOGIE)
(a) Somatic accompaniments and psychic expression
When we speak of somatic accompaniments of psychic events we simply

register a relationship (for example, between fear and dilatation of pupils).
We register it and make it part of our knowledge. But if we speak about the
expression of psychic events, we imply that we understand the somatic
phenomena in terms of what the psyche wishes to express, e.g. laughter is an
immediate understanding of something funny. Expressive phenomena are
2S4
BODY AND MOVEMENT
always objective, in so far as they can be perceived by the senses, and manifest
themselves as matters of fact, which can be photographed or recorded. On the
other hand, they are always suhjective since actual perception of them does not
make them expressive; this comes only when there has been understanding of
their meaning and importance. Insight into' expressive phenomena requires
therefore rather different evidence beyond the simple registration of purely
objective physical facts. It has been said that all our understanding of expression rests on conclusions drawn by analogy from one's own psychic life and
applied to that of others. Conclusions by analogy are a myth. The fact is
rather that we understand quite directly, without any need for reflection; we
understand in a lightning flash, at the very moment of perception. We understand an expression we have never seen in ourselves (it could be that it is a
future man who studies himself in a mirror). Then there is the fact that
children who cannot yet speak will understand gesture. Lastly, even animals
understand expression to a limited extent. The psychological process of
empathy has been invoked tci explain the understanding of expression.
Whether this expl~ation is true or false, it remains a psychological problem,
not a methodologIcal one. The phenomenon of understanding expression is
always a direct one, our consciousness recognises in it something final and
immediately objective. We do not see ourselves in the other person but the
other person or his meaning as existing in their own right, the other's experience, which in that form we have never had. All the same we are not to
talce unde~t~ding. of expres~ion as something. simply right and valid just
hecause of Us unmediacy. Even 10 the case of mere sense-perception this is not
so; each particular is governed by our knowledge as a whole; and there are
deceptions in the sensory sphere. It is the same with the understanding of
expression, except that deceptions are more numerous and control more
difficult--conclusions by analogy come secondarily; each individual expression
is capable of many possible meanings and only understandable in relation to
some whole. We also show a wide range of difference in the vividness and
breadth of our understanding of expression. Understanding is linked with
one's own possibilities of experience, one's own history, and one's own
measure oflearning, its width, depth and general complexity. For this reason
we find that where there is a certain mental poverty, there tends to be a denial
that the understanding of expression can have any validity. There is a commonplace use of it and a certain violence done to it within the confines of the
individual's prejudices. We must not forget that any knowledge we may have
of the ?sychic life of others has come to us through the understanding of
expressIOn. .Performances, as such, somatic accompaniments as such, even our
understand10g of mental content as something merely objective, all teach us to
recognise the psyche but only from outside.
A hasic mistalce in method is to confuse our concepts; for instance, calling all
somatic accompaniments and sequelae the phenomena of expression. It is
true they are this but only in so far as they can be 'understood' as psychic
expression, as in a gesture. Increased intestinal peristalsis prompted by affective changes is not an expressive movement but simply a synergic accompaniment. The frontier of understandable expression is not well demarcated.
Dilated pupils as phenomena of fear are not 'understood' by us, but if we
know of this fact and notice it several times, this knowledge seems a direct
perception of fear in the pupils; this is only so, however, if the fear is simultaneously grasped as a genuine expression. A dilated pupil as such has no
inner link with fear in our minds. It can have other causes, atropine, for
example, which come to mind just as quickly. Similarly if someone constantly
needs to go to the lavatory. In the appropriate situation and with other genuine
expressive phenomena present we know that some strong affect is at work;
otherwise we would be inclined to think in terms of some purely physical
disturbance.
(h) Understanding the expression

We perceive in form and movement a direct manifestation of psychic
events or psychic mood. If we reflect on this type of seeing we are bound to
doubt its importance for the comprehension of empirical reality. We are
making use of a symbolism that is universal; we are seeing quite directly everyone's person and movements of adaptation, not as mere mathematical quantities nor as sensory qualities, but as something living, carriers of mood and
significance. For clarity's sake it is as well to review the different ways in which
we see shape and form:
To begin with we need to extract some clear forms for observation out of all
the confusion of the phenomena, and to look for favourable conditions in which to
descry what we may call the basic phenomena, basic configurations, simple forms,
etc. Next, there is need for analysis. We need to see what these configurations are,
how they change, develop and summate into a whole. Here the path of investigation
diverges.
Either we resort to mathematics, that is think or build constructs in terms of
quantities and derive our basic forms in this way. If successful, we become as it
were a second creator of forms and shapes, which we contrive, handle and survey.
Knowledge thus gained is thought of in mechanistic terms, limits are set and endlessness controlled by the use of mathematical formulae.
Or we try to stay close to the real shapes and forms, which will not submit to
mathematical handling because their nature is infinite. We study morphology
(Goethe), observe the growth of forms and their endless transformations, try and
help ourselves with diagrams, and delineate types. But we use all these simply as
pointers on the way, so that we can find some language for nature's 'blueprints',
the primary configurations, whether of animals or plants, without making any
attempt to deduce them (a mistake Haeckel made in his general morphology). 'The
basic forms are not spatial and therefore subject to mathematical definition as such,
but they are shapes that live. Their inner structure which can be mathematically
explained is only one of their aspects. Morphology is not deductive but tries to lead
us towards a pure apperception through a process of dynamic and structured seeing.
~S7
BODY AND MOVEMENT
What we see in this way is the totality of basic characteristics belonging to the
spatial phenomena of our environment. Clear vision is always accompanied by a
'feeling'-an overtone, betokening the meaning, the sense of the forms, their psyche.
Something inward, as it were, reveals itself directly present in the external form,
whether this is the aesthetic-ethical effect of mere colour or at the other extreme the
emotional appeal of animal forms or the human shape.
We would like to put this 'soul of things', their psychic quality, into words,
understand it, and make it a fruitful concept at which we have arrived methodically.
The path of investigation diverges once more.
Either we mistranslate this quality into a rational meaning, something we can
know, and we say that things, forms and movements signify something. The'signatura rerum' then represents a physiognomy of the universe of which we can make
use to control everything through an immense system of meanings in which things
are simply the signs. This leads us to a superstitious pseudo-science, the rationalism
of which offers a striking analogy to the mechanistic explanations of the world,
which it successfully applies, but it differs from these in the fundamental deceptions
on which it rests and its lack of general validity (e.g. astrology, medical pharmacology derived from the 'signatura rerum', etc.).
Alternatively, we can stay close to the 'soul o/things', their psychic quality. No
interpretations are made but we open our senses to living experience, to the perception of the inward element in things. Goethe's 'pure reflective gaze' accompanies
a contemplation of form which does not Icnow but sees, and this vision of the inward
life of things (Klages uses the term 'Bilder') forms the substance of our union with
the world. This union may be of unlimited depth; it comes as a gift with every step
we take and cannot be methodically developed; it remains bound up with everything that reveals itself to a receptive attitude and an unfeigned preparedness to
accept. This mode of perceiving with its empirical clarity comes to us late in time.
Hitherto it has been embedded in superstition and delusion and it has been continually exposed to self-defeating efforts at defence through rational argument and
systematic theory, which has attempted to bring it within the boundaries of reason.
stood and the rest of human reality accessible to us in speech, etc. Secondly,
we can test one phenomenon of expression against another, and ~rdly we can
constantly relate every particular to some whole. The understandtng of expression is the same as general understanding, in that the particulars may be
meagre and deceptive and can only be rightly understood in terms of the
whole which they have gone to form. This is the natural round of understanding and the psychology of expression follows the same rule.
The understanding of expression has its place within this universal world
of psychic perception, this 'vision of the soul of things'. The psychic quality,
the inward element, can be seen in the outward form and movement of the
human hody, made visible to us as expression. But this psychic quality is
something radically different from the psyche of the nature-myths. Psychic
expression as we understand it in men is something empirically real. It is
accessible to us, present as something that responds; we treat it as an empirically
real force. The decisive question then arises; which phenomena are an expression of real pyschic life, which are merely conditioned by chance somatic
events? And which are only an expression in the sense that a branch has a
form, the cloud has a shape, and water has a flow? Sensitivity for form and
movement is a precondition for our perceiving expression at all, but something more is needed if this is to develop into any knowledge of an empirical
We can investigate the phenomena of expression in two different ways:
psychic reality.
It is easy to give a theoretical answer. Empirical confirmation is first
achieved by making a demonstrable relation between the expression as under-
Understanding of expression becomes most questionable whe? ~pplied to individuals as a science of character. Anyone may come across th1s 1f he has had
anything to do with graphology or with the study of. physio~omy and gesture.
Such studies when concretely applied are nearly always 1mpress1ve, seem to succeed
by inspiration and, though fashions fluctuate, are warmly ac~laimed. I~ indivi~ual
cases the interpretation is usually compelling unless the env1ro~ment IS es~ec1ally
critical. This seems due among other things to the fact that meanmgful ~ppos~tes a~e
always linked and something is always right provided one. can fi~~ the. r1ght d1alect!c
in which to express it. There is also nearly always somethmg stnking 10 the person s
mood or nature, which only needs to be emphasised and expanded verbally. Lastly
one may be lucky and hit on something very p.ersonal, a~d the matters that are not
correct are quickly forgotten. Our first acquamtan~e With chara~erology, g~ph
ology or the study of physiognomy may seem.someth1~g of a reve~atlon and espec1al!y
seductive because such methods are often hnked W1th some kmd of natural philosophy. If we can avoid the seduction without losing sight of the genuine impulses
which are part of it, we have made a step towards scie~ce and a liberal phi~osophy.
The first basic experience of disillusion comes when, W1th graphol?~ for 1Ostance,
we find the most superficial of efforts is met with the most enthus1astlc acceptance.
We have to experience such embarrassing situations before we can be properly
critical as psychologists.
(c) Techniques of investigation

I. We can explore the extra-conscious mechanisms which condition the expression. In the case of speech we know of disturbances in the extra-conscious apparatus,
appearing in the form of motor and sensory aphasia. Co~responding disturban~es,
known as amimia and paramimia, occur with gesture. For mstance, when the patient
wants to say 'yes' by nodding his head, he opens his mo.uth, but he can~ot find the
right movement. Finally, there may be spontaneous exc1ted .gestures which are. not
any expression of psychic states but only disturbances 10 the extra-c~nsC1ous
apparatus. Thus in certain cerebral diseases (in pseud?-bulbar ~alsy, fo~ 1Ostance)
we can recognise a forced laughter and crying followmg any kind of stlmulu~. In
such cases the neurologist is investigating disturbances in the extra-conSC10US
apparatus ~f expressive movement. It is of course .possible to do thi~ with no~
functioning if we record the movements exactly as 1f the? were SO~tlC .acco~pan1ments and analyse their somatic function. Duchenne1 tr1ed to do thiS :W1~ differ~nt
kinds of facial expression, comparing them with the effects of electr1c stimulation
I
Duchenne, Micanisms a. /a Physiognomie humaine (186:1).
BODY AND MOVEMENT
of individual muscle groups. He wanted to find out which groups were concerned
in each case. Similarly with the help of Kraepelin's writing.balance, it was possible to show that in the simple movement of making a full-stop, every individual
has a specific and constant pressure-curve. Sommer demonstrated the movement of
the face muscles during mimicry.1
2.. The above gives us some knowledge of the extra-conscious mechanisms; we
also add to our technical equipment for the recording of expressive movement (use
of camera, film, tracing, etc.). But we have not added anything to our knowledge
of the psyche. The second and more properly psychological investigation of expressive phenomena sets out to do just this. It hopes to extend 'understanding'beyond
this point. In everyday life we all have the common experience of understanding
expression and the investigation aims at making such understanding conscious; it
seeks to increase and deepen it and delineate it properly. Something like this is
clearly possible if we take an unprejudiced look at graphology. Much that is new
can be learnt from handwriting-even though it is only one of the many modes of
expression.
Some technical preconditions are needed for the deliberate study of expression and
for any planned attempt to extend our understanding: material has to he secured from
the stream of phenomena and collected in some way so that comparisons may be
made at any time. Movements are very difficult to get hold of-they can only be
filmed and this limi ts matters very much. In moments of psychic import the apparatus
is not at hand or would be too disturbing. We have to fall back on description and
on repeated observation of new cases as far as one can get repetition in this way.
Sometimes we may make use of drawing. Handwriting has an advantage in that if
the writer is relatively fluent it offers complicated movements that can be compared
at any time. The bodily shape, the physiognomy, may be dealt with best by photography but even here we run into considerable difficulties.
We can see that only some of the phenomena of expression can be recorded
by means other than description. Yet clear and methodical description is the first condition for any truly scientific grasp which will make the immediate understanding
of expression conscious, control and expand it. In graphology scientific development
became possible through the technically skilful, objective, complex and quite unpsychological analysis of the form of the handwriting (see Preyer's work); in the
same way the scientific study of physiognomy was developed through accurate
description of body-shape.
psychologist has before him a movement of gesture that has so to speak been
'frozen' and can therefore be examined aU the more easily.
(d) Summary
Phenomena of expression may be divided as follows: (I) Material for the
study ofph.ysiognomy: This is a study of facial and bodily form (body-build)
in so far as both may be understood as the expression of a psychic life, manifesting itself in them. (2) Material for the study of involuntary gesture: This is
a study of the actual changing facial and bodily movements, which are unquestionably an immediate expression of psychic events and rapidly come and
go. (3) Material for the study ofgraphology: In handwriting the investigating
1 Cf. Trotsenburg, 'Ober Untersuchung von Handlungen', Arch. Psychiatr. (D), vol. 6z,
p. 72.8. Record of hand-pressure as a time-sequence in various individuals and under various
conditions.
I.
THE STUDY OF PHYSIOGNOMY
This is the most problematic field of expression, and doubts have been felt
whether it can even be considered as such. It should only deal with the persistent features of the physiognomy which have come about through expressive movements and appear as a fr0'{en gesture (e.g. 'folds of thought' on ,the
forehead). Only such phenomena allow for understanding. They can to some
extent be portrayed as expressive gestures, and have no particular principle of
their own.
If the psychiatrist thinks of the characteristic appearance of many of his
patients, which often suggests his diagnosis at first sight, very little of this will
strike him as the expression of anything psychic. None of the phenomena
which reveal the somatic process in the hahitus belong to the field of psychic
expression:
e.g. the plump, swollen forms of myxoedema; signs of paralysis in the face, the limbs
and the speech in G.P.!.; the tremor, sweating, high colour and puffiness of delirium
tremens; the miserable, physical habitus of psychoses where there is severe physical
illness; the emaciation, wrinkled skin, the dimness of the corneal margin and other
signs of age.
If on seeing a hunchback we unwittingly ascribe to him a bitter and

sardonic mentality, something else has entered the situation. He may have
acquired his deformity in childhood through a lesion in his spinal column, and
there is no psychic element, in any case. But sometimes such a deformity or
some other physical suffering may entail psychic consequences such as the
development of resentment and as it happens we wrongly suppose the hunchback to mean this. Or perhaps resentment is really there in face and bearing and
the hunchback itself only increases the strength of our impression, but this is
not what is meant by an expressive physiognomy. Generally we must imagine
that from an early age the physical frame plays a part in shaping a person's
self-awareness and general behaviour. All through one's life, what one feels
about oneself and one's appearance is continually being supplemented by such
items as whether one is small or tall, strong or weak or sickly, whether one is
in any sense beautiful or ugly, even though originally this had nothing to do
with one's psyche. The individual models himself according to his body and
with its help and in its company there is psychic growth, so that body-form
and psychic life become reciprocal even if at first they were apart. We also find
that in different people body-form and character match in varying degree: in
one case our whole impression is one of unity; in another, the nature is lean
though the body is fat, and in another the phlegmatic temperament matches
rather oddly with the bony frame. In every case primary somatic factors take
BODY AND MOVEMENT
effect in the body~form and the psyche comports itself in relation to these, but
essentially they do not coincide with the psyche in the sense that they are an
expression of it.
Leaving aside every gesture, every 'frozen' gesture, every physical trace
of illness, everything we may have linked with the psyche as a primary somatic cause for an understandable psychic change, we find our total impression
of the somatic phenomenon of an individual still leaves something to account
for; that is, the persisting physical form of the individual, what we have called
his physiognomy, the unique individual quality which has grown up with him
and is only capable of a slow and limited variation as life runs on. Once
puberty is past, it tends to settle finally, though sometimes this occurs rather
later. In so far as the bodily habitus is not linked with the specific disturbance
of any organ (with endocrine effects) such as in myxoedema, acromegaly, etc.,
but really exhibits the true fashion of the individual's life, we may call it his
physiognomy. When we look at different kinds of physiognomy we can
immediately picture an appropriate psychic life, indistinct perhaps but undoubtedly belonging and creating a certain psychic atmosphere. If we follow
these impressions up and try to reduce this 'feeling' to some kind of knowledge, we find there are two ways of doing this, each different from the other
in theory and method. We have to keep the two distinct if we want any clear
discussion on these matters.
kind deserve interest and need not undermine our scientific facts. Those who claim
to read the essential features of anyone in the way just defined might as well claim
to see the essence of the universe in the symbols of nature--they are what we used
to call 'natural philosophers'. The whole thing is really metaphysics. The kind of
being which expresses itself simultaneously in human character and the shape of the
ear must lie at so deep a level that it is inaccessible to empirical research. Suppose we
try to apply such methods: someone has his character read from the shape of his
ear; let us then check the assessment with all the biographical data we can find. We
shall undoubtedly come across major successful perfomlances of an unexpected kind
as I found in my own investigations. These spring from the individual's unchecked
direct intuitions. The absurdity becomes apparent of bottling up such human
powers into a science of bumps, ridges, proportions, etc., so that we may read
mechanically from the shape of someone's ear what a whole lifetime can hardly
reveal, the essential nature of a man. We cannot objectify the intuitions that come
to us of the nature behind the forms because what is involved is not the measurable
aspect of a form but its undefined nature. The situation is not one of registrable
individual forms and their measurement but of the mutual relationships of form
and measurement. These relationships are not specific ones which can be measured
but tail off into an indefinite potentiality which cannot be reduced to any rational
dimension.
2. Completely different from the above is the method of ohjective research. It
abandons intuitive understanding and tries to relate certain well-defined body-shapes
and character traits. This is done simply by counting the frequency of simultaneous
occurrences. The aim is not to find any essential connection, nor is any found;
nothing comes to light as a psychic phenomenon but there is only statistical correlation. Even if only a few empirical cases of body-build fail to be associated with
the expected psychic type or are associated with another or opposite type, this will
exclude any important, necessary relationship between body-build and character or
at any rate makes it questionable. Statistical correlations such as these only throw
up the question, they do not give us any information about the nature of the
relationship.
It seems in fact to be extremely difficult to find an exact correlation statistically
because bodily form as well as character do not lend themselves unequivocally to
simple measurement and enumeration. We can only see them in the form of types.
But these types are not of a generic nature, and we cannot classify under them
unreservedly. They do not appear in reality in pure form except very rarely and
usually they are 'mixed' . We use them as a kind of 'yardstick', not as actual categories to which a case either belongs or not. Even in 'mixed' cases we cannot
measure them as we can the protein content in urine and say so much of this type,
so much of the other. Counting is too exact and there is nothing quantifiable. Different observers not in contact with each other are likely to come to different conclusions on the same material. However that may be, we are not dealing here witll
the question of physiognomy but with the kind of enquiry which asks what the
relation of diabetes or Basedow's disease or tuberculosis is to dementia praecox.
The only difference is that in these latter instances the relationships can be exactly
numbered, and found to be either absent or present and if present to what degree.
This cannot be done with the relationship between body-build and character; it
cannot be exactly reckoned. Perhaps something as yet unrecognised lies behind all
I. In regarding the physiognomy of an individual the nature of the psyche is

perceived directly in the bodily form. Descriptions of body-build together with
the relevant character-type have a striking evidential quality and they convince us
immediately, like a work of art, when there is apt and revealing presentation by the
expert. We certainly get the impression that things are in fact just as he says. But
we may wonder whether this is a method of research or for any expansion of our
impression. If there is something valid, the following would hold: A 'being' which
cannot be divided into body and psyche develops from the basic constitution
(Anlage) of man and every living thing. However valid such a division may otherwise be, it is not so here because the 'being' appears in what is physical; the same
'being' which is body and psyche and embraces both. Instead of the two standpoints
of bodily, external reality, on the one hand, the subject of biological science, and
on the other psychic, incorporeal existence as 'experience' with its inner relationships, we have the idea of a 'being' which could encompass them both but which
always remains individual yet somehow typical, constituting the innermost character
of man. There would appear to be some unitary characteristic present in all that could
be read off from behaviour and bearing and-to take an extreme example-even
from the shape of the ears. People witll this orientation see in the latter something
indistinct, incomplete but essentially characteristic. They tend to express all this in
the form of epigrammatic and arbitrary judgments and speak of an ethical bump, a
metaphysical ridge or a lecherous lobe, etc. We would do well to keep an eye on
logical possibilities of this sort and be clear about them. If we discard the whole
study as a fanciful sort of game and clarify our own minds about it, we can see to
it that such ideas are not admitted as exact formulations. Yet genuine efforts of this
BODY AND MOVEMENT
this, something which gives some colour to these unproductive investigations, but
even if this underlying factor could be found by the first line of approach we should
not be able to make it accessible to quantitative and exact research.
'caught' by any amount of calculation and thought, but only by the artist's
eye, features that can be caricatured in the wide play of their peculiarities and
eccentricities but do not alter the character essentially. It is obvious that the
study of physiognomy is not a teachable science, anyhow at present; yet,
thanks to the artist, we have any number of portraits, characterisations, nonconceptualised meanings, in the sphere of physiognomy.l So far we have an
irreconcilable division between seeing a form and measuring a proportion or
a quantity. In the case of crude connections measurement is more certain than
our own assessment. In the case of fine morphological relationships, which
matter in physiognomy, the eye is a much more sensitive and exact instrument.
3. Finally there is a meaning in bodily form which goes heyond the psychological meaning. This is grasped by the artist, who distorts the body-shapes
according to his own inner vision, and chooses extended, thick, slanting or
angular forms, without any caricature of some exaggerated psychic feature.
The human form is drawn into the universal symbolism of all the forms and
shapes of the world. Man is then seen as of metaphysical rather than of psychological importance. Physiognomy is of no relevance here. But the scientific
problem still remains, where and how is the dividing line to be drawn between
the specific symbolism of the human psyche, as revealed in the physiognomy,
and the universal, metaphysical symbolism of the cosmos. It is this which casts
doubt on the study of human physiognomy once it has taken the first step
towards being a science with a set of communicable concepts.
An empirically valid study of physiognomy could grow only in the field
described under point (2.)-the symbolism of morphological wholes. Here we
could try to produce a methodical theory and some training in the observation
of the human physiognomy, or again, we could produce a theory of what
certain physiognomic features may mean in terms ofpsychic content:
As to method, the innate ability to see meaningful form can be cultivated
by the specific exercise of it, training the eye through description, by schematic
illustration, by the use of carefully selected and contrasted photographs, by
analysis of the work of great artists, and by instructing the student to observe
living behaviour, and if possible measure it, for although numerical findings
teach us little, they give good opportunity for intelligent seeing. The constant
reward of this methodical approach is the factual experience of the observer,
who finds he cannot have enough of this scrutiny of the human countenance.
Even though his general scientific knowledge is not greatly enlarged, there is
a steady broadening of his vision so far as human nature is concerned. He
acquires a visual knowledge, if not a conceptual one. 2
In terms of content, the significance of certain physiognomic features may
be stated, some classification of basic types may be made, certain schemata of
These two ways of investigation which w!! have just described are completely heterogeneous from the point of view of method. The first way lays
itself open to a wide sweep of possible interpretations through the use of
bodily forms as symbols, but after a while it narrows down dangerously into
preconceived categories, unequivocal assertions and banalities. The second
method makes an objective study of countable factors but in the process loses
the form; there is a desire to be exact and exactness is shown, but one is reduced
to simple elements, endless correlations and the heaping up of findings which
only end in saying nothing. The symbolic nature of the study of physiognomy
calls for some exact research to confirm it, but the process of doing this
annihilates itself. Simple, objective factors might well be material for the study
of physiognomy, but they happen to lack any obvious symbolic significance.
In this chapter we shall confine ourselves to the first line of approach
which is the only truly appropriate study of physiognomy, and we will reflect
on this remarkable way of viewing bodies, heads and hands. The judgments
made in this respect may be conceived as threefold:
I. Single forms. Single features are generally conceived as charactersymptoms and we take them as 'signs' in our conclusions as to a person's
nature. This is as far as the study of physiognomy usually can go; where it
aspires to be a science it only becomes absurd. All statements of the sort that
such a study must make are quickly contradicted by actual experience. It is also
somewhat grotesque to suppose that human characteristics should manifest
themselves in such crude, measurable form; in character we are dealing with
structures that are highly differentiated and do not lend themselves readily to
conceptual formulation. 1
2.. Instead of using 'signs' as symptoms of human properties, we let ourselves experience the inward effect of significant form~ We steep ourselves in
the morphological whole. Nothing is deduced from this but we catch sight
directly of something psychic which displays itself as a natural unity of head,
hand and bodily form, and is seen as such by our inward eye. This can hardly
stand as a scientific formulation or communication; it is more like an artistic
translation, a portrait. It concerns itself with those slight, intangible deviations
which can alter the whole cast of countenance, those features which cannot be
1 Phrenology has a place here. The work rests on a theory of localisation of character-properties
in certain cranial areas visible on the skull, from which one can see whether these characteristics
are well or poorly developed. This theory, created by Gall, had much influence during the nineteenth century; it was unsuccessfully resurrected by Mohius, who made some experimental comparisons and claimed he could recognise a 'mathematical organ' in a prominence of the lateral
forehead. (P.]. Mobius, Oherdie Anlage {ur Mathematik (Leipzig, 1900. See also Gustav Scheve
Phrenologisc~e Bilder (Leipzig, 1874), 3rd edn. Chiromancy also has a place here, which deduce~
chara~ter traIts from the hand (apart from fortune-telling). See v. Schrank-Notzing, Handlesekunst
u. Wusenschaft. G. Kilhnel, Z. Neur. (1932.), vol. 141. F. Griese, Die Psychologie der Ar6eiterlaand
(Vienna and Leipzig, 19:1.7).
1 For the human face in Art, see Bulle, Der schone Mensch im Altertum (MUnchen, F. Hirt,
19U), pp. 42.7-54 (bibliography, and in particular that concerning ancient physiognomists).
Waetzoldt, Die Kunst des Portriits (Leipzig, 1908).
Cpo the excellent analysis of L. F. Clauss, Ratss und Seele.
BODY AND MOVEMENT
opposites and different dimensions may be drawn up, and every individual be
classified accordingly. This systematic treatment of types of physiognomy has
always been thought questionable:
At present there seems no attempt to study physiognomy which would allow

comparison with these older attempts in the degree of their thoroughness, wealth
of material and general depth of human understanding. Yet it is the fashion to talk
about the physiognomy of things. Nowadays we look and interpret where we used
to explain and comprehend or else scrutinise and question. In this way, many remarkable notions creep in which, though they teach us nothing specific, do not
leave us totally unmoved. 1
264
Looking at the matter historically we find there ,is an extensive literature on this
matter of the human physiognomy. There are ancient Indian writings, in which, for
example, three types were distinguished (taking into account bone-structure, bodycircumference, size of genitalia, hair and voice). These were expressed as animal
types, the Hare, the Ox and the Horse. In ancient times such problems were also
discussed in Europe.1 A comparison of human and animal types always has something impressive about it which goes beyond the mere joke, but it is difficult to say
anything serious about it. In the eighteenth century educated people were much preoccupied with the question of physiognomy,2 and it became fashionable. Lichtenberg analysed the subject critically but did not refrain from dabbling in it himself.s
Hegel endeavoured to grasp and settle it once and for all. 4 It was always tempting
to advance the solid, comprehensible elements, i.e. human physiognomy understood
as 'frozen' gesture, and to remain satisfied with this.
However, in the cultural world of the romantics, C. G. Carus6 once more developed a learned and systematic theory of human physiognomy, which can be
recommended for its careful comparative method to anyone interested in this subject. Carus wished 'to see and understand the whole world as a symbol of God, and
man as a symbol of God's idea of the soul'. His symbolic system, therefore, draws
into its context the whole cosmos as well as the fields of morphology and physiology. For him the symbolism is visible but not comparable; it is something direct
that cannot be mediated. Carus studies 'the outcome of the creative acts of idea, the
organisation and in particular the external appearance of the individual as a whole'.
From this we needs must arrive at a clearer understanding of his inner psychic being
and character. The moment of vision is conclusive, 'it is tlle capacity to discover the
kernel in the husk, the nature of the psychic idea in the symbol of the form'. Carus
wanted to tum this unconscious vision into a science and a practical art; he wanted
to know what were the basic principles which could be applied to countless individuals, and what practical skill was needed to apply the principles in the individual
case. In this general discussion, there is something most suggestive, which somehow
confirms our own vague and imprecise experience, but when he tries to conceptualise this into a science, he meets the same fate as others in the field. When he
comes to particulars, he ceases to be convincing. He tries measurement (organoscopy), describes body-surface according to its individual modelling (physiognomy),
observes changes in form during the course of life (pathognomy). He draws into
his net every scientific finding and anything that appears possible material from the
physiognomic point of view. Thus he accumulates a wealth of data and tries always
to keep the whole in view while he attends to the smallest detail. To him is due
the creation of the first and up to now the only basic 'scientific' system for the study
of physiognomy.
See the literature quoted by Bulle.
Lavater, Physiognomische Fragmente (Leipzig, 1775). Goethe, Cottasche }uhilaumsausgahe, 33,
pp. 20 if. Klages, Graphologische Monatschefte (1901), vol. 5, pp. 91-9'
8 Lichtenberg, tJher Physiognomik wider die Physiognomen (Gottingen, 1778).
, Hegel, Phiinomenologie des Geistes (Ausgabe Lassons, pp. 203 if.)
& C. G. Carus, Symholik der m.nschlichen Gestalt (Leipzig, I8S3).
1
If we have grasped what has been said above about the methods and
history of the study of physiognomy, we may still be doubtful whether
scientific research can replace intuition with any definite findings, but we are
not on that account prepared to ignore this whole field and let the subject
drop. Even if exact knowledge is not possible, such studies are an education
of our sensibility for form. Our responsiveness to form and shape is increased
and cultivated through the presentation of forms as concrete, observable
wholes, which we can fully accept without according them the status of
empirical facts of general application. They create for us rather an 'atmosphere'
without which wewould be the poorer when we come to study our psychiatric
realities. The artistic approach offers us something incomparable, but the
psychiatrist on his side can always try to represent the forms he sees as 'types'.
This has been done and we are impressed, though not by the theory, only by
the 'art', which enriches our mode of observation but does not tell us what to
think.
I. One such attempt was the once-famous 'theory of degeneration'. It was
supposed that in the morphological deviations of bodily form one could
detect the degenerate nature of an individual (signs of degeneration, stigmata
degenerationis). His character, his tendency to neurotic and mental illness, and
in particular his criminal predispositions, were also revealed.
These morphological abnormalities were, for example: Bodily proportions that
deviated markedly from average, e.g. too long legs in relation to the trunk; peculiar
head-formation, like turret-skull; deviant bone-formation, e.g. too small chin, extreme smallness of the mastoid bone; dental malformation; high palate; malformations such as harelip; excessive or absent body-hair; special hairy moles; shape of the
nose and ears (to which much attention was paid); attached ear-lobes, big and protruding ears, prominence of the Darwinian ear-fold, mobility of the ears.
This theory of degeneration tried to look into the deep substratum of life
from which psychic and somatic phenomena simultaneously spring. The
psychic degeneration-as shown in personality disorders (psychopathies),
psychoses and mental defect-was also supposed to declare itself in the
appropriate bodily deviations. This theory held something intuitively
plausible for contemporary thought. But once it tried to make a scientific
1 Rudolf Kassner, Die Grund/age tkr Physiognomik (Leipzig, 19:12), an essay which deals with
human physiognomy and certain experiences in an unmethodical way and reflects on the philolophical interpretations of the impressions.
166
theory out of this intuitive grasp of the human shape, it was applicable only
within extremely narrow limits.
If we are going to talk. of abnormal familial deviations (without thinking of
progressive degeneration) we have to conceive of certain constitutions, which
occur familially, and give these families a distinctive character which is
recognisable sometimes through quite slight indications. 1 In such cases the
signs of degeneration are connected with anomalies of the nervous system or
other organ-systems. They are the result of faulty development and group
themselves together in typical syndromes of morpholOgical and functional
signs (e.g. trembling, deafness). The most significant example is status
dysraphicus.
It has often been emphasised that we frequendy nnd stigmata such as these
in healthy people and many severe psychic abnormalities are found without
them yet this theory has had historical importance and however critically it is
reviewed it still has a certain validity. We may reject it scientifically but we
cannot be talked out of it completely~ We cannot draw any practical corisequences from it but we are unable t() be wholly indifferent to the forms
described. Degeneration is a C()ncept which, if one wants to get hold of it
. firmly in relation to the empirical facts, melts away in one's grip. It seems to
want to say something about the ultimate springs of life but fails to do so. It
can however do one thing. It can keep interest and enquiry alive and supply us
with a tenn for something which we see intuitively but for which no adequate
theory is as yet forthcoming. In addition it means from the start that we
abandon the study of physiognomy proper and treat the signs of degeneration
as symptoms, thus exchanging the scrutiny of the human physiognomy for a
naturalistic pseudo-science. Symbolism vanishes but the particular relationship
of symptom to degenerative disease with which one is left cannot be taken as
a medical fact and must definitely be disputed.:I
1. Kretschmer tried to relate body-build to psychic properties. His
theory is a comparable one in its methods but very different in content. He
distinguishes the dysplastic types, which occur in relatively few people and
then three main body-builds: leptosome (asthenic), athletic and pyknic. The
following are the main cues given by his descriptions:
(a) Leptosome: little increase in girth with undiminished growth in length,
slend~r, lanky people; narrow shoulders, narrow flat chests; sharp costal angle,
recedmg face owing to insufficient development of the chin, similarly a receding
forehead, resulting in an angular profile, with the tip of the nose as the vertex; nose
excesSively long.
Associated with the above is a schizothymic character: corresponding to the thin,
angular, sharp-nosed body we find an angular, cold, edgy nature.
F. Curtius, 'Ober Degenerationszeichen', Eugen. usw., vol. 3 (1953), p. 2.S.
2 Lombroso, Due Ursachen u. Belcampfung des Verhrechens (D) (Berlin, 1912.). Baer, 'Ober
jugendliche Marder', Arclz. Kriminalantlzrop., voL I I (1913), p. 160.
I Kretschmer, Korp,rhau u. Charalcter (Berlin, 192.I), 1940 edn., pp. 13, 14. Kretschmer and
Enke, Die Person/icUeit Jer Athletilcer (Leipzig, 193 6).
1
BODY AND MOVEMENT
(6) Pyknic: squat figure, soft, broad countenance on a short, thick neck, tendency
to put on fat; deep, round chest, fat belly, slenderly built motor-apparatus (shouldergirdle and extremities), skull large, round, broad and deep but not high; wellmodelled contours, harmonious proportions.
Associated with the above is the cyclothymic or syntonic character; a wellrounded, natural, open nature. Corresponding to the body-build, we find a balanced,
warm-hearted, accommodating character; they are people who are active in their
environment, frank and sociable, either on the serious side or rather cheerful.
(c) Athletic: broad, wide shoulders; a tall figure; strong bone-development;
strong muscles; thick skin; heavy bony structure; large hands and feet; high forehead; massive, high-vaulted head; strong, protruding chin; facial cirCumferenceelongated egg-shape; broad cheek bones and prominent supra-orbital ridges. The
facial skull protrudes in comparison with the cranium.
Associated with the above is a quiet, reflective nature to the extent of being
cumbersome and clumsy. There is a poverty of responsiveness, and due to this the
person appears very stable and his reactions massive. There is a dislike of movement, they are sparing of speech, and there is an absence of lightness and flexibility;
this leads to what has been called the 'viscous' temperament. 'A spirit of heaviness
lies over everything.'
Kretschmer's theory of the connection between body-build and character

is only one section of a much more comprehensive conception of man as a
whole, which will be discussed later on in this book (p. G.p). Here we need say
only one thing: These types are intuitively perceived forms, which enrich and
clarify our seeing in the same way as Art does, but not as a concept would.
We feel that we can see in the body-build-as we saw the psychic deviation in
the morphological degeneration-a certain type of character which has been
most vividly described by Kretschmer. But this enrichment of our vision does
not have any empirical significance and does not allow us to draw any conclusions. A single, well-defined case can empirically contradict any general
validity it may seem to have, yet if we take the theory on its own terms it is not
one which we would repudiate completely.
.
Kretschmer's book begins as follows: 'People think of the devil as thin, with a
pointed beard. Fat devils have an admixture of good-natured stupidity. A conspirator is hunchbacked and coughs behind his hand. The old witch has a thin and
bird-like face. Where there is wine and merriment, who is there but the fat knight,
Falstaff, with his red nose and gleaming patel The woman of the people with her
sound commonsense, stands hand on hip, sturdy and round as a ball. Saints look
emaciated; they are long-limbed, pale and gothic. In short: virtue and the devil
should have a sharp nose; humour a broad one.' He then takes as his motto for all
this, Caesar's remarks to Cassius:
'Let me have men about me that are fat;
Sleekheaded men and such as sleep o' nights;
Yond' Cassius has a lean and hungry look;
He thinks too much; such men are dangerous
Would he were fatterl .'
BODY AND MOVEMENT

268
Conrad comments on the unsurpassed description which then follows of leptosome and pyknic body-build and schizothyme and cyclothyme personalities. He says
quite rightly-underlining what is unscientific, particularly from the point of view
of the natural sciences-'Any attempt to improve on the picture would only distort and spoil it, like touching up the painting of one of the Old Masters.' Max
Schmidt expresses his enthusiasm also by saying, 'Kretschmer has given an almost
inspired description of the two types. If one thinks of all the different schizophrenic
and manic-depressive patients whom one has encountered in the past, and lets them
pass through one's mind, they will fall quite effortlessly into these two types.' In
Denmark-sotheDanishauthor writes-we find two historic cases, Christian VII and
Grundvig: 'These two personalities might well stand as a symbol for the two characteristic types of psychosis. Christian VII, the small, slender, asthenic leptosome,
degenerate in colour and schizophrenic; Grundtvig, the large, broad, corpulent and
pyknic cyclothyme.'
Indeed the descriptions affect us like a worlc ofart and the impact is one of direct
conviction. The achievement lies in the compelling force that makes the reader see
with Kretschmer's eyes. But it is precisely this which poses the question: exactly
WMt does this truthfulness mean!
Can we say with Conrad: 'We may be sure no fruity, comfortable or
cheerful soul inhabits that lean, lanky and narrow-chested body, nor is there
a dry, prim, sentimental soul in that fat, stubby-limbed and capacious frame.'?
I do not think so. Such certainty belongs to intuition, to the study of physiognomyand to this extent no further investigation is needed. But empirically it is
far from certain and there are constant contradictions by the individual case.
There have therefore been those who were not satisfied with direct, intuitive
insights of this sort. Instead they luwe counted how often character-type and bodybuild coincide in this way. Mere correlation appears in the place of an essential connection. But this means we embark on a radically different course. Correlations can
exist between phenomena which have no observable or essential relationship to each
other. When we find correlations, the next question is 'why?' The unity of the
human physiognomy cannot provide a cause, because its nature is not causal; it is
a plasticity that we somehow understand. In the second place, if it were the cause,
no exceptions must be found in the coincidence of the effects. The method of seeking correlations gives rise to a type of knowledge quite distinct from that gleaned
from the study of human physiognomy.
The paradox remains: We know practically nothing, yet it is in the nature
of the drive for knowledge to try and find some satisfactory shapes and forms
even where there is no exact knowledge, on which judgment may be based;
there is the urge at least to see. Anyone so engaged has to travel far before he
can predict or schematise his findings. Lichtenberg said long ago: 'I have
always found that those who expected most from the study of physiognomy,
which is a practical art, were those with a limited knowledge of the world.
People of wide knowledge are the best students of physiognomy and expect
most of the rules to be broken.' 'The study of physiognomy, next to prophecy,
is the most deceiving of all human arts that have ever been concocted by our
extravagant minds.'
2.
INVOLUNTARY GESTURE (MIMIK)
The study of physiognomy concerns itself with estahlish.ed bodily form as a

distinguishing characteristic of the psyche. The study of involuntary gesture
deals with bodily movement as a manifestation of psychic life. In the study of
physiognomy there is no principle which makes the connecti~n between ~ody
and psyche understandable, and which could serve us method1cally ~s a. rellable
criterion. In the study of involuntary gesture, however, such prmc1ples do
exist. It is here and not in the study of physiognomy that we stand on the
firm ground of insights that can be discussed.
(a) Types of bodily movement

We have to make some distinctions in order to visualise clearly what is
meant by involuntary gesture. We must first exclude those phenomena which
we discussed earlier on, the accompaniments and sequelae of psychic processes,
such as blushing, blanching, shaking at the knees, tremor, paralytic rigi~ity of
the face in acute fear, etc. These are movements which we do not d1rectly
'understand' but only link with psychic events through experience, without
any inner glimpse of the psyche.
.
In the second place we must distinguish voluntary movements from mvoluntary gesture. Vol~ntary movements have an intended goal, while the
expressive movements of involuntary gesture are unintentional. oluntary
movements include gesticulations, signs and indications (e.g. shakmg of the
head, nodding, waving) which by convention say something (though the
convention differs in different cultures). The movements are related to speech
as an incomplete means of communication. Involuntary gesture pro~er, h~~
ever has got no intention and does not consciously want to commumcate: 1t 1S
a universal human form of utterance, understood in part even by animals, so
it seems.
Movements ofinvolwuary gesture: for instance, a cheerful expression of face,
or a tense or sorrowful one, etc. These are involuntary and unintentional. All
voluntary movements, however, have an aspect of involuntary ges~r~, ?one
is quite like the other even if the same end is in view; they vary in the m~1v1dual
and according to the emotional state. The way someone looks at me, g1ves me
his hand, the way he walks, the timbre of his voice, it is all involuthntary eXthpre~
sion; it contains a self-revealing, unintentional content alongside e one at 1S
purposely intended.
. . . .
Among involuntary gestures, we may further d1stmgUlsh the followmg:
I. There are infinite nuances, a wealth of self-revealing movements, which ~on

stantly accompany psych.ic events and make them visible in the person's expressIOn.
They are transparently clear to others, and can be understood as the ceaseless play
BODY AND MOVEMENT
of a secret, sensitive resonance in the features, look and voice. To some extent these
phenomena are common to man and animals.
2. Laugking and cryingl are in a class apart. They are reactions to a human crisis;
small, somatic catastrophes in which the body, being so to speak at a loss, becomes
disorganised. But the disorganisation is still symbolic-symbolism is present in all
gesture-yet here the situation is not transparently clear to others because both
responses are marginal. Laughing and crying are exclusively human, they are not
shared by any animal, but for the human race they are universal.
3. There are certain movements which are marginal as between movements of
expression and somatic accompaniments. In spite of their reflex character, they seem
to have an element of expressiveness: yawning, stretching the limbs when tired.
Animals share these movements too.
4. All movement can merge into rkytlunic repetition. Klages2 has dealt with the
subject of the nature and universal significance of rhythm.
2. Movements are influenced by the personality which selects unwittingly their

mode and form according to what 'suits' it, what it feels is fine, fitting, stylish, sound
or desirable in some way. There is a drive for this self-presentation which uses 'keysymhols of tke personality' in shaping all involuntary gestures. Natural direct expressiveness then gets moulded by a more conscious expression, of which the person is
himself aware. Klages was the first to grasp this-particularly in the case of handwriting-and noted the way in which complex personal and social ideals take on
expressive shape.
3. Frequently repeated movements of gesture leave certain tracel in the body,
particularly in the face. The study of physiognomy, so far as It understan~1 the
traces of gesture, establishes certain forms of 'froten' ,esture and so may be seen al
part of the study of gesture, the only area in the whole study of physiognomy that
has some empirical basis for further exploration.1
(h) Understanding involuntary gesture-general principles

It lies outside our experience to say whether or not the morphological
processes that freeze into the forms of human physiognomy have sprung from
psychic impulses. On the other hand, however, it is our continual experience
that bodily movements are linked with the psyche, with its mood, purposes
and essential nature. The understanding of the movements of gesture has
therefore a good basis which can be tested and communicated. This relationship between the psyche and that movement which is its 'expression' has been
retluceJ to certain principles. These can render our immediate interpretations
conscious, control them, relate them and finally expand them. The principles
of expression have been recognised and formulated by eminent investigators. 8
They hold for all kinds of movement, voluntary and involuntary, self-revealing gestures of face, gait and posture and handwriting as the record of such
movement. There are two main principles:
I. Every inner activity is accompanied by a movement which is an understandable symbol for it. Bitter feelings, for instance, reveal themselves involuntarily by
movements connected with having a bitter taste in the mouth. Keen thinking goes
with a firm, fixed gaze directed to the near-distance as if some object stood there.
With involuntary gesture the person is not aware himself of the symbolisation, and
the observer, directly perceiving the bitterness or the keen attention, does not know
either in the first instance how he came to perceive it. Here we see a direct manifestation of the psyche. These symbolic processes have been investigated in great
detail; Piderit has studied gesture, Klages uses a wider context and in the case of
handwriting goes into the matter more minutely.
Plessner, achen u. Weinen (Arnheim, 1941).

I L Klages, Vom Wesen au Rhythmus. Pallat and Hilker, Kiinstlerische Korperschu/ung
(Breslau, 19~3, reprinted, Kampen and Sylt, 1933).
Piderit, Grund{iige aer Mimik u. Physiognomik (Braunschweig, 1868). Mimik u. Playsiognomik (Detnold, 1867), 3rd edn., 1919. Klages, Ausaruclcshewegung u. Gutaltungslcraji (Leipzig,
1936). Darwin, Der Ausaruclc aer Gemiitshew'IIungsn hei. Menschen u. Tieren (187~). Hendel's
1
(c) Psyclzopatlwlogical ohservations

I. We have only occasional, unsystematic descriptions of patients' involuntary gestures and the fixed forms of expression that arise from them.
Here are a few, haphazard examples:2
Tke passion for movement of manic patients, who make aimless movements for
the sheer sake of moving, out of 'delight' in it as such, and the drive to give vent
to exuberant excitement; pressure of movement in anxious patients who are always
seeking peace and respite, always trying to get rid of something, and run to and
fro in desperation, push against walls and gesticulate monotonously.
The indestructibly exuberant features of manic patients, exactly like those of
natural delight; the unnatural, silly, exaggerated jollity of kehepkrenics, the painful
dejectedness of cyclothymes appearing as a slight indication at the comers of the
mouth and eyes; the profoundly downcast, passively resigned expression of the
severe depression which turns into chronic melanckolia; the cold, apparently empty
expression of mute melancholies (even when the patients can talk about their distress it is not quite convincing); the distracted features and excited despair in the
alarming anxiety of agitated melancholia.
The dream-like, absentminded expression of certain patients with clouded consciousness, who seem to be revelling in a number of imaginary experiences; the empty
expression of many kysterical twiligkt states, which can change so easily into expressions of fright or worry or an ungenuine astonishment.
The empty, expressionless face of many demented patients, who sit around like
human vegetables with a fixed expression (sometimes perpetually smiling, sometimes defiant, sometimes dull, sometimes tormented); paranoid patients who stalk
about, dignified and grave, full of stoic calm and contempt; the sharp, piercing look
of the paranoid woman; her suspicious, mistrustful, testing and dogged countenance;
the sudden glance shot by some stuporous catatonics.
Bihliothek-phylogenetic viewpoint; he confuses expression proper with somatic accompaniments.
BUhler, Ausarucktheorie (Jena, 1933). Lersch, Gesicht u. Seele (MUnchen, 193~). Fischer, Ausaruck
aer Personlichkeit (Leipzig, 1934). Strehle, Analyse des Geharens (Berlin, 1935)
1 F. Lange, Die Sprache aes menschlichen Antlittes, eine wissenschaftliche Physiognomik
(MUnchen, 1937).
I Oppenheim, Allg. Z. Psychiatr., vol. 40, p. 840. Th. Kirchhoff, Der Gesichtsausaruck h.im
Guunaen u. h,im G,isteskranken (Berlin, J. Springer, 1922).
The shifting, soft, melting expression, the swimming eyes of hysterics, their
flirtatious, half-conscious, highly exaggerated looks.
The inconstant features and restless eyes of neurasthenics. The tom, tonnented
look of some early hehephrenics behind which surprisingly little psychic content is
to be found.
The loutish look of the ineducable, the brutal, animal expression of true moral
insanity; 'the sad eyes of the trapped animal' which Heyer noted in the childish,
retarded inmates of his institution.
Homburger described many of the 'motor fonns of expression'. 1 Heyer described
the state of certain personality disorders (psychopaths)-'hard, tight individuals,
every movement well controlled, nothing soft, supple, biddable or easy about them;
the whole bearing boardlike'.
Besides observations on bearing and movement as significent psychic

expression, attention has also been paid to the way in which expression in
its turn affects the psyche. Stance and posture are accompanied by an inner
posture and atmosphere. Hence the possible significance for the psychic state 2
of physical exercise and physical culture. We have a particular case of this
in the body posture during sleep.3 'Everyone has his sleep ritual or likes to
ensure certain conditions without which he cannot sleep' (Freud).
2. Laughing and crying are of special interest. This phenomenon can occur
as a physical compulsion in cases of bulbar paralysis. There is no psychic
motivation. Schizophrenics are often seen to laugh; melancholics are tearless;
depressives may sob loudly but get no relief.
3. Yawning' is a complex movement which occurs involuntarily and seems
akin to stretching. It occurs spontaneously on waking, during fatigue and
boredom. It seems a purely physical event but under certain conditions can be
an expressive movement. Landauer5 takes stretching as purely physiological
but has no evidence for this. We can think of a series of such reflexes including sneezing which never become expressive movements in this way.
4. For a long time attention has been directed to the rhythmical movements
and stereotypies of mental patients. Comparisons have been drawn between the
rhythmical movements of idiots and demented patients and the circling movements of wild animals in captivity. But so far no real analysis has been made. 8
Klasi1 has defined stereotypies as 'manifestations which are repeated over a long
period always in the same form. They are separated off from the person's,total
activity; that is, they are automatic and neither express a mood nor are they at
all appropriate to any objective purpose.' They are diverse in origin and meaning. They may be remnants of once meaningful movements or may spring
1 Bumke's Handhuch der Geisteskrankheiten (1932.). Also Z. Neur., vol. 78 (192.2.), p. 562.; and
vol. 8S (192.3), p. 2.74.
J. Faust, Aktive Entspannungshehandlung, 2.nd edn. (Stuttgart, 1938).
3 H. Thorner, Nervenar{t, vol. 4 (1931), p. 197.
, E. Levy, Z. Neur., vol. 72., p. 161.
I Landauer, Z. Neur., vol. 58, p. 2.96.
6 Cpo Fauser, AI/g. Z. Psychiatr., vol. 62. (190 5).
7 Klasi, (Joer die Bedeutung u. Entstehung der Stereotypien (Berlin, Karger, 19:12).
BODY AND MOVEMENT
from a delusional world; they may be rituals, movements of defence against

bodily hallucinations, and so on.
Since Klages the concept of rhythm has taken on a definite and narrower
meaning in contrast to 'beat'. Rhythm is living, infinitely variable. expn:ssion;
beat is mechanical, arbitrary repetition. Langeliiddeke1 has lnvestlgated
schizophrenics, manic-depressives and patients suffering from Parkinsonism
and has taken Klages' point of view.
3.
HANDWRITING
Handwriting is particularly suitable for the investigation of movements of

expression because it is a fixed form and can thus be more thoroughly examined.
Simulation usually plays little part. In the majority of people there is a great
deal of play-acting in their other expressive movements, from movements of
embarrassment (scratching the head, twic.1dling buttons) which like certain
laughter is intended to cover up something, right up to gestures confirmed by
constant exercise and habit. These have no special meaning but surround the
person with a wall of conventional expression behi.nd whic~ the real self.hides.
In handwriting, however, we see much less of this. The disadvantage IS that
valuable results can only be obtained when the handwriting is well established
and to some extent formed. It would take us too far afield if we were to discuss
the details of graphological understanding in respect of character, temperament
and mood and the regular changes that take place under different affects, during perso~ality development, in abnormal mental states and under different
experimental conditions. 2
As with all understandable phenomena that can only be understood as a
whole every individual feature of the writing has such complex relationships
and p~ssibilities that only a most thorough and detailed examination will give
us anything like a clear picture. The essay of Klages 3 shows us how even the
pressure used in writing can lead us on to the psychology of ~e whole
personality, provided we regard the effoxt as a movement of expreSS1On. The
older method of interpreting certain special 'signs' in the handwriting has been
completely discarded.
The writing of mental patientsil has been investigated chiefly from the
A. Langeliiddeke, 'Rhythmus u. Takt', Z. Neur., vol. II3 (192.8), p. I.
Klages, Die Prohleme tkr Graphologie (Leipzig, 1910); Handschrift u. Charakter:, :md ed~.
(Leipzig 191.0) Graphologischen Monatshefte (MUnclien, 1897-1908); and Graphologlsche PraxIS
(Miinch;n, 190;-8). Preyer, Zur Psychologie des. Schreihens (Hamburg, 1895, 191~). G. Me~er,
Die wissenschaftlichen Grundlagen der Graphologte Gena, 1901). R. Saudeck, WISSSflschaftl,che
Graphologie (Miinchen, 191.6); Experimentelle Graphologie (Berlin, 192.9).
a Klages, Zur Theorie des Schreihdrucks, Graphol. M. 6 and 7.
..
'Koster Die Schrift hei Geisteskranken (Leipzig, 1903). Erlenmeyer, D,e Schrift (1897).
Goldscheid:r, Arch. Psychiatr. (D), vol. 2.4. Kraepelin's Psycho!ogische Arheiten. Lamer, 'Manischdepressives Irresein', Z. Neur., vol. 2.0, p. 447. Arch. Psychiatr. (D), vol: 53, ~: I. AUg. Z. P?,.,
vol. 71,P. 195. Schonfeld and Menzel, Tuherkulose, Charakter u. Handschrift (Brunn, P~gue, Leipzig, 1934). Jakoby, Handschrift u. Sexualitat (Berlin, 1932.). Unger, 'Gelsteskrankhelt u. Handschrift', Z. N,ur., vol. Ip (1935), p. S69.
1
THE INDIVIDUAL'S PERSONAL WORLD
point of view of neurological disturbances. It has also been investigated from

the point of view ofcontent, but hardly at all as a form of psychic expression.
Paralytic handwriting has been described a long time ago: we get omissions,
reduplication ofletters, mistakes of meaning, tremor and ataxic phenomena in
moving the pen. Certain .tkmenting processes show themselves strikingly in the
handwriting: repetition of the .same word or letter in an otherwise orderly
script, fantastic flourishes and ornamentation of a manneristic and stereotyped
kind. In many organic dements the writing finally disintegrates into a completely
unformed scribble. Disturbances such as agraphia are analogous to aphasia:
otherwise healthy patients can no longer read words or write them or can do
neither. They write meaningless letters and syllables, in the same way as
patients with sensory aphasia speak. paraphasically. In manic and in depressive
states the writing shows typical changes in size, pressure and form (G. Meyer,
Lomer).
All these objectified meanings have an aspect which we can understand as

an involuntary expression of the psyche, something which we could call their
particular tone, melodic line, style or atmosphere. To this extent everytlUng
may be said to be mere expression and therefore-as language itself indicateshave a 'physiognomy' in the widest sense. Goethe interested himself in
Lavater's study of physiognomy. He enlarged the meaning to include the
entire range of human phenomena:
"74
SECTION TWO
THE )NDIVIDUAUS PERSONAL WORLD
(pSYCHOLOGY OF THE PERSONAL WORLD-WELTPSYCHOLOGIE)
We contrast the phenomena of expression with those other meaningful

objective psychic phenomena in all of which there is a meaning conceived,
intended or carried out by the individual himself. The meaning has to be understood before the psyche is understood. In this sense we understand the objective meaning, the rational content, the intended purpose and the aesthetic
vision in the sense-data of speech, written words and behaviour. Just as the
precondition for seeing anything at all is a sensitive capacity for the perception
of movement and form plus a certain trustworthiness of impression, so there
is a precondition for understanding the meaning of these objective mental
products whenever they occur. The precondition is a broad understanding of
the world of the mind and a wide experience. To acquire broad understanding
is only the first step; having taken it, we can proceed to comprehend meaning
directly as essentially the expression of an individual psyche. The same problems are encountered here as we met when considering the psychology of
expression.
We divide these objectified meanings into action in the world and pure
mental creation. To obtain clear concepts we must now describe action and
creation in a methodical manner, just as we described handwriting, movement
and bodily form. The more fundamental the content, the more we have to
leave the everyday world of common sense and look for appropriate scientific
concepts and an appropriate methodology (e.g. linguistics, aesthetics, the
humanities, etc.). But up to now psychopathology has confined itself only to
the simplest objective manifestations of this sort.
"75
The study of physiognomy 'deduces the inner from the outer' but what is the
'outer' in Man? Surely not just his naked fonn, his unintended gestures which
denote the forces within him and their interplay? A host of things modifies and
shrouds him: his social status, his habits, his possessions and his clothesl It would
seem extremely difficult, if not impossible, to penetrate all these different layers into
his innennost self, even find some fixed point among all these unknown quantities.
But we need not despair ... he is not only affected by all that envelops him; he too
takes effect on all this and so on himself and, as he is modified, so he modifies all
that is around him. Clothes and furniture help us to deduce a man's character. Nature
fonns man, man naturally transforms himself. Set in the vast universe, he builds his
own small world within it, makes his own fences and walls, and furnishes everything
after his own image. His social status and circumstances may well detennine his
surroundings but the way in which he lets himself be detennined is of the greatest
significance. He may furnish his world indifferently, as others of his kind, because
this is how he finds it. Indifference may grow into neglect. But he may also show
eagerness and energy, he may go on to higher levels or (which is not so common)
take a step back. It will not be held against me, I hope, that I try in this way to
enlarge the field of physiognomic study.
This organic, comprehensive view of human beings and of the way in

which they behave in their own world supplies the background for every
individual analysis. For this we must first differentiate our concepts as
follows: taking the individualfindings one by one, we can distinguish behaviour,
in the form of attitude and gesture, how a man presents himself to himself and
others; the way he has shaped his environment-his choice of clothing, dwelling
and his physical environment; the whole way he lives-how he acts, the paths
he selects, the entirety of his behaviour, of the environment he has shaped, and
of his usual repetitive, everyday conduct; overt deliberate actions, which represent specific volitional acts, deliberately designed for effect, with full awareness
of all that they imply.
These individual findings will bring us at last to some conception of the
patient's world,a conception of what he actually experiences as his reality. We
can grasp directly the transformation that has taken place, a transformation that
affects his world and his way of living in that world; that is, we can gralp the
whole new configuration of this patient's world, the only thing that ilve.
lucidity and meaning to the individual phenomena as they appear.
ANALYSIS OF CONDUCT
(a) Behaviour
Behaviour, especially in the minor things of everyday life, may be interpreted as a symptom of personality or of an emotional attitude, but usually
such interpretation is not elaborated as it tends to be rather vague and indefinite. We describe the patients' 'habitus' instead and try to depict the behaviour. Behaviour as such is not particularly valuable as an objective symptom but in studying it we get a clue from the idea ofpossible interpretation.
Individual pieces of behaviour are easy enough to name: e.g. nail-biting, destructiveness (tearing up linen), etc. In the old texts we find descriptions of how
patients behave when they get together on their own, at home, at work, out of
doors, indoors and we find classifications such as: sociable, solitary, restless, immobile, pacing about, the collector, etc.
The description of the many odd kinds of behaviour met with in chronic
states and acute psychoses is a task which falls to special psychiatry. What we
need, therefore, is to find some typical behaviour complexes rather than strings
of separate features. The following are a few examples:
Catatonic, and also hebephrenic, behaviour! is characterised by a dramatic
quality and theatrical posing. Patients declaim and recite with vivid and absurd
gesticulation: Trivialities are announced in a lofty manner as if the highest interest
of mankind were concerned. A displaced preference for serious matters shows itself
in a mannered, stereotyped fashion: Bearing and clothing become odd and strange.
The prophet lets his hair grow and assumes the appearance of an ascetic.
Hehephrenic behaviour is illustrated by the following letter, written by a patient
who was perfectly conscious and well oriented, after he had escaped from his father
during a walk outside the hospital, though he had been quickly caught again.
'Dearest Dad .. it was a pity you did not understand me . I am really not at
all ill you should have walked. I am now back in hospital because of your
galloping after me .. I hope you realise there is nothing wrong with me you
will understand I have to go back to my piano studies. I asked you again, please
forgive me, chasing after me made you a little heated don't be angry with me
over this, greeting to you all, most sincerely your self-reproachful, because he
couldn't-can't, can't couldn't (latest word!) escape from the hospital, Kart Fetch
me soon.'
During the examination of patients who consciously or unconsciously want to
conceal something, there is often a very characteristic 'talking round the point'. A
patient when asked about his hallucinations, which he previously had disclosed,
said: 'All the time one lives one hears voices; its only too easy for one to get the
wrong idea; the expression "one hears voices" is really a legal phrase. In the beginning I did hear something, but after I had been in this hospital for half a year I got
convinced that there could be no question of hearing voices in the popular sense
1
Kahlbaum, Die Katatonie (Berlin, 1874), pp. 31 fr. Hecker, 'Die Hebephrenie', Virchows Arch.,
vol.p.
1.77
of the word.' General remarks sometimes are all that one gets to hear: 'That not
so much' 'I can't say for certain . .' 'I would like to tell you, something is not
quite right .. .' . 'My enemy . ? people say so .. .' 'I'll tell you, if I have to
be so .. .'
In acute states we see any number of mannerisms and grimacings. Patients behave
quite incomprehensibly (though sometimes the motive appears when later on some
self-description is given). One patient may solemnly kiss the earth, again and again;
others devote themselves to a military drill; others clench their fists, beat wildly on
walls or furniture, assume strange postures.
At the start of a psychosis behaviour often shows restlessness, haste, irresponsibility. There is an apparent lack of feeling for everything, which is suddenly interrupted by an outbreak of strong feeling; uncertain, puzzled questions are asked of
everyone, an exaggerated attraction or repulsion is shown to relatives; there are
sudden, unexpected actions, journeys, long walks in the night. It is as if the adolescent years have returned. Attractions and interests change rapidly. Patients become
devout, become indifferent to erotic interests or inhibited. They seem only interested
in themselves and engrossed in themselves. People close to them notice their expression has changed, it is no longer naturat At first it is uncanny to see these
subtle changes, the smile becoming more of a grin, etc.
The behaviour of the cheerful, excited (manic) patient and the sad, retarded
(depressed) patient is directly self-evident.
In some reactive hysterical psychoses, childish hehayiour is particularly characteristic. Patients behave as if they had become children again (,retour a l'enfance'
-Janet). They cannot count, make gross mistakes, move helplessly like infants,
put naive questions, show their feelings like children, and generally give a 'silly'
effect. They do not seem to know how to do anything, like to be spoiled and
nursed, make childish boasts: 'I can drink such a big glass of beer, I can drink
70-80 glasses .' Such behaviour is an essential part of the Ganser-syndrome.
An example of paralytic hehayiour: A capable and respectable business man in
Vienna leaves his job when 33 years of age. A few days after that he is in Munich
and steals a wallet with 60 Marks in it from his room-mate, as well as a watch and
a waistcoat. Next day he buys a motor-bike for 860 Marks, and pays for it with a
Jooo-mark note. He has several such notes as well as a purse with 250 pfennig
pieces. He does not know how to ride the bike and pushes it. Next day he has his
motor-bike repaired in Nurnberg. Meanwhile he tells everyone that he wants to go
to Karlsruhe where his business is. It is noticed however that he cannot ride the bike
and the firm persuade him to go to Karlsruhe by train and they will send it after
him. A few days later the motor-bike is returned to them, 'addressee unknown'. In
Karlsruhe meanwhile the patient has perpetrated a few thefts at his hotel. He sells
some stolen shoes to a shoemaker for 3 Marks. He introduces himself as the editor
of the Badisches Landes'(.eitung and says he wants to go to the States. He buys three
pairs of socks, and a camera but by evening he has been arrested and taken to the
mental hospital at Heidelberg. The dilapidated man has no insight, comments on
his thefts, 'everyone can slip up sometime'; otherwise he adjusts to his stay in hospital, satisfied and apathetic. He can be talked into any kind of notion; memory and
power of registration are very poor; he talks all kinds of nonsense all day long.
Soon the physical symptoms that had been noticed immediately began to increase
and a severe paralytic dementia developed.
(0) The shape given to the environment

Housing, clothing, and environment all feel our impact whether we are
conscious of this or not, and they may be considered as the very emanation of
human nature. Nowadays we see little of this" in our patients. Mental hospitals
do not afford much opportunity with their smooth walls, hygenic equipment
and everything bare, cold, strange and impersonal. In some nursing homes,
however, we see sometimes how characteristically and with what affection
chronic patients will shape their environment, how they collect peculiar
treasures and arrange them in strange patterns. We can also see how greatly
attached some patients are to this private world of theirs and how all their
happiness often depends on having possession of one small room they can call
their own.
(c) The whole way oflifo

A patient's whole way of life is built up of behaviour and actions that repeat themselves endlessly. They go to make up his general conduct in regard
to others, his work and his family. From the patient's life history we can often
see whether we are dealing with some development of an unchanging 'Anlage'
or whether everything points to an alteration in the whole conduct from a
given point in time.
Our destinies depend a good deal on the details and small circumstances
which we have created for ourselves but rather more perhaps than we usually
care to think on the type of our personality, and great good fortune is sometimes understandable as the direct result of a person's attitude in that he has
taken quick advantage of an opportunity which others have let slide. It is in
this sense that we try to understand a person's fate as in part at least the direct
product of himself.
(d) Overt actions

The mentally ill person can live outside hospital and not be primarily
conspicuous for those symptoms which later strike us as important and basic
features of the illness (e.g. subjective experiences). What makes him conspicuous is his noticeahle oyert social conduct. From the standpoint of-psychological analysis, this is something 'peripheral', but individual actions are so
striking that they often come into the centre of consideration as something
ominous both for the community and the patient.
The ordinary environment always stresses the content of the activity and originally scientific psychiatry was no exception. Different modes ofaction were designated
according to characteristic content and classified as different illnesses. Psychiatry thus
built up a theory of monomania, which was soon discarded as it was only concerned
with a description of externals; a few of the names still survive: kleptomania, 1
pyromania, dipsomania,2 nymphomania, homicidal monomania, etc.
1
G. Schmidt, Z6I. Neurol., vol. 9z (1939).
Gaupp, Die Dipsomanie (Jena, 1901).
'-79
Wandering, suicide, refusal of food and above all crime are the overt
actions of patients that achieve most notoriety.
Wanderingl is observed in paranoiacs who go from place to place hoping to
escape persecution; also in demented patients who can no longer make any social
adjustment but let fate drive them aimlessly up and down the country. It can also
be observed in melancholic patients who will wander about in anxious distress but
we come across it mostly in the form of particular states such as the lo-calledfoluestates.
Fugue-states imply wandering which begins
usually without any adequate understandable connection with the preceding psychic state; they do not
appear as the sequelae of chronic disorder. The wandering has no plan. and there is
no destination. 'Fugue-states for the most part may be regarded as a morbid "action
of constitutionally degenerate individuals to states of dysp!aoria. These states of
dysphoria may be autoc!at!aonous adverse moods. Insignificant factors in the environment may however precipitate t!aem. The tendency to run away may become !aahitual
and it can then be precipitated by smaller and smaller stimuli' (Heilbronner).
Suicide' when due to psychosis may be the result of extreme mental anguish in
melancholia, an extreme weariness of living and utter despair or, in dementias, it may
spring from a sudden impulse. A half-hearted attempt at suicide is not so uncommon. The individual sees to it that some lucky chance saves him at the right
moment. Most suicides, however, are not committed by the mentally ill but by
people who are abnormally disposed (psychopaths). The percentage of suicide in
psychotic patients as against the total number of suicides varies with different
authors from 3 per cent to 66 per cent. Gruhle assumes that some 10 per cent to
10 per cent of all suicides are due to genuine psychosis. Suicide in really mentally
ill people is characterised by a particular cruelty and by the tenacity with which the
attempt is repeated if it miscarried in any way. Often psychosis can be recognised
by this one feature alone.
In acutely ill patients we sometimes come across brutal attempts at self-mutilation; they gouge out their own eyes, cut off the penis, etc.3
There are a number of psychic reasons for the refusal to eat:' conscious intention
to commit suicide; total absence of appetite; disdain of food; fear of being poisoned;
blocking when offered food (sometimes these patients will eat when unobserved);
retardation of all psychic life to the extent of stupor. Other patients on the contrary
will eat everything eatable and uneatable; everything they come across goes into
their mouth; they will eat faeces, drink urine.
Sometimes patients will later give their reason for not eating: for instance, '1
have lost the feel of my body and think I have become a spirit which lives on air
and love .. .' '1 don't need to eat any longer; I am waiting for paradise to feed on
fruits' ... 'Latterly food revolts me, 1 think it is human flesh or live animals which
I can see moving' (Gruhle).
suaa'NY,
1 Ludwig Mayer, Der WanJertrieh, Diss. (Wiirzburg, 1934). Stier, Fahnenf/ucltt u. uru"auhte
Entfirnung (Halle, 1918). Heilbronner, 'Ober Fugue u. fugueahnliche Zustiinde', Jh. Psycltiatr,
vol. ~3 (1903), p. 107.
a H. W. Gruhle, Selhstmord (Leipzig, 1940) (excellent informative review). See my Pltilosophie
(193~), vol. ~, pp. 300-14, for a philosophical discussion.
I Freymuth, Allg. Z. Psycltiatr., vol. 51, p. zoo. Flagge, Arch. Psycltiatr. (D), vol. II, p. 184.
, KrUger, All,. Z. Psycltiatr., vol. 69 (1912.), p. )z6.
The texts 1 on criminal psychology give good orientation in regard to the crimes
committed by mental patients and people suffering from personality disorders
(psychopaths).
Persecuted paranoiacs not only write to the papers, compose pamphlets, write to
the Public Prosecutor, but take their own steps to murder; they not only write loveletters to famous people but will attack the supposed mistress in the street. The
despairing melancholic kills his family as well as himself. Patients in twilight states
may become violent as a result of sudden delusional notions or some accidental
stimulus.
An especially alarming event is the meaningless murder committed in the preceding or initial stages ofschi{ophrenia. Motivation appears lacking, the deed is carried
out with an unfeeling callousness, there is no insight or regret. The person talks
with an alien indifference of what he has done. These really sick people have not
been recognised as such by those around them and often not by their own doctor.
They consider themselves quite well but it is impossible really to understand what
they have done. Only later on does diagnosis become certain. 2
takes his ways and byways and is the material from which he currently builds
his personal world.
It is not the task of psychopathology to investigate all this but it is important for any psychopathologist to have some orientation here and be
factually informed about the concrete worlds from which his patients come.
The question arises whether there may be transformations in a psychopathological sense, whether there are specific 'private worlds' in the case of
psychotics and psychopaths (personality disorders). Or whether all 'abnormal'
worlds are only a particular realisation of forms and components which are
essentially universal and historical and have nothing to do with being sick or
well. In this case it is only the mode of their realisation, and the singular way
in which they are experienced, which could be called abnormal.
In every case it is most rewarding to try and grasp this abnormal world
as such, whenever it may be open to our observation. Patients' conduct,
actions, ways of thinking and knowing become connected meaningfully in all
their detail once we have a comprehensive picture of their transformed world
as a whole; then, given the over-all context, they become understandable even
if the total structure has to remain incomprehensible to any form of genetic
understanding. 1
Two distinctions have to be made: there is the constant metamorphosis of
all human worlds through the processes of culture, the historical manifold, and
there is an 'llTZhistorical variety of psychopathological possibilities. L. Binswanger reminds us that Hegel's thesis still holds: 'Individuality is its own
world'. But we can investigate it either as a cultural, historical phenomenon or
as a psychological or psychopathological one. Whether and when psychopathological world-pictures, in themselves unhistorical, have had any relevance
for history and culture is a matter for historical research but no unequivocal
answers have yet been found.
The fact ofa 'personal world' is both a subjective and ohjective phenomenon.
Just as feelings give rise to thoughts which clarify the feelings and increase
them by acting back on them, so the subject's total frame of reference grows
up into a world, which manifests itself subjectively in emotional atmospheres,
feelings, states of mind, and objectively in opinions, mental content, ideas and
symbols.
When does a 'personal world' become abnormal? The normal world is
characterised by objective human ties, a mutuality in which all men meet; it is
a satisfying world, a world that brings increase and makes life unfold. We can
speak of an abnormal personal world: (I) if it springs from a specific type of
event, which can be empirically recognised, e.g. the schizophrenic process,
2.
TRANSFORMATION OF THE PERSONAL WORLD
Every creature and hence every man lives in a world which surrounds him
( Umwelt), that is, the world which the subject apperceives and makes his own,
which becomes active in him and on which, he in his tum, acts. The objective
setting (ohjelctive Umgehung) is all that is there for the observer even if not there
for the subject who characteristically lives as if it were not there. The picture
of the world (Welthild) is that part of the surrounding world of which the
individual has become conscious and which has reality for him. The surrounding world and the objective setting both include more than the world-picture
does: they include all that is unconsciously present in the surroundings, all that
is actually effective and existent in feeling and mood, all that is simply the
objective setting and all that has taken unknown effect.
The concrete world of the individual always develops historically. It
stands within a tradition and always exists in society and community. Therefore any inquiry into how a human being lives in the world and how different
he may find it must be of an historical and social nature. We are presented
with a wealth of complicated structures which we may call after the particular
human manifestation prevailing at the time: e.g. man as a creature of instinct,
economic man, man in power, professional man, the worker, the peasant, etc.
The world which objectively exists provides the space in which the individual
1 v. Krafft-Ebing, Gerichtliche Psyclwpathologie. Cramer, Gerichtliche Psychiatrie. Hoche,
Handhuch Jer gerichtlichen Psychiatrie, 3rd edn. Further: Monatsschrift far Kriminalhiologie u.
Strafrechtsreform, Bisher, pnd edn.
I Glaser, 'Totungsdelikt als Symptom von beginnender Schizophrenie', Z. Neur., vol. 150
(1934), p. I. K. Wilmans, 'Ober Morde im Prodromalstadium der Schizophrenie', Z. Neur., vol. 170
(1940), p. 583. BUrger-Prinz, Mschr. Krim., vol. p (1941), p. 149. Schottky, 'Ober Brandstiftungen', Z. Neur., vol. 173 (1941), p. 109.
1 von Gebsattel, E. Straus, von Bayer, L. Binswanger, Kunz, all make valuable contributions.
Here we are dealing only with the descriptive aspect of such enquiries. What they try to achieve
in the way of a 'constructive-genetic' psychology and anthropology is discussed later (p. 540).
It sometimes may seem that these authors are only describing well-known findings in another
way, but it is just in this fresh description that we find something essentially new, a concept of
the whole that poses fresh questions.
even though the products of this world may be thoroughly positive. (2) if it
divides people instead of bringing them together. (3) if it narrows down progressively, atrophies, no longer has any expanding or heightening effects;
(4) if it dies away altogether, and the feeling vanishes of 'being in secure
possession of spiritual and material goods, the firm ground in which the
personality roots and from which it gains the heart to achieve its potentialities
and enjoy its growth' (Ideler). Children who are uprooted from their own
world at an early age fall prey to destructive nostalgia; so, at the beginning of
psychoses, the transformation of the person's world may become an annihilating and ruinous catastrophe.
We cannot say how far this study of personal worlds will lead, we can only
attempt it. Formulations of a comprehensive and general character may sound
impressive but their use is limited. The chief thing is how successful can one
be in presenting these concrete, private universes clearly and convincingly for
purposes of observation. What sort of world is the patient'S world, seen with
his eyes? Here are a few reports:
community. But we find just the opposite. They hardly ever understand each
other; if anything, a healthy person understands them better. There are, however, exceptions. These should be of the greatest interest. We can in this way
obtain indirectly an objective picture of a typical schizophrenic world. A
community of schizophrenics is certainly almost an impossibility, since in every
case it has to grow artificially and is not there naturally, as with all communities
of healthy people. In acute psychoses lack of awareness excludes any communal
life anyway. In the chronic end states, however, it is the individual rigidity
and the pervading egocentricity of the delusion that precludes any communal
life, or almost so. A number of favourable conditions have to coincide for any
schizophrenic community to arise and grow. We have found that it can happen
and on occasion has actually existed. This is of some importance. v. Bayer
observes:
(a) The worlds of schizophrenic patients

Schizophrenic psychic life, particularly thinking and delusion, can be
analysed as a particular phenomenon of experience (experience of primary
delusion) and as a disturbance of the thought-process (schizophrenic thinking).
In both cases attention has to be given to the form of the disturbance. We may
rightly feel that this is an advance on the old classification of delusion according to content, but we should be wrong to neglect the question of the possible
components of the disturbance, the enquiry into the specific schizophrenic
nature of the patient's world-formation. There is without doubt a typical and
common connection between content and psychosis: delusions of catastrophe,
coslqk delusions, delusions of reprieve, rather less common but still very
characteristic delusions of persecution, of jealousy, of marriage, etc. One effect
of the change in personality already shows itself in connection with the primary
experience of delusion, namely that the content is held to with the utmost
conviction. von Bayer! quite rightly says the schizophrenic world discloses
itself in the delusion more tangibly, vividly and in greater detail than in any
other of the psychopathological phenomena. He finds that the formal changes
in experience and function never by themselves define the nature of the
schizophrenic psychic life satisfactorily. Rather it is an established fact that
schizophrenia brings with it a transformation of the content of experience. It is
not merely chance contents of a general human kind haphazardly interpreted
into meaningless structures, but primary contents themselves that constitute
the character of the disturbance.
Schizophrenics, however, are not surrounded by a single schizophrenic
world, but by a number of such worlds. If there were a single, uniform worldformation schizophrenics would understand each other and form their own
1
W. v. Bayer, 'Ober konformen Wahn', Z. Neur., vol. 140 (1932), p. 398.
A married couple fell ill simultaneously with a schizophrenic process, and this
enabled their delusions to develop in common; it spread to the children (who were
healthy and in them the illness was only 'induced'). A family delusion was elaborated
with a common content and common behaviour resulted. They developed common
ideas as to the origin and course of the persecution directed against them; 'people
talk about them, newspapers allude to them; people are sent to spy on them; some
machine hums and blows evil-smelling fumes into the house, and projects magic
pictures and shapes on to the ceiling'. The husband tended to have visual, the wife
acoustic hallucinations. The man reported thought-withdrawal, the wife had experiences of being bound. The community-aspect lies in the content not so much
in the formal aspect of the disturbances. They achieved a form of understanding in
a world they knew in common, in which the individual peculiarities of the separate
experiences were absorbed into the common whole: 'we are persecuted; whenever
we encounter the outside world, the persecution is there'. So these patients with
their children lived as a group in a world of their own and mutually afHicted. Persecution and threats continually increased in their environment, the Authorities, the
Republic, the Catholics, etc., were all acting against the family. Persecution came
from all directions, from the whole of the world that surrounded them, near and
far. The persecutors were always sly and secret, allusions always hidden, something
caught in passing, showing that they were being controlled, talked about or mocked.
Secret machinations assumed vast proportions. The patients were ringed round by
a world of enemies, in a world which they understood in common, constantly
nourished on new experiences. The result was common action, e.g. measures of
defence against the 'machine', alterations to the house, plans to discover the persecutors, etc. The last result of all was the admission to hospital.
The means of communication were of course no different from those used

by healthy people; logical constructions, the giving of reasons and information,
systematising, with daily repetition and confirmation. The content of the communication, however, was the delusion that had risen from the springs of
schizophrenic experience. Because of the actual proximity of the family members this became something which they all could share. We cannot unfortunately answer the question whether the patients understood among themselves
something which we fail to understand. If this were so, we should be able to

see at last the specific content of a schizophrenic world. The putting of the
question is more important than the empirical answers so far obtained. In
v. Bayer's case the delusional content was only one of personal persecution,
a relatively trivial content. How would if be if one encountered the not very
likely possibility of a schizophrenic community united in common delusions
of a merciful cosmos, a content which they mutually elaborate as true by means
of their common experience of it?
For the time being the question stays open: why is schizophrenia in its
initial stages so often (though not in the majority of cases) a process of cosmic,
religious or metaphysical revelation? It is an extremely impressive fact: this
exhibition of fine and subtle understanding, this impossible, shattering pianoperformance, this masterly creativity (van Gogh, H61derlin), these peculiar
experiences of the end of the world or the creation of fresh ones, these spiritual
revelations and this grim daily struggle in the transitional periods between
health and collapse. Such experiences cannot be grasped simply in terms of the
psychosis which is sweeping the victim out of his familiar world, an objective
symbol as it were of the radical, destructive event attacking him. Even if we
speak of existence or the psyche as disintegrating, we are still only using
analogies. We observe that a new world has come into being and so far that is
the only fact we have.
Or if anyone who had been there came into my flat, I found my movements restricted. I got the feeling that the room was very small and that my dress was touching everything. I washed everything in Dettol to get some peace. Everything got
large again and I felt I had room. If I wanted to go to the shops and there was
someone in the shop, I couldn't go in because the person might come up against
me; so I got no peace all day long and the thing persecuted me all the time. Sometimes I had to wipe something off, here or there, sometimes I had to wash. Pictures
in the papers which showed such things troubled me. If my hand touched them,
I had to wash. I cannot write it all down, there is too much that upsets me. Inside
I am in a constant turmoil.
(h) The worlds of ohsessional patients

The obsessional patient is pursued by ideas and images which not only
seem to him alien but silly, and yet he has to keep to them as if they were true.
Ifhe does not do this he is overtaken by unbearable anxiety. The patient, for
instance, finds he must do something or else someone will die, or something
dreadful will happen. It is as ifhis doing and thinking can obstruct or influence
events in a magical way. His thoughts become built into a system of meanings
and his actions into a system of ceremonial rituals. But whatever he does or
thinks, a doubt is always left behind whether his performance has been correct
or complete. The doubt forces him to start all over again.
Straus1 reports on the self-description of a 40-year-old obsessional patient,
who was 'contaminated' with everything connected with death, corruption,
graveyards, etc., and had constantly to defend herself against this 'contamination' and undo it. In her self-description she even had to leave out any words
so related and there are therefore certain gaps:
In January 1931 a very dear friend. His wife came to see us every Sunday
after she had been to .. At first this did not trouble me. After 4-<> months I felt
uneasy about her gloves, then her coat, her shoes, etc. I saw to it these did not get
too near me. As we lived close to ... everyone who went there made me uneasy,
and quite a number go. If any of these people touched me, I had to wash my clothing.
1 E. Straus, 'Ein Beitrag zur Pathologie cler Zwangserscheinungen', Moe!'r. Psyc!.iatr., vol. 98
(1938), p. 61.
v. Gebsattel 1 gives an unusually impressive description of how these

patients live in their own peculiar world, or rather how they lose their own
life, world and all, in the trap of a magical mechanism:
Certain actions have to be repeated endlessly by the patients; they have to be
endlessly controlling or making sure, they have to carry out something which is
never completed until they are exhausted; all the time they are convinced of the
nonsensical nature of their activity. The hand-washing, the rituals and ceremonies
are a defence against disaster. They mean something different from what they mean
to the beholder: everywhere contamination threatens, corruption and death-all
kinds of disintegration. It is a magical world, though there is no belief in it; yet
the obsessional patient has fallen into it; it is a pseudo-magical counter-world. It
becomes restricted increasingly to negative meanings. The patient only responds to
contents which symbolise loss or danger. The friendly, inviting forces of existence
vanish, giving place to hostile and repellent ones. There is nothing that is harmless,
natural or obvious. The world has narrowed to an artificial uniformity, a rigid,
strictly regulated unchangeability. The patient is always in action but nothing is
achieved. 'There is restless exertion without a break; he is always trying to cope
with an enemy who is always behind him.' Existence becomes for him a move
towards non-existence in the images of 'dirt or faeces, poison or fire, all that is ugly,
impure or corpse-like'-and a futile defence against such a move. The countenance
of the world has contracted to sheer hostility. But this world ceases to be a world
as things undergo increasing derealisation. They no longer are, they only have
meanings, and negative ones at that. There is a loss of solidity, richness and form,
and hence of reality; the world is no more. The patient however is seized by a
frightful feeling of being driven, because the whole apparatus of measures which
must be taken if the patient is to do what he wants grows more and more complicated.
The counter-compulsions and the auxiliary structures grow endlessly and increase
the impossibility of reaching the desired goal. The patient is now never finished, but
only stops through exhaustion. Since the patient knows the absurdity of what she
does, but cannot stop doing it, she shies away from onlookers. 'Few doctors can
have seen a patient like H. H., who goes through the most fantastic manipulations
for hours when drying his limbs, or practices endless puppet-like compulsions.
E. Sp. in the same way will lock herself in when she stands in the middle of her
room in the evening, and carries on into the early morning with her repetitive compulsions, half senseless with exhaustion, gesticulating into the air and imitating the
never-completed task of washing her stockings.'
1
v. Gebsattel, 'Die Welt cler Zwangskranken', Moe"r. PsyclWtr., vol. 99 (1938), p.
10.
286
PSYCHE OBJECTIFIED IN ACHIEVEMENT
v. Gebsattel compares the world of the ananJ.:asts with that of the paranoics.
Both live in worlds that have lost their candour, both see meanings everywhere in meaningless occurrences. No accident can be treated any more as
mere chance. There are only intentions. Both show us indirectly how much
we need a world that does not take any notice of us but to which we yet belong.
The obsessional paitent however knows that the meanings that come to him
are nonsensical. For the paranoic patient the meaning of the phenomena is
integral with its reality. For the anankast there is still left a glimmer of former
reality with its characteristics of harmless forthrightness. He cannot attain to
this but he can still glimpse it through the 'Walpurgis' night of his magic
meanings. The paranoic retains a measure of trust and naturalness in his
delusional world, and a portion of certainty and conviction which has no
analogue in the feverish restlessness of the anankast. Even that dreadful disorder, schizophrenia, with its delusions, might seem a respite in face of the
restless chase of the wideawake mind, knowing otherwise yet helpless in the
grip of its obsession. The obsessional patient in his small corner of compelling
magical performance seems to see the whole world vanishing from him, with
all his senses alive and intact to tell him so.
The world of the obsessional patient has two basic characteristics: It is a
transformation of everything into threat, fear, formlessness, uncleanness, rot
and death; and it is such a world only because of a magic meaning which
supplies the content of the compulsive phenomena, but which is wholly
negative: the magic is compelling, but the mind sees it as altogether absurd.
altered state, in which, it is true, a temporary transformation does take place;

this transformation, however, does not contribute anything essential in respect
of the whole it represents (which can only be grasped in the form of the subjective experience of the state, and as a change in the flow of the person's
psychic life). Analysis of the world of the ohsessional patient seems more
productive; it has brought out very clearly an integration of a very peculiar
kind. The enquiry into the schitophrenic worlds takes us furthest into fundamentals, but here it is only the problem that has grown in significance, the
actual answers are sparse.
(c) The worlds ofpatients with y/ight-of-ideas'

1. Binswanger has tried to understand these worlds as if they were meaningful wholes. 1
There is a mood for a 'joyful existence', a basic attitude of 'bounding life' which
makes the world look flat, not only this but it grows distant and faint for the patient
and gives to his rapid, always distractible grasp of what is near and far, an absorption in the moment, a haste and confusion of movement, a ceaseless series of distractions. His world is pliant and variegated, bright and rosy. All that is left for
curiosity and activity is a chatter of words and a play with speech. According to
Binswanger there is, all the same, a specific pattern in this particular world that
gives it a meaning as a whole. It has grown into a peculiar world of its own, cOnditioned by the spirit which illuminates it from within; this vital experience brings
about immense vigour, the melting of boundaries, wholesale intrusions and the
crowding together of things, an ineffective busyness, a general flitting, a press of
talk and grandiloquent speech; in short, the whole behaviour of the manic state.
Let us compare these various attempts to understand the meaningful
structure of such worlds. From this point of view the illumination of the
fligkt of ideas seems only to catch at something quite superficial. Here we are
not dealing with any real transformation of a person's world, but with an
1
L. Binswanger, Okr IJe6lljlucAt (Zuridt, 1933).
SECTION THREE
THE PSYCHE OBJECTIFIED IN KNOWLEDGE AND
ACHIEVEMENT
(PSYCHOLOGY OF CREATIVITY- WERKPSYCHOLOGIE)
Psychic life is perpetually engaged in the process of making itself objective.

It externalises itself through the drive to activity, the drive to express, to represent and communicate. Finally comes the pure mental drive, the wish to see
clearly what is, what I am and what these other basic drives have brought
about. This final effort to objectify might also be expressed as follows: What
has become objective should now be comprehended and patterned into a
general objectivity. I want to know what I know and understand what it is I
have understood.
The basic phenomenon of mind is that it arises on psychological
ground but is not something psychic in itself; it is an objective meaning, a
world which others share. The individual acquires a mind solely through
sharing in the general mind which is historically transmitted and at any given
moment is defined for him in a contemporary form. The general or objective
mind is currently present in social habits, ideas and communal norms, in
language and in the achievements of science, poetry and art. It is also present
in all our institutions.
This objective mind is substantially valid and cannot fall sick. But the
individual can fall sick in the way in which he partakes in it and reproduces it.
Moreover almost all normal and abnormal psychic events imprint themselves
somehow on the objective mind according to the way in which it appears to the
individual. But if mind in itself cannot fall ill how is the individual seen to be
sick in this respect? By reason of deficiencies, losses, distortions and inversions
and everything contrary to normal in the realisation of his part in mind; also by
reason of a specific kind ofproductivity, which indicates sickness not so much in
its results but in its source (Van Gogh's pictures, Holderlin's later hymns);
lastly by reason of the positive significance which patients give to these deficiencies
and abnormalities. The essence of being human and of being a sick human
288
2.89
shows itself in the way in which the individual appropriates structures of the
mind to his own use and modifies them.
A further basic phenomenon of mind is that only that exists for the psyche
which acquires objective mental form, but whatever has acquired this form
at once acquires a specific reality which impresses itself upon the psyche.
Words, once formed, are like something insurmountable, and the psyche is at
once confined by the mind through which it grows real.
Lastly, it is a basic phenomenon of mind that it can only become real if
some psyche receives or reproduces it. The genuineness of this mental reality
is inseparable from the authenticity of the psychic events that mediate it. But
since it is through structure, modes of speech and diverse forms of activity and
behaviour that mind becomes objective, automatisms of speech, conventional
activity and gesture may substitute for the genuineness of authentic reproduction. Genuine symbols vanish into supposedly known contents of superstition; rationalisation supplants the authentic source. Both these factors play
a significant part in psychic illness. On the one hand we find a maximum of
mechanical and automatic behaviour and on the other a disturbing vigour of
experience which overwhelms the psyche. The most extreme possibilities are
realised in the illness.
We will now glance at the mental productivity of patients, which is a huge
problem and we do no more than touch upon it briefly.
in the general manner, such as the imitation of infantile speech (agrammatism)

in hysterical states, etc. l
(2) The question of the autonomy of speech. Disturbances in the speechapparatus of a neurological character are to be distinguished from the transformations in speech due to psychic changes while the speech apparatus itself
remains intact. A vast number of phenomena appear to lie between these two
(psychotic speech-disturbances-see pp. 191 ff.), and belong properly to
neither. They suggest that there is such a thing as autonomy of speech. In this
connection we notice peculiar speech-structures and it is difficult to see their
derivation; it is just as if speech developed a quality of independence, was
producing on its own or having a disorder of its own. It is not an independence of the speech-apparatus but of mentation which appears in pure form in
speech. The transformation of the individual and of his experience of mental
productivity appears not as something secondary in his speech but primarily
as speech. Speech may be called a tool and in this sense mind and tools are not
in opposition but mutually shape each other; in the marginal case however
they fuse into one; something purely linguistic. Later this becomes a factor in
mental achievement which may leave an imprint on literature. The excellent
work of Mette 2 draws our attention to this in a very fruitful way. .
(3) Formation of new words and private language. The formation of new
words 3 has long been noticed as an abnormality of speech. Some patients only
produce one or two such words; but others produce so many that they seem
to have produced a private language of their own, though it remains unintelligible to us. We can group these new word-formations according to how
they originate: r. New words are formed quite intentionally to describe feelings
or things for which customary speech has not yet found words. These selfstructured 'technical terms' (termini technici) are to some extent quite
original and the etymology is incomprehensible. 2. New words are formed
rmintentionally, particularly in acute states, are then used secondarily to denote
something and get taken over into the chronic state. A patient of Pfersdorff
described certain of his hallucinatory phenomena as 'sensuous weapons'
(sinnliche Gewehre). The patient is asked, 'What does this mean?' and he says,
'The words come to me like that, there is no explanation.' In acute psychoses
we also find that recognised words have been given a different meaning:
A patient says: I used some words as I said before to express ideas quite different
from what they customarily expressed-they had acquired a different meaning for
me: for example, 'scabby', which I used quite comfortably for 'brave and plucky';
'Gohn', the argot word for 'muck-raker', was used for a woman, rather like the
student's 'char'. Ideas pressed thickly and I could not find exactly the right word
for them, so I babbled inventively, like small children do, and created terms to my
own taste such as 'Wuttas' for 'pigeons' (Forel).
I.
INDIVIDUAL INSTANCES OF CREATIVE WORK
(a) Speech. (cp. pp. 185 ff.).
Communication between rational beings and with their own selves is conducted by means of speech. Speech is a precondition for thinking (speechless
thought only occurs as a passing phase within spoken thought, otherwise it
remains as indistinct and broken as the thinking of apes).
Speech is the most universal of human 'works'. It is the very first and it is
present everywhere and conditions everything. It exists in a great many forms
as the given tongue of a particular human group or nation and it is always in
the process of a constant slow transformation. The individual speaks by taking
part in the common achievement. l
We have observed speech as performance and are now concerned with it
as an achievement.
(I) Speech. as expression. Where the speech apparatus is normal, speech
apart from its content is psychic expression: as, for instance, shrieking, shouting, whispering in every possible nuance of tone, as we can observe in any
disturbed ward; or it may be in the form of monotonous, expressionless speech
or speech heightened in tone and lively. It may show itself in the rhythm, in
nonsensical emphases, in normal syntax or in syntax that cuts across sense; or
10. Jespersen, Die Sprache, ihre Natur, Efltwickluflg u. Entstehung (Heidelberg, I91S). An
excellent book but there is an immense literature on this subject.
Isserlin, Allg. Z. Psychiatr., vol. 7S (1919), p. r.
A. Mette, Oher Bt,i,hUflgefl ,wisch'fI Sprac/a,ig'fltamlichk,il'" ScAi{op/l"""

ProJuktiofl (Dessau, 1918).
Galant, Arch. Psychiatr. (D), vol. 61 (1919), p. u.
""tI tlwA"rl"A"
2.90
3. Words of new formation come to the patient in the form of 'hallucinatory

content'. The patients themselves, as in the foregoing cases, are often surprised
at these strange and alien words. Schreber heard in this way the whole 'basic
language' of his 'rays'. He always emphasised that until he heard the words
they had been quite unknown to him. 4. A~ticulate sounds are produced, to
which the patients themselves probably attach no meaning. In fact there is no
longer a speech-structure, as all meaning seems to have lapsed. An example
would be the verbal remnants which one tries to catch in demented paralytics.
One patient during his last few weeks of life could only produce the one word
'misabuck' on every occasion.
New word-formations are the main element in the private language of
schizophrenics: 1
Tuczek observed the development of such a language as a kind of game due to
delight in translation and a certain facility for playing with words. It was done quite
consciously without any need to express delusional experiences. Pride in this secret
achievement and pleasure in success were the only motives: 'just listen how nicely
it sounds I' Many different principles were involved in the word-formation but the
words were then established and one could notice the not inconsiderable memory
performance involved. There was undoubted creative ability. The syntax remained
German and it was only the vocabulary that had been reconstructed.
bizarre, and the style high-flown and striking, though for the most part we
can understand them. The patients do not report their experiences, persecutions and other personal facts, but develop theories, new cosmic systems, new
religions, new interpretations of the Bible, or of universal problems, etc. The
form and the content indicate that they originate from patients suffering from a
schizophrenic process. The presentation often will show the main delusion of
the author (he is the Messiah, he is an inventor).l 4. Transitional types of
writing develop from the above, and we get scripts that are thoroughly confused. Arrangement vanishes, the thoughts grow disconnected; there is a
series of bizarre, unintelligible thought-formations. I In the end everything
becomes incomprehensible: hieroglyphics are written, single syllables, there
are ornamentations, and colours are used to characterise external events.
S. Finally we get the poetry of undoubted psychotics. GauppB published the
case of a paranoic patient, who portrayed his own fate in a play concerning the
sick King Ludwig of Bavaria; this dramatic work was an act of liberation for
him and the only thing that had any value while he was in the hospital; he
found his own nature again in the person of his dramatic subject. K. Schneider'
published some verses of a young schizophrenic, which express the gruelling
change taking place in his person and in his world. The most magnificent and
the most disturbing examples are the later poems of Holderlin.
(h) Patients' written productions s
(c) Drawing, Art and Handicraft
Patients who commit themselves to literary creation corresponding to their

level of education often show us plenty of rational content mixed up with
phenomena of expression, displayed in the language and writing. In rare cases
there is a remarkable productivity of original speech. We can distinguish the
following different types of writing: I. Language and style are in good order
and the writing shows normal sequence of thought. Only the content is
abnormal; the patients report on their terrible experiences, try to clarify them
and set forth their delusional ideas. Such writing in spite of the intense affect
is sensible and controlled. The description by patients with insight after they
have recovered from their psychoses also comes into this category. We find in
this group a number of valuable self-descriptions. 2. The second group of
writings comes from person suffering from abnormal personality development
(querulants etc.). The writer elaborates his delusion-like ideas in a natural
manner and in a thoroughly coherent way but extravagantly, fantastically,
contentiously and fanatically. No self-description of morbid experiences
occurs-and indeed such personalities have not had them-but they direct
their attack upon mental hospitals, the authorities, doctors or they elaborate
their ideas as inventors, explorers, etc. Most published writings of patients
belong to this group. 3. More rarely we find writings, where the manner is very
1 Tuczek, 'Analyse einer Katatonikersprache', Z. N.ur., vol. 72., p. 2.79. Jessner, 'Eine in der
Psychose entstandene Kunstsprache', Arch. Psyclaiatr. (D), vol. 94 (1931), p. 382..
I A. Behr, Schriftste//erische Tiitigkeit in tier Paranoia (Leipzig, 1905). Sikorski, Arch. Psychiatr.
(D), vol. 38, p. 2.S9.
,I
j
We have grouped together defects in performance, the art of schizophrenics and the drawings of neurotic patients:
I. Defects ofperformance. These indicate organic neurological disturbance,
poor education or insufficient training. As such they obstruct psychic expression and the communication of intention, but in themselves they have no
positive significance as achievement. We encounter them as a lack of skill (the
individual cannot draw a straight line), lack of education (the individual has
not got the first elements of the technique of drawing); or as a disturbance of
motor function and dexterity through some organic illness (signs of ataxia,
tremor, etc.), or a disturbance of elementary psychic functions, such as
registration, concentration, which leads to scribbles, fragmented shapes and
lines rather than what could be called drawing (organic disorders, paralysis in
particular). The same sort of defects appear in all the unsuccessful articles
which patients make, and which can be seen in any clinical museum. 5
2. Schi'{ophrenic art. 6 We can only identify with certainty the cruder
1 Swedenberg is an example; also Brandenberg, 'Und es ward Licht', in Behr, p. 381. Panucz,
Tagebuchblatter eines Schizophrenen', Z. Neur., vol. 12.3 (1930), p. 2.99.
2 Example-Gehrmann, Korper, Gehirn, See/e, Gott (Berlin, 1893)'
3 Gaupp, Z. Neur., vol. 69, p. 182..
' Schneider, Z. Neur., vol. 48, p. 391.
Lenz, 'Richtungsanderung der kiinstlerischen Leistung bei. Himstammerkrankungen', Z.
N,ur., vol. 170 (1940), p. 98. (Defects of performance and change of performance.)
Nearly all clinics and institutions have such a collection. Owing to Prinzhom, the psychiatric
clinic in Heidelberg has a number of schizophrenic productions of all kinds.
293
schizophrenic signs. They give the paintings and drawings a very characteristic
appearance; meaningless repetition of the same line or of one and the same
object, without any unity of construction, a scrawl that is all but 'methodical',
a fine exactness which is no more than verbigeration in the pictorial field. It is
all very similar to the involuntary 'doodling' normal people will do in moments
of concentrated attention or during a lecture.
Schizophrenic art may be a real expression of the schizophrenic psyche and
represent the world of schizophrenic thought that has developed in the patient,
but we only get this when there is a certain level of technical skill and where
the schizophrenic signs have not swamped the whole picture. 1 Content is
characteristic; mythical figures, strange birds, grotesque and misshapen forms
of people and animals, a bold and ruthless emphasis on sexual characteristics,
usually the genitalia; in addition there is an urgency to present some universal
whole, a world-picture, the essence of things. Occasionally complicated
machines are designed depicting the source of the hallucinatory physical
influences. Perhaps even more important is the form of the picture. Taking it
as a whole we try to find out whether it has any meaning for the patient as a
whole or whether it is only a collection of miscellaneous elements. Where in
fact is his point of unity? The following are some characteristic signs: a certain
pedantry, exactness, laboriousness; a striving for violent effects; stereotyped
curves; making everything in a circle; or there are angular lines which give all
the pictures an air of similarity. When we try to understand the effect of the
drawings on their author and talk to him about it we find the simplest thing is
symbolically important and a rich fantasy woven around it.
It cannot be denied that when the patients are gifted people suffering from
process schizophrenia their drawings and paintings have a considerable impact
on normal people, by reason of their primitive force, vivid expression, weird
urgency and strange significance.
If patients are well off and not too ill to be restrained, they may really
achieve the most remarkable productions such as those artistic efforts which
Goethe saw belonging to Count Pallagonia and the Lodge at Lemgo. 2 The
latter was a house where the owner who had been a lifetime building it had
filled it to overflowing with carvings of his own and had covered everything
with fantastic structures and countless repetitions so that there was not a
single clear space or empty corner left.
3. Drawings of neurotic patients. C. G. Jung introduced the method of

letting patients draw and of giving particular attention to their 'psychic
pictures', their plan of the cosmos or their basic conception of existence. He
takes the Indian mandalas as an analogy.1 These 'psychic pictures' should help
us to penetrate into unconscious psychic life. Apart from the conscious use of
symbolism and myth, psychoanalytic interpretation finds in them a way to
elucidate the unconscious.
1 Prinzhorn, 'Das bildnerische Schaffen des Geisteskranken', Z. Neur., vol. 52 (1919), p. 307.
(A historical survey of psychotic art). Morgenthaler, Ein Geisteskranker als Kunst/er (Bern and
Leipzig, 1921). Prinzhorn, Bildnerei der Geisteskranken (Berlin, Springer, 1922) (standard book
on the subject, well illustrated). It also gives good summary of points for analysis: urge to make
-drive to play-drive to decorate-tendency to make diagrams-tendency to arrange-desire to
symbolise. A detailed report on ten schizophrenic pictures. Points of similarity, childhood drawings,
unsophisticated drawings, drawings of primitives, of ancient cultures, folk-art, spiritualistic drawings. Jaspers, Strindberg u. van Gogh (Leipzig, Ernst Bircher, 1922; 2nd edn., Berlin, 1926).
2 Fischer, 'Ober die Plastiken des Ften. Pallagonia', Z. Neur., vol. 78 (1922), p. JS6. Weygandt,
Z. Neur., vol. 101 (1926), p. 857. Kreyenberg, 'Ober das Junkerhaus', Z. Neur., vol. II4 (1928),
PI52
2.
THE TOTAL MENTAL ACHIEVEMENT-THE PATIENTS'

GENERAL OUTLOOK-'WELTANSCHAUUNG'
We have tried to give as vivid a description as possible of the patient's

existence in his own personal world. He himself cannot describe the shape of
the world in which he lives, the factual whole of his world, and indeed he does
not know it himself. Actions and behaviour all show what he thinks is the
meaning of a situation and its effective possibilities or in what way it strikes
him as obvious and unquestionable. We have to try and put everything together if we are to get even a partial glimpse of the patient's actual world. This
is difficult because we can scarcely abandon our own limited worlds. Every step
in understanding, however, increases our knowledge and also expands our
own existence or suggests such an expansion. Object-awareness, the existing
forms of which were described in the section on phenomenology, is always
related in content to complex unities which give the momentary content of
experience its meaning, function and significant living context. The content is,
as it were, steeped in a number of worlds which perhaps are never fully known
in their totality but only show themselves indirectly in the way the ideas move
and form and the many images and thoughts emerge.
Under favourable circumstances an individual can become aware of his
personal world in a systematic way. He makes a poem about it or a work of art;
he may breed a philosophy or elaborate ideas about the universe. What the
patient tells us and what he puts there for us to see is the foundation for any
subsequent representation of how he regards the world that has grown in his
consciousness. Instead of coming indirectly to the conclusion that we are
investigating only the configuration of a world, we have to grasp at the totality
of a mind as it objectifies itself in its own way. So far we have barely begun to
do this:
From the point of view of method this field offers unlimited scope. But patients
do not often offer us anything empirically objective to investigate. There have been
certain important historical phenomena and by a lucky chance we may get something from our patients. The methods for knowledge in this field are only acquired
through a training in the humanities. We will make two brief points:
Nietzsche conceived all knowledge of the world as 'interpretation' (Auslegen).
Our understanding of the world is an interpretation and our understanding of some
1
Heyer, DdT Ol'gani.rml/s der See/" (Milnchen, 1932).
~9S
alien world is an interpretation of an interpretation (cp. my book Niet{sche, Berlin,

1936, pp. 2.55 ff.). In understanding the world therefore we not only find an absolute
objectivity of the true world but an element of movement for which (from the point
of view of the observer of different worlds) the idea of the one, real, true world
acts as a marginal concept of which he himself 'can never take possession.
Eachman's world is already a special one. This special world which the individual
knows as his own and has so far confronted is always something less than his real
world, which remains obscure, all-embracing, an over-reaching whole (see my
Psychologie der Weltanschauungen, Berlin, 1919, Auf!. 3, 192.5).
end of the world is here, the 'twilight of the gods'. A mighty revolution is ~t
hand in which the patient plays the major role. He is the centre of all that IS
coming to pass. He has immense tasks to perform, vast po;rers. F~ul~~s
distant influences, attractions and obstructions are at work. Everythtng IS
always involved: all the peoples of the earth, all men, a~l the. Gods, etc. ~e
whole of human history is experienced at once. The patient ltves through tnfinite millennia. The instant is an eternity to him. He sweeps through space
with immense speed, to conduct mighty battles; he walks safely by the abyss.
Here are a few examples from self-descriptions:
Analysis of the patients' worlds as they have come to know them is only in
its beginning and we group the few attempts that have been made as follows:
(a) Realisation of extremes
There is a particular interest in those realisations of mental possibilities

which can be called neither healthy nor sick in themselves and are certainly not
psychological in character, though they are something that the patient experiences. Thus nihilism and scepticism are only complete in psychosis. Nihilistic
delusion in melancholia gives us the prototype. The world does not exist any
more, the patient himself does not exist; he only appears to live and he must
live like this for ever. He has no feelings and he cares for nothing. At the
beginning of a schizophrenic process, complete scepticism is not just blandly
conceived but is experienced as a desperate affair. 1 There are also classic
realisations of mystical experiences in hysteria and revelations of a metaphysical-mythical character in the initial stages of schizophrenia.2
(6) Patients' specific outlooks (Weltanschauungen)
We may ask what is the special factor which allows a philosophic knowledge of Being to spring up from the schizophrenic base. We may also ask to
what extent are these philosophic possibilities merely a caricature. The mind
has its historical aspect and is tied to its culture; it has racial characteristics and
is bound to tradition. As such it is no subject-matter for psychopathology but
something intelligible in its own right, something eternal in time. As a reality
of temporal existence, however, it is bound up with the empirical reality of the
individual and as such can be explored. The conditions for mental productivity
and the actual realisation of this are accessible to our investigation.
Journeys of the soul into the Other World, the transcendental geography
oflands beyond our senses, form a universal lore. But it is only in patients that
we find it all decisively confirmed in the form of a lively, vivid experience.
Even today we can observe such events occurring in the psychoses with an
impressive wealth of detail and intellectual depth.
The 'cosmic experience' is characteristic of schizophrenic experience. The
Cpo my own work, 'Schicksal u. Psychose', Z. Neur., vol. 14 (1913), pp. 2.13 ff., 2.S3 ff.
This is shown magnificently in the work of Holderlin and van Gogh. Cf. my 'Strindberg
und van Gogh' (Bern. 192.2.), 2nd. edn. (Berlin, 1926).
1
I have said that I had countless visions connected with my ideas of the end of
the world. These were both horrible and magnificent. I will think of a few of them.
In one I was going down in a lift into the depths of the earth, and I went down
as it were back through the whole history of man and the earth. In the uppe: strata
there were still woods in leaf; as I got lower it grew dark and black. On leavmg ~he
lift I came to a huge graveyard and found amo~g 0t?~rs t~e plac~ whe~ the mhabitants of Leipzig lay and the grave of ~y w1fe. ~1ttlng m the hft agam I ~r~
gressed to point 3. I was afraid to enter pomt I, wh1ch mark.ed the absolute o.ngm
of mankind. As I travelled back, the lift-shaft collapsed belund me enda~germg a
'sun-god' who lived in it. In this connection it seemed there were two hft-shafts,
perhaps corresponding to the division of the realm of god into tW? (?), then the
news came that the second shaft had collapsed; all was lost. Another tlme I traversed
the whole earth from Lake Ladoga to Brazil and built there a so:t of ca~tle an~ a
wall with the keeper's help for the protection of god's kingdom agamst the mflowmg
yellow tide. I related this to the danger of syphilitic infection. On yet another
occasion I had the feeling that I was being pulled up to heaven and saw the whole
earth under me, a picture of incomparable splendour and beauty stretched out under
the blue dome.
Wetzell gives an account of the experience of the end of the world as felt
by schizophrenics:
The end of the world is experienced as a transition to s~mething ne~, vaster,
and is felt as a terrible annihilation. Despairing agony and bhssful revelat.lOn. occur
in one and the same patient. At first everything seems queer, uncanny and s1gmficant.
Catastrophe is impending; the deluge is here. A unique catastrophe approaches: It
is Good Friday; something comes over the world; the last Judgment, the bre~ng
of the seven seals of the Book of Revelation. God comes into ~he world. ~he H.me
of the first Christians is here. Time wheels back. The last r1ddle of .all 1S be.mg
solved. Patients are exposed to all these terrifying and magnificent expenence~ w1thout showing it to anyone. The feeling of being quite alone is unspeakably fnghtening and patients implore not to be l~ft. to the~selves, or alone in the desert, the
frozen cold or in the snow (although 1t 1S the m1ddle of summer).
In contrast to the experiences of delirium, these typical cases of schizophrenic experience display clear consciousness, a relatively sound memory and
A. Wetzel, Z. N.ur., vol. 78 (192.2.), p. 403
2.97
good perception, if the attention can be attracted by something and is not

entirely chained by the content of the experience. Patients can be doubly
orientated, to the psychotic experience and to reality. However, such typical
.
. cases do not seem particularly common.
The schizophrenic world of acute psychosis with its double orientation is
something quite different from the world of the chronic states. This can grow
into a system of ideas which for the patients carry memories of unforgettable
occurrences in the acute state, and take deep effect. However in the end the
double orientation vanishes.
A delusional system with a typical world outlook of its own then develops
on the basis of the transformed self, on the experience of superhuman powers
and emanations, as well as of shattering dissolution, of hidden significance and
altered mood. Hilfiker has described this as follows: 1
made to unravel them. For instance a patient devised a numerical system for
'solving life's problems'.l
The self is identified with the All. The patient is not just someone else (Christ,
Napoleon, etc.) but simply the All. His own life is experienced as the life of the
whole world, his strength is world-sustaining and world-vitalising. He is the seat
of this supra-personal power. The patients talk of an automatic power, of primary
substance, of seed, fertility, magnetic powers. Their death would be the death of
the world; if they die, everyone else dies. Three different patients said: 'If you do
not keep in touch with me, you will perish.'-'Once I am dead, you will all lose
your minds.'-'If you can't find a substitute for me, everything is lost.' Patients
feel they have a magic influence on nature: 'When my eyes are bright blue, the sky
gets blue'-'all the clocks of the world feel my pulse'-'myeyes and the sun are
the same.'
One of Hilfiker's patients said: 'Only one peasant in the whole of Europe can
support himself, and that man is I ... if I look at or walk over a piece of wasteland,
it becomes good land ... my body bears fruit .. it is a world-body .' He, his
wife and his son-three human lives .. are the first seers and listeners; they are
the three international peoples related to soil, water and sun, and correspond to the
sun, moon and evening star ... 'the warmer we are, the more productive the sun
becomes ... No state can support itself. If the world grows poor, they must come
and fetch me; they have to have someone to support the world; the world must
be represented or the world will disappear.'
(c) Patients' own observations of a philosophical character
This group includes descriptions that note the modes in which the patients'
general world-outlook appears and try to discover the particular modulation
or colouring or even their identification with normal attitudes. Mayer-Gross
tried to do this and showed how a remarkable form of jesting and joking,
irony and humour appears in schizophrenic behaviour.2 Gerhard Kloos took
these observations further and deeper. 3 Many patients have shown powers of
scientific reasoning and a certain freakish philosophy and efforts have been
1
2
Hilfiker, 'Die schizophrene Ichauflosung im All', Allg. Z. Psychiatr., vol. 87 (192.7), p. 439.
Mayer-Gross, Z. Neur., vol. 69, p. 32.2..
G. Kloos, 'Ober den Witz der Schizophrenie', Z. Neur., vol. 172. (1941), p. n6.
Newspaper accounts of deaths, accidents, etc., were an occasion for him to prove
that they had to happen. He devised combinations of figures from the names,
circumstances, etc., which he said showed that what the papers reported as accident
had in fact been inevitable. 'When everything is said and done the Trinity predetermines all that actually exists.' This unintentional parody of scientific method
shows the mechanical nature of the reasoning; this was also to be seen in the other
expressive phenomena, such as the pedantic arrangement of the material, the severely
regulated handwriting, pointed and affected lettering, endless repetition and a
general over-schematisation.
We can also find in the background of delusions of invention a philosophical attempt at preservation through the application of the reasoning
powers; this is particularly seen in the repeated constructions of a 'perpetuum
mobile'. 2
1
2
Pauncz, Z. Neur., vol. J2.3 (1930), p. 2.99.

Tramer, Teclmisches Scl.affin Geisteskranker (Miinchcn, 1926).
PART II
MEANINGFUL PSYCHIC CONNECTIONS
PART II
(PSYCHOLOGY OF MEANING-VERSTEHENDE PSYCHOLOGIE)
In Part I we studied individual psychic phenomena. These were either
patients' subjective experiences, which could be vividly represented by us
(Phenomenology) or phenomena which could be grasped ohjectively in the
form of observable performances, somatic symptoms, or meaningful phenomena found in expressive gesture and in personal worlds and creations
(objective psychopathology). In Part I we were mainly interested in describing the facts as they presented themselves to us, but the question constantly
intruded as to what might be the source of this or that phenomenon and with
what else it might be connected. Up to now a great deal of our material has
only allowed description, but in the following Parts II and III an attempt will
be made to show what is our present knowledge in regard to connections.
In doing so we shall assume the same theoretical distinction as has been
made between subjective psychopathology (phenomenology) and objective
psychopathology. I. We sink ourselves into the psychic situation and understand genetically hy empathy how one psychic event emerges from another.
2. We find by repeated experience that a number of phenomena are regularly
linked together, and on this basis we explain causally. Understanding the
emergence of psychic events from each other has also been termed 'psychological explanation', but this term is justifiably disliked by scientifically minded
investigators, who are solely concerned with what can be perceived by the
senses and with causal explanation, and who have reason to protest should
'psychological explanation' ever seem to be taken as a substitute for their own
efforts. Meaningful psychic connections have also been called 'internal
causality', indicating the unbridgeable gulf between genuine connections of
external causality and psychic connections which can only be called causal by
analogy. These latter will be dealt with here in Part II; causal connections
will be discussed in Part III. But first the main difference between the two
and their mutual relation needs to be clarified from the viewpoint of our
methodology. 1
1 'Understanding is a fundamental human activity that from. time immemorial has proceeded
on its own methodical, conscious and scholarly way.' Cpo Joachim Wach, Das Verstehen, 3 vols.
(Ti1bingen, 1926-33); Droysen distinguished the methods of natural scienoe from those of history
and called the one explanation and the other understanding respectively (Historilc, 1867). Dilthey
distinguished descriptive, analytical psychology from explanatory psychology. Spranger spoke of
psychology as one of the humanities and I myself spoke of a psychology of meaningful ph,lIom"",.
This last term has won the day. The work of Max Weber was mostly responsible for my deUbel1lt.
use of understanding as a method which would be in keeping with our great cultural tradition
I was also influenced by Rosch,r and Kniu, etc., in Schm61lers' Jahr6Qch,rn, vol.. "1,
'P,
301
302
(a) Understanding and explaining

We only try to grasp one kind of connection in the natural sciences, that
is causal connection. By observation of events, by experiment and the collection
of numerous examples, we attempt to fonnulate rules. At a higher level we
establish laws and in physics and chemistry we have to a certain extent reached
the ideal which is the expression of causal laws in mathematical equations.
We pur;ue a similar aim in psychopathology. We come acr~ss particular
causal connections though as yet we do not know how to generahse from them
(the connection, for instance, between diseases of the eye and halluci~atio~).
We also find general rules (the rules, for instance, of constant heredlty; dlsorders that belong to the group of manic-depressive psychoses appear in one
family whereas disorders of the dementia-praecox group occur very rarely in
such families and vice-versa). But it is rare for us to find any laws (as, for
instance there is no General Paralysis without syphilis), nor can we ever
formula;e causal equations in the manner of chemistry and physics. This
would presuppose a complete quantification of the events obser;ed an? si~ce
these are psychic events, which by their very nature have to remam quahtatlve,
such quantification would as a matter of principle remain impossible without
losing the actual object of the enquiry.
. ,
In the natural sciences we find causal connectlOns only but m psychology
our bent for knowledge is satisfied with the comprehension of quite a different
sort of connection. Psychic events 'emerge' out of each other in a way which
we understand. Attacked people become angry and spring to the defence,
cheated persons grow suspicious. The way in which such an emergence takes
place is understood by us, our understanding is genetic. Thus we understand
30 (1903-6), reprinted in Gesammelte Aufslit:ce :cur Wissenschaft.slehre (Tiib~en, 19:1:1) My ide~
were then carried further by Dilthey (Ideen iiher eine heschrezhende u. {erglWernde Psyclwlogre,
Berliner Akademie, S. her. 1894, together with Ebbinghaus' criticism in Z. Psyclwlog., vol. 9) and
by Simmel (Prohleme der Geschichtsphilosophie).
.
My article of 19u (,Kausale u. verstiindliche Zusammenhiinge zwischen Schlcksal u. Psychose
hei der Dementia praecox' Z. Neur., vol. 14, p. 158), and this present book (1913) were greeted
as something radically ne':', although all I had done was to link psychiatric reality with the traditional humanities. Looking back now, it seems astonishing that these had been so forgotten and
grown so alien to psychiatry. In this way within the confines of psychopatholo~ there gre~ a
methodical comprehension of something which had always been present, but which was fading
out of existence and which appeared in striking reverse, 'through the looking-g~ass: as it we~e, in
Freud's psychoanalysis-a misunderstanding of itself. The way,,:,as clear for s~lentdic consCIousness to lay hold on human reality and on man's mental estate, hiS p.sycho~s Included, but there
was an immediate need to differentiate the various modes ofunderstandmg, clanfy them and embody
them in all the factual content available to us.
Since then a whole literature has arisen on this topic in both psychology and psychopathology:
L. Binswange~, Internat. Z. Psychoanal. (0), vol. I (1913) Z. Neur., vol. :16, p. 107; G~le,
Z. Neur., vol. 28; Kretschmer, Z. Neur., vol. 57; van der Hopp, Z. Neu~., vol. 68; Kurt Schneider,
Z. Neur., vol. 75; Isserlin, Z. Neur., vol. 101; Stransky, Mschr. Psych,atr., vol. p; Bumke, Zhl.
Neurol, vol. 41; Kronfeld, Zhl. Neurol, vol. :18; Starring, Arch. Psychol. (~), vol. 58; W. ~lumen
feld, Je. Philol. vol. 3 (19:17); Walter Schweizer, Erklaren u. Verstehen m der Psycholog,e (Bern,
1927); G. Roffenstein, Das Prohlem des psychologischen Verstehen; (Stuttgart,. 1926); fi~all~,
Kronfeld, Das Wesen der psychiatrischen Erkenntnis (Berlin, 19:10); Blnswanger, Emf'uIarung m dll
Probleme der allgemeinen Psychologie (Berlin, 192:1)
psychic reactions to experience, we understand the development of passion, the

growth of an error, the content of delusion and dream; we understand the
effects of suggestion, an abnormal personality in its own context or the inner
necessities of someone's life. Finally, we understand how the patient sees himself and how this mode of self-understanding becomes a factor in his psychic
development.
(0) Concrete reality and the self-evidence of understanding (Understanding and

Interpretation)
The evidence for genetic understanding is something ultimate. When
Nietzsche shows how an awareness of one's weakness, wretchedness and
suffering gives rise to moral demands and religions of redemption, because in
this roundabout way the psyche can gratify its will to power in spite of its
weakness, we experience the force of his argument and are convinced. It
strikes us as something self-evident which cannot be broken down any further.
The psychology of meaningful phenomena is built up entirely on this sort of
convincing experience of impersonal, independent and understandable connections. Such conviction is gained on the occasion of confronting human
personality; it is not acquired inductively through repetition of experience. It
carries its own power of conviction and it is a precondition of the psychology
of meaningful phenomena that we accept this kind of evidence just as acceptance of the reality of perception and of causality is the precondition of the
natural sciences.
The self-evidence of a meaningful connection does not prove that in a
particular case that connection is really there nor even that it occurs in reality
at all. Nietzsche convincingly and comprehensibly connected weakness and
morality and applied this to the particular event of the origin of Christianity,
but the particular application could be wrong in spite of the correctness of the
general (ideally typical) understanding of that connection. In any given case
the judgment of whether a meaningful connection is real does not rest on its
self-evident character alone. It depends primarily on the tangible facts (that is,
on the verbal contents, cultural factors, people's acts, ways of life, and
expressive gestures) in terms of which the connection is understood, and which
provide the objective data. All such objective data, however, are always incomplete and our understanding of any particular, real event has to remain more
or less an interpretation which only in a few cases reaches any relatively high
degree of complete and convincing objectivity. We understand only so far as
such understanding is suggested to us by the objective data of the individual
case, that is, by the patients' expressive movements, acts, speech and selfdescription, etc. It is true that we can find immediate meaning in a psychic
connection quite detached from concrete reality, but we can only assume the
reality of such a connection to the extent that the objective data will allow. The
fewer these are, the less forcefully do they compel our understanding; we
interpret more and understand less. The position will be clarified if we compare
30 4
these immediately understood connections with the rules ofcausality in respect of

their differing relationship to concrete reality. The rules of causality are obtained
inductively and culminate in theories about what lies at the root of the given
reality. Particular cases are then subsumed under them. Genetically understandable connections, however, are ideal, tYpical connections; they are selfevident and not inductively obtained. They do not lead to theories but are a
measure for any particular event, whereby it may be recognised as more or less
meaningful. Because we note the frequency of a meaningful connection this does
not mean that the meaningful connection becomes a rule. This would be a
real mistake. Frequency in no way enlarges the evidence for the connection.
Induction only establishes the frequency, not the reality of the connection
itself. For example, the frequency of the connection between the high price of
food and theft is both understandable and established statistically. But the
frequency of the understandable connection between autumn and suicide is not
confirmed by the suicide-curve, which shows a peak in the spring. This does
not mean that the understandable connection is wrong since one actual case
can furnish us with the occasion to establish such a connection. The fact of
frequency adds nothing to the evidence thus gained and the establishment of
frequency serves a different purpose. A poet, for instance, might present convincing connections that we understand immediately though they have never
yet occurred. They have not been realised yet but contain their own evidence
in the sense of being ideally typical. It is easy to fall into this trap of stating
some meaningful connection as concretely real when it only offers evidence of
this general kind. Jung, for example, says 'it is a well-known fact that it is easy
to see where there is a connection and where there is not', but in the case of real
people we know that the exact opposite may be the truth.
(c) Rational and empathic understanding

Genetic understanding has many modes and certain essential distinctions
need to be preserved. For instance, thoughts may be understandable because
they emerge from each other according to the rules of logic and here the connections are understood rationally (that is, we understand what is said). But
where we understand how certain thoughts rise from moods, wishes or fears,
we are understanding the connections in the true psychological sense, that is by
empathy (we understand the speaker). Rational understanding always leads to
a statement that the psychic content was simply a rational connection, understandable without the help of any psychology. Empathic understanding, on
the other hand, always leads directly into the psychic connection itself. Rational
, understanding is merely an aid to psychology, empathic understanding brings
us to psychology itself. From this we can see how there are obvious differences
in the modes of understanding and later on we shall have to make yet other
indispensable distinctions. But for the present we shall continue to speak of
psychological understanding as a whole.
(d) Understanding is limited and explanation unlimited

It is ~ mistake to. suggest that the psyche is the field for understanding while
the phYSIcal world IS the field for causal explanation. Every concrete eventw~e~er of a physi~1 or psychic nature-is open to causal explanation in
pnnclp!e, an~ ~sychlc pr?cesses too may be subjected to such explanation.
There IS no !tmlt to the dIscovery of causes and with every psychic event we
always look ~or cause and effect. But with understanding there are limits every"!'here. The ~l~t~nce of special psychic dispositions (Anlagen), the rules govern~n~ the acqUlsltton and loss of memory-traces, the total psychic constitution
10 ItS sequence of different age-levels and everything else that may be termed
the substratum of the psyche, all constitute limits to our understanding. Each
limitatio? is. a fresh stimulus to formulate the problem of cause anew.
In thlOklOg about causes in psychology we need elements which we can take
as cause or effect, e.g. a bodily event as cause, an hallucination as an effect.
Every concept in phenomenology and the psychology of meaningful phenomena becomes drawn into the domain of causal thinking to serve as an element
of causal explanation. The units of phenomenology (e.g. hallucinations, modes
of p~rce~tion, :tc.) are explained by bodily events. Complex meaningful connecttons 10 therr turn are considered as units (e.g. a manic syndrome plus all its
contents can be regarded as the effect of a cerebral process or of some emotional
trauma .such as. the death of an intimate). Even that entirety of meaningful
connecttons wh.lch we term the personality of an individual may be considered
causally as a unIt or element and its original causes investigated from the point
of view of heredity, for example.
When ~earching for c~uses we are always forced to think of something
extra-cor:sczous that under!tes the phenomenological elements or meaningful
conne.cttons.. We .~nd ourselves constrained to use concepts such as extraconscIous dlSposltton (Anlage), psychic constitution and extra-conscious
mec~anism. These. concepts,. however, cannot be expanded into comprehenSIve ~sychologlcal theones and we can use them only as working hypotheses 10 so far as they prove themselves useful for our enquiries.
Eve~ act of understanding in respect of concrete psychic events points to a causal
as a matter of course. But this connection only becomes accessible to us
In the first place through understanding. So long as there are no other data than those
provided by the understanding to help us establish the empirical facts, it is useless to
speculate furthe: and construe the connection by extra-conscious facts (see the
chaP.ter on theo;"es). If we had these other data, important causal connections could
be dlsc~vered SImply as the result of empirical research. On the other hand, we are
wrong If we say that psychic causal connections can be fully echoed by empathy and
that the=efore we can discover causal mechanisms by such empathy. Speculative
elaboratton of extra-conscious mechanisms through empathic understanding la a
she~r waste of time and the literature is far too full of such attempts. Understanding
by Itself does not lead to any causal explanation except in indirect fashion when It
happens to come up against the ununderstandahle.
'
~onnectlOn
306
307
(e) Understanding and unconscwus events

Extra-conscious. mec!tan.isms therefore are construed as something additional to conscious psychic life. They are extra-conscious in principle and not
verifiable. They remain purely theoretical constructs which we use to penetrate into the extra-conscious sphere, while phenomenology and the psychopathology of meaning remain concerned with conscwusn.ess. It is never wholly
clear, however, where, from these latter points of view, the frontiers of consciousness are. Both continually expand beyond the immediate frontiers and
penetrate deeper. Phenomenology finds itself describing hitherto unnoticed
modes of psychic experience, while the psychology of meaningful phenomena
grasps psychic connections that were previously unobserved (e.g. Nietzsche's
conception of moral attitudes as reaction-formations against awareness of
weakness and misery). Every psychologist experiences how his own psychic
life is gradually iU~ how he grows more aware ofwhat had previously
gone unnoticed in himself, and also how his own last frontier is somehow
never reached. This unawareness, which is turned into awareness by phenomenology and the psychology of meaningful phenomena, this unnoticed content which becomes conscious in this way, must not be confused with what is
genuinely unconscious. This is in principle extra-conscious and something of
which we can never become aware at all. We can actually experience something
of which we are unaware, in the sense that we have so far not noticed or regarded it, but we cannot experience this in the sense that it is extra-conscWus.
h would be as well to keep the term extra-conscious for the latter type of
unconscious event and speak of what we are generally unaware in respect of the
former.
phenomena in considerable number and compares his activity with that of an

archaeologist who builds up his interpretations from fragments of human
works. The great difference is that the archaeologist interprets what has once
actually existed whereas in the case of this 'as if> or pseudo-understanding the
real existence of what is said to be understood remains entirely undetermined.
The psychology of meaningful phenomena is thus faced with great
possibilities of expansion in that it is bringing unnotie,d material into consciousness. It has to remain doubtful whether this fiction of pseudo-understanding can also penetrate into extra-conscious matITial. We can make
no general statement regarding the usefulness of characterising certain phenomena 'as if' they were understood; the matter can only be decided in the
individual case.
(f) P seudo-un.derstanding
Psychology traditionally takes on the task of bringing into consciousness
material of which we are unaware. Evidence for such insight has always rested
on the fact that, circumstances being favourable, other people could notice the
same things, provided they had undergone the same experiences. Certain
events, however, cannot be understood in this way. They do not seem to be
genuine experiences that have been subsequently brought to notice, yet we
believe that in some sense they are understandable. For instance, Charcot and
Mobius draw attention to the fact that the distribution of sensory-motor signs
in hysteria coincided with the patient's crude and mistaken anatomical notions,
and thus the signs became meaningful. But it could not be proved that such
notions did in fact give rise to the disturbance, except when there had been
direct suggestion. The signs were understood only as if some conscious event
had determined them. It remains an open question whether in these cases such
an event could be the source inasmuch as the actual, unnoticed psychic
event is never demonstrated, or whether this is just an apt but fictitious
characterisation of certain symptoms. Freud described these 'as-if-understood'
(g) Modes ofcomprehensive understanding (cultural, existential and metapkysical)

We repeat the differentiations which we have made so far:
I. Phenomenological understanding and the understanding ofexpression: the fonner
is our inner representation of patients' experiences, gained with the help of their selfdescription. The latter is our direct perception of meaning in an individual's movements, involuntary gestures and physical fonn. 2. Static and genetic understanding:
the fonner grasps particular psychic qualities and states as individually experienced
(phenomenology); the latter grasps the emergence of one psychic event from another,
the whole moving psychic context of motive, contrasting effect and dialectical opposite (the psychology of meaningful phenomena). 3. Genetic urulerstanding and explanation: The former is the inner, subjective, direct grasp of psychic connectedness, so far
as it can ever be grasped in this way; the latter is objective demonstration of connections, effects and ruling principles, which cannot be understood by empathy and
are only explicable in terms of cause and effect. 4. Rational and empathic understanding: the fonner is not really psychological understanding at all. It is a purely cognitive understanding of rational content, common to all (e.g.: we can understand the
logical structure of a delusional system of a world in which an individual lies submerged). The latter-empathic understanding-is the proper psychological"understanding of the psyche itself. 5. Understanding and interpretation. We speak of {lnderstanding when what has been understood has been fully expressed in some movemc;nt,
utterance or act. We speak of interpretation when in a given case sparse clues allow
us to apply with a reasonable degree of probability certain meaningful connections
that we have come to understand from elsewhere.
The above differentiations are really sufficient for our present purpose,
which is to clarify the perception of empirical facts. In practice, however,
understanding is constantly in touch with something more comprehensive in
which all such acts of understanding lie embedded. We will, therefore, indicate
those main areas over which our understanding moves, over and beyond what
has been discussed so far.
(a) Cultural understanding. It is not only the logical content which has to
be understood in an objective, non-psychological sense, but all the other
mental content, the pattern of ideas, the images, symbols, ideas of obligation,
308
ideals, etc. We do not understand a person merely by isolating out a number of

such contents, but the degree to which the psychologist is at home with them
will limit and condition his psychological understanding. This kind of understanding is a cultural not a psychological u~derstanding, but the psyche only
becomes accessible to us if in this sense we understand the element in which it
lives, the things that are visible to it, the things which it accepts and allows to
take their effect.
(6) Existential understanding. In the act of understanding psychic connections, we come up against the limits set by the ununderstandable. In one
sense we may see this as the extra-conscious, the limit of the understandable.
As the body that carries us we have to accept it in all its causal connections, as
matter we have to shape it and as material possibility we have to grasp it and
where it fails this has simply to be endured. In another sense what cannot be
understood is also the source of the understandable and it thus goes beyond
the understandable; it is a self-illuminating process, something becoming
understandable, if only we can lay hold of it out of the unconditioned absolute
of Existence itself. Therefore, in relation to the ununderstandable, where this
is a limiting factor that can be causally explored, psychological understanding
becomes an empirical psychology. But in relation to the ununderstandable as
a phenomenon of possible Existence, it becomes the philosophical illumination
of Existence itself. Empirical psychology affirms how something is and how it
happens; the illumination of Existence through what may be possible makes
its appeal to Man himself. Both have radically different meanings, but psychological understanding contains them both, linked inseparably together. From
this rises an almost insurmountable ambiguity. In both instances the act of
understanding presupposes and implies something that cannot be understood;
this baffling element, however, is twofold and heterogeneous. Without the
one aspect (the 'givenness' of causality) the understandable would cease to
exist and without the other (Existence being itself) there would he no content.
The ununderstandable discloses itself to causal enquiry as instinctual drives,
biological somatic facts and supposed specific extra-conscious mechanisms.
The ununderstandable is as much present in all normal life as it is in morbid
states and processes, in a deviant form. The ununderstandable from the existential aspect presents itself as a freedom, which discloses itself in free decisions,
in a grasp of absolute meanings, and in that basic experience where the
marginal situation rises from the empirical situation-that marginal point
where we are roused from ordinary existence into an autonomous self-hood.
The illumination of Existence itself brings concepts into being, which lose
their meaning altogether if a misguided psychological opinion then treats
them as available modes of concrete existence and therefore as relative. The
field of empirical research has no freedom nor does it contain anything of that
liberating challenge offered by the philosophical illumination of Existence
proper: the challenge of validity, awareness of the absolute, of marginal
situations, ultimate decisions, responsibility, and of oneself as an original
source. Through the psychology of meaningful phenomena, existential illumination comes into contact with this something that goes beyond understanding, with the reality proper that lies in the possibilities of autonomous
self-hood through the processes of memory, attention and revelation. If we
treat this illumination as some kind of psychological theory of general application, we have confused and misstated its nature; so too, if actions, behavioural
modes, instinctual drives and people themselves are classified in psychological
categories of existential illumination, and treated for the once in this respect
as natural facts.
(c) Metaphysical understanding. Psychological understanding is linked
with empirical experience and free, existential achievement. Metaphysical
understanding reaches after a meaning into which all the other limited meanings can be taken up and absorbed. Metaphysical understanding interprets the
empirical facts and the free achievement as the language of unconditioned
Being.
This interpretation is not a mere device of reason, something futile, but the
illumination of fundamental experiences with the help of symbol and idea. As
we look at the inanimate world, the cosmos, the landscape, we experience
something we call 'soul' or 'psyche'. When faced with what is living, we
proceed to grasp a number of purposeful connections and then advance from
that to a vague perception of a Life that embraces all things and in the sequence
of its forms realises itself as a fathomless meaning. As with nature, so it is with
man-and we are confronted by him in all his actuality and freedom. He is not
only an empirical reality to us but under the scrutiny of our metaphysical
understanding, he, like everything else that is real, becomes a meaning we cannot verify. He is not only meaningful like a tree or a tiger but meaningful in
his own unique way as a human being. This metaphysical experience of him is
not a matter for the science of psychopathology but the latter can help in
clarifying facts that will refine the experience: for instance, the fact that
extreme psychotic states offer us a human parable, and that they seem to contain inverted and distorted attempts to realise and elaborate marginal situations,
which are common to us all. There is also the fact that patients see into depths
which do not so much belong to their illness as to themselves as individuals
with their own historical truth. Finally there is the fact that in psychotic
reality we find an abundance of content representing fundamental problems of
philosophy: nothingness, total destruction, formlessness, death. Here the
extremest of human possibilities actually breaks through the ordinary boundaries of our sheltered, calm, ordered and smooth existence. The philosopher
in us cannot but be fascinated by this extraordinary reality and feel its challenge.
Digression into understanding and appraisal: all potential meaning implies an
unresolved tension, in the intellectual field between truth and falsehood, in the field of
existence between empirical event and freedom and in the metaphysical field between
what inspires faith and what arouses dread (between the love and wrath of God).
n understanding (and this includes psychological understanding) we experience this
tension constantly through the basic phenomenon that our understanding is also an
appraisal. Meaningful human activity is in itself an expression of values and everything understandable carries for us an immediate positive or negative colouring:
everything understandable has a constituent potentiality of worth. In contrast we do
not value the ununderstandable as such but only as the means and condition for our
understanding; we disapprove of a memory disorder which we understand as a
purposeful suppression but we simply assess the physiological mechanism of memory
as a tool.
The scientific attitude suspends all value-judgment in order to arrive at knowledge. But though this is possible when attempting causal explanation it is not possible with empathic understanding, at least not exactly in the same sense. We can,
however, make an analogous claim for impartiality when we try to know what we
have understood. We may lay claim to impartiality when we have shown an understanding that is fair, many-sided, open and critically conscious of its limitations. Love
and hate bring values which are indeed the pacemakers of understanding but their
suspension brings us a clarity of understanding that amounts to knowledge.
In understanding a concrete case we inevitably appear to make an appraisal and to
fail in scientific understanding because with human beings every meaningful connection as such is immediately judged negatively or positively. This is due to the fact
that the understandable as such implies some evaluation. To understand correctly is
to appraise; to appraise correctly is finally to understand. Hence in all understanding
there lies on the one hand a finding of fact which can be free of appraisal and on the
other a challenge to appraise which calls out value-judgments. Correct understanding
is hard to come by and rare, so our appraisal of others is usually false and depends on
chance and emotional impulse. Every man likes to be judged favourably so that a
favourable appraisal tends to make him feel understood. Thus in everyday language
understanding and positive appraisal have become identical. Where people have been
negatively judged-particularly in situations that expose them-they will consider
themselves particularly hard to understand and will nearly always see themselves as
persons misunderstood.
It is true there is the idea of objective appraisal, that is, of understanding and
correct appraisal compellingly linked together. The establishment of understanding
would then be the final true appraisal. But this is only a theoretical coincidence.
Understanding can be linked equally with contrary value-judgments (thus Nietzsche
continued to understand Socrates but sometimes he evaluated him positively, sometimes negatively). So long as we merely understand, the understandable becomes
contradictory in itself, ambiguous and a source of ambivalent behaviour, the more
fully it is grasped.
have perceived an expression, which brings an inward meaning to light; and

(3) we have represented a direct experience which phenomenologically is
irreducible and can only be statically produced as a datum.
We can have no psychological understanding without empathy into the
content (symbols, forms, images, ideas) and without seeing the expression and
sharing the experienced phenomena. All these spheres of meaningful objective
facts and subjective experience form the matter for understanding. Only in so
far as they exist can understanding take place. They come into a context
through the comprehension of our genetic understanding.
These subjective and objective findings are not, however, the only
province of psychological understanding. On the contrary: (I) it is hardly
possible to talk about contents without thinking of the psychological reality
for which they exist; and (2.) we can hardly scrutinise an expression without
understanding the motive at work; and finally ()) we can hardly describe anything phenomenologically without immediately coming upon meaningful
connections.
Psychological understanding operates where there is a totality of complex
facts. It also meets with the ununderstandable in the form of extra-conscious
mechanisms or of Existence itself. When understanding wishes to investigate
causes, an extra-conscious bodily mechanism is inevitably implied and
inversely it is impossible to talk of extra-conscious mechanisms without presupposing something that can be understood or has been understood and that
evokes at its own limits the idea of some such mechanisms. When understanding wishes to grasp and illumine Existence as possibility and so call men back
to themselves, it touches on a source of freedom in Existence itself without
which everything understandable would lose its foundations, lack personal
reference and become ineffective and void. Existence itself, however, can only
manifest itself in an understandable phenomenon and only so can it attain its
own self-realisation.
The understanding psychologist proceeds as follows: he starts from a
comprehensive intuition of meaning. He then makes an analysis: expression,
psychic content, phenomena on the one hand, extra-conscious mechanisms on
the other, while existential potentialities are detected as an empirically unexplorable base. As a result of this analysis of facts and meanings he gains an
enriched understanding of all the connections. In the given case the results
will be scrutinised, the procedure repeated and insight steadily increased by the
collection of objective data interwoven with fresh intuitions of the whole,
which lead in their tum to a fresh analysis.
Thus our psychological understanding lies as it were midway between the
objective facts, the phenomena of experience and the implied extra-conscious
mechanisms on the one hand and the spontaneous freedom of Existence itself
on the other. We might deny the object of psychological understanding altogether and maintain that phenomena, psychic contents, expression, extraconscious mechanisms are all subjects for empirical research alone, while the
310
(h) How what can be understood psychologically moves midway between meaningfol objectivity and what cannot be understood
At the point where our psychological understanding comes to a halt, we
find something which is not itself psychologically understandable but a precondition for such understanding. Let us summarise:
In depicting connections that can be understood genetically, we always
find: (I) we have presupposed a mental content which is not a psychological
matter and which can be understood without the help of psychology; (2.) we
)11
3I2.
possibilities of Existence itself are purely a matter for philosophy. But let us
be a decisive knowledge of the whole. Every act of understanding is a mode

of apperception. It throws a beam of light into human reality. It is not the
method which makes mankind accessible as individuals nor as a whole. All
psychology of meaningful phenomena is therefore incomplete.
try to manage with such a division of the field I Most of our psychological
seeing and thinking would disappear and it would become impossible to speak
of the facts and fundamentals of the Human Being without bringing back the
psychology of meaningful phenomena once more. But this meaningful psychology is always in balance between these two realms and we can never speak of
it in isolation. It is related to them both and if there is to be a complete presentation they cannot be separated.
Thus the psychology of meaningful phenomena never comes to any point
of rest within itself. If it does, it has either become an empirical psychology,
busy on the comprehension of phenomena, expression, content and extraconscious mechanisms, or it has become the philosophical illumination of
Existence itself.
Psychological understanding only serves psychopathology in so far as it
makes something visible to our experience and fosters our observation. As I
understand, I find myself asking what are these facts I am looking at and what
am I indicating? When do I reach the limit of my understanding? The midway
status of psychological understanding has to be constantly re-established by
objectifying the psychic phenomena and discovering the limit of this understmding.
This intermediate status of our understanding throws some light on the
old question of the psyche in its relation to mind and body. We see the mind
as meaningful material content, to which the psyche relates itself and by
which it is itself moved. We see the body as the psyche's existence. We never
seem to grasp the psyche itself but either explore it as something physical or
try to understand it as content. But just as the whole realm of the corporeal
cannot be exhausted by the various physical phenomena which are biologically
explorable-indeed, this extends right up to the body-psyche unity of expressive phenomena-so too the reality of the mind is linked to the psyche, inextricably bound to it and carried along by it.
Our view of concrete reality would be unnecessarily limited if we simply
conceived the psyche as bodily expression and grasped it thus exactly, finding
it here whole and complete, the psyche itself, with nothing to mediate it.
Expression is only one of the dimensions in which the psyche is appareI1t and
it is not an enclosed unit but can be understood only in connection with what
does not become expression.
We conceive the psyche as the objective correlate to the method of understanding. The psyche appears to recede and in its place we are occupied with
its foreground (phenomena, expression, psychic content) and with conditioning factors (the body and Existence itself). What psychological understanding
gives us is the bond that holds together all that we can understand and all that
belongs to it which we cannot understand.
The midway position of the psyche makes it impossible for genetic
understanding to be self-contained and round itself off in what is thought to
31 3
(i) The fonction ofunderstanding in psychopathology

There are two main undertakings. We try first to extend our understanding to unusual and remote connections which at first sight perhaps
seem incomprehensible (for example, sexual perversion, instinctual cruelty,
etc.). Secondly, we try to discover universal and in themselves understandable connections in those psychic states where abnormal mechanisms appear as
the conditioning factor (for example, hysterical reactions). In the first instance, it is a matter of understanding something that is felt to be pathological or unique but in any case alien from everything understandable; the
emphasis lies on the special nature of the understanding. In the second
instance, it is a matter of recognising the abnormal realisation of connections
which are for the most part quite understandable in themselves and by no
means unusual. Here emphasis lies on the abnormal extra-conscious mechanums.
These, however, become accessible to us only when we set out to understand.
Two chapters have been devoted to the above. The one deals with the
'what' of meaningful connections. They themselves provide the main theme
and here the abnormality lies in the nature of what needs to be understood.
The other deals with the 'how' of meaningful connections and the way in
which they reach realisation through extra-conscious mechanisms. Here the
abnormality lies in the mechanisms themselves. They cannot be understood
as such and form the ground of the peculiar manifestation of what in itself
needs to be understood.
The subsequent chapters deal with the two basic properties of what is
understandable. These are: (I) All that is understandable, understands itself;
it is in particular an operation of self-reflection, for example the attitude of the
patient to his illness; (2) Everything understandable has its own coherence
within the individual. The concrete total of meaningfol or understandable connections constitutes what we call the personality or character of a person. This
forms the subject-matter of the final chapter.
To ensure clarity of discussion on the subject of the understandable, we
will recapitulate as follows: In the psychology of meaningful phenomena, the
application of directly perceived, understandable connections to an individual
case never leads to deductive proof but only to probabilities. Psychological
understanding cannot be used mechanically as a sort of generalised knowledge
but a fresh, personal intuition is needed on every occasion. 'Interpretation is
a science only in principle, in its application it is always an art' (Bleuler).
CHAPTER
I.
THE SOURCES OF OUR ABILITY TO. UNDERSTAND AND THE TASK

OF THE PSYCHOPATHOLOGY OF MEANINGFUL CONNECTIONS
We all know a great many psychic connections which we have learnt from
experience (not only through repetition but through having understood one
real case which opened our eyes). We make use of these connections in our
analysis of psychopathic personality and of those psychoses which are still
open to partial 'psychological explanation'. The richer we are in such meaningful insights, the more subtle and correct will our analyses be when we apply
'psychological explanation' in a given case. Neither in normal psychology nor
in psychopathology has there been any attempt to elaborate the psychology
of meaningful phenomena in any systematic way, perhaps because it has been
thought impossible or too difficult to do this. Such meaningful connections as
we all know and as constantly conveyed by our language lose all their force
if we try to give them a general formulation. Anything really meaningful tends
to have a concrete form and generalisation destroys it. But we expect systematic
knowledge in science and if we cannot systematise meaning we can at least
order our methods according to principles ofunderstanding. First, however, we
should remind ourselves of those sources on which the richness, flexibility and
depth of our understanding depend.
In the case of every investigator it is a matter of his human stature as to
what he understands and how far this understanding reaches. Myths are works
of creative understanding and they have been creatively understood by all
great poets and artists. Only through a lifelong study of poets such as Shakespeare, Goethe, the ancient dramatists and such modems as Dostoevsky,
Balzac, etc., do we arrive at the required intuition, and gain a sufficient store
of images and symbols and the ability to exercise an understanding imagination necessary to guide the concrete understanding of the moment. We are
sensitised by reflection over the whole range of the humanities. If the investigator has the basic features clear this will ensure that he has some real
measure of understanding and can frame certain possibilities. As an investigator into meaning I am conditioned by the sources of my understanding, by
such confirmation as I find and by my own problems. These all decide whether
I remain tied to banal simplifications and rational schemata or whether I
endeavour to comprehend men in their most complex manifestations. It is fair
to say to the investigator of meaning: 'Tell me where you got your psychology
from, and I will tell you who you are'. Only a close association with poetry and
human reality at its greatest will provide the horizons within which the most
314
simple everyday occurrence can become interesting and vital. The levels
reached by the one who would understand and by the object of his understanding will decide whether orientation is towards the ordinary or the extraordinary, the plain and uncomplicated or the complex and manifold.
Besides the world of meaningful myth and poetic image, there is a whole
literature of intense thinking on the matter of understanding, based on Plato,
Aristotle and later the Stoics. But it was Augustin, who first elaborated psychological understanding for the Western world. After him there were a number
of attempts in aphoristic form, mainly among the French: Monta;"." La
Bruyere, La-Rochefoucauld, Vauvenargues, Chamfort. Magnificent and towering above them all was Pascal. Only Hegel produced a system: IThe Phenomenology of the Mind', while Kierlcegaard and Nietr.scl&,l stand out unique
as the greatest of all psychologists interested in meaning.
Basic patterns ofhuman life underlie all our understanding and at the back
of our minds we are more or less clearly aware of what man is and can be.
Every psychopathologist visualises these patterns to himself but does not give
validity to any single one. He tries them all out and sees what his concrete
observations are and how his potential experience can be widened.
Psychopathology is not called on to develop and present all manner of
meaningful connections in their totality. The realm of meaning is unbounded
and we are protected from any apparent subordination to rigidly schematised
thinking, simple or complex, if we remain fully aware of this and fortify ourselves by interweaving the heritage of the past with our own life experiences.
The true problem for psychopathology is that meaningful reality which specific
extra-conscious mechanisms, normal or abnormal, have brought into being.
Psychopathology, however, is obviously called upon to give a searching
presentation of rare connections with ahnormal meaning as they appear in individual, concrete cases. This is something outside the natural sciences and
causal explanation and as such is not often attempted, certainly not in any
thoroughgoing way. The tendency to accept only the causal knowledge of
the natural sciences has obscured the sovereignty of any such investigation
and has falsified objective enquiry by the introduction of 'psychological
explanation', much as, in the natural sciences, pure understanding tends to get
falsified by the use of theoretical constructs. Valuable contributions have been
made in the fields of sexual perversion by the expert examination of Court
cases and by good psychiatric case-histories. In psychopathology it may well
be the task of special psychiatry to describe personality disorders and make
us aware of singular meaningful connections (in the instinctual life, in the
scale of values and in behaviour), but there are also a number of common
meaningful connections which are the subject of relatively frequent observation and form part of the ordinary equipment of everyday practical understanding.
1 Cpo my lectures 'Vemunft u. Existenz' (Groningen, 1935). Re Nietzsche, see my book
Ni,t{scla" EilfftJlaru"l in aas V,mllntlnis S';fIU Plailosoplaierens (Berlin, 1936).
316
Note on the examples given of meaningfol connections: There is an infinite

world of meaning and in this chapter we can only indicate a few possibilities.
During the last decades certain basic modes of understanding have grown into
our everyday practice in rather haphazard fashion. We do not need to select
arbitrarily a number of meaningful connections from the valuable literature
mentioned above, but in psychopathology we have to be aware of our methods
and of the viewpoints that have general acceptance among the psychiatrists
and psychotherapists of today. These current points of view indicate the ways
of understanding that are most acceptable today. They may not be universally
valid nor so for ever but they are appropriate for our own particular world.
All understanding presupposes some picture of the individual and his personal
world at the same time as it enlarges this, and so it is with our contemporary
understanding. The following seem to me material among the presuppositions
that underlie our present picture of man: the impoverishment of the possibilities of inner experience compared with earlier times; the determination to
correct this poverty by adhering to tradition; a knowledge of radical conflicts;
a frankness of basic attitude and irreligion, inducing a tendency to believe in
systems of faith-healing and certain passionately adopted symbols.
In what follows we present some contemporary viewpoints but the
principle remains that we need to be acquainted with the great historical
traditions of understanding as a background for our everyday, practical
understanding. These should never be forgotten as original sources and as
standards of measurement when contemporary experiment tends to crowd
into the foreground of our awareness.
We present examples of meaningful connections from three aspects: (I)
Meaningfol content-instinctual drives are the sources of a subject's movement, which takes place within an individual relationship to the world. This
movement becomes meaningful to itself in life through the use of symbols (we
discuss instinct-psychology, psychology of the real, the psychology of
symbols); (2) The basic forms of the meaningful-the individual's movement
takes shape as an opposition offorces with accompanying tensions, reversals,
reconciliations and critical decisions. The movement is reciprocal (we discuss
the psychology of opposites, the psychology of reciprocity); (3) Self-reflection
as a basic phenomenon of all meaningfulness (we discuss the psychology of
self-reflection).
These three aspects of understanding (content, form and self-reflection)
converge into one coherent meaningful whole. They are not a set of mutually
exclusive and diverse elements but each one illuminates the whole from its own
point of view. Therefore our psychological understanding if)t is to be complete is constrained by each one of them to include the rest.
2.
317
CONNECTIONS WITH A MEANINGFUL CONTENT
(a) Instinctual drives, their psychic manifestations and transformations
All experiencing contains an element of being driven. There is something

Instinctual in everything we do and suffer, in everything we would bring
about, enjoy or angrily avoid; it is the same whether we pursue something,
grasp it, hold on to it and affirm it or whether we fly from it, avoid, by-pass or
destroy it.l
(I) Concept of Drive. The question 'what is a drive?' may be answered in
several ways: drives are instincts which we experience, that is, functions carried
out as the result of an urge without conscious awareness of content or aim but
In such a way that complex purposeful activity finally reaches its end by being
moved towards it. Drives are physical wants, e.g. hunger, thirst, need for
sleep; that is, urges which reach their target directly provided the means are
there. Drives are a form of creative activity shown, for example, in bodily
movements that develop and manifest the bodily essence or in some way
express and represent it (urge for expression, urge for representation); or they
are shown in directed effort (urge for knowledge, creative urge). Drives are
motivated acts, that is, impulses which are conscious of their aim and reach it
Intentionally using the available means to a purpose.
Any such dissection of the whole state of being driven, which is a unity in
Itself, always reflects some attempt at interpretation. We have then to ask which
point of view governs the interpretation. Thus the above classification was
according to the purposes objectively achieved (instincts); according to physIcal urges (drives); according to what is creatively produced (creative urges);
according to the ideas, subjective goals and purposes present (motivated
action). Such classification has only relative meaning. For instance the 'sexual
drive' contains all these categories in itself: it is an instinct manifesting itself
as an inborn function which fertilises without conscious awareness; it is a
physical want or need (tumescence and detumescence); it shows erotic
creativeness and motivates actions which will realise erotic ideas.
We can make a further differentiati0n of the whole state of 'being driven'
from yet another point of view and ask whether the motive ofthe urge is to gain
pleasure (by pleasure in this context we always mean physical pleasure) or
whether the content provides the goal, to achieve which displeasure, pain and
suffering are accepted, or whether displeasure itself can motivate the drive.
Pleasure is an experience of harmonious biological function, of general wholesomeness and success, of a capacity to linger over things; pleasure also lies in
psychic equilibrium and well-being. Drives, however, are not aiming just at
such pleasure, but are beyond pleasure and pain. We cannot describe their
essential nature except approximately through an attempt to classify them from
a number of different aspects.
1
Nietzsche: TriJupsychologie. See my Niet{sclre, pp. 113-1~.
318
There are still other points of view which we may follow, and we can
differentiate according to certain broader aspects of meaningfulness which we
are about to discuss. Thus we may take the relationsnip of tne individual to nis
environment, in which case drives are conceived as stemming from the primary
defencelessness of existence, in particular' of man in his world. In order to
survive he has the drive for power and self-assertion. He has gregarious drives
(social feelings) for tne survival of tlte species. If these two are mistakenly
turned into absolutes, all drives become reduced to these basic drives and the
highest aims are interpreteq as merely devious ways whereby the basic drives
achieve their elementary goals. Or we may take symbols as meaningful content
and interpret them as a means, a language, a deception in the process of the
self-realisation of the drive. Finally, we may take tlte dialectical tension which
psychic movement creates. In this case we direct our attention to the conflicts
that spring from resistance to a drive. We ask what resists and what is resisted.
We understand the movement of self-control and discover what is irresistible
and how it may grow to what is uncontrollable, always however for the time
being, never absolutely so.
But, whatever our classification, there is a basic element of something
given in all human drive. It cannot be understood as meaningful in any way,
but from it all understanding of meaning has to start. At the same time there
is a psychic impulse which drives towards definition through content. Understanding the drives and how they manifest themselves throws light on something which is itself a process of continuous self-illumination.
(2) Classification ofdrives: The contents of drives are as manifold as life itself. Every drive contains an urge and hence a movement which is moved on
as it were by the force of something which is experienced (a symbol-according to Klages), something felt in theurge itself, unaccompanied by any specific
idea or thought. Drives can therefore be distinguished from each other by
their content, and enumeration of this would be as endless as that of the content of feelings. The important thing is whether classification can penetrate
the elementary properties of drive and there have been repeated and various
attempts to make some kind of catalogue.
It is a drive to return to the inorganic. The drive for food has something in common
with the drive to destroy because it destroys what is eaten. The drive to live (Eros) is
differentiated into the ego-drive and the sexual-drive. The ego-drives are drives for
IIClf-preservation (drive for food, acquisitive drive, defensive drives and gregarious
drives) and for self-expansion (drives for power and importance, the drive for knowledge and creative drives). The sexual drive includes the drive for the preservation of
the species, care for the generations. 1
Drives are polarised in some of the following possible ways: Drives arising out of
a surplus of energy may be contrasted with those arising out of a deficit, e.g. the
need to discharge energy as against the need to regain it. Then there are drives that
can be aroused at any time as against drives which are essentially periodic, which are
gratified and then arise anew. Some drives represent a continual need which can only
be gratified repeatedly and are incapable of further development. They can be satisfied completely but only for the time being. In contrast, other drives change each
time they are satisfied; they grow, develop and are never satisfied completely. The
hunger does not diminish but increases with every gratification.
Freud distinguishes drives according to those opposites which he regards as the
most profound-the drive to live and the drive to die. The drive to die is a drive to
destroy which can be directed outwards (aggressive drive) or inwards against the self.
In the follOwing classification drives are divided into three levels of drive:
Group 1. Somatic, sensory drives. Sexual drive, hunger, thirst-need for
sleep, drive for activity-pleasure in sucking, in taking food, in anal and
urethral excretion. 2
In this group the basic polarity is that of neea and satisfaction. All the
drives have some bodily correlate. The drives are positive only with no other
positive drive opposing. The negative would be disgust or aversion.
Group 2. Vital drives. They have no definite localisation in the body but
are directed out towards human existence as a whole. They are:
(a) Vital drives for existence. The will to power-will to submit; the urge
to self-assertion-urge to surrender; self-will-social drive (herd instinct);
courage-fear (aggressive anger-retreat for help); self-importance-urge to
humility; love-hate.
In this group the drives fall into pairs, each drive with its counter-drive.
The preservation and intensification of life seems to be of objective significance
In them all but only at the price of conflict which makes at any time the exact
opposite possible-the destruction of life, whether of oneself or another and
ultimately perhaps the urge for universal destruction. The polarity of drive
and counter-drive will often produce an amazing dialectic, bringing about
conversion of the opposites, one into the other .
(b) Vital psycltic drives. Curiosity, protection of the young, the drive to
wander, to find ease and comfort, the will to possess.
In this group the drives are defined by their particular content at any
time.
(c) Vital creative drives. The urge to express, to demonstrate, make tools,
work and create.
Group 3. Drives of tlte numan spirit. Drives to comprehend and give oneself to a state of being which manifests itself as an experience of absolute
values, whether religious, aesthetic, ethical or pertaining to truth. Philosophy
undertakes to examine this world of values and clarify it independently from
subjective psychological experience. It is a psychological fact that there is a
basic experience of this sort, qualitatively different from that of the two
1 There are many other classifications: e.g. Klages (GrunJlagen Jer Charakterkunde (8th eeln.,
1936); Der Geist als WiJersacher Jer See/e, vol. 2, pp. 566 fr.). Macdougall, Aufhaukriifte Jer Seele
(D), (Leipzig, 1937), pp. 76 fr.
Investigation of this group can only be through physiological examination, e.g. D. Katz,
'Psychologische Probleme des Hungers u. Appetits', Nervenarr.t., vol. 1 (1928), p. 345. Hunger u.
Appltit (Leipzig, 19P)'
previous groups and extremely complex and rich and derived from a dedication
to these values. It is an instinctive longing for them when they are absent and
a sense of delight incomparable to any other pleasure when the longing is
fulfilled. It is decisive for any picture we form of people that we should know
how this whole group of phenomena affects their lives. Although as a group
these drives may sometimes recede to vanishing point they are never quite
absent in any man.
The common factor in this group is the drive for immortality, not in terms
of temporal duration but in the sense of participating in some temporal form
in a pattern of Being that cuts across Time. l
The material of these three groupings is of such heterogeneous meaning
that we may well hesitate to talk in terms of drive in every case. And yet any
such grouping has to separate what in reality is linked. Taking this classification as. a hierarchy of drives we see that each preceding group can realise itself
without the others but not vice-versa. It is characteristic for man alone that his
whole instinctual life is pervaded by the drives of the last group. Nothing in
man is simply identical with what we find in animals, nothing can be carried
out simply and naively (Man, says Aristotle, can only be more or less than an
animal). Inversely, however, man cannot, as it were, participate in nothing but
purely intellectual or spiritual drives. A tinge of sensory-somatic drive is
always present but to deduce from this that higher drives are nothing but a
veiled form of basic ones would be a mistake. 'To be involved' is not 'to be
origin'. The universality of the effects of sexual drive does not mean that this
is always the determining, let alone the only, power of the psyche. Suppose
we propose the more modest thesis that the mind is powerless, all power comes
from the lower levels, or in other words that our deepest experiences and
strongest impulses always originate at the lowest levels of our existence-this
thesis of Schiller (hunger and love (sexuality) preserve humanity so that only
those ideas can realise themselves that win the support of the natural drives)
is by no means unequivocal. Such a thesis may perhaps hold for the massevents of history but by no means certainly so for all times. It may help us, it
is true, to understand how spiritual, or ethical, motives are often advanced or
kept in the foreground of consciousness when essential and vital drives are
de focto in sole charge. But this does not exclude authentic spiritual and intellectual drives from ruling the lower levels of drive, utilising them as tools and
as a source of energy. We cannot doubt the primary quality of every movement of our impulses but their interaction and collision presents us with a
fundamental problem of human existence. Once we see that this is so, we can
no longer believe in any final and unequivocal classification of drives within
a single and uniform hierarchy.
(3) Ahnormal drives. There is a countless host of these. We find perverse
tastes, like the pica of pregnant and hysterical women who develop cravings
for sand or vinegar, etc. We also find insatiable hunger, or an abnormally

increased thirst which can become an addiction. l There is the drive for any
kind of emotion at any cost, for excessive gesture and expression, the desire for
inactivity, countless persistent drives to wander, get drunk, etc. All require
particular analysis, which is the province of special psychiatry. Perverse sexual
and other instinctual activities, usually correlated with the type of sexuality,
are one of the main topics for investigation. We find an urge to suffer and
pleasure found in pain, suffered or inflicted. The drive to be cruel is so widespread that it might almost pass for normal. Nietzsche saw it so and took
orgies of cruelty as a basic factor in human affairs. When related to sexuality,
such drives are called sadism (infliction of pain on others) and masochism
(suffering pain) where the inflicted pain is the condition for sexual pleasure.
But sexual frigidity is also linked with a drive to torture and with a lust for
power, showing itself as a delight in inflicting pain. Moralistic attitudes towards others may often be a manifestation of the drive for power and the
drive to torture ('right' sounds very like 'racked', said Nietzsche). Those who
have gained importance in the history of culture are markedly surrounded by
the specific atmosphere of abnormal instinctual states, of passionate hate,
sado-masochistic pleasure, sexually frigid cruelty and a craving for domination
in love, etc. It is important to know of the many and limitless transformations
of these abnormal instinctual states if we are to understand some of the cultural
movements of history, for instance, the link between asceticism, lust for
mastery, cruelty (particularly in the Middle Ages) and fanaticism in almost all
its forms. History obscures all this. It is not something which is talked about
and handed on. Often it can be inferred only from concrete experiences
accessible to the doctor but now and again accidentally preserved documents
and records may give us a powerful illustration. But understanding will also
show us the effects of healthy instinctual states and can trace the clear atmosphere of passions free from perversions and cultural transformations of this
sort. Of the two, it almost seems that the healthy passion is the rarer. 2
We can observe the power these instinctual perversions exercise over the
whole of a person's life. If we try to understand, we are always faced with
ambiguity: is a particular abnormal instinctual disposition the origin of a
personality change or is an abnormal personality the condition of the possible
abnormal manifestations? From the point of view of psychological understanding both seem to be the case. In outstanding personalities a most abnormal
320
1 See Miinsterberg, Scheler, Rickert, etc., for Values and their classification. Recent work:
S. Behn, Philosophie der Werte als Grundwissenschaft der piidagogischen Zieltheorie (Miinchen, 1930).
32.1
1 H. Marx, Innere Sekretion, pp. 42.0 If. (Handhuch der inneren Medi{in, von Bergmann, Staeholin,
SOllie Berlin, 1941), vol. 6, part I).
2 The literature on abnormal sexuality is immense. For nineteenth-century description see
v. Krafft-Ebing, Psychopathia sexualis (Stuttgart, 1886), 14th edn., 1912.. Havelock Ellis, H.
Hohleder, Vorlesungen jiher Geschlechtstrieh u. Gesch/echtslehen der Menschen (Berlin, 1900),
2nd edn., 1907. I. Bloch, Das sexuallehen unserer Zeit (Berlin, 1906). A. Moll, Handhuch der SexuallI'issenschaften. Recent psychological enquiry, e.g. v. Gebsattel, 'Ober Fetischismus', Nervenar{t,
vol. 2., p. 8. Kronfeld, 'Ober psychische Impotenz', Nervenar{t, vol. 2., p. pl. Hans Binder, 'Das
Vcrlangen nach Geschlechtsumwandlungen', Z. Nellr., vol. 143 (1932), p. 83. A. Paunez, 'Dec
L('~rkomplex, die.' Kchrscits des Oedipus-complexes', Z. Neur., vol. 143 (1931), p. 2.94.
32.3
instinctual disposition may be balanced by humane qualities which render it

factually ineffective (as with Wilhelm von Humboldt). In other cases we have
the impression that abnormal drives retain their power and perhaps originate
in the personality, which is therefore defenceless against them. Ruinous consequences thus appear-instinctual disposition and personality are equally
involved-so that the individual is unable to build a life with others. Or we
find a number of intermediary stages where as a result of perverted drives a
person is in ceaseless struggle with himself and stands tortured by an unsurmountable division in his existence. In the last resort the decisive thing is the
personality into which the abnormality is absorbed and from which it springs,
either evaporating, as it were, in the personality'S pure ether or stamping
itself indelibly upon it.
The following is a classification of the ways in which abnormal drives can
be understood:
(aa) As disintegration of the higher levels of drive. As the higher levels
vanish, drives at the lower levels gain uninhibited outlet and increase in
importance within the psychic life as a whole. We may observe, for instance,
the ravenous hunger of dements. In terms ofpersonality this is a devastation of
the psyche.
(Ob) As dissociation hetw~en the levels ofdrive. Different levels of drive split
away instead of cohering and mutually limiting each other as clearly differentiated parts of one whole. Drives at each level are realised to the exclusion of the
others, the sensual purely sensually, ideal ones purely ideally. The ravenous
eating of certain neurotics is of this kind. More common is a splitting-off of
sexuality and the isolation of this essential drive without any integration of it
into the whole psychic destiny. Heyer speaks of those who 'forget the loving
surrender to Eros by reducing it to banal sexual gratification'. All natural
drives have something of the psyche in them, but the isolated drive is characterised by violence and soullessness. In terms of personality the effect is
recklessness, heartlessness and malice.
(cc) As inversion of the relation hetween lower and higher levels of drive.
Lower-level drives fulfil themselves in their own appropriate way by being free
to lend themselves to some deep and indivisible unity, e.g. the sexual drive
in love. Love manifests itself in the sexual drive as one of its forms. But the
lower-level drives may realise themselves in the shape of higher-level drives
by perversion so that the higher drives are not really there, except as a mask,
as, for example, when religious feelings are experienced as sensual gratification
or dedication to God as lust.
If we call this higher-level mask a 'symbol' and state that the sexual drive
finds realisation in such 'symbols' we have to admit that such 'symbolic'
gratification does exist. But it is not universal and when it occurs it is always the
sign of an abnormal psyche. It is the direct inclusion of sensual drive in a noncorporeal form (the drive, so to speak, empties the form as it takes possession)
instead of a sublimation in which the drive is there but transformed into a part
of the whole. This direct inclusion of the sensual element changes the very
nature of the non-corporeal, turns it into a means, into dead matter, disguise
and deception. In terms of personality the effect is that of dishonesty and
hypocrisy.
(dd) As fixation ofdrive. Perversion rises through the accidents of our first
experiences. Gratification remains tied to the form and object once experienced,
but this does not happen simply through the force of simultaneous association
with that former experience. If so, such phenomena would have to belong to
human experience in general. The conditioning factor is rather something else,
which we believe to have found when we suppose a hypothetical 'arrest at an
infantile level' of the psyche as a whole.
322
For example: Fetichism is a perversion in which the objects of sexual attraction

may be shoes, fur coats, underwear, girls' pigtails, etc. v. Gebsattel studied shoefetichism. The shoe for the patient was not just an object, but a living thing which he
addressed, cuddled, as a child cuddles a doll. The fetish formation corresponds to an
auto-erotic state of development arrested at an infantile level. The shoe-fetich!st is
'incapable of letting his love and sexuality reach beyond himself. He cannot bring
them togetherintoany real consonance with the realisation of another living "Thou".
Created in flight from other personalities and the other sex, the fetish becomes a
substitute for the other "Thou" as well as for the other's body. The fetichist in the
course of his development becomes fixed in the maternal/paternal love relationship
and never grows out of it.'
Psychoanalysts interpret neurotic attention to food and digestion as an infantile
attitude, coprophilia as well and other manifestations of anal-eroticism. They understand scrupulous cleanliness and anxious orderliness and other features of the 'analerotic' person in the same terms.
The personality reveals the effect of these fixations as an inner lack of

freedom, as inhibition and a general impoverishment of feeling.
(ee) Transformation of drive into craving. Drives are not yet cravings.
Craving as compared with drive is not only stronger and more difficult to
overcome but it is experienced as something alien and compelling. Craving
springs from an abnormal and intolerable state which it is supposed will be
alleviated by satisfaction of the craving. Drives can turn into cravings. How
does a craving arise? Firstly, through knowing. Reflection on sexuality can
itself create a craving even though the drives themselves are not particularly
strong. Secondly, a chance intake of intoxicants may lead to withdrawal
phenomena (addictive cravings in the narrower sense are those due to intoxicants). Thirdly, there is a certain peculiar and increased sense of emptiness into
which people may fall repeatedly through disposition or situation, and in order
to escape from it they surrender to a craving. Thus v. Gebsattel remarks
'every sort of human interest can degenerate into a craving' in that it may be
put into the service of this emptiness, whether it be work, collecting things,
striving for power, indulging in sentimental feelings, making a cult of beauty,
etc. Instead of a growing personal life, all that happens is a repetitive craving
for the same thing. The dissatisfaction felt is only gratified for the moment, it
is never removed. It returns at once and demands unreflecting repetition
without any growing continuity of content.
All perversions are cravings (v. Gebsattel). They are more compelling than
normal drives. The urgent desire for intoxicants is a craving. In this case there
is a physiological emptiness produced in the person, for instance when morphine has been given for medical reasons and its effects cease. It needs a certain
self-discipline to overcome this state. Ifhowever this whole sense of emptiness
is an integral part of the personality and precedes the craving altogether, both
factors combine, the physiological state and the urge to banish the emptiness
in intoxication. We may say that all alcoholics, morphinists, etc., who are
addicts, carry with them a basic, psychic readiness and that they can replace
one craving with another but can never become radically free from any because
the cause of the craving cannot be abolished.
(4) Psychic developments due to transformation of drive. Not all impulses
arise from a basic drive. On the contrary we have to differentiate between
primary drives and those drives which are only disguises, substitute activities
or only apparent instinctual drives. In this case the meaningful connection is
as follows: our real environment often impairs the gratification of instinct and
this will happen sometimes to every one. Every instinctual gratification brings
some kind of pleasure, and every impediment arouses displeasure. Where
reality denies true instinctual gratification, the psyche will seek such gratification by a number of devious and unnoticed ways, although in principle we are
always capable of noticing when this moment arises. Since real gratification is
impossible, success is obtained through a deception. From this arise the host
of our illusionary gratifications, the unnoticed dishonesty of human nature.
Here are a few examples from this really inexhaustible field:
(aa) One possibility is that we simply exclude concrete reality from our
consciousness. We believe that what we wish is real and what we do not wish
is unreal. The majority of human judgments are distorted in this way. With
one group of psychoses-the so-called reactive psychoses-we gain the
impression that the psychosis achieves a flight from reality-a reality that has
become unbearable.
(hh) Another possibility is that the ungratified drive takes another ohject as a
symhol and gains a different, slighter but nevertheless acceptable gratification.
The objects of the above third group of drives are very often turned into
symbols by ungratified drives belonging to the first and second group. The
drives of the third group are then not really experienced, but only apparently
so. This becomes obvious in the different character of the subjective experience
and also by the fact that as soon as a possibility for real instinctual gratification
arises the false enthusiasm for the other values vanishes.
(cc) Similarly, there can be a translation of values, a 'falsification of yaluescales' (Nietzsche) whereby underprivileged people make their reality bearable.
Poor, weak, impotent individuals turn weakness into a strength, e.g. in the
formation of certain moral values, to make their existence tolerable. Nietzsche

understood such a shift in values as the product of resentment at the positive
values of others who were rich, privileged and strong. Schelerl has made an
excellent analysis of the relevant connections and shows the deceptiveness of
these changes in values.
Another falsification which is the direct opposite of that springing from
resentment is the attachment of value to social status (Legitimitatswertung).
The individual for whom things go well, who is fortunate in his birth and
belongs to the ruling classes, tends not to ascribe this to luck but to his own
innate superiority and natural merit. The privileged position is not seen in the
first place as a challenge but simply as the individual's due. In addition to
everything else underprivileged people have to bear, he maintains that their
suppression is right because they are inferiors. Full of self-regard, he takes
affluence, power and superiority as a sign of aristocratic nobility, and health,
strength and good spirits as a sign of his ultimate worth. He does not let himself see the accidental nature of his own position and the roots of ruin in all
this. He cannot stand modesty, humility or any knowledge of the realities
which bought him all his advantages. He wants to avoid any threat of fall and
decline and to escape the responsibilities of his position. He therefore makes
use of the rightness of his status as a protective screen so that he can be free of
his obligations and enjoy his possessions in peace. Thus suppressor and suppressed alike may both falsify their scales of value in a complementary manner,
just as a sense of the realities, truthfulness and openmindedness are possible for
them both.
(h) The Indiyidual in the World
The basic human situation is that each one stands in the world as an individual, a finite being, dependent but always with a possibility for activity
within certain changing but none the less constricting bounds. Living is an
encounter with a world which we call concrete reality. To live involves
struggle, impact, creation. It means breaking against the world, adapting to
it, learning and getting to know it.
I. The concept of situation. All life takes place in its own particular surroundings. In abstract physiological terms we say stimulus causes reaction.
In real life, the situation releases activity, and gives birth to performance and
experience; it may evoke them in some way orput them forward as something
that has to be done. Social studies investigate the human situation as it derives
from the objective relationships of social life. The psychology of meaningful
phenomena investigates individual attitudes to typical situations. It objectifies
the way in which coincidence, opportunity and destiny come to us through the
situation itself and how we grasp or lose them. Situations have urgency, their
sequence is changeable and unfixed, !U1d mankind can contrive them. We use
1 Max Scheler, 'Ober Ressentiment u. moralischen Werturteil', Z. Pathopsychol., vol. I (191~).
p.
~68.
the term 'marginal situations' for the ultimate situations like death, guilt, and
inevitable struggle, which determine the whole of life unavoidably, though
they go hidden and unheeded in our everyday existence. The human experience, appropriation and conquest of these marginal situations remain the
final sources of what we really are and of what we can become.
2. Concrete reality. What concrete reality is cannot be maintained with any
objective certainty but it depends to a certain degree on beliefs which the
community generally accept. In trying to understand someone, we have to keep
apart what he accepts as concrete reality and what we ourselves know it to be.
Hence because concrete reality has no absolutes all understanding exists, as it
were, in suspense.
Concrete reality is nature, in particular our body and our physical and
mental abilities. Concrete reality is the social order which indicates what the
individual must expect in any social situation from certain acts or modes of
behaviour. Other individuals are also concrete reality and communication with
them creates the familiar, supporting foundations of our life.
Man is driven towards concrete reality to fulfil his existence in bodily
soundness and skilful performance or in social privilege and responsibility or
perhaps in the only way in which he can truly realise himself, in the bond of
close and genuine relationships. But such fulfilment does not just come
automatically to him on its own.
3. Self-sufficiency and dependency. As humans, we tend to imagine some
sort of ideal being that is self-contained and self-sufficient and content in itself
without needing to receive anything from without because there are endless
riches to be derived from itsel But if we want to become such a being we have
first to learn the drastic lesson that in everything we are dependent. As vital
beings we have needs that can only be satisfied from without. We have to live
in society, and playa part there in order to get our share of the goods necessary
for life. We have to live with other~, surrendering to them while preserving
ourselves, giving and taking in mutual relationship. We have to live, loving
and hating, or we will grow empty and void in our solitude. We have to live
in exchange with each other, and continually create afresh from what we learn,
hear, understand and appropriate, if we are to partake in the human spirit to
which we would have no access without our fellows.
There are limitations, inhibitions and collisions in all our external contacts,
whether with nature or with man, with society or with the individual. Life is
realisation through the processes of creation and adaptation, through struggles
and resignations, compromise and fresh efforts at integration. In such realisation the polarities between preserving our own space and surrendering it to
others become a unified whole and there is no dispersal into mutually exclusive
opposites.
But we cannot avoid conflict, conflict with society, other individuals and
with oneself. Conflicts may be sources of defeat, lost life and a limitation of our
potentiality but they may also lead to greater depth of living and the birth
of more far-reaching unities, which flourish in the tensions that engender

them.
All finite life has a double character. It reacts to situations, facts and people
and in its reactions it also becomes active and creative in the concrete reality of
the confronting situation. Action and reaction are wrongly conceived as
opposed and it is a mistake to imagine the possibility of an absolute creativity
engaged in objectless activity. It is equally wrong to take reaction as the fundamental feature of life.
In the course of time the modes of activity and reactivity and of their
admixture (with one or other pole predominating) take up a certain pattern
of distribution in anyone individual as with others, and thus a group-type is
formed. As extreme examples we find: a contemplative, closed inwardness that
devotes itself to quiet being and passes its life untested, unproven, in a continuity of looking and remembering. On the other hand there is the activity of
the extravert, that accepts no finality of being but always wants to make a
change, and prove itself in so doing, passing its days in conquest, creation and
organisation.
4. Typical basic relationships of the individual to reality. The above-described ways of existence in concrete reality are never pursued without meeting
resistance. Success is never complete. There is a constantly moving relationship
between activity and reactivity and this can be meaningfully construed in
terms of typical contrasts:
(aa) Kretschmerl confined the relationships between the self and outer
world-that is the individual's style of life-to the following possibilities:
)2.6
I.
A simple sthenic or asthenic relationship

Sthenic: feelings of superiority over the world, of strength and power
to act. Tendencies to excessive self-assurance, recklessness and
aggressiveness.
Asthenic: feelings of inferiority, weakness, passivity. Tendencies to
underestimate the self, give way and be uncertain in one's
behaviour.
2.
An internally contradictory, expansive or sensitive relationship.

Expansive: Sthenic/asthenic polarity. Hence hidden feelings of insufficiency, overcompensation, touchy self-consciousness,
readiness to take offence or feel injured. Tendencies to
paranoid and querulant behaviour.
Sensitive: Asthenic/sthenic polarity. Hence ambitiousness, vulnerable
self-esteem, sudden strong feelings of insufficiency, uncertainty about life, self-torture, scrupulous conscience with
little cause, feelings of moral reproach. Tendencies to ideas
of reference.
3. Intermediate life-styles: conciliatory, practical and adaptable, in harmony with one's
milieu. No contrast felt between the self and the outer world.
1
Humke's Hanahucla aer Ceisteskranklaeiten, vol.
I,
pp. 686 If.
(hO) To complement this typology of temperament, the content of the

person's life-style can be classified according to his attitude to reality, and the
meaning this acquires for him in the course of time. The contrasting polarities
are as follows: Either his work, performance and life in general draw validity
for him from some continuing whole or he 'finds every activity a game, an
adventure, an experiment. In the former case we find the following of some task
or calling, carried on historically by successive generations. The work of the
past is a tangible whole which comes to life again daily in the individual's own
activity. The farmer is such a type and knows himself to be a disappearing
link in the service of his farm and acts accordingly. But in the latter case, we
have the game of the adventurer, where everything is in pieces. There is no
meaningful sequence of activity, the moment is supreme. His world is without
plan, completeness or grace. The adventurer in his reality gives us a symbol
of the impossibility of perfect fulfilment.
Both these contrasting polarities express a basic attitude to reality and in
each case the reality is felt as radically different. For the one, reality signifies
an enduring existence in an historical sequence of work, family and further
development; for the other, reality has no foundation and signifies an eternal
gamble and defeat.
5. Denial ofreality through self-deception. It is difficult to expose ourselves
fully to reality. Reality exacts constant self-denials, continuous effort and
painful experiences and insights. There is therefore a strong urge to withdraw
from reality. Life always finds a possible way to circumvent it, screen it off or
find some substitute and this is accompanied by the momentary pleasure of
easy gratification but it is always at the price of loss of health or life. In a host
of individual situations, as indeed throughout his whole life, man is constantly
faced with this choice of either penetrating or denying reality. The following
are some of the ways in which withdrawal from reality seems to offer substitutes, gratification and satisfaction.
(aa) In place of the denied reality, the object of gratification becomes one's
own self-created contents. Montaigne wrote: 'Plutarch says of people who
waste their feelings on guinea-pigs and pet dogs, that the love element in all of
us, if deprived of any adequate object, will seek out something trivial and false
rather than let itself stay unengaged. So the psyche in its passions prefers to
deceive itself or even in spite of itself invent some nonsensical object rather
than give up all drive or aim. What would we not hold on to, rightly or
wrongly, so as to have something on which to vent our wrath?' Objects are
then not taken as such but as symbols for something else.
We escape from reality with the help offantasies. These conjure up easily
and lavishly all that in reality would be so hardly and sparsely achieved.
Fantasies are related to wishes which arise from the inhibitions and deprivations of individual existence and they bring us relief though they have no
concrete reality. Bleuler calls this self-incapsulation in an isolated world
'autistic thinking'. The contents of fantasy longing may be, for example, one's
lost childhood, foreign lands, spiritual homelands, but the crucial point is the
tendency to tum away from present conflicts and obligations. It is an aspect
of metaphysics and poetry that they rob man of his real personal part in
Existence itself in favour of a dissipation of his powers in fantasy, and this was
most profoundly comprehended by Kierkegaard.
(bb) At first these modes of unreal subjective gratification are only a sort of
game we play, but they can lead to a subjective realisation of their contents. A
transformation occurs which must be due to some underlying abnormal
mechanism which we no longer understand. Here belong the hysterical
realisations (in all kinds of bodily and physical phenomena), elaborate lying
in which the person convinces himself (pseudologia phantastica) and the
construction of delusion-like worlds in schizophrenic processes.
(cc) Transformations of this sort do not often occur in normal, understandable psychic life, but once the game of fancy has started, it frequently
leads to self-deception. The self-deception can be corrected but we see it at
work in the understandable forgetting of painful things or obligations, the
subsconcious relief of illusionary misinterpretations, of which we are certainly
subjectively aware, and in temporary excursions into hysterical behaviour.
The contrast to such behaviour is the striving for reality, truthfulness and
authenticity. The person wants to have a transparent vision of what he really
is in his concrete reality. Such an effort returns him to the world if defiance has
not led him to the utter clarity of negation and isolation.
The behaviour of neurotics and psychotics, criminals l and eccentrics has
been understood as a form of self-deception, a self-surrender to a fictitious
existence, which has arisen from an urge to get away from reality. Seclusion of
the self comes to mean falsity because self-deception and self-constriction
inevitably follow. Seclusion from reality as given is indeed a seclusion from
the very basis of being which manifests itself through reality. And 'sin is
separation from God'. Falsity of this sort has been thought to be a universal
human trait; like Ibsen, we look for the 'life-lie' which everyone needs and
acknowledge Goethe's saying that no one ever reaches such insight into truth
and reality as would take away the conditions of his own existence. Others
limit this world of radical self-deception to a particular group of persons who
suffer from personality disorders (psychopaths) and define personality-disorder (psychopathy) as 'a suffering from self-deceptions necessary for life'
(Klages). Any reasonable psychologist will guard against generalising in
either direction. We try to understand our problems but we do not expect any
final answers.
The struggle is real. We see that we are threatened, that the situation makes
demands. Flight, attack or defence are all weapons we can use. But the whole
procedure may become obscure. Unbearable reality tends to get veiled. We do
not accept the threat nor the demand that we should fight or endure it. Our
defence becomes an avoidance in self-deception. We have no clear intention
1
Andreas Bjerre, Zur Psychologie des Mordes (Heidelberg, 192.5)
33 0
but make an instinctive arrangement to get away from the demands of the
situation, perhaps through illness or some misfortune or suffering. Both the
situation and its demands and the meaning of our own attitude are hidden from
conscious scrutiny. In addition to the deliberate deception of others or substituting for it, we find self-deception and a'distortion of reality. The person's
consciousness can no longer accord with his unconscious.
6. Marginal situations. Man is always in one situation or another, and all
these situations are finally resolved into marginal situations, that is, certain
impassable, unchangeable situations that belong to our human existence as
such. In these situations mere human existence founders and awakens to
Existence itself. 1 Empirical psychology can throw no light on these marginal
frontiers nor on what an individual can become when confronted with them,
whether he conceals them from himself or lays himself open to them. But the
psychopathologist interested in meaning must be aware of all this because the
personality disorders (the psychopathies and neuroses) and the psychoses are
veritable sources of human possibility, not only deviations from a healthy
norm. The abnormal happening and experience is very often a manifestation
of something that is a strictly human concern. The psychopathologist who
confines himself to mere observation and objective phenomena cannot perceive
this; he can only do this within the bond of human fellowship where one person shares his destiny with another.
Neurosis (personality disor:der) has been conceived as failure in the
marginal situations of life. The goal of therapy has then been visualised as a
self-realisation or as a self-transformation of the individual through the
marginal situation, in which he is revealed to himself and affirms himself in the
world as it is. 2 This conception is valid so far as its philosophical truth is also
valid for the neurotic person. The practical philosophy of becoming truthful
also has a therapeutic effect. But we should remember that avoidance of
marginal situations does not in itself create illness. We see it carried out
quite successfully in a perfectly healthy dishonesty and cowardice, without
any abnormal phenomena.
(c) Symhols as the content of ultimate knowledge
To understand the individual, we need to understand what he knows, what

objective contents exist in his consciousness. The crucial point, however, is not
so much what he knows but what this means to him, that is, how was his knowledge acquired and what are its necessary effects? The nature of an individual
is determined by what he experiences, sees and is confronted with as his own
concrete reality. Most of all it is determined by his concrete certainty of this
reality. What sort of God he has sums up the man.
I. Ultimate knowledge. The knowledge which belongs solely to the indi'Ober Grenzsituationen', see my P},ilosop},ie, vol. 2, pp. 201 If.
Johanna Durck, 'Die Existenzformen von Bemachtigung u. Verneidung', Zhl. Psyc},ot},er.,
vol. 12, p. 223.
1
33 1
vidual and which conditions the certainty of his knowledge or is the precondition
of any other knowledge he may gain, we have termed ultimate knowledge.
Another term is the 'a priori'. As such, it is the general 'a priori' of universal
consciousness in the categories of understanding. As regards ideas, it is the
'a priori' of the intellect; as regards practical drives and forms of reaction, it is
the 'a priori' of human existence. Historically it is the 'a priori' of the person,
present in his own world as part of his tradition, as a momentary figure in
time, as an incarnation of the universal, which has meaning and import, not as
a universal but as an infinite particular.
Ultimate knowledge resides in the prevailing types of intuition, in the
types of seeing and conceiving primary phenomena and facts, in the modes of
individual and group existence, in the various tasks and callings and the dominant values and tendencies. Symbols play an important part within it and are
all-pervasive.
2. Concept of the symhol and its significance in real life. Kant states: 'every
object must be concrete before we can grasp it. Symbols help us to grasp
things by analogy. For example, monarchy may be represented as a body with
a soul and dictatorship as a machine. There is no similarity between actual
object and image but they have the common principle of making us think
about both and their inner causality. Now if "reflection on an object of direct
apperception is transferred to an entirely different concept which can never be
directly apperceived", then we have the symbol. In symbols we behold all that
our reason thinks without there being any corresponding concrete apperception for the thought. What is beheld in the symbol proper is only accessible in
symbolic form; the object of the symbol never shows itself directly as concrete
experience. "Thus knowledge of God is purely symbolic." To take the symbols,
for example, of God's will, love and might in a direct fashion, only lands us in
anthropomorphism, and if we ignore the intuition in the symbols we shall slide
into Deism.' 1
Symbols that do not contain a concrete reality become non-committal
aesthetic contents. They are only fully symbols if they express reality. Human
thinking is prone to take this symbolic reality as if it were the reality of direct
apperception, so that symbols tend either to become objects of superstition
(where their concreteness is mistaken for reality) or to pass as unreal (mere
metaphors or symbols when measured by concrete reality itself). To live
deeply rooted in symbols is to live in a reality which as yet we do not know
but can appreciate in its symbolic form. Symbols therefore are infinite, accessible to infinite interpretation and inexhaustible, but they are never reality
itself as an object which we could know and possess. 2
It is true that ultimate knowledge has categories to structure it and ideas
that form complex unities but the reality that lays hold of us in it takes a
Kant, Kritik der Urteilskra/t, Section ~9.
Fr. Th. Vi scher, Das Symhol in 'Kritisc},en Giingen'. His conception is an aesthetic one, and
the reality-content vani~hes.
1
332.
~ymbolic form. This means that ultimate knowledge is not a well-developed

Intellectual knowledge but lies in apperceptions and images that carry infinite
meanings and bring to us the language of reality. Their presence, as it were,
protects us, helps us to reassure ourselves and brings us peace. Even the
logically systematised knowledge of the philosophically educated person
comes at last to the determining symbol. Even systems of ideas are like symbols
in their complex unities and when they carry a real awareness mean more than
is seen in them by reason. All basic philosophic concepts are, not so much
definitions, but rather comprehensive symbolic apperceptions, which not even
the most detailed of rational systems can fully explain.
Symbols are an historical 'a priori' but their truth impresses us as something ete~al i~ time. The~ order themselves in an infinite succession. They
come to 11ght In myths, phIlosophy and theology. They appear in the play of
the imagination, flourish uncommitted in aesthetics, compel with absolute
power in extreme situations and are the hidden guide of every full-bodied
meaningful life.
'
Everything in the world can become a symbol. The basic forms ofHfe the
universe and of all that happens, the elements, the basic facts of our exist:nce
types of real things, human ideals and counter-ideals. Everyone of them c~
be turned into a symbol according to what we value. If seen Simply as objects,
they cease to be symbols, even when one signifies the other (e.g. the machine
signifying the dictatorship) provided both are seen on equal terms, explaining
each other as ends in themselves. Where symbols become carriers of infinite
meaning, of something inaccessible except through the symbol, they become
as it were 'creatures with souls', attracting us to themselves, inspiring us delighting us, making us shrink but always absorbing us. They leave ilieir
imprint on us in so far as they leave us free, but should they become lasting
objects of superstition they keep us fettered.
In common usage the word 'symbol' has many meanings. In its widest sense
it is used merely as a sign, as a metaphor or simile, as some schematic abbreviation for what we see in the world, as anything significant. We must always
ask 'a symbol of what?'. If the answer refers to some other concrete object then
we are not dealing with a genuine symbol. The genuine symbol contains the
:of what' within itself and there is no actual object referred to, except perhaps
In the form of some transcendental philosophic concept.
In the psychology of meaningful phenomena we need to differentiate carefully between a symbol as a carrier of meanings that have a personal validity
springing from the person's life-history, a kind of surrogate structure as i;
~ere, and a symbol as a carrier of a comprehensive meaning, the bearer of an
lmmane~t transcendence. Jung conceived the first as arising from the personal
unconSCiOUS, and the latter as from the collective unconscious.
3 The possibility of understanding symbols. Cari one understand symbols?
O.ther people's symbols, not one's own, can only be seen as they appear from
Without. We cannot understand them from within, from the very heart of thei1'
333
reality. The symbol must incorporate one's own life if the meaning is to be
fully understood. Our own symbols can be illumined, and translated into
metaphysical ideas and in the process much is brought out of the dark into a
rich unfolding. While they remain part of our life and we live in them they
can be understood. Formal understanding of symbols, on the other hand, can
only reach as far as an aesthetic appreciation, the special excitation of feeling by
a tentative play with exotic material, while the true seriousness of reality is
lacking. Symbolic knowledge amounts to more than thinking in images.
Psychological understanding of symbols moves among perilous amhiguities. We study symbols in myths and religions, dreams and psychoses, in
daydreams and in the personality-disorders (psychopathic states). We get to
know about them but only from without and our own beliefs are not involved.
On the other hand, in the course of such scientific study we get bent on the
truth of the symbols themselves; we would like to heal through communicating our knowledge of symbols; we want to bring them to life ourselves, and
invite participation in them. There is a confusing interweaving between knowledge of symbols as historical and psychological facts-seen from outside even
when we have some inner representation of them in ourselves-and knowledge of symbolic truth. The two meanings get inextricably mixed.
4. The historical study of symbols. The exploration of symbols is usually
confined to myths, fairy-tales and sagas. Research into Greek mythology
seems to have been the main source especially since the Romantic period
(Creuser). The most productive authors have been O. Muller, Welcker,
Nagelsbach, Rohde'! Schelling's2 imposing and comprehensive study still has
interest in spite of gross mistakes in detail, but among all these interpreters,
Bachofen3 remains the one who had inspiration, as it were, in spite of his
collector's zeal and solid approach.
Nowadays it is Klages 4 and Jung 5 who have become known as the interpreters of symbols. What Burckhardt termed 'archaic images' (,urtumliche
Bilder'), Klages termed 'images' and Jung 'archetypes'. But there are certain
essential differences between Klages and Jung. Klages' interpretation has a
fascinating vividness. His presentation of the symbols of poetry and art
remains as perhaps the really lasting contribution in all his great work, in
10tfried MiiUer, Prolegomena :CU einer wissenschaftlichen Mythologie (G6ttingen, 182.5) Die
Dorier (Breslau, 1844); F. G. Welcker, Grieshische Gotterlehre (G6ttingen, 1857); C. F. Nagelsbach, Homerische Theologie (Niimberg, 1840); Nachhomerische Theologie (Niimberg, 1857). Erwin
Rohde, Psyche (1893), 4th edn., 1907.
2 Schelling, Philosophie der Mythologie u. OJfenharung (Werke, 2. Abt., Stuttgart, pp. 1856 fr.).
In particular vol. 1 of the Vorlesungen, pp. l-l0-'Ober die Geschichte der Mythologie'.
3 J. J. Bachofen, Die Auswahl 'Der My thus Yon Orient u. Occident' (Miinchen, 192.6). Historical
introduction by A. Baeumler. Selection by Rud. Marx in Kroner's Taschensausgahe.
'Ludwig Klages, Der Geist als Widersacher der Seele (Leipzig, 192.9).
C. G. Jung, Wandlungen u. Symhole der Lihido (Leipzig and Vienna, 1912.). Seelenprohleme
der Gegenwart (Ziirich, 1931). Ober die Archetypen des kollektiven Unbewussten, ErallOsjahrhuch
(ZUrich, 1935). On Jung himself: Die kulturelle Bedeutung der komplexen Psycho logie, Festschrift
{um 60 Gehurtstag (Berlin, 1935).
334
which he brings forward rather doubtful evidence for the development of a

strange, precritical philosophy through a synthesis of rationalism and gnosticism. Jung on the contrary lacks the impressive vividness of Klages and his
work has nothing like the same weight. He is the deft master of all the means of
interpretation but the inspiration is missing. Klages has inspiration, in as much
as he is the true successor of Bachofen, whose work he rediscovered. Jung's
expositions become tiring and irritating because of many undialectical contradictions. As the reader emerges from many of Klages' pages, he is struck by a
winged quality which is lacking from the work of Jung who favours a worldly
scepticism. The present day is poor in symbols and both these men are anxious
to discover primary reality. Jung's efforts strike me as a fruitless new start
through the exploitation of what is old, while Klages' attempt, as he appears to
have felt himself, seems a rather hopeless recollection of the lost depths of
history.
Jung's theories have gained esteem among psychotherapists, and even outside
these circles there has been some enthusiastic agreement. The eminent Indologist,
H. Zimmer, speaks of 'the magical, soul-guiding function ofJung's teaching'. 'It has
discovered in the underworld of our being the eternal source, the ancient murmurings.
The Myth which peoples and their poets have spun for our understanding is thus
restored to its home in these unplumbed depths from which all its forms arise.' 'C. J.
Jung's art of dream interpretation throws a remarkable light upon the dark world of
myth and fairy-tale'. Each should look for himself and see what he can find. But for
myself, I ca'lnot be convinced that such judgments are correct.
s The possible Junction of symhol-exploration. Symbols have a certain role

in modern public life but they tend to be few. Compared with earlier times,
life nowadays is extraordinarily poor in symbols. Yet it is a fact that symbols
appear in great number in dreams, daydreams, psychoses and personality
disorders (psychopathic states); whether they do so as by-play or in all
seriousness cannot be determined. In psychopathology, symbols have become
a favourite object of attention for psychotherapists because in psychotherapy
symbols become important. There are three reasons for this: firstly, they give
us an insight into what are the dominating preoccupations of the individual;
secondly, unnoticed- symbols can be evoked, fostered and brought into consciousness; and thirdly, symbols can be used to give indirect guidance to the
patient. This at least appears to be so, although all these three procedures have
been doubted by some. But if symbols do have this importance--hard to overestimate--then their exploration becomes of extreme consequence.
(aa) Recognition of symholic material. Psychotherapists began by letting
patients tell their dreams. Similar contents were also found in psychotic
experiences, fantasies and delusions. Lastly it was discovered that an otherwise
unregarded world emerged in the dreams of everyone. These findings became
significant, in as much as parallels could be drawn between them and universal
myths, in the same way as ethnologists had already found parallels between
myths all over the globe, giving rise to the hypothesis of 'elemental human
335
ideas' (Elementargedanken-Bastian).l These were thought to arise spontaneously everywhere without any spread of ideas through communication.
Similarly psychotherapists assumed something universal to humanity and not
only could it be discovered by ethnologists and mythologists but it could be
found in dreams, personality disorders (neuroses) and psychoses. It was
necessary, therefore, to have some general acquaintance with the myths of the
world as they appeared in religion, in fairy-tale and legend and in the poetic
imagination.
(bb) Recognition of symholic connections. Symbols may be analysed from
three different aspects: philosophically as to their truth (Plato, Plotinus,
Schelling); historically, as to their development in concrete reality; psychologically, as to their origin in the individual psyche and their effect upon it, in
accordance with the general rule or as a variation. These three approaches
involve questions of very different significance. All three equally demand an
understanding of the content, it is true, but questions regarding the eternal
truth of the symbols pursue a goal independent from those regarding the
universality of symhols as concrete historical phenomena, and both sets of questions are quite independent from the question of symbols as cause and effect,
even though all three sets of questions are found constantly intertwined in any
exploration of the symbols themselves.
I. Systematisation of symhols. We now comprehend that the human being
lives in symbols all the time. They are his dominating reality and since this
symbolic existence is part of the basic structure of human life, our aim is to
grasp these symbols in all their particularity, collect them in all their diversity,
survey them carefully and bring them into some kind of order. We have two
different standpoints at our disposal. We may either approach them as strange,
exotic forms which, even if we cannot understand them, we would at least like
to know from the outside. Or we may see them as a unique world of symbolic
truth from which, to our detriment, we have grown alienated to a great extent
but which we might recapture. This would give us a vast world of constantly
moving images which represent the truth of primary types. We should then
seek for the basic elements as unchanging elements in our human awareness of
reality. The systematisation of symbols will not then appear to us as a classification of certain peculiar fantasies but a ground-plan of truth. The development
of possible symbolic content means that a space is opened up in which the
individual can become a substantial self. Bereft of symbols, his impoverished
psyche would, as it were, freeze into nothing, and, left with reason alone, he
would make but a futile bustle in a world that has somehow grown empty.
When the collection and classification of symbols from the purely external
point of view (morphology of symbols) has been distinguished from the
inward construction of symbolic truth as a whole (philosophy of symbols),
we find that both can serve each other though the one does not complement
the other. If we confuse the two, we discredit them both.
1
Richard Andr4!e, Etlanograplaische ParalMe u. Vergleicht, p. 1878. N.D. 1889.
336
Heyer undertook a classification of symbols.1 We may follow him (see p. 2.45)

as he presents his 'circle of life', moving through the different psychic levels fro~
vegetative through the animal to the spirit, and we may see how they are roote~ In
myth and symbol. We may feel convinced that his classification provides a stimulaung
picture though from a very special point of view which both philosophy and ~sycho
logy would find extremely questionable. But we must not let ourselves be misled by
Heyer's first-class writing and the heady atmosphere of ideas that stem from the
world of Goethe and others and have very little to do with the matter in hand.
2. The laws ofsymbols. When observing subjective visual images we cannot
but be astonished by the way figures, landscapes, people we have never seen,
suddenly emerge out of nothing. The same thing happens in dreams. In a way
we cannot really measure, our unconscious life gives form to something that is
presented to consciousness later as finished and complete. !his final pro?uct
is a content and has meaning. In so far as we find no meanmgful connectIons
and see only an aggregate of random, meaningless fragments, we talk of
chance but the demand for meaningful understanding always spurs us on to
look for some rule or connection.
We should indeed find such a connection provided we are not dealing with
irrelevant fragments and chance groupings but with contents that emerge from
unconsciousness with at least the partial significance of symbols. In attempting
to interpret any factually experienced content symbolically we make two basic
discoveries: firstly, interpretation is unlimited, there is no end to it and the
ramifications of meaning go on for ever.
Jung writes: 'Once we examine the types in relation to other archetypal forms,
there are so many far-reaching symbolic-historical connections that we are drIven to
the conclusion that the multiformity and opalesence of the basic psychic elements
defeat our ordinary human powers of imagination.'
Secondly, interpretation becomes itself an experience, a continuation of

a symbolism in which there is a continually growing content which throws
light upon itself, a productive process. In the translation of symbols, we reach
no terra firma.
In the course of interpretation it becomes clear whether the symbols of
the dream or fantasy stand in any kind of relation to waking life, that is,
whether their meaning has any influence on waking life or dominates it altogether. We can hardly doubt that symbols playa leading role in all waking life.
They display themselves with effect; they ?ot only play around life but,~e~er
mine its course and this fact has been explamed by Jung who calls upon hvmg
dispositions and systems of reaction' that rule our lives unseen, unregarded and
for this reason all the more powerful. 'There are no inborn images but there
,
d .
are inborn possibilities of images, and these set limits to even the most anng
imagination.' The philosophical 'a priori' becomes here, speaking psychologically, the effective structure of the archetypes. 'On the one hand they pro1
G. R. Heyer, Organismus J" S"I. (Munchen, 1932.).
337
vide a powerful, instinctive bias, and on the other we may conceive them as the
most effective help for instinctive adjustment.'
The archetypes of Jung have multiple meaning and as such they are not
true symbols. For Jung they are universal and stand for all those forces which
bring into being the specific forms, images, ideas and modes of apprehension
in which the world and mankind appear to me, in which I fantasy and dream,
in which I build my beliefs and in which I find the certainty of my Being.
Thus among the archetypes we also find authentic symbols, and that is when
transcendent contents of Being itself define for me the meaning and significance of people and things in the world; that is, when my attitude to these
is decided not by any particular purpose or interest, vital antipathy or sympathy, but by something in them which transcends them. Symbols may either
be the clear voices of Being itself, transcendence objectified, or they may
simply be products of the human psyche (mere images or ideas), and it is in
this latter sense that they tend to be ofimpo.tance in psychological discussions.
This leads to a confusing ambiguity: Do symbols offer us an ultimate truth
or should we see through them and treat them simply as semblances? It is the
same if we try to clarify the basic principle that in symhols I am confronted with
something that also contains myself. Is the process of becoming one's true self
a self-illumination, whereby in understanding symbols we understand the
real truth? Or is this commerce with symbols just a struggle with our own
shadows and it is precisely in understanding the symbols as semblance only
that we become our true selves?
In Jung's work the following basic phenomenon plays an important part:
Throughout life there is a constant division within us. Our relationship with objects
is a relationship with ourselves, especially when we think we are dealing with something that is certainly not us. I hate and love my own possibilities present in the
other, in criminals, adventurers, heroes and saints, gods and devils. I ascribe to the
object what lies dormant in myself. I master this or become its victim by fighting it
outside myself or making it my own by hating or loving it. The same circumstances
prevail in the individual psyche as Hegel saw in the universe. I become what my
opponent is. I am more or less transformed into that which I fight against.
Jung argues: The system of adaptation, through which at anyone time we keep
contact with the world, is the 'persona'. We either retain control of these systems,
which are formed by the archetypes, or we fall captive to them by identifying with
them or becoming obsessed by them. The 'shadow' on the other hand is the sum
total of the inferior functions, which are always with us, just as no one can ever be in
the light without throwing a shadow. The shadow draws its form from the archetypes. The man who is possessed by his shadow, that is, who lives beneath himself,
stands in his own shadow. He gets unconsciously caught in a trap of his own devising
when there is nothing in reality to make him stumble. The archetypes form his world
into successive situations of failure, misfortune and lack of achievement.
3 The origin of symhols. From the empirical study of symbols we learn of

the parallels that exist in the symbols of different peoples. We have to conclude
33 8
that there is something which is universally human, something which humanity

shares. We also find definite types ofsymbols, which are limited to a number of
parallel cultures and are not universal. Finally we come across certain unique,
historical symbols, which belong to particular peoples. Thus symbols expressing
the most general polarities are to be found everywhere (male and female,
waxing and waning, rhythm and recurrence, elementary natural phenomena),
and in this way we can discover the basic symbols of the human race, existing
timelessly in the unconscious, quite apart from human history and tradition.
But we never discover Apollo and Artemis, for instance, in this way. They
belong to history, and are unique and irreplaceable. They cannot be found
even in the depths of the unconscious and are accessible through cultural
tradition alone. Between these two extremes lie those special symbolic forms
which are not universal but belong to a wide range of cultures. In conclusion,
there are a number of peculiar contents, not found everywhere but yet in so
many places that they cannot be strictly historical and in spite of their oddity
seem of a general character: for example, the cephalopods (Kopffussler).
Symbols only affect life in their particular, historically unique, form.
They have universality of structure and content, it is true, but in itself this is
ineffective. There is however another view which holds to the contrary, that
effectiveness lies just in that universal characteristic which disguises itself under
the many historical variations.
Schelling held to the first view. He had a magnificent vision of the peoples
of the earth and their myths coinciding in origin. The Babylonian Tower of
Babel bore witness to the dispersion of the unified human race into peoples,
who as they groped their way were at the mercy of their myths. There were as
many myths as there were peoples. Every myth creates its people, just as all
peoples create their myths. 'The general principles of myth-formation took
on specific shapes from the very start.'
Jung takes the opposite view: He distinguishes a collective unconscious
from the personal unconscious that grows out of the life-history. The collective
unconscious is the universal biological and psychological basis of human life.
It exerts its influence on everyone, though it is deeply hidden. Yet he conceives
this universal element as 'the mighty cultural heritage of human development'
and again as 'the residue of all human experience right back to its most obscure
beginnings'.
Jung construes the collective unconscious as a domain of archaic images which
are the truest thoughts of mankind. This again does not avoid ambiguity. On the
one hand the construct implies an objective knowledge, based on research, of earlier
times and of the hidden dispositions of men (Anlagen); on the other hand it calls for
participation in these substantial truths for one's own good.
He writes as follows: 'The most archaic images are the oldest, most universal and
profoundest thoughts of mankind. They are as much feelings as ideas and indeed
they even have something like their own independent life, something perhaps like
their own particular soul, as may be seen clearly in all those gnostic systems which
339
accept as a basic tenet the existence of a perceiving unconscious as a source of knowledge. St. Paul's image of the angels, archangels, principalities and powers, the
Gnostic's archons and aeons, the heavenly hierarchies of Dionysius Areopagitica, all
stem from the relative sovereignty of the archetypes: These contain all that man
could think of as most beautiful and magnificent as well as all the wickedness and
devilry of which he is capable.
These historical-cum-psychological theses are very questionable, quite
apart from their supposed bearing on truth. At first glance there are surprising
analogies to be drawn between the myths of almost all races and between these
myths and the contents of dream and psychosis. But they are insufficient to
provide us with a convincing construct of a universal and fundamental human
unconscious, fully stored with content. Looking at these analogies more closely
we find they are superficial and confined to general categories. It is precisely
their effective content which is missing. For example, the point of similarity
in dying and rising gods (Osiris is killed, Dionysius torn to pieces, Christ
crucified) does not constitute their essential nature. The analogy throws light
on what is inessential.
(cc) Awakening of latent contents. The psychotherapist in his exploration
of symbols is impelled by a wish to find the symbolic truth and participate in
it. He runs a considerable risk here of being confused and deceived.
I. The occurence of symbols in dreams, fantasies and psychoses is a psychological phenomenon which needs to be differentiated as such from the existential significance of symbols in the sensible, waking state. If we take dream-experience as a
starting-point for interpretations ofhuman life which are to he existentially effectiye, are
truth and well-being thereby enhanced? Perhaps so, but can it not easily happen that
what matters in earnest is then deflected on to a shifting play of feeling and supposed
statements of what is only supposedly so?
2. Self-fulfilment comes from the success or failure of some particular, historical
solution of the great problems of the human order. For the person who loses this
capacity for self-fulfilment in the course of his life, myths and poetic images lose their
meaning also. If he becomes aware of this deficit, the withering seed of human possibility may reach out for the air in which it may breathe and grow. In this case hreathing space may he given through some idea ofthe hasic human possibilities from Homer to
Shakespeare and Goethe and as the old, eternal myths preserve them. The individual
may not be untouched by these yet they sti1I do not represent his own original reality.
3. Where historical and psychological knowledge is treated as if it could provide
effective symbols for suffering people, superstition may be the result, a credulous
belief which attempts in a limited fashion to fixate symbols that are themselves indefinite, constantly in motion and not to be grasped objectively. Deeply rooted
traditions are turned inside out in the process and misused for therapeutic purposes
(they become a sort of measuring-rod for happiness and health). Where this is so,
,
the symbols are symbols no longer.
4. The individual may find in symbols a language for something which would
otherwise never be objective to him or have any influence on him. Once these symbols are evoked from his unconscious, the question arises as to what historical factor
340
needs to be added to give form to the awakening symbol and bring it to self-awareness. Whoever tries to answer this question can only prophesy. He cannot be didactic,
he can only proclaim. He cannot hold up any helping mirror nor ask helpful questions,
but he can proffer something material. The scientist and philosopher may think this
goes beyond human power and possibility. We ,stay confronting the symbols with
wondering respect as a whole world of hidden truth. Science and philosophy carry
us only so far as the frontier where our understanding tries to approach the symbols,
not in a general way but in their individual and historically concrete form; here we
listen for the echo in ourselves which may help us to understand whatever comes to
meet us in the other person.
S. Over against this whole world of symhols we have within ourselves a primary
reSOurce whereby this whole world is made relative. We are liberated from our
bondage to symbols by self-reflection. This protects us from credulity, which is a
constant threat to us, and carries us through and beyond all symbols, making it possible for us to form a new and deeper bond, that of Existence itself now linked with
an imageless transcendence that speaks to us in the absolute of goodness and in the
miracle of receiving oneself as a gift in the spontaneity of freedom. It shows itself in
the uncommitted certainty with which we find our way through inward acts and outward behaviour, once the directness of reason has discovered for us the choices and
decisions of Existence itself.
3.
BASIC PATTERNS OF MEANING
(a) Opposing tendencies in tke psycke and the dialectic of its movement
Psychic life and its contents are polarised in opposites. It is through the
opposites, however, that everything is once more re-connected. Image calls
forth counter-image, tendencies call forth counter-tendencies and feelings other
feelings in contrast. At some point sadness turns spontaneously, Or with but
little provocation, into cheerfulness. An unacknowledged inclination leads to
exaggerated emphasis on an opposite one. Meaningful understanding must
always be guided by such opposites, and were we to enumerate them all we
should be surveying the whole field of psychology.
I. Logical, biological, psychological and intellectual opposites. In order to
consider the various opposites we need some general standpoint: we may
regard them as the diverse categories of logic, as biological and psychological
realities and intellectually, as spiritual possibilities which might realise
themselves.
We have to differentiate the logical categories ofmere otherness or difference
(e.g. of colour and tone) fren oppositeness. Within the latter we have again to
differentiatepolari~(redand green) from contradiction (true and false). Weare
concerned here with a universal form of thinking which cannot proceed without there being 'the one' and 'the other', that is without differentiation and
without at least two points of reference. We are also concerned with a form
of universal Being as it appears for us (since reason cannot think anything which
has not something else external to itself; all Being therefore is polarised for
reason as it operates; otherwise it would be unthinkable).
In biology we observe real polarities: inspiration and expiration, the systole

and disastole of the heart, assimilation and dissimilation of metabolism,
antagonistic functions with their opposing rhythms, wakefulness which finally
compels sleep and sleep which in its turn compels waking. In the functional
cycles in which inner secretion plays a part, there are polarities in the latter
also. (Thyrotoxicosis and myxoedema contrast as opposites and seem to contain something that makes them diverge in opposite directions.) One basic
polarity of all living things is the division into male and female and their
reunification.
In psychology the polarity of opposites is all-pervasive. We find activity
and passivity, consciousness and unconsciousness, pleasure and displeasure,
love and hate, self-surrender and self-assertion, all polarities of the psychic
states and drives. We find also a will to power and an urge to submit, self-will
and social sense (I and We), an urge towards the light, towards self-direction,
responsibility, activity, life; and an urge towards the dark, towards safety,
irresponsibility, peace and death. There is also an urge to disrupt order and
an urge to conform. There are an infinite number of opposites and polarities
which can be developed in this way. In their rich and varied transformations they dominate the psychology of meaningful phenomena and its written
productions. All such psychology has to deal with polarities.
Intellectually, polarity leads to the establishment of opposing evaluations:
true-false, beautiful-ugly, good-bad, positive-negative. Our mind lays hold
on all the blind and accidental polarities, recognises their significance and views
them as symbols from the spatial levels of up and down, left and right, for
example, up through darkness and light, the biological poles of male and female
to the psychological antagonisms of pleasure-displeasure, joy-sadness, upward
rise and downward fall. For the mind itself, however, the movements it carries
out upon itself are essential. As it makes its way from one pole to the other, it
cannot tolerate contradiction and endeavours to overcome all contradictions,
unify the polarities and contain them within tensions of ever-widening range.
The mind grows conscious of the fact that all these opposites belong together and it becomes aware of the manner of their connectedness, and all this
becomes an immense work of its own doing. Our intellect identifies the infinite
transformations of the basic phenomenon wherever it appears, and grasps it,
bringing it into being within itself. Opposites do not merely exist but all Being
is moved by them. Opposites are bound to each other and thus become the
source of constant movement. This movement is termed a dialectic. In the face
of such movement, there arises the dissatisfaction, or rather the revolt, of
reason, which desires to establish things and know what it is presented with in
terms of facts. So, too, wherever reality is dialectical in character, terms of
definition become universally inappropriate.
2. Dialectical modes. In concrete psychic reality, the movement of opposites
takes place in three ways: I. Reversal through time without consciousness
taking part-inspiration changes into expiration, grief into cheerfulness,
34 2
enthusiasm into boredom, love into hate and vice versa. 2. A hattIe of opposites,
both opposites are present in the psyche, the one hurling itself against the other.
3. The self decides between the opposites, excluding one in favour of the
other. Where there is reversal of opposites we are concerned with an impersonal
event; where there is battle between opposites, we are concerned with an
inner activity and in the decision between them with a final doice. The two
latter modes lead to radically different dialectical movements; in the one case
there is a synthesis of 'this as well as that', in the other a choice-'either-or'.
In synthesis the opposites are locked in a constructive tension, at any
moment there is the possibility of harmonious resolution into some whole
which, it is true, must immediately dissolve into fresh movement. As this
proceeds, however, it builds up, by holding the opposing polarities together
in an increasing complexity and to an ever-widening extent. The whole as a
unity of opposites serves as origin and goal and by this movement through
the opposites comes to its full realisation. Here the dialectical mode leads to
the whole.
With choice the matter is quite different. The person faces the 'either-or'
and has to decide what he is and what he wants. The ground of validity and
responsibility is won with the absoluteness of a decision that excludes all other
possibilities. The contradictions of human existence and of what is possible
in our world have a final character. We are not honest if we try to escape them
by hiding them from oneself even if the most admirable harmony is achieved
thereby. There is the moment of truth where one's action is good or bad and
where a total, all-embracing attitude which excludes all opposites, becomes
impossible. This dialectical mode leads to the frontiers of decision.
Both modes carry a special risk for the psyche. Aiming at the whole,
looking only at this and feeling only this, the psyche may without noticing
lose its ground, be enticed into pleasing generalities and, using the dialectic of
'this as well as that' grow characterless, unreliable and sophisticated. On the
other hand where the psyche endeavours to reach the sure ground of decision
through the sacrifice of one of the opposites, it may become unnatural,
psychically impoverished, enjoying a lifeless one-sided quiet. It may moreover
become a victim of what has been sacrificed or excluded (in short, repressed)
which returns unnoticed as it were and overpowers the psyche from the rear.
These two dialectical modes have positive aspects. To see 'this as well as
that' offers a middle way where opposites may be linked together for the construction of further wholes. The 'either-or' alternatives of decision offer an
absolute validity. These two modes also have negative aspects. We find
featurelessness in the one and restrictiveness in the other, each having a certain
falsity of its own. In considering these aspects we discover that we cannot set
the positive aspect of the one against the negative aspect of the other but keep
both the positives in mutual contradiction.
What then is the psyche to do in the face of these two basic dialectical
possibilities? Does it have to support the one against the other? Or is there
343
some further possible synthesis of the synthesis and antithesis (of maintaining
the whole and of choosing alternatives)?
It is fundamentally characteristic of our temporal human situation that we
cannot accomplish such a synthesis. This means that in life we select and realise
our destiny from among the chances and risks of historical events, while all
correct resolutions disappear at the frontiers of tragedy and in the presence of
other transcending possibilities.
Dialectical transformation is a universal and basic form of thought, and is
in contrast with rational understanding, which it uses and surpasses. It is indispensable for the understanding of the psyche and bestows a satisfactory
quality of its own on our conception of human situations, human facts and
movements. 1
3. Application of the dialectic of opposites to psychopathological understanding. 2 We formulate the following as a measure for psychically healthy people:
There is normally a full integration of the opposites that arise in the psyche,
either through a clear, decisive choice or through some comprehensive synthesis. In abnormal circumstances one of these tendencies becomes independent
without the other ever asserting itself, or else integration just does not occur.
Or it is just the counter-tendency that gains a special independence. Measures
such as these can be applied to the analysis of meaning in the neuroses and
psychoses.
(aa) In schi'{ophrenia we can find examples of the drastic realisation of one
tendency without its counter-tendency: automatic response to a command,
echolalia and echopraxia, patients put out their tongue when asked, even
though they know they are going to be pricked. They imitate senseless movements and repeat parrot-fashion. We also find examples of the failure to unify:
a simultaneous positive and negative affect in relation to the same object,
which Bleuler called 'ambivalence'.3 In normal life this will lead either to direct
choice or some kind of constructive synthesis. Schizophrenic patients, however,
can love and hate simultaneously in an undifferentiated and unconnected way,
or consider something both right and wrong so that, for instance, though they
are correctly orientated, they will continue to adhere to a delusion-like
orientation with the utmost conviction. We further find examples of an independence of the counter-tendency: negativism, where the patients oppose everything or do the direct opposite of what is asked. They go to the lavatory but
use the floor. When supposed to eat they refuse, but gladly take other patients'
food away from them. In classical cases the patient goes backward when asked
1 The philosophy of Hegel and of his learned followers (in diluted form) expands the complexity of such 'dialectical' possibilities, going far beyond psychology though including it. Hegel's
'Phanomenologie des Geistes' is almost inexhaustible.
I Re the psychology of opposites, examples are given by Th. Lipps: Vom Fahlen. Wollen u.
Dtnken (Leipzig, 1907), 2nd edn. For psychopathology see Bleuler, Gross, Freud, Psychiatr.
ntur. Wschr., 1903, I; 1906, II; 1910, I. Jb. Psychoanal., vol. 2, p. 3. Bleulet, Dementia Praecox
od,r Gruppe der Schi{ophrenien (1911), pp. 4), 158 fr., 405.
a E. Roenau, 'Ambivalenz u. Entgegnung von E. Bleuler', Z. Neur., vol. 157 (1936), pp. In,
166.
to go forward. One patient, when out in the garden in pouring rain, asserted
that a hot sun was shining. Kraepelin interpreted certain stuporous states in
this way. He observed the beginning of movements and retardation caused by
these counter-drives which he distinguished from the simple inhibition of
psychic events with accompanying motor manifestation. Sometimes voices
tell the patient the opposite of what is intended. They call 'Bravo' for instance,
signifying that the patient should not have done this or that.
(hh) In the neuroses, we interpret the inability to stop or finish as a failure
to unify and choose; for example, the incapacity to decide. Psychotherapy in
particular will show this dialectic of tension and release, which is found at all
levels, from the biological to the psychological and intellectual, from the
muscles via the will up to the person's basic philosophy. What in the physiological sphere leads naturally and rhymically to equilibrium, becomes in the
psychic sphere a change from a mere event to a definite undertaking. The
undertaking, it is true, is only discharged when vital events successfully carry
the necessary movement, but the struggling, self-driving human effort is also
a necessary part, that inner activity through which alone the individual becomes what he is. Physiologically, we find spasm and flaccidity, with health
being neither. In. the psyche we find rigidity and flabbiness, wilfulness and
irresolution, and clear, candid purpose which is not a party to either. The
polarities of tension and release, inevitable for the mastery of every kind of
opposite, give rise to movements which either deviate into rigidity or flabbiness, or change over from tension through release into a temporarily successful
synthesis which creates further new tensions.
4. Fixation ofpsychopathological concepts as opposing ahsolutes. On studying
the efforts of characterology and meaningful psychology we cannot but notice
the prevailing importance of opposites. Even the most modest contrast, once
it has become conscious, gains a compelling force. Almost unavoidably one
keeps yielding to the temptation of taking it as an essential with which the
deepest energies are allied. But if we use this to help us comprehend psychic
life in its entirety, we only rob the contrast of its distinctness and increase its
ambiguity. Apparently it may throw light in all sorts of directions but it tends
to grow commonplace and in the end, in spite of its continual applicability, it
comes to denote nothing more than some generalised opposition.
A number of diverse opposites that have been generalised in this way offer
us an analogy: for instance, the contrast between object-cathexis and narcissism
(Freud), extraversion and intraversion (Jung), objectivity and subjectivity
(Kiinkel).
Basically, in generalising a contrast, we do one of two things. We either
perceive two possihilities ofequal worth hut polarised (intraversion-extraversion)
usually with a recognised connectedness between the two poles, or we contrast something valued with something that devalues it (life-bestowing and lifedestroying) as in the case of sensual drives and the repressing morality of the
mind (Freud) or Klages' psyche and spirit (which he sees as an adversary of
the psyche). Again, a universal, reconciling, pandaemonic point of view stands

in contrast with a daemonic dualism of God and Devil.
We believe we can detect the error which occurs when opposites are made
absolutes. Hence it seems to us that our understanding may make use of every
opposite in one way or another, if we take it in its own proper polarity and that
some serviceable meaning may be given to it, however limited this may be.
But we cannot map out opposites in their totality so as to understand the whole
range of human existence. Understandable meaning is tied to the polarity of
opposites, but the deeper we grasp this the more we are pointed on into the
non-understandable, extra-conscious ground of life and the non-understandable, historical absolute of Existence itself.
344
345
(h) The reciprocity of Life and Meaning

Dialectic is the form in which a basic aspect of meaningful connections
becomes accessible to us, namely, that these connections are not a simple
sequence of events but show a constant reciprocity, a repercussion on motivation, a progression of expanding or diminishing cycles of movement.
Affect is expressed in gesture and bearing. Both these have repercussion on the
affect, increase it, differentiate it and let it develop. An obscure drive may come to
light in action, productivity or idea. Only in this way does it gather in strength and
definition and reach its realisation. The individual defends himself against inner
impulses which he rejects. They thereby grow stronger. Or he ignores them and gives
them little rein and they weaken.
Such reciprocal movements as these appear not only in the psyche hy itself
but also as it develops in its own milieu. The resistance of things evokes the
human will. As man lays his impress on things, they in turn mould him. So
events in their course bring quantitative increase and qualitative change.
Authentic becoming, living and acting all need to form a whole, to round
themselves as they build. Mere sequences of events, mere willing and persisting
in one direction only, bring limitation, rigidity and end destructively. If we
wish to understand, we must be able to stay suspended and learn to leave the
firm grounds of unequivocal definition. At the same time we must take our
leap into the reciprocity of life. We have mistaken its meaning if we forgo any
risk and inSist on one and not the other, insist on having and not losing,
asserting and not submitting, and will only live not die. Indeed we must
always accept the opposite, risk it, let it become a thorn of distress and include
it as a factor in all our movements. Anything that merely is without -an
opposite means fixation, loss of all otherness and soon an end to all that has
already become lifelessly fixated. But when we expose ourselves to the reciprocal
dialectic of movement and risk, life expands its meaning. Any intention that
moves in one direction only, any fixation of reason, is only an instant-an
indispensable instant-in the whole system of circling movements. From these
it derives its meaning, and by these it is measured and they are also the condition for its realisation. Our ideas, everything that is comprehensive, human
life, intellect and Existence itself all take this circular course and as the moving
cycles are broken asunder, fresh ones form.
We may compare meaningfol human existence with biological existence. Even
in biological events we need to grasp this reciprocity. For example, there is the
reciprocity of endocrinal-neurological relationships (H. Marx). The simple
antagonism of endocrines with opposing effects is insufficient. It is the totality
of the reciprocity that takes living effect. Purposeful intensification of one isolated factor introduces something that takes different effect according to the
various reciprocities, as constituted in anyone individual. Hence room for the
unpredictable is quite extensive. Prediction depends on how far one knows
the whole set of reciprocities. Another example: the functions of neuromuscular and sensory events only become comprehensible within the total
internal and external situation of the living organism (the Gestalt-kreis: v.
Weizacker). Meaningful life also fulfils itself in reciprocal movement in a
comparable way but there is one difference. We are dealing with conscious and
unconscious events. Unconscious events may be carriers of the complementary
part of the reciprocal event or take effect as a primary source of freedom, which,
though it never becomes a conscious intention or an object for empirical
investigation, is itself a determining factor. The specific inner tension, the
recoil back on itselfagain, the mutual reinforcement or release-the 'mysterious
paths of the inner reversals' (Nietzsche)-are the incalculable elements within
the meaningful totality of psychic movements.
others. His isolated wish for status will then grow and he will prod it on into
new, futile and even more disastrous behaviour. For this sort of circular
behaviour psychotherapists tend to use the term 'circles of bedevilment'
(Teufelskreise)-Kiinkel. A 'vicious circle' is formed instead of one of the
genuine, constructive cycles of life. The meaningful behaviour then becomes
a kind of thrashing about which only forces the victim down into the quicksand of his own devising. Thus we may pair the creative cycle with the
destructive one, and liberating and expanding cycles with those that inhibit
and restrict.
They are the acts which determine our life from early childhood onwards. A
small boy who had only just started to speak. saw his baby brother on his mother's lap
where he felt he ought to be. He was startled, hesitated, his eyes filled with tears.
Suddenly he went to his mother, stroked her and said: 'I do love him too'. He
remained after that a reliable and loving brother.
Biological events only provide an analogy for what is meaningful. In the
field of the meaningful, we discover risk, fear of making the inescapable leap
(always into the reciprocity of the whole), choice and creation. In the biological
sphere on the other hand there only is the cycle of reciprocal events which,
though perhaps not mechanical, is nonetheless automatic and unfree.
Cycles of meaning are static when they are configurations of complex expression, personality and achievement taken as a whole. The cycles which we are
now discussing are movements. These meaningful reciprocal movements are of
two opposing kinds, those that drive life upwards or those that drive it to
destruction. All meaningful life, it is true, remains within their confines but it
can either develop within them or use them to annihilate itself. An individual
can thus try to overcome resistances by means which can also defeat him.
He can fight against something in such a way that he only strengthens his
opponent. He may want to gain in status but so long as he concentrates on this
alone and not on the actual matters which he must deal with ifhis goal is to be
reached, his behaviour is likely to lose him his own self-respect and that of
347
There are a number of cycles in which disturbances are self-aggravated. Fear adds
to fear and grows out of fear until it reaches an extreme pitch. Excitement is fought
and increases. An affect overflows as it is surrendered to and verbalised. Anger grows
in raving; obstinacy grows more and more obstinate. Inversely, a suppressed drive
will grow and man, by suppressing his sexuality, sexualises himself.
Such cycles grow into something neurotic because of mechanisms that split apart
what normally remains integrated and isolate what normally has its place in the whole.
In this way the unconscious becomes inaccessible to consciousness. What is repressed
gains increasing independence from the repressing impulse, and the self experiences
defeat by something else which is still at the same time a part of itself.
4.
SELF-REFLECTION
We can say: all that an individual does, knows, desires, and produces will
indicate how he understands himself in the world. What we have termed the
'psychology of meaningful connections' is then an understanding of his understanding. But it is a basic human characteristic that man as man understands
his own understanding and gains a knowledge of himself. Self-reflection is an
inseparable element in the understandable human psyche. It was therefore
already implied in the connections we discussed above, which were understandable in content and form. Self-reflection may be halted at the start: action
in the world and knowledge of things may then be largely unconscious, and
carried out without any self-reflection. But it is only the stirrings and possibility of self-reflection that make psychic activity human.
The psychology of meaningful connections must understand self-reflection,
which it practices itself. As practitioners of this psychology we either achieve
for another what he has not yet achieved by his own self-reflection or else we
understand his self-reflection, share and expand it.
(a) Reflection and the UJ!conscious
Self-reflection has its place in the comprehensive relationship of the

conscious and the unconscious. We will first consider all that is included in the
term 'Reflection'. Reflection means growing illumination, which comes about
from the separation of what is related.
The clarification of psychic life begins with a separation of subject and
object (Self and Object). The things we feel, experience, and strive for, grow
clear to us as ideas or images. We can only expect illumination when there is an
object, a form, something thinkable, in short when there is some objectivisation. Separation gives rise to further reflect~on: I turn back again on myself by
directing reflection upon myself (self-reflection); I reflect on each content, each
image and symbol to which as mere objects I have been bound in the first place
without any full awareness, and I ask what are they? From this point awareness
grows unchecked up to the final awareness of awareness itself. Lastly, I reflect
on the division into subject and object as it takes place within the whole, that is,
by a philosophical transcendence, I make myself aware of what this division
means to me in terms of a manifestation of Being.
Each act of reflection throws light on something which up to then had been
unconscious and obscure and with this comes release; release from the obscure
bondage of the undifferentiated, from the given thus-ness of the self (Sosein),
from the power of uncritically accepted symbols and from the absolute reality
of the objective world. Each release 'from something' begs the question 'release for what?'. When I grasp an object, I win freedom from an obscure bondage to the undifferentiated. It is a relief that at last I know what up to then I
have only felt. If I know what happens to me, I have taken the first step to
freedom in contrast to being blindly overpowered. Out of the given thus-ness
of the self, as I might conceive it ifI turn myself into an object, I emerge freed
by self-reflection for the task of becoming myself. Instead of a determined
finality, I gain potentiality. Instead of bondage to symbols I gain through
knowledge of them the freedom to transform them. Imprisoned as I am in the
supposed absoluteness of existing objects, my awareness of existence as mere
appearance enables me to transcend them into objectless Being itself, but there
is no illumination except by way of the totality of objective possibilities.
Each liberation implies risk. Each release brought by reflection cuts the
ground from our flet, takes away substance, earth and world, unless with every
step towards freedom there remains an ever-changing bond that extends with
the extending freedom. In all the objectification one must also feel the allembracing darkness at its source, and in the course of one's own individuation
accept and incorporate everything one finds oneself to be in one's given
existence. So, too, in our conquest of the imprisoning symbols, our life must be
borne along by the symbolic nature of the whole and in the very act of transcendence we must also merge ourselves deliberately into the world as it
exists. The hovering flight of freedom loses touch with its ground completely
unless we confine it somehow. Wings need the wind's resistance.
In psychological terms, this losing touch with the ground can be formulated as the extinction ofthe unconscious, upon which, after all is said and done,
I live my life in all its varying stages of consciousness. The drives of life, its
matter and content, come to me continually from the unconscious. I meet the
unconscious constantly in everything that enables my performance, from my
evftj'd,y ,utom"" "riviti" to my ""rive ,nd original thinking and to the
decisions which form the very substance of my freedom. Illumination at its

highest rests on the darkness of the unconscious. All clarification implies a
something that grows clear.
Our life is not a simple bi-polarity of intention (reason, will) and that
which is unconscious. There is rather a complex hierarchy ofchanging relationships between consciousness and what is unconscious, and this pervades the
whole of our psychic and intellectual existence. There is never the one without
the other or else there follows psychic catastrophe, destruction or decline.
The bright power of the Will which operates in the clarity of knowledge is
still unconscious in its core. In so far as it is continuous realisation, it is a
step forward in the never-ending illumination of man. It does not abolish the
kingdom of the unconscious but rather uses its own consciousness to give
such a kingdom infinite extent.
349
(b) Self-reflection as a spur to the psychic dialectic

If we give the term 'mere happening' to whatever occurs to us without our
being aware of its significance, and keep the term 'experience' for what is felt
to be a significant happening, self-reflection then becomes an indispensable
element in experience, since there is no awareness of significance without
self-reflection.
Yet self-reflection is something essentially different from knowledge. 'To
know that one knows' is not the same thing as knowledge itself. Knowledge
requires an object which will continue to exist and be available. But selfreflection is that kind of knowing which makes itself the object and changes
itself at the same time. It never reaches, therefore, the quiet stability of a
knowledge of something which continues to be as it is, that something 'which
I am' but remains with us as a continually prodding spur.
To change our metaphor, self-reflection acts like a ferment, whereby something merely given is turned into something accepted, mere happening into
history, and the sequence of a life into a biography. If we are to understand
self-reflection, it means we must try to grasp its nature in its structure.
i
I
(c) The structure of self-reflection

The structure of self-reflection is hierarchical. Isolated, wholly unequivocal
self-reflection does not exist. l
I. Self-observation. I notice events in myself which are my modes of perceiving, remembering, feeling, etc. I track down what is there in all the
fleeting, elusive phenomena. There is a distance between myself and what I
observe as an external object in myself, and this I take into account. My
attitude is neutral as with any datum.
2. Self-understanding. I ascribe what happens in me to motives and connections and try to throw some light on this. In so far as this self-review is no
more than observation, it can indicate a host of possibilities. But meaningful
1
cpo my Ni,t{sclz., pp. 111-13,335-8, for the attitude of the self to the self.
interpretation of myself is also endless and always relative. In the last resort I
neither know what I am nor what moves me nor which motives are the decisive
ones. Everything at all possible I can recognise within myself somewhere,
hidden perhaps, but still a possibility. The mere wanting to know robs all
self-understanding of its ground.
'
3. Self-revelation. Passive self-understanding provides the medium for
actual self-revelation., This occurs through profound involvement with an
activity which philosophy descries as a form of inner behaviour, the absoluteness of decision; in psychology such activity eludes definition though the
crises of self-understanding with all their obscurities and inversions are
accessible enough. Kierkegaard remains unsurpassed in the art of making this
revelation tangible through the use of conceptual constructs in the medium of
understanding. l The following are a few points of interest to the psychopathologist.
If we are mere spectators, revelation does not come to us. I am only
revealed to myself by an inner activity which also transforms me. Apparent
revelation, unembarrassed exposures of the inward self, lavish self-confessions,
endless introspection and self-description, revelling in the observation of
inner events, usually cover a lurking attempt at concealment with no intention
to reveal the self. Revelation is not an objective event, like a scientific finding,
but rather a form of inward behaviour, a grasp of the self, a self-election, a
self-appropriation. Uninhibited expressions of what is supposed to be the
brutal truth are only pseudo-honesty; the fixed nature of the assertion already
carries falsity. The honesty of revelation is as humble as it is deep and it is
simple as well as effective.
Revelation comes in being oneself. Being oneself is never the same as
being an object. What I myself actually am is never anything that can be unambiguously recognised and defined as an object. The basic relationship in
being an object is the causal relationship. The basic relationship in being oneself is the relationship of the self to the self, the process of absorption, inner
activity and self-determination.
If we desire final knowledge in the field of self-understanding, we have
made a completely wrong start. The absoluteness of existential decision manifests itself in the midst of the unlimited flow of possible interpretation. What
is existentially in order is only in the balance for knowledge. It may be that
whatever is done is certain for the moment but it then becomes open for
further interpretation. The unifying source and the line of its direction, which
emerges through the phenomena and carries them further, is unknown to us,
and we cannot know it because it is precisely this directing source which
mobilises and furthers all our knowledge. It manifests itself in our knowledge
and not on its behalf.
1 Cpo my PsycAologie Jer Weltanschauungen (pp. 419-)1.) 3rd edn.-where I refer to passages
in Kierkegaard's works.
3SI
(d) Examples of tlte effict of self-reflectionl
From the philosophical point of view self-reflection takes a variety of paths

and has many contents; we will not follow these up here but merely give a
few illustrative examples of interest to psychopathology:
I. Tlte connection hetween intended and unintended events. One of the major
polarities in the psyche is that of intentional act and unintentional becoming,
intention (activity) and occurrence (passivity). Intention is the purposefulness
that springs from reflection. But the whole wealth and variety of psychic life
and content depend on dispositions (Anlagen) that lie outside intention (talent,
drive, affectivity, impressionability, etc.). Intention can only delimit, select,
mobilise or inhibit. Without intention, the psyche would grow and develop
in an aimless and unconscious manner just like non-psychic life. Intention,
without all that wealth of content to mobilise or restrain, can achieve nothing.
It would, as it were, only tick over like an idle machine.s
Intention spreads its influence far beyond conscious events, though there
are great differences in individuals. For instance, a person can wake up or fall
asleep at a given time intentionally.
The will may intentionally influence the body in three ways: (J) by the direct
influence of intention: e.g. movements to restrain the expression of pain or the simulation of a paralysis; (2) by the indirect influence of intention: e.g, we put ourselves
into a sorry state so that we cry or have palpitations; (3) by the influence of intention
without any conscious awareness of how this happens: e.g. through simple imagination or the affective toning of vividly evoked images and attitudes. Here the suggestive effect goes much further than that of direct intention. But it is an autosuggestive
operation in itself and needs the intention to evoke and guide it.
Where the reciprocal relationship of intention and occurrence is unbroken,
it is a sign of healthy psychic life. As unintentional events begin to gain in

autonomy and the will to lose its influence, we begin to be interested in what
causes this phenomenon, which is often thought to be a morbid one. Where
intention exerts its influence but the psychic dispositions which it seeks to
mobilise or restrain are only slight, we talk of an individual who is psychically
impoverished. Therefore, that psychic influence on the body which we term
'hysterical' cannot justifiably be called morbid, so long as it is wholly due to
intention.
We once had an opportunity to observe a village family engaged in spiritualism:
One of the sons introduced the subject of spiritualism from elsewhere. The incredulous members tried it out. Soon one person, then another, found that they could
'do automatic writing'. In the end all of them, except the mother, managed to do
1 Reflective phenomena are discussed in the section on Phenomenology (pp. 109 fr.), the
IeCtion on expression (p. 213), and on character (pp. 370 fr.).
I Klages recognised and gave a good description of this psychological polarity. But we cannot
follow him in identifying will with intention and purpose. At its greatest, the will is full of content
.nd I. Itself an original source.
3S3
something. They now thought they were in contact with dead friends and relatives
and held seances in a room reserved for this purpose. In one such seance we could observe trances in which people danced, seizures where there were broken utterances
-sometimes meaningless-and automatic writing. These people thought everything
was evoked by the dead. The cries of someone in a seizure were cries of spirits. The
phenomena were the same as hysterical phenomena but only appeared when wanted,
when people came into the room with the intention of holding a seance. They thought
themselves quite healthy since they had no such hysterical phenomena in their
ordinary life. Just as intentional falling asleep succeeds more or less according to the
individual disposition, so the 'phenomena' in these seances were sometimes more,
sometimes less, successful. However, later on several members of this family actually
did fall ill with hysteria.
can establish the goal but neither instinct nor the transmitting mechanism
obey.
Drives and instincts follow a complex course without any help from consciousness and in humans they are under a controlling force which can use
intention to set them in motion or restrain them. Moreover, through learning
and conscious practice man continually enlarges the realm of automatic events.
All our co-ordinated motor activity-and later activities such as writing,
riding a bicycle, etc.-is carried out consciously at first and then becomes
automatic, and we only reach the peak of our potential performance through
a host of automatisms. Complex thought-processes and techniques of observation become automatic in this way and provide us with tools for every occasion.
What was once a lengthy performance is now shortened to a moment through
the possession of a function that can be completed almost instantaneously.
Everything that is instinctive, impulsive or automatic-the whole manifold of
unconscious happenings-penetrates right up into the most highly conscious
performance. The carrier is always something unconscious. Health consists in
a continuing interplay at all levels from reflexes up to clear-cut volitional acts.
The healthy person can rely on his instincts. They neither dominate him nor
elude him, they are under his control and they themselves direct the impulse
to control through a sweeping certainty which can never be sufficiently explained by plain intention or by simply having an idea. Hence they have
mobility and plasticity; they are not mechanical and there is nothing fixed or
determined about them.
2.. Awareness of personality. Reflection produces an awareness of the self as
a person. It modulates and colours this awareness and is the source of its selfdeceptions.
Fully developed awareness of personality, where the individual is aware
of himself as a whole, of his persisting drives, motives and values, is an intermittent awareness and in the last resort is nothing but an idea. Indeed we
distinguish if from that immediate awareness which can be partly understood
as a reaction to the environment of the moment. We have thus an 'impressionalself'-a particular, momentary shift of personality-awareness, which falls
back on the self proper through the impression made on others. Or in a quite
general sense there is a 'situational-se/f'which will come more or less strongly
to the fore according to the individual disposition. Then, if we are thinking of
the response to the environment as a response to a lasting milieu, not just a
momentary response, we can contrast a 'social-se/f'with the personal self proper.
But in all these instances awareness of personality is always composed of two
inseparable constituents: a feeling of self-valuation and the plain awareness of
one's own particular being.
At all times man not only has to be but has to adopt some attitude. Not
only does he communicate himself but he also presents himself; that is, he
plays a role and not always the same one, since this depends on his function,
position and situation. The role is not purely formal. The external attitude
There are two ways in which the reciprocal relationship between intended
and unintended events may be disturbed:
(I) Intention feels overpowered or powerless in the face of the unintended
occurrence. The healthy person surrenders to the unintended possibilities of
his inner life, as they arise. But even if this should amount to ecstasy, he only
loses his own influence momentarily. Domination by what is 1U/,intended is
experienced in the numerous morbid phenomena which are conditioned by the
original constitution or by the start of a process. Unintended events-automatic instinctual forces-elude intentional control and in spite of changes in
situation and intention continue on their own course uninterrupted.
(2.) Intention has some influence on the unintended events but fails to steer
them in accordance with the intention. Instead it interferes disturbingly with
their spontaneously purposeful and orderly flow. For instance, it fosters insomnia instead of bringing sleep. Full concentration on a performance hampers
its success. If it were unintended and automatic, it would go much better. In
such a case people will suffer particularly from 'an agonising apperception of
the moment'. Wherever they are, whatever they do, no sooner do they allow
their conscious attention to intrude than they get confused and can do nothing
that they intend; if they will only let themselves go, they are at their best.
Drives and instincts are not bound simultaneously to the motor reaction,
like reflexes. The instinctual certainty shows itself rather in an unconscious
choice of the right way to gratify the drive according to the situation. The
instinctual drive is disturbed if the natural control of the mechanism fails or
if no unequivocal goal is found. Conscious reflection may be responsible in
either case. (The same thing may occur even more radically through inversion
of the instincts themselves, through associative links or through fixation in
infantile attitudes such as we have discussed above.) If conscious reflection
should then want to improve things, it only increases the disturbance. Once
the mechanisms of transmission fail, intention has to carry out what can no
longer be instinctually performed: there are intentional movements of expression, forced speech, and torturous gestures and behaviour. Where the
half-conscious instinctual goal is no longer unambiguous, conscious intention
begets an inner one, which may be tentative and can become a reality. This
playing of roles is a natural gift and so is the capacity to take up some
attitude and change it, if necessary.
Psychology cannot answer the question as to what the individual person
reaUy is. We understand how almost all r~les can be separated from the
person himself. He stands outside them, they are not he, himself. But what this
self then is remains inaccessible to us, a mere point outside. Or else it issomething which cannot be grasped psychologically-his innermost nature
which never presents itself, the inward element which never becomes the outer
and therefore empirically does not exist. In comparison with this, all awareness
of personality is mere foreground.
The situation is different when a person identifies himselfwith his actuality
in the world in some finalised act or attitude. Human life is then embedded
in an historical record which can either be a matter for psychological observation, in which case it becomes something restrided, fixed and immobile, or it
is an instance of truly being one's self, in which case there is a transcendence
of everything observable and of all reflection. It is pure, unreflected self-being
at the summit of infinite reflection. This does not exist for empirical knowledge,
and when there is an instance of it, it becomes apparent through the language
of history, not through the language of universals. Weare left, therefore, with
the ambiguity of all the phenomena through which the individual in the world
becomes identical with his empirical reality, that is, they may either signify
his decay and decline or his moment of personal fulfilment.
From the psychological point of view, we are impressed by the fact that
awareness of the self is linked inextricably with awareness of one's own hody.
The human being is his body and at the same time, in .reflecting upon his body,
he stands outside it. The fact that he is his body leads to the objective problem
of the relationship of body and psyche. The fact that through reflection he is
aware of his body as his own and yet as something outside himself is an integral event of his existence. His body is a reality of which he can say: I am
it and it is also my instrument. The ambiguity of the physical awareness of the
self derives from this double activity of identifying the self with the bodysince empirically no separation is possible-and of standing outside it as an
unfamiliar object, in no way belonging to the self.
3. Ultimate (hasic) lcnowledge. We use the term 'ultimate knowledge' for
all the presuppositions that invest whatever else we know and give it firm
foundation. Ultimate knowledge resides in ideas and images rather than in
concepts. It is the awareness of reality as against mere being. Everyone develops
in accordance with his ultimate knowledge. The direction he takes in the
formation of his self is determined by what he himself knows.
Once there is reflection on this knowledge, it becomes conceptualised in
cOnsCiOUSTUSS. There are then two possibilities: Either it grows more certain,
more logical and more reliably present at any moment, as well as more conclusive. Whereas the effective symbols were inconclusive, free but sure, the
conceptualised knowledge is fixed, firm and dogmatic. Or it becomes a possibility of thought, a potential question. Effective symbols then become its
refuge while the conceptualised knowledge loses all hold and pitches over into
emptiness.
If we want to understand an individual, it is indispensable that we participate in this ultimate lcnowledge of his, which is hard to glean, hidden as it is
behind a confusing mass of words and foreground phenomena. Understanding someone's ideas and trains of thought teaches us to see the fastnesses of his
nature which cannot be invaded, his inner sanctuaries and absolutes. It also
shows us the real danger oflosing hold altogether, when the individual openly
and unreservedly asserts his absolute freedom in an historical concreteness that
has no general application.
This is the sphere in which it becomes clearly apparent how an individual
sees himself and his world. In the last resort he can never know himself but
he draws up schemata of himself that depend on what his ideas are at the
time. In the ideal case this would include all that is known of psychology and
psychopathology. Alternatively he may keep his own Being open and remain
exposed to the world of meaning in all its width and depth and possible
interpretation.
314
s.
3H
THE BASIC LAWS OF PSYCHOLOGICAL UNDERSTANDING AND

OF MEANINGFULNESS
As long as our understanding is limited by the framework of the natural

sciences, we find we are involved in contradictions, uncertainties and irritating
irrelevancies. This inclines us to push the whole procedure aside as unscientific. But the understanding of meaning demands other methods than
those of the natural sciences. What is meaningful has quite different modes of
Being from the objects of those sciences. The methods of understanding are
governed by certain general basic principles which need explicit formulation
if we are to know what goes on in understanding, what cannot be expected
from it and where the peculiar satisfaction of knowledge can lie in this field.
Where we follow the method of understanding, what is meaningful
possesses properties and certain hasic principles will apply to them. (a) What is
meaningful only has empirical reality in so far as it appears in perceivable
facts. It is related to this that all empirical understanding is an interpretation.
(h) What is meaningful in the particular instance is part of a connected whole.
This whole, the character or personality, determines its meaning and lends it
colour. A related principle is that all understanding takes place within 'the
hermeneutic round' -that is, we may only understand the particular from the
whole but the whole may only be understood via the particular. (c) Everything that is meaningful moves in opposites, and it is related to this that,
methodologically, opposites are equally meaningfol. (d) What is meaningful is
bound, as a reality, to extra-conscious mechanisms and rooted in freedom. It
is related to this that all understanding remains inconclusive. Although it goes

beyond every level so far reached, it comes up finally against the two marginal
limits of Nature and Existence itself. Meaning is self-generating and there is an
infinite recession of what can be understood. Therefore the understanding
related to it is equally inconclusive. (e) The particular, whether an objective
fact, an expression, intended content or act or indeed any single psychic
phenomenon, loses meaning when isolated but gains meaning in context. It
is related to this that all phenomena are open to unlimited interpretation and
reinterpretation, just at the point where understanding stops. (}) What is
meaningful can reveal itself through phenomena or hide itself in them. It is
related to this that the process of understanding is either illumination or
exposure.
(a) Empirical understanding is an interpretation

'The understood' attains empirical reality only so far as it is manifested in
objective, meaningful phenomena of expression, action and creation. The
criteria of reality for all meaningful connections lies in these demonstrable
phenomena and in those experiences which can be phenomenologically observed. Meaningful connections, it is true, are self-evident. Our psychological
imagination-a most desirable precondition in psychopathology-continually
designs for us what seem to be convincing patterns as such, yet in the face of
psychological reality these are no more than hypotheses that need to be tested.
The scientific practice of the psychology of meaning is marked by its careful,
critical approach, which keeps distinct what is understood empirically from
what is understood as a self-evident possibility. Every step in understanding
is then linked to objective phenomena, but it is recognised that all understanding nevertheless remains interpretation, however much the certainty of understanding increases with the extent to which phenomena are concordantly
interpreted. Another possible way of understanding is always at hand.
The statement-inner and outer are the same (what never becomes external,
does not exist internally either)-is valid only for the aspects of the psyche
that can be known empirically. Those marginal facts, which existentially might
become real as pure inwardness, elude understanding. The inner without the
outer manifestation is not a fact that we can demonstrate empirically. But
empirical existence is not an absolute. The understandable is an interpreted
connection between meaningful facts and as an empirical fact it is only in the
foreground of human selfhood.
(h) Understanding follows 'tke kermeneutic round'
We understand the content of a particular thought or the flinching of the
body in fear of a blow. But such isolated understanding is meagre and unspecific. Moreover, the whole nature of an individual pervades even the most
isolated outpost of his being, giving it objective context and the complexity of
psychic motivation. Understanding therefore will push on from the isolated
MEANINGFUL CONN-ECTIONS
357
particular to the whole and it is only in the light of the whole that the isolated
particular reveals its wealth of concrete implications. What is meaningful
cannot in fact be isolated: There is no end, therefore, to the collection of our
objective facts which provide the starting-point for all understanding. Anyone
particular starting-point may gain an entirely new meaning through the
addition of fresh meaningful facts. We achieve understanding within a
circular movement from particular facts to the whole that includes them and haclc
again from the whole thus reached to the particular significant facts. The circle
continually expands itself and tests and changes itself meaningfully in all its
parts. A final 'terra firma' is never reached. There is only the whole as it is
attained at any time, which bears itself along in the mutual opposition of its
parts.
(c) Opposites are equally meaningfol

We can perhaps understand how a person who is feeling weak and wretched
must feel spiteful, hateful, perhaps envious and revengeful, towards people who
are better endowed, happy and strong, since psychic poverty is linked with
bitterness. But the opposite is just as understandable. The person who feels
weak and wretched can be frank about himself, can be unassuming and love
what he himself is not, and in the uprush of this love create what he can within
his limited possibilities and thus purge his soul in the school of need and pain.
We understand how weakness of will may be obstinacy and how the rake may
also be a bigot, but the opposite is equally understandable. Therefore when
only single elements of such understandable connections appear, we cannot
jump to the reality of the rest. We should always look out for possible
ambiguities.
The most radical mistakes spring from conclusions drawn as to the reality
of what has been understood, whenever these conclusions have been based on
the self-evidence of some one-sided understanding. The exclusion of the
opposite, without any attempt to follow it up and understand it, means that we
manipulate reality in favour of an 'a priori' understanding that makes an
arbitrary selection of the facts, since understanding is achieved but not within
any empirical whole. It follows that we shall soon find it possible to understand the exact opposite. These arbitrary reversals of understanding, this
sophistry of psychological understanding, is rooted in some confusion over
the equal meaningfulness of opposites and thus the necessity arises, if we are
to understand the real person, of linking our understanding exactly with the
totality of the meaningful objective facts.
(d) Understanding is inconclusive
That which is meaningful is itself inconclusive because it borders on the
ununderstandable, on what is given, on human existence and on the freedom
of Existence itself. Understanding must be related to the nature of the meaningful and therefore must itself be inconclusive. (Furthermore it always remains
an interpretation, since even with the fullest possible number of objective

meanings, empirical finality is never reached.)
That which is meaningful is rooted in extra-conscious mech.anisms and
dispositions, for instance, in instinctual drives. It has to start, therefore, from
something which is not understandable. But the starting-point is a flexible one.
With the self-development of what is meaningful, there is an accompanying
change in the starting position, so that even when understanding borders on
the meaningless, this is not final because once meaning is understood it moves
within its own precincts and changes them as it expands them.
Understanding founds itself on existential freedom, though freedom cannot
be grasped in itself, only in its meaningful effects. Understanding, therefore,
in its tum is inconclusive, related as it must be to the inconclusiveness of
everything that can be understood in time. Where the freedom of Existence
itself is accomplished in time as something historically concrete, the accomplishment cannot be made objective. Hence we cannot get to know it as a
fact but it is itself infinite, because as an existential conclusion it is eternity in
time. It is no longer any object for psychological understanding.
If understanding is inconclusive, then our predictions of what someone
will do or how he will behave are equally so. Yet in fact we make such predictions with considerable certainty. This certainty, however, does not mean
that it is necessarily derived from understanding. What has already happened
repeatedly is expected to happen again in the future, either it results from
the frequency of experience or it is rooted in the existential certainty of
communication, the reliance we place on our companions in fate. Such complete certainty is not knowledge. Perhaps it is greater than the certainty that
any knowledge can give but it is of a radically different character. It lies
beyond all calculation and is not subject to any objective laws nor is it lifeless
matter of which knowledge can dispose.
aiming at, must not adopt the orientation of the natural sciences nor use their
criteria nor must it take over the formal logic of mathematics. The truth which
understanding seeks has other criteria, such as vividness, connectedness, depth
and complexity. Understanding stays inside the sphere of possibility. It offers
itself in a tentative way and remains mere proposition within the cool atmosphere of knowledge that comes from understanding. It does, however, structure the objective meaningful facts, so far as they can be defined as facts, when
meaning lies open to unlimited possibilities of interpretation. On the other
hand, as empirically accessible material grows, understanding becomes more
decisive. Multiplicity does not necessarily imply haphazard uncertainty but
can mean a flexible movement within the range of possibility that leads to an
increasing certainty of vision.
(e) Unlimited interpretation
Myths, dream contents or psychotic contents are all subject to unlimited

interpretation. As soon as we believe we can make some definite interpretation,
another presents itself. Antiquity was well aware of this endless quality of all
symbolic interpretation, and in mythology it has been a principal matter for discussion since the seventeenth century when Bayle emphasised it as a basic fact.
It was also noticeable later in the dream-interpretation and psychoanalyses of
modern times. This is not by chance nor are we mistaken about it. It lies in the
very essence of meaningfulness. The understanding and what is understandable are in constant motion. Even in the self-interpretation of one's own life,
though superficially the facts may not seem to change, their meaning changes
for us or moves on to other levels and from this viewpoint our earlier understanding may be preserved as something with a preliminary, partial and foreground quality. The same applies to the understanding of myths, dreams and
delusional contents. Understanding, therefore, in defining the knowledge it is
359
(f) To understand is to illuminate and expose

In practice the psychology of meaningful connections develops a remarkable double function. It may often appear malicious in its exposure of deceptions and beneficial in its affirmations when it throws light on essentials.
Both activities belong to it. The malicious aspect often seems to predominate
in actual fact. In a mood of scepticism or dislike we think we are always 'seeing
through it'. The intended truth of this understanding is the penetration of
general dishonesty. There is a mischievous psychology of opposites in which
opposites are used simply to turn all that an individual does, says or wants into
the opposite of what seems to be his real meaning. Symbolic interpretation is
brought into use in order to find the meaning of every drive in some unconscious baseness that has been repressed. The psychology of 'being in the world'
narrows the individual down and confines him to his particular environment
and, according to this psychology, he knows no escape from it. The psychology
of instinct exposes all higher impulses as manifestations of more elementary
phenomena hidden within them. The individual who would understand himself gets into a desperate situation within himself-'a self reflected in a hundred
mirrors'-and in the end seems to find nothing that is the self. In contrast to
this, understanding which illuminates and does not expose involves an
attitude which is basically positive. It approaches human nature sympathetically.
It tries to visualise, it deepens its observations and watches the living substance
grow before its eyes. The psychology which exposes acts reductively and
finds 'this is nothing but .. .' The psychology which illuminates makes us
positively conscious of that which is. The psychology which exposes is an
unavoidable purgatory in which man has to test and try himself, refine and
transform himself. The psychology which illuminates is a mirror in which
positive self-awareness and sympathetic observation of the 'other' become a
possibility.
Excursus into psychoanalysis
Freud's psychoanalysis is, in the first place, a confusing mixture of
psychological theories (see p. 537). In the second place it is a philosophical

movement or a creed which has become a vital part of certain people's lives
(see p. 773). In the third place it is a psychology of meaningful connections
and , as such, we will give it a brief characterisation as follows:
I. As a cultural, historical phenomenon, psychoanalysis is a popular psychology. What Kierkegaard and Nietzsche had achieved at the highest cultural
level was again achieved at a lower level and crudely reversed to correspond
with the lowest level of the common man and metropolitan civilisation. Compared with the valid study of psychology it appears as a mass-phenomenon
and lends itself, correspondingly, to a massive literature. Practically all the
basic ideas and observations stem from Freud himself, and his successors,
though they form the bulk of the movement, have hardly added a thing.
It is not correct to say that Freud had 'for the first time and without
question introduced the meaningfulness of psychic deviations into medicine ..
as compared with a psychology and psychiatry which had become devoid of
psychology . .' In the first place meaningful understanding of this sort was
already in existence, though by 1900 it had retreated into the background. In
the second place, psychoanalysis made use of it in a misleading way and this
blocked the direct influence on psychopathology of great people such as
Kierkegaard and Nietzsche. Psychoanalysis therefore is partly responsible for
the general lowering of the cultural level in psychopathology as a whole.
It can be said that psychoanalysis appeared with shattering truthfulness in
a hypocritical age. This is only partly correct and again only at a lower cultural
level. It unmasked a bourgeois world which lived without faith within the
conventions of a society that had definitely relinquished religion and morality
'with "sexus" as its secret god'. But the exposure was no less false than
that which it unmasked. Both were bound to sexuality as their supposed
absolute.
2. With regard to psychopathology, psychoanalysis has the merit of having
intensified the observation of meaningful connections. The attention that was
paid to small and minute signs and to phenomena which hitherto had been
unnoticed or thought unimportant, taught our consciousness to apprehend
countless expressive phenomena. Such apprehenSion expressed itself as interpretation. Gestures, actions, mistakes, modes of speech, forgetting, as well as
neurotic symptoms, dream-contents and delusions, all came to mean something
other than what they appeared to do at first or what was at first intended.
Almost everything became a symbol for something else-according to Freud's
teaching a symbol for sexuality.
Here are some examples from Kielholz1 to illustrate this symbolic understanding
of behaviour: a single woman of advanced years stole from the village councillor a
young bull and a pair of uniform trousers-symbols for her sexual desires. A soldier
steals from his room-mate at night a purse with keys which he kept in his trouser1 Kielholz: 'Symbolische Diebstahle', Z. Neur., vol. 55, p. 304.
.j
I.
pocket. This was after he had competed unsuccessfully with him for a barmaid's
favours on the previous evening-a symbol for his wish to rob his comrade of his
potency.
The following self-description shows how such 'significant meanings' may be
experienced in hashish intoxication: a woman proband tore up a cigarette which was
offered her. This act could be interpreted as a mere wilful act but it had a deep significance for her. The cigarette embodied for her the essence of a 'role' which she had
to play but resented strongly. 'The cigarette made me become the officer's wife so I
tore it up.' 'The cigarette was not a symbol for the officer's wife but the whole ~ffair
itself' (Frankel and Joel).
Interpretation brings with it a basic feeling of 'getting behind the scenes'.
One uncovers, exposes and displays, as it were, the art of cross-examination a
police-technique. Almost the whole of psychoanalytic understanding is domi~
ated by this fundamental, negative attitude of unmasking. With C. G. Jung it
grows a little less obvious and in the case of Heyer has almost vanished. With
him, it was not there initially and it intruded so little he did not seem to notice
it in others.
3 Psychoanalysis caused new and vigorous attention to be paid to the
inner life-history of individuals. A person becomes what he is because of his
earliest experiences. Childhood, infancy, even intra-uterine life, are thought to
be decisive for an individual's basic attitudes, drives and essential characteristics. Much of our understanding of what a person has become stems in fact from
what has befallen him, from his experiences and disasters. So too we come to
understand how he is what he is, how his body and its psychosomatic functions
work, what he wants and what is important for him. But here also psychoanalysis made use of certain individually valid observations as a point from
which to start its journey into the sphere of early personal histories, which
were deductive only and to the uninitiated appeared quite unfounded. To
some extent the method is analogous to that of archaeology, where one tries
to find some connection between the prehistoric fragments and so rebuild the
ancient world. With the psychoanalytic method-as Freud himself knewthere is linked a reduction in scientific requirements. 'If,' said Freud on one
occasion 'we can temper the severity of the requirements of historical-psychological investigation, we may be able to clarify problems which have always
seemed to merit our attention'. We are thus led into a world of hypotheses
which are not only unproven but unprovable. They remain pure speculation
and leave any meaningful phenomena far behind. This can be seen particularly
in the contents as understood.
4 The content of understanding is of very great interest and actually enriches it. The individual's personal contents are thought to become meaningful
in terms of what happens to mankind generally, and this is meaningful in its
turn in terms of history. Psychoanalysis was wanting to master the whole
human realm of original meaningful content by an interpretation of cultural
history, the early history of the 'collective unconscious' in particular (Jung),
which was thought to have its effect on man from the dawn of time onwards.
Here is an example taken from Freud:
mysterious and pregnant with foreboding. Thus in an age without faith such
thoughts may well have a certain charm for some. One thing only is right in
all this, namely, that in prehistory and in the individual's own history inner
events probably playa part which continuously eludes empirical research and
which external factors alone can never satisfactorily explain.
;. The limits of every psychology of meaningful connections must necessarily remain the same for psychoanalysis in so far as the latter is meaningful.
Understanding halts first before the reality of the innateness of empirical
characteristics. These, it is true, are neither finally knowable nor can they be
firmly established. But meaningfulness comes to a halt before them, as something impenetrable and inalterable. Individuals are not born equal but rare
and ordinary in their degree through the most manifold dimensions. Secondly,
understanding halts before the reality of organic illness and psychosis, before
the elementary nature of these facts. This is the decisive reality though many
of the phenomena show much particular content that in one aspect at least
seems meaningful. Thirdly, understanding halts before the reality of Existence
itself, that which the individual really is in himself. The illumination of psychoanalysis proves here to be a pseudo-illumination. Though Existence itself is
not directly there for psychological understanding, its influence is felt in the
limits it sets for psychological understanding at the very point whele something is which only shows itself in the inconclusiveness of the meaningful.
Psychoanalysis has always shut its eyes to these limitations and has wanted to
understand everything.
In Totem und Tahu (1912) Freud developed a theory of history which he further
elaborated towards the. end of his life. The following picture emerges: Mankind lived
originally in small groups, each under the power of an older male who appropriated
the females and punished all younger males, including his own sons, or killed them.
This patriarchal system ended in a revolt of the sons, who united against their father,
overpowered him and mutually devoured him. The totemistic brother-clan thus
replaced the father-clan. In order to live in peace the victorious brothers gave up their
claim to the females for whose sake they had killed the father in the first place and
imposed exogamy on themselves. Families were then instituted with matriarchal
rights.
.
But ambivalent emotional attitudes on the part of the sons towards the fathers
remained in force all through the later development. The father was replaced by a
certain animal as totem. This was regarded as an ancestor and protector and was not
to be killed. However, once a year all the men in the community gathered for a feast
during which the totem animal though venerated on all other occasions was now tom
to bits and communally eaten ... this ritualistic repetition of the father-murder
became the beginning of social order, custom and religion.
Following the institution of brother clan, matriarchal rights, exogamy and totemism, a development began, signifying the return of the repressed (analogous to the
repressed in the individual human psyche). It is a valid assumption that the psychic
precipitation from this early period has become a heritage which only needs to be
evoked with every new generation and which is not in any way a new acquisition. The
return of the repressed goes through a number of stages. The father once again becomes head of the family though his power is not unlimited as in the original horde.
The totem animal is replaced by God. Ideas of a supreme deity appear. The only God
is the return of the father of the original horde. The first effect of encounter with what
had long been missed and desired was an overpowering one. There was admiration,
awe and gratitude. The intoxication of devotion to God is a reaction to the return of
the great father, but ancient feelings of hostility also return and are experienced as
feelings of guilt. In St. Paul we can see how an understanding of this breaks through
-we have slain God the Father and therefore are we wretched. The same thought
was concealed in the teaching of original sin. But at the same time there came good
tidings. Since one of us has sacrificed his life, our guilt is all absolved. What had to be
atoned for by a sacrificial death could only have been murder-that is, the murder of
the father. But in the sequel Christianity evolved from a father-religion to a sonreligion. However it did not escape the fate of having in some way to put the father
aside.
This account shows how Freud himself evolves a rationalistic, psychological 'myth' analogous to the formation of imaginative myths. His myth
contains less empirical reality than these old myths. It is a product of the
ostensible modern loss of faith and, moreover, has the disadvantage that
although the content is poor enough and nothing but rational platitude, the
empirical scientific value of its absurdity is stressed. But by evoking these
ancient myths Freud breathes round his platitudes an air of lost memories,
SPECIFIC MECHANISMS
CHAPTER VI
MEANINGFUL CONNECTIONS AND THEIR

SPECIFIC MECHANISMS
(a) The concept of the extra-conscious mechanism
Normally we do not give a thought to those extra-conscious mechanisms

which are the understructure of our psychic life and without the intact
functioning of which no meaningful connection can ever be realised. We live
wholly by a genetic understanding of psychic events and, since we have no
direct knowledge of extra-conscious mechanisms, there is all the less reason
to bring them to mind. We only come to think of changes in them when in the
course of some illness meaningful connections dwindle away or appear in some
abnormal fashion, e.g. as physical sequelae (perhaps the psychogenic paralysis
of an arm). We then add an hypothesis of abnormal mechanisms to give some
temporary explanation for the existence of such abnormal meaningful connections. It is an important function of psychopathology to try and find out all it
can about meaningful connections arising on the basis of extra-conscious
mechanisms and the present chapter is concerned with this. The mechanisms
themselves are inaccessible to investigation. Our understanding of the meaningful connection is the only way in which the facts can be grasped at all and this
can only be done indirectly.
It is fundamentally important for the comprehension of abnormal psychic life
that we clarify the concept ofpsychic mechanism as an extra-conscious precondition of
psychic phenomena and of their effects on bodily function. As yet there has been no
successful description of these mechanisms in more exact bodily or physiological
terms. They remain purely a theoretical, psychological concept to help us bring
some order into the phenomena (hysterical phenomena, for example), the true existence of which has sometimes been denied both by physicians with a purely somatic
orientation and even by psychiatrists, who intellectualise. Investigation of mechanisms from their point of view is impossible. We can only describe the different ways
in which meaningful connections come ahout in actuality. Any detailed theoretical
construct which tries to go beyond the use of extra-conscious mechanisms as a general
auxiliary concept would be un testable and, so far as I know, has never been fruitful.
The Freudian investigations, in so far as they are constructions of extra-conscious
events-and they are that to a large extent, particularly in dream-interpretation-are
wide open to criticism. But sometimes they provide us with surprising insights when
they ev.idently describe actual meaningful connections (a number of symbolisations,
repressions, etc.). Hence we will leave the general concept of extra-conscious mechanisms and move on to a construction ofthem in detail, in the exceptional cases where we
can make convincing use of such a construction for the ordering of the phenomena
(cp., for example, the concept of dissociation).
364
Our present subject-matter, therefore, is not meaningful contents as such

but how they come to appear through the mechanisms that give them their
form. We would like to recognise the abnormal mechanisms. But the presentation of extra-conscious mechanisms,as shown by the meaningful content, only
brings order into phenomena, and does not provide us with any theory. The
following grouping, therefore, is not in the nature of a logical deduction, and
the individual paragraphs tend to overlap. Our aim is to demonstrate the large
variety of the phenomena in question, rather than the narrow confines of a
theory, which in the last resort can never be true.
(b) Meaningful content and mechanisms
In dreams and psychosis there arise contents which can only appear
through given mechanisms of this sort, but have nothing to do with the
mechanism itself in so far as it is there and brought into action. On the other
hand meaningful psychic content-along with physical illness, fatigue and
exhaustion-can often be a factor in setting these mechanisms in motion.
Psychic drives and attitudes even playa part in falling asleep and frequently
turn the inner attention in a certain direction in dreams: I want to go on
dreaming this or I do not want to do this but want to wake up. A person can
only be hypnotised if he is willing. In all psychogenic reactions (Erlebnisreaktionen), it is the meaning of the experience which is the decisive factor
in precipitating the state.
(c) Mechanisms that are universal and constantly in action and those that are
specifically evoked by psychic experiences
Whenever meaningful connections are taking effect, then extra-conscious

mechanisms are invariably active, such as habituation, memory, after-effect,
fatigue, etc. There are in addition still other mechanisms which are set in
motion by meaningful psychic traumata; they can be grasped only through
understanding the meaning and in themselves retain a glimmer of meaning,
even though we ourselves are still vague. Nietzsche's insights into such
mechanisms offer us an example:
Instinctual drives will simply realise themselves wherever possible, where there is
no resistance. Resistances arise countering this realisation. 'If instincts have no outward discharge, they will tum inwards ... our whole inner world, originally confined between two membranes, has gained extension and grown, acquired depth,
width and height, pari passu with the fact that the individual power of outward discharge has suffered inhibition.' This inhihition arises either from the reality situation
or from active suppression. The inhibited instincts in either case take effect in a
changed form, namely:
I. A search for inadequate and in any case different contents, a disguised or symholic gratification. 'The majority of drives-hunger is an exception-can be gratified
"with imaginary supplies".'
2. An inadequate discharge of existing tensions or moods. 'Even the psyche needs
SPECIFIC MECHANISMS
certain cloaca for the discharge of its excreta, and for this purpose it makes use of
people, relationships, status, its country or the world at large.' 'Malicious remarks
made about us by others are often not intended for us but express anger or a mood
brought on by quite different reasons.' 'The individual who is dissatisfied with himself is always ready to wreak this dissatisfaction on others' ... 'Gifted, but lazy,
people always appear irritated when one of their friends has finished a good piece of
work.' 'It is only envy that is stirring and they are ashamed of their own laziness.' 'In
this mood they criticise the new work and their criticism turns into a revenge which
deeply alienates the author.' Confession is a special kind of discharge. The individual
'who communicates himself' gets free of himself and the person 'who acknowledges
something, can forget'.
3. A process which Nietzsche termed 'suhlimatwn'. There is 'strictly speaking,no
selfless way of acting and no point of view is entirely disinterested. In each case there
are only sublimations, in which the basic element appears volatile and only reveals
itself to the sharpest observation.' Nietzsche speaks of 'people with a sublimated
sexuality'. 'Some drives-the sexual drive, for instance-can be much refined through
the intellect (into human love, prayers to the Virgin and the Saints, artistic enthusiasm.
Plato considered the love of knowledge and philosophy to be a sublimated sexual
drive). Yet with this the drives retain their old direct effect.' 'The quantity and quality of an individual's sexuality extend to the highest reaches of his mind.'
(Freud has popularised these ideas in cruder form. He took over the term 'sublimation' for the transformation of sexual drives into artistic, scientific and ethical
activity, etc. He used the term 'conversion' for the appearance of physical phenomena
due to psychic causes and 'transformation' for the appearance of different psychic
phenomena, anxiety, for instance, in place of the sexual drive.)
We caneasilyunderstand that where real satisfaction is lacking, a substitute
is looked for and mentally conceived. But if an actual substitute-gratification
is to be experienced or an actual sublimation is to take place, some extraconscious mechanism is called for. Sublimation in particular and the real relief
brought by confession both have to be attributed to something completely
unconscious. It is through th~ meaningful connection itself that such mechanisms are set in motion.
In kleptomania the theft can be literally experienced as an act of sexual gratification. Sensuous pleasure in the phenomenon accompanies many neurotic phenomena.
So with the drive to self-inflicted pain the struggle with the symptom is also enjoyed
and through this cycle of pseudo-gratification there comes about a destructive
increase of the symptoms.
(d) Normal and abnormal mechanisms

All meaningful psychic life comes to realisation by means of normal extraconscious mechanisms. We speak of abnormal mechanisms when psychic experiences lead to an exaggerated or entirely new kind of transformation. Here
margins are fluid. We take as our norm the ideal type: that in the meaningful
personality connectedness remains intact, there is always a possibility of full
illumination through self-reflection and the link with consciousness and the
state of consciousness continues sensible and subject to control.
NORMAL MECHANISMS
SECTION ONE
NORMAL MECHANISMS
(a) Psychogenic reactions (Erlehnisrealctionen)

This is not the place to remind ourselves of all the infinite world of human
experiences. We would only observe the basic fact that the individual in his
temporal course passes by fate and change through a number of situations and
events and comes upon fundamental experiences that shake him to his roots
and form his subsequent nature.
We must distinguish between violent emotional shocks such as terror,
horror, rage (arising, for example, from sexual assault, earthquake, death, etc.),
which are due to sudden catastrophe and those deep emotional changes which
grow slowly out of the fixities offate (the wasting of hope with increasing age,
lifelong captivity, the crumbling of self-deceptions which had helped one to
evade reality, restricted living through poverty and lack of opportunity, a
lack of positive experiences). 'Each generation, class or individual collects
cultural wounds of their own in the areas of nature and external circumstance,
and every one has a different point at which he is most vulnerable, a different
quarter from which he is most likely to receive his most violent shocks, for one
it is his money, for another his reputation, for a third his feelings, religion,
knowledge or family' (Griesinger). In the order of frequency the chief role
seems to be played by: sexuality and eroticism, fears for life and health, worry
over money, material existence and domestic life; then come motives related to
success in one's calling and in one's human relationships; finally there is religion and politics. Where we want to analyse the meaningful connections we
must apply ourselves to the particular contents of each individual case.
Traumatic experiences can bring a person into a state and afford him experiences which may well appear to him abnormal compared to his everyday
life. We consider these experiences normal in the first place so long as they
remain under that person's control and, in the second place, so long as they
have no obscure, disturbing sequelae; thirdly, so long as they are more or less
possible for anyone to have. (Man has an extraordinary capacity for extreme
endurance.)
Terror by itself, without any other precondition (psychic attrition,
physical weakness), is hardly likely to precipitate a psychosis. Such effects of
terror in the 1914-18 war were always linked with other causes. The explosion at Oppau l (where 657 workers out of 6,000 were killed and 1,977 were
wounded) did not cause a single acute reactive psychosis.
But acute traumatic experiences may lead to very remarkable phenomena:
I.
In the most vehement emotional upsets when there is desperate fear of death a
complete loss o/adequate emotional response has sometimes been observed-a marked
1
Kreiss, ArCh. Psychiatr. (D), vol. 74, p. 39.
NORMAL MECHANISMS
SPECIFIC MECHANISMS
apathy appears, a rootedness to one's place, with unfeeling, quite objective observations of events as if one were merely registering them. This has been noted particularly among the survivors of earthquakes and conflagrations. They seem indifferent to everything. These states may sometimes be difficult to distinguish from a
vigorous self-control in a taxing situation. Occasionally this stunning through pain
has been described subsequently as a subjective calm.
Baelz1 describes his own experience of a Japanese earthquake: 'There was a sudden,
lightning change in me. All my better feelings we~e extin?uished, all sympathy.and
possible participation in others' misfortunes, even Interest In my threatened relattves
and my own life disappeared, while mentally. I remained quite clear an~ I ~~~~ to
be thinking much more easily, freely and quicker than ever. Some earher mhlbltton
seemed to have been suddenly removed and I felt responsible for no one, like
Nietzsche's superman. I was beyond good and evil ... I stood there and looked
on at all the ghastly events around me with the same detached attention with which
one follows an interesting experiment . then, just as suddenly as it came, the abnormal state vanished and gave way to myoid self. As I came to, I found my driver
tugging at my sleeve and begging me to get out of the danger from the nearby
buildings.'
From the description of a South American earthquake (Kehrer, Bumke's Handhach, vol. I, p. 337) .. 'Nobody tried to save their relations. I was told it was always
like this. The first shock paralysed all the instincts save that of self-preservation. Once
real misfortune happens, many regain their senses and one sees miracles of selfsacrifice.'
2.. Experiences occurring seconds hefore an apparently certain deat~ (during a fall
from a height or during drowning) are rarely reported but often discussed. Albert
HeimS gives the following account: 'As soon as I began to fall I saw I was bound to
be dashed on the rocks and waited for the impact. I dug my fingers into the snow to
try and break my fall and tore my fingertips without feeling any pain. I heard my
head bump on the rocky comers and then I heard the thud when I fina~ly hit bottom
. I only began to feel pain after an hour. It would take me ten ttmes as many
minutes to tell all that I thought and felt during the 5-10 seconds of the fall. First I
saw my possible fate ... the results for those I would leave behind .. .' then I saW
my past life rolling off as countless pictures on a faraway stage ... It all looked
translated as it were-beautiful without pain or fear or anguish ... atoning thoughts
pervaded' everything and sudden peace flooded me like magnificent music .. I
grew more and more enveloped in a marvel~ous blue sky of small clouds, rose ~nd
faintly violet ... I floated quietly and tranqUIlly away among them ... observatton,
thought and feeling went on side by side ... then I hear~ a thud and the fall;tas
over .. .' Heim was unconscious for half an hour after thiS as a result of the Impact, though he himself did not notice it.
. '
.
3. Here is one illustration from the descriptions of front-lzne experrences In the
first World War: Ludwig Scholz3-'We were reduced to having to "wait and see"
although we were in immediate danger. Our minds froze, grew numb, empty and
dead. Every soldier knows such an experience if he has had to lie still under heavy
barrage. One gets so tired, so utterly weary. Thoughts crawl, to think is such a
1 Baelz, Allg. Z. Psyehiatr., vol. S8, p. 7 1 7.
I A. Heim, 'Ober den Tad durch Absturz', Jh. sehweit.Alpenclub, 1891 (quoted by Birnbaum).
3
Ludwig Scholz, Seelenleben des Soldaten an der Front (quoted by Gaupp).
I
i
~
labour, and even the smallest voluntary act becomes painful to perform. Even talking,
having to reply, get one's thoughts together, jars on the nerves and it is felt as a sheer
relief to doze and not have to think of anything or do anything. This numbness may
indeed grow into a dreamlike state, time and space disappear, reality moves off infinitely far, and while one's consciousness obediently registers every detail like a
photographic plate, feelings waste away and the individual loses all touch with himself. Is it you who sees, hears and perceives, or is it only your shadow?' This is an
experience common to men 'who are condemned to inactivity and at the same time
are exposed to grave and immediate danger'. Scholz goes on: 'Feeling is frozen. As
the firing gets louder and never ceases, it blends with a sense of fatalistic calm. The
threatened man becomes numb, cool, objective-the senses slowly grow enveloped
with a merciful stupefaction, become clouded and conceal the worst from him ...
the monotony of uninterrupted droning noise narcotises him ... the eyes slowly close
and right in the middle of the deadly uproar he faIls asleep.'
4. Experiences while heing severely wounded. Scheel 1 describes his experiences as
follows: 'In 1917 I sustained two shot-wounds in my jaw with damage to my tongue,
two right-sided shots in the arm and a shot in the seat ... I immediately collapsed
though consciousness was preserved. At first I felt no pain ... on the contrary I felt
almost quite comfortable and well, the running blood gave me the feeling of a warm
bath ... my thinking, though preserved, was retarded. I could hear grenades exploding near me and the cries of the wounded but I had no idea of the danger of my
situation ... I understood everything said and I can still hear my battalion commander raIlying those who were calling out though not so badly hurt: "grit your
teeth-what are you shouting about? Here's Lieutenant Scheel-so badly hit but not
a word out of him" .. My silence was interpreted as sheer heroism, but if it had
been known it was only the effect of shock which robbed me of the pain the others
were suffering ... I lost all power of movement once I was hit ... I never felt uncomfortable nor the bump on the ground when I fell.'
). In the period immediately after traumatic experiences there may be the most
vivid dreams (e.g. battle-dreams of the wounded). There is a compulsion to see,
hear and think the same thing over and over again. It haunts the individual's mind
and he gets depressed, feels changed, cries, is tense and restless.
Grief, it seems, is often not immediate but takes time to grow. After the first
period of calm, there is violent reaction. We speak of a time-lag in the affect.
6. People differ enormously in their psychogenic reactions. Baelz writes: 'In an
earthquake, some are terrified by the slightest tremor, while others keep comparatively
calm even when the quake is severe. People who have given proof of their courage
in combat or elsewhere may grow deathly pale at the smallest tremor, while a sensitive woman who might be terrified by a mouse will remain relatively calm'. From
these and similar remarks we can see the wide extent of what is normal.
(h) After-effects ofprevious experience
Everything we experience and do leaves its trace and slowly changes our
disposition. People with the same disposition at birth may eventually find
themselves in entirely different grooves, simply through their life-history and
experiences and the effects of their upbringing as well as of their own efforts at
1 Scheel, Munch. med. IPsehr., vol. II (1926) (quoted by Kehrer).
SPECIFIC MECHANISMS
NORMAL MECHANISMS
self-education. Once such development has taken place there is no point of

return. In this lies the personal responsibility involved in every single
experience.
The course of psychic events leaves diverse after-effects: I. Memory-traces:
which make the recall of events possible. 2. The facilitation of psychic events
through repetition (practice). 3. Abbreviation of the same ev.ent~, so the same
result is achieved with fewer conscious phenomena (automattsatton or mechanisation). In learning to ride a bicycle most movements are first learnt consciously
and one does not rely on one's instincts. But as we learn we gradually give up
conscious guidance of our movements until the decisive moment is reached
when we dare to trust the learned mechanism (acquired instinct). Finally automatisation has gone so far that only the expressed intention of wanting to ride
the bicycle needs to be in consciousness. Everything else happens automatically
while consciousness can be concerned entirely with other matters. 4 A general
tendency for the same psychic experience to recur (hahit). 5. Lastly there are
unnoticed influences often at work in emotionally-toned experiences, and they
have an effect on other psychic events, on feelings, values, actions and the
general conduct of life (effect ofcomplexes). Memory, practice and mechanisation
have already been dealt with in our discussions on the objective psychology
of performance, so here 'We shall only deal with habits and the effects of complexes which have a meaningful aspect for us. They are to be encountered in
practically every psychological analysis.
I. Hahits dominate our life to a degree which we only rarely admit.
Traditional customs and accidentally acquired habits affect most of our actions
and feelings. Habits grow on us and become needs. Even bad actions to which
one has been forced soon grow bearable through the strength of habit. Habits
are responsible for the constancy of our attitudes and are an effect of discipline.
They become our 'second nature'. What we have grown used to-even if it is
criminal-becomes entirely unremarkable to us. Spontaneity of the psyche
retires in the face of it. To try and analyse or sort out the diversity of our
habits would present us with an endless task.
II. After-effects of emotionally-toned experiences, particularly unpleasantlytoned ones. These normally fall into the following types: (a) affects, like habits,
once they have run their course can he folly roused again through association as
soon as one element of the original experience reappears. Moods may thus
appear which at first seem quite groundless to the person concerned until the
associative link has been recognised. (h) Affects can displace themselves in that
objects which were associated with an unpleasant or pleasant experience may
take over the same feeling-tone. Hence emerge the countless subjective
emotional values which objects acquire for people as a consequence of chance,
coincident experience. This displacement can also take place when affects are
simply aroused associatively, without any fresh reason or fresh object, so that
the subjective feeling-tone which the object acquires for the person may originate in something which can no longer be disentangled either by the individual
concerned or his analyst. If, however, there is patient evocation of associations,

in some cases it is possible to arrive at a meaningful clarification. (c) Unpleasant experiences are worked out. Either we give free rein to our affects in
tears or acts, in irony, defence reactions or creative activity, utterances or
confession so that they exhaust themselves in this way (ahreaction) or free
discharge is inhibited and the whole experience is therefore worked out intellectually. The experience is summed up as a whole, the connections are
weighed up, conduct evaluated and action decided upon as seems necessary.
This is an emotionally-toned, intellectual task and in so far as it is a true and
genuine effort, character traits for the future become engraved and basic
principles formed as a result of this impassioned yet reflective intellectual
labour. (d) When unpleasant experiences are blocked from outlet and
'swallowed direct', denied, deliberately pushed aside and forgotten, 'repressed'
without any such intellectual elaboration, they tend to show exceptionally
strong after-effects. In this case the associative re-awakening and the emotional
displacement-which always occur as after-effects-tend to be even more
intensive and widespread. Repression, however, can occur without any such
consequences, particularly when the personality is stolid and dull.
370
371
Attempts have been made to demonstrate the normal after-effects of emotionallytoned experiences, particularly through the use of association-tests. 1 The investigator
examines the effects of certain facts known to him. He compares the reactions to a
series of stimuli of people who are and are not involved in these same facts. A number
of differences can be detected (e.g. prolongation of reaction-time, forgetting the
reaction, meaningless or absent reaction, exaggerated gesture or other accompanying
phenomena on the part of those involved) and these can be explained partly as simple
after-effects of the experience and partly by a tendency to conceal. However, such
reactions occur not only when something has reaIIy been experienced or done but also
when the proband merely imagines he is suspected to have experienced or done
something like that.
The disposition, which is the residual result of the experience or type of
experience and which uniformly influences the later psychic life in a way that
is meaningful in terms of the original experience, is called a complex (Jung).
All complexes have it in common that they are supposed to characterise a
particular, irrational after-effect arising from some experience in the past. This
leads to feelings, judgments and actions which do not have their source in
objective values or in objective truth or purpose but in these personal aftereffects themselves. IJ is always implied that if the individual concerned only
had good self-observation and would exercise self-criticism he would not
attribute any objective validity to the content of such after-effects. Complexes
have a tendency to dominate the personality to such an extent that the individual
1 A critical summary with full bibliography is given by O. Lipmann, Die Spuren interusebetonter Erlehnisse u. ihre Symptome (Leipzig, 1911). He also indicates the symptoms shown in
other tests (e.g. experiments on evidence). Ritterhaus, Z. Neur., vol. 8, p. 2.73. Jung 'Diagnostische
A',sociationsstudien', J. Psychiatr., va Is. 3,4, s-a basic study.
'
SPECIFIC MECHANISMS
no longer has complexes but the complexes have him. The concept of the
complex carries various shades of meaning:
I. Projection of a single experience on to the world as perceived: After an
experience which has made one despise oneself one feels-and one's whole
demeanour betrays it-highly embarrassed as if people were noticing. One
instinctively believes that the change in oneself will be conspicuous to everyone else. A 'delusion-like' state develops from over-valued ideas. Goethe
describes this in Gretchen's experience: 'The most casual of glances troubled
me; it was no longer mine to be happy and unaware, and go about unknown,
of good repute and not imagine the silent watcher in the crowd.'
2. The disposition which remains on as the trace left by an experience:
When certain elements bring back the experience, it recalls the other elements
through association and this leads to aJfectiyely-toned reactions that are personal
to the individual (e.g. antipathy to a place or to some phrase, etc.).
3. The disposition which as a result of prolonged experience of certain
situations leads to particular affectively-toned reactions. For example, a man
becomes afraid whenever he has anything to do with the military. He accumulates hatred and resentment against superiors or preferred persons and on some
trivial occasion there is an explosion of rage. One person has an antipathy
towards every party-opponent or a liking for the 'outsider' as such. Another
finds those types attractive which remind him of some loved person. Another
has an irreversible servant/master attitude which rests on long habit and tradition, and with which, should the external circumstances change, he will have
to wrestle as if with an uncontrollable inner force.
(c) Dream-contents
The decisive step in the mastery of reality is the making of a clear distinction between dream and waking life and between the meaning of both experiences. The dream, however, remains a universal human phenomenon. It may
be regarded as an indifferent pseudo-experience or as a symbolic or prophetic
experience, the interpretation of which is an affair of some importance. The
psychic life is so changed in dreams that it could be called abnormal were it not
tied to the sleeping state and were it not so common a human experience. It is,
so to speak, an abnormal event which is normal and comparisons between
psychoses and dreams are an old matter.
In the first place sleep and dream can both be investigated as to what
objective somatic factors are involved. We can thus consider the dream's
richness of content and its frequency in relationship to the factor. of ageing
(more in the young than in the old), or to the depth of sleep (more frequent
when sleep is light), etc.
Secondly, one can investigate the psychic existence of the dream-experience
phenomenologically, the modes in which objects present themselves, the levels
of dream-consciousness, the shifting contents, their infinite variability and
interchangeability.
NORMAL MECHANISMS
373
Lastly, we can try to understand the contents of the dream-experience, what
they mean. The question whether dreams have meaning has been debated down
the ages.
I. Dream contents can be regarded as heing ofcultural interest in themselves,
in so far as they are an experience. It is as if deep meanings for humanity come
to light in dreams. We look then for typical dream-contents-characteristic
anxiety dreams, dreams in which one experiences a longing for something
unattainable. The dreamer feels harshly abandoned in a desert place while all
that he strives for vanishes into the infinite distance. He wanders through a
labyrinth of rooms. There are dreams of flying and faIling.
2. We either dismiss the infinite variety of dream as chance and impenetrable chaos or we can try to answer the question why particular contents
occurred in this situation to this individual and not to others. In answering
this question, we 'interpret' the dream. We practise the psychology of meaningful connections and enquire into experiences, conscious or unconscious aims
and wishes, into the personality and life-history, the stituations and special
experiences of the dreamer and into tendencies common to everyone. In
opposition to the concept of dreams as accidental and chaotic events, Freud put
forward the proposition of their complete determination and meaningfulness.
Perhaps both these extremes are wrong. Some dream-contents do perhaps
have a meaning other than their relationship to trivial, insignificant experiences
of the previous day or two. Perhaps they can be understood in a much more
fundamental way.1
Let us set out possible interpretations briefly in the form of question and
answer:
What does symbol-formation mean? One dreams that one is in the street
naked-the bedclothes have fallen off. One dreams one is at a drinking-partythe dreamer is actually thirsty. One dreams one is flying-obstacles, frustrated
wishes, difficulties, are thus overcome. The dream images are-at least in
part-objectifications of something else which appears in them symbolically
and which can be interpreted as their 'meaning'.
What is it that is symbolised? Silberer suggests the following grouping:
I. Bodily stimuli (somatic phenomena). 2. Functional phenomena: the ease
of the psychic state, how heavily it is burdened, how retarded. 3. Material
1 '~ream-interpretation' is extremely ancient (cp. the famous classic: Artemidor, trs. Fr. Krauss,
Symholtk der Traume (Vienna, 1881), but this nearly always meant interpretation of dreams as
prophetic signs, revelation of metaphysical meaning, divine commands. Modern dream-interpretation understands dream-content as stemming from wishes, repressions, symbol-formation as
a pictured representation of the dreamer's situation, state, and of the prognosis in relation to 'his
own somatic and psychic happenings. Schemer (Das Lehen des Traums (Berlin, 1861 found
symbolic portrayal of bodily events-physical stimuli such as restricted respiration, pressure sensations, etc., in great numbers. Wundt (Physiologische Psychologie, 5th edn., pp. 6)2 If.) accepted
this in principle with some individual interpretations. But Freud's work was the first to olfer a
fresh. inte,rpretation of gre~t importance: Die Traumdeutung (Vienna, 1900), 1st edn.-containing
"n historical survey. H. Silberer, Der Traum (Stuttgart, Enke, 1919) is a short book giving an
introduction to Freud's theorising. For a historical presentation see L. Binswanger, Wandlungen
in der Auifassung und Deutung des Traumes (Berlin, 19l8).
374
SPECIFIC MECHANISMS
p henomena: the content of wishes, the desired goals. Freud differentiates

. tr
different levels of wish, as it were: those that are the unfulfilled, mOnenSlve
ones of every day; those which have cropped up during the day b~t have ~
dismissed and repressed; and, at the deepest level of all, unconsclOUS Wlshes
which are hardly ever related to daily life but stem from the world of
infancy as for example the incest-wish.
WIt~t are tlte ways of symbol-formation and of moulding tlte dream-c~nte~t?
Symbol-formation may take place directly and openly as the mere PictOrial
representation of a thought, something self-evident and scarcely t? be doubted.
But this type plays the smallest part in Freud:s dream-inter?re~atlon. Far m~re
important are the wishes dismissed by conSClOusness as obJectlonable and diSguising themselves in images that are difficult to recognise on ~e face of it,
in order to reach symbolic fulfilment in the dream. Many t~nd~ncles to ~ymbol:_
formation combine within the single image (over-determ1Oatlon), the censor
transforms the symbol till it becomes unrec~gnis~le to .consciousness. Thus
and in many other ways, according to Freud s pomt of View, does the dreamcontent proceed to structure itself
. Instead of discussion, an example, abstracted from Silberer and condensed,
will illustrate better what is meant:
Paula's dream. In an Egyptian temple, altar of sacrifice. Many men present but
not in ceremonial dress. Emma and I stand near the altar .. I put an old ye~lowed
manuscript on the altar and say to Emma . just watch ... if what they say IS true,
sacrificial blood should appear on the paper. Emma smiles incredulously. We.stand
there a fairly long time .. suddenly a red-brown spot appears on the paper 10 the
form of a drop. Emma trembles all over. Suddenly I am in an open field and see a
. bow . I call the lady of the house (for whom Paula worked
magm'ficent ram
th as
companion) to show her but she will not come. !hen ~ come to a narrow pa enclosed by high walls on both sides. I become ternbly fnghtened because the narrow
path with its high walls seems endless. I scream, no on com~s. S~ddenly. the w~ll
7
gets lower on one side' I look over it and see close to It a Wide rlYer which agam
blocks the way. I walk ~n and see an uprooted rose-bush. I decide to plant it b~ck as a
memorial in case I die there and start to dig with a stone from the wall. It IS pure
black garden earth. I plant the bush and lookin? up from the work I see the wall
quite low and beyond it beautiful fields and sunlight.
.
Silberer interprets the dream as follows: Paula,. who ha~ not .had sexu.al mtercourse for some considerable time, must have taken It up agam. WI~hout usmg contraceptives she was anxious about the consequences because her per~od was delayed.
She had ideas of death as if faced by a great danger. Paula c~mmumcate~ her dream
by letter and after a few weeks she confirmed the interpretation. Some time after the
dream she had given herself to a man but at the time of the ~ream it was only the
thought of doing so that had occupied her mind. The dream did not re~ect an actual
event but the intention and the fantasies linked with it. As to th7 deta!ls: T~e altar
stands for the marriage altar. The apparently irrelevant emphaSIS on not m ceremonial dress' together with the other details may be seen to refer to the absence of
contraceptives (which Paula called 'covers'-Ueberzieher). The u~folded manuscript stood for the vagina where blood is expected to appear. Several times people are
NORMAL MECHANISMS
375
called but do not come-the 'good lady' of the house does not come-the menstrual
periods are not so 'good' as to start. The frightening passage between the walls refers
to a phantasy about the lower bodily passages and to birth ... Silberer deals in more
detailed fashion with the blood and the rose-bush. The anxiously awaited bloodstain
is in the first instance the menstrual blood supposed to appear in the vagina (the
folded manuscript). The manuscript is yellowed, Paula is worried that she is growing
old. Hence the second interpretation of the blood, defloration blood-Paula wishes
she was 'virgo intacta' (a clean page) so that defloration was still possible. The rosebush is a symbol of sexuality and fertility. Paula thinks of the possibility of becoming pregnant. She has in fact played with the idea that if she becomes pregnant she
would rather die but she would like the child to live. The walls are the walls of
inhibition. As she breaks these down, she makes her own grave, giving the child life.
Silberer, whom I have only quoted in a fragmentary way, concludes: 'This by no
means exhausts all the dream connections, which are extremely complex and it would
fill a whole book to go through them everyone.'
Wltat criteria are tltere for correct interpretation? Any interpretation can be
made to sound plausible if we pursue the path of associations, which leads
from everything to everything else, and if we follow the line of reasonable
connection, especially as in dreams platitudes are common and contradictions
a matter of course and usually there are a host of over-determinations, transformations of meaning and heterogeneous identifications, of oneself with the
content and so on. We can recognise the content but because of the unlimited
possibilities of its interpretation, we need some special criteria for preferring
one interpretation to another, or for declaring one particular interpretation
as the correct one. Initially it is a question of probability-should we accept
the coincidence of comprehensible contents of experience with comprehensible
dream-contents as accidental or significant (for instance, in Paula's dream, the
Egyptian temple allows the reminder that the man with whom she wanted to
have intercourse used to call her 'sphinx'). But that does not get one very far
because it is obvious that all dream material is rooted in some experience or
other. Interpretation presents the problem of finding out what factor is decisive
for the content and what is just accidental. In the last resort it is the subjective
evidence of the dreamer that will be decisive, when he is awake and interprets
the dream or has it interpreted for him. Only the dreamer can give validity to
the colouring, feeling and emotional tone attaching to the dream-content, and
this validity is essential if the interpretation is not to be just an unending game
of logical associations. We certainly come across the most illuminating instances but usually the particular case presents endless problems and verification becomes an impossibility.
Instead of correctness (in the sense of making an empirical statement of a
meaning that is already effective in fact) interpretation may have a certain
truth, in that it brings the given dream-material into some relation to reality,
to an actual train of thought which can now become effective in life through
an act of self-understanding. Here the process of dream-interpretation is not
the process of getting some empirical knowledge, but a productive activity, a
376
NORMAL MECHANISMS
SPECIFIC MECHANISMS
number of psychic events which fall into neither category. We call them the
phenomena of suggestion. Their content can of course be understood but not
in t~rms of the person's character nor in terms of a logical or other adequate
motive. It can only be understood in terms of a specific psychic effect which
other persons have exercised on the individual, or which he has exercised on
himself in an almost mechanical way without the aid of his own personality or
any motive that strikes us objectively as sensible or comprehensible. 'Realisation' sets in without counter-ideas, counter-motives or counter-evaluations.
Judg~~~ts, feel.ings, attitudes ~chieve their realisation without any question
or CntlC1Sm, Without act of wtll or personal decision. Under cover of the
hypothesis that there are mechanisms of suggestion which are ununderstandable and cannot be further explored, the resultant phenomena unfold
themselves in a series of understandable connections, in so far as the content
of the psychic operation and the content of the phenomena that ensue have
some correspondence with each other.
In the widest sense involuntary imitation belongs to the phenomena of
suggestion. (This is not so with voluntary imitation which in each case can
be understood in terms of the individual's motives and goals.) In a crowd the
single person loses his self-control not because he himself is enthused but
because the crowd infect him) Thus passions spread and it is in such imitation
that fashions and customs have their source. We imitate the movements, phrases
and ways of others without noticing it or intending it. So far as we are not
dealing .with an understandable development of our personality, the forces of
suggestIOn are at work. 2 Every kind of psychic experience can be aroused in
this way, feelings, points of view, judgments. Most striking of all are the involuntary imitations of physical phenomena, appearing without any influence
of the conscious will. Somebody, for instance, feels acute pain in that part of
the body where someone nearby has sustained a fracture of the bone or
someone has paralysis or cramp because the sight of others so suffering' has
alarmed him. It is possible to speak of an imitative-reflex. It is one of the basic
characteristics of human nature.
A type of suggestion is that ofjudgments and values. We exercise judgments,
affirm values and take up attitudes which we have simply taken over from
others without intending or knowing that we have done so. It is not our
judgment, evaluation or attitude yet we feel it is ours. This acceptance of others'
judgment as our own along with the semblance of its being our own all the
same has been termed 'suggested judgment'.
~II the kinds of suggestion we have discussed so far may operate unintentionally and involuntarily. There is no intentional suggestion and the victim
himself does not notice it. But suggestion may also be intended and in that case
form of communication between the interpreter of the dream and the dreamer
himself, a communication which influences his whole outlook, something
which indirectly educates him for better or worse, but capable at any stage of
deviating into nothing but an entertaining game. In every case the analysand
is open to the analyst's suggestions and theories, and success depends on the
degree to which he accepts them.
What is the scientific significance of dream-interpretation? In the first place
it may discover universal mechanisms and determine their presence or absence.
But as far as Freud's theory is concerned, I find it to be largely a construct
fro~ extra-conscious material, with no scientific interest since verification is
impossible. On the other hand, much of it strikes one as particularly apt, for
instance all that refers to the psychology of association, but this soon becomes
a rather boring performance, an endless process of analysing contents according to the conventional procedure. In t?e second place, it is tho~ght that by
dream-interpretation we can penetrate mto the depths of a partzcular pers?nality, with the idea that we can get a better history in thi~ way than by. taking
note of accounts given when consciousness is clear. ThIS may be qutte true
in certain rare cases but the proof of correctness can only be furnished by
further data from experience. In the third place, there is the question whether
we get a broader understanding of meaning, a widening of the intellectual fiel~ in
respect of dream-interpretation and through its use. So far our understandmg
has been almost wholly of an elementary, primitive and platitudinous kind
and to this has been added our re-discovery of folk-myths in the content. But
the result in this third respect seems to me almost zero. In the fourth place,
we might conceive of the biological significance of dreaming in general. Freud
explains the dream as the 'guardian ofsleep'. Sleep~di~turbing wishes ar~ hu~hed
through dreamed-of wish fulfilments. This basiC Idea. cannot be ~lsmlssed
lightly and a small proportion of our dreams ~ay pOSSibly b~ of thiS .so~t.
Taking it all in all, I think that some truth IS to be found m the prmclples
of dream-interpretation. My objection is not raised against its correctness
(though it provides an endless field for fantasy and mock-p.erfor~a~ce) but
rather against the importance attached to it. Once the mam prmclples
learnt and tested out on certain cases, there is little else to learn. The dream IS
a rem~rkable phenomenon, but after the first flush of enthusiasm i~ve.stigate
it we are soon disillusioned. So far as any knowledge of psychiC Me IS concerned, the information we gain in this way is of the slightest.
ar:
:0
(d) Suggestion
On the appearance in an individual of a wish, a feeling, a judgment of
something, an attitude, or alternatively when he acts, we usuallyth'understand'
.
the content in terms of his previous traits, his basic nature and e presentmg
situation. Moreover if, in spite of the fact that we know him extremely well,
our understanding fails us, we look to see whether the phenomena might not
constitute the 'ununderstandable' part of a morbid symptom. There are a large
377
: Gustav Le Bon! Psy~~ol?gi~ der Mas~en (?e~m~ trans.) (Leipzig, 1912), 2nd edn.
Tarde (Les LOIS de limitation) deSCribed ImitatIOn and enlarged the concept considerably.
lie, ,:"anted to make it the basi~ of, sociology, as a result of the common procedure of turning one
1',11 tlcular mode of ~nders~a~dlng Into an absolute. Involuntary imitation is only one among many
lI.hcr r"ctors that give a dlstmctive character to particular social circles, strata, callings, etc.
SPECIFIC MECHANISMS
NORMAL MECHANISMS
the concept of suggestion grows more circumscribed and is of more superficial

application. It then signifies only the intentional influence of people on each
other (which in its intensified form becomes hypnosis). Finally a suggestion
may be realised with the knowledge of the person affected. I want something and
I expect it, or I am afraid, in spite of what I krlow, that I cannot defend myself,
or rather it is just my knowing that prompts the suggestion. But knowledge
of this sort is already self-suggested; it is the knowledge of a believer, the
expectation of the unavoidable.
awake but all his movements and experiences are conditioned exclusively by
rapport and suggestion (somnambulism). These states are subsequently covered
by complete amnesia. We do not differentiate hypnotic states solely by their
depth but according to the kinds to which individuals are prone in varying
degree. Somnambulism is a kind of partial wakening, which remains tied to
specific conditions. There are certain remarkable post-hypnotic effects (Terrninsuggestion). The hypnotised individual will carry out an order days or weeks
after it was given under hypnosis, he will pay a visit perhaps. At a certain
time, in a way which he himself cannot understand, he will experience an
urge to do something and he will give in to this unless some overwhelming
inhibition, rooted in his personality, makes him resist. He will often fabricate
a motive which suits him and which he will consider as the real reason for his
action. Finally, physical phenomena can be suggested under hypnosis and so
brought about though voluntarily this would be impossible, e.g.: determining
themenses to a particular day, reduction of bleeding, blister formation on the
skin (suggesting that a piece of paper is a mustard-plaster).
Experiments have shown that in human beings the effects of suggestion are
universally drastic. For instance, at the end of a dark passage a light-coloured bead is
suspended and the task is to say when it first becomes visible as one approaches it.
It is seen by two-thirds of all the probands, even when it has been removed. A professor tells his audience to tum away and pours distilled water from a well-wrapped
bottle on to a wad of cotton wool, ostensibly to test how quickly a smell will spread in
a room. At the same time he sets a stop-watch. Two-thirds of his audience, those in
the front bench first, give the sign that they have perceived the smell. In the same way
one can achieve mass-hypnosis and other forms of suggestion but in all these cases
we find a minority who do not respond. They exercise natural powers of criticism,
perceive nothing, experience nothing and find themselves surprised.
Autosuggestion has a special role and may be contrasted with suggestion

from others. For one reason or other, and it may be quite understandable, an
individual is struck with some idea, some expectation or conjecture and the
content is immediately realised within his psychic life ... He expects to smell
something and at once he smells it. He supposes something to be so and
immediately there is conviction. He expects a blow to paralyse him and at that
moment his arm is paralysed. Here is a mechanism which only produces worthwhile results when a conscious will is at work. We intend to wake up at a
certain time and succeed in waking up punctually. We want to banish a particular pain and in fact it disappears. We want to go to sleep, and in fact we do.
(e) Hypnosis
With most people, provided they are willing and believe in the power of
the person in authority and have confidence in him, one can in the first place
suggest that they are feeling tired, are tranquil, are surrendering to the words
of the suggestor, and should concentrate on these words alone. One can then
induce a state varying from the mildest sleepiness to the deepest degree of
hypnosis with exclusive rapport with the suggestor. Such a state provides the
most suitable condition for the realisation of further suggestions. How successful this is depends on the depth of the hypnotic state. Insensibility of the skin,
different postures, immobility, specific sensations, hallucinations, can all be
evoked. Once the hypnotist has ordered it, the hypnotised individual cannot
move, or a potato tastes to him like a luscious pear. While deeply hypnotised
he carries out a theft, etc. During the deepest stages of hypnosis, the eyes are
again open, the individual starts up, walks about and moves as if he were
379
Hypnosis resembles sleep yet is something quite different. The difference lies in
the rapport, in the 'island of wakefulness' in the otherwise sleeping psychic life.
Hypnosis is also something different from hysteria. The phenomena of hypnosis
and hysteria are identical so far as their mechanism goes, but the difference lies in the
fact that with hypnotic phenomena the mechanism is brought into action by specific
conditions which are transitory while with hysterical phenomena it is maintained as a
lasting peculiarity of the psychic constitution of certain individuals.
However, there is some relationship between hysteria and the capacity to he hypnotised. The latter is common to all humans but it varies in type and degree. The
deepest degree of hypnosis is achieved most commonly by those who are inclined to
spontaneous hysterical mechanisms and by children (whose psychic life is normally
much closer to the hysterical psychic life). On the other hand some patients cannot he
hypnotised at all, for instance, the dementia praecox group and other patients who can
only be put into the lightest of artificial sleeps which one can hardly call hypnosis,
e.g.: psychasthenics.
Hypnosis is a human phenomenon and presupposes self-reflection and the
adoption of an attitude to the self, and hence it is not possible in very young
children. There is no hypnosis of animals. What is referred to by that name
refers to reflexes which are physiologically quite different and in nature
essentially quite another matter from human hypnosis.!
There is in addition autohypnosis. Here it is not another person but I
myself who put myself into a hypnotic state intentionally through autosuggestion. In this state I can achieve far more wide-reaching physical and
1 Hypnotic phenomena were closely studied in the last decade of the nineteenth century and
descriptions are largely concordant Explanations and theories are numerous and of changing
nature but not of particular interest here. The most important are Bernheim, Die Suggestion
(German), from Freud (Vienna, 1888); Forel, Der Hypnotismus (Stuttgart, 1902), 4th edn.; MolI.
Der Hypnotismlls (1907), 4th edn. Of the psychologists Lipps, Suggestion II. Hypnose (AMr. Bayr.
Akad., 1897); Wundt, Hypnotismus u. Suggestion (Leipzig, 1892).
SPECIFIC MECHANISMS
ABNORMAL MECHANISMS
psychological effects than in the waking state. This control of physical events
and this sort of awareness derives from very ancient practices and still survives
in the Yoga techniques in India. In the Occident it has almost been forgotten.
Levy was the first to use it in the field of medical therapeutics l but it was
J. H. Schultz who elaborated every aspect methodically, tested it, made
observations and gave it a physiological and psychological interpretation. 2
Everyone can through the exercise of his own will bring suitable conditions about whereby a switchover into the hypnotic state occurs without
any external suggestion. This calls for relaxation-the most comfortable
position for the body, reduction of outside stimuli-a co-operative readiness
and concentration (fixing on some point, monotony). According to Schultz,
the switchover is a vital event that occurs without any suggestion only when
concentrated relaxation is present. We are dealing with a basic vital reaction,
analogous to the release of falling asleep. Autohypnosis is a 'concentrative
alteration of set', commonly of course the effect of suggestion but not strictly
tied to this. It is rather an automatism that requires certain conditions for its
appearance.
in India where the exercises are the operation of a life-time and the individual
throws his whole existence into them. In psychotherapy the procedure becomes a way of obtaining a period of recreation, refreshment and repose. It
enables a certain control over bodily events which, analogous to the control of
the muscles, are then, so to speak, appropriated through the vasomotor
cardiac and vegetative systems. The aim is to bring about a regulation of
sleep, suspension of pain and a relaxation of the self.
The experiences in this state are typical. At first, feelings of heaviness, warmth,
sense-phenomena, phantom limbs, heart-regulation. As the state deepens, a wealth of
experience becomes possible, productive picture-worlds, automatisms such as
medium-writing, etc. In rare cases performances in such a state reach a fantastic
level.
It is essential that the switchover establishes itself slowly at first and not too
effectively, but gradually improves with practice. Repetition brings it on more quickly
and finally it can be brought on at once by an act of will. It is possible to link the
switchover with partial relaxation of the muscles of the neck-shoulder region. As
training progresses, the switchover takes place immediately this local relaxation
occurs. 'The well-trained person, therefore, should he want to arrest an emotional
state that has unexpectedly arisen, only needs to carry out the above-described sliding
and lowering of the shoulder-girdle. This can be done whatever the posture and so
inconspicuously that only those who know will notice the postural change.'
Thus the switchover is a technique that can be learned. It takes 6-8 weeks to
acquire it in the first place. 'Usually only after 3-4 months this self-directed switchover is so wellieamed that a considerable performance becomes possible.'
In India this procedure has been developed for thousands of years to a

degree that to us seems almost unbelievable. Schultz has investigated this
procedure under the conditions of occidental culture and looked at it purely
physiologically, apart from the original contents of philosophy and faith. He
secured the facts as a whole but in so doing he robbed the procedure of its
philosophical weight. He separated empirical reality from metaphysical
reality. Once the content was lost, there only remained a technical method.
The effects of this method are limited if we measure them by those achieved
1 Levy, Die natiirlicl,e Willenshildung (D) (Leipzig, 1909).
2 J. H. Schultz, Das autogene Training (Leipzig, 19)2).
SECTION TWO
ABNORMAL MECHANISMS
Abnormal extra-conscious mechanisms are defined not as a single type but
from a number of standpoints:
I We speak of abnormal phenomena when in their amount, degree and
duration these go beyond what is usual. From this standpoint we find temporary transitions occurring everywhere between phenomena, that can be
called average, and those that are pathological. Excitement becomes overexcitement, inhibition becomes paralysis.
2. Associations that have become mechanical habits tum into despotic and
hinding ties, into fixations. A normally mobile psychic life becomes immobile.
As a result it is directed by complexes, fetichisms and inescapable images and is
trapped finally in a cul-de-sac. Here too we find all sorts of transitions from
the normal to the manifestly abnormal.
3 ~ince all psychic life is a continual synthesis of what has been separated,
a holdmg together of what tends to fall apart, final and complete dissociation
(splitting-off) is something abnormal. Consciousness, the momentary crest of
our psychic life, is linked normally with the unconscious in a mutual reciprocity. Nowhere is the latter closed to consciousness, but it can be grasped,
acquired and sustained by consciousness at every point. From consciousness
itself over the borders of what is unnoticed to what is unconscious there
stretches an entirely accessible expanse where everything is potentially linked
with consciousness. All that happens and is experienced, even if for the moment
it may become almost independent, will presently find its return-link with the
personality, be accepted, defined and shaped into the context of the psychic
life as it is led in its entirety. Radical dissociation (splitting-off) is abnormal in
every case and so is its inaccessibility for consciousness, its failure to integrate
into the personality and the disruption of continuity with the individual life as
<I whole. This dissociation (splitting-off) is to be sharply demarcated from
t hose divisions of normal life that commonly reunite again into context. Diss.ociatio~ (splitting~off)-like the crossing of a Rubicon-demarcates anarchy
trom umfied experience. Interpretation according to the category of dissociation
Ilccurs with numerous modifications: neurotic symptoms, organ-complaints,
come to be regarded as phenomena tom away from their meaningful lifesource. Independence of apparatus leads, for example, to uninhibited isolation
SPECIFIC MECHANISMS
ABNORMAL MECHANISMS
of the sensory fields. The term dissociation (splitting-off) is given to the inability to remember experiences which remain effective none the less. A lack
of relationship in psychic development, the disintegration of integrated
wholes, unconnected double-meanings, double-interpretations and similar
phenomena in dementia praecox have led to the use of the term dissociationinsanity (schizophrenia). Experiences of a double-self are called dissociation of
the self. The continual problem is what is it that produces this tearing apart
and by what means can re-integration take place and with it the restoration
of meaning, definition and proportion.
Dissociation (splitting-off) itself, however, has not been clarified as a concept methodologically or systematically. It is a descriptive concept for something factually experienced as well as a theory for what happens in the particular state of dissociation and it provides the hypothesis for an occurrence
which eventuates in this dissociated state. As a basic idea we encounter it
everywhere in psychopathological thinking. It certainly does not describe
anything uniform but in every case it touches upon modes of extra-conscious
mechanism.
4. There is a mechanism that switches over the state of consciousness.
J. H. Schultz distinguishes the switchover that takes place in hypnosis and
his autohypnosis from that which takes place in suggestion. In hypnosis the
switchover is usually achieved by means of suggestion but favourable circumstances and appropriate actions can also bring it about automatically. A
similar switchover happens daily in the experience of falling asleep; this may
partly be due to the will to sleep acting autosuggestively but it can happen
without this, simply through tiredness, habit or conditions that induce sleep.
Schultz differentiates the switching-over process, the state of consciousness
induced by the switch-over and the phenomena and effects possible in this
state. All this is really indivisible but these three aspects can be separated out
for consideration.
All changes of consciousness and general alterations of a person's state can
be considered as switchovers analogous to the switchover into sleep or
hypnosis. In abnormal psychogenic reactions, hysterical phenomena, and
psychotic states, however different they are in meaning and implication, we
always find the same, sudden jolt into an entirely different psychic state which
becomes the condition for new abnormal phenomena to appear. The switchover can obviously be of very different kinds, if only we had more exact
knowledge and did not have to apply a somewhat crude analogy. A switchover
is something specific but we can only grasp this specific element in a crude
way, principally by an analogy with normal extra-conscious mechanisms.
Reviewing the various ways in which we have characterised abnormal
extra-conscious mechanisms we see that we neither know nor understand any
one of them. Our formulations only represent various ways in which we try to
grapple with the puzrJe. We have factual knowledge of the phenomena possible
on the basis of these hypothetical mechanisms and to a limited extent we know
what has set these mechanisms in motion. Where these abnormal mechanisms
~ome :rom rem~ins p~ob~ematical, even if they are called into action by stimuli
In which psychiC excitation plays a contributory part. We attribute them to
specia~ abno~al dispositions (constitution), to cerebral processes or to other
somatic morbid processes. Or we speak of psychic causes in the narrower
sense, when the formation of the mechanism derives from some unwonted
psychic sh~ck, t??ugh ev.en here we have to make the additional hypothesis of
some predlsposltlon which would not have manifested itself without that
particular trauma. Or we have to suppose that anyone may be brought into
the power of abnormal extra-conscious mechanisms by certain situations and
experiences, which is a view favoured by some investigators on the basis of
individual o?servati.ons and pr?bably without sufficient ground. In any case
the~e are q~lte speCific mecha?lsms, such as those effective in schizophrenia,
which certainly cannot appear In everybody, and it is likely that there are many
others also, such as those in gross hysteria.
Where some understandable experience triggers off the extra-conscious
mechanism we think we have understood the transformation as much as the
content but we are mistaken. The everyday occurrence of such mechanisms
leads to familiarity with them but not to any understanding of them. What is
understandably abnormal in extra-conscious mechanisms is not their meaninglessness, which applies. to all mechanisms as such, but the extraordinary
character of the mechamsms that occur. There are most unusual realisations
of meaningful connections, based on abnormal mechanisms for which the
meaningful element itself-due to preconditions usually unknown-has
become a causal factor.
. T~e switchover into altered consciousness occurs understandably and
mtentlonally through suggestion and autosuggestion. The same thing
happen~ unde~tandably but unintentionally through psychogenic reaction
(Erlebmsreaktlon). It may also occur understandably in illness poisoning
extre~e fati.gue, all of which enforce the switchover, whereas su~gestion and
exper1~nce, If ~hey are to operate as causes, call for some kind of 'co-operation',
and thiS remams as the one factor in the causal chain which is psychologically
understandable.
I.
PATHOLOGICAL PSYCHOGENIC REACTIONS
The term 'reaction' has a number of different meanings. We speak of the reaction
of the physical organism to the influences and conditions of the external world, of the
react~on of an o.rg~n,. for instance the brain, to events within the organis~; of a
reaction of the mdlvldual psyche to a psychotic disease process and finally of a
reaction of the psyche to an experience. In the following we shall deal only with this
last type of reaction.
T~e meaning which certain events have for the psyche, their value as
experience, the psychic commotion which accompanies them, all evoke a
SPECIFIC MECHANISMS
reaction which in some measure is 'understandable'. For instance, in the reaction to prison, there are the psychological effects of knowing the significance
of what has happened, and the possible consequences; then there is the whole
atmosphere of the situation, the loneliness, darkness, cold walls, the hard bed,
harsh treatment and the tension and uncertainty as to what will happen. Perhaps there are other factors too, such as lack of nourishment, owing to poor
appetite or bad food, and exhaustion through sleeplessness. Such physical
effects prepare the ground in part for the specific type of reaction that follows
and contribute to the establishment of the whole clinical picture of prison
psychosis. The pathological reactive state does not often occu~ after one sin;gle
experience but after the summation of many effects. PsychiC and phYSical
exhaustion were often observed to be the basis in reactive war psychoses,
where the onset was sometimes triggered off by a relatively trivial experience
following long resistance to severe trauma.
However well we understand the experience, its shattering significance and
the content of the reactive state, the actual translation into what is pathological
remains nevertheless psychologically incomprehensible. Additional extraconscious mechanisms have to be construed. We explain these by means of
special predispositions (Anlagen) or a somatic disease process, or we suppose
that psychic shock as such may cause a transient alteration in the underlying
structures of our normal psychic life. Psychic distress is immediately followed
by a host of bodily accompaniments and similarly it can effect an alteration in
the psychic mechanisms which in their tum condition the abnormal state of
consciousness and the manner in which the meaningful connections are
realised (clouding of consciousness, dissociation, delusional ideas, etc.). This
alteration in the extra-conscious foundations is a theoretical construct; we
have to conceive of it as causally conditioned and analogous in some way with
the manifest somatic sequelae of an emotional upset.
(a) Reaction as distinct from phase and thrust

Pathological reactions are to be differentiated in principle as follows:
I. Pure precipitation ofpsychosis-where the content has no meaningful connection with the experience. For instance, a bereavement may precipitate a
catatonic illness or a circular depression. The type of psychosis need not
correspond to the experience at all. The psychic upset is only the last and
possibly quite dispensable provocation upon which an illness breaks out either
as a transient phase or as the thrust of some process which would finally have
emerged without this provocation, and which now takes its own course following its own independent laws. From this we must differentiate 2. Reaction
proper-where the content is meaningfully connected with the experience. The
reaction would never have occurred without the experience and throughout its
entire course remains dependent on the experience and what is connected with
it. The psychosis remains linked to the central experience. Where the psychosis
is simply precipitated or rises spontaneously we can observe a primary growth
ABNORMAL MECHANISMS
of the illness which can only be explained in physical terms and is unrelated to
the patient's life-history and experiences. It has content as every psychic illness
must have, but this is only accidental and carries none of the effective weight
of previous experience. Where there are recoverable phases, we find a subsequent tendency to recognise the experience clearly as an illness and to look
at it in a detached way as something completely alien. In reactive psychoses we
observe either an immediate reaction to some incisive experience or some kind
of explosion following a long period of unnoticed growth and meaningfully
connected with the life-history and recurrent impressions of every day. When
the psychosis is over the patient may be able to assess the psychosis unreservedly as an illness. However, the psychotic contents which have grown
out of the life-history tend to have lasting effect on the subsequent life
so that the patient, in spite of his intellectually correct attitude, is apt to stay
attached to the morbid contents in his emotional and instinctual life.
The concept of pathological reaction has an aspect of meaningfulness
(experience and content), a causal aspect (a change in what is extra-conscious)
and a prognostic aspect (this change is transient). Even though the immediate
translation into an abnormal state is reversible, and particularly when there is
rapid recovery after the cessation of traumatic events, after-effects will persist
owing to the close link between the experience and the personality, and where
there is repetition and summation of the experience will lead finally to a reactive, abnormal development of personality. After every reaction, it is true,
there is return to the 'status quo ante' as regards the specific psychic mechanisms and functions, the capacity to perform, etc. But the various contents may
continue to exert an influence.
It is only in the obvious borderline case that reactions proper need to be
radically differentiated from 'thrusts' (Schuben). On the one hand we have
psychoses materially conditioned by psychic trauma and showing convincing
meaningful connections between the psychotic content and experience (the
reactive psychoses proper). On the other hand we have psychoses which are
the result of processes. Here the psychotic content has no meaningful connection with the life-history though of course what content there is must be
drawn from the former life but its value as experience, as part of the context
of the patient's life, is not the decisive reason why it has merged into the
psychotic content (genuine phases or thrusts).
(h) The three different ways in which reactions hecome meaningfo/

We understand the extent ofa trauma to be adequate cause for breakdown.
We understand a meaning, which the reactive psychosis subserves. We understand the contents of reactive psychosis in particular.
I. Psychic experiences as we have seen are always accompanied by bodily
changes. They set in motion extra-conscious mechanisms which indeed we
cannot describe in detail but which are a necessary theoretical postulate that
provides the ground for abnormal reactions with a meaningful content. In
SPECIFIC MECHANISMS
ABNORMAL MECHANISMS
some cases, however, psychic traumata will lead to somatic or psychic disturbances which have no meaningful connection with the content of the
experience. The experience is itself the 'psychic source' for an event entirely
alien to it. Extreme psychic excitements give rise directly to drastic effects.
How this comes about usually remains hypothetical. But generally speaking
we know that affects influence the circulation, that they bring about somatic
sequelae by acting via the vegetative sympathetic/parasympathetic nervous
system and the endocrine glands, and that the somatic changes in their tum
have an effect on the brain and the psyche. It is possible that affects bring
about seizures in epileptic patients via some such chain of somatic events.
Through the media of circulatory changes and rise in blood pressure, an
affect may possibly bring about the bursting of blood-vessels in the brain and
strokes. The following effects of psychic events are particularly worth noting:
wants to be irresponsible and develops a prison-psychosis. He wants to get

compensation and develops a 'compensation-neurosis'. He wants to be cared
for in some institution and develops the varied complaints of the haunter of
hospitals. Thus patients strive instinctively for the gratification of their wishes
and these reach fulfilment in the psychosis or in the neurosis (purposive
psychosis, purposive neurosis). In rare cases the illness can be laid on more or
less consciously. In the first place the illness is fostered by an initial, possibly
conscious simulation. Subsequently the patient finds himself confronted by it
without being able to help himself. Or a psycho-neurotic affective upset arises
extraneously in the first place and only becomes hysteria in due course, inasmuch as the illness serves a purpose (release from the Services, compensation,
etc.).
Kohnstamm gave us the phrase 'failure in the duty to keep well' (Gesundheitgewissen). The healthy individual who naturally wishes to be and keep
healthy will gloss over many complaints and bodily discomforts. A number
of immediate phenomena are thus made to disappear because he does not pay
any attention to them. Even when somatic illness impairs performance and
calls for sensible treatment, healthy people will inwardly detach themselves
from it.l It is not easy to determine anyone's limits of endurance (it is perhaps
easier to decide where continuing effects may do harm, may bring about a
worsening of the illness or be the cause of death). In extreme situations, where
an individual is utterly exhausted, he is overcome by feelings of real powerlessness, the whole vital tone falls to indifference and the simple statement that
one can do no more rings true and credible. If nevertheless the question is
pressed, whether one did not want to do more, and was there not a wish to
give in to the existing weakness and helplessness, there is often no possible
answer. But with hysterical and hypochondriacal reactions in the form of
physical illness, the absence of any sense of obligation to keep healthy is
usually only too obvious.
3. We understand the slide into psychosis or into physical illness from the
contents. It is like aflight into illness in order to escape from reality and relieve
oneself of responsibility in particular. What needs to be endured inwardly,
worked through or integrated is replaced by a physical illness for which one
appears to have no responsibility, or by a wish-fulfilment in psychosis, an
actuality that not only obstructs but masks the empirical reality. The flight
into psychosis allows one to experience as apparently real what reality itself
refuses, though usually not without ambiguity. The psychosis manifests all the
individual's fears and needs as well as his hopes and wishes in a motley procession of delusion-like ideas and hallucinations.
(aa) Abnormal psychic states are cured by psychic shock. The best-known
example is the way in which even heavily intoxicated persons are suddenly sobered
up by some important situation which makes severe demands on them. It is surprising
how the undoubted physical effect of alcohol can suddenly be annulled in these cases.
Apart from this group and belonging to the field of meaningful connections are
the cases where the contents of abnormal personalities are changed by the impress of
psychic experiences. Morbid jealousy in an abnormal personality ceases as soon as
some serious illness absorbs the attention, or neurotic complaints fade away as soon
as the individual has to exert himself strongly.
(00) Severe psychic traumata (catastrophes, earthquakes, etc.) may change the
entire psycho-physical constitution. The signs and manifestations of this sometimes
lack all meaningful connection with the experience itself. There appear changes in
the circulatory system, anxiety states, sleep-disturbances, reduction in performance
and numerous psychic and neurasthenic phenomena which tenaciously remain over
long periods.
(cc) Very severe psychic excitements seem to produce effects similar to those of
head-injuries. Cases have been observed which after delirium ended fatally and others
also which showed a Korsakow syndrome (Stierlin). It is still uncertain1 to what
extent we are dealing here with a disorder which can only be due to an existing arteriosclerosis and therefore must be regarded as organic and to what extent a psychic
experience can bring about such organic sequelae where the blood vessels are healthy.
(dd) It is pOSSible-though rare-for some pleasant experience to produce a
somatic illness by upsetting the equilibrium. Psychasthenic patients for instance often
tell of an increase in their discomforts after delightful experiences and in that context
will speak of some 'set-back'.
2. We understand a meaning in the reactive psychosis: The abnormal psychic
ftate as a whole serves a certain purpose for the patient and the individual
seatures of the illness are all more or less adapted to this end. The patient
1 See Bonhoeffer: To what extent are there psychogenic illnesses and morbid processes other
than hysteria? Arch Z. Psychiatr., vol. 68, p. 371. Bonhoeffer does not differentiate between
meaningful connections and causal effects.
1 Kant (writing on the power of the mind to be master of its own morbid feelings through
the exercise of sheer determination) says: 'a rational person will ask himself when he is worried
whether there is any real ground for it. If he does not find any, or even if there is one and he
cannot do anything about it, he will tell himself this and return to his daily routine. That is, he
leaves his apprehension where he found it as if it were no concern of his and turns his attention
10 what he has to do.'
ABNORMAL MECHANISMS
SPECIFIC MECHANISMS
Let us now summarise: The psychosis has a meaning, either as a whole or

in its individual details. It serves as a defence, a refuge, an escape, as a wish.
fulfilment. It springs from a conflict with reality which has become intolerable.
But we should not over-rate the significance of such understanding. In the
first place the actual mechanism of the transformation can never be understood. In the second place, there are almost always more abnormal phenomena
present than could ever be accommodated wholly within a single, meaningful
context; and in the third place even where traumatic experience plays its part
as a causal factor, it is hard to assess the extent of its causal significance.
There are some unusual cases which are reactions in certain extreme situations
created by the individual's own actions (infanticide, murder). A development changes
the person's entire life and leads to delusion-like conversion experiences in the course of
an acute psychosis. The contents are then tenaciously maintained as a basis for the
individual's whole life. 1 There was a patient who was a farmer's daughter, and who
up to then had seemed robust and psychologically healthy. She was pregnant by a
Russian prisoner of war and killed the child immediately after birth. Another case
was that of a borderline defective who committed murder through the influence of
another person. Weil summarises as follows: In both cases-the infanticide and the
murder-the psychoses started as a matter of fact after confinement in prison. Both
wrestled in prayer and this led the child-murderess to the certainty that God wanted
it like that and the murderer further than that to a false memory, that he had once
offered himself to God as a sacrifice so that God would use him to show that bad
deeds too came from God. Both had visions from the same sphere. The one found her
'peace of soul' and the other his 'peace of heart'. Both accepted the reality of the
phenomena and their significance, that is they were tokens of redemption and grace.
Through the psychosis both were absolved from remorse. She became 'God's child'
and he became 'the preferred child of God'. Both were converted and had feelings of
elation. Neither persons were alike in constitution, personality or character, so that
their analogous psychoses of wish-fulfilment were all the more remarkable.
These cases differ from schizophrenia (the early stages of which are often marked
by baseless conversion experiences) through the absence of primary symptoms, the
centering of the psychosis on delusional content which was almost wholly meaningful, the purposiveness of the delusional content as a unique meaningful revolution of
the individual's essential attitude and the absence of any chaotic, haphazard or nonsensical symptoms.
It is noteworthy how in such a context even feeble-minded persons may have
meaningful and magnificent experiences. Weirs case described his ecstasy on Xmas
morning, after his wrestle in prayer with the desperate question of his misdeeds: 'As I
looked atthe wall it grew clearas glass. I seemed high in the air like the sun .. then
it got rather dark like night, then red ... I saw a frightening, great fire coming from
far away, closer and closer .. as if the world and the earth was on fire ... I saw millions of people on the bare fields, no houses, or trees, nothing but horribly disfigured
faces, most of them praying in fear, turning their eyes up and lifting their hands as if
they still hoped they would be saved . . . there was some red light from the great
fire and I saw the devil chasing about in it ... then it got dark but not for long .
then for a minute I saw the mighty world of heaven above this one ... I can't really
say how lovely and wonderful everything was ... I saw the souls so wonderful and
beautiful ... everything suddenly went ... and it got pitch dark ... and the thought
came back that I was in prison . .'
(c) Classification of reactive states

For purposes of review, we classify reactive states as follows:
I. According towhatprecipitates thereaction. 2. According to the particular
psychic structure of the reactive state. 3. According to the type of psychic
constitution that determines the reactivity.
I. According to the precipitating factors: First we distinguish the prisonpsychoses which have been investigated very thoroughlyl and on which the
whole teaching on the matter of reactive psychoses has been built. Next there
are the compensation-neuroses after accidents,2 the psychoses due to earthquakes and catastrophes,3 the reactions of homesickness,4 battle-psychoses,5 the
psychoses of isolation, whether due to linguistic barriers or deafness. 6 Vischer7
has described reactive states which occur when there is isolation along with a
few comrades as in the prisoner-of-war camps:
The situation: loss of freedom for an indefinite period. Communal life with a
1 Siefert, tJher die Geistesstiirungen der Strafhafi (Halle, 1907). Wilmanns, tJher Gefiingnispsychosen (Halle, 1905). Homburger, Lebensschicksale geisteskranker Strafgefangener (Berlin, 1912.).
Nitsche u. Wilmanns, Referat in Z. Neur., Ref. u. Erg. 3 (1911). StraUssler, Z.,Neur., vol. IS
(1913), p. 547. 'Ober den Begnadigungswahn der lebenslanglich Verurteilten.' RUdin, tJber die
klinischen Formen der Seelenstiirungen bei {u lehenslanglichem Zuchthaus Verurteilten (Miinchen,
1910).
2 Wetzel, 'Ein Beitrag zu den Problemen der Unfallneurose', Arch. So{ialwiss., vol. 37 (1913),
P535
3 Stierlin, tJber die medi{inischen Folgeniustande der Katastrophe von Courrieres (Berlin, 1909).
Cpo Duch. m~d. Wschr., vol. z (19U). Zangger, 'Erfahrungen bei einer Zelluloid-Katastrophe',
Mschr. Psychzatr., vol. 40, p. 196. Die Wirkung der Fliegerangriffe auf die Bevolkerung in
Freiburg.' Hoche, 'Beobachtungen bei Fliegerangriffen', Med. Klin. vol. 2. (1917)' Air attack did
not cause a single psychiatric admission. But there were individuals who got into a state of sleeplessness and perpetual fear which only stopped when the weather was bad and air attack impossible.
There was also over-sensitivity to acoustic stimuli. Those able to leave town did so. The overwhelming majority got accustomed and some neurotics got into a state of pleasant excitemer.t
during attacks. Victims of direct explosion fell into the type of apathy described by Balz.
'Author's dissertation on Heimweh u. Verbrechen, Arch. Kriminalanthrop., vol. 35.
6 Wetzel, 'Ober Shockpsychosen', Z. Neur., vol. 65, p. 2.SS. Kleist, 'Schreckpsychosen', AUg.
Z. Psychiatr., vol. 74. Bonhoeffer, 'Zur Frage der Schreckpsychosen', Mschr. Psychiatr., vol. 46
(1919), p. 143. Handhuch der art{lichen Erfahrungen im Weltkriege (1914-1S), pub. by O. v.
Schjerning, vol. 4. Bonhoeffer, tJber die Bedeutung der Kriegserfahrungen fur die allgemeine Psychopathologie. Gaupp, Schreckneurosen u. Neurasthenie.
Allers, 'Ober psychogene Storungen in sprachfremder Umgebung', Z. Neur., vol. 60.
7 Vischer, Di. Stach.ldrahtkrankheit (ZUrich. Rascher & Co., 1915). Cpo Zur Psychologie der
It is really doubtful whether we can conceive of such cases as being healthy

and not hysterical. There must be some quite specific predisposition or gift for
such a transformation (if indeed these cases did not tum out in the end to be
schizophrenic).
1 Villinger, 'Do psychogenic, not hysterical, psychoses spring up on normal psychological
ground?', Z. Neur., vol. 57. Weil, 'Ein Bekehrungserlebnis als Inhalt der Haftpsychose cines
oligophrenen Morders', Z. Neur., vol. 140 (1932.), p. 152..
Ob"gang.C.Jt (BllIeI, 1919)'
SPECIFIC MECHANISMS
ABNORMAL MECHANISMS
limited number of comrades, always the same, no privacy. Cropping up of violent

antipathies. Increased irritability. People cannot bear the least contradiction. Craving
to discuss things. Petty in one's relationships. Each interested only in himself. Foul
language. No concentration. Restlessness and irregular habits. Complaints about
excessive fatigue (e.g. when reading). Frequent jumping up, inability to sit still.
Loss of memory. Greyness of mood. Distrust. Frequent sexual impotence. Few
remain free of such a state if they have been prisoners for longer than six months.
There are many subtle variations of the symptoms.
Vischer: recalls Dostoevski-Memoirs from the House of the Dead. He also
recalls the experiences of a few people living isolated from the world for a long time,
white people living in the Tropics (jungle-madness); ships' crews (particularly in the
old sailing vessels), monastic life (Siemer, H., Meine fiinf Klosterjahre, Hamburg,
1913), polar exploration (Nansen's description, Payer, Ross).
<the return from theatrical gesturing to the behaviour of the disciplined soldier was
extremely impressive'. Such cases contradict the view that such 'theatrical, hysterical'
behaviour must always be to a great extent rooted in the total personality.-This
clouding of consciousness, however, does also occur in individuals who remain
aware of the original event for a long time. They even realise that they are ill and
their subsequent memory is largely unimpaired.1
(d) If a dreamy state dominates the picture, and there is a kind of behaviour
which strikes one as contrived and childish (puerilism), a talking past the point (e.g.
how many legs has the cow-five) or, in a word, a state of 'pseudodementia' and if,
in addition, one finds physical signs of hysteria (analgesia, etc.) then one is dealing
with the Ganser syndrome. 2 If while consciousness is still clouded, with disorientation,
there is theatrical repetition of the content of the precipitating experience (sexual
assault, accident, etc.) and there are 'attitudes passionelles', emotional expressions and
gestures, we term the state a hysterical delirium. Stuporous pictures may also be
observed (stupor of fright), fantastic delusions while orientation is clear as to place
and time. During the course of long imprisonment elahorate ideas ofpersecution may
grow out of normal mistrust and understandable suspicion, and querulant tendencies
may develop from the notion that the whole conviction was unjust. None of these
states can be sharply differentiated but we find them combined with one another in
the most varied ways.
(e) Reactions with hallucinations and delusions. These have been observed in the
prison-psychoses and arise from the persisting influences of the unpleasant situation.
Patients are anxious and tense and do not feel in control of their own thoughts.
They want to get some result, see something happening, take up an attitude. They
long for something unattainable. They hear suspicious noises. People have malicious
views about them. They hear suspicious footsteps along the corridor and suddenly a
voice says: 'Today we shall finish him off'. The voices multiply and one of them calls
the patient by name. Now he see figures as well, he is in a dream-like daze, tears at his
mattress in fear, attempts suicide. States such as these are fairly common. The contents are later easily elaborated into delusion-like ideas and the patient is convinced
he is really being persecuted and is to be killed. Kurt Schneider' has reported some
rare and interesting cases of acute paranoid reactions.
390
2.. According to the type ofpsychic structure of the reactive states: A whole
series of types could be characterised. Clear demarcation would only be
possible if we could distinguish the different extra-conscious mechanisms and
so recognise the specific hysterical or paranoid reactions, the reactions of
altered consciousness, etc. At present this is impossible. We have to be satisfied
with enumerating a number of types:
(a) All experiences, particularly the less important ones, are reacted to with
feelings that are qualitatively understandable but are excessively strong, linger on
abnormally, and quickly create fatigue and paralysis (psychasthenic reaction). States of
reactive depression are very common, but reactive manias are extremely rare. Sadness
tends to grow naturally, cheerfulness may exceed all bounds and become unmanageable but it is volatile and dissipates itself. Abnormality, apart from lying in the strength
of the reaction, may also lie in the intensity of the after-effects. It is a common experience for our mood in the morning to be influenced by the dreams of the preceding
night even if traces are slight and only susceptible to introspection. Some people are
greatly affected by their dreams which may dominate their whole day. Similarly the
duration of after-effects may be abnormally long, a melancholy feeling is slow to
creep away; all the affects run a long-drawn-out and curving course.
(h) There may be an explosion in the form of fits, tantrums, rages, disjointed
movements, blind acts of violence, threats and abuse. There is a working-up of the
self into a state of narrowed consciousness (prison-outbreaks, frenzies, short-circuit
reactions, are some of the terms used). Kretschmer calls this whole group <primitive
reactions'. They quickly rise to full height and as quickly disappear again.
(c) Strong affects, anger, despair, fright, bring with them a certain clouding of
consciousness, even within the normal limits of intensity. Memory afterwards is incomplete. In the abnormal situation there are twilight states with disorientation,
senseless acts and false perceptions, also theatrical repetitions of certain acts which are
rooted in the original experience rather than in the present reality. We call such states
hysterical. In the state of clouded consciousness the original experience is usually not
in mind and it can be completely repressed during the brief psychosis. Afterwards it
can be completely forgotten. Wetzel observed shock-psychosis in the Front Line, in
cases where the patients had repressed the death of their comrades who had been
mortally wounded. They showed theatrical behaviour and woke up suddenly when
39 1
3 Finally we can classify reactive states according to the type of psychic

constitution which determines the reaction. In wartime we can sometimes
observe reactive psychotic states. They are of brief duration and occur in
personalities who show nothing psychopathic either before or after the event. 4
The idea might well be held that everyone has his 'limits' at which point'he
falls ill. Yet even if no predisposition can be demonstrated objectively in such
cases, and even if robust personalities are found who fall ill on rare occasions
though their psychic health appears particularly good, we still have to retain
the view that in such cases there is a specific 'Anlage', nevertheless, since many
Straiissler, Z. Neur., vol. 16 (1913), p. 44 1
Ganser, Arch. Psychiatr. (D), vol. 30 (1898), p. 633. Hey, Das Gansersche Syndrom (Berlin
1904). Raecke, Allg. Z. Psychiatr., vol. 58, p. 115.
'
K. Schneider, 'Ober primitiven Beziehungswahn', Z. Neur., vol. 1'1.7 (1930), p. 72.5. Knigge,
Z. Neur., vol. 153 (1935), p. 62.2..
Cpo Wetzel, 'Ober Schockpsychoiien', Z. Neur., vol. 65, p. 288.
1
SPECIFIC MECHANISMS
people can be physically wrecked, suffer from cerebral disease and utter
exhaustion and still show no reactive psychotic state. In most cases, however,
the preconditioning factor is clearly visible in the constitution as a whole,
quite apart from the reaction. This constitutional factor is either innate and
persistent (personality disorder-psychopathy) Or it fluctuates (phases) or it
is acquired and transient (exhaustion). So it is with the observed characteristics of increased reactivity (excitability, irascibility) and the hysterical,
psychasthenic reactions. But these may all appear in certain people and at
certain times that to the superficial observer seem quite unremarkable. We see
the same people who at other times appear quite normal display excessive
affectivity and an inability to absorb experience on the occasion of some
relatively trivial provocation. The unfavourable times may be conditioned by
pure endogenous phases or by psychic or physical exhaustion, head injury or
long-lasting emotional stress, insomnia etc.
Organic disease processes may, like the constitution, be the basis for
abnormal reactions. In schizophrenics we find reactive psychoses based on the
advancing disease process. These differ from the thrusts of the process itself
because the patient returns approximately to his former state, whereas the
thrusts of the process bring about a lasting change even though the florid
manifestations may subside. 1 Content in the thrust is general and derived from
any past event; content in reactions is well defined and derived from single or
several experiences from which the psychosis emerges as a continuum. Thrusts
occur spontaneously, reactions are linked temporally with experience.
Obviously there are reactive aspects in all illnesses in so far as there is still
some connectedness in the psychic life, but so far as the course of the illness
is concerned they are almost always inessential. 2
In conclusion let us once more summarise the factors common to all
genuine reactions: There is a precipitating factor, which stands in a close timerelationship with the reactive state and has to be one which we can accept as
adequate. There is a meaningful connection between the contents of the experience and those of the abnormal reaction. As we are concerned with a reaction
to an experience, any abnormality will lapse with the course of time. In
Particular, the abnormal reaction comes to an end when the primary cause .for
the reaction is removed (regaining one's freedom, the return of the homesIck
girl to her people). Reactive abnormalities are therefore a complete contrast to
all morbid processes which appear spontaneously.
However, causal and meaningful connections are so interwoven and the
imposition of the one on the other so complex that in the individual case we
1
ABNORMAL MECHANISMS
393
cannot draw any sharp distinction between reaction proper and phase or
thrust. A lack of meaningful content can be misleading in cases of psychogenic
reaction, and the wealth of such content be equally so where there are disease
processes. On the one hand we may find abnormal psychic states actually
caused by psychic trauma (e.g. catastrophe psychoses, primitive reactions with
raving and fits), where there seem to be few meaningful connections between
content and cause and, on the other hand, we find extra-conscious processes
effecting changes in psychic constitution where the individual phase or thrust
exhibits an abundance of meaningful connections with the person's lifehistory.
(d) The curative effect of emotional trauma
It is an interesting fact that experiences may precipitate a psychosis but can
also have a favourable-although not a curative--effect on a psychosis already
in existence. It has been observed, relatively frequently, that paranoid patients
suffering from a schizophrenic process lose all their symptoms on being admitted to hospital (symptoms such as hallucinations, persecutory ideas, etc.).1
It has also been reported that patients in states presenting a marked catatonic
picture have been aroused by strong affect as if 'from a deep sleep' and have
progressed to recovery from the acute state. Bertschinger, 2 for example, reports
the following case:
A young woman who had behaved immodestly for weeks and who enjoyed
showing herself in the nude, was surprised in a very indecent situation by someone
in the institution whom she had known before. She blushed and was embarrassed and
for the first time in weeks was able to go to bed. From then on she remained quiet
and could soon be discharged.
There are many subjective reports by patients that this or that experience
exerted a particularly favourable influence on them as they were recovering
from acute psychoses. A striking objective improvement can also be observed;
a patient, for instance, who has been stuporous for long periods, becomes
accessible when relatives visit (if they do so infrequently). But after a few
hours the old state has reasserted itself and the course of the illness goes on
unaffected.
We may wonder to what extent the heroic treatments of a hundred years
ago and the modern therapies of insulin and cardiazol shock effect the change
which we call 'cure' through providing a traumatic deatll-experience, through
a repeated reduction of the patient to extremities, and to what extent there are
somatic causal factors at work in these endeavours.
Bleuler first formulated the concept of a reactive psychosis in schizophrenia (Schizophrenie,
19 II ). On the problem of reactive states in schizophrenics, see my paper, Z. Neur., vol.. 14
Also Bomstein, Z. Neur., vol. 36, p. 86. Van der Torren, Z. Neur., vol. 39, p. 364. K. Schneider,
Z. Neur., vol. 50 (1919), p. 49' Schizophrenic reactions without process (schizoid reactions)
affirmed by Popper, Z. Neur., vol. 62., p. 194. Kahn, Z. Neur., vol. 66, p. 2.73. Critique of the
above views: Mayer-Gross, Z. Neur., vol. 76, p. 584.
2 Schilder, Z. Neur., vol. 74, p. I, shows this in certain cases of delusions of grandeur in G.P.I.
Riklin, 'Ober Versetzungsbesserungen', Psychiatr.-neur. Wschr. (1905).

Bertschinger, 'Heilungsvorgange bei Schizophrenen', Allg. Z. Psychiatr., vol. 68 (19II),
p. 109. Cpo Oberholzer, Z. Neur., vol. 2.2. (1914), p. Il3.
1
SPECIFIC MECHANISMS
394
2.
ABNORMAL AFTER-EFFECTS OF PREVIOUS EXPERIENCE
(a) Ahnormal kahits

We will give a few striking manifestations of habit: once someone with a
personality-disorder (a psychopath) gets caught up in a situation while he is in
a certain mood, he finds he can no longer abandon it. For instance, an unpleasant word at the start of a meeting spoils the whole evening. A querulant
attitude towards the hospital where he is cannot be laid aside. In another
hospital, where conditions may be worse, he has no complaints.
Criminal acts tend to be repeated. There are some striking examples offered by
women poisoners (Marquise de Brinvilliers, Margarethe Zwanziger, Gesche Margarethe Gottfried and others) who did not seem to consider their murders anything out
of the ordinary. There was no particular purpose but they murdered out of pure
craving for power and finally simply for pleasure. Feuerbach (Merkwurdige Kriminalfolie, Bd. I, p. 51) describes a case: 'Making poisons and administering them rapidly
became an ordinary enough business for her, whether done in joke or in earnest.
Finally it became something which she pursued with passion not for its consequences
but for its own sake ... poison appeared as her last, most faithful friend. She felt
drawn to it irresistibly and could not abandon it. It became her constant companion,
and when caught by the police she had poison in her handbag .. when the arsenic
found on her was shown to her after many months in prison, she appeared to tremble
with joy, her eyes shone entranced as she stared at the white powder. However, she
always talked of her deeds as mere "minor offences" . there is nothing remarkable
about what we have become accustomed to.'
Abnormal movements and abnormal expression will linger on some time after
acute psychotic states as a matter of habit, though there is no longer any actual cause
for them to do so.
Once a strong normal or abnormal reaction has been experienced after
some trauma, this produces an effect which varies in degree according to the
individual. The same reaction returns with the same strength after lesser
stimuli that lie in the same direction as the original experience, or it recurs after
stimuli which are merely reminiscent of it and finally after all kinds of emotionally toned events, where the connection with the original experience can only
be understood with difficulty or not at all. Someone who has experienced
lightning at close quarters is put into a state of extreme panic by every
thunderstorm. Someone who has seen a beast slaughtered may never be able to
eat meat again (not for any theoretical reason but simply because of the inner
resistance). Hysterics develop their first morbid symptotns after severe trauma.
At this stage the contents of the symptoms are understandable in terms of the
experience (paralysis of an arm, aphonia). But later the same symptoms are
brought on again by other-sometimes quite trivial--experiences. They have
become habitual, abnormal types of reaction. The tendency to form insurmountable habits is universal and with personality disorders this is stronger
than in normal circumstances. There is every gradation from habits which
ABNORMAL MECHANISMS
395
could in certain circumstances be dealt with as 'bad habits' to unalterable
acquired forms of reaction. In the case of sexual perversions, it is well known
that these spring from chance events, particularly those of childhood, and may
then continue to conduct themselves like primary instincts. 1
A case of Gebsattel's may serve as an example of the after-effects of experience
(Gegenwartsprohleme der psychiatrisch-neurologischenForschung, p.60, Stuttgart, 1939).
-A 40-year-old man was flung against the roof during a car accident. For a moment
things went black and for a second he lost consciousness. Shortly after that he went
to work in his office. Subsequently, among other symptoms, he could not go out in
the dark without an anxiety attack. He could not look out of the window at night
nor enter a dark room from a lit corridor. He always sat with his back to the window
and entered a room backwards until he could switch on the light (cathartic hypnosis removed the symptom). It turned out that darkness recalled the moment of the
accident-blackness before the eyes-along with the fear of the black door of death.
In schqophrenic psychic life we meet with hahits which in an excessive form
dominate the whole psychic life. These are termed stereotypies.
Every kind of event that can be possibly linked with the psyche--from the simplest of movements to the most complex actions, chains of thought and experiencesmay be repeated perhaps thousands of times in such a monotonously regular way
that anyone would be forced to compare such an individual with an automaton.
Patients walk round the garden in exactly the same circle, take up one and the same
place, make the same sequence of arbitrary movements, lie for weeks in bed in the
same position, always have the same mask-like facial expression (stereotypes of
movement and posture). They will repeat the same words and sentences, the same
lines and shapes when they draw. Their thoughts move in the same circle. For instance, a patient wrote the same letter for years to the Paris Police, Petersburg,
which she often handed over to the Doctor in batches without ever bothering about
what happened to them afterwards. One often observes in old cases turns of phrase
recurring over the years as the only verbal utterance. A patient greeted everyone
with 'For, for or against, against'. He was satisfied with the answer 'For, for' and
never said anything else.
(h) The effects of complexes

These become abnormal when they get out of the individual's control
split-off (dissociated) and operate from the unconscious.
I. A patient could not return to the place where he had become bankrupt
without getting into a severe depressive-paranoid state and showing symptoms
1 In regard to sexual perversions (homosexuality in panicular) views are opposed. There are
those who explain them as inborn instinctual tendencies, the content of which is determined from
the start and those who regard them as accidents of the life-history, a fixation of the first experience
of waking sexuality directed to inappropriate objects and so acquired. As usual with such opposite
opinions, both parties can be right, depending on the case. Cpo Stier, 'Zur Aetiologie des kontriiren
Sexualgefuhls', Mschr. Psychiatr., vol. 32 (1912). Also Naecke, Z. Neur., vol. 15 (1913), p. 537.
Some workers think that in many cases homosexuality is due to a predetermined Anlage of the
tleXual feelings, while the perversions (e.g. fetichism, exhibitionism) are acquired through experience and rest on sexual fixations that can be partly reversed.
'1
SPECIFIC MECHANISMS
ABNORMAL MECHANISMS
of a neurasthenic complex. When facing a situation where something terrifying has once been experienced, one undergoes an access of fear; for instance,
after a railway accident, there may be a fear of travelling in trains, and after an
air attack, or earthquake, the same thing happens. At the slightest sign that
such a situation is imminent, or indeed when there is the very smallest resemblance, anxiety will appear.
Further, in cases where the experience seems to be a source of complexeffects, usually these have understandable roots reaching beyond this one
experience into the past. An experience which in itself is not so significantand inadequate for understanding-may become the source of a neurotic state,
because the ground was already prepared by previous experience. For instance, the individual with erotic problems is much more hurt by upsets in
other fields than someone whose erotic life is happy and whom the same event
may leave quite untouched. Lastly, the roots of abnormal psychic states and
symptoms ramify into the whole past history, and if one is patient one can
tease out a whole nexus of meaningful connections, the threads of which all
happen to cross at this one point. Freud brought this situation to light with
his concept of 'over-determination'.
2. In all the cases we have mentioned so far the complex in question can
become conscious, though hitherto it has been disregarded. With the help of
some self-criticism, the individual can make himself aware of it. But the complex becomes the source of certain morbid bodily and psychic symptoms,
which can be traced back to anexperience it is true,but while the morbid state
is in being, the experience is forgotten, truly unconscious and not something
that is merely disregarded: split-ojfCdissociated) complexes or repressed complexes (e.g. some prison psychoses, where the patient is no longer conscious
of his crime but when an attempt is made to evoke the memory of what he has
done, develops florid symptoms). In order to comprehend these phenomena
we need the theoretical concept of dissociation (splitting-off) of psychic events.
appear after extirpation of one labyrinth in a dog. Within a week the disturbances
disappear. If the other labyrinth is then extirpated, disturbances appear once more,
only moreseverely. Aftersome months, everything is again all right. One then begins
to ablate the leg-area in the cortex. The usual disturbances disappear after some weeks.
If then the other leg-area is ablated, all the other previous symptoms reappear floridly
and do not disappear. If the eyes are occluded by a bandage, the few remaining
c~pacities for ~ovement disappear completely. Here we see how the second labynnth, the cortIcal areas for movement and posture and the visual sensations which
subserve stance and movement all take over from each other until every possibility
for compensation is exhausted.
Good compensation often occurs in organic cerebral diseases. For instance, after
hemiplegia and aphasia. But that this is only a compensation and that the defects
remain latent is proven by the immediate, severe disturbances created when big
demands are made or when there are strong affects, and by the rapid fatigue and slowing down of function.
When there is restitution of disturbed function, there is either a kind of new
creation, in that areas which up to then have been resting now develop the relevant
function (in the lower animals there can be a morphologically recognisable regeneration), or there is compensation, in that other functions which before had been only
ancillary now take over all the work.
Comparable with this are the psychic compensations that arise when whole
sense areas are missing. Helen Keller in spite of her total blindness and deafness was
able to acquire the culture of a modern individual by using the sense material of
touch alone. Perhaps some contrast-phenomena also belong to the field of psychic
compensation (colour-brightness in the visual sphere; and, in the sphere of affects,
incomprehensible good spirits following deep pain, etc.).
(c) Compensation
Inner defects, defects in experience, psychic losses take effect through
compensation, a utilisation, as it were, of the total possibilities of the person
concerned.
The analogy is drawn from physiology, in particular from neurophysiology,
where the direct morbid phenomena are differentiated from the compensatory
phenomena. 1 The living organism usually reacts to all disturbances and destructions
with alterations in function which serve the continuance of life under the changed
conditions. When such events take place, we speak of substitute phenomena, of selfregulation. These matters have been studied in detail in the case of neurological
phenomena which have only secondary interest for psychopathology.
Ewald's experiment is most striking. Disturbances in posture and movement
Anton, 'Ober den Wiederersatz der Funktion bei Erkrankungen des Gehirns', Mscnr. PsyclJiatr., vol. 19, p. I.
1
397
However, when we come to 'meaningful' psychic connections we are dealing with something quite different. 'There is such a thing as a neurotic
cowardice which is really deep-rooted self-defence. Where the individual
should be mastering his anger, he shows lassitude and apathy. When compassion threatens to upset him, he works himself into a blase and detached
attitude. He avoids all thought-complexes that are affectively toned, he evades
the matter in hand, the thing that is important, and deflects himself to what is
peripheral' (Anton).
We can understand the psychological development of these connections,
which indeed are self-evident, but if we conceive them as 'compensation' for
some 'weakness' this can only be in a metaphorical sense. Such connections
do not have much in common with the compensations we have been recounting
above. It is, moreover, doubtful whether they can be said to be at all purposeful
in the biological sense. There is no replacement of this or that missing function
but there is an effort to bring about a subjective reduction of displeasure which
biologically may even be harmful.
(d) Disintegrating and integrating tendencies

Experience has constructive as well as destructive effects. If we look at life
SPECIFIC MECHANISMS
ABNORMAL MECHANISMS
and the psyche in a vague and general way, everything that happens may be
seen as a 'dying and becoming'. Life is a constant re-emergence from dying,
that is from dissolution, a physical dissolution into mere chemical-physical
processes, a psychic dissolution into mere mechanical-automatic events.
Psyche and mind are the constant holding-together of opposites and polarities
into which at every moment they tend to fall apart. If we call these integrating
tendencies, plasticity, then disintegration may be seen as an increasing rigidity.
Life may thus be measured by the level of plasticity, and a process of recovery
become a progress towards plasticity.
This vague, general view of life can be analysed further: from the hiological aspect life is a constant integration of the body in its environment.
From the aspect of the mind, life is a synthesis of all the facts of mental experience through the dialectical process of negation, preservation and integration. From the existential aspect it is the discovery of the ultimate origins of
one's own being.
In no one case can we comprehend these events in their entirety and so
control them. Everything rests on the unconscious which at the decisive
moment creates something fresh whereby disintegration is overcome. Failure
in this creative effort of the living whole is death itself and all its preparatory
stages. Our knowledge and practice can advance only so far as those limits
where we encounter the decisive act of the living event in its entirety. As an
object of knowledge, we only circle round it, and in our therapeutics we only
deal with it through the use of stimulus, set task and persuasive appeal. It is the
act of life itself, the act of creating, the act of being oneself. We are not in
control of these acts but they are the prime source of every potentiality. Our
knowledge and our practice deriving from this knowledge may be capable of
psychoanalysis but not of psychosynthesis. The latter always has to emerge
from the unconscious element in life, in mind and in Existence itself. We can
prepare the way, foster, inhibit and endanger it but we cannot achieve it
through any kind of arrangement, power of persuasion or goodness of intent.
There always remains the all-embracing precondition which we call the vitality
of life, idea, creativity, the initiative of Existence itself. We can call it Grace, or
the Gift of oneself, but none of these names say anything of what it properly is.
There is above all no finality. Dying, growing rigid, failing to appear, are
but instances of Life. Life in its entirety can never be attained by humanity.
Man travels along the path of ever-recurring death and renewal until his finite
existence in time is extinguished in death.
tendency to split off. But all these generalisations only give broad expression to the
over-all aspect, which only becomes of scientific relevance when there can be empirical demonstration in some definite context.
Even in severe pathological states, as long as the person remains alive, we find
tendencies towards some restitution of a whole. These may range from compensations
for particular defects to the recreation of personality in schizophrenics. In the case of
demented patients, integrated worlds come about somehow. There is always something that moves into a new context, into direction and control under new conditions,
that arise perhaps from tendencies that have themselves become abnormal. Certain
efforts at order oppose the distractions, the derailments, the disintegration and the
3.
399
ABNORMAL DREAMS
(a) Dreams during physical illness
Sometimes the beginning of a physical illness will show itself in an individual's dreams or when he is dozing. Abnormal body-sensations and general
feelings of abnormality, as yet unnoticed in the waking state, now penetrate
into consciousness. In febrile illnesses there are troubling dreams with compulsion-like phenomena as if one were spinning round. Then after various
haemorrhages there are vivid dreams that leave strong impressions behind.
(h) Ahnormal psychotic dreams
Epileptics, just before a seizure, often have frightening and troubling

dreams. After the seizure these are pleasant and easy, and on the night of the
seizure there are never any dreams. l Similarly with catatonic illness of brief
duration. The brief periods of sleep during the thrust are usually dreamless.
(On the other hand hysterics always dream during their attacks.)2
In acute psychoses, particularly in early schizophrenia, the mode of
dreaming often alters.
Kandinsky gives the following description: 'During the sense-delirium my dreams
(so far as visual images and the feeling of moving in space were concerned) were
unusually vivid. It was hallucinating during sleep. In an hallucinating patient the waking
and sleeping states generally are not so sharply differentiated. In the dream the images
are so vivid that the patient is, as it were, awake while he sleeps, and in the waking
state the hallucinations are so strange and various that we might say the patient is
dreaming while he is awake. During my illness the dreams were often no less vivid
than something experienced in reality. When certain dream-images came into my
mind, I sometimes had to weigh things up carefully and it took me some time to
recognise whether I had really experienced them or only dreamed them.'
Schreber thinks: 'The fact that someone who sleeps restlessly believes he sees
dream-images that have been conjured up, so to speak, by his nerves is such an
everyday occurrence, it needs no talking about. But the dream-images of the previous night and similar earlier visions went beyond anything I had ever experienced,
at least when I was well, so far as their plastic clarity and photographic truth were
concerned.' Another patient recounted that her dreams were so remarkable that she
often did not know whether it was reality or dream. 'Last night she had the feeling of
flying. The moon moved above her head as she floated, two faces appeared between
a small cloud. Another time the angel Gabriel appeared, then she saw two crosses,
Christ on one, herself on the other. Such dreams made her happy. On waking she
1 Gottke, Arch. Psyc!.iatr. (D), vol. [01 (1934).
Boss, 'Psychopathologie des Traumes bei schizophrenen u. organischen Psychosen', Z. Neur.,
vol. 162 (1938), p. 459.
I
SPECIFIC MECHANISMS
ABNORMAL MECHANISMS
was blessedly content.' Patients often take such dreams as reality. They experience
persecutions, bodily influences; sometimes it seems as if the sensory base for delusional
ideas may well lie in abnormal dream experiences of this kind.
and had sexual intercourse with us. In all this I was not at all afraid and was suddenly
able to fly over a beautiful landscape.'
We may ~uestion whether there are 'prognostic dreams', any anticipation
of the future 10 the dream, the dream-images being a symbolic representation
of on~'s
life an? ill~ess. Boss describes as 'endoscopic dreams' the representatI~n 10 the pa~lent s Ego of the past, present and anticipated psychotic
happemngs and belleves he has found instances of this in neuroties schizophrenics and in organic disorders, as well as certain prophetic drean:s before
the onset of an illness.
Boss describes two modes of dream experience which are only found in schizophrenics. They are not easy to elicit because the patients 'themselves detect the
work of the psychosis in the dreams and are guarded about them':
0:m
The 'dream-hustle'. The dream-scenes flit past the dream-consciousness with an

unpleasant and uncanny rapidity. The scenes are pale and fleeting and appear to
chase along and vanish. The patients try vainly to hold on to something in the dream.
Quite intentionally they will keep themselves lightly asleep from the fear of losing
hold of reality entirely in these troubling dreams.
'Dream-actuality. The content of the dream is quite trivial but the patient awakes
trembling in extreme terror and screams for help. She had dreamt she was in bed in
hospital and a nurse came and propped her pillow up. This schizophrenic patient was
so frightened because the outside world had long grown shadowy to her and she
experienced the dream-scene in all its long-forgotten actuality and warmth of feeling.
'These patients cannot bear it when in their dreams their affects try once more to
establish a profounder relationship with their objects.'
A patient dreams she sees the onset of an eclipse. There was a faint twilight.
Then she saw herself standing .in the middle of a busy street. A crowd of people and
motor cars came towards her m reverse. The minute they arrived close to her they
always avoided her an? slid by her with ever-increasing speed. Everything passed her
by and she became giddy and sank down in a faint. She found herself again in a
ho~~ly farmhouse roo~ where an oil-lamp gave a warm light. A fortnight after this
stn~tng dream, the pattent passed through a mild schizophrenic delusional state
which lasted two days. She was, however, soon able to regain a hold on herself and
after the att~ck she was if any~~ing rather more released and emotionally warmer
than before, Just as she had anttclpated in her dream.
(c) The content ofahnormal dreams

Herschmann and Schilderl believed they had found that melancholies
frequently had happy and joyous dreams, and that generally speaking just
those symptoms of melancholia which .are not specially prominent in the
waking state will make their appearance in dream.
Boss investigated series of dreams in schizophrenics, starting at the time
when they were well and following them through their illness. He found an
increase in brutality and raw crudity, 'a reduction in the dream-censorship'.
The Ego lost its powers of repression. When remission occurs, the dreams
change but never return to the same degree of normality as does the waking
personality.
Boss writes:
4.
Herschmann and Schilder, 'TraUme der Melancholiker', Z. Neur., vol. 53, p.
HYSTERIA
:Vhen the will pur~o~efully controls the play of the mechanism of sug-
gestIon, ~ m~ntal fo~ce. IS 10 operation that rules our own unconscious psychic
and ~odtly ~Ife and It IS not a case of illness. But if mechanism of suggestion
functIons Without our knowledge or yolition and against our will then something
most unhealthy happens which we describe as hysterical.
In h>:sterical phenomena every kind of suggestion is developed in exaggerated fashion. All sorts of tendencies are stimulated and reach realisation without
any inhibition from critical attitudes in the personality as a whole or from
previous experiences. Quite often there is a meaningful choice of the phenomena which are realised, meaningful in terms of the wishes and drives of the
~ersonality ~h.ich. are thus displayed. During inoculations we may observe
lOvoluntary ImitatIOn, when after someone has fainted, all the others faint one
after the oth~r. Only a few decades ago hysterical fits were spreading in girls'
school~, for lOsta?Ce, as th~y used to do in convents. The effects of suggestion
on the Judgmen~ 1S shown m the hysterical gullibility. The mechanism operates
~s auto-sug~estIon whe~ falsehoods, which were initially conscious, develop
lOto self-bell.eved fantaSies (pseu?ologia phantastica). The mere play-acting
of a ment~1 tllness .may develop Into an actual psychic change. A patient relates how 10 her chtldhood she became frightened and gave up playing at madness when she noticed this tendency for its realisation. In people of hysterical
pre?isposition. pris?n-psychoses frequently represent actual psychic changes,
whIch have arIsen 10 the first place from simulation and from the dellire to be
'We found poorly censored dreams with little symbolisation. The obvious content stands in stark contrast to the patients' own moral attitudes. In spite of this they
arouse no anxiety or very little and so with the other affective defence-reactions of the
Ego. Such dreams are an early and important symptom for the diagnosis of schizophrenia.' He says crude sexual dreams occur in hebephrenic patients, aggressive
dreams in catatonic ones and homosexual dreams in paranoid patients.
The following is an example of a dream of a schizophrenic patient in the sixth
year of his illness: 'I was going across a moor with my mother and Anna. Suddenly a
furious anger rose in me against my mother and I deliberately pushed her into the bog,
cut off her legs and pulled her skin off. I then watched how she drowned in the bog
and felt a certain satisfaction. As we were about to walk on, a big man with a knife in
his hand ran after us. He took Anna first and then me, got us down on the ground
1
401
130.
..I
,
402
SPECIFIC MECHANISMS
ill. Out of the role which is merely played develops real delusion, the 'wild
fellow' gives place to the autonomy of irresistible excitement. Half-simulated
physical complaints tum into compensation-hysteria which then becomes an
actual self-established illness. An hysteric in prison developed involuntary
and i~istent pseudo-hallucinations of sexual scenes between the publicprosecutor and his fiancee, due to his anxious fancy that they were having an
affair and he came to believe in the reality of these relationships. The essential
suggestibility of hysterics can be seen in their adaptability to any and every
environment. They are influenced so easily that they do not seem to have a
personality of their own. They take on thdr environment as it is at the time,
they are criminal, devout, industrious, enthusiastic for suggested ideas which
they will adopt with as much intensity as their originator and just as readily
drop in the face of some other influence. They intend to give only one interpretation to a situation and to exhaust the possibilities of this. A patient ~e
ceived 250 Reichmarks from his Accident Insurance. He felt enormously nch
and thought of nothing else, became engaged, bought rings, furniture, clothes
on hire-purchase, and then took to theft and got two years in prison. He felt
subsequently that his condition had been like an illness.
ABNORMAL MECHANISMS
40 3
life are in some way connected, in that what is dissociated exerts an influence
on conscious operations and reaches up, as it were, into what is conscious.
Th~ ~learest example is that of the post-hypnotic time-suggestion. A girl pays
a VIS.lt at twelve noon as she had been ordered to do under hypnosis on the
prevlOUS day, though she does not know anything about this order. She feels
she is driven to pay this visit but she finds quite a different motivation for it
s~sequ~ntly. When these time-suggestions concern the performance of certam fo?hsh acts-to put a chair, for instance, on the top of a table-the urge
do ~o IS felt subsequently most keenly but it may perhaps be so erroneously
motivated or regarded as so stupid that it is suppressed. In these cases the
connection between the original experience (the hypnosis) and the emergence
of the urge from the unconscious can no longer be doubted. The 'dissociation
of ~sychic complexes' is a good metaphorical expression for these phenomena,
which, should they appear spontaneously, we call hysterical. It is of course only
a metaphor, a theoretical construct which Janet developed very clearly, in
?rder to cover cer~ain cases and it is not necessarily applicable to psychic life
10 general. Followmg Janet rather freely we may illustrate the situation in the
accompanying diagram (Fig. 3):
The concept ofhysteria has been the subject-matter of many discussions. The net
result has been that the concept increasingly moved away from the early concept of a
disease-entity towards a general psychopathological characterisation of certa~n phenomena which occur in all sorts of illnesses, though most commonly there IS also a
predisposition present. We differentiate hysterical character (p. 443) from hysterical
attack (accidents mentaux) and these in tum from hysterical stigmata (physical
symptoms-po 2.41). In all these three, we distinguish the tendency or ra~er the,wis.h
to be ill-as we do all other contents and tendencies-from the mechamsm which IS
connected in some way with the dissociation. 1
We have got to know certain peculiar amnesias either restricted to a single
experience or covering the entire past which do not prevent the patient all ~he
same from moving and acting unconsciously as if he remembered everythmg
quite well. We also know the disturbances in sensation which we may find in
hysterics and which never involve the consequences of any real loss of
sensation. Janet has described all these peculiar facts in a metaphorical way as
'the dissociation of psychic material'. 2 In normal life we find a true forgetting,
a genuine loss of psychic dispositions or else the continuously maintained
unity of psychic life, that is, the lasting ability to endure passively the aftereffects of past experience as well as to be actively aware of them. In abnormal
states, however, we find dissociations of entire psychic areas. Sensibilities,
memories, have effects which can be objectively described but which do not
become conscious. Feelings, actions, performances appear which are conditioned by this dissociated psychic life. The dissociated and conscious psychic
1 'Ober die Psychopathologie der Hysteria', Janet, L'etat mental des Hyst,riqu,s, 2nd edn.
(Paris, 1911).
Janet, L'automatisme psychologiqu" 6th edn. (Paris, 1910).
Nom~al
II Appearance of a hysterical symptom

III Hypnoid state
IV Twilight state or 'double personality'
V Chronic hysterical state without manifest symptoms
The shaded parts indicate the unconscious. The blank parts indicate the
conscious psychic life. In column I the healthy state of the shifting border
~etween what is unnoticed and what is extra-conscious is indicated by a dotted
hne. ~n th~ ~ther sections a full line is drawn to denote the sharp separation,
the diSSOCiation. In column V we find the chronic hysterical state, for the
moment without any manifest symptoms. The dissociated elements are
quiescent. In column II the appearance of a hysterical symptom (nausea
vomiting, false perceptions, etc.) is indicated. In column III a hypnoid state of
SPECIFIC MECHANISMS
ABNORMAL MECHANISMS
day-dreaming is shown and in column IV there is a twilight state excluding

normal consciousness. These latter cases have been strikingly described as
double personalities! or as alternating consciousness, because the dissociated
psychic life appears so richly developed that it feels as if one is dealing with
another personality. When however the state comes to an end, the normal
personality has no memory of it.
It is rare to find cases where Janet's experiments are successfully demonstrated and there is proof of the existence of a dissociated consciousness. Posthypnotic suggestions are also rare and alternating consciousness particularly
rare. None the less the same W1.derlying mechanism is assumed for a great number
of hysterical phenomena. The chief justification for this assumption lies in the
observations made by Breuer and Freud,2 concerning the origin of particular
symptoms, which were found to lie in upsetting experiences (psychic traumata).
While Janet had conceived the dissociation to be spontaneous and to arise
solely from the Anlage, these authors recognised that dissociation could also
be brought about, given the Anlage, by certain experiences. This is not only
so after physical accidents (hysterical paralysis of an arm after a fall from a
carriage in one of Charcot's famous cases) but after all kinds of affects as well
(fright, anxiety, etc.). 'Thus a painful affect which arises during a meal may be
repressed and later cause nausea and vomiting which continue as hysterical
vomiting for a month.' 'In other cases the connection is not so simple. The
relationship between the cause and the pathological phenomena is only a
symbolic one, as it were, when, for instance, neuralgia is added to psychic
distress or vomiting to the affect of moral contempt.' The experiences that
underlie the morbid symptoms are not remembered by the patients in their
ordinary state but they can be brought out under hypnosis. Memories are
split off or dissociated, the patient has no access to them, yet he suffers from
their effects without knowing it. Once the memories are made accessible to the
waking consciousness (psychoanalysis) and the patient simultaneously lives
through the original affects once more (abreaction) a cathartic effect sets in:
the symptoms in question have vanished. During the traumatic experience
there is a hypnoid state and this along with intentional repression of affect or
unintentional 'damming up' of it, all playa part as factors which facilitate the
dissociation.
The whole process of repression and its effects may be illustrated by some
examples from Pfister3 who has set them out in a table which we reproduce in
a modified way below. The factual correctness of the examples is not so
important as the way they show us how repression and dissociation are to be
conceived:
1 Azam, Annal. mid-psychol. Quly, 1876). Summary: Binet, Les alterations de la personnalite
(paris, 1891), 2nd edn., 1902. Classic ca~e: Morton Prince, The Dissociation ofa Personality (New
York, 1906). Cpo Flourney, Die Seherin von Genf. (Leipzig, 1914). Hallervorden, Z. Neur., vol. 24
(1914), p. 378.
2 Breuer and Freud, Studien iiher Hysterie (Vienna, 1895). Freud later developed very different
views. The original views on these traumatic connections were followed up chiefly by Frank,
Ober Ajfektstorungen (Berlin, 1913), theoretically and therapeutically.
8 Pfister, Die psychoana/ytische Methode (Leipzig, 1913).
Experience
Conflicting wishes and drives Understandahle result in Resulting understancla!Jl4

producing repression of one
a dissociated image of
content of an ohjectiv.
side
real gratification of a
manifestation
wish or of escape (dissociated realisation)
(a)
(h)
I5-year-old
gir1; student
wants to kiss
her; she manages to resist
wish to be
kissed
A boy masturbated and

stole from his
mother
need to con- shy to confess the

fess such
sexual mis- things
deed and the
theft
I6-year-old
feelings of
girl is in love desire
with a priest
whom she has
seen once
shy of
forbidden
sexuality
'I have been kissed too

much'
Swollen lips
He intends to confess
one evening but shame
prevents. The thought
then comes: '1 can't
talk any more as 1 want
to; it's all dark ahead'.
At that time he showed

hysterical mutism and
dim vision. He knows
nothing of his previous
monologue which comes
to light only in analysts
feelings of
'The priest assaults me
something
sexually'
forbidden and
unattainable
Spreads malicious accusations: The priest molests

her with obscene remarks. She knows she is
lying but cannot help it.
Reproaches herself
bitterly
Repression does not always depend on direct action by the personality but it
is much more often due to the hardly noticed conflict between opposing
drives and wishes and to the final 'damming back' of the one or the other.
Repression as such does not produce hysteria. Normal people can repress
successfully without any such disturbance but in some individuals repression
discovers hysterical mechanisms which transform the repressed material. This
conversion into symptoms is what is pathological and could not come about
without the dissociation. The conversion issues in bodily symptoms and in
psychic ones. It appears both as affect and as lack of affect, and as disturbance
of function, etc.
In order to try and grasp the relationship between the experience and the
symptom, we either have to take the meaningful, symbolic connections which
we previously discussed, the transference of affects, etc., over into the dissociated psychic life as we conceive it, or we have to turn to yet another
analogy: that of the energy of affects which can be transformed into other
forms of energy. When repression prevents discharge in a natural reaction,
the suppressed energy will show itself in changed form elsewhere. Janet constructed the concept of 'derivation'. The diverted energy discharges itself
through motor attacks, pains, through other uncalled-for affects. The affect is
converted, e.g.: repressed sexual libido converts into fear and vice versa. The
SPECIFIC MECHANISMS
ABNORMAL MECHANISMS
affect reactivates old pathways (e.g. evokes rheumatic pains that were there
before or heart-pains and so on). This analogy undoubtedly holds for a few
cases; ~e only have to be cautious with any general theoretical elaboration.
The use of these analogies of dissociation and of transformation of affectenergy led to findings which, as Breuer and Freud were able to show, vividly
illuminate the 'contradiction that lies between the statement that "hysteria is
a psychosis" and the fact that a number of clear-headed, strong-w~lled and
critical people of good personality are to be found among hysteriCS. The
waking, thinking individual may well be thus, but in the hypnoid state, he is
changed as we all are in dreams. But while our dreams do not influence our
waking-state, the products of the hypnoid state extend far into the waking life
in the form of hysterical phenomena.' The incomprehensible excess of feeling,
the excessive enthusiasm for things which objectively do not seem to justify
such enthusiasm, becomes explicable through the analogy of an influx of
affect-energy from the drives, the content of which (as symbol, or through
similarity, etc.) has a meaningful connection with the content of the enthusiasm. Inversely, the incomprehensible coldness becomes explicable through
the concentration of all affect-energy in one single area of drive and a fixation
on the contents of this. Thus in hysteria, if we presuppose mechanisms of
dissociation and transformation, this allows us to bring the notable contradictions of affective excess and insufficiency into some meaningful connection
with the patient's experiences.
Dissociation is a fairly obvious theoretical help in clarifying the ambivalence
of hysterics. The person clearly has the conscious intention to get well and this
is perfectly credible; there is the wish to get rid of the paralyses and other
disturbances. He also has another intention-not connected with the firstwhich strives with all its might against it once recovery comes on in earnest.
The conscious will of the personality will only regain its normal power and the
other intention will only vanish, at least in this particular form, if there is a
remarkable switchover which has often been seen to take place, through
suggestion-therapy, or through some severe and painful shock or through
some of the chances of the life-situation.l
We may ask what are the criteria whereby we can legitimately assume in
any particular case that the source of a phenomenon is psychic dissociation
(i.e., there is a repressed, 'encapsulated' affect which has now become a
'foreign body' that operates with an alien power)? (I) the precipitating psychic
experience must be objectively established; (2) there must be a relationship
between the symptom and the experience which is understandable in the context; (3) the lost memory should return during the hypnotic state together
with other concrete phenomena of the experience when emotionally re-lived
(abreaction) and there should be subsequent recovery from the symptom in
question; (4) all kinds of expressive phenomena accompanying the appearance
of the symptom should do so in a way which is understandable in the first

place and which points to content other than that which is present in consciousness (for instance, sexual movements during an investigation into the refusal
of food).
The relationship between the content of the repressed experience and the
content of the illness can be seen particularly clearly in some hysterical
deliria where the precipitating experience (accident, sexual assault, etc.) is
repeatedly relived in a hallucinatory way though it is no longer remembered
in the normal consciousness. We also see the same thing in some Ganser
twilight-states during captivity where the crime is now forgotten but every
wish is felt to be gratified (innocence, liberty, etc.).
Suggestions become all the more effective, the more they are directed towards the patient's wish.es (the enormous effect of auto-suggestion in neurotic
patients who are receiving compensation for some traumatic event), and the
more they arouse fear (the immediate realisation of hypochondriacal complaints which initially were only suspected). Timid people can be made ill by
relevant suggestion as in the same way one can make them well again.
1 Kretschmer vividly described hysterical volition. 'Die Willensapparate der Hysterischen',

Z. Neur., vol. 54, p. ~Sl.
Everything connected with suggestion and hysteria is obscure and misleading to the
investigator.
In every field of psychic life it is extremely common but always surprising to
observe a deficiency in the conscious psychic events which, when looked at from another
angle, proves to be not a true deficiency at aU. The missing element continues to exist
in the unconscious,as we say, and to spread its influence from there. It can be brought
back into consciousness by psychic means (suggestion, affect). A large number of
disturbances are of this order: total amnesia for circumscribed periods, for particular
objects or for the entire past; total disturbance of registration, loss of sensation,
paralyses, loss of volition, alterations in consciousness, etc. Just as astonishing as the
deficiency itself is the way in which in some sense it is 'not there'. A patient who has
forgotten her entire previous life behaves as if she still knew everything. The blind
person never stumbles over anything as she walks about. The paralysed person can
walk when situation and impulse force her to it. It is always possible to discover
conditions under which the deficiency appears to be corrected. All tests, therefore,
which try to make some clear distinction between hysterical phenomena and simulation
come to grief. With hysterical phenomena we are never dealing with events which allow
us to study certain psychic functions more precisely in the deject-state. In hysteria
psychic functions are always disturbed in one and the same way, a way which we
cannot characterise precisely and the unity of which in many cases we can only guess
at rather than know and to which we give the name of the hysterical mechanism. The
study of this hysterical mechanism teaches us about one side of psychic life that is as
puzzling as it is important. The mechanism we are dealing with, once we have recognised it, reveals itself as something we can also trace in ourselves and in everyone
to a slight degree. But the phenomena which are conditioned by it only lead to the
study of the mechanism itself. It is an old mistalce to malce use of hysterical phenomena
for the analysis and interpretation ofpsychic and somatic phenomena in general. Hysterical disturbances of memory, for instance, are wholly unsuitable for us to learn from
when it comes to the particular functions of memory, just as hysterical somatic
,1
SPECIFIC MECHANISMS
ABNORMAL MECHANISMS
disturbances can teach us nothing about the normal physiology of the organs. We
have to admit, however, that all psychic events take on a new aspect once the
.
.,
hysterical mechanism is in charge.
Once suggestion and hysteria play a part, ther~ IS n? chance to ~nve~t1gate an~
laws or necessities of a physiological or psychological kind. Eyerythzng, It seems, zs
possihle. All these phenomena, therefore, can only be used to illustrate hysteric~l
mechanisms and nothing more of physiological or psychological relevance. Cases m
which they playa part must be omitted from any m~terial ~vidence offered i~ support
of any psychological theory or thesis. Exact expenment IS not really pOSSible, and
nothing can be properly verified or determined. Just as it can be said that the most
experienced psychiatrist can be tripped up by hy~terics, so it m.ay be sai~ that ~ven
the most critical of investigators in the psychological and somatic field wtll contmue
to be caught by the phenomena of suggestion. It is however annoyi~g to find so~e
authors who make use of what are obviously phenomena of suggestion and hysteria
as supportive evidence for a general insight into psychology and physiology.
there must be something which made him so miserable. People also wanted to ex.
plain delusions of persecution by the affect of distrust, and delusions of grandeur by
euphoric moods, but they did not realise that, though one may understand ordinary
mistakes and over-valued ideas in this way, one can never do this with delusions.
Frightening hallucinations in sleep during fever or a psychosis have been attributed to
some kind of anxiety, otherwise conditioned. In all these cases we can, it is true, find
meaningful connections, and they teach us something about the relationship of
delusional content and previous experiences but nothing at all of how the delusions,
false perceptions, etc. could have come about in the first place.
408
The phenomenon of so-called induced insanity (psychic epidemics)! is a

particularly striking kind of suggestion-phenomenon to which many, though
not only hysterical, persons are prone. There is a wide spread of hysterical fits,
attempts at suicide and delusion-like convicti.ons. It is ?f cours7out. of ~he
question that any disease process can be transm1tted psych1cally. D1ssemmatlon
comes about through a mass consciousness, a group feeling, which plays all
the greater part-sometimes to an uncanny degree-the greater the number
of persons involved. There is the ~articularly interesting case where so~eo~e
suffering from a paranoid process mfects a number of healthy people With h1s
ideas so that he becomes the centre of a movement which quickly dies down
again when once he is removed from it. Inversely, as para~oid person~ a~e
beyond any influence, these cases have produced the proverb1al remark: It IS
easier for one madman to convince a hundred sound people than for a hundred
sound people to convince him'.
.
).
MEANINGFUL CONTENT IN THE PSYCHOSES
Much has been explained as meaningful which in fact was nothing of the
kind.
Thus attempts have been made to make feelings the explanation for all abnormal
phenomena. If we use the term 'feeling' to denote everything for which common
usage permits us to use the word, there is always some truth in this, but it then comes
to very little if we go on to derive delusions, for instance, from f~elings. ~deas of
senselessness, sinfulness, impoverishment, can be understandably said to anse from
depressive affects and it was generally supposed that the depressed patient concluded
1 Wollenberg Arch. Psychiatr. (D), vol. 2.0, p. 62.. Schonfeldt, Arch. Psychiatr. (D)., vol. 2.6,
p. 2.02.. Weygandt, Beitrag :cur Lehre von den psychischen Epidemien (Halle, 1905). Hellpach, :Die
psychischen Epidernien' (in der Sammlung, Die Gesellschaft), Schoenhal~ Mschr. Psyc~tr.,
vol. 33, p. 40 ('Uteratur'). Riebeth, Z. Neur., vol. 2.2. (1914), p. 606. Peretti, AUg. Z. Psycl"atr.,
vol. 74, p. 54 fr. W. Dix, Ober hysterische Epidemien an deutschen Schu/en (Langensalza, H. Beyer
and Sohne, 1907)' Nyiro and Petrovich, Z. Neur., vol. 114 (19 28), p. 38
new
For delusions to develop a new factor has to be added. If one calls the
element 'the paranoid mechanism' this is only a name and one which includes
very heterogeneous material such as the formation of delusion-like ideas as
well as of delusions proper.
(a) Delusion-like ideas

There is nothing new in the circumstance that the contents of delusionlike ideas have 'meaning' in terms of the patients' life-experiences, wishes and
hopes, fears and anxieties. Friedmann! has described peculiar cases of 'mild
paranoia' where the content of the delusion confines itself to the connection
with some specific experience. Birnbaum2 has described the frequent occurrence of delusion-formation in prison, where the delusions are changeable,
can be influenced and tend to disappear on discharge. He therefore termed them
'delusion-like fancies' rather than delusional ideas. The content was to a large
extent meaningful in terms of wishes and the situation in general.
This is also the place, perhaps, for the 'sensitiye delusion of reference' ,3 found in
the psychasthenic individual who is tender, thin-skinned but full of self-conscious
ambition and obstinacy. They become ill because of some experience of humiliating
insufficiency, in particular defeats of a sexual-moral nature, for instance, the late love
of middle-aged single women, which cannot find any free outlet. Paranoia comes
instead with depressive self-reproach, fears of pregnancy and delusions of reference.
The patient knows she is observed and spited by family and friends, the public and
the newspapers. She fears pursuit by police and Courts. There are transient, acute
psychoses with excitement and severe neurasthenic symptoms and so many delusions
that the clinical picture may well look like some progressive incurable disorder but
content and affect remain centred round the originating experience.
1 Friedmann, Mschr. Psychiatr., vol. 17.
2 Birnbaum, Psychosen mit WahnbiJdung u. walmhaft, Einbildungen bei Degeneration (Halle,
1908).
8 Kretschmer is responsible for the description. Der sensitive Be:ciehungswahn; ein Beitrag :cur
Paranoiafrage u. :cur psychiatrischen Charakterlehre (Berlin, 1918). These processes may only be
special types of paranoid schizophrenia in personalities which have remained intact and natural.
Similar cases may be seen where no decisive experience precedes the psychosis, as K. Schneider
demonstrated in his own patients (Z. Neur., vol. 59, p. 51). But the clear delineation of such types
and the tracking down of all the meaningful connections brings knowledge of a kind with a
value of its own in as much as it reduces what are otherwise chaotic phenomena into some sort
of order and form.
'1
410
SPECIFIC MECHANISMS
(h) Delusions in schqophrenia

From time to time and incidentally attempts have been made to understand the contents of delusion as well as other psychotic symptoms in terms of
the individuals' wishes and longings. This approach has been extended to
schizophrenia by the Ziirich school (Bleuler and Jung). H?wever, ~ey did not
stop at the obviously meaningful contents but followed 10 Freud s footsteps
and treated them as symbols. They have thus come to 'understand' almost all
the contents of these psychoses by applying a procedure which as the results
show only leads on into endlessness. In the most litera! sense they have r:
discovered the 'meaning of madness' or at least they beheve they have .. Th.elr
results cannot be summarised briefly nor are they ready for an objective
formulation. We therefore refer to some of the publications of this school for
an orientation on the problem. 1 The following is a crude exampl~: Voices
accuse the patient of sexual intercourse; to have perpetrated thiS would
correspond with his repressed wishes.
Bleuler and Jung conceived that schizophrenic ps!choses, the conte?ts of
delusions of catatonic behaviour and of false perceptions become mean10gful
in terms ~f repressed complexes of a dissociated kind. This 'interpretation'. of
symptoms is doubtful but can be discussed. It is noteworthy that according
to Bleuler these complexes need not be repressed. They can have remained in
consciousness and yet dominate the schizophrenic deliria. From this angle
there is sometimes a surprising analogy to be drawn between hysteria and
schizophrenia and Jung draws attention to this. The whole ~nterpretati?n is a
translation to schqophrenia of concepts which have heen arrlve~ at ~urtng the
analysis of hysteria. We should, however, never forget the radical dtfferences
which exist between hysteria and a schizophrenic process and which show
themselves for example in the fact that schizophrenics as opposed to hysterics
cannot be hypnotised and are not at all easily suggestible.
Meaningful contents are to be found in every kind of objective phen~men~.
Even the contents of hallucinations, for example, need to be looked at 10 thiS
way. They are not completely accidental but to some extent have meanin~ful
connections and are significant of experience in the form of commands, Wlshfulfilments, ~easing and ridicule, agonies and revelations. Freud called hallucinations thoughts turned into images. 2
(c) Incorrigihility
In countless cases the mistakes of healthy people cannot actually be corrected but usually the mistakes are shared in common with others and this adds
confirmation. Conviction comes not from 'insight' but from the sense of 'all
1 Jung, Ober die Psyehologie der Dementia praecox (Halle, 1907)' Bl~uler, Die Se"i{op~"ni'
(Vienna, I9II). Maeder, 'Psychologische Untersuchungen a~ Dement~a praeco~kranken j Jb.
psyehoanal. u. psyehother. Forseh., V?l. 2., p. I8S. Cir~~mspect interpretations are given by Hans
W. Maier, 'Ober katathyme Wahnblldung u. ParanOia, Z. Neur., vol. 13, p. HS
I Jung, Der Inhalt der Psychose, 2.nd edn. (Leipzig, 19 1 4)'
ABNORMAL MECHANISMS
411
of us together'. The mistake which is delusion is peculiar to the solitary

individual. In that respect delusion has been referred to as an illness of the
social self (Kehrer). But the truth of an individual may also assert itself against
the majority and it may hardly be possible to differentiate this from delusion so
far as the social behaviour is concerned. In trying to understand the incorrigibility we may find what interest it serves: the delusional content is of
vital necessity for the deluded person and without it he would inwardly
collapse. Indeed no one, even the healthy, can be expected to appreciate a
truth which makes utter nonsense of his existence, but the incorrigihility of
delusion has something over and ahove the incorrigihility of healthy people's
mistalces. So far, however, we have not succeeded in defining what this is.
We may speak of a stahility of affect (Bleuler) or emphasise the tendency of
delusion to spread or progress, or talk of the logical reasoning which serves
the delusion and can never turn and refute it but in so doing we simply give
a name to something which we can neither see nor comprehend. And yet it is
precisely this problem that gives us no peace. Delusion, particularly the delusional system, presents itself as a whole coherent world of appropriate
behaviour apparent in a personality that is quite sensible and by common
standards not otherwise to be considered ill. This constitutes what is called
'being unhinged or mad', and is all the more alarming in that quite often
others in the environment may take over the delusion. In principle, but not
perhaps in practice, untruth can always be overcome by the great process of
human reason which amongst a welter of mistakes, falsifications, obscurities,
sophisms and bad intentions pursues truth. In the case of delusion, however,
we may see someone irretrievably lost in untruth-an extreme situation which
we may not be able to correct yet would much like to comprehend.
(d) Classification of delusional content
From very early on we have collected the contents of delusion and classified them. They are of striking variety, imaginativeness and eccentricity. The
initial folly was committed of considering every single delusional content as a
special illness and giving it a name (Guislain) without noticing that nomenclature of this sort has no end. But the contents dohave a number of general,
common characteristics that recur repeatedly and give a peculiarly uniform
character to the multiplicity of the contents. We are not wanting to extend
the wealth of contents but only to discover basic types. In this respect we can
look at the material from several angles:
I. Delusions that are ohjective and delusions centred on the person. Human
drives and wishes, hopes and fears, are universal so that most delusional formations may be regarded as in the closest relationship to the individual's particular weal or woe. The patient is almost always the centre of his delusion but on
rarer occasions the delusional formations are objective in content, the delusion
is about the meaning of the world, is connected with some philosophical
problem or historical event not related to the person of the patient. The patients
4U
SPECIFIC MECHANISMS
ABNORMAL MECHANISMS
have made a magnificent invention and work at it all the time; they have
squared the circle, trisected an angle, etc. or by the use of numerical symbols
they have prophetically grasped the basic laws of events. The patient feels his
personal importance as a discoverer, the content has no particular significance
for himself. He fills his time with hard mental work that is meaningful to him.
He has an interest in being right, since if he were not life would lose all meaning for him, but what he has thought out is objective. These constructions,
however, which in themselves are interesting, do not occur nearly so often as
those which are egocentric.
2.. Actual delusional content. The following are frequent contents which
relate to the patient's well-being or otherwise:
sional formation as lying in the patient's experience of having his own will
overpowered by the whole will of the community. What is visible in the
delusion is the conflict between reality and the individual's own desires, between compelling demands and private wishes, between being honoured or
humiliated. Delusion always encompasses hoth poles, so that honour and
humiliation of the self, delusions of grandeur and delusions of persecution go
together. Cauppl described the mutual relationship between delusions of
persecution and of grandeur as a meaningful whole, which he based on the
sensitive personality disposition (accompanied by pride, shame, fear), presupposing that the form of the delusion as such cannot he understood.
Kehrer 2 described delusions of persecution and grandeur as similar meaningful
wholes. Whether we are dealing with a schizophrenic process or a personality
development in which the individual reacts to life's conflicts in a delusion-like
way, the meaningful element remains no different. There is a difference only
in the course taken, in the form of the experience and in the psychic phenomena
in their totality.
4 Forms ofparanoid attitude to the enyironment. Kretschmer differentiated
wishful, comhatiye and sensitiye paranoics. The delusion may be a reactive
gratification of illusionary wishes, or an active affirmation of its own truth to
the world around, or it may suffer its ideas of reference and persecution with
little outward action but content itself with the inner pride of delusions of
grandeur. Whichever it is, essential differences of content result in fact. On
these lines, prison-paranoia with its delusion-like imaginings is a type of wishful paranoia, querulant delusion is a type of combative paranoia and delusions
of reference and grandeur are a type of sensitive paranoia.
(a) Delusions of grandeur: relating to origin (aristocratic stock, royal birth,

brought up as a foster-child), to possessions (owning large estates, castles, etc., which
are withheld by intrigue), to abilities (great inventors, discoverers, artists, possessors
of special wisdom, gifted with inspiration), status (adviser to leading diplomats, the
real director of political destinies). (b) Delusions of diminished status: relating to
property (delusions of poverty), to abilities (demented, ineffective), to moral status
(delusions of sin, self-accusation). (c) Delusions ofpersecution. The patient feels noticed,
observed, put at a disadvantage, despised, ridiculed, poisoned, bewitched. He is persecuted by authorities or by the public prosecutor for crimes of which he is falsely
accused, by gang'>, Jesuits, Freemasons, etc. There are also delusions of physical
persecution on the basis of bodily influences (false perceptions) and 'made' phenomena (passivity feelings), and querulant delusions about injustices, plots and treacherous manipulations. (d) Hypochondriacal delusions. In contrast with neurasthenic
complaints of palpitations, headache, weakness and pain, there are delusional contents such as, the bones have softened, the heart is not right, the bodily substance
has altered, there is a hole in the body, etc. There are delusions of being changed;
the patient is changed into an animal and so on. (e) Erotic delusions. Erotomania is
the term for the delusion that one is loved by another person though there is not the
slightest sign of this and the person concerned declares the contrary (delusions of
love and marriage-delusion). (f) Religious delusions. These may appear as delusions
of grandeur or of diminished status: the patient is a prophet, mother of God, bride of
Jesus, or the patient is the devil, is damned, or the anti-Christ.
The description of delusional formations as characteristic for particular

diseases is the province of special psychiatry. For illustration's sake we would
simply remark here that it is characteristic for certain paranoid processes to
have delusional contents about great world events of which the patient is the
centre. He is 'in touch with the whole world', the 'whole history of the world
depends on him' or he is the centre of cosmic revolutions in which he plays a
very special if passive role. A patient who was already quite deluded said,
'Every spark of well-being has been quenched, and so I have wandered about
for thousands of years, always unwittingly reborn. The reason for this must
be attributed to the creation of the world:
3. The binding of opposites. All delusion is understandably rooted in the
tension between opposites. Friedmann saw the basic conflict in every delu-
1
2
Gaupp, Z. Neur., vol. 69, p. 182.

Kehrer, 'Der Fall Arnold', Z. Neur., vol. 74, p. 155.
413
f1
PATIENT'S ATTITUDE TO HIS ILLNESS
CHAPTER VII
THE PATIENT'S ATTITUDE TO HIS ILLNESS

An individual can face himself reflectively and in the same way a patient
can face his own illness. Psychic illness looks different to the medical observer
from what it looks like to the patient who is reflecting on himself. Thus it
happens that someone, who regards himself as quite healthy, may be analysed
as mentally ill or that someone may consider himself to be ill in a way that has
no objective validity and is in itself a morbid symptom, or that someone
through his own contriving may influence morbid processes for good or bad.
The concept of 'the patient's attitude' embraces a number of different
phenomena. What unites them is that through them we try to understand the
patient's attitude to the symptoms of his illness. We may observe how the vast
majority of normal personalities will react to illness with the healthy part of
themselves, as it were. But in understanding the particular attitude adopted we
come up against the limits ofinsight which a person has into himself. These limits
provide one of the most important criteria for personality type and in particular for the change which the personality has undergone as a whole through
the illness.
(a) Understandable attitudes to the sudden onset of acute psychosis (perplexity,
awareness of change)
Perplexity is one of the most understandable reactions in normal people to

the onset of an acute psychosis. It is therefore a frequent observation and in
some psychoses this perplexity pervades the most severe confusional states as
a sign of what has been preserved of the normal personality, otherwise masked.
Retardation, difficulties in comprehension, incoherence, inability to collect
one's thoughts (Unbesinnlichkeit), all evoke the same reaction, which shows
itself objectively in the puzzled expression, the searching about, a certain
marked restlessness, a marked amazement and distractedness, and in such
remarks as:
'What is it? Where on earth am I? Am I really Mrs. S. L.? 1 don't know what is
wanted of me .. What am 1 supposed to do here? ... I don't understand any of it
. .' In addition there may be the questioning of the psychotic content: 'Surely 1
haven't killed anyone? Surely my children are not dead?' etc.
A schizophrenic wrote the following, which illustrates the perplexity felt
in relation to the psychotic situation while the sensorium was still clear:
'1 understand my situation less every day and so I make more mistakes every day.
I simply cannot act in any considered way but just act instinctively because 1 cannot
414
reach any real conclusion. What are the brown blankets on my bed? Do they represent people? How am 1 supposed to move if my mouth has to be closed? What am I
supposed to do with my hands and my feet if my nails are so white? Am I supposed to
scratch? What on? My environment changes every minute as the nurses move about.
I don't understand them and therefore cannot respond. How can I do anything right
ifI don't know what is right? I think as simply as 1 thought when I was Leonora B.
and cannot grasp this queer situation. 1 understand it daily less and less.' (Gruhle).
From this purely reactive and understandable perplexity which comes from
an inability to orientate oneself to the situation and grasp the new experiences
we must differentiate other forms of perplexity, which is often difficult to do
in the individual case.
There is (I) Paranoid perplexity: with a clear sensorium. The patient is driven
into a painful restlessness by the delusional experience and the still vague contents of
his consciousness. He feels something is afoot and goes round searching; he asks
questions and cannot make things out: 'If you would only tell me what it is, there is
something I know' a patient asked her husband. (2) Melancholic perplexity: The
utterances are reminiscent of the reactive type. The patients are in the grip of their
delusions of poverty, diminished status and nihilism and view everything in an
anxious, questioning way: 'Why are there so many persons? All these doctorswhat is to happen? Why are there so many towels?'
At the beginning of a mental illness some persons undergo an uncanny
feeling ofchange (as if they had been bewitched, enchanted or there may be an
increase in sexuality, etc.). All of this adds to the awareness of impending madness. It is difficult to say what this awareness really is. It is the outcome of
numerous, individual feelings, not a mere judgment but a real experience.
A woman who suffered from periodic insanity described how this feeling arose
even when the psychosis itself was not at all unpleasant. 'The illness itself does not
frighten me but only the moment when I begin the experience again and do not
know how it will turn out.' Another patient who suffered from brief, florid psychoses
wrote: 'The most frightening moments of my life are when 1 pass from my conscious
state into confusion and the anxiety which goes with it.' Referring to prodromal
phenomena, the same patient said: 'The uncanny aspect of the illness is that its
victim cannot control the passage from healthy to morbid activity .. .'
We often learn of individual instances, noted at the start of an illness: an
isolated false perception, a conspicuous change in affectivity, an unfamiliar and
uncontrollable tendency to rhyme, verses come to mind unwittingly and so on
But here we are not dealing with some feeling of over-all change but with posthoc statements of what it was like at the beginning. The fear ofgoing mad is
sometimes found in the early stages of a process, particularly among bettereducated people. They become terribly restless and try to reassure themselves
by testing out their environment. A patient put a woman friend's finger into
his mouth to see if she would show signs of fear. If not, he would bite it. He
,1
416
took this as a sign that she thought him quite well and for a short time this
reassured him.
as the above-mentioned distractions, or by some active effort of will; for instance, an effort directed against the 'made' (passivity) movements or against
'made' (passivity) feelings of anger. Self-control also will help many in respect
of the physical complaints in psychic illness and the agonising feelings which
abnormal psychic life brings along.
In the cases so far mentioned the patients' attitude is on the whole understandable. As it becomes less so and the attitude to the illness becomes stranger,
this in itself becomes a sign of the change in total personality which the illness
has wrought. Thus in many cases it is remarkable how the patient gets used to
his symptoms (for instance, to painful false perceptions and other experiences
which are passively accepted), how he grows to look at them indifferently in
spite of alarming content, and how apparently he does not notice fundamental
delusional contents of utmost importance to him or else forgets them again
rapidly. On the other hand we may be equally surprised by the overpowering
strength of some hallucinations and delusions which seem to dominate the
patient as by some physical compulsion. It is striking how some contents
appear to captivate the patient's attention and how he is moved profoundly by
matters that seem quite trivial. In the acute, florid psychoses we may observe
how patients simply submit to feelings of loss of will, and bear the most
agonising things passively. This helpless state, which they often characteristically describe, links up with their feelings of indifference as to what will come.
Even where mighty cosmic revolutions are concerned, the patients nevertheless go on with their accustomed jokes or make frivolous remarks.
Much can be learnt from patients' own interpretations, when they are trying
to understand themselves. A schizophrenic patient explained the specific contents of what he saw as follows:
Further, the fear of becoming mentally ill and feelings of impending madness are
common but baseless symptoms which are found particularly in people suffering
from personality disorders (psychopaths) and mild cyclothymics who do not as a
matter of fact fall ill.
(h) Working through the effects of acute psychoses

Individuals have a complex-laden attitude to everything which has once
been a significant experience for them. For example, someone cannot think of
his terrifying war-experiences without lapsing into uncontrollable gloom.
Another may resist seeing again the object of an old passion or revisiting a
place or environment where there has been unresolved suffering. Thus we
find psychoses which introduce new significance in themselves, others which
are linked in content with the personality and yet others which always remain
entirely alien to the personality and bring no added burdens or significance to
the psyche. Here the patient often will show an obvious embarrassment when
talking about things except to the private ear of his doctor.
Mayer-Gross1studied the forms which after-effects took following acute schizophrenic psychoses and analysed them according to their meaningful connections.
He distinguished: despair, 'renewal of Hfe', shutting out (as if nothing had happened),
conversion (the psychosis offered something fresh by means of a revelation) and
integration.
(c) Working through the illness in chronic states

Relatively sensible patients, particularly in chronic states, offer us a great
variety of reactions to the individual phenomena of their illness. The patient
works through his symptoms somehow. Laboriously he develops a delusional
system out of his delusional experiences. He assumes an attitude to the contents of his experience; for example, he remarks on rue increasing stupidity of
the originator of the voices, who repeats trivial phrases endlessly or meaningless fragmented sentences. Awareness of physical illness and psychic change is
often ascribed to painful influences of all kinds. The patient thinks of means of
defence against these, particularly against the feelings of physical influences
and various kinds of 'made' phenomena (passivity phenomena). Various
methods of distraction are used and are sometimes helpful (saying a paternoster, working). In other cases patients will pass their time with the contents
of their false perceptions. They evoke their visual pseudo-hallucinations intentionally and enjoy them. They annoy the voices by changing the rhythm
of their step which the voices follow and this change puzzles and silences them.
A number of unpleasant phenomena can be countered by self-control, such
1 Mayer-Gross, 'Ober die Stellungsnahme zur akuten abgelaufenen Psychosen', Z. Neur.
vol. Go (I9U, p. lGo.
417
'The figures seem exaggerated personifications of little, unimportant mistakes I

have made; for instance, when I have enjoyed a meal, there might follow on the same
evening-like an echo of the sensation-a demon who showed himself in the shape
of a ravenous, gluttonous man-beast with enormous mouth, luscious thick red lips,
fat belly of enormous size. I felt this monster near me until for a time (perhaps 2 to 3
meals) I had refrained from enjoying the food which seemed to be the source that fed
him.' 'In everyone around me I saw their smallest failings as ugly, menacing figures
that stepped out of them and attacked me' (Schwab).
The same patient interpreted his illness as a whole: He unified into a single
meaning everything that the psychiatrist saw as the sequence of the process:
'I believe I caused the illness myself. In my attempt to penetrate the other world I
met its natural guardians, the embodiment of my own weaknesses and faults. I first
thought these demons were lowly inhabitants of the other world who could play me
like a ball because I went into these regions unprepared and lost my way. Later I
thought they were split-off parts of my own mind (passions) which existed near me in
free space and thrived on my feelings. I believed everyone else had these too but did
not perceive them, thanks to the protective and sllccessful deceit of the feeling of
418
personal existence. I thought the latter was an artefact of memory, thought-complexes, etc., a doll that was nice enough to look at from outside but nothing real
inside it.
In my case the personal self had grown porous because of my dimmed consciousness. Through it I wanted to bring myself closer to the higher sources of life. I
should have prepared myself for this over a long period by invoking in me a higher,
impersonal self, since "nectar" is not for mortal lips. It acted destructively on the
animal-human self, split it up into its parts. These gradually disintegrated, the doll
was really broken and the body damaged. I had forced untimely access to the "source
of life", the curse of the "gods" descended on me. I recognised too late that murky
elements had taken a hand. I got to know them after they had already too much power.
There was no way back. I now had the world of spirits I had wanted to see. The
demons came up from the abyss, as guardian Cerberi, denying admission to the
unauthorised. I decided to take up the life-and-death struggle. This meant for me in
the end a decision to die, since I had to put aside everything that maintained the
enemy, but this was also everything that maintained life. I wanted to enter death
without going mad and stood before the Sphinx: either thou into the abyss or I!
Then came illumination. I fasted and so penetrated into the true nature of my
seducers. They were pimps and deceivers of my dear personal self which seemed as
much a thing of naught as they. A larger and more comprehensive self emerged and I
could abandon the previous personality with its entire entourage. I saw this earlier
personality could never enter transcendental realms. I felt as a result a terrible pain,
like an annihilating blow, but I was rescued, the demons shrivelled, vanished and
perished. A new life began for me and from now on I felt different from other
people. A self that consisted of conventional lies, shams, self-deceptions, memoryimages, a self just like that of other people, grew in me again but behind and above it
stood a greater and more comprehensive self which impressed me with something of
what is eternal, unchanging, immortal and inviolable and which ever since that time
has been my protector and refuge. I believe it would be good for many if they were
acquainted with such a higher self and that there are people who have attained this
goal in fact by kinder means.'
Such self-interpretations are obviously made under the influence of
delusion-like tendencies and deep psychic forces. They originate from profound experiences and the wealth of such schizophrenic experience calls on the
observer as well as on the reflective patient not to take all this merely as a
chaotic jumble of contents. Mind and spirit are present in the morbid psychic
life as well as in the healthy. But interpretations of this sort must be divested
of any causal importance. All they can do is to throw light on content and
bring it into some sort of context.
Every chronic illness confronts the patient with a task, whether he is a cripple
who has lost limbs but is otherwise quite healthy, whether he suffers from a
somatic illness which affects him as a whole or whether he has a somatic illness
accompanied with psychic disturbances. What can be achieved by people who
are legless, armless or blind has been described often enough and it testifies to
the energy, persistence and skilfulness of such individuals. But physically they
were healthy. The situation is entirely different when the disturbance is not
"
limited to an auxiliary member but strikes at the vital powers of an individual

and affects his entire somatic and psychic state.
We may take an example from behaviour in chronic states following encephalitis
epidemica (Dorer).l His cases show what different possibilities there are. The patients
have to find their way about in a new situation. They suffer from the consequences of
their illness at every moment. Their environment is changed, their occupation gone,
the whole world alters in relationship to the patient. Isolation follows almost of
necessity. Dorer describes the over-sensitive individuals who retreat into themselves, think only of themselves and demand the attention of the environment for
their sufferings. They despond, become egotistical and complaining. Then there are
those who 'in spite of everything' make greater displays of energy, want salvation at
any price, undertake the most impossible things, and appear hunted and harried and
tum into self-conscious outsiders. There are also those who remain spectators of life
and so on. He wants to illustrate the saying: In the last resort it is a person's character
that determines what the illness makes of him. The character shows itself to be modified by the particular culture with which it is interwoven and by relationship to
the human community and the latter's response.
Cd) The patient's judgment of his illness

We can properly speak of attitudes only where the personality observes
and passes judgment on the experience with which it is faced. When the judgment is a psychological one the patient makes himself aware of his experience
and the manner of it. The ideal of a 'correct' attitude to experience is achieved
by patients when they 'have insight into their illness'. Up to now we have got
to know some features in patients' attitudes when faced with the content of
morbid phenomena. We did this by looking at the reaction to the changed
psychic life and at the way patients work through the contents. We will now
describe features in patients' attitudes which appear when they turn away from
content to their own selves and the experience they are having, and ask the
reason for what is happening. They are in short passing a judgment on their
illness either in its individual aspects or as a whole. We are concerned here with
everything that can be collectively called awareness of illness or insight into
the illness. 2
The term 'awareness ofillness' is applied to the patient's attitude when he
expresses a feeling of being ill and changed, but there is no extension of this
awareness to all his symptoms nor to the illness as a whole. It does not involve
any objectively correct estimate of the severity of the illness nor any objectively
correct judgment of its particular type. Only when all this is present and there
has been a correct judgment of all the symptoms and the illness as a whole
according to type and severity, can we speak of insight, with the reservation that
the judgment can only be expected to reach that degree of accuracy attainable
Dorer, Charakter u. Krankheit, 'Ein Beitrag zur Psychologie der Encephalitis epidemica'.
Pick, Arch. Psychiatr. (D), vol. 13, p. 518. Mercklin, Allg. Z. Psychiatr., vol. 57, p. 579.
Heilbronner, Allg. Z. Psychiatr., vol. 58, p. 608. Arndt. Zbl. Nervenkh., vol. 28, p. 773.
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420
by the average, normal individual who comes from the same cultural background as the patient. Clearly the attitude of the personality to the illness will
be well defined, well formulated and individualistic according to the intelligence
and educational level of the patient. Someone steeped in the natural sciences
and psychopathology will have a different attitude from someone with a background of theology or the humanities. We must always take the patient's
milieu into account when attempting to evaluate his attitude as a morhid one.
The same opinion might signify nothing but superstition in a simple peasant
but betray a profound personality change, tending towards dementia, in an
educated person.
I. Self-ohservation and awareness of one's own state. The patient's observations and judgment can encompass the phenomenological elements, the disturbances in psychic performance, the symptoms in all their complex unity,
and the entire personality; in short, it can encompass everything that becomes
the subject-matter for psychopathology.l
Below a certain level of psychic differentiation, individuals seem to live

purely in their environment and lack all knowledge of themselves. In the case
of idiocy, the fully developed acute psychoses and deep dementia, the problem
does not even arise as to what attitude the personality adopts. It would be
better here not to speak of the absence of any awareness of illness but to talk
of a loss of personality, which embraces the missing awareness of illness automatically as a part-element. To some extent those remarkable cases of organic
dementia that are quite unware of the most severe hodily defects can be said to
belong to this category.
In organic cerebral illnesses (tumour, softening, etc.) where paralysis, blindness,
deafness or other such severe defects have occurred, we sometimes find an absence of
awareness. 1 The completely blind patient says he can see perfectly well, reacts to
examination with grumbling resentment,gets indignant and finally helps himself out
by creating phrases of his own, like a patient with a Korsakow syndrome. When
asked 'what is this?' (a watch held in front of him) he says ashe gropes in the air 'you
see it there, there it is'. 'What is it you want?' .. He describes anything possible, the
examiner for instance, goes around gesticulating as if he saw everything, swears,
maintains it is dark, etc. Redlich and Bonvicini have shown how a general psychic
change (torpor, apathy, euphoria, severe disturbance in registration) can make such
failure in awareness understandable. Related to this is the fact that some patients can
be brought to a certain insight into their blindness for short periods but they immediately forget it again. However, there seem to be particular defects in performance
which are difficult to detect by their very nature, where defective insight does not
necessarily appear as disintegration of personality. Thus Pick2 describes: 'the
amnestic aphasic individual who gropes for the missing word and has continuously a
feeling of the inadequacy of his speech, whereas the aphasic who talks in telegrammatic style or uses infinitives never hesitates for a single moment when speaking. He
does not feel that anything is missing which he should look for (even when the
patient is aware of his speech defect).' In the same way we can observe the paraphasic flow of talk in patients with sensory aphasia who do not seem to grasp that no
one understands them, whereas the patient with motor aphasia hardly utters a word;
he makes attempts to speak but gets held fast in his own awareness of disability and
gives up the effort.
Patients' self-observation is one of the most important sources of knowledge in

regard to morbid psychic life; so is their attentiveness to their abnormal experience
and the elaboration of their observations in the form of a psychological judgment so
that they can communicate to us something of their inner life. Self-observation
depends on interest, on some psychological aptitude, on powers of discrimination
and on the sick person's intelligence. Under certain circumstances, however, selfohservation may appear as a painful symptom ofillness. Patients are compelled to spend
their time analysing their experiences. All their other activities are disturbed and
interrupted by this self-observation and the results may be very poor indeed. Reflection on one's own psychic life has here become compulsive and torturing. Such cases
have quite unjustifiably given rise to the assertion that self-observation can be harmful. Kant had already warned against it as leading to rumination and madness. Selfobservation does not cause illness but some morbid conditions do produce an abnormal kind of self-observation.
There is an awareness of one's awareness. We may feel 'torpid', 'dozy' or
especially alert. This latter seems to occur sometimes to an abnormal degree.
Vision is felt to be extremely clear-as happens in schizophrenia-and this
may have some connection. Again there is something quite different in
encephalitis lethargica, as in the case of a patient who wrote:
2. Attitudes in acute psychoses. In psychosis there is no lasting or complete

insight. Where insight persists we do not speak of psychosis but personality
disorder (psychopathy). Individual phenomena may be judged correctly but,
apart from that, the innumerable manifestations of the illness are not recognised as such and inversely there are morbid feelings where the content is a
false one and is itself a symptom. For instance, a melancholic patient considers
she is rotting away physically or a paranoid patient thinks his thoughtprocesses are being interfered with by external machinations. Patients will say,
'I have the feeling that I was never so wideawake and aware before the illness.
Perhaps it is a result of my constant self-observation and immediately making myself
aware of my smallest thought or slightest movement. Every bodily event, such as
sneezing, coughing, thinking, fills me with a burning curiosity as to how it comes
about. I then try to feel myself into it as far as possible.' The patient described what
she called 'registering', i.e. drawing into awareness every physical and psychic event
. 'this registering spoils enjoyment and anticipation, because I have always to keep
telling myself: now you are enjoying yourself; now you have expectations' (MayerGross and Steiner).
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421
1 Redlich and Bonvicini, 'Ober das Fehlen der Wahmehmung der eigenen Blindheit bei
Himkrankheiten',/h. Psycl.iatr., vol. 29. Bychowski, Neur. Zhl., vol. 39, p. 354. Stertz, Z. Neur.,
vol. 55! p. 32 7. Pick, .Arch. Augenhk., vol. 86 (I920), p. 98. Patzl, Z. Neur., vol. 93, p. II7.
Pick, Agrammatuch, Sprachstorungen, p. S4.
See Z. Neur., vol. 6, p. 460, for my analysis of reality-judgment in false perception.
,
'I don't know ... am I mad or what?' ... 'I see something but I don't know
what, am I imagining it?' 'I don't know what all this means, am I bewitched or what?' In acute psychoses there are transient states of far-reaching
insight. The patient returns from his fantastic experiences for a moment and
finds he is in hospital; he may even try to expedite his committal to a mental
hospital. Sometimes at the beginning of a process we find considerable insight,
the correction of delusions, the proper assessment of voices, etc., which one
might well consider as recovery and a benign psychopathic state, but insight
of this sort is quite transient. We can occasionally observe how it comes and
goes within a few hours or days. Sometimes clear consciousness will arise in
the very middle of the schizophrenic experiences. The patients will say afterwards 'for a moment I was again aware that I was disturbed', or 'Suddenly I
was quite aware that the whole thing was nonsense'. Thus the momentary
insight which emerges is more far-reaching than the content of most of the
verbal utterances suggest:
particular the schizophrenias, where subjectively honest judgments seem to

show full insight, but when examined more closely it is clear they do not.
Patients will assert they have passed through a mental illness, they are convinced
of the unreality of past contents and feel quite well again but they do not talk
quite freely about all the contents and even if they want to one notices an inappropriate excitement when they are asked to talk about them. They will
blush, grow pale, perspire, give evasive answers and say they do not want to
be reminded of the matter because it is upsetting. There is every gradation
from cases such as these to others where the patients refuse to answer pointblank. Occasionally we can notice that individual details (persecutions, etc.)
are still maintained as real and remarks are dropped such as 'theoretically
speaking, I am a bit doubtful whether it was really so or not; but in fact I
cover it up or I should be locked up for ever' ,etc. In cases such as these we
cannot talk of full insight. The patient's personality has been lastingly affected
by the content of the psychosis-often without his realising it. He is not in a
position to look at it at all objectively as something detached from him. He can
only deal with it as something troublesome that has to be dismissed. In other
cases patients do not remember the acute psychosis as unpleasant. They are
even sorry their memory of it is slowly disappearing. They do not like missing
the rich experiences which the psychosis brought into their life. Gerard de
Nerval began his description of his illness as follows:
Miss B. explained she was not ill but pregnant. It was not a delusion, it was terrible that it had happened and the future was frightening. She didn't know what to do
for worry. However, after a few minutes she explained quite spontaneously how
situations like this had always passed before (she had had several similar phases from
which she had always recovered).
In states ofpersonality disorder (psychopathic states) where the patient is
almost overcome, insight is still always there. Von Gebsattel described the
insight of an anankastic patient as follows:
'She can distinguish between what is morbid and healthy. She feels she is "double"
and thinks one day the whole compulsive system will have to "collapse like a house of
cards" or "vanish like a ghost". At times the "scales fall from her eyes". She then
"sees everything clearly and naturally" and feels very happy, but only for a moment.
It is as if one had just left the theatre and "got rid of the scenery". She feels one day
she will be able to step out of her illness or wake up from it as if from a dream.'
3. Attitude to psychosis after recovery. In order not to be deceived regarding

the total picture of the illness, it is more important to penetrate beyond the
content of the judgments as expressed (which can so easily mislead us) into
the real attitude of the patient to the psychosis from which he has recovered
rather than to the acute psychosis while it lasts. We get a clear picture of complete insight, it is true, in patients who recover from deliria, alcoholic hallucinosis or mania. They will say without reservation, and in respect of anyone
of their symptoms, that they have been ill. They will speak freely and frankly
about the psychotic contents which are now quite alien to them and a matter
of indifference. They can talk about them simply and detachedly and even
laugh about them as if they did not belong to them. The consequences they
draw from this insight are entirely understandable; they worry about relapse,
the odium of certification, etc.
In contrast with this, cases are not so rare with other psychoses, and in
'I shall try to record the impression of a long illness that took place in the
mysterious recesses of my mind. I do not know why I use the expression "illness"
because, as far as I am concerned, I never fel t better in my life. Sometimes I took my
powers and abilities as twice as great. I seemed to know and understand everything
and my imagination gave me immense delight. Should one regret the loss of all this
when one has regained once more what men call reason?'
4. Attitudes in chronic psychoses. The verbal contents in chronic psychotic

states often mislead one into thinking that a great deal of insight is present:
Patients with incurable paranoid disorders of the dementia praecox group may
for instance make remarks such as the foIIowing: Miss S.: 'my trouble is secondary
paranoia'; 'I am suffering from hallucinatory-paranoia of the Krafft-Ebing type; I
seem turned upside down'. 'I am suffering from paranoia-sexualis, doctor, my textbook is dated 1893 and there was no dementia praecox then.'-Mr. B., a workman, is
asked whether he is ill and replies, 'I have nothing to say on that; I come up against an
iron curtain-disbelief. The world takes it as delusion, the world wants reality. I
can't prove anything. I keep it to myself, otherwise I shall get shut up in hospital' ...
After an excited period the same patient said: 'It is all absolutely nothing, a fata
morgana; I only believe what I see. That is the right principle for nowadays.' Another patient when reproached said: 'I can do that, you see I am mad'.
Although such utterances lead one to expect a far-reaching insight, the
patients in fact have none. They are convinced of the reality of their delusional
contents and at the same time draw no consequences from their apparent
insight. They have merely learnt what psychiatrists and other people think
and turn out appropriate phrases which to them are quite meaningless.
(e) The determination to fall ill

Through self-reflection an individual can see himself, judge himself and
mould himself. But there are forces which work in the other direction. The
individual would like to be transparent, and not see himself, he would like to
deceive himself and veil reality. In the morbid sphere we find a determination
to be ill, an instinctive drive towards illness and in opposition to this the inner
ohligation to keep well. The will can interfere with the psyche which it may
darken or illumine, inhibit or yield to, inflate in some respect or repress in
another.
When the individual is ill, there are all these various possibilities open to
him in so far as a state of illness is not only an objective biological condition
but a subjective state as well, in the form of an awareness of illness. This latter
is not merely something dlat happens alongside the illness, the mere reflection
of it in consciousness, but it is an effective factor which is an actual link in the
morbid state itself.
Objective physical illnesses run a typical course: there ~s a feeling, of di~c~m~ort ?r
of general disturbance not yet accepted as an illness. The Judgment I am 111 arises m
the setting of a radical reorientation of the vital self-awareness. This is due to the collapse of the patient's capacity to perform which forces hi.m t? stop work o~ seek
medical opinion. What up to then had only been som~thl~g lrks~me and did .not
really count now becomes an important symptom and a Justified object of attention.
The individual tends to the 'either-or'. Is he well or sick? If he decides he is well,
then he should not worry over his irksome symptom, but if he thinks he is ill ~is
discomforts and failing performance justify him in expecting to be treated Wlth
consideration, nursed and cured. When there are not only manifest physical illnesses
but also a rich interplay of somatic and psychic symptoms and phenomena, the
patient's basic attitude can sometimes be of decisive importance for the whole course
which the morbid somatic phenomena take.
An attitude of 'not bothering about it' and of 'self-control' in the maintenance of normal life is the direct opposite of heing overpowered by somatic illness and of that completely unnoticed surrender to illness, which appears almost
as a purposive determination to he ill. Patients want sympa~y, want .to create. a
sensation or evade some obligation, want to get a penslOn or enJoy certam
fantasy pleasures. Determination and surrender of this sort pla~ a great p~rt
in neurotic illnesses as well as in the development of pseudolog m phantastlca
(self-credited, fantastic lying, linked with apparently consequential behaviour)
and other hysterical phenomena. After an initial phase of deliberate behaviour
such patients are rapidly mastered by the illness against their will. T~e il~ness
takes its own course (prison-psychoses, for example). One can also glve m to
manic excitement, one can foster it or manage to control it to a moderate
degree.
We find people who have a need to be ill. When anything morbid appears, they
will foster it and instinctively say 'yes' to it, though consciously they ask for medical
treatment and cure. Their illness becomes the main content of their life a means of
playing a part, calling on others' services, gaining advantage or evading ilie demands
of reality. Generally formulated, we may say that these people are determined that
events for which they are accountahle and in which they are understandahly concerned shall
he taken as mere casual happenings, for which they themselves are entirely irresponsihle.
For other people there is the necessity to be healthy at all costs and to be regarded as
healthy. They would rather try to blame themselves than feel they are in the grip of
some illness. They do not allow nervous phenomena to develop, for instance, because they are continually clearing these up for themselves. They do not want to
accept predetermined causal relationships and will try to transform most situations
into something understandable, undetermined and something for which they themselves can be held accountable. In abnormal states, if this attitude is taken too far, it
may be a relief for them to have to accept something at last as a 'morbid 'event.
Where the tendency to be ill has played a part in the development of morbid
physical states, a remark of Charcot's becomes most applicable: 'There is a particular
moment hetween health and sickness when everything depends on the patient.'
Psychic behaviour undoubtedly influences physical disturbance. Someone receives a distressing telephone message. On putting the receiver down, his hand and
arm feel tired. He gets writer's cramp when writing. He ignores it while at work and
after sleep, the disturbance vanishes, but it may be preserved and return at the slightest stimulus. A patient feels 'the sensation of something shooting down his arm'
whenever he faces some depressing or disadvantageous situation. Mobius reports on a
patient with akinesia algera, who 'tried to divert his attention forcibly on to something
else, as he supposed thinking about his own state would be bad for him. He only
failed, when going off to sleep and on waking up. He then felt his thoughts rushing
into his limbs, as it were, and how these became more sensitive.'
Kretschmer tried to clarify how a more or less definite determination to do so
could maintain and develop a transformation into bodily phenomena.1 We ourselves
can see how the same patellar reflex can be strong or weak depending on whether we
determine to reinforce it or not. This normal event can again be seen with hysterical
phenomena. In the first place there is an acute affective reflex (e.g. trembling all over).
At its initial peak it can hardly be suppressed. The intensity of the reflex then recedes
and at this point it is readily accessible to voluntary reinforcement. Through
habit, it becomes more resistive again and progressively stronger, and finally it cannot be suppressed even with all the will in the world. Volition can strengthen the
reflex for the moment and then silently install itself within the reflex through repetition.
(f) The attitude to one's own illness: its meaning and possible implications
Kierkegaard wrote the following from his own experience: 'The worst
affiiction of all is, and continues to be, that one does not know whether one's
suffering is an illness of the mind or a sin.'
1 Kretschmer, 'Die Gesetze der willkiirlichen Reflexverstiirkung in ihrer Bedeutung fur des
Hysterie- u. Simulationsproblem', Z. Neur., vol. 40. p. 354. Kretschmer works out a connection
very well but we do not have to make it an absolute and deny the existence of hysteria.
The crude psychopathological categories which we use to classify and

apprehend our subject-matter do not penetrate to human fundamentals. The
individual has an original source from which he takes his start and which
enables him to detach himself from all that happens to him or overcomes him,
or that, in so far as he detaches himself from it, is not he. His 'Anlage', sex,
race, age, illness-even if it be schizophrenia-are all in some way he himself,
in so far as he is inextricably tied to them all. But he can also confront every
one of them; he can adopt an attitude in face of them and instead of identifying
with them ('this is just how I am'), he can make them his business and by so
doing for the first time fulfil what he actually is in himself. He then has to
understand this reality of his, interpret it, get to know its content by bringing
out the meaning of the given facts. He must question what Nature has added
and what comes from him, he must ask what is meaningless and what may be
meaningful and what are the actual functions he is given to fulfil. This interpretation that understands and appropriates meaning can never end. The
knowledge which we have that is objective and compelling has only limited
extent and beyond this the individual's comprehension and attitude towards
himself make endless progression. Those categories and images of human
existence which are derived from the human world put the individual on the
track but the mode of his behaviour goes beyond the explicit knowledge of the
moment. It is linked with his essence in a way that cannot be objectified and is
the whole that arises from what is given, understood and created, and the
manner of its rising is something that no observer can unearth: there may be
refusal or self-limitation, love or hatred for one's own foundations, methodical
self-discipline bent only on giving form and shape or an inner behaviour
whereby man meets himself at last through his own contriving.
If we keep this brief sketch of the basic situation of human life before us,
we have to accept the possibility-only rare cases show it clearly-of extremely meaningful behaviour, produced by the vicissitudes of an individual's
historical existence, being exhibited by cases which we have initially taken as
schizophrenics; this is all our science was able to see and we discover we have
reached the limits of our knowledge. What we have called the attitude of the
patient to his illness contains a polarity: objective knowledge on the one hand,
relating to the morbid process, and on the other a comprehending appropriation
of it, related to the foundations of the patient's own true existence. The
objective knowledge is identical in meaning with medical knowledge. The
patient may read books or be a psychiatrist himself and apply scientific concepts. But the 'appropriation' is by contrast an act which is meaningful only in
the midst of an in-between existence, which unfolds all the more plainly the
more complete the knowledge happens to be. As scientist~ we should guard
against making the average our measure for everyone. The possibilities that
are universal in man as man lie hidden and hardly appreciable and only seek
expression in rare cases. Existence itself provides the limits for human knowledge and from it arises that element in the individual which confronts each
41 7
ill~ess as something other than itself but yet identifies itself simultaneously
with what we commonly call the 'morbid' contents. The constant search for
meaning, interpretation and inclusion, in respect of everything that seems
objectively founded in the disease process, does not immediately signify lack of
insight into the illness. Kierkegaard went to the doctor 'as a gesture to human
institutions' and presumably also out of the urge to be fully and compellingly
persuaded that he could accept as an illness what he had considered to be his
sins. He was of course deeply disappointed. Presumably medical categories
were as much related to what he was experiencing as the speech of Hottentots
to platonic philosophy. It would have been no different in principle if he had
been confronted with a psychopathology of the highest conceptual level. The
secret contact with God, experienced in all seriousness and in clear consciousness, and in a way in which there could be no knowledge of what God said or
intended, is not something to be juggled away in the form of a scientific knowledge of some natural event.
The psychopathologist, however, is always left with knowledge of this
marginal nature. He is acting counter to reason should he postulate a fundamental change in Existence itself rather than some disease process which he
could confirm empirically. Existence itself cannot be touched by the knowledge or experience of psychopathology.l
1 It would be extremely interesting to have a thorough knowledge of the phenomena in cases
where there is self-interpretation and in which existential and therefore religious motivations play
~ part. We know little of Kierkegaard's contact wim me doctors. Nietzsche's conception of himself
In the. co.nte~t of his illness is fairly informative (reported in my Nie/rsche, pp. 93-9)' In the
psychiatriC hterature see Gaupp, 'Ein cyclothymer Psychiater tiber seine seelischen Krankheitszeiten', Z. Neur., vol. 166, p. 705.
TOTALITY OF MEANINGFUL CONNECTIONS
CHAPTER VIII
THE TOTALITY OF THE MEANINGFUL

CONNECTIONS
(CHARACTEROLOGY-CHARAKTEROLOGIE)
I.
DEFINING THE CONCEPT
It is always of first importance in psychopathology that we should make

unequivocal use of well-defined concepts. No concept, however, has to carry
so many meanings or is put to such multiple use as the concept of personality
or character.
(a) What personality really is

We see the personality in the particular wayan individual expresses himself,
in the way he moves, how he experiences and reacts to situations, how he loves,
grows jealous, how he conducts his life in general, what needs he has, what are
his longings and aims, what are his ideals and how he shapes them, what
values guide him and what he does, what he creates and how he acts. In short,
personality is the term we give to the individually differing and characteristic
totality of meaningful connections in anyone psychic life. Within this we now
have to to make a number of distinctions:
I. Personality does not include everything meaningful. For example, the way
in which a sudden sense-perception attracts attention is a matter for general
understanding and without relevance to personality, so too with the fascinating
power of anything new, etc. Nor do we include in the personality any of those
psychic connections which we look at in isolation and which do not carry any
meaning on into the total context but are handled as separate fragments though
we may well look at them from within, for their own sake. We just say that all
such events have something impersonal about them, even though we understand their meaning. Where the psychic life consists exclusively of such fragments, as in fully developed psychoses, we do not speak of personality at all
(though we may still notice something essentially individual in the background of the acute events, showing in the perplexity and the unexpectedly
clear judgments).
The psyche, so far as we take it in general as consciousness and experience,
is not the individual personality but simply the universality of every psychic
existence. Personality or character first come into being through the complex
unity of content in anyone individual.
2.
A totality of meaningful connections does not always mean personality.
For example, an idiot may run away from some terrifying object. We uncler4 28
."
stand this and form some over-all picture of the meaningful connections in his
psychic life, yet we hardly conceive of him as a personality. For an individual
to be a personality he must have some feeling of himself, some sense of the
self as an individual. We do not mean by this the abstract self-awareness
which accompanies all psychic events in identical fashion but a sense of self
that is aware of its own particular self in all its historical identity. This is
personality-awareness as opposed to mere sense of identity. There is no personality without self-awareness. Characterology ends at the lower levels of
psychic life, where the self-aware personality also ends. Animal characterology,
whether of types or individuals (as with chimpanzees) is of a fundamentally
different order. It is an analogous understanding of different types and modes
of behaviour of which the creatures themselves are quite unaware.
3. Not every individual variation is to he ascribed to personality, and not
those individual variations of the psycho-physical apparatus which form the
substrate of the personality. Capacity for performance, memory-power,
fatiguability, learning ability, etc., every such basic characteristic of the psychophysical mechanisms, talents and intelligence, in short, all the working-tools
of personality which condition its development but are not the personality
itself, have to be kept rigidly separate if we want to differentiate within the
personality the aspects that have no understandable meaning and the meaningful connections themselves. The close connection between intelligence and
personality, even if it is of a reciprocal nature, should not lead us to regard
them both as one. Intelligence is a working-tool and we test, measure and assess
its power according to its performance. Personality is a connection in the self,
aware of itself. The former is passive material, the latter is personal activity
moulding this material according to the personal interests, aims and moods.
The former is a precondition which makes personality possible in the first
place and permits it to develop. The latter is a force which puts the tools to
work and if they were not so used they would only deteriorate. The concept
of dementia or mental defect as generally current relates to destruction of
intelligence and personality.
Summarising we can say: personality is constituted from psychic events
and manifestations in so far as these point beyond themselves to a single,
fully understandable context, which is experienced as such by an individual
who is clearly conscious of his own particular self.
(b) How personality comes into heing
So far in our remarks personality or character has been conceived as

something which is as it is. It has been there from birth onwards and essentially does not change but only reveals itself, it becomes aware of itself but does
not produce itself. This however is only one aspect, which may mislead.
Personality is just as much a development whh its consequences, and attains
reality in the world through every kind of situation and through the opportunities and objectives that spring therefrom. Personality has an historical basis
and is a self-creation of man in time. It is not .mer~ly th~ expression o~ something that has always been as it is, ~ani~estmg ~tself m time. In .th1s sen~e
personality only shows itself in the hfe-h1story, m as ~~~~ as th1S ta~~s m
the whole course of the individual's life with all its poss1b1hues and dec1SlOns.
Thinking about personality therefore is full of ambiguities as wit? a~l
psychology of meaningful connection. ~n so far ~s it affirms that som~thLng zs
so, it turns into knowledge; in so far as 1t throws hght on what can he, It works
as a call to freedom.
evaluated in terms of the consistent thinker, of the individual with a resolute

and consistent will, or an artistic style of life. So we come to speak of different
types of ideal personality, for example the sage, saint or hero. But none of
these concepts of personality concern us here.
Not only from the philosophical point of view but also in the interests
of research we should be fully aware of the limits set to our investigations
when we are confronted with the human individual. There are no prohibitions
on research, it is true, and we must try to grasp whatever we can in fact grasp,
confirm, examine and investigate. But we shall come to grief in our enquiry
and go astray whenever we think we know too much or consider we can
know the whole or the fundamentals. Where science is baffled radically, investigators may then know that they are entering an area where they no longer
confront mankind as scientists but as mere fellow-men. The individual as
'Existence itself' is more than the totality of his meaningful connections and
more than the sum of his biological Anlage. All our attempts to define the
concept of personality or character have something in common. Personality
is always something inconclusive and points on to something else. In subjectmatter the psychology of meaningful connections remains mid-way between
all the modes of the non-understandable, yet this only becomes manifest in
fact through its operations. Accordingly, the personality which we understand points in the first place to the non-understandable from which it has
arisen, that is the constitution and all kinds of biological determinants, and in
the second place points to the non-understandable which the ever-changing
personality both manifests and serves, that is Existence itself, the transcendental
source and eternal goal of man. In personality we do not see any final Beingas-such, an end in itself. Empirically it can be at times the totality of what is
understandable but always in such a way that something remains in the person
whereby what is empirically extremely improbable always remains possible.
At any moment freedom can have birth and give everything a different meaning. The personality as understood is not what an individual actually is but an
empirical and inconclusive phenomenon. What an individual really is himself
is his very Existence in the face of Transcendence, and neither of these are ever
a subject for scientific enquiry. Existence itself cannot be grasped as personality
but it reveals itself in different personalities, which in themselves can neve!"
be final.
430
(c) The understandable personality and its opposite:

As our knowledge of meaning grows we are forced u~ against the ~011understandable. At any given moment the totality of meanmgful connectlOns
is grounded in the non-underst.andable. From the .external point of view? tJ:e
non-understandable is the realzty of the world wh1ch advances on each md1vidual and determines his life from birth through what it gives or withholds,
demands or lets pass. From the inward point of view it is the bi.olo~i.cally
given Anlage on the one hand and on the other it is the freedom of the md1v1d ual
as potential 'Existence itself'. This latter is not an object for ~owledge nor can
it be investigated, and as psychologists and psychopatho!oglsts we o.nly c~tch
a glimpse of the individual, in so far as he becomes an object for our mve~uga
tion. The non-understandable element, which is the carrier into actuahty of
everything understandable, we try to .gra~p as some~h~~g biolog~cal.
.
I. The meaningful connections, mstmctual aCtlV1tleS, emotional drives,
reactions acts aims and ideals always call for the additional construct of an
Anlage ';hich'manifests itself in these actual con~cious psychi~ events and
their expression. We also call this Anlage personahty. ~y so domg. we mean
to convey the extra-conscious disposition that underhes the totahty of .the
meaningful connections. This will indicate that, although the personahtyAnlage is wholly understandable in its manifest conn~ctions, we canno.t understand it in its actual existence as a whole, and as such 1t has to be explamed, for
example, by the laws of heredity and grasped as. a constitut~onal entity:
2. That underlying factor of personality wh1ch we call ItS freedom 1S not
an object but a limiting factor in personality res~arch. We may say that one
individual is a 'personality' and that another IS not. Such statements are
philosophical assessments and not empirical findin?s. They are mea?t to cO.nvey that the truth of Existence itselfseems present m the person. Pht1o~o??~C
ally we may be able to throw some light on ~hat are. then the pos~lb1htles
but we can gain no empirical knowledge of the1r actuahty. From the 1d~as .of
Existence itself we can build ideals which philosophically we at once d1sm1ss
as false. By the expression 'personality' we are p~rhaps ~oncei~in~ s?me ideal
of maximum unity as a maximum wealth of paruculars m the md1v1dual, and
he approximates to this ideal unity all the time as he ~dapts to the actual
circumstances of his life. Consistent thought and acuon, coherence, and
reliability are all attributes of this ideal personality. Personality is then
2.
43 1
METHODS OF PERSONALITY-ANALYSIS
Analysis of personality has been practised throughout the years by psychologists, others who study mankind, philosophers and psychiatrists, all making
use of similar concepts and similar methods. 1 These various efforts at personality-study differ from the biographical approach to personality in that they
1 Analysis of personality (characterology) is an ancient pursuit: e.g. Theophrastus, Characters.
Cpo also Bruno, Das literarische Portrilt der Griechen (Berlin, 1896). Kant, Anthropologie.
J. Bahnsen. Beitrage tllr Charakterologie (Leipzig, 1867), 2 vols. (He is the author of the term
432.
try to find out something typical that can be given a general formulation. The
biographer ot! ftle other hand is confronted with the. unending task of cox:nprehending a concrete personality and here personahty-stu?y ma~ h~lp. hIm
to a certain extent. The business of personality-study then IS to dlscnmmate
the types, the schemata which, in contrast to the concrete personality, stand
out plain and clear no matter how they ramify, and it makes use of these,
wherever possible, to give some conceptual form to the whole vast range of
personality formation in hux:nan ?eings:
. .
.
Each personality has an mfintte reahty and potentlahty. At any g1Ven moment it is the form taken by its own historical contents, a form that has been
shaped by fate, calling, function and effective partici~ation in the acu: al cultural
heritage. Thus man in his concrete and complex untty becomes subject-matter
for the humanities and social sciences and is not even exhaustible by them.
Our conceptual psychological analysis can only offer relativel~ crude means of
orientation. We will now present the methods of such analysIs:
(a) Awareness of tlte possihilities of verhal description
Language provides enormous resources on which to draw for the characterisation of human nature. Klages counted four thousand words in German that
denote something psychic and concern aspects of personality, and h~ is
certainly right in pointing out how the infinitely fine nuances of these vanous
terms have got lost in the ordinary usage of the words and have to be rescued
deliberately. Whereas the psychologist finds difficulty in securing suffici:nt
terms for dealing with psychic mechanisms, he is here embarrassed w~th
abundance and has difficulty in finding those differentiations of personahty
which can be taken as really fundamental and profound. No constructed system
of personality characteristics is possible which ;;ill be comprehensive an~
generally valid. We can only work through the aVailable an~lyse~ and appr0.rmate to ourselves the language of poets and thinkers and m thIS way achIeve
some psychological grasp through direct understanding. Only so shall we
learn to formulate what we have grasped and these efforts will help us to be
flexible cautious and free of bias. We can make ourselves aware of the way
in whi~h language, although in fact it works without any system, is itself
permeated by an inexhaustible ho~t of potential ~ys~ematisa:io~s. Language
usually holds an unnoticed sway m every psychtatrIc descnptton-whether
meagre or full-and ranges through all the dimensions of social, ethical and
aesthetic assessments, quantitative assessments too, as well as the concepts of
'charakterologie'.) Klages, Prin,ipien Jer Charakterologie (Leipzig, 1910); 7th and 8th edns., 193 6,
with the title GrunJ/agen Jer CharakterlunJe. Cpo also p. 262 with its references to the psychology
of meaning and p. 221 with references to the st~dy of physi~gn~my a~dy:e theory ~f expression.
There is an extensive and varied literature on thiS, degeneratmg mto tnvlaltty, credulIty, quackery
and mere enthusiasm which has increased in quantity since 1920. So far we have no clear, unambiguous science of characterology-or sCien.tific st,:dy .of personality. Ther~ is no method b~t
a conglomeration of all sorts of interests beSides sCientific ones. Paul HelWIg, Charakterologle
(Leipzig, 1936), gives a good critical review.
433
the psychology of expression and physiognomy. To be aware of language is a

continual reminder of the infiniteness of human nature.
The art of characterisation and personality analysis cannot be methodologically defined nor learnt but it depends on this mastery of language and
therefore, at any given time, on the current cultural trends. It will change with
general values and modes of thought and in particular with the range of
possible human experience.
(h) The concepts of personality-study are those of the psychology of meaningful
connection
We might say that all psychology of meaningful connection is personalitystudy, in so far as it concerns itself solely with the connection of what is
meaningful in terms of the whole man and tries to grasp the particular quality
of an individual.
According to the basic schema that prevails automatically, the meaningful elements are grounded in certain constant 'properties'. The personality is
then conceived as a sum of these properties or as a meaningful connection
between them. Properties constitute the lasting foundation. Particular attitudes
are thought to arise from a combination of such properties, and there develops
an unending play of properties in combination. This sort of language may be
unavoidable but as a conceptual foundation for personality-study it is misleading. It robs the personality of movement and, even more important, it
removes the dialectic of opposites in everything meaningful.
Suppose we wanted to understand complete personalities as a comhination
of properties and therefore would like to know which properties we should
understand as predetermined opposites, which properties were to be understood as linked with which and which were mutually exclusive, we should be
landed with some remarkable experiences and learn that our aim was impossible. In every psychology of meaningful connection each contrasting pole is
equally understandable and correspondingly the opposites are bound directly
to each other. All living that is meaningful functions in opposites. The matter
of our understanding dies, as it were, once it has been unilaterally and exclusively fixated at the one pole only. The power of living lies in uniting the
opposites, in overcoming them through integration and not in a limited
unilateralism. Courage lies in the overcoming of fear and he who has nothing
to fear is no longer courageous.
As a result of tllis basic relationship of the contrasting poles, all the ideal
types of 'properties' and personalities that have been constructed tend to fall
into pairs of opposites. Whereas empirical personality-study of the individual
in his unceasing development may at any time confirm Goethe's saying, 'he
is no closely wrought ingenious book but a man with his contradictions', the
theoretical constructs, on which empirical research depends, are wholly
characterised by such contrasting poles. This means however that these constructs are not actual personality-types but constructs of ~deal types whereby
434
435
his nature. This is indeed clarified by the attempt at classification but it still
does not suffice to describe the man as a whole.
'Type' carries quite another meaning when the term is used to convey a
real type as against an ideal type. The reality of the type then rests on some.
thing that is not understandable, a biological source, a constitutional factor.
As a result the type can only be established by making correlations of frequency
and can only be partly understood.
Intermediate between the ideal and the real type lie descriptions ofcharacter
based on experience. These have acquired a certain validity for the time being
though the principles on which they rest are not really clear.
at times we are helped to understand certain connections. They concern

perspectives of understanding, not material being. Such personality constru~ts,
therefore, as have been achieved remain inconclusive so far as human reahty
is concerned. They are not final diagnoses of a man's quality but a challenge
to everyone who would understand others as wen as himself to look to ~he
freedom of the potential self. A quality that is absolute in the sense of betng
finally established always denotes we have reached the limits of our understanding~ T~ quality of a man can never be stated with absolute certainty as
to the future and, so far as the actual manifestation has gone, can only be fixed
in retrospect by ignoring the play of chance and free decision. Personalities
are never whole and conclusive. If they were, they would be without life and
potentiality, one-sided and stultified, grown into an automaton.
Thinking about personality therefore returns us via the 'ad hoc' assumptions about 'properties' to the fusion of these 'in meaningful movement. The
turning of qualitative being into something with properties will however
always remain a basic shortcoming of personality-study.
ATTEMPTS AT BASIC CLASSIFICATION OF CHARACTER
Faced with the various classifications of personality we get an impression

of en~lessness. Almost every fresh contributor thinks he has grasped the
essenttals of human nature. He sets Out his schema rather dogmatically and at
first tends to convince uncritical readers. But there is a considerable difference
in the various classifications according to the writer's cultural level the
vi~idness of his observations and in particular the depth of his metaphysics
With which are linkea his initial presuppositions about human nature. To
represent all that has been thought in this field would need some historical
account of the various human types which those who study personality have
create~. In every age ce~tain forms intrude into the current philosophy as
essential fo:ms ?fhuman ltfe, usually as ideal figures of good and bad, examples
of contrastlOg Ideals. We shall only remind the reader here of the enormous
literature which .embodies such ways of thought, and set out below what
seems to be of general importance in all this:
(c) Typology as a method

If we think of a property as something lasting, understandable in its
manifestations, in modes of reaction and expression and the general behaviour
of the individual, we are in process of developing a type. We form the property
and aU its consequences into a construct and viewing it as a whole recognise
it as something obvio\lsly connected. If we then make one or several such
properties the basis of a comprehensive totality and proceed to apply it to the
person as a whole, noticing the meaningful connection between this and what
the individual experiences and does, we are in the process of designing a
personality-type.
Such types remain ideal types even if we have conceived them from our
scrutiny of real people. Their general nature is revealed through the individual,
it is not arrived at by deduction or abstraction, but duly perceived by omitting
everything that does not belong. They do not come into being as statistical
averages but remain purely formal. They only occur in reality as approximate
forms, as classical borderline cases. Their truth rests on the inner connectedness of the meaningful whole; their reality, except in the rare borderline case,
rests on the fragmentary emergence of the type which is limited in reality by
other factors, not to be understood in terms of the type, which cannot therefore
exert sole influence.
Every type is of universal application. But individuals lend themselves
more or less readily to various types. The types are mutually related in such
a way that contrasting types do not exclude each other in the actual individual
but are bound directly to each other.
Thus the whole meaning of types makes it impossible for anyone indi
vidual to be sufficiently characterised by any single type. What corresponds
more or less to a type in the concrete individual is always only one aspect of
(a) Single, individual forms
In the first place we have what constitutes the unfailing foundation of all
personality-study, that is, the vivid perception of individual forms which
i~print ~hemselves unforgettably on the memory and live on in our imagin~t1~n. Figures from poetry, historical figures whose biographies are known,
ltV1?g people we have met, are all indispensable for us to keep in mind.
:hls wealth of inner vision, which is there long before concepts arise but
IS. remarkably fruitful, is a precondition for any thinking about personaltty and every psychopathologist needs to widen and deepen this vision
constantly.
Scientific knowledge enters ,dth the tendency to conceptualise and introduce so~e systematic o:der, along with the tendency to methodical compari~on of Ideas and expenence. Systematic classifications are of several kinds:
rdeal types, general systems of personality-structure, and the setting up of real
types.
&.
43 6
(h) Ideal types

Typologies which are systems of ideal types ~utline the p.er~onality
possibilities in a vast number of polarities: self-assertion and submlsSlveness,
happy and sad, extravert and introvert, etc. Th~s schema of opposites appears
without exception in all typologies of personahty..
.
The intention is to give pairs of opposites as precisely as possible, d~ne
their meaning and distinguish them and keep them apart from human reahty.
Most important of all, the opposing pairs are not allowed to flow together a?d
be submerged in one contrasting unity.l To be ideal, a typology ~fperson~~ty
ould first have to make a systematic classification of all the possible polanttes
:nce they had been precisely defined, a mau:e~atics, as i~ ~ere, of th~ meaningful; after this was done it could go on to hmltless empmcal.analysls. .
The simple schema of opposites becomes more refine? If the me~nmgful
'properties' ramify out into other dimensions from a smgle polanty.. ~or
example, polarities have been conceived where bou: ~oles hav-e a pOSitive
value, e.g. frugality and generosity, and there are deViations. from b?th po~es,
e.g. meanness and prodigality. Or in some systems, a ~ean IS c~ncelved l~mg
between two extremes, something moderate, genume and !lfe-enhancll~g.
This in tum is either conceived of as undialectical, an ~neqU1:ocal.qua.nttty
avoiding the extreme, or dialectical, i.e. a comprehensive Unlty ~t? mner
tensions and including the extremes within itself as constant posslblhues for
deviation.
It becomes clear that in all these constructs of ideal types, the types .that
seek to be comprehensive and make a synthesis cannot be accurately descnbed
at any time, while the single type-polarities are unambigu?us and clear. But
this lack of ambiguity is bought at a price, namely that ~~ smgle .type has to .be
a deficiency-type and the single, well-defined charactenstlc acquires a nega.tt~e
value, run aground as it were, and what has become the manifest charactertstlc
is nothing else but a human failing.
(c) Personality-structure in general

Klages made the most effective attempt to ?ring some or~er into personality-structure. His study of personality outstrips all the prevlO~s effor~s. He
differentiated between purely formal characteristics of personaht~, WhlC~ .he
termed the personality-structure, and what he called the personallty-qualwes,
including the instincts, drives and interests.
Within the personality-structure three distinctions are drawn:
.
I. The tempo of emotional excitability, i.e. tl:e dur~tion of the ~mottonal
wave, the strength of the reactivity. These constftl~te dlfference~ of temperament' and there are fluctuations between phlegmauc and sangume.
1 Psychiatric attempts to create a personality-classification suffer I thi~k from creating on(y ~n'
'f
'tes which then have to contain much heterogeneous material and become confusmg
palro OppOSl ,
C G Ph"
h T
(ZOO i h Rascher
although the central theory may be quite clear. Jung? . syc owgtSC e ypen ur c ,
,
192.1); Kretschmer, E. Korperbau u. Charakter (Berlin, 19 21 ).
437
2. The predominant prevailing mood. This fluctuates between melancholic

and euphoric, between dyskolos and eukolos.
3. The formal properties of volition. There are fluctuations here between
strength and weakness of will. Strength of will appears as an active force in all
forms of energy and spontaneous action and as a passive strength in perseverance, tenacity, resistance and, reactively, in obstinacy and stubbornness.
Klages then proceeds to contrast these three structural forms with the
personality-quality, its substance or essential content as it were. This he terms
the system of mainsprings (the personality in the narrower sense as against
temperament, prevailing mood and formal disposition of the will-power).
This is the personality proper. It contains a polarity. Instincts are confronted
by the will, conscious goals and purposes are set against the gratifications
groped for by the instincts and, alongside the qualities of the world that are
merely felt, there are consciously recognised and judged values. On the one
hand there are contents, the material out of which the personality is forged, and
on the other hand is the will which gives these contents form, inhibits, fosters
or suppresses them but cannot add anything to them. The will, from the way
it is experienced, always implies an element of control, self-maintenance, awareness and activity. But in all the instinctual drives there is an element of simple
permissiveness, self-surrender, unawareness and passivity. On the side of the
will and the drive to self-maintenance we find reason (realism, discrimination,
sense of duty, conscience) and egoism (acquisitiveness, ambition, caution,
craft). On the side of instinctual life and self-surrender we find enthusiasm
(drive for knowledge, love of truth, thirst for beauty, love) and the passions
(greed, lust for power, sexual drive, revenge).!
Klages also most skilfully constructed a number of ideal personality-types
lying outside this personality-structure. They are more concrete and truer to
life than the theoretical structure which is simply an aid to reasoning when one
is trying to classify. The great variety of ideal types is due to the many perspectives according to which man as a whole can be understood. Klages
started from basic mood and sensibility, from the tempo and inner tensions of
psychic life, from will-power and the mainsprings of the drives and their
specific hierarchy.
In contrast to all this, as a last perspective, Klages takes the mode of
operation whereby an individual becomes aware of his own self through
reflection. The personality develops passively out of a given Anlage and over
against this is the personality that develops reflectively, through the work an
individual does on himself and through his own inner activity.
But every analysis of personality halts at the point where man reaches inner
superiority over himself and can properly be himself. The individual, who
1 My exposition does not represent Klages' teaching exactly. He rested everything on his metaphysics, according to which the Will (the spirit) enters life from without as a destroying force,
as an absolute devil coming in to the full self-sufficiency of life. 'Personality' only exists in the
transitional periods when life is not completely destroyed but in process of being destroyed.
Klages' position here is a matter of faith and so cannot be disputed,
becomes matter for his own study without letting this drop to the level of
being mere datum or falling himself prey to the devastating effects of reflection,
can never be characterised in terms of psychological description.
Once the study of personality starts to pigeonhole people into pure types,
it comes to grief. In the first place an individual can never be exhausted by any
one type, since this only serves to delineate one aspect of him. In the second
place every complete schema of types must be rela~ive, onl~ on: out o~ many
possibilities. Thirdly, personality is always part of Its own Situation whlc~ h~s
a host of possibilities that can never be known absolutely. The personahty IS
always in development and can never be sealed off. Speaking scientifically and
humanly, with living people we cannot draw a line as it were and balance the
accounts, so as to discover what a person really is. To circumscribe a personality-disorder (psychopathy) with the 'diagnosis' of a type, is doing v.iolence
to the situation and falsifies it. But in simple human terms, to claSSify and
track down someone's personality implies a categorisation which, if we look
at it closely, is insulting and makes any further communicat~on impossible.
We should not forget this point when we are trying to throw llght on matters
by conceptualising the human personality.
epileptics can only be regarded as genetypically related to these hereditary

illnesses.'
43 8
(d) Real types
These arise from the restriction which reality imposes. They take advantage of the ideal constructs of what is understandable but as soon as ~mpirical
observation enforces the confusing unity of the understandable and ItS opposite, they abandon the constructs. The weakness of the real types which ha:e
been formulated so far is that their reality-basis is in doubt. They compromise
between meaningful constructs and theoretical developments from isolated
biological observations. They are satisfying in a few classical cases? givi~g
illustrative 'clinical pictures' but since they are inadequate or not appl.lcable l.n
the great mass of cases, they lack universality. There is no systematic claSSIfication of them as would befit their origin in given reality. They can only be
enumerated. Thus Kretschmer devised three personality types, each moving
between two poles, between excitable and sluggish (schizothyme), gay and
serious (cyclothyme) and explosive and phlegmatic (viscous). The masterconcept into which fall these three sets of polarities, fails because one can only
enumerate the concrete sources for these meaningful observations. The true
significance here is that underlying these real types there is a bio!og~cal reality
which one day we may be able to grasp (cp. the chapter on COnStltut1On). Such
a reality as this is quite different from the phenomenon, since in .the .last res?rt
the phenomenon can be there without the reality as we conceive It. For 10stance Luxenburger only accepts schizoid personality-disorders (psychopaths)' as such when there is evidence of some blood-relationship with a
schizophrenic. There are also schizoid personality-disorders (psychopaths)
where this hereditary position does not apply. 'Kretschmer's types if seen in
biological proximity to schizophrenics, manic-depressives or hereditary
4.
439
NORMAL AND ABNORMAL PERSONALITIES
There is no simple answer to the question when and why personalities are
abnormal. We have to bear in mind that, speaking generally, 'abnormal' is not
a matter of statement but an evaluation. The facts themselves give rise to this
evaluation where the personality is considered as the totality of the meaningful
connections. Personality characteristics vary according to the degree of unity
or the amount of scatter in the meaningful elements in a given individual. The
more scattered and disconnected these elements are the more abnormal the
individual. Alternatively we observe that everything meaningful in the given
unity achieves a certain equilihrium and harmony which together form a whole,
then the more disharmony there is and the less equilibrium the more abnormal
the individual (desequilibre). Or we pay attention to the polarities and their
synthesis in meaningful living and then the more one-sided the expression is
the more abnormal we find it. These, however, are all extremely general points
of view, so that we never find the norm fully expressed in any single individual.
The systematic principles indicated in the above paragraph are only to help
in the actual perception and representation of exceptional personalities. They
are not the source from which such perception and representation derive.
Valuable results are obtained in psychopathology through types created by the
intuitions of those who investigate and give us impressive and unforgettable
delineations of personality that we can recognise. These personality-types are
potentially innumerable and they are real types, designed with the help of a
number of ideal types. We can only enumerate them, group them and use
them as illustrative examples. This is a matter for special psychiatry, and we
will comment briefly as follows:
We distinguish two kinds of real types: I. Abnormal personalities, that
simply represent dispositions which deviate from average and appear as
extreme variations of human nature. 2. Personalities that are genuinely ill,
where a change has taken place in their previous Anlage as a result of some
additional process.
1.-
VARIATIONS OF HUMAN NATURE l
Variations of human nature that deviate from the average cannot be called
sick as such. Nor do we usually call the least common variations particularly
abnormal. In practice we more often investigate those which come within the
orbit of clinics and consulting rooms. 'Personality-disorder' (psychopathic
personality) is the term which we use in this connection for all those 'who
1 Attention should be drawn to the oldest and most basic of psychiatric contributions: J. L. A.
Koch, Die psychopathischen Minderwertigkeiten (Ravensburg, 1891-3). Then to Kurt Schneider,
Die psychopathischen Personlichkeiten, 4th edn. (Vienna, 1940). Here there is clear orientation,
unprejudiced views and ready access to the entire literature.
440
nature of the personality than all the other variations in structure, temperament
and will-power. There is a more definite cleavage here between people with
different dispositions than anywhere else. The most frequently investigated of
these well-marked personality-variants is that of 'moral insanity' (Kurt
Schneider's 'affectionless' or 'unfeeling' psychopath). This term has been used
to describe personalities who come at the end of a series of transitional states
and exhibit the characteristics of the 'born criminal' to an extreme or rare
degree. 1 They strike us as strange creatures, highly exceptional in many ways:
their destructive drives are unaccompanied by any sensitivity for what is
right, they are insensible to the love of family or friends, they show a natural
cruelty alongside isolated displays of feeling that seem strange in the context
(e.g. a love of flowers), they have no social impulses, dislike work, are
indifferent to others' and their own future, enjoy crime as such and their selfassurance and belief in their own powers is unshakeable. They are completely
ineducable and impervious to influence.
Another such type is the fanatic who devotes himself wholly to a single
cause and is blind to everything else. He does this so unconditionally that he
will unconsciously risk his whole existence on its behalf. Credulous belief, the
exaggeration of some isolated purpose out of all context is a special interest of
their existence. They are driven, harried people who get a specific and agonising pleasure from their identification with some solitary cause. Kurt Schneider
differentiates the 'comhative fanatic' (aggressive fanatic) from the 'dampeddown or more reserved fanatic'. The former will assert their rights or their supposed rights and are 'querulants'. The latter merely tend to demonstrate and
nurse their convictions. They are the born sectarians, cranks and representatives of esoteric doctrines for which they live with an inner self-assurance and
proud contempt for everyone else. 2
suffer from their abnormality or whose abnormality makes society suffer'

(Kurt Schneider).
Classification according to the basic concept which characterises the group
gives us the following: I. Variants ofhasic personality-disposition which Klages
differentiated according to the 'personality-structure'. 2. Variations of a
supposed biological substratum which has been termed 'psychic energy'.
3. Variants induced by the basic dialectic of all the meaningful elements,
the dialectic ot self-reflection (self-reflective personality-types).
(a) Variations in the hasic personality-dispositions
I. Basic dispositions of temperament. 1 An abnormally excitable temperament (sanguine) reacts quickly and in lively fashion to every kind of influence,
it lights up immediately but excitement dies down equally fast. The individual
leads a restless life, and likes extremes. We get a picture of vivacious exuberance or of an irritable, troubled hastiness, a restless psyche with a tendency to
extremes. The opposite pole is then a phlegmatic temperament. Nothing moves
this individual out of his peaceful placidity. He hardly reacts at all and when
he does he does so very slowly with prolonged after-effects.
An ~normally cheerful (euphoric) individual bubbles over happily. He is
blissfully light-hearted about everything that happens to him and is contented
and confident. The happy mood brings a certain excitement with it, including
motor-excitement. A depressive on the other hand takes everything hard, his
mood is always clouded, he sees the worst of everything and tends to keep
quiet and immobile.
2. Basic will-power. 2 Basic powers of will differ greatly from one man to another, independently of drive or content. Wealc-willed individuals make any
effort of will with much difficulty. They tend to let everything slide. Those
who have no will-power at all, the drifters, simply echo any influence that
impinges on them. They cannot resist and follow wherever they are led by
opportunity or other people for better or worse. They may make a show of
momentary energy but never stick at anything unless an unchanging environment keeps them to it. Otherwise they follow every fresh impulse evoked
by a world that constantly transforms them. They change colour with their
environment. Strong-willed individuals bring unusual energy and perseverance
to all that they do. Their activity pushes everything else aside with a relentless
assertiveness. It is as if they could not shake anyone's hand without crushing
it or take up a cause without realising it.
.
, 3. Basic dispositions of feeling and drive. An individual's nature is most
decisively determined by the complexity or the poverty of his drives. Abnormal
variations in the quality of the personality proper, of the whole system of
instinctual and emotional dispositions, are more profoundly important for the
1
2
(h) Variations in psychic energy (the neurasthenic and the psychasthenic)
We speak of neurasthenic and psychasthenic syndromes. They may be

characterised perhaps as follows:
I. The neurasthenic syndromeS is defined by 'irritable weakness'. There is
on the one hand exceptional irritability and sensitivity, a painful sensibility and
abnormal responsiveness to stimuli of all kinds. On the other hand we find
abnormally quick fatiguability and slow recuperation. Fatigue is subjectively
l,Longard, Arch. Psychiatr. (D), vol. 43. F. Scholz, Die moralische Aniisthesie (Leipzig, 1904).
Dubttscher, Z. Neur., vol. 154 (1936), p. 422. Binswanger, (Jher den moralischen Schwachsinn mit
hesonderer Beriicksichtung der kindlichen Altersrufen (Berlin, 1905).
2 Kolle, 'Ober Querulanten', Arch. Psychiatr. (D), vol. 95 (1931), p. 24. Stertz 'Verschrobene
Fanatik~r:, Bert. klin. Wschr., v~1. 1 (1919). Grohmann, Die Vegeterieransiedlung i~ Ascona (Halle,
1904). Em sozmles SondergebIide auf psychopathischer Grundlage', Psychiatr.-neur. Wschr.,
vol. 1 (1904). ~reuser, 'Ober Sonderlinge', Psychiatr.-neur. Wschr., vol. 1 (1913-14).
8 Beard, Dze Nervenschwache (D), (Leipzig, 1883). Mobius, Zur Lehre von der Nervositfit.
Neurol. Beitriige. Heft. 2 (Leipzig, 1894). Krafft-Ebing, Nervositiit u. neurastl,.nische Zustiind.
(Vienna, 1899). MUlier, Handbuch der Neurastl.enie (Leipzig, 1893). Binswanger, Die Neurastheni.
(Jena, 1896). Bumkc's Handhuch, vol. 5.
Kretschmer gives an admirable portrait, Kiirperhau u. Charakter, 2nd edn. (193 6), ~p. II~-H.
Birnbaum, Die krankhafte WiliensschlViiche (Wiesbaden, 1911). E. Gra~sel, Dze If/iilens-
schwiiche (Leipzig, 1937).
441
f
442
strongly felt. There are innumerable discomforts and pains, a dull feeling in
the head, everything seems affected and the patient feels battered with intense
feelings of fatigue and weakness which turn into lasting phenomena. This
syndrome covers all those phenomena that are known as sequelae of fatigue,
of exhaustion, overwork and excessive effort but no more than these, and
provided such phenomena appear after the slightest stimuli or effort or remain
as permanent accompaniments through life.
2. The psychasthenic syndrome 1 is less easily detected. The phenomena are
many and varied and are held together by the theoretical concept of a 'diminution of psychic energy'. The diminution shows itself by a general low level of
psychic resistance to experience. The individual prefers to withdraw from his
fellows and not be exposed to situations in which his abnormally strong 'complexes' rob him of presence of mind, memory and poise. Self-confidence
deserts him. Compulsive thoughts arrest consciousness or chase through it and
he is tormented by unfounded fears. Indecision, doubts, phobias, make
activity impossible. A host of abnormal psychic and emotional states are
scrutinised and analysed by a compulsion-like self-observation. This results
unavoidably in an inclination to do nothing and daydream, and this makes all
the symptoms worse. There is occasionally a rush of intoxicating happiness
from an impression made by personalities that are idolised but imperfectly
understood, or by some quite ordinary landscape which suddenly seems most
magnificent, but usually this is paid for by a painful relapse into morbid
symptoms. The psyche generally lacks an ability to integrate its life or to work
through and manage its various experiences; it fails to build up its personality
and make any steady development.
On rare occasions syndromes such as these occur as states of genuine
exhaustion or as concomitant phenomena of disease processes. (Some of
Janet's cases of psychasthenia are obviously in part schizophrenic.) But they
are so closely linked with meaningful contents of the individual life-history
that they appear more as personality-variants than syndromes, and as such can
be characterised by the diminution of psychic energy and in fact are often
linked with some somatic and physiological weakness though they may also
occur without this.
Thus one could say that all the variations of personality and temperament
may occur as psychasthenia. They may be termed this when there is a prominent element of weakness, a lack of energy and a reduction in effectiveness,
when drives are weak and faint, emotion less vivid, the will powerless and performance in any direction grows modest. The best way to describe this type is
to make use of the analogy of deficient psychic energy. There is no doubt that
something of this SOrt does exist among the congenital variations.
There are a number of peculiar phenomena which in a mild degree are
widespread and can at times also occur as symptoms of phasic and other illness
but which we are accustomed to call symptoms of personality-disorder when
they are both numerous and troublesome and when there is no manifest illness
but something like an illness that dominates the individual's whole life. To
these belong compulsive phenomena, the carriers of which are called anankasts
(on the basis of the uncertainty of the self, according to Kurt Schneider), also
depersonalisation and derealisation, etc., the carriers of which are called
psychasthenics.
1 Janet, Les ohsessions et fa psychastMnie, ~nd cdn. (Paris, 1908).
443
(c) Reflective personalities

The personalities we have depicted so far may be understood in terms of a
~onstituti~n :whi~h they have always had. The so-called reflective personality
IS to be dlstlOgUlshed from these as a personality-formation resulting from
awareness of self, from attention directed to one's own nature together with the
purposive wish to be 'like this or that'. To this group belong, for example:
I. Hysterics. In psychiatry the term hysterical has several connotations:
physical symptoms (hysterical stigmata), transient abnormal psychic states
with altered consciousness (accidents mentaux) and hysterical personality. It is
unfortunate that the same term is given to them all, particularly as hysterical
personality is ordinarily used to cover very heterogeneous material. Janet
rightly says: 'Hysteria can affect all kinds of people, good and bad. We must
not ascribe to the illness personality-traits that would have been there anyhow.'
Hysterical personality is common enough but it is not always linked with
hysterical mechanisms. Moreover, the types of personality which are called
hysterical are very varied. 1 To characterise the type more precisely we have to
fall back on one basic trait: Far from accepting their given dispositions and life
opportunities, hysterical personalities crave to appear, both to themselves and
others, as more than they are and to experience more than they are ever
capable of. The place of genuine experience and natural expression is usurped
by a contrived stage-act, a forced kind of experience. This is not contrived
'consciously' but reflects the ability of the true hysteric to live wholly in his own
drama, be caught up entirely for the moment and succeed in seeming genuine.
All the other traits can be understandably deduced from this. In the end the
hysterical personality loses its central 'core' as it were, and consists simply of
a number of different exteriors. One drama follows another. As it can no
longer find anything within, it looks for everything without. It wants to
experience something extraordinary with its natural drives. It does not rely on
the normal processes of life but wants to use these for aims that make the
simple drive uncertain or get lost altogether. Through unnecessary and exaggerated expressions it tries to convince itself and others of the existence of some
intense experience. It is attracted to anything external that offers strong stimulus, to scandal, gossip, famous personalities, anything impressive, extravagant,
or extreme in art or outlook. Hysterical personalities have to ensure their Own
importance and so playa role and try to make themselves interesting every1 cpo Kraepelin, for his description in his Lehrhuch; also Klages, Die Prohl.me der Graphofogie,
pp. 81 If.
444
where even at the expense of their calling or integrity. If unnoticed for even a
brief period, or if they feel they somehow do not belong, they grow unhappy.
Such situations immediately make them aware of their inner emptiness. They
are therefore extremely jealous if others seem to trespass on their own particular
position or sphere of influence. If they cannot otherwise succeed, they will get
attention by falling ill and playing the part of a martyr, a sufferer. Under some
circumstances they will be reckless with themselves and inflict self-injury; they
have a wish to be ill, provided they reap the reward of some corresponding
effect on others. In order to heighten life and find new ways of making an
effect, they will resort to lying, at first quite consciously but soon this becomes
unconscious and they come to believe themselves (pseudologia phantastica)l:
there are self-accusations, accusations against others of invented sexual assaults,
a pretence to strangers that they are important personalities, very rich or of
high rank,etc. In all this the patients notonly deceive others but themselves as
well. They lose awareness of their own reality and their fantasy becomes their
reality. But there are certain distinctions to be drawn. In one case we find complete unawareness of falsehood-'I did not know I was lying'. In another case
we find parallel awareness 'I was lying but could not help myself'. 2 The more
the theatrical aspects develop the more these personalities lose any genuine,
personal affect. They become unreliable, are no longer capable of enduring
emotional relationships and never reach any real depth. All that is left is a stage
for imitative and theatrical performances, the perfect artifice of the hysterical
personality.
The nature of hysterical personality has long been known to psychologists with
understanding. Shaftesbury used to speak of 'enthusiasm that is as it were secondhand'. Feuerbach describes a 'feigned sensibility which seems to tickle the inner
senses compellingly with something that is not really felt but only imagined as felt'.
'In such a state the individual tries to deceive himself and others with a mere grimace
of feeling, and as this grows habitual he ends by profoundly poisoning his surest
source of truth, his inner feeling. Deception, lying, falsehood, treachery and everything that goes with it-these are all seeds of enormous growth in a psyche which is
used to falsify its own feeling and, moreover, they very easily suffocate any genuine
feeling. This explains why a feigned sensibility can be reconciled not only with a
definite coldness but with downright cruelty.'
2. Hypoclwndriacs. It is abnormal for the body as such to play an important
part in the individual's concern. The healthy person lives his body and does
not think about it. He pays no attention to it. The mass of physical suffering
is largely due to psychic reflection rather than any manifest physical illness.
Excluding what might be due to a labile physical constitution (asthenia) and
what are typical somatic accompaniments of psychic events, we find we are left
with a whole field of physical suffering which arises from self-observation and
1 Delbriick, Die pathologische Luge (Stuttgart, 1891). IIberg, Z. Neur., vol. 15 (1913). Stelzner,
'Zur Psychologie der verbrecherischen Renommisten', Z. Neur., vol. 44 (19 19), p. 391.
2 Wendt, Allg. Z. Psychiatr., vol. 68, p. 48:z..
445
worry and which steadily increases as the body becomes more and more the
centre of an individual's life. Self-scrutiny, expectation and dread all disorder
:he bodily fu~ctions, ~ive rise to pain and cause sleeplessness. The fear of being
III and the WIS? to ~e 1~llead a c.onstant reflection on the body and together
t~rn the C~~SClO.us hfe l.nto a l~fe with a sick body. The person is not physically
SIck but stul he IS not slmulatmg. He feels he really is sick, that his body has in
fact change~ and he suffer~ like any sick person. The 'invalide imaginaire' is in
some pecuhar way really tIl by reason of his own nature.
3 The self-insecure personalities (Schneider, whose description I follow
he~e) or the sen.:i~i~e p~rs~nality (Kretschmer): In these cases a continuously
helghten~d sensl~lht~ Imposed on a reflective awareness of insufficiency.
The s:lf-mse~ure .mdlVl?Ual finds every experience a disturbing one because he
expenences It .'V:1th . heIghtened se~sitivity instead of working through it
~aturally and glvmg It some approprIate form. In his own eyes his performance
IS no~ sufficient. His position vis-a.-vis others always seems to him under
questlOn. Actual or merely imagined failure becomes a matter for selfaccusation. J:Ie will look for the fault in himself and does not forgive himself.
When workmg over his experiences inwardly, he does not repress so much as
have an extra battle with himself. He leads a life of inner humiliation and
defeat brought about by outside experiences and his interpretation of them.
The h~lp~ess urge to ~et some external confirmation of this inner grinding selfdepreCIatIon makes hIm see more or less intentional insults in the behaviour of
other ~eople. T~is may reach the degree of delusion-like ideas (without these
becom~ng delUSIon proper). He suffers immensely from every external slight
for whIch he once more seeks the real reason in himsel Self-insecurity of this
~ort le~ds to ?ve~-c?~pensation for feelings of inferiority. Compulsive-like
formality, whIch IS rIgIdly adhered to, strict social observances lordly gesture
~xaggerat~d displays of assurance, are all masks for the inner bo~dage. Demand~
mg behavlOur covers the actual timidity.
:0
!S
II.
PERSONALITY-CHANGE DUE TO A PROCESS
~e differentiate abnormal personality-types that are Anlage-variants, as

descnbed above, from sick personalities in the narrower sense, where the
change has been brought on by a process. The fact that most mental illness is
accompanied by a marked change in personality has given rise to the statement:
ment~l illness is an illness of personality, but we can see mental patients
su~ertng from fals.e per~eptions or even delusions, and yet not showing any
notIceable change m theIr personality at this particular stage. Further, we find
acute psychoses that lead to total fragmentation of psychic life into a number
of unconnected acts where one can no longer speak of a personality at all, yet
o11.e can unex~ectedly trace the natural, unchanged personality, temporarily
vet!~d, for ,;hlch one can have empathy. It shows itself in the patient's perpleXIty and m the occasional questions and judgments he puts forward.
All the personality-changes brought about by a process have in common

the limitation or disintegration of the personality. The term 'dementia' used in
such cases implies disturbance in intelligence, memory, etc., and also a change
in personality.
(a) Dementia due to organic cerebral processes

Certain character traits seem due sometimes to processes of this sort. Thus
we find jocularity (Witzelsucht) with certain brain-tumours, 'gallows-humour'
in alcoholics, religiosity, habitual lying and pedantic meticulousness in
epileptics, and euphoria in multiple sclerotics.
Such traits can be explained partly in the same way and using the same concepts as apply to other changes. The process removes the acquired inhibitions,
instinctive impulse is translated into action at once without any counter-image
or counter-tendency. Once ideas are evoked, they take immediate effect. A
paralytic, for example, can easily be made to cry and then laugh by the evocation of opposing ideas ('incontinence of affect').
Disintegration goes furthest in the known organic cerebral processes such
as Paralysis (and similarly in severe arterio-sclerosis, Huntington's chorea and
other organic cerebral diseases).
(b) Epileptic dementia
Epileptics who are victims of a progressive process show typical changes
in their nature. l The slowing down of psychic events (down to the level of the
nervous reflexes) shows itself in increasing difficulty of comprehension and the
enormous prolongation of reaction-time. To this is added a tendency to
perseverate. The affect tends to linger on and stereotypies develop. The loss of
spontaneity and activity is accompanied by an elementary, urgent but aimless
restlessness. Egocentric touchiness and a craving for constant approbation
leads to increasing irritability and explosive reactions. Brutal motor discharges
may occur in patients who otherwise are quite inoffensive. There are also
descriptions of the so-called 'clinging' patient and attitudes of ingratiating
effusiveness. Nervous tension and empty affect complete the picture. The
constrictedness of the patients which makes them appear taut, rigid, pedantic
and circumstantial can look like conscientiousness, conservatism and solidity
etc.
(c) 'Dementia' in schi{ophrenia
Among the personalities which are due to a process, those of the schizophrenic group deserve special mention. Many chronic mental hospital patients
belong to this group. Variation in personality may range from a very slight
alteration in the individual due to a reduction in understandability, to almost
1 K. H. Stauder, Konstitution und Wesensveriinderung der Epileptiker (Leipzig); Max Eyrich,
'Ober Charakter und Charakterveranderung bei Kindlichen und Jugendlichen Epileptikern',
Z. Neur., vol. 141 (1932.), p. 640'
:'(
447
complete fragmentation of his personality. It is not easy to see any common

factor. Earlier psychiatrists tried to characterise something which they called
'affective dementia'. Nowadays we lay additional emphasis on the lack of
integration in thinking, feeling and volition, and on the inability to recognise
reality as reality and take it properly into account (Bleuler's 'autistic thinking',
that is, thinking turned in on itself and on its phantasies with no regard for
reality). At the same time, the tools of intelligence remain intact. It is easier to
describe the common factor in subjective terms, that is, in terms of the effect on
the observer, rather than try to do so objectively. All these personalities have
something baffling about them, which baffles our understanding in a peculiar
way; there is something queer, cold, inaccessible, rigid and petrified there, even
when the patients are quite sensible and can be addressed and even when they
are eager to talk about themselves. We may think we can understand dispositions furthest from our own but when faced with such people we feel a
gulf which defies description. Also, they do not find those things puzzling
which for us are quite unintelligible. They may run away from home for a
trivial reason which seems quite adequate for them. They do not draw the
obvious consequences from facts and situations, they have no adaptability and
show a puzzling angularity and indifference. One such type is the hebephrenic
personality, which has been characterised as an hypertrophy and an arrest in
devE:1opment of the awkward traits of adolescence. If we study the nature of
these people closely, we find we have to create a large number of types which
we shall not distinguish here. The mildest personality change consists in a
growth of coldness and stiffness. Patients lose agility, grow much quieter with
less initiative.
How the schi'{ophrenic personality views the change. Some patients with a
mild degree of illness will talk about how their nature has changed. They are
'less excitable', 'their interest is shallower but they talk much more'. They
notice that they keep on talking and cannot stop but show no kind of agitation.
They sometimes observe that they are staring into the comer for no particular
reason and that their general performance is suffering. Some can only say that
they feel 'a profound change' has taken place. They feel 'they are not as
flexible as before' and not so excitable. H61derlin has expressed this knowledge
of the schizophrenic change in himself in simple and moving words:
W 0 bist du? Wenig lebt ich, doch atmet kalt
Mein Abend schon. Und stille, den Schatten gleich
Bin ich schon hier; und schon gesanglos
Schlummert das schauemde Herz im Busen.
(Where art thou? So short my life,
Yet comes my cold evening.
I am here like the shadows, like them
I am silent and my shuddering heart
Has already ceased singing and sleeps in my breast.)
Later on, in the advanced state of his illness, he wrote:

Das Angenehme dieser Welt hah ich genossen
Der Jugend Freuden sind wie lang! wie lang! verflossen,
April und Mai und Julius sind feme.
!eh bin nichts mehr, ich lebe nicht mehr geme.
(1 am no longer party to this world's delight,
The happiness of youth fled long, how long, ago,
April, May, July 1 cannot reach,
Now 1 no longer live and have no joy.)
NAME INDEX
Abderhalden, 165,474
Ach, 156
Adler, 83, 815
Albrecht, 686, 781
Alkan, Leopold, 239
Alkmaon, 787
Allers, 389
Alter, 76
Alzheimer, 564, 576
Amann, 467
Andree, Richard, 335, 734
AnschUtz, Georg, 62
Anton, 396
Aquinas, Thomas, 724, 73 I
Aristotle, 202, 3 I S, 320, 753, 761
Arndt, 419, 616, 716
Artemidor, 373
Aschaffenburg, 118,166,209,465,688,726
Augustin, 315, 756, 821
Azam, 404
Babinski, 238
Bachofen,334
Baelz, 368, 389
Baer,266
Baerwald, 178
Baeumler, A., 333
Bahnsen, J., 43 1
Balzac, 314
Bappert, 207
Barth, Elfriede, 727
Bastian, 335
Baudelaire, 57, 126, lSI, 467
Bauer, I., 634
Baum, Joseph, 467
Baumgarten, Franziska, 683
Bayer, W. v., 282, 519, )22
Bayerthal,49 1
Bayle, 358
Beard, 441, 742
Beck, Ed., 723
- K., 237
Becker, 477, 828
Behn, Siegfried, 320
Behr, Albert, 290
Benary, 199
Benn,685
Berger, H., 231
Bergmann, v., 229, 238
Bergson, 83
Beringer, 57, 143, 164,213,467,485,646,
668,733
xliii
Bernds, M., 732

Bernheim, 379, 835
Bertschinger, 393
Berze, J., 124,498, 581
Betzendahl, W., 706
Bichat, 48o
Bickel, H., 230
Binder, H., 133, 321
Binet, 220, 404
Bingel,464
Binswanger, Ludwig, 80, 160, 209, 21 I,
281, 286, 302, 373, 540, 673, 749
- Otto, 141, 238,441
Birnbaum, 409, 440,597
Bischoff, 498
Bjerre, Andreas, 329, 725
Bleuler, 62, 217, 313, 328, 343, 392,410,
447,537,54,565,567,578,584,693,
697,7 11 ,84 1,849,857
Bloch, 235
- I., 321, 627
- Oskar, 478
Bliiher, Hans, 733
Blum, F., 7
Blume, 76
Bobertag, 220
Bolk,660
Bon, Gustave Le, 377,737
Bonhoeffer, 128, 141, 220, 386, 389, 468,
47;, 482, 593, 69 1, 7 19, 7 27, 834,
846, 854
Bonvicini, 421
Bornstein, 392
Boss, M., 399, 834
Bostr6em, 485, 684
Boumann,86
Bourget, 15
Bovet, Th., 73 I
Braid,848
Brandenburg, 29 I
Bratz, 237
Braun, 470
Bremer, F., 638
Breuer, 404, 406, 537,835
Briner, 844
Brinkmann, 684
Briquet, 237
Broca, 481
Brodmann, J., 592
Brown-Sequard,483
Bruns, 685
-Ivo, 431
xliv
NAME INDEX
Buchner, Lothar, 2.I7

Biihler, Charlotte, 683
BUhler, Karl, 3, 167, 271, 682
BUrger, Max, 683
BUrger-Prinz, Hans, 202, 208, 280, 706,
72 9
Bulle, 263
Bumke, 3, 133, 23 0, 302, 465, 567, 709,
743
Burckhardt, Jakob, 333
Busch, 207
Bychowski, 42 I
Calmeil, 565
Candolle, de, 498
Carrell,83
Carus, C. G., 264
Cervantes, 731, 786
Chamfort, 3 I 5
Charcot, 237, 4 25, 571, 734, 791, 848
Cicero, 701, 787
Clauss, L. F., 263
Conrad, Klaus, 268, 523, 525, 562, 656,
7 22
Correns, S07
Cramer, 90, 280, 581, 589
Creuzer, 333
Crinis, de, 491
Curtius, Fr., 266, 502, 521, 57%, 638,
7S%
Cusanus, Nikolaus, 7S3
Dacque,663
David, J. J., 57
Damerow, 794, 8so
Dannenberger,498
Darwin, 241
Dees, 840
Delbrlick, 440
Descartes, 1%2, 223 f., 480
Dexler,7
Diem, 499 f.
Dilthey, 301
Dix, W., 408
Dobrick, 848
Dorer, 184, 2.IO, 419, 842
Dostojewski, 85, 116, 144, 314, 390, 545,
73,786
Dreyfus, 238, 843
Droysen, 301
Dubitscher, 441
Dubois, Paul, 837
Duchenne, 257
DUbel,616
DUrck,Johanna, 330
DUrer, 731
DUser, 646
Ebbecke, U., 232
Ebbinghaus, 3, 173, 22.I, 302

Economo, C. v., 479
Edet, 191
Ehrenwald, 82
Eicheberg, 235
Eliasberg, 218, 721, 740
Elsenhans, Th., 3
Emminghaus, 39, 582, 685, 739, 8)2
Enebuche, 230
Engelken, 114
Enke, W., 266
Entres, 497
Epicurus, 477
Eppelbaum, 178
Erb,742
Erdmann, J. E., 682
Erlenmeyer, 273
Ernst, Paul, 725
Esquirol, 732, 849, 853 f., 856
Esser, 608
Estabrook, 498
Ewald, G., 396 f., 474
Exner, Franz, 726
Eyrich, Max, 446
NAME INDEX
Fritsch,481
Frobes, S. J., 3
Flirbringer, 627
If
Fahrenkamp, K., 470

Faria, 848
Fauser, 27%, 474
Faust, J., 233, 272, 836
Fehrlin, 57
Feuchtwanger, 218, 740
Feuerbach, 394, 444, 607
Fischer, 292
- Eugen, 507
- Fr., 57,64,81 ff., III, 117, 126
- G. H., 270
Fishberg, 741
Flach, 689
Flourens, 481
Flournoy, Theodore, 404, 736
Forel, 57, Ill., 128, 379, 7 11 , 833, 835,
848
Forster, 75, 118
Foerster, 0., 183
Fort, G. v. Le, 626
FouilJee,7 11
Frank, 404, 836
Frankel, F., 57, 92, 103, 126, 183, 361,
467,469
Frankhauser, 498
Freeman, 834
Freud, 244, 302, 306 f., 3 18 , 343, 344, 3S 963, 366, 373-8, 396, 404, 406, 410,
53 2,537-40,546,630,699,739,7735, 83, 80 5 f., 81 3, 835, 855
Freymuth, 279
Friedmann, 119, 133, 409, 412, 629, 641,
68 9
Frischeisen-Kohler, 520
Galant, 289
Gall, 262, 481 f.
Galton, Fr., 49 8, 525, 832
Ganser, 194, 277, 391, 40 7
Gaspero, Di, 638
Gaupp, Robert, 6, 233, 278, 29 1, 389, 413,
427, 564, 605, 613, 679, 682, 688,
7 19,7 23,855
Gebsattel, v., 83, 133, 204, 281, 285 f.,
321 , 323, 395, 4 22 , 534, 54-6,
80 3
Geiger, 108
Georgi,229
Gehrmann, 291
Giese, F., 165, 721
Gjessing, R., 248, 474 f.
Glaser, 238, 280
Glaus, 613
Gobel,752
Goring, M. H., 811
Goethe, 92, 256, 264, 275, 314, 327, 339,
372, 73 1
Gottke, 399
Gogh, van, 284, 287, 294, 655, 729 f.,
733
Goldscheider, 233, 273
Goldschmidt, R., 507,631
Goldstein, K., 483
- and Gelb, 170, 199
Goltz, 483, 486
Gorn, 229
Gowers, 689
Graf, 0., 206, 52o
Grafe, 235
Grassl,440
Gregor, A., 165, 171, 229, 727
Greving, H., 250
Grien, Hans Baldung, 73 I
Griese, F. R., 262
Griesinger, 367, 459, 482, 788, 849 f.,
853
Grohmann, 441
Groos, 788
- Karl, 682
Gross, 343, 546, 68 5
Grotjahn, 717
Gruhle, H. W., 41,57,73 f., 103, 112, 115,
121,123,128,185,236,279,32,415,
533,581,59,69,725,727,788,790,
840
Grunau, 740
Grlinthal u. Storrung, 176, 204
Gudden, 483
Glitt, 832
Guttmann, 597
xlv
Hacke, 740
Hacker, 144
Hagen, F. W., 23, 64, 98, 725, 795, 85 1
Haflervorden, 404
Hansen, 235, 239, 848
Hartmann, 605
Hauptmann, 202, 478, 629
Havelock Ellis, 321, 627
Haymann, 248, 465
Head, 88, 167, 19,483
Hecker, 276, 513, 68 5, 735, 849
Hegel, 55. 264, 281, 315, 343, 533, 821
Heiberg, 845
Heidegger, 776
Heidenhain, A., 729
Heilbronner, 171, 175, 191 f., 203, 29,
212, 279, 419, 595, 688, 828
Heilig, 723
Heim, Albert, 368
Heinroth, 639, 788, 85 1
Heise, 498
Heller, 235, 841
Hellpach, 408, 457, 723
Hellwig, A., 736
Helwig, Paul, 432
Henneberg, 194
Hennig, 62
Herschmann, 400
Hetzer, H., 699
Heugel, Dorothea, 836
Hey, Julius, 194, 391
Heyer, Gustav R., 235, 245 f., 27 2, 293,
322, 336, 361, 718, 787, 83 6
Hilfiker, 296
Hilker, 270
Hippocrates, 682
Hirsch, Aug., 732, 735
Hirsche, 638
Hirschfeld, 627
Hirschlaff, L., 835
His, 719, 742
Hitzig, 481
Hoche, 144, 280, 389, 569, 581, 588
Hochheimer, W., 199,203
I foffding, 108
Holderlin, 284, 287, 291, 294,729,733
Honigswald, 211
Hoepffner, 151
Hoffmann, E. T. A., 730
- W., 683
Homburger, A., 180,238,389,685
Homer, 339
Hoop, van der, 302
Hom, P., 720
Husserl, 3,55
Ibsen, 329, 786
Ideler, K. W., 57, 125,282,639,731,7)5,
755, 8SI
xlvi
NAME INDEX
NAME INDEX
Ilberg,44I
Isserlin, 166, 289, 302, 597, 727, 834
Jackson, Hughlings, 533, 789
Jacobi, Wilhelm, 73 I
Jaensch, E. R., 68, 475, 682
Jahn, D., 250
- Ernst, 731
Jakobi, 57, 851, 854
Jakoby, H., 273
James, 57, 63, 467
Janet, 57, 62, II4, 122, 124, 175, 277,
402 If., 442 f., 532, 539, 641, 688, 8S4
Jankaus,721
Jauregg, 833
Jentsch, 476
Jeremiah, 764
Jerusalem, 738
Jeske, 716
Jespersen, Otto, 288
Jessen, 787, 850
Jessner, L., 290
Joachim, 717
Jodl,108
Joel, 57, 92, 103, 126, 361, 467, 469
Joerger, 498
Johannsen, 634
Jolly, 630
Jong, H. de, 230
Jonge, Kiewiet de, H2
Jores, Arthur, 471 If., 625
J essmann, 720
Jung, C. G., 166, 220, 293, 332 If., 332-9,
334, 361 , 37 1, 410, 43 6, 540, 700,
709,724,729,739,773, 812 f., 815 f.
- Richard, 144,231
Junius, 616
Just, GUnther, 497
..
Kafka, 474
Kahlbaum, 64, 75, 126, 181, 192, 276,
566 -73, 606, 849, 852
Kahn, 39 2, 733
Kaila, 202
Kandinsky, 57, 64, 68 f., 74, 192
Kant, 36, 216, 33 1, 387,420,431. 4P, 454,
480, 560 , 756, 759, 821, 8S6
Kassner, Rudolf, 265
Katsch, 229
Katz, D., 89, 319
Kaufmann, 592, 835
Kehrer, 369, 4II, 455, 614, 629, 687, 719,
83)
Keller, Helen, 397

Kern, B., 206
Kielholz, 360
Kierkegaard, 315, 329, 350,360,425 If.,
701 ,73 1,754,773 f., 776, 814, 821
Kieser, 57,73
Kihn, B., 490

Kirchholf, Th., 271, 717, 844
Kirschbaum, 685
Klages, L., 14, 2P, 264, 270 f., 319, 329,
333 f., 344 f., 351,432-8,74,754,788
Klasi, 229, 272, 834
Klein, R., 91
Kleist, 180, I8i, 202, 389, 482 , 572
Klien, 83, 171
Klieneberger, 828
Klinke, 57, 103
Kloos, Gerhard, 83 If., 94, 119, 220, 296,
470, po, 544, 68 9, 729
Klose, 491
Knauer, 230
Koch, J. L. A., 439
Kohler, 144
Koppen, 827
Koster, 273
Kohnstamm, 235, 239, 387, 533
Kolbe, p2
Kolle, Kurt, 441, 614, 649 If.
- G., 47 1 , 499
Kollibay-Uter, Hanna, 464
Korbsch, 466
Korsakow, 592
Kraepelin, 144, 165, 178, 184, 194,205 If.,
443,4 6 5,468 , S62, 566 -73, 585, 589,
606, 614, 622, 628, 718, 733, 844,
849, 8p If.
Kralft-Ebing, v., 321, 441, 627, 629, 850,
853
Krambach, 473
Kranz, H., P5
Krapf, 613
Kraus, 627, 634
Krauss, 726
- Fr., 373
Kreichgauer, 502
Kreiss, 367
Kretschmer, E., 40 f., 266-8, 302, 327, 390,
406, 409, 4 25, 43 6, 438 If., 445, 4H,
488 , 533, 562 , 588,623,638 f.,64 I 68,669,734, 855, 857
Kreuser, 441, 844
Kreyenberg, 292
Krisch,650
Kronfeld, 57, II8, 171, 302, 321,604
Krueger, 279,491, 501
KUhn, Alfred, 507
KUhnel, G., 262
KUlpe, 3, 36, 108, 156, 167, 209
Klimmel, W., 237
Klinkel, 344, 347, 641
Kunz. Hans, 281, 540, 774 f.
Kutzinski, 827
La Bruyere, 3 I 5
Laehr, Heinrich, 723, 845
Landauer 272
Lang, Theo, 632 f.
Langbehn, 706, 729
Lange, Fritz, 271
- Johannes, 21 5, 497 f., 519, P5, 59 6,
614,632,649,670, 8p, 855
- Wilhelm, 728
LangelUddeke, A., 207, 273
La Rochefoucauld, 3 I 5
Lavater, 264, 275.
Lehmann, Alfred, 736
Leibbrand, Werner, 858
Leibniz, 226
Lenz, 291, 507,722
Leonhard, R., 590
Lersch, Ph., 270
Leschke, 229
Lessing, 721
Leuba, James H., 731
Leubuscher,734
Levenstein, 71 I
Levy, 380
- E., 272
Levy-BrUhl, 738
Levy-Suhl, 827
Lewandowsky,23 8
Lichtenberg, 264
Liebault, 848
Liebmann, 191
Liepmann, 139, 151, 166, 170, 180, 187 f.,
29, 21 4, 482, 537, 564, 59 2
Lipmann, 0., 371
Lipps, Th., 108, II7, 139, 343, 379, 53 2
Lissauer, 170
Lowenfeld, 133, 627
Lombroso, 266, 726
Lomer, 273, 597
Longard, 441
Lorenz, I., 638
-K',7
Lottig, 720
Lotze, R., 117, 525
Loyola, 729, 806
Lucas, Pr., 498
Lundborg, 498
Luniatschek, 729
Luther, 15, 501
Luxenburger, H., 438, 497, 517, pI f.,
P5, 528, 564, 655, 7 16, 722 , 786
Macdougall,3 19
Maeder, A., 410, 774
Magnan, 50S, 565, 584
Maier, Hans W., 410, 469
Mann, Thomas 505
Mannheim, 88
Martius, 634
Marx, H., 240, 321, 471, 625
- Rudolf, 333
xlvii
Mathes, 638
Mathias, E., 836
Matusch, 686
Mauz, Fr., P4, 642, 647, 650, 844
Mayer and Mehringer, 189, 194
Mayer, Ludwig, 279, 835
- W',473
Mayer-Gross, 57, 64, 126, ISO, 296, 392,
4 16,467
Mayr, v., 716
Meduna, L. v., 833
Meerloo, 488
Meggendorfer, 616
Mehringer and Mayer, 189, 194
Meier, E., 464
Meinert, 57
Meinertz, J., 778
Mendel, 507 If.
Menninger-Lerchenthal, 92
Menzel, K., 270
Mercklin, 4 I 9
Mesmer, 848
Messer, A., 3, 167
Mette, Alexander, 289
Meyer, C. F., 673
- Max, 686
Meynert, 459, 481 , 546, 56 5, 577, 593,
851
Minkowska, Franziska, 524, 613
Minkowski, 83, 85, 219
Mita, 239
Mittenzwey, 537
Mobius, P. J., 25, 238, 262, 4 2S, 44 1, 49 6,
626, 633, 728, 853
Monkemoller, 717, 733
Mohr, Fritz, 228, 235, 834
Moll, A., 321, 379, 627
Monakow, v., 483
Montaigne, 238, 315, 328
Moreau, J., 498
Moreau de Tours, 467
Morel, 505, 565, 854
Morgenthaler, W., 70, 292, 732
Moritz, K.Ph., 732
Morton Prince, 404
Mosiman, 73 I
Mosse, 717
Moszkowicz, L., 631
Mtihry, A., 732
MUller, 170, 441
- Elias, 167
- G. E., 173
- Johannes, 64 If.
- Ludwig Robert, 478
-M.,833
- Otfried, 333
MUnsterberg, H., 165, 320, 623
Mugdan, 687
Muralt, v., 175
xlviii
NAME INDEX
NAME INDEX
Naecke,395
Naef,595
Nagelsbach, C. F., 333
Naser, Erwin, 470
Nahlowsky, 108
Nansen,390
Neisser, Clemens, 789, 839
Netval, 57, Jl5, 120, 4~3
Neuburger, 845
Neuda,533
Neumann, 849
Newton, 826
Nietzsche, ~93 f., 310, 315,349,360,366,
4 27, 53 2, 729, 73 6, 738, 75 6, 761,
773 f., 776, 785 If., 800, 80S f., 808,
814, hi, 832, 85)
Nioradze, 736
Nissl, Fr., 491, 565, 576, 8S4, 857
Nitsche, 424, 389, 506, 841
Nonne,719
NordenskiOld, Erik, 454
Novalis, 787
Nyiro,408
Oberholzer, 393, 498, 833
Oehlkers, Fr., 50,
Oesterreich, J., 62, 124
- Tr. Konstantin, 735
Oetiker,76
Olfner, 173, 206
Oppenheim, u8, 2.71, 719
Otto, J. H., 740
Pagel,845
Palisa, 689
Pallat, ~70
Pappenheim, 685
Pascal, 315.
Pavlov, 229,233, 235, 242 If.
Pauncz, 291, 297, 321
..
Payer, 390
Peipers, 503
Pelz,234
Peretti, 408
Peters, 174, 520
Petrovich, 408
Pette, H., 684
Pfahler, G., 621
Pfersdorlf, 194
Pfister, 404
Pick, 77, 158,419,421,484, 584,685
Piderit, Th., 270
Pikler, Julius, 12.0
Pilcz, 498, 723
Pinel, 842
Pinner, 235
Pitaval, 725
Plaskuda, 15, 183
Plato,315,335,336,701,756,765,786,814
Plessner, H., 270

Plotzl, 93, 232, 421
Plotinus, 335
Plutarch, 328
Poe, E. A., 730
Poehlmann, ~38
Polisch, 526
Pollak, ~35
POPP,7 J1
Poppelreuter, W., 165
Popper, 3~9
Preuss, K. Th., 738
Preyer, W., ~58, 273, 68~
Prinzhorn, Hans, 292, 750, 803, 834
Putter, 682
Pusch-Weber, 503
Puysejur, 843
Quincey, Th. de, 467
Radbruch, 726
Radl, Em., 454
Racke,688
Raecke, 39 1, 593
Rahm, 239
Ranschburg, 173
Rauschke, 118
Redlich, 4 21 , 479
Rehm, 0., 171, 247
Reibmayr, A., 504
Reichardt, 247, 485, 491
Reinhardt, 473
Reinohl,503
Reiss, 502, 640, 703, 739
Repond,473
Ribot, Th., 502, 640, 703, 739
Richer, Paul, ~38, 734
Rickert, 3~0
Ricklin, 175
Riebeling,49 1
Riebeth, 408
Riese, 89
Riklin, 393
Ritter, J. F., 736
- R., 498
Ritterhaus, 371
Rodenwaldt, 178, 215
Romer, 178, 498, 605, 7~3, 740, 840
Roenau, E., 343
Rosel, R., 729
Rolfenstein, G., 302
Roggenbau,540
Rohde, Erwin, 333, 73 6
- Max, 723
Rohleder, H., 321, 627
Rosenberg, 498
Rosental, Stefan, 689
Ross, 390
Rothfeld, 184
Rudin, Ernst, 389, 500, 513, 832

Rumke, 112 If.
Ruffin, H., 175,484
Runge, 630
Ruttke,83 2
Saethre, 593
Samberger, 228
Same, 687
Sandberg, 97
Saudeck, Rob., 273
Saukel, M., 833
Saulle, Legrand du, 50S
Schabelitz, H., 467
Scheel, 369
Scheid, K. F., 57, 198 If., 250, 474 If., 540
Scheid, Werner, 173, 178
Scheler, 320, 325
Schelling, 333, 33 8
Schemer, 373
Scheve, Gustav, 262
Schilder, Paul, 88,90, 175, 392
Schiller, 320
- Maria, 208
Schindler, 235
Schloss, 605
Schlub,498
Schmidt, J. W. R., 73 6
- Gerhard, 57, 95, 99, 101 f., 104, 278
- Max, ~68, 6p, 664
Schmoller,711
Schnapper, 716
Schneider, 183
- Carl, 81, 88, 146, 213, 583, 586-92,
839 f.
- Ernst, 76, 165
- Kurt, 57, 61, 99, 109, 116, 12.2, 133,
143, 173,291,302,391 f., 409,439 f.,
445,540,612,652,654,688,7 27,73 1
Schonfeld, W., 273
Schonfeldt, 408
Schoenhals, 408
Scholz, 685
Schott, S., 743
Schottky, J oh., 280, 520, 668
Schreber, 57, 61 f., 106, 141 f.
Schrenck-Notzing, v., 262
SchrOder 212
Schrottenbach, 229
Schule, 841, 850
Schultz, J. H . 176, 227, 235,380 If., 609 f.,
632, 704, 729, 802 f., 834, 836
Schultz-Henke, Harald, 816
Schulz, H., 529
Schwab, 52,71,92, 126, 146, 4 17
Schweizer, Walter, 302
Selz, 167
Serko, 52,62,7,85,91 f., 467
ShaftesburY,444
xlix
Shakespeare, 197,314,339,731,786
Sherrington, 157, 159
Sichel,670
Siebeck, 502, 572, 752
Siefert, 389
Siemer, 390
Sikorski, 290
Silberer, H., 68, 373 f.
Simmei,302
Simon, H., 840
Sioli, 501
Sittig, 0., 533, 789
Sjogren, 516
Snell, 736
Soeur,Jeanne,734
Soldau, W. G., 736
Sollier, 217
Sommer, Robert, 7, 16 5
Sommering, 480
Specht, 128, 207
Spee, Friedrich von, 736
Speman, 160
Spengler, 740
Spielmann, 849 If., 8S4
Spielmeyer, 686
Spiess, Christian Heinrich, 732
Spranger, E., 301, 683
Sprenger, 736
Stahlmann, 2.37
Staudenmaier, 57, 66, 7 2, 93, 129 f.
Stauder, K. H., 446
Stein, Johannes, 65, 126
Steiner, 57, 64, 163, 487, 63 0 .
Stelzner, 444, 503, 62 9, 727
Stern, L., 723
- W., 178, 221, 62.2., 682
Stertz, 142, 191, 4:!.I, 44 1, 473
Stier, 395, 7 23
Stierlin, 386, 389
Stiller, 637, 659
Stoddard, 740
Stohr, 178
Storring, G. E., 39, 176 f., 302
Stoll, Otto, 734
Storch, 21 4, 540, 597,739,779
Stransky, 151, 302, 593
Straus, E., 89, 133, 160, 204, 281, 284,
540 -5.
Str'aussler, 389 If., 828
Strehle, H., 271
Strindberg, 72.9 f.
Stringaris, M. G., 469
Strohmayer, 593, 68 5
Surin, Father, 125
Swedenborg, 103, 2.91, 7 2 9, 733
Swift, Jon., 729
Tarde, 377
Tertullian, 731
NAME INDEX
Theophrastus,43 1
Thiele, R., 118
Thorner, 2.72.
Tiling, 639
Tonnies, 710
Torren, van der, 392.
Tourette, Gille de la, 2.38
Tramer, M., 2.97, 72.7
Trendelenburg, A., 2.02.
Tromner, 2.33, 835, 848
Tschermak, 507
Tuczek, 67, 2.90
Tugendreich,717
Tumlirz, 683
Uexktill, v., 12.
Uhthoif,72.
Unger, H., 2.73
Urbantschitsch, 68
Utitz, 82.8
Vauvenargues, 315
Velasquez, 731
Veraguth, 80, 2.2.9
Verlaine, 72.9
Verschuer, O. v., 525
Vierkandt, 710
Viersbeck,711
Villinger, 388
Vischer, A. L., 389, 390
- Fr. Th., 331
Vocke, 740
Voget, L., 72.5
V ogt. Oskar and Cecile, 490
Voigtlander, Else, 72.9
Vorster, 501
Voss, 2.48
Vries, 507
Wach, Joachim, 301
Waetzoldt, W., 2.63
Wagner-]auregg, 833
Walter, 473
Watt, 156
Watts, 834
Weber, 144,476,848
- Ernst, 2.2.9
- Max, 6, 2.06, 301, 561
- and Jung, 144, 148
Wehofer,62.
Weidenreich, 637, 659, 718
Weil,3 88
Weinberg, 2.31, 503
Weinert, 2.38
Weininger, 0., 62.6
Weitbrecht,57
Weizsacker, V. v., 157,2.18,2.3 6,2.40,2.46,
676 f., 72.0, 791, 803
Welcker, F. G., 333
Wendt, 444
Wentscher, Else, 117
\Vernicke, 181 f., 183 f., 187 if., 190,459,
482., 535-7, 546, 56 5, 577, 584, 605,
851. ft".
WesenhOfer, 660
Westphal, 96, 133, 137, 139, 147,476
Wetzel, 2.95. 389 if., 72.5 f., 72.7
Weyert, 72.1
\Veygandt, W., 408, 465,597,731
Wiedekind, 475
Wiersma, 142., 2.30, 62.1
Wilbrand, 170
Wildermuth, 196
Wilhelm, R., 72.9
Wilmanns, K., 2.38, 2.80, 389, 72.7, 784,
854
Wilsdorf, K., 503
Winter, 711
\Vinterstein, 85
Wirth,139
\Vittermann, 498
Wittig, K., 72.0
Wittkower, 2.43
\Vitzel, 2.17
Wolf, Ch., 630, 633
Wollenberg, 408
Wollny, 49, 57, 106
Wunderlich, 633
Wundt, 3, 142., 167, 2.2.9, 373, 379, 853
Wuth,474
Zangger, 389
Ziehen,1I8
Ziermer, 498
Zimmer, H., 334
Zola, 505
Zucker, Konrad, 2.03, 736
Zutt, 144, 72.0
GENERAL INDEX
Abderhaldens Reaction, 474
Abnormality, abnormal, abnormal mechanisms, 306, 381 if.
a. personalities, 439 if.
a. worlds, 2.81 if.
drives, 32.0 if.
a. dreams, 399 if.
A. as deviation and source of potentiality, 330
- vide: Disease-concept, 779 if.
Aboulia, I I I
Abreaction, 371, 404, 405 if., 835
Absences-vide: Epilepsy, 142.
Absolute, 34 f., 549
relative complex unities as A., 750 f.
causal knowledge as A., 460 if., 546 if.
A. in characterology, 344
psychological knowledge as A., 809 f.
A. and philosophy, 770, 771
Absolution, feelings of, delusions of A., 116, 2.82., 388 if.
Accident Neurosis, 2.07 f., 389 if., 72.0 f.
Accompaniments, somatic A. and psychic expression, 2.53 ff.
somatic A. of psychic life, 2.2.2. ff., 2.2.8 if.
-vide: Body, Psyche
Acromegaly, ()38
Act; intentional A., 61 f.
Act-psychology, 160 if.
links by association or by A., 162. f.
reduction of the A.-synthesis (amentia), 593
Actions, conspicuous A. of patients, 2.78 f.
instinctual and impulsive A., 117 f.
compulsive A., 136 f.
Activity and Passivity, 351 fi".
disturbances of A. and P., 352 if.
A. and reactivity, 32.7 if.
disturbances of A. (catatonic syndrome), 601 fr.
A. of the self, 12.1 if.
Acute and Chronic Psychosis,
basic diiference, 573
schizophrenic experience in the beginning of the A.P., 151. ff.
delusional awareness in A.P., 103 fr.
delirium acutum, 476
attitude of patients to the onset, and to recovery from A. & c.P., 414 if., 42.2 if.
working through the psychotic experience, 416 f.
prognosis, 842. f.
institutional treatment, 840
Adaptation, 696
system (Jung) of A., 337
asocial conduct, 72.4
Adventure and conservatism in the basic attitnde to reality, )28
Affective illnesses, 577 if., 596, 606
heredity of A., 500 f., pi if.
Anlage, 640 f.
Alfective and instinctual disposition, abnormal, 440, 446
affective states, abnormal, 10E IT.
Ii
Iii
GENERAL INDEX
Affective and instinctual (contd.)

symptom-complex, 596 f.
Affects, affective, clouding of consciousness in A., 143
emotional stupidity, no
illusions due to A., 65
overvalued ideas, 107 f.
after-effects of emotionally toned experiences, 370 ff.
transformation of the energy of A., 405 ff.
encapsulated A., 406
'incontinence of A:, 446
compulsive A., l34
physical accompaniments of A., 229
A. in epileptic attacks, 237
Cathartic therapy, therapy in a. disturbances, 835
-vide: Reaction
recovery through strong A., 393
After-effects of earlier experiences, 369 ff.
abnormal A., 394 ff.
After-images, 66 f.
Age; senility, old age, 683, 686, 700 f.
A. and performance-ability, 683
A. and illness, 686
Age-epochs,
biological A., 628 f., 681 ff., 639 f.
biographical, 700 ff.
A. and psychic illness, 684 ff.
Age-epoch; the biological process of life, 68 Iff., 628 f.
psychic relationships, 700 ff., 764 f.
A. and psychic illness, 684 f.
A. and death, 765 f.
Agnosias, visual Agnosias (psychic blindness), 171 f., 199 If.
Agoraphobia, 136
Agraphias, 274
Akinesia, akinetic, 486 f.
a. disturbance of motor activity, 180 f.
Alcohol; alcoholic
a. delirium, 141, lSI
A. (Korsakow), 178 f., 592
A. intolerance, 467, 593
Alcoholism
heredity, 52.7
A. and social situation, 716
-vide: Craving
Alienation of the perceptual world, depersonalisation, 62 ff., 94, 12.1
A. as a characteristic of imagery, 75 f.
A. in the shared world and the growth of new worlds, 117, 72.4
Allelomorphy, 510
Alloy, constitutional A., 645, 661
Alternating consciousness, 143,404 f.
Ambivalence, 343
Amentia (Type), 593
Amimia, 257
Amnesias, amnestic, 148, 174 f., 402. If.
a. disorientation, 172
a. sympton-complex (Korsakow), 592
a. aphasia, 187
A. in hypnosis, 379
A. in the epileptic seizure, 175,237
lifting of A. under hypnosis, 175,404,406 f., 835
GENERAL INDEX
liii
Amputated limbs (sensations), 89

Analgesia, 6 I
Analogy, use and abuse of, 19 f ..
A. in constitution-theory, 653 fl.
Analysis, Analysts, Analysers
Analysers and describers in psychiatry, 849 f., 853 f.
group of complex unities in A., 28 ff.
.
-vide: Unity (complex), Element, Idea, SyntheSIS, Analytical psychology, and
Psycho-analysis
Anamnesis, history-taking, 827
social anamnesis (history), 711 f.
-vide: Investigation
Anankast,443
world of the A., 284 ff.
-vide: Compulsion
Angst-vide: Anxiety
Animal; Man and Animal, 7 If., po, 379,429,763
Psychopathology of A., 7 fr.
Anlage, 12., 15, 430 f., 455 fr., 473, 476, 514 f., 635, 703 f., 832.
hereditary A. in endocrine illnesses, 473
A. and constitution, 635 f.
A. and psychosis, 639 fr., 653 If.
hereditary A. and environment, 514 f., 83 2
.
A. and upbringing, 721 f.
-vide: Heredity, Twin-studies, Constitution, Character, Personality and Bemg-Thus
Anti-social conduct, 72.5 f.
Anxiety, II3, 134, 136,284,384,414 f., 593 f., 59 8,688 f., 80 3
phobias, 136
anxious verbigeration, 193 f.
somatic accompaniments of A., 2.2.8, 239, 245
A. over going mad, 415
A. in heart diseases, 470
fear of death, 477 f.
A. with falls, earthquakes, 368
Apathy, apathetic, III, 417
A.-disorientation in, 172.
A. in traumatic experiences (psychogenic reactions), 368
a. syndrome, 488
Aphasias, 187 fr., 2.14
insight with A., 42.I
A. and localisation, 189 fr., 482, 488 f.
theory-formation, 534 fr.
Apparatus, :U9 fr.
observations of somatic accompaniments, 2.2.9
Apperception and orientation, 171 fr.
disorder of A., 171 fr.
experiments in A., 166
-vide: Agnosias
Apraxias, 180 fr., 183, 2.14, 537
Archaic psychic states, archaic, 737 fr.
a. thinking, in schizophrenia, 214
-vide: Primitive, Collective, Archetypes
'Archetypes' (Jung), 333 fr., 336 f.
Arithmetical ability in imbeciles, 217 fr.
Art, schizophrenic A., 2.91 fr.
question of the creative significance of illness, 729
physiognomy of illness, 262 f.
presentation of the ill person in A., 786
'interpretation-an art', 313
Iiv
GENERAL INDEX
Arteriosclerosis, organic dementia, 218

calcification of arteries, premature, 686
Asocial and anti-social conduct, 724 f.
Association; A-psychology, 160 ff.
A.-mechanism, 161
link by A. and by Act, 162 f.
A. experiments, 166 f.
dissolution of affects, 370 f.
interpretation of psychotic speech on A. principles, 194
flight of ideas, their interpretation, 210 f.
A. theory (Wernicke), 534 ff.
-vide: Aphasias, Localisation
Asthenia, asthenic, 637 f.
polarity of asthenic/athletic, 327 f., 53 1 ff., 659 f.
Asthma, 239, 245
Ataxia, 179
Athetotic movements, 181, 184
Athletic, 267 ff., 642 ff., 658 ff.
Atmosphere; changes in the A. of perception, 62 ff.
- of imagination, 7S
- of the time-experience, 8S
- of space, 81
delusional A., 98 ff.
fluctuation in feeling-tone, 688
psychic A. and vital events, 243
Attack, Phase, Period, 687 ff.
seizures, convulsions, 236 ff., 478
paralysing A.; narcoleptic A., 119 f.
- vide: Epilepsy
Attention, 138 ff.
A. and fluctuations in consciousness, periodic fluctuations, 140 ff., 6S f.
Illusions due to inattention, 6S f.
direction of A. (volitional phenomenon), 117, 191, 242
A. and pain, 228
interference, 352
post-encephalitic motor disorders and the effect of A., 184, 191, 486 f.
schizophrenic phenomena and A., 141 f.
Attitude of patient to his illness, 414 ff.
'Audition coloree', 62
Aura-awareness, A.-ext>eriences, 116, 144 f., 148
Autistic thinking, 328, 447
Autobiography, 71 I f.
Autogenic training, 235, 380 f., 729 f., 802 f., 816, 836
Auto-hypnosis, 379
Automatic, automatically arising disorders of function, 241
acquisition of automatisms, automatisation, 35 I, 353, 370 f., 695 f.
a. mechanisms of association, 161 f.
Automatic obedience, 343, 601
Autosuggestion, 212, 378
Failure of A. in falling asleep, 234
Average, A. and Differentiated, I2 ff.
A. types and Ideal types, 561
Concept of A. and value-concept in the disease-concept, 780 fI'.
- in psychiatry, 783 ff.
Awareness, an, 61
false A., vivid physical A., 78 ff.
delusional A., 103
Awareness of-vide: consciousness of
GENERAL INDEX
Iv
Basedow's disease, after fright, 239

Basic attitude, of this book, 34, 41 ff., 747 ff.
philosophic B., 756 ff.
B. of physician, 805 ff.
Basic function, psychophysical, 198 ff.
methods of investigation, 199 ff., 493 ff.
B. and intelligence, 214 f.
disease-concept, disturbance of B., 790
-vide: Function
Basic knowledge, ultimate knowledge, 330 f., 354 f.
Bastardisation (hybridisation), 503 ff.
Battle-experiences, 568 f., 389 ff.
Being, awareness of, 759, 770 ff.
marginal B. and dogmatics of B., 747 ff.
-vide: Existence, human; Existence, awareness of
Being, dogmatics of and Methodology, 33 f., 42 fT., 348 f., 747 ff., 776 f.
-vide: Ontology, Theories
Being, finiteness of man, search for B., certainty of 13., 763 ff.
awareness of B. through historical realisation, 76;
-vide: Historical character
basic philosophical positions, the Encompassing, 7'19 fr., 770 fT.
freedom, the language of an absolute B., 309
-vide: Freedom, Existence itself
symbols, the language of B., 330 f., 337 iT., 3;4 f.
appearance of B. in subject/object division ill self-reflection, 348 ff.
ontology, 776 ff.
Being-Thus, Thusness and freedom in self-refkction, 347 ff.
- in character, 429 f.
- in development as a whole, 761 ff.
- responsibility for Being-Thus, 761
- in attitude to one's illnesses, 424 ff.
B. as limit to psychotherapy, 803 ff.
-vide: Freedom
Beziehungswahn-vide: Reference, delusions of
Biographies, biographical, the task of biography, 429, 431 fr., )5; ff., 558, 572,
671 ff.
methods, 674 ff.
basic categories in B., 678 ff.
particular categories of development, 69; ff.
criteria for a process in a life-history, 702 ff.
'b. perception', 676 f.
social studies and B., 679 f.
psychiatric B., 679 f.
pathographies, 728
B. and psychopathology of character, 431 f.
historical aspects of B., 732 fr.
-vide: Case-histories, Case-study
Biology, biological, Man as a b. whole, 5)6 iT., 617 fr., 681 fr.
Man as a life-history, 694 fr.
biological age-epochs, 681 fr.
genetics, 507 fr.
significance of B. for psychopathology, 4) 4
B. and mechanistic thinking, mechanism and organism, 4)2 fr., 531 fT.
'b. psychiatry', 585 fT.
'b. radicals', 587 ff.
'total b. event' (psychic process), 693
Conrad's evolutional hypothesis in his theory of constitution, 659 ff.
Bios, the individual life, idea of B., 671 ff., 677 fr.
B. as biological event, 68 I ff.
Ivi
GENERAL INDEX
Bios (contd.)
B. as the life-history, 694 ff.
the variety of individual lives, 703
the limits of the B., 754
Bliss, experience of, in hashish, opium, intoxications, 151 f.
B. in acute schizophrenia, 152
-vide: Happiness, abnormal feelings of
Blocking, 142
motor disorders interpreted as volitional n., 184
B. produced by opposing drives, )43
-vide: Negativism, Distractibility
Blood pressure, 230
Body and psyche, concept of, n2 ft:
separation and relatedness of B., 2U ff.
spheres of enquiry, 225 ff.
as concrete enigmata, 754
B. and psyche unity as an idea, u 3 f.
the idea of the Eidos, 617 f.
of the constitution, 6) 3 ff.
of the Bios, 671 ff.,677
expression of psyche through B., 2S 3 ff.
effects of B. on psychic life, 451 ff., 46) ff.
somatic accompaniments and sequelae of psychic life, 2U ff., U9 fT.
psyche between mind and B., 3I 2 f.
Man as B./psyche unity, the limits, as the Encompassing, 354, 627, 75S ff.
treatment of patients as B./psyche unit, 796 fT.
-vide: Body (soma), Body-build, Constitution, Existence itself, the Encompassing
Body (soma) and psyche, 4 fr.
-vide: Psyche, Somato-psychology, Expression, Eidology, Extra-conscious
constant somatic accompaniments of psychic events, u8 ff.
somatic disturbances, conditioned by psyche, 2)6 f.
- how they arise, 241 fT.
- in reactive psychoses, )8) ff.
influence of will, ) 51fT.
- vide: Volition
influence of reflection
- vide: Hypochondria, Reflection
somatic symptoms in psychoses, 246 II:
somatic illnesses and their efrects on psychic life, 469 fi:, 475 fr.
symptomatic psychoses, 475 fr.
somatic accompanilbents and psychic expression, 25) fr.
B. movements and the psyche, 270 fr.
physical treatments, 83:1 fr.
- vide: Somatic
Body-awareness, 88 fr.
B. and Self-awareness, 354 fr.
Body-build, 618 fr.
B. and character, 258 fr.
theory of Types, (Kretschmer), 266 fr., 438, 641 ff.
(Conrad), 656 f.
B. and psychosis, 641 fr.
changes in endocrine diseases, 473, 475
B. and social situation, 717
Body-distortion, experience of, 91
Bodily experiences, 'made' (passivity) experiences, 91
Body-feelings, changes in, 90 f., 110
Body-form and understanding of expression (Physiognomy), 258 fT.
-vide: Body-build
Body-functions, disturbance through reflection, 133
GENERAL INDEX
Body-schema, 88, 90 f.
Body-sensations, 88 fr., 90 fT., 227 fT., 598, 689
Bodily senses, hallucinations of, 90
Body-weight, 247 f.
Brain, B. as extra-conscious basis of psyche, 457 fr.
cerebral processes, 463, 478 fr.
localisation, 480 fr., 492 fT.
theory-formation, 534
clinical facts, 483 fr.
frontal lobe, 484 f.
brain-stem, 485 f.
paralysis of cerebral function, 488 f.
brain-structure, 490 ff.
pathological/anatomical findings, 491 f.
'Mental illnesses are cerebral illnesses', 459 f., 478 if., 482, 496, 5H fT.
senile changes in B. 458,686
B.-size and intelligence, '491
localisation of motor-disorders, 179
performance defects in B.-disorders, 198 ff.
Brain-diseases, cerebral processes, 478 if.
symptoms, 479 if.
symptom-complexes, 492 f.
diagnostic schema, 604 f.
B. and endogenous psychoses, 576
dementia through B., 218 f., 392 f.
loss of awareness of defects, 421 f.
seizures, 236 f.
- vide: Brain-processes
'Brain-mythology', 28 f.
Brain-processes, cerebral processes, 478 fT., 692 f.
symptom-groups, 479 if.
localisation (Wernicke), 187 fT., 480 if., 492 fT., 534 if.
limits of causal knowledge, 460 fT.
performance-defects, 159, 170 f., 107
methods of examination, 199 fT.
disordel'd body-awareness, 88 f.
aphasias, 187 if.
apraxias, 180 f.
agnosias, 170 f.
compensations, 396 f.
'fluctuations of B.-functions', 191
-vide: Organic Brain-diseases
Brain-research, in psychopathology, 457 if., 565, 567 r., 570 r., 577
-vide: Brain, Brain-diseases, Brain-processes
Brain-stem lesions, symptoms of, 485 if.
B. and sleep, 233 f.
Brain-swelling (cerebral oedema), 491
Bulbar-palsy, 180, 257, 272
Capacity, feelings of, changes, III f.
abnormal capacity, 120, 15)
Cardiac patients, anxiety states in, 470
Cardiazol shock, 833 f.
Case-history, biographical aim, 31, 572,680 r., 829
-vide: Biographics, 671 if., 678 f.
pathographies, 728
historical aspects, 732 if.
-vide: Describers and analysers, 849 r., Self-descriptions, 852 f.
Case-study, 2J r.
lvii
lviii
GENERAL INDEX
Case-study (contd.)
C. and biography, 572,675 f.
-vide: Case-history and Biographics
Castration, effects of, 653
Catalepsy, 183
Catastrophe, psychoses in, 368, 386, 389 ff.
Catatonia, catatonic, symptoms, motor-phenomena, 180
interpretation of C., 182 ff.
c. behaviour, 276
distorted speech, 192 fT.
somatic disturbances, 229 fT., 249 ff.
symptom-complex, 601 fT.
c. stupor, 601 f.
physiological investigations, 248 f.
fatal catatonia, 249
localisation, 487
Cathartic methods in therapy, 835
Causal knowledge, causal, the c. connections of psychic life, 451 ff.
simple c. relationships, 451 ff.
c. events as extra-conscious events, 457 ff.
C. not to be made an absolute, 460 ff., 547, 462
general survey, 462
understandable and c. connections, differentiation of, 303 ff.
c. explanation and genetic understanding, 302
the un-understandable as starting point for the problem of C., 305 f., 308
- vide: Extra-conscious
the theory of C., 531 ff.
critique of theorising, 547 ff.
the psychic c. connection, determination (Freud), 537 ff.
confusion of meaningful with c. connections, 549 ff.
c. and meaningful research, 711 f.
c. and meaningful interpretation in statistics, 23,713 f.
c. effects of the cultural milieu, 716 ff.
c. connections and therapy, 830
-vide: Science, Natural science, Theories, Knowledge
Cause, causal, concept of, many meanings, 451 ff.
c. knowledge; C. and disease-entity, 563
Cerebral functions, paralysis (symptom-complex), 488
'cerebral symptom-complex', organic syndrome, 479
Cerebrum, cerebral
-vide: Brain
Chance, as limit for the Bios (individual life), 754

Change, awareness of C. in early psychosis, 414 f.
Changed worlds, primary delusions, 280 ff.
changed external world, c. perceptual world, 62 ff., II2
endlessness of space, 8 I
new worlds from free-floating feelings, 115 f.
-vide: World, 'Weltanschauung', Cosmic experiences
Character (personality), concept of, 428 ff.
c.-structure, 436 ff.
abnormal C., 439 ff.
reflective C., 443 ff.
body-build and c., physiognomy, 259 ff.
typology of Kretschmer, 266 ff., 438, 641 fT.
heredity and c., 516, 519, 655
theory of degeneration, 265 f.
C. and psychosis, 639 ff., 642 ff., 653 ff., 655
C. changes through processes, 445 ff.
through organic cerebral processes, 445 f., 479
GENERAL INDEX
lix
through frontal lobe lesions, 485

through epilepsy, 446
through schizophrenia, 446 f.
localisation, 481
correlation between C.-traits, 621
C. and adaptability, 696
.
..,
-vide: Personality, Personality-change, Anlage, Constitution, PhYSiognomy
Characterology, characterological, 428 ff.
c.-analysis, methods, 431 ff.
attempted basic classifications, ideal and real types, 435 ff.
C. as meaningful psychology, 433 ff.
- vide: Understanding
basic laws of psychological understanding, 355 ff.
understanding of oposites, 340 ff.
turning into absolutes, 345 ff.
Childhood, 682 f., 699 f.
psychic disorders in C., 685
C. development of schizophrenics, 641
Choice and decision, seriousness of, its historical concreteness, 762, 763 f.,
de!~fopment, crisis and C. in the life-history, 698, 700 ff.

dialectic as a way to the limits of c., 341 f.
inability to make a c., 344
absolute existential C. and self-realisation, 350 f.
Chorea, Huntington's, 203
Choreic movements, 181, 184
Chronic, acute and chronic psychoses, differentiation, 574
C. states, institutionalisation, 840 ff.
-vide: Acute
Circular affective illness and Anlage, 640 ff., 644 f.
-vide: Affective illnesses, Mania, Depression
Civil status and incidence of illness, 723
Civilised milieu, effects of, 7 16, 717
Classification, methodical C. as aim, 43 ff.
survey of the C. in this book, 45 f.
retrospective survey, 747 ff.
Climacterium, 625, 629 f., 686 f., 844
Climate, effects of, 464
Clinical psychiatry, 571 f.
C. pictures of illness, 571 f.
Cocainism, 469
Colitis membranacea, 239
Collective, the C. (family), 718
the c.-unconscious, 361 f.
c.-unconscious as domain of the Archetypes, 322 f., 338, 361 f., 709
-vide: Archaic psychic states
'collective psyche' -vide: Mass-psychology
psychic epidemics, 735 ff.
-vide: Suggestion
Colour-sound problem (synaesthesia), 62
Colour-vision in intoxication, 62
Coma, 147
Combination of psychoses (mixed P .), 612 ff.
Communication, modes of C., limits of C.
in therapy, 796 ft, 799 f., 804 iI, 8 17
Community, the individual in the World, 326 If., 7 10
-vide: World
failure of empathy, 63 f.
-vide: Alienation
Ix
GENERAL INDEX
Community (contd.)
schizophrenic C., 283
C. as culture, 274 ff.
C. and society (social psychology), 709 a:
Compensation-neurosis, 387,389 if., 720 f., 780
work-curve and C., 208 f.
Compensation (over) of the insecure, 445
Complementary movements, 181, 184
Completion-tests, 221
Complex, 370 f.
elfects of C., 142, 395 f.
association experiment, 166
-vide: Hysteria, Dissociation
interpretation of schizophrenic psychoses in terms of dissociated C., 410 f.
Comprehension, Explanation, Understanding, of connections, 1.7 f.
Compulsion, compulsive, c. phenomena, 133 If., 1.09 If., 487
psychic C., 133 If.
c. belief, 134 f.
c. drives and c. acts, 136 f.
c. movements, 181 if.
-vide: Movement.
wod! of c. patients, 1.84 Ii'.
explanation of c. illness by basic vital disorder (Werdenshemmung), 590 a:
_vide: Retardation of thought, Flight of ideas, 176 If., 209 if.
c. detention in institutions, 841
C., awareness of, 133
c. cleanliness, 134, 1.84 f.
Concentration, difficult C. in affects, 141.
inability to c., x?6
Concomitant perception, abnormal, 62
'Concrete', 'Reduction to concrete', 202
Concrete-logic, methods of, 1.5 if.
Concussion, after-elfects, 593
Conditioning-vide: Association
Confabulation, 77, 178 f., 592.
Confession, 366, 835
Confusion (as distinct from Flight ofIdeas), 1.08 If., 2.13 f.
Connections, enquiry into C. (Understanding and Explaining), 2.7 f., 301 if.
causal C., 451 if.
-vide: Causal Knowledge
meaningful c., 30t if.
-vide: Understanding
the totality of meaningful c., 418 if.
theory-formation (psycho-analysis), 537 if.
absence of C. as a symptom, 148, 592. f.
presence or absence of C. in psychotic experience, 150
Consciousness, state of c., 9 if., 137 if.
totality of c., 137 if.
alterations of c., 141 if.
psychotic alterations of c., 147 If.
syndromes of altered c., 593 if.
fluctuations of C., 142. if.
clouding of c., 143, 147 f., 391 f.
-vide: Amnesias
heightened C., 143 f.
empty c., 143,1.11
alternating C., 143,404 f.
-vide: dissociation
switch-over in state of C., 380, 381. If.
GENERAL INDEX
C. and the unconscious, 138

C. and the inner life-history, 695 If., 701 f.
Circular movement of C., 346
self-reflection, 347 If.
stages of transformation, 348 f.
-vide: Volition
body-C., 88
C. of significance in events, 98 f.
reality-C., 93 if.
C. in time-experience, 81. If.
C. of one's own state, 419 if.
C. of a change in oneself, 414 If., 41.0 f.
Consciousness of C., 42.0
C. of inhibition of Will, lI8
C. as such, C. in general, common C., universal c., 198, 331,760
C. of self, 12.1 if.
Object-C., 60 If.
C. of one's own existence, 12.1 If.
C. of compulsion, 133 f.
C. of one's own performance, changes in, 12.2. It.
C. of existence as such as an awareness of reality, 94
lack of C.-vide: Alienation
transformation of C.-vide: Delusional experience
changes in C. (loss of 'I'-feeling), J 1.1 f.
metaphysical c., 348
-vide: the Encompassing
Conservative or propulsive 'temperament of development' (Conrad), 660 If.
Constellation (in association-mechanisms), 162Constitution, constitutional, 619 If., 633 If.
C.-theory of Kretschmer, 638 f., 641 If.
C.-theory of Conrad, 656 If.
value of C.-theories, 666 If.
the riddle of C., 751.
personality-disorders and C., 688
C. as the basis of abnormal reaction, 391
c. disposition of the vegetative system, 232 f.
C. and Race, 668
C. and character, 438
epileptoid c., S24
Constructive-genetic psychopathology (v. Gebsattel), 540 If.
Contact with patients, 2.1, 826 If.
Contamination, 194
Content, Form and C. of phenomena, 58 f..
primary delusional experiences, notions, and delusional c., 98 f., 105 f.
195 f.
determination of C. by culture and situation, 732 if.
connection between C. and psychosis (schizophrenic world), 282. If.
form and C. in schizophrenic art, 291 if.
understandable C. and mechanism, 365 ff.
connections with understandable C., 317 If.
understandable C. in psychosis, 408 If.
invented C. in place of denied reality, 32.8 f.
Continuity, experience of C. as time-experience, 83
disturbance of C., 83 If.
discontinuity of time, 84
C. as life-long attitudes, 382
-vide: Life-history
break in C., 381 f.
-vide: Dissociation, Development
Ixi
lxii
GENERAL INDEX
Conversation with patients, 140 f., 194, 21I, 826 f.

talking past the point (Vorbeireden), 194
Conversion-experience (religious), 388 f.
'Co-ordinating factors' (Spemann), 160
Corpus striatum, 183
Correlation, methods, 31 f., 621 ff.
C. in typology of character-traits, 61I f.
C. in constitution-theory, types of body-build, character and psychosis, 261, 266 ff.,
641 ff.
critique of C. methods, 645 ff.
C. of genetic l,lnits, 516
C. of hereditary groupings, pI ff.
-vide: Statistics, pI ff.
Cosmic experiences, self-descriptions, 294 f., 412
-vide: Schizophrenic world
Cosmic colIapse, experience of (Weltuntergangserlebins), 108,284,296 ff., 413
Crash, experience of a, 85
as fall from a height, 308
Craving, 321, 323 ff., 468,631
Crime, criminal, lines of investigation, 329, 725 ff.
.c. statistics, 726 f.
C. and 'Free-will', 793 ff.
'born criminal', 441 f.
heredity in twins, 525 f.
tendency to repetition, 394 f.
recidivist type, 718 f.
criminal mental patient, 279 f.
-vide: compulsive drives, compulsive acts, 136 f.
home-sickness and C., 389
individual criminals, description, 725 f.
-vide: Prison psychosis, Murders, Poisoners
Criminality, attitude of psychiatrist, 727, 793 ff.
Crisis and choice in life-history, 698 f.
'Crossing-over' (constitutional theory), 645 f., 65 I
Crying, Laughing and crying, 270, 272
Crystal-clear sight, feelings of, 115
abnormal clarity of thought, 121
heightened awareness, 143 f., 420
aura-awareness, 85, 144 f., 148
Cultural spheres, tdiffering effects, IS
pathological aspects in different c., 740
Culture, man as a cultural being, 709 ff.
differences in c., 13 ff.
cause of C., 13 ff.
degeneration through c., 742 f.
-vide: Illness, forms of, 733 f., Differentiation
Cure, curable, aim of c., what is c., 802 ff.
C. or incurable, 692 f., 843 f.
Kraepelin's differentiation of psychoses, 608
C. as criterion for diagnosis of neuroses, 609 f.
emotional traumata as c., 393
-vide: Prognosis, Therapy, Treatment, Practice
Cycle, cyclic movement, reciprocity, 452 ff.
C. of physiological connections, 235 ff.
reciprocity of Life and Meaning, 345 f.
cycles of progression and dissolution, 346 f.
'vicious circle' in neurosis, 573
the 'hermeneutic round', the C. as basic form of understandability, 356 f.
'life-spheres' (Lebenskreise) Heyer, 245 ff., 336
GENERAL INDEX
Gestalt-C. (v. Weizacker), 157 f.

-vide: Diagnostic schema
Cyclothyme (personality-type), cyclothymic, ::.68, 438, 601 ff.
c. depression, 110
treatment of Cyclothymia, 836
-vide: Body-build
Cyclothymic individual, 267, 438, 601, 642 f.
Dasein-vide: Existence as such; Existence, human; Existence in a world
Day-dreaming, 148 ff., 150
Deaf-muteness, 186 f.
Deafness, psychogenic, ::'37 ff.
Death, as biological reality, 682
D. as psychotic reality, 309
dying, death-struggle, 477 f.
dying and tendency towards whole, 398 f.
man and D., 672 f., 763 ff.
D. fear in falIs, earthquakes, 367 f.
D. urge and life urge, 318
Deductive, d. thinking in psychopathology, 16 f.
Degeneration, theory of D., 319, 365 ff., 500 ff., 505 f.
marks of D., 365 f.
'degenerative madness', 565
symptomatic psychoses, 476
problems ofD. in history, 715 f.
problems of D. and modem world, 740 ff.
nervous D., 742 ff.
Deja VU, 77
Jamais vu, 85
Delirium, delirious, 172, 468
types of D., 593
hysterical D., 391, 407
delirium acutum, 476
d. states in cerebral processes, 479
d. experiences, 151
difference of d. from schizophrenic experiences, 295
offspring of patients with D. tremens, 526
Delusion, concept of, delusional, 93,95, 195 if.
modes of approach, 195 ff.
delusion-like ideas and delusion proper, 96 ff., 106 ff., 409 ff.
metaphysical D., 107
origins of D., 96 ff., 195 ff.
D. and compulsive belief, 135 f.
D. and clarity of consciousness, 138
D. in schizophrenia, 410 ff.
primary d. experiences, 98 ff.
d.-atmosphere, 98
d.-perception, 99 ff.
D. of significance, of reference, 100 f., 409 ff., 640
d. images, 103
d.-awarenesses, 103 f.
d.-contents, 106, ::.82 ff., 732
understandability of D., 196 ff., 408 ff., 640 ff., 703 ff.
-vide: Un-understandable, Process
incorrigibility of D., 104 ff., 195 ff., 410
d.-elaboration, system, 106, 195 ff., 283 ff., 296 ff., 416
paranoid symptom-complex, 599 ff.
-vide: Paranoia
Dementia praecox as a group of diseases, 423, 567 ff., 692
lxiii
Ixiv
GENERAL INDEX
Dementia, subnormality, 216 fT.

congenital, 217 fT.
organic senile D., 2J8 f., 458, 686
schizophrenic D., 218 f., 446
sociogenic D.; cultural subnormality, 220
pseudo-D., 220 f.
accompaniments of D., 229, 272
absence of awareness of illness, 421 f.
aphasia, not D., 215
Demography, 722
Depersonalisation phenomena, 133 ff., 598
-vide: Psychasthenia
Depression, depressive, D. and Mania, Types, 596 f., 440, 606 ff.
cyclothymic D., HO
d. stateS, loss of reality and time-experience, 84
feeling of loss of feeling, I I J
reactive depressive states, 390
D. and hypomania, 217
transitions, 687
D. derived from 'inhibition on becoming' (v. Gebsattel), HO f.
heredity, 501 ff., S18 ff., 521 f., 528
Anlage, 640 f.
-vide: Mania
De-realisation -vide: Alienation
Derivation, 405
Describers and analysers, 849 f., 852 f.
DCsequilibre, 506
Desertion (military), 605
Destiny, whole way of life, 278
Anlage and D., 703 f.
D. and psychosis, 294, 367 ff.
-vide: psychogenic reactions, 294, 684
perversion of drive, power of, 320 f.
significance of social situation, 716 ff.
-vide: Life-history, Existence itself, Historical, Reaction
Deterioration, 271, 274, 446 ff., 844
-vide: Dementia, 216 fT., 421 ff.
Determination, determining, d. tendencies, 138 f., 162
absence of d. tendencies, flight of ideas, 210 f.
psychic D;. (Freud), 537 ff., 699 f.
D. of dreams, 313 fT.
'over-determination', 374 f., 396
Development, 'temperament of' (Conrad), 661 fT.
Development,
of individual as a whole, life-history, 694 ff.
mental D., 698 fT.
experience of D., 701 f.
individual categories of D., 695 ff.
particular problems of D., 699 f.
D. of personality v. Process (basic psychopathological question), 702 ff.
personality and psychosis, 639 ff., 653 fT.
personality-change and process, 445 ff:
-vide: Personality, Transformation, Process
psychic D. through transformation of drives, 324 f.
developmental-historical hypothesis (Conrad), 659 ff.
-vide: Constitution, Character, Personality
Diabetes, 239
Diagnosis, diagnostics, starting points for D., 611 f., 788 ff., 829 .
diagnostic schema, 604 ff., 789 f.
GENERAL INDEX
Ixv
-vide: Disease-entity, 563 ff.

examination-methods, 826 ff.
analysis and D., 20 f.
-vide: Disease-concept
Dialectic as a psychic movement, the movement of opposites in psychic realitY,340 ff.,
318
D. in the life-history, 697 f.
psychopathological understanding in D. of opposites, 343 fT.
D. cycles of progression, 345 f.
self-reflection in the D. of the psyche, 347 fT.
-vide: Opposites
Differentiation, D. of psychic life, 13 ff., 253,431
D. and psychoses, 639
D. in attitude to illness, 418 f., 425 ff.
D. and self-observation, 420
D., Social, 711
D. and giftedness, 217
Subnormality, 217
D. and the idea of the whole, 617 f.
-vide: Unity (complex), Idea, Unity, Man, Biographics
Diminished status, delusions of, 412
Dipsomania, 278, 688
Discharge, motor discharge, 118
epileptic seizure as D., 6SS f.
D. of inhibited urges by inappropriate paths, 365 f.
-vide: pathological psychogenic reactions, 383 ff., 389
Discharge, from hospital, time of D., 841
Discovery, delusion of, 296
Disease-concept, 3 fr., 7 ff., 29 fr.
structuring the psychiatric D., 788 ff.
D. in the diagnostic schema, 604 ff.
D. and practice, 794 if.
neurosis and health, 575, 816
Disease-entity, clinical picture, synthesis of D., 564 ff.
clinical D., 566 fr.
basic differences in the total field, 573 ff.
clinical states, symptom-complexes, 582 fi".
particular complexes, 592
D. as guide to research, SS6 fT., 563 ff.
idea of D. and diagnostic schema, 604 ff.
Disease-groupings, 604 fT.
-vide: Diagnostic schema
Kraepelin's grouping, 566 fT.
Carl Schneider's symptom-groups, 586 ff.
Distribution of D. in the population, 722 f.
-vide: Disease-entity
Course of illness as indicator for D., 566 ff., 608
Disease, Illness, D. and Health, 779 ff.
-vide: Disease-concept
D. in biology and in man, 7 ff., 785 ff.
patient's attirude to D., 414 if., 425 ff.
the wish to be ill, 424 f., 445
flight into illness, 387 f.
dependence of somatic illness on the psyche, 236 ff., 241 fT.
-vide: Body
D. and milieu, 716 ff.
historical aspects, 731fT.
differentiation -,-vide: Differentiation
creative significance of D., 729, 786 f.
Ixvi
GENERAL INDEX
Disease (contd.)
metaphysical understanding of D., 309 f., 778 f.
empirical investigation, pathography, 728
classification of D. (diagnostic schema), 604 ff.
history of illness, disposition in D., 732 fr.
-vide: Constitution
Disinhibition, 583
Disorders of Drive, 485 ff.
compulsive drives, acts, 136 f.
Disorientation, 148, 172, 592 ff.
amnestic delusional D., 172
apathetic D., 172
Disposition, D. and Anlage, 430, 4SS f., 505 f.
D. in mechanisms of association, 161 f.
D. as effect of experience (complex), 371 f., 699 f.
D. towards illness-vide: Constitution, Heredity, Anlage, Disease-concept
Dissimulation, 828
Dissociation, experience of one's own D. ('the double'), 124 ff., 734 f.
D. of perception (splitting), 64
concept of D. (schizophrenic), 381 f., 578 f.
theories of D., 530 f., 539 f.
Being as D., as the opposite, 340 ff.
D. into subject/object; self-reflection, 347 ff.
life in D.-a basic phenomenon Oung), 337
-vide: schizophrenia
Dissociation, splitting-off, 381 f., 402. fr.
split-apart, 347
cleavages, 539
multiple personalities, 128 fr.
split-off consciousness, 148
split-off complexes, 396, 410
dissociation between levels of drive, 322
hysteria, 402 fr.
neurosis, 575 f.
-vide: mechanism
Distractibility, blocking, 141 f., 2.12
Diurnal variations in mental illness, 464
Dominance, exchange of; constitutional theory of Kretschmer, 645 f., 6SX f.
Dominance and recessiveness in heredity of schizophrenia, 518 f.
'Doppelganger' -vide: 'Double, the'
'Double, the' (Doppelganger), 92 f.
doubled, double-personality, 403 f.
d. intention in hysterics, 406 f.
d. orientation, 150, 172,296
experience of becoming double, 125 f.
possession, 734
-vide: Dissociation, Doubling, Twilight state
Doubling, the experience of the Double (self-description), 124 ff.
D. in dissociated personifications, 128 f.
-vide: Dissociation, Possession, Doubled
Drawings of patients, 291 fr.
drawings of neurotics, 293
Dream, dream contents, 144 f.
time-experience in D., 85
time-experience in schizophrenic D., 399 fr.
comparison of D. with archaic psychic states, 618 ff.
1. contents and D. interpretation, 372 ff.
theory of D., 537 ff.
D. in symbol-research, 333 ff.
GENERAL INDEX
psychotherapy and D., 338 ff.

endless interpretation of D., 358 f.
dreamy states, day-dreaming, 147 ff., 150
D. after calamitous experiences, 369
after-effects of D., 390
-vide: Psycho-analysis
Drive, experience of drive, phenomena of, basic concepts 117 ff.
concept of D., classifications, 317 ff.
'
D. and Will in character-building, 436 ff.
variations in state of D., 440
transformation of D. into craving, 323 f.
psychic developments from D. transformation, 344 f.
control and disturbance of D. by reflection, volition 351 f.
mechanisms of inhibited D., 365 f.
'
instinctual acts and disturbances of D., lIS ff.
influenced, 'made' D., 124
compulsive D., 136 ff.
D. to speak, pressure of talk, 191 ff.
abnormal instinctual impulses, disorders of D. 320 fr. 630 fr.
D. in social situation, 718
"
Drugs, availability and psychosis, 716
effects of D., 116,466 ff.
self-descriptions, 466 f.
-fo.r descriptions of phenomena vide: Hashish, Alcohol, Mescalin, Opium
cravmg, 323 f.
Drugs, intoxicating D., cravings for D., 323 f.
-vide: Poison
Dying, 477
-vide: Death
'Dying and becoming', 397 f.
Dynamic theories, 532 f.
Dysarthria
-vide: Speech, articulation, disorders of
Dysfunction, organic-vide: Functional
Dysmegalopsia, 80
Dysphoric states and fugue states, 279, 688
Dysplastic forms of growth, 641, 658
Earthquakes, psychoses after catastrophe, 367, 386 389 ff.
Eccentrics, cranks, 441 f., 724 f.
'
Echolalia and Echopraxia, 182, 193, 343
Eclipses Mentales, 143
Education, E. guidance, 721, 800, 838
E. and a right to self-education of the patient, 836 fr.
The limit of the unchangeable, 804 f.
-vide: Therapy
Eidetic, the, 68
Eidology, 617 ff.
the task of E., SS5 fr.
methods of E., 620 ff.
the idea of the Eidos, 617 f.
Electro-convulsions, 833
Electro-encephalogram, 231
Element, the elements and the whole, 28 ff., 31 ff., 555 f.
the idea of the element in association psychology, 160 ff.
E. and Gestalt (Association-, Act-, Gestalt-psychology), 162 ff.
in the basic scheme of the reflex arc, 156 ff., 1S8 ff.
in causal psychological thinking, 305 f.
in biological psychiatry of Carl Schneider (,Radicals'), 586 ff.
Ixvii
lxviii
GENERAL INDEX
Element (contd.)
mechanistic theories, 53 I
-vide: Mechanism, Unity (complex)
Emaciation, 2.47 f.
Emotional stupidity, 2.2.0
Empathy, empathise, E.
in patients (abnormal E.), 63 f., 113
rational and empathic understanding, 304
un-understandable psychic life, 578 If.
-vide: Schizophrenic, Un-understandable
Empiricism and Philosophy, 46
Empirical understanding in interpretation, 315 f.
Encephalitis, 184
E. epidemica, 118
post-encephalitic states, :uo, 419
oculo-gyric crises, 689
movement-disorders, 186 f.
E.lethargica, 64 f., 112., 143 f., 2.33, 42.0, 476, 486, 685
Encompassing, the, 754, 756 If., 759 If., 77 1
-vide: Existence itself, Origin
Endlessness, being overcome by endlessness in research, 31 If., 754
Endless possibilities in interpretation, 358 f.
Endocrine illnesses, 470 If.
Endocrine findings in psychoses, 2.48 f., 473 If.
Endocrine diseases, 470 If.
Endogenous and exogenous concepts,
causes, 454 If.
related pairs of concepts, 457
endog. and exog. Psychoses, 475 If.
endog. psychoses and organic cerebral illness, 576 f.
diagnostic schema, 605 If.
-vide: Constitution, Body-build
Energy (Dynamic theories), 532. f.
variations of psychic energy (Neurasthenia and psychasthenia), 441 If.
Enigmata at the margins of dilferent modes of knowledge, 752. If.
Environment, I I f., 32.5 If., 419 f., 454 f.
basic situation, 32.5 If.
E. and Anlage, 2.14, 2.2.0, 455 If., 514 f., 5205 f., 832.
E.-elfects of, 469 If., 709 If., 716 If.
E. and adaptation, 696 If., 72.4 f.
E. and self (schizophrenic loss of the division), 12.6 f.
E. and self in performance, 156 f.
paranoid attitude to E., 413
new meaning of E. in delusions, 98 If.
E. and picture of world (active awareness of E.), 2.80 If.
change of milieu (therapy), 838
shaping of E., 2.78
changed E. isolation of pt., 419
--vide: Social, Milieu, Situation, \Vorld, Dilferentiation, Twin Research,
Outside world
Epidemics, psychic E., 408, 735 f.
Epilepsy, epileptic, epileptoid, the disease-group, 446, 606 If., 687
e. attack, 61, 2.36, 654 f., 688
e. state, 688
Aura-awareness, 85, 116, 144 f.
e. fluctuations of consciousness, 142. f.
recovery of amnesias by hypnosis, 175
dreams, 399
E. and body-build, 641 f.
GENERAL INDEX
lxix
e. constitution, 52.4654 f.,

heredity, pi If., 5208
E. at puberty, 685
social distribution, 72.2.
therapy, 830
Equivalents, 687
Erklaren: see Explaining
Errors in healthy people-delusion-like error-(incorrigibility) 104 If.
-vide: incorrigibility
,
Eugenics
-vide: Heredity
Euphoria, 440, 596 f.
Examination of patient, 82.5 If.
E. methods, 140 f., 82.6 If.
E. of psychophysical basic function in performance defects 199 If.
E. of intelligence, 2.10 f.
'
E. of phenomena of expression, 2.57 f.
experimental E., 165 If.
-vide: Diagnostics, Self descriptions, Contact with Pt.
Excitation and Inhibition (Neuro-physiological), 157
-in flow of imagination, 2.10 f.
state of E. as psychic epidemics, 735 f.
catatonic E., 603 f.
Existence (human); concept; human existence as the Encompassing 759 f.
the 'a priori' of E., 331
'
E. as basic relationship of being in a world (life as E. in its world), I I f.
E. a~d ?~havi~ur of the individual in his world (World-psychology), 2.74 If.
the mdlVldual 10 the world (psychology of meaning), 32.5 If.
in frontier-(marginal)-situations, 330
biological and meaningful E., as a circular event, 345 fT.
-vide: World, Environment, the Encompassing
Existence (human), drives of, 319
Existence, illumination of, and psychology of meaning, 309 If., 312. f., 360 f., 761 a:, 766,
769 f., 776 If.
-in the frontier-situations, 330 If.
-as self-reflection, 347 If.
-self-revelation, 350 f.
polarity and dialectics, 340 If.
basic knowledge, 354
knowledge and E., 767
E. as self-illumination of the patient in gaining an attitude to his own illness,
42.5 If.
Existential communication, 798 f., 817
the demand for self-illumination by the psychotherapist, 812. If.
-vide: Understanding, Communication, Revelation Self-attainment
'
Existence itself, 354 f.
~ .freedom of m~ as possible E., limit of research, 450 f., 755 f.
limit of psychological understanding, 308 f., 310 f., 345 f., 354 f., 363, 695 f.
-of psychopathological knowledge, 415, 705 f.
th~ encompassing of E. as the origin, 398 f., 430 f., 438, 698, 760, 764
umty of E., 340 f., 351 If., 397 f., 687 f., 756
E. and character, 419 f., 438
E. and reason, 760
E. and Bios. in the life-history, 694 If., 699 If.
Transformation of E. and process, 705 f.
-vide: Development, Personality-change
appeal to E. in therapy, 798 If., 817, 839
-vide: Existence illumination of; Personality, Man Philosophy
Existential philosophy and psychopathology, 775 If. '
Ixx
GENERAL INDEX
Existenz, see Existence itself

Exogenous and Endogenous Causes, 454 If.
forms of reaction (Psychoses), 475 f.
Expansive sensitive (life-attitude), 32.7
Experience, first experience, its historical significance in life, 697 f.
significance of earliest E., 323, 395, 699 f.
after-elfects of earlier E., 307 If., 394 If.
E. and development, 701 f.
pathological forms of E., 148 If.
delirious E., I 51
-in intoxication, 151 f., 467 If.
delusional E., 177 If., 180 If.
contents of delusion-like ideas, understandable from E., 409 f.
transformation of the content of E. in schizophrenia, 282 f.
mechanisms set in motion by psychic E., 365 If.
E. of the acute schizophrenic psychosis, 152 f.
Experience and task of phenomenology, 5), 5S If.
psychotic experience, 147 If.
reality experience and delusion, 93 If.
differentiation, modes of, 13 f.
Experiments in psychopathology, I('5 If.
Experimental method, 24 f.
task, the, 165 f.
observations, 160 f.
effects of fatigue, 465 f.
performance tests used in typology, 622 f.
E. and types of body-build, 642; -at examination, 827; -literature, 165
Expert opinion-in court, 36, 727, 794 If.
Explaining and Understanding, 27 f., 302 If.
Explanatory psychology, 451 if.
delusions of explanation, 536
-vide: Theories, Causal knowledge, Extra-conscious
Expression
psychology of E. (expression of psyche in body and movement), 251, 253, 311 f.
speech as E.; 288
expressive movements (grimacing), 181
to see E., an elementary phenomenon, 225, 254 If.
everything as E., 275
the limits of E., 754
Extra-conscious, concept of the extra-conscious in theoretical causal connections, 457 If.,
9 If., 530 If.
in causal psychological thinking, 305 f.
the unconscious as the extra-conscious, 306
extra-conscious mechanisms, 305, 313, 364 If.
the extra-conscious understanding of expression, 257 f.
'pseudo-understanding', 305 f., 539 f.
the extra-conscious vital basic event and basic disturbance (theorv), 540 f.
-vide: Theories, Mechanism, Body
.
Facilitation and Inhibition, 157 ff.
Fainting attacks and seizures, 236 ff., 241
Faith, religious and philosophical F., 764 f.
F., superstition and delusion, 107 f.
-vide: Philosophy, the Encompassing, Transcendence, Man
Falling asleep, 146 f., 2)2 If., 272 f., 382 f.
F.-a, thinking and schizophrenic thinking, 213
False memories, 75 If., 178
Farse perceptions, 64 if., 169 f.
F.p. on awakening, 146
GENERAL INDEX
Ixxi
F.p. and reality judgment, 94 If.

F.p. and attention, 140 If.
concomitant causes, localisation, 168 f., 483 f.
-vide: Illusions, Hallucinations
Family cohesion, its influence, 718
Family Trees, 498 f.
Fanatics, 441
Fancy, delusion-like fancy, 409 f.
Fantasy, fantastic; f. visual phenomena, 66 f.
forms of f. psychogenic connections, 148 If.
flight from reality into F., )28 f., 150 f.
pseudologia phantastica, 217, 328, 424 f., 685
'Faseln' (muddling up, scattered thinking), 213, 586
Fatigue and Exhaustion, elfects of, 80, 83, 157,206 If., 441 If., 465 if.
symptom-complex (Neurasthenia), 441
Exhaustion-Neurosis, 80 f., 83
-vide: Psychasthenia
Feelings, 108 ff.
alterations in bodily feelings, 110
F. of capacity, III
loss of F. (Apathy), III
after shattering experiences, 367 f.
F. of having lost feeling, III
heightened F., 112 f.
Feeling-sensations, 112
unattached F., II3
abnormal F. of happiness, 114
F. of 'crystal-clear' sight, lIS
F. of absolution, 116
coldness and excess of F. (hysteria), 406
F. accounting for abnormal phenomena, 40 8
F. of a change in beginning of mental illness, 414
-vide: Alfect
Fetichism, 323
Fever, psychogenic, 238
acute febrile schizophrenia, 476
phantasies during febrile illnesses, 151
dreams, 399
febrile episodes in schizophrenia, 250
Finiteness of Man and certainty of Being, its self-illumination, 763 If.
Foundering of all human finiteness, 764 ff.
Flexibilitas cerea, 181
Flight into illness, 387
Flight of ideas, Inhibition of thought, 209 ff., 286 f., 596
-and pressure of talk, 192
'Relative mental defect', not F. of I., 217
world of patients with F. of I., 286 f.
Flow of psychic life, changes in, 208 If.
automatic mechanism of association, 160 fT.
automatic mechanisms of drives and instincts, disturbance through reflection 352 f.
'Folie a famille', 283
'
Forgetting, 174 ff.
Form, F. and content of phenomena, 58 f.
understanding of meaning and the significance of F. (understanding of Expression),
255 fT.
Formalistic logic, its mistakes, 31 if.
'Formniveau', 14, 2P, 271
Freedom as possible Existence, ground and limit of understanding, 308, 310,244 f., 357,
363, 4 29 If., 755 f., 759
lxxii
GENERAL INDEX
Freedom (contd.)
F. and transcendence, 762. f.
F. in the life history, 694 If.
reflection as F., 348 f.
question of 'free-will', 794 f.
right to F. of the patient, 796 f., 798 If., 837
-vide: Existence itself, Being-Thus
Frenzies, 390
Frontal lobe lesions, 484 f.
Frontier
-vide: Limit
Frontier-situation, marginal situation, 32.6, 330
Fugue states~2.79, 688
Function (performance-psychology), F. and phenomena, IS8
experimental investigation of F., 16S If.
basic F., I s8, 16S f., 198 If.
the psycho-physiological basic F., 199 If., 493
localisation of F., 483 If., 488 f., 492. If.
'organic-functional' concepts of, 460
F. and intelligence, 2.13 f.
totality of F.-relationships as constitution, 653 If.
Functional disorders of organs, 2.37 If.
-in relation to psychic disorders, 2.40 If.
Functional group and schizophrenic symptom-complexes (C. Schneider), 586 If.
Functional hallucinations, 66 f., 74 f.
F. psychoses, 473
Furor, 603 f.
-vide: Catatonia
Future, awareness of, disturbances, 86 f.
Ganser twilight-state, G. syndrome, 2.77, 389 f., 407
Geist; see mind, spirit, culture
Gene, genotype, phenotype in Genetics, s08 If.
-in psychopathology, 113 If.
-in constitution-theory, 644 If., 684
as limit and enigma, 160, 7S2.
Genealogy (family history), 519 If., 497 If., 498 If.
degeneration-theory, 2.64 If., S05 If.
intellectual families, 743
social class, 72.2.
neuropathic families, 52.1,641
'alloy' and 'cross-over', ,645, 6p
-vide: Constitution
Generic group and type; concepts of, 560
Genetic Research, 498 If., 7S 3
Genetic understanding, 2.7, 301 If.
Genetics, 507 If.
application in psychopathology,S 13 If., p6 If.
-vide: Constitution
Geographical factors and illness, 732.
Germ-cell, injury to, S2.6
Gestalt, G.-psychology, IS7 f., 160 If.
elements and G., 164 f.
G.-formation as a basic function, 2.04
modes of our vision of G. (understanding expression), 2.55 If.
physiognomy, 2.59 If.
-Mimik. (Inv. gesture), 2.69 If.
body-shape (Kretschmer), 2.67 If.
-vide: Body-build
GENERAL INDEX
lxxiii
Giddiness, 90, 2.2.7

Gift, Talent, heredity of musical gifts, 503
G. of scholarly abilities, po f.
distribution of G., 72.2.
one-sided G. in Imbeciles, 2.17 f.
G. not a uniform ability, 2.17
-vide: Scholastic attainment, Intelligence (180 If.), Localisation of gifts (42.),481
Glycosuria, 2.39
Grandeur and Persecution, delusions of, 413
Graphology, 2.73
Grenzsituation
see Situation, Frontier, marginal
Grimacing, 181, 2.77
Growth, principles of (Conrad), 657
Gymnastics, physical culture-as therapy, 2.72. , 836 f.
Habits, habitual, 370
abnormal H., 394 11.
stereotypes, 395
h. reactions, 2.42.
-vide: Automatic
Half-sleep, Fantastic connection of experiences, 148 fl.
Hallucinations, hallucinatory, 64 If., 2.2.7 f.
functional H., 66 f., 74 f.
genuine H., 66 If.
Pseudo H., 68 f.
H. in the various sense areas, 70 If.
H. in memory (false memory), 75 11.
H. transitions from physical awareness to, 78
complex H. of various senses (Personifications), 12.8 fT.
hypnagogic H., 146,2.33 f.
h. experiences, 148 If.
h. and pseudo-h. contents in delusional experiences, 98 If.
delusional h. reactions, 391
h. neologisms, 2.90
understandable contents of H., 410
explanation of H. by sejunction, 5)6 f.
Handwriting, 2.73 f.
Happiness, abn. feelings of H., 114 If.
-vide: Aura
H. with Hashish and Opium, 151 f.
Haptic Hallucinations, 90
Hashish-intoxication, 92., 102. f., 12.6 f., 143, lSI f., 361, 466 If.
Head injuries (sequelae), 61, 170 f., 479, S92.
-vide: Brain-processes, 478 If.
Health and Disease, 779 If.
concept of H., 787 If., 802. f.
H. and Neurosis, 816
Health Consciousness, 387 f., 42.4 f.
Hearing, false perceptions, 7S f.
increase of H., 61 If.
Hearing-mute, 187
Heautoscopy (Doppelganger, the Double), 92. f.
Hebephrenic behaviour, 2.76
'talking past the point', 194
Mimik, involuntary gesture, 2.71
body-build, 649 f.
type, 2.19 f., 446 f., 68S
Heightened feeling, 112 f.
lxxiv
GENERAL INDEX
Hereditary Anlage, 508 fr., 514 fr.

Heredity, 497 fr.
H. in Biology, 50, fr.
application in man, 512.
H. in psychopathology, 513 fr., 517 f.
H. in statistics, 499, 507 f., SI9 f., 518 fr.
homozygotic and heterozygotic H., 501 f.
H. and tradition, 709 fr.
-vide: Heredity, Degeneration
Heredity loading of healthy and sick persons, 499 f.
Heredity of Psychoses,s 18 f.
H. of psychic phenomena,s 19 f.
H. in constitution, 643 fr., 650 fr.
hereditary statistics, 499 fr., 518 fr., p.o fr.
Heredity and Social class, 7:1.:1. f.
'Hermeneutic round' of understanding, 356 f.
Hierarchy of the Drives, 319 fr.
'Hirnmythologie', see 'Brain-mythology'
Historical character of Man, 697, 699 fr.
-vide: Age-epoch, Life-History, Choice
Concrete H. as choice, 76:1. f.
-in communication between physician and patient, 798 f.
History, historical world and the unhistorical psychopathological world, 281 f., 709 If.
the task of psychopathology and H., 709 fr., 712.
historical material, 71 I fr.
historical aspects, 13:1. fr.
in biography, 671 f.
life-history of the individual, 694 fr.
H. of Psychopathology, 844 ff.
H. of illness, 73:1. ff.
H. of hysteria, 754 ff.
Homesickness, 389
Homosexuality, 65 I f., 733
Hormones, the endocrine system, 470 fr.
Human Existence
-vide: Existence, human
Hunger, thirst, 3:1.0 f.
Hybridisation
-vide: Bastardisation
Hygric hallucinations, 90
Hypalgesia, hyperalgesia, 61
Hyperkinetic states, 181 fr.,486
Hypnosis, 146, 175, 234 fr., 240, 378 fr.
auto hypnosis, 380 fr.
historical aspects of H., 848
H. in therapy, 835 f.
recovery of Amnesias under H., 175, 404,406 f., 836
Hypochondria, hypochondriacal, 444 f., 133, :1.4:1.
h. delusion, 412.
Hypomania, 583, 596 fr.
Hypophysis, diseases of, 47:1. fr.
the endocrine system, 470 fr.
Hypoplastic and hyperplastic (growth tendencies), 658
Hysteria, hysterical, 386 fr., 389 f., 401 fr., 685
the hysterical personality, 131, 3:1.7 f., 443 f., 641, 995
h. symptoms, 236 f., 242 fr., 277, 350 f., 399,424 f.
tho sensations, 227 f.
h. delirium, 391
h. seizures, 236 f.
GENERAL INDEX
lxxv
h. possession, 734 f.
h. fantasies (day-dreaming), ]48, ISO
the h. mechanism, 242, 328
h. realisations, 386 fr., 424 fr.
reactive psychoses, 386 fr.
pseudo-dementia, 220
-vide: Prison psychoses
H. and Hypnosis, 175, 380
H. and schizophrenia, 410
prognosis, 844
history of hypnosis, 734 fr.
H. and social situation, 718 f.
Idea, research under guidance of ideas, 44, 555, 559 f., 617 f., 643 f., 666 f., 674 ff.
747 fr.
I. of the Bios, 671 fr.

I. of the Eidos, 617 ff.
I. of the constitution, 633 ff., 643 f., 648 f., 686 f.
hypostasisation, 651 f., 666 f.
I. of the disease-entity, 563, 569
I. of the body-psyche unity, :1.2:1. fr., 617 fr.
I. of the whole, 44
-vide: Unity (complex), Unity, the Encompassing, Man
Ideal-type, 581
Identity of the self, in schizophrenia, 215 f.
Idiocy, 183, 217
Ill, the patient, patient's attitude to illness, 414 fr., 782, 789, 796, 836 ff.
-to his own psychic experience, 149, 417
-self-descriptions, 56 f.
attitude to treatment, 800 fr., 839 fr.
examination of patient, 140 f., 826 f.
methods of treatment, 850 fr.
patient and physician, 795 fr., 800 fr., 805 fr., 8 I 3 fr., 836 fr.
Patient in cultural history, poetry and art, 130 fr., 786 f.
Metaphysical understanding, 309 f., 778 f.
the border between health and illness
-vide: Disease-concept, Personality, Personality-change
Illness
-vide: Disease
Illness, awareness of, and insight, 417 fr., 4:1.2 f.
-in organic dementia, 218 f.
-absence of awareness, 602
Illness, form and cultural content of, 730
-and social situation, 716 fr.
Illuminate or Unmask, 359 f.
scientific and philosophical knowledge, 767~' .
.
.
-vide: Existence, illumination of, Self-!llummatlOn, Understandmg, Self-RevelatIOn
Illusions, 65 fr.
1. in various sense-areas, 70 fr.
-illusional contents in delusional experiences, 98 fr.
-I. in Hashish intoxication, lSI f.
-vide: Hashish
Image, Imagery, I. and Perception, differences, 60 f., 69 f.
Characteristics, 69 f.
I. anomalies of, pseudo-hallucinations, 68 f.
anomalies of I.-characteristics, 75 f.
false memories, 75 fr.
idea, act, Gestalt, 160 f.
stream of 1" mechanism of association, 160 fr.
lxxvi
GENERAL INDEX
Image (contd.)
in flight of ideas, retardation of thought (interpretation), 209 ff.
Imagery-type of, 208
Imbecility, 217 f.
psychoses in I., 15
I. and giftedness, mathematical talent in I., 217 f.
-vide: Subnormality, and Dementia
Imitations, involuntary (phenomena of suggestion), 377 f.
Immortality, drive for (Verewigungs drang), po
Implanted, I. thoughts, U2 ff.
-vide: 'made'
Impoverishment, delusions of and destitution, 107 f.
Impulsive acts, 117 f.
Impulsive movements, 182
Incest, 503 f., 738
Inconsequence (C. Schneider), 586
Incontinence of Affect, 446
Incorrigibility of delusion, 96, 104 ff., 194 f., 410 f.
Individual diagnosis, 571 f.
Individual facts, 2.5 f.
comprehension of the I. of psychic life, 53 ff.
Individual, unity of the I., 755 f.
the I. as a limit, a movement and enigma in research, 557 f., 754 f.
-vide: Biographics, Existence itself, 671 ff.
Individual variations in performance; types, 209 f.
Induced madness, 408, 734
Infancy and early childhood (biographical significance), 699 f.
Infantilism, 32.3, 638
Infectious diseases and psychoses, 476 f.
Infinity, experience of infinite space, 8 I
collapse of time, 87 f.
Influence, experience of I., 1:Z:Z ff.
-vide: 'Made' experience
Inhibition, neurophysiological, I. and Facilitation, 157 f.
subjective I., 110 f.
awareness of I. of will (subjective I. of will), 118 f.
I. of thought, 208 ff.
I. and discharge, 365 f.
I. and stupor (catatonia), 601 fT.
discarding acquired I., 446 f.
I. in organic cerebral processes, 'vital I.', 540
'Disinhibition' (theory), 533
-vide: Stupor, Depression, Insufficiency
I. in Depression, 596 f.
Inner and Outer World, as basic concept, I I f.
-vide: Environment
Insensivity to pain, 61
Insight
-vide: Illness, Awareness of, and insight
Insight, into illness, 218 fT., 419 fr., 422, 602
Instincts. the I. as material subservient to Man, 352 fT.
disturbed I. by reflection, I p, 352 f.
-vide: Drive
Institutional psychiatry and university psychiatry, 846 f.
Institutional treatment, 220, 470 f., 839 fT.
number of in-patients in institutions (increase), 740
I. care, I. education of children, 699
--vide: Isolation
Institutionalisation and m. hospital treatment, 793 f., 839 f.
GENERAL INDEX
Insufficiency, feeling ofl., III f., 216

the insecure (sensitive), 445
'Sensitive delusions of reference', 409
Insulin-cardiazol-shock, 475. 833 f.
Integration, integrative action, 157, 159 f.
Intellectual, intellect,
-vide: Mind
Intellectualistic prejudice, 19 f.
Intelligence, 198
analysis of I., 214 ff.
I. and personality, 429 f., 574 f.
I. tests, 21 5, 220 fT., 622. f.
I. and heredity, 520 f.
I. and size of brain, 491
types of disordered I., 2.16 fT.
disorders of apperception, 172 f.
I. and delusion, 96 fT.
Intensity-changes in sensation, 61 fT.
Intentional Act, 60 f.
.
I. act (Association-Act-Gestalt-psychology), 160 fl.
Interpretation, Interpret, 425 fT.
I. and understanding, 303 f., 350 f.
causal and meaningful interpretation (statistics), 715
self-I. by patients, 417 ff.
symbol-I., 330 fT.
I. and psycho-analysis, 361 fT.
dream-I., 373 ff.
endlessness in I., 35,8 f.
in self-understanding, 348 f.
in symbol-I., 336 f.
in auxiliary hypotheses, 33 f.
intellectual-I. and illusion, 66 f.
metaphysical I. of illness, 778 f.
Interpretation, Nietzsche's concept of I., 293
views governing I. in differentiating drives and instincts, J 17 fT.
Investigator, presupposition of the I., 20 f., 315 fT.
historical type of I. in psychopathology, 844 fT:
.
Involuntary, inter-play of V. and I. events; domam of the I.; disorders, 351 fT.
-vide: Volition
Isolation, 419
psychoses in I., 389 f.
tendency to I. in schizophrenics, 724 f.
-vide: Institutionalisation and Institutional treatment, 724 f.
Jealousy, delusions of, 107 f., 282 f., 693
Judgment, 194 fT.
ability to make J. (Intelligence), 214 f.
reality-J. and delusions, 94 fT., 195 fT.
pathologically distorted J., delusional notions, 95 fT.
-vide: Incorrigibility, Suggestion
J. of patient on his illness, 419 fT.
Kleptomania, 278
Knowledge, scientific and psychopathology, 767 fT.
historical aspects, 844 fT.
demand for synthesis, basic philosophical attitude, 748 If.
methodology, 41 fT.
K. of human nature, 706 f.
lxxvii
Ixxviii
GENERAL INDEX
Knowledge (contd.)
K. and illumination, 706
K. and practice, 791 If., 830 If., 845 If.
research-worker's K., u If.
K. and values, 16 If.
Korsakow-syndrome, 479, 592.
alcohol, Korsakow, 178 f.
K.-patients and basic function, 2.02.
Time-experience in K. syndrome, 85
Lability of personality-awareness, I2.7 f.
Laughing and crying, 2.70, 2.72.
Learning experiments, 166
Left-handedness, 2.08 f.
Leptosome, 2.66, 637, 642., 6so, 6S8, 718
Levels, theory of, 336, 533 f.
-vide: cycle, life-cycle
ordering of the drive-levels, 318 f.
dissociation, perversions, 32.1
Life, living, L. as organism, 452. If.
tendency to disintegrate and integrate, 397 f.
separation and interaction of inner and outer world, 11 f., 454 f.
theories of L., 532.
'spheres of life' (Heyer) 'Lebenskreise', cycles of Life, reciprocity of Life and meaning,
2.49 f., 336 f., 34S If.
Man as a living whole, 55 5, 752. If.
-vide: Biology, Organism, Organic, Man, Unity (complex), Life-history
Life, epochs of, and social factors in psychosis, 684 f., 716 If.
Life-History, 361 f., 671 If., 694 If., 700 If., 765
L. as basis for clinical typology, 571, SH If.
in Biographies, 671 If.
-vide: Case-History
Life-long attitude (typical basic conditions), 32.8 If.
Limit, margin, frontier, 748 If.
L. of types of knowledge and the concrete enigmata, 751 If.
L. and freedom, 755 f.
L. as basic philosophical attitude, 756 f.
L. of understanding and causal knowledge, 305
Literature; viewpoints for the Index.in this book, 49
endlessness of literature, 34
literary products of patients, 2.90 If.
Localisation problem, history of, 480 If.
grouping of phenomena, 186 If., 483 If.
basic questions, 492. If.
theory-formation, 534 If.
-vide: Brain, Brain-processes, Phrenology
Loss of consciousness (eclipses mentales), 143
Lying, pathological, 77, 446, 685
pseudologia phantastica, 151, u8, 32.9, 424 f.
the 'life-lie', 32.9, 802.
-vide: Neurosis, Hysteria
Macropsia, 80
'Made' phenomena ('passivity experience'), 90 f., 122. If., 141 f., 195 f., 416, 579 If., 599
'M' body-experiences, 90 f.
'M' thoughts, I2.2. If., 5)6 If., 599 f.
contrived experience (hysteria), 443 f.
self-descriptions, 578 If.
Man, the Human Being as a whole, 559, 748 If.
GENERAL INDEX
Ixxix
Mania, Mania and Depression, symptom-complex, 596 f.

body-build, 641 f., 649 f.
Mimik, involuntary gesture, 269
heredity, 2.69, 500 If., 518 If., 521 If., 529 f.
Anlage, 639 f., 670
curability, 843 f.
Margin-vide: Limits
Marriage, between relatives, 503 f.
Mass psychology, 737
suggestion, 376 f.
mass phenomena, psychic epidemics, 735 If.
mass statistics and individual statistics in crime research, 72.6 f.
mass statistics in genetics, 499 f., 52.8 If.
Meaning, awareness of M., experience of M., M. and understanding of expression,
2.54 If.
new M. of environment, change in awareness of M. in delusional experience, 98, 103 If.
1S2 If.
experience of uncanny M. at onset of psychosis, 1520 f.
delusions of significance, 100
Mechanism, mechanistic, concept cf extra-conscious M., 10, 364 If.
understandable content and M., 365 If.
normal and abnormal M., 366 If.
normal M., 367 If.
abnormal M., 381 If.
hysterical M., 2.43 If., 401 If., 734 If.
-vide: Neurosis, Hysteria
'paranoid M.', 409 If.
concept of M. in performance-psychology, ISS If., 205 If.
automatic association-M., 161 If.
motor-M. disturbances, 179 If.
extra-conscious M. in expressive phenomena, 257 If.
M. of drives and instincts, disturbance of, 3520 f.
mechanistic theories, 531
-vide: Dissociation, Causal knowledge, Psycho-physical
Medicine, medical, somatic M. and psychopathology, 3 ff.
disease-concept, 780 If.
medical prejudices, 2.0 f.
M. and philosophy, 8S8
Meditative exercises, Yoga practice, autogenic training, 380 f., 72.9 f., 802. f., 806
Melancholia, types of, 598,686
dreams in, 399 f.
delusions and delusion-like ideas, 106 f., 294
involuntary gestures of, 2.71
discharge from hospital, 841
curability, 843
Memory, disturbances of, amnesias, 148, 173 If., 175 If., 896
dissociated memory, 402. f.
M.-falsifications, 177 ff.
false memories, 75 If.
-vide: Consciousness, clouding of
M. as that which encompasses, 760
sense-memory, 66
Mendel's laws, 508 If.
Menopause, 685 If.
-vide: Climacterium
Menstruation, disturbances, 2.37, 2.48, 629
Mental Hospital
-vide: Institution
Mental illness, basic dilferentiation, 577 if.
lxxx
GENERAL INDEX
Mental illness (contd.)

diagnostic schema, 60; If.
an elementary human phenomenon, 7 If.
M. is cerebral illness, 4 f., 4;9 f., 478 If., 482, 496, 535 If.
-vide: Brain
M. is illness of Personality, 44; If.
-vide: Personality, Development, Disease, Statistics, Increase of M., 740
Mescalin intoxication, 62, 64, 71,81,8),91,152
Metabolic illnesses, 472
Metaphysics, metaphysical delusions, 107
m. experiences in free-floating, feeling-, states, I) If.
m. revelation in early schizophrenia, 28 4. 194
m. interpretation of illness, 778 If.
flight into M., )28
m. understanding, 309 f.
m. understanding of symbols, )30 If.
Methodology, Methodological, necessity of M., 5 If., 8;6 f.
m. criticism and erroneous M., 37 If.
basic m. attitude of this book, 41 If., 747 If., 768, 777, 856 f.
ordering by M., principle of classification, 4) If.
-vide: Unity (complex), Science, Idea
Methods in psychopathology, 22 If., 3S If.
Method and object: classification according to method, 4), 747 If., 768 If.
Metromorphic, metroplastic, 6S8 f.
Micropsy., 80
Milieu, Anlage and M., 11 If., 214 f., 70)
social M., 710 f.
elfects of cultural M., S If., 742
change of M., therapy, 838, 840
shaping the environment, 278
institutional M., 841
-vide: Environment, Social
Mimik, involuntary gesture, 269 If.
Mind, Mental Man as M., the encompassing Mind, 760
man in conflict with himself, dialectical movement of M., 761, 340 If., 397 f.
cultural development of man, 672 f., 678, 698
M. objectified in world, knowledge and world, 273, 287 If.
creative products of patients, 288 If., 730
total M. achievement in the Weltanschauung, 293 If.
basic knowledge, 330 f., 354 f.
cultural understanding, 307, 310 If.
M. as limit and enigma, 752 If.
psyche in relation to M. and body, 312 f.
intellectual drives, )19 f.
transformation of abnormal instincts into cultural movement, 322
psychopathology of the M., 728 If.
Mixed psychosis, 612 If.
Mixing, genetics, 503 f.
constitutional alloy, 645, 657
Mixed states (manic and depressive), 597
Monomanias, 278
Moodiness, 688
Moody sullenness (distinct from apathy), 111
Moral insanity, 441
Moral statistics, 716
Morphological, Morphology, 255 f.
complex unities of M., 262
m. duration of body forms (theory of degeneration), 26S f.
-vide: Body build, Brain
'I
GENERAL INDEX
lxxxi
Morphine, see: Craving

Mortal danger (prognosis), 842
Motility, disorders, 179 If.
interpretation, 202, 534 If.
Motor-disturbances, 179 If.
M.-aphasias, 187 If.
M.-excitement, 181
Movement, perception of, 87
image of M., 87
disturbance of M. as abnormal experience, 87
as disordered performance (agnosias), 170 f.
importance of M., 202
-vide: Time experience
Movement, understanding M. (Mimik), 269 If.
types of body M., 2>9 If.
motor disorders, 179 If.
drives to M., 117 f., 271, 597
hypt;rkinetic states, 181 f., 486
lack of M., 119 f., 181 If.
rhythmic M. and stereotypes, 272
spontaneous M. and absence of spontaneity, 486 f.
-vide: Stupors, Catatonic
Murders, meaningless, 280, 328
poisoners, 394
Muscle-sensation, hallucination of, 90
Muscle-tension, 181, 182 f.
-vide: Catatonic
post-encephalitic disorders
Mutation, ;11, 516
Mutism and urge to speak, 191 If.
in thought retardation and flight of ideas, 21 I f.
Mutism, pressure of talk, 191 f.
Mystical experiences, 294
Myth, mythical, understanding of M., 314 f.
in symbol research, 333 If.
origins of M., 338 If.
dream content and M., 338, 339 f., 362 f.
archaic psychic states in psychotic experience, 737 If.
-vide: Archetypes, Metaphysics
Narcoleptic attacks, 119 f., 689
Narcosis, continuous, 841
Natural sciences in psychopathology, 768
Natural scientific theory-formation, 547 If.
-vide: Causal knowledge, Theories, Mechanism
Negativism, 182 f., 343, 601
Neologisms-formation of new words-abnormality of, 289
Nervous system and physical function as a whole, 470 If.
-vide: Organism, Endocrine
Neurasthenia, symptom-complex, 441
illness of our time, 717, 741
Neurology, neurological, N. and psychopathology, 4 f.
the n. and psy. viewpoint in performance-psychology (the n. basic schema of reflex
arc. and psych. basic schema of task and performance), ISS If.
applied basic concepts, 157 If.
n. anomalies in perceptual disorder, 169
-vide: Brain, Brain process, Localisation
n. findings without organic basis, 238 f.
n. disorder in body awareness, 89 f.
lxxxii
GENERAL INDEX
Neuro-mechanisms, 169 if.

Neuropathic families, 521 f.
Neurophysiology, neurophysiological
-vide: Neurology
translation and application of n. viewpoints and basic concepts into performance
psychology, ISS if.
Neurosis, N. and psychosis (core-neurosis), 575 f., 704, 704 f.
N. and health, 575, 816 f.
principles of classifications, 609 f.
accident-No (compensation), ~ f., 387, 389 if., 720 f.
organ-N., 238 if.
increased incidence of N., 742
concepts of N. as failure in frontier-situation in the dialectics of tension and relaxation
344 f.
'
the will to be ill, 424 f.
therapy, 816 if., 831 if.
prognosis, 843 f.
communications from neurotics about their body perceptions, 228 f.
the work performance of neurotics, 207 f.
drawings, 293
-vide: Psychotherapy
Nihilism, experience of N. in psychoses, 294, 688
Normal and abnormal world, 280 f.
mechanisms, 367 if., 381
personality, 439 if.
Nosology, 563 if.
the aim ofN., 5SS if.
Notion (delusional notion) as false memory, 103,75
Numerical system of a mental patient, 297
Object, O. and methods of its observation, 46 if.
self and 0., 57 if., 59 if., 347 f.
Object-awareness, 97
self-awareness, 97, 121 if.
abnormal changes, 61
affective tone in perception, 112
unattached feelings, I 13
Objectification of psyche, 9 f.
meaningful 0., 251 if.
O. in expression, 213 if.
O. in a world, 273 if.
O. in knowledge and production, 287
Objective and subjective facts of psychic life, 26
main grouping; the problem, 13 f.
classification of meaningful O. facts, 2SI ff.
objective psychology, ISS if.
performance psychology, ISS
somato-psychology, 222 if.
psychology of expression, 213 if.
psychology of personal worlds, 274 if.
work-psychology, 287 if.
Objectivity, and the Encompassing, 771 fT
-vide: Subject/object division, the Encompassing
Observation, experimental, 165 if.
Occultism, 736 f.
-vide: SpiritualiSm
Occupation and psychosis, 722.
Occupation therapy
-vide: Work
GENERAL INDEX
Ontology and psychological theory of structure, 776 if.

-vide: Being, Existence itself; Existence, human; Being, dogmatics of
Opium, O.-poisoning, illusions in, I16, 1;1 if.
-vide: Drugs, 466 if., Poisons, Craving
Opposites, psychic 0., dialectics of their movement, 340 if.
O. in the life history, 698 f., 701, 761 f.
O. in psychopathological understanding, 343 if.
O. made absolute, 344 f.
O. equally understood, 357 f.
O. in characterology, 433 if.
O. in typologies, 434 if.
O. in constitution-theory, 657 .
tendency for dissolution and unification in living events, 397 ff.
-vide: Cycle
tension between O. in delusion, 412 f.
Optic (visual) agnosias (soul-blindness), 171 f., 199 if.
subjective imagery (eidetic), 68 f.
Organ, function, disturbances of, O.-neuroses, 236 if.
O.-choice, O. as hidden language, 244 if.
O.-deterioration (Abderhalden) in psychosis, 474
Organic, 'organic-functional', the concepts of, 460 f.
O. symptom-complexes, 592 f.
0.- and psychic process, 692 if.
-vide: Brain-process
O. disease process and reactive psychosis, 390 f.
O. diseases, dependent on the psyche, 238 f.
psychogenesis of O. illnesses, 240 f.
O. theories, 532 if.
-vide: Body, Disease-concept
O. dementia, 218
Organism, mechanism and 0.,452 if.
O. and environment, 156 f.
transformation of O. in the Bios, 681 if.
three homeostatic systems, 470 if.
Orgiastic states, cults, 730
Orientation, disorders of, 172
double O. ISO, 172, 296
O. in relation to body, 89
Origin, 398 f.
in inner activity, 340 f., 341 if.
in self-revelation, 3SO f., 3S4 f.
decision as 0., 342 f.
-vide: Existence itself, Encompassing, Unconscious, Basic
Symbol
Outside world and awareness of self, 126 if.
turning away from 0., 148
self and 0., 325 if.
-vide: Environment, Existence (human), Reality, Alienation
Over-valued ideas, 107 f., 135
Overwakefulness of consciousness, 144
lxxxiii
Knowledge,
Pain, sensitivity, insensitivity, 61, 228

Parallelism of psychic and bodily phenomena, 4 f., 18 f.
-vide: Body and psyche
Paralogia, paraphasia, 194
Paralysis, paralytic, diagnosis of, 4SS fT., 478 if., 565 f., S67 f., )76 f., 606, 607,
616
P. and schizophrenic disturbances, 576 f.

P. and paranoia, 197
Ixxxiv
GENERAL INDEX
Paralysis (contti.)
paralytic dementia, :18 f.
behaviour of a Paralytic, :17 f.
paralytic writing, :74
P. and social situation, 4SS f.
P. and syphilis, 711 f.
therapy, 833
prognosis, 843
Paramimia, :f7
Paranoia, paranoid, symptom-complex, f83 f., f99ft".
self-descriptions, f 99 f.
definition of, 196 f., :86 ft"., 606, 614
'paranoid mechanism', 409 f.
mild P., 409 f.
acute p. reaction, 391
the 'paranoic', 197, :86ft".
-vide: Delusion, Sensitive d. of Reference; Process
Paraphasia, 194
Pareidolia,6f f.
Parkinsonism, 160, 486ft".
Passivity, loss o(wiU, 119
-vide: Activity
'Passivity feelings, thoughts, experiences, etc.'
-vide: 'made' experiences
Past, the, time-experience of P., 84 f.
Pathographies, :94 f., 7:9
-vide: Case-history, Biography
Perception and imagery, 60 f., 69 f.
perceptual anomalies, 61 IF.
alienation of P., 6: ft".
splitting of P., 64
false P., 64 f., 169 f.
P. and reality-jucWuent, 94 f.
delusional P., 99 if.
perceptual mechanism, disturbance of, 169 ft
Performance, Performance-psychology, 53, 153ft".
P. and task, ISS ft".
individual P. and P. as a whole, 16f ft".
individual P. and P.-defects, 168ft".
P. as a whole, 198ft".
psychophysical basis for P., 199ft".
P. tests in experiments, 165 ft".
P. in genetics, f:o
P. in pharmaco-psychology, 468
search for basic functions, 199 ft".
work-P., 191, :OS ft".
individual variation of types of P., :Q1 f., 6u, 64:
examination of intelligence, ::0 ft".
P. tests in confusional states, :13
P.-defects in mental patients, :91 f.
lack of awareness of P.-defects, 42.1 f.
localisation of P. disorders, 483 ft".
-vide: Brain-processes
P.-ability and age, 683
changes of body-feelings, 110 f.
fluctuations of P.-ability in aphasias, 191 f.
P. and personality, 2.07ft"., 62.1 f.
P.-defects and personality disorder, 573
limits of P.-concept, 7S3
GENERAL INDEX
Ixxxv
Period, phase, attack, 687 ft"., 691 f.

period, 691 f.
Periodic fluctuations of consciousness, 142. f.
-vide: Personality-disorders
Perplexity, 414 f., 394
Persecution, delusions of, :82. f., 4I2.
Perseveration, 162., 192.,2.02. f.
Personalisation and depersonalisation, I2.1
Personality, concept of, 4:8ft".
P.-structure,436 ft".
normal and abnormal P., p.-disorder, 439 tr.
variations of P. and psychosis, 639 ft"., 6U tr., 70: tr.
development of P. or process, 639 tr., 653 If., 702. tr.
changes of P. by Processes, 44S tr., 692. If.
-vide: Personality-change
P. change in primary delusion, lOS If.
P. change in schizophrenia, 2.I8 f.
through imprisonment, 468 f.
attitude to illness, 414 If.
loss of P., 42.0 f.
experience of double P., U4 f.
alternating awareness. 404 f.
movement as expression of P., 184 f.
-vide: Character
P. and intelligence, 164 f., 2.07 tr., 2.18 If., 42.9, 574, 6202. f.
P. and vital aspects, :06 If., 419
P. and drives, 32.0 If., 630 f.
actual and lasting P. in catatonic symptom-complex, 601 f.
appeal to P. in therapy, 836 If.
-vide: Life-history, Development, Dilferentiation
Personality, awareness of, 12.7, 3U tr., 4:8 if.
self, awareness of, I2.1 tr.
lack of P. in dreams, 144 f.
feelings of change, I2.6 f.
lability of, 12.8
Personality-change, basic question: development of personality or process?, 139 tr.,
6S3 tr., 692. f., 702. If.
P. in course ofHfe and morbid P. as psychosis, 639 tr., 6U tr.
P. through processes, 446 tr.
P. in primary delusion, 106 If.
P. in schizophrenic dementia, 2.18 f.
P. after poisoning, 468 f.
self-assessment, 447
feeling of P. at start of process, 414 f., 95 If., I2.7 tr.
attitude to illness as sign of P., 416 If.
P. and literary products, 2.90 f.
performance-defects and P., 574 f.
-vide: Process
Personality-development
-vide: Age-epoch, Development, Personality, Personality-awareness, Personalitychange
Personality-disorders (psychopathy), diagnostic schema, 606, 609 f.
'psychopathic personalities', 439 fT., 733 If.
states of personality-disorder, 688
insight in P., 42.I f.
-vide: Neurosis
genetics of P., S2.I f.
Personality-traits, properties, personality as combination of traits, 433 tr.
P. a8 basis of type-construction, 434 tr.
lxxxvi
GENERAL INDEX
Personality-traits (conttl.)
P. in a schema of opposing traits, 436 ff.
'basic P.', 6~3
Personifications, dissociated, 1:18 fr.
P. in self-interpretation of a patient, 417 f.
Perversions, 3:10 ff., 3~3 ff., 394 ff., 630 f.
Petit Mal (attack), 14:1, 689
Phantom limbs, 89
Pharmacopsychology, 467, 643
Phases; reaction, phase and thrust (Schuh), 384 f.
attack, phase, period, 687 f.
phase, 691 ff.
phase and process, 69~ ff.
phase in relation to age-epochs, 681 ff.
phase in relation to personality development, 639 f.
relation of personality to phase, 639 f.
relation of phase to process, 641 f., 6S3 ff.
a series of phases, 149
-vide: Age-epochs, Development, Personality
phase of diminished or heightened productivity, :15 I
Phenomenology, concept and aim, H ff.
phenomenological orientation, H f.
P. as a viewpoint in this book, 47 f.
Phenomenon, experienced phenomenon, form and content of phenomenon, 58
transitions, 59
direct and indirect P., 58
reflective P., 131 ff.
abnormal P. of psychic life, S7 ff.
P. and the state of consciousness, 137 ff.
the objective P., ISS ff.
P. and causes of, 4SI f.
localisation of P., 483
Phenotype and Genotype in genetics, s08 f.
P. and G. in psychopathology, SI3 f.
in constitutional theory (Kretschmer), 644, 650
Philosophy, philosophical, basic philosophic attitude to Man, 756 ff.
p. concept of the Encompassing which we are, 759 ff.
religious and p. contents of faith, 764 f.
P. in psychopathology, 775 ff., 837
basic p. positions, 819 ff.
the p. confusion, 771 f.
existential P. and psychopathology, 308, 77~ ff.
empiricism in P., 46
medicine and P., 858
value of studying P., 5 f.
p. prejudice, 16 f.
P. as a source of understanding, 308, 314
P. as source of basic knowledge, of symbols, of frontier-situations, 331 ff.
problems of p. possibilities, in early schizophrenia, :183, :194 f.
P. guiding research by ideas, 560
-vide: Idea, Unity (complex), Methodology, Man, Understanding, Existence itself,
Existence (human), Illumination, Metaphysical
Phlegmatic, 440
Phobias, 136
-vide: Anxiety
Phrenology, ~6:1, 481
Physician and Patient, :11, 676 f., 795 f., 805 ff., 8u fr. 818 fr., 836 ff.
methods of examination, 8:16 ff.
basic attitude of P., 770, 805 fr.
GENERAL INDEX
lxxxvii
medical practice, 8'31 fr.

-vide: Therapy, Psychotherapy
Physiognomy, Physiognomic, :159 fr.
p. gaze, :157, :160
p. prejudice, ~6:1
training in P., :163 f.
-vide: Body-build, Constitution, Character
P. as 'frozen gesture', ~71 ff.
p. literature, historical review, :164 ff.
extended meaning of P., :175
-vide: Expression
P. of things, I U
Physiology, physiological, total picture of p. events, 471 ff.
homeostatic systems, 471 ff.
p. cycles, ~31 f.
P. of nervous system
-vide: Neurology, Brain, Reflex Arc
p. investigations into catatonic stupor, :150
in schizophrenia, :150
Plasticity, 398
Pleasure and displeasure, 317
delight, 596 ff.
Plethysmographic investigation, :130
Poetry, poets, poetry of mental patients, :191 f.
great poets as source for understanding, 314 f.
forms of madness in poetry, 730, 787
Poisoning, psychoses following P., 466 fr.
vide: Drugs
Polarity, 340 ff., 398 f.
-vide: Opposites, Dialectics
Possession, 735 fr.
-vide: Doubling, Dissociation, doubled
Post-encephalitic states, 419
oculo-gyric crises, 689
-vide: Encephalitis
Post-hypnotic effects, 377 ff.
Practice, 790 ff.
knowledge and P., 791, 8:19 ff., 845 fr.
P. and philosophy, 7119 fr.
extra-mural and institutional P., 794 ff.
-vide: Physician, Psychiatrists, Treatment, Examination, Psycho-therapy, Therapy
Practice (training), P.-capacity, retention of practice, 157, :106 f.
methods (in therapy), 836 fr.
-vide: Autogenic training
Pregnancy and Psychosis, 6:19
Prejudices, 16 ff.
Present, past and future in abnormal time-experience, 8:1 ff., 85
Presentation, technical principles of P., 49 ff.
-vide: Total presentation
biographical P., 674 ff.
Presentation, urge for, :1SJ f.
Pressure of speech, J18, 191 ff.
Pressure-curve, :158
handwriting, pressure of, :173
Presuppositions for research in psychopathology, 16 ff.
Primary (basic) phenomena, 57
reality-experience as P., 93 fr.
Primary symptom, 584
Primitive and schizophrenic psychic life, 737 fr.
Ixxxviii
GENERAL INDEX
Primitive (conttl.)
parallels and analogies, 214
collective unconscious, 338 f., 361 f.
'primitive reactions', 390, 533
Prison psychoses, 386 fr., 389 fr., 396, 407
conversion experience in prison, 388 f.
'delusion-like fancies' in prison, 409
day-dreaming in prison, ISO
pseudo-dementia, 220
-vide: Hysteria, 401 fr.
Private languages, 289
Process, P. and phase; organic and psychic P., ~2 fr.
personality-development or P., 653 ff., 702 fr.
personality transformation by P., 44S fr.
limit of understanding, 704 fr.
P. and neurosis, 704 fr.
-vide: Development, Personality, Personality-change, Brain-process
Production, cultural p. of patients, 281
literary productions of patients, 290 f.
Productivity, fluctuations of P., 216
morbid P., 284, 287, 294
Prognosis, long and short term, 842 fr.
-vide: Diagnosis, Cure, Acute
Propulsive 'temperament of development' (Conrad), 660 f.
Protracted recovery, 844
Pseudo-bulbar palsy, 2S7, 272
Pseudo-dementia, 194, 220, 391 f.
Pseudo-hallucination, 68
Pseudologia phantastica, lSI, 218, 329, 420, 79S
Pseudo-understanding, 306
Psychasthenia, psychasthenic, symptom-complex, 216, 441 f.
'sensitive idea of reference', p. reaction, 409, 640
p. reaction, 389
theory oflevels, 533
Psyche, psychic, as objectified, 9 f.
P. as consciousness, 9 f., 137 fr.
differentiation of p. life, 13 fr.
expression of P. in body and movement, 253 fr.
P. and body, 311 fr.
-vide: Body and psyche, Body
somatopsychology, 5 f., 222 fr.
P. between Mind and Body, 311 f.
P. and character, 428
-vide: Character, Personality
comprehending p. life through opposition of whole and parts, 27 f., SS 5 fr.
-vide: Unity (complex), Elements
P. as Encompassing, HO fr.
-vide: Encompassing, 480, 435, 364, Man, Existence itself
p. energy, variations of, 441 fr.
dynamic theories, S)2 fr.
association theory, 534 fr.
p. development from transformation of drives, 324 f.
Psychiatrist, types of P., attitude of P., 806 fr.
necessity for self-illumination of P., 812 fr.
Psychiatry as an art v. psychopathology as a science, I fr.
history of P., 844 fr.
German and French, P., 8S) f.
modern P., 854 fr.
GENERAL INDEX
Psychic (soul) blindness, 171 f.

investigation to find basic function, 159. 198 fr.
Psychic epidemics, 408, 785
Psychic life, elementary and mediated by thought, 13 2
differentiation of P., 13 fr.
-vide: Psyche, Differentiation
Psychic and sOInatic approach, 848 f.
Psychic theories, 534
Psycho-analysis, psycho-analytic, P. as psychology of meaningful connection,
3S9 fr.
interpretation of dreams, 373 fr.
P. as psychological theory, 537 fr., 546
P. as a philosophical movement, 772 ., 814 f., 819
P. as therapy in affective disturbance, 835
with dissociated memory, 404 f.
demand for 'training analysis', 8 I 3 fr.
application of P.to contents of schizophrenic delusion, 4 1 0
Use of P. to penetrate the psycho-physical connections
-vide: Psychotherapy, Understanding, Unconscious
Psycho-galvanic reflex, 229
Psychogenesis of organic illnesses, 239 fr.
Psychogenic and hysterical, 243 fr.
psychogenic seizures, 236
Psychogenic reactions, 367 f.
after-efrects of earlier experience, 3~ fr., 381 ff.
pathological psychogenic reaction, 383 fr.
psychic traumata, 404, "JOO
destructive and constructive effects of P., 397 fr.
Psychogram, psychography, 562
Psychology, psychological, psychology and psychopathology, 3 fr.
objective P., ISS fr.
Performance-P., ISS fr.
SOInato-P., 222 fr.
P. of expression, 2B fr.
Personal world, P. of, 274
Work-P., 287 fr.
P. of meaning, 301 fr.
empirical P. and philosophical illumination, 776 fr.
explanatory P., 4SI fr.
danger of P., making p. knowledge an absolute, 809 f.
p. techniques, 815
-vid~: I!ypnosis, Autogenic training, Meditative practice, Practice (training)
p. preJudice, 19 f.
Psychology of the personal world, 274
Psychopathie-vide: Personality-disorder
Psychopathology, general P., definition, I fr.
aims, 38
presentation, 39 f.
intention of this general P., 41 fr.
Review of P., 747 fr.
P. as a science, I fr., 747 fr., 767 ff., 844 ff.
P. and other sciences, 35 fr.
-vide: Methodology
P. and philosophy, 6, 16 f., 36, 308 fr., SS8 fr., 747 fr., 85 8
P. and existential philosophy, 775 fr.
P. and psychiatry, I ff.
P. and psychology, 3
P. and meaningful psychology, 301 fr.
P. and somatic medicine, 3 fr.
O.P.-oo
Ixxxix
xc
GENERAL INDEX
Psychopathology (contd.)
P. and natural science, 302, 547 ff.
-vide: Theories, Causal knowledge, Brain-research
P. and social studies (humanities), 36 f., 301 ff., 314 ff.
experimental P., 24, 165 If.
aim of p. education, 50, 857 f.
Psychophysical, p. basis of performance, 198 ff.
basic p. functions, 199 ff.
methods of investigation, 199 f.
basic characteristic of p. mechanism, 205 ff.
the p. apparatus, 165
Psychosis, over-all classification, 604 ff.
mixed P., 612 f.
spontaneous and reactive P., 384 ff.
acute and chronic P., 574
-vide: Acute p.
symptomatic P., 475 ff.
P. following chronic poisoning, 468 ff.
P. and neurosis, 575 f.
endogenous P. and organic Brain-diseases, 576 f.
patients' attitudes to P., 414 f.
behaviour at onset of P., 277 f.
P. and personality
-vide: Personality, Personality-change, Process
somatic findings in P., 246 ff.
Psycho-somatic basic facts, 226 ff.
Psychotherapy, 791 ff., 795 ff.
methods of treatment, 834 ff.
aims, limitS of P., 801 ff., 818 ff.
P. and illumination of Existence, 818 f.
public organisation of, 810 f.
symbol-research and P., 333 ff., 338 f.
-vide: Psycho-analysis
historical aspects of P., 849
Psychotherapist, the personality of, 805 ff., 812 ff., 819 ff.
-vide: Physician
necessity of self-illumination of P., 813 ff.
'training analysis', 813 ff.
sect-formation, 773 ff., 819
-vide: 'Weltanschauung', Psycho-analysis
psychiatrist and P., 576
Puberty, 625, 628, 683, 685
'pubertas praecox', 629
P. and epilepsy, 685
Puerilistic behaviour, 277, 391 f.
Pulse rate, 230, 235
Pupillary movements, 230 f.
Purposive neurosis, purposive psychosis, 386 f.
.
-vide: Compensation, Accident neurosis, Prison psychOSIS
Pyknic and leptosome (statistical differences), 642 If.
'alloy' and 'cross-over', 645
polarity, growth tendencies, 657 f.
p. and cyclothymic, 261 f., 659 ff.
Pyknomorph-cyclothyme, 661 ff.
Pyromania, 278
Qualitative changes in sensation, 61 f.
Quantitative findings and concepts, 20 f.
Q. measurements (in Performance-psychology), 155 ff.
GENERAL INDEX
xci
'Querulants', 441
Q.-delusion, 107 f., 727
Questionnaires, 823 f.
intelligence tests, 220 ff.
-vide: Examination
Race (Sex, constitution, Race), 618 f., 668 ff.
racial mixing, 503 f.
racial degeneration through culture, 741 f.
Radicals, biological in functional grouping, 586 ff.
personality, 'radicals of', 623
Rage, effects of, 479, 487
Rational and empathic understanding, 304
Reaction, reactive, psychogenic reaction, 367 ff.
abnormal after-effects of early experience, 394 ff.
abreacting, 371, 404
'association-experiments', 371
pathological R., 383 ff.
r. states, review of, 389 ff.
r. psychosis in schizophrenia, 390 f.
R, phase and Schub (Thrust), 384 f., 390 f.
understandability of R, 385 ff.
'R-systems' (Jung), 337 f.
modes of R in vegetative systems, observation by instruments, 229 ff.
Reactivity and actiVity in life, 327 ff.
reactive and autochthonous abnormality, 456
Rea1ity-awareness and delusion, 93 ff.
reality-judgment, 94 ff., 420
incorrigibility, 104 ff.
Reality, Awareness of Reality, Reality experiences and delusion, 93 ff.
-vide: Delusion
Delusional experiences, 97 ff.
loss of R of time-experience, 84 f.
double-orientation, ISO, 172, 296
-vide: Existence (human), Consciousness of one's own existence, Being, Being,
Awareness of; World, Transformation of World, 'Cosmic experience'
the individual and R., 325 ff.
concept of R, 326 f.
Basic situation, of individual and R., 327 f.
flight from R, 324 f., 387 f.
R-penetration and R-denial, 328 ff.
appropriation of R, symbolically present R., 330 f.
-vide: Realisation
self-evidence of understanding and R, 303 f.
Reason and Existence itself, 760
Recessivity and dominance in schizophrenic heredity, 518 f.
Reduction to the Concrete, 202
deterioration of individual organs, 474
disintegration of higher levels of drives, 321theory of levels, 533 f.
Reference, delusions of, 100, 103, 115,391
'sensitive delusions of R.', 409, 640
Reflection, 131 ff.
self-reflection, 347 If., 420 f.
R. and the unconscious, 347 ff.
R as liberation, 348
danger of R., 348, 809
R in character-development, 349 ff., 437, 443
disturbance of drives by R., 352 f.
xcii
GENERAL INDEX
Reflection (conta.)
-vide: Volition
Reflectivity, reflective, S8
r.-phenomena, 131 If.
r.-personality, 370 If.
r.-character-development, 437
effects of self-R., 351 If.
-vide: Mimik (Involuntary gesture), 2.69 If.
Volition, Unconscious
Reflex, R. and performance, ISS If.
the R. and the total of R.'s, integration, IS8 f.
R.-apparatus, psychic R.-arc, ISS If., 158 If., 179 f.
theories (Wemicke), 534 If.
psychogalvanic R., 2.29 f.
voluntary R.-enforcement, 425
Refusal to eat, 2.79
Registration, in memory, 173 If.
disturbances in R., 147, 175 :If., 2.04, 69 2
isolated, total loss of R., 177 f.
disturbances with flight of ideas, retardation, 209 :If.
with confusion, 213 f.
with organic dementia, 218
-vide: Intelligence, 214 If.
'Regression', 700, 702.
Reiteration, phenomena of, 487
'Relative mental defect', 217
Religion and psychopathology, 731 f., 792
Religions (statistics), 723
Reporting, experiments in, UI, 371
R. and falsification of memory, 178 f.
Repression, 371, 395 f., 405 f., 410, 537 f.
-vide: Hysteria, Complex
Reproduction-ability (in memory), disturbances in, 173 :If., 176
-vide: Amnesia
Reproduction, psychoses of, 62.9
'Resentment' (Nietzsche), 32.5 f., 372. :If.
Respiration, 2.30, 836
Responsibility in attitude to self, 696 f., 836 If.
-vide: Freedom, Existence itself
Restlessness, 114, 487
Revelation-process in early schizophrenia (cosmic, religious, metaphysical),
Ii!4 If.
metaphysical interpretations, 778 f.
Revelation, 349 f., 353 f., 359,798 f.
-vide: Existence, illumination of; Understanding, Self-illumination, Commllnication
Reversals (Nietzsche), 346
Rhythm, rhythmic, 270 If.
r. movements in mental illness, 183, 273
Right- and Left-handedness, 2.08 f.
Right-handedness and aphasias, 187
Roles, R. as attitude, 354 f.
R.-playing, 128 f.
hysteria, 443 f.
Rumination, 134
Sanguine type, 440
Scepticism, 2.94, 819 f., 807 f.
Schicksal-vide: Destiny
GENERAL INDEX
Schizophrenia, schizophrenic, natural" s. life, 343, ;81 1., 177 If., 607
symptom-complexes, 598 :If.
symptom-groupings (C. Schneider), S86:1f.
diagnostic schema, 60S fT.
s. personality-change, 446 f.
-vide: Personality, Process
a-social behaviour, 72.4
reactive psychosis in S., 391 f.
delusions in S., 410
s.-experiences at onset of processes, 152. fT.
time-experience, 84 If.
'cosmic experiences', 2.95
dream-experiences, 399 If.
feelings of happiness, 114 f.
attacks and 5.,2.36,689 f.
fever and S., 2.49, 476
stereotypes, 395
deterioration in 5., 2.18 f., 446, 843 f
s.-catastrophe, 843
prognosis, 843
therapy, physical and psychoth., 832. fT.
s.-world, 2.82. f.
s.-art, 2.9 I If.
literary products of S., 2.90
s.-thought,2.13
S. and body-build, 641 f., 649 f.
S. and personality-type, 640, 653 If.
-vide: Personality
heredity in S., 500 f., SI8 f., pI f., 52.8 f.
paranoia and 5., 613 f.
S. and hysteria, 409 f.
s. psychic disturbance as distinct from psychic phenomena in Paralysis, 176 f.
insight and 5., 422 f.
tendency to 'understand' the process, 410, 704:1f.
metaphysical interpretation of S., 778 f.
primitive and schizophrenic psychic life, 737 :If.
Schizothyme and leptosome, 2.66, 438, 641 f., 653 :If., 72.4
Scholastic abilities, heredity of, S2.0 f., 721
S. and experience; intelligence tests, 214 f.
'Schuh' (thrust) and reaction, dilferentiation, 384 f., 391 fT., 692. f.
-vide: Thrust
Science, scientific, psychopathology as as., 2. If.
historical aspects, 843 If.
concept of S.; S. and modes of S. in psychopathology, 747 If., 768 :If.
philosophy and S., 768 If., 771
s. knowledge and philosophical illumination, 766 f.
S. and practice, 791 If.
-vide: Knowledge, Methods, Methodology, Causal knowledge, Theory
Scopolamine effect, 87
Season of year, 464
Seclusion from reality, 32.8
-vide: Reality, Environment, World
seclusion as hospitalisation, 794
-vide: Institutional treatment
Secretion, endocrine system, 470 If.
findings in psychoses, 473 If.
inner secretion and habitus, 638
-vide: Cycle, Organism
Sects, sectarians, 44 I
xciii
xciv
GENERAL INDEX
Seizures, convulsions, 2.)6 if., 478, 608, 688

-vide: Epilepsy, Attack, 688
convulsion-therapy, 833
Sejunction, 536
Self, feeling of, 42.9
loss of feeling of self, U2.
Self-awareness, UI if.
S. and object-awareness, 57,60 f.
S. and body-awareness, 88 f.
S. and personality-awareness, J2.I, U7 if., 353 if., 428 if.
changes in S., U7
S. of unity of the self, U4 if.
S. of activity of S., UI if.
S. of identity of the S., us if.
S. and external world, 126 f., 32.S fr.
schizophrenic changes in the self, 294 if.
-vide: Personality
Self-deceptions (denial of reality), 328 if.
reality-drive, 329
Self-descriptions of patient, 5S if.
attitude to illness, 56, 4J4 if.
literary products of patients, 290 f.
examination techniques, 139 f.
-vide: self-interpretation
Self-education, 836 if.
Self-evidence of understanding and interpreting, 288
Self-illumination of the patient, 42.S fr., 414 if.
S. in therapy, 798 if., 83 8
S. and its errors, 809 f.
S. and pseudo-knowledge, 143 fr., '45
S. in the understanding of drives, 3J6 if.
S. in the understanding of symbols, 337 if., 353 f.
S. pfthe investigator, 16 f., 18 if.
demand for S. in psychotherapist, 8u if.
S. of the finiteness of man, 763 if.
-vide: Existence, illumination of; Self-reflection; Understanding; Self-revelation
Self-insecure individuals, 443, 445
Self-interpretation of patients, 417 if.
S. with existential reference, 424 if.
Self-mutilation, 279
Self-observation, 349
abnorinal S. as symptom, 420
S. of schizophrenic personality change, 447
S. under experimental conditions, 475, 167
Self-realisation by reflection, 347 if.
S. in the frontier-situation, 330
S. in basic knowledge, 354
S. in revelation, 798 f., 803 if., 817
-vide: Existence itself; Existence, illumination of, Communication, Revelation,
Historical character, Choice
Self-reflection, 347 if.
S. as freedom and risk, 348 f.
S. as diiferentiation, 13 f.
S. as element of inner development, 696 if.
S. in psychotherapy, 809 f.
attitude to illness, 4 I 4 f.
eifect of S., 351 if.
S. and symbolism, 339
-vide: Reflection, Reflectivity
GENERAL INDEX
I
;
xcv
Self-revelation, 798 f., 330, :Ho, 354 if.

-vide: Existence, illumination of
Self-sufficiency and dependence, 326
Self-transformation as self-realisation in marginal situations, the therapeutic aim, 330
-vide: Personality development, Personality-transformation
Self-understanding, 349 f.
S. of patient in interpretation of his illness, 415 if.
misleading pseudo-knowledge, 543 if., 545 f.
Senile dementia, 218, 686
Senility and old age, J76, 683 f., 686 f., 700 f.
senile dementia, 218
Sensations, change in intensity and quality, 6J f.
abnormal accompanying S., 62
abnormal feeling-S., 1U
subjective bodily S., 2.2.7 if.
Sense-areas, senses, 70 if.
hallucinations, 90 f.
synaesthesias, 74 f.
simultaneous hallucinations, u9 if.
personifications, u9 if.
significance of level of attention in false perceptions, 140 f.
disorders of the sense-organs in production of hallucinations, 169 f., 483 f.
sense-deficiency, 1<>9
Sense-memory, 66
Sense-perceptions (awareness of body), 88 f.
hallucinations, 90 if.
abnormal feeling sensations, 1U
Sensible state, 140 f.
Sensitive, sensitive individual, 445, 327
'sensitive delusions of reference', 409, 640
personality and delusions of grandeur and persecution, 411 f., 640
'sensitive paranoic', 413
'Sensitiver Beziehungswahn' -vide: Sensitive delusion of reference
Sensitivity, reduced S. to pain, 6J
Sensory aphasias, 187 if.
Sex, sexuality, 365 f., 618 f., 623 if.
S. and psychosis, 62.8 fr., 685 f.
Shock,157
S.-psychoses, 367 if., 389 f.
S.-therapy, 475, 832 f.
Shouting, state of, U4 f., 192.,487,690
Simulation, 82.9
'purposive psychoses', 386 f., 388 fr., 719 f.
S. and hysteria, 2.44
Sin, delusions of, 107 f.
Situation, concept of, J25 if., JO f.
marginal S., or frontier-S., 32.6 f., 330
social S., 709 fr., 716 if., 732 if.
S. and therapy, 837 if.
-vide: Milieu, Environment
Sleep, 144 if., 2.32 f.
S. and hypnosis, 379
disturbances of S., 2.33 if., 87
sleeplessness, 2.33 f.
excessive sleep, 2.34
falling asleep and waking, rituals, 2.34 f., 2.72.
Slowing-down (psychic), 486 f.
Social psychology, 710 if.
Social psychology and society, 709 if.
XCVI
GENERAL INDEX
Social, social history, 7II If.

s. situation and illness, 716 If.
s. situation and treatment, 840
s. distribution of diseases, 7l2. f.
socially conditioned subnormality, l2.0
s. usefulness and disease-concept, 780 If.
asocial and antisocial behaviour, 714 If.
Social science, social study, the humanities, and psychopathology as as., 3S f., 301 f.,
314,678,768 f., 811
cultural assessment of sickness, 730 f., 786
-vide: Philosophy, Science
.
Sociology and psychopathology, 709 If.
meaning of S. and methods, 713 If.
social situation and illness, 716 If.
Somatic, somatic medicine, 3 If.
disease-concept, 780, 789, "9
-vide: Prejudice, 18 f.
s. localisation problems, 8~o f.
physical methods of treatment, 831 If.
psychosomatic basic facts and disorders, 117 If.
s. disorders in relation to psyche, 136 If.
origins of s. disorder, 141 If.
understandability of s. phenomena in psychic context, "41 If.
s. findings in psychoses, 146 If.
s. illnesses in diagnostic schema, 604 If.
-vide: Body, Organic
Somato-psyche, 88
Somato-psychology, 111 If.
S. findings, classification, 116 If.
Somnambulism, 379 f., 734 f.
Sopor, 147
Sosein-vide: Being-Thus
Space, experience of, 79 If.
anomalies of Sp.-experience, 80 If.
experience of infinite S., 81 f.
alfective Sp., 81
spatial experience and body-awareness, body-schema, 88 f., 91 f.
S. proper to self and external S., 89
objective S. and subjective S. 69 If.
S. and time, 79 If.
Species, the totality of the species (Eidology), sss If., 617 If.
Sex, Constitution, Race, 617 If.
physiognomy, 2S9 If.
-vide: Body-build, Character
degeneration of S., 26S f.
-vide: Degeneration, Anlage, Personality
Speech (articulation), disorders of, 186 f.
Speech confusion, 193
Speech disorders, articulation, 187 f.
S. disorder in right-handedness, 187
in left-handedness, 208 f.
in aphasias, 187 f.
in psychotic states, 191 If.
problem of independent speech, 288 f.
Speech and language, 18S
S. and understanding, ISS If.
spontaneous S., drive to talk, 192 f.
Spiritualism, 736 f.
spiritualist family, 3S2 f.
GENERAL INDEX
Spontaneous movements, loss of, 48S f.

encephalitis, post-encephalitis, 183 f.
-vide: Encephalitis
Spontaneity of speech, spontaneous, reduction, loss, 18), 116, 48~ If.
s. urge to talk, 191 f.
shouting states, 124 f.
speech as s. performance, 184 If.
as a product, 288 f.
private language, 290
possibility of verbal character-analysis, 43 1
State, bodily state, awareness of, 88 f.
dilferent states in psychosis, S74 ff.
clinical S. (symptom-complexes), S82 If.
s. of consciousness, 137 If.
Statistics, "3, 648 If., 6S6 If., 714 ff., 716 f.
correlations, 31, 161, 614 f., 644 ff.
-vide: Correlations
S. in genetics, 499, ~07 f., P9 f., S27 f.
-vide: Genetics
social S., 713 ff., 741 ff.
crime S., 716 ff.
suicide S., 713 f., 740 f.
constitution type S., 64S ff., 6S6 If.
individual and mass S., 716 f.
. S. and the diagnostic schema, 614 If.
Statue-like postures, 181
Status dysraphicus, 638 f., 6S8
Stereotypies, 39S
S. in movement, 181 f., 173
Sthenic, asthenic, 3"7
-vide: asthenic
Stigmata, stigmatisation, 'stigmatised' people, "3S
'vegetative S.', "41
hysterical stigmata, 401 f.
'Stigmata degenerationis', 16S f., s06
Stimmung-vide: Atmosphere
Stimulus and reaction, reflex arc, IS3 If.
summation of S., IS8
association-experiments, I6S f.
-vide: Reaction
Stocks and peoples, 713
Structural theory, psychological, 776 f.
Stupor, 113, 219, 391, 487 f., S83, 601
Stutter, 186 f.
Subject, subjective and objective psychic facts, 24 If., S3 f.
s. and objective psychology, ISS
s. phenomena of morbid psychic life, SS If.
(phenomenology)
Subject-object division and self-reflection, 347 ff. 7S6
s.-object division in consciousness generally, 760 f., 770 ff.
-vide: Encompassing
Sublimation, 322, 366
Subnormality-vide: Dementia, types of, 116 If.
Suggestion, 376 If., 407 f.
psychic epidemics, 73S
suggestion-therapy, "40, 83S f., 837 ff.
S. and hysteria, 401 If.
hypnosis, 234, 378 ff.
leading question, 818 f.
xcvii
xcviii
GENERAL INDEX
Suicide, "79 f.
S. statistics, 741 f.
Summation, 157
Superstition, 107, 339,73" ff.
Survey of this book, its plan, 45 ff.
'Switch-over' in conscious state, 380 ff., 382
-vide: Hypnosis, Auto-hypnosis, Autogenic training
Symbol, concept of, and importance for life, 330 ff.
connection of symbols, 335 ff.
origin of S., historical uniqueness, 337 ff.
re-awakening of S., 339 f., 839
understanding of S., 33", 336 f.
ambiguity of S., 337
endless interpretability, 357 f.
S. in self-reflection, 339 f., 347 f.
interpretation of speech disorder as disorder of symbolic formation,
190 f .
Symbol, concept of S. in psychoanalysis, 3"" f., 3"4, 3,,8 f., 358 ff., 365 f.
symbolisation, 373
application to schizophrenic delusion, 410
possibilities and limits of symbolic understanding, 33" ff., 358 ff.
Symbol research, history and aim, 3H ff.
Symbolic satisfaction, 3"" f., 3"4, 3,,8 f., 365 f.
Symbolism of expression; shape and form, "55
S. of movement, "69 ff.
-vide: Physiognomy, Mimik, Body-build
Symptom, concept of, 459
primary and secondary S., 584
supremacy of S. in diagnostics, 604 ff., 611 ff.
symptom-complexes, 582 ff.
symptom-groups, schizophrenia, 585 ff.
Symptom-complexes, 565, 58" ff.
particular complexes, 59" ff.
Symptomatic psychoses, 475 ff.
Synaesthesias, 6", 74
Synopsia, 6"
Synthesis, synthesis of our knowledge of man, 748 ff.
S. of clinical pictures, 563 ff.
S. and choice in dialectics of psychic reality, 34" f.
Syntonic character, '1.67
Syphilis, 455, 5'1.6
paralysis, sylphilis and social situation, 717
System, methodological, in psychopathology, 41 ff., 747 ff.
Talking past the point (vorbeireden), 194
Talking round the point, '1.76
Task and performance, ISS ff.
hierarchy of complex unities, 164 f.
the set task in experiments, 165 f.
methods of examination, 198 ff.
basic function, search for, 198 ff.
intelligence tests, '1.'1.0 if.
investigation of work-performance, '1.05 ff., 597
types of performance, '1.07 f.
Taste and smell, false perceptions, 74
Technical methods, '1.3 if.
-vide: Experiment, Statistics
psychological technique, 815 f.
-vide: Hypnosis, Autogenic training
GENERAL INDEX
xcix
Temperament, 328,440 if., 363 ff., 64'1. if., 647 f.

-vide: Body build, Constitution, Character
Tendency and counter-tendency, 340 if.
psychic tensions, dialectic movement, 340 if.
schizophrenic dissociation of a tendency, 343 f.
disintegrating and integrating T., 397 ff.
Tension and release, 344
T. in the beginning of the acute schizophrenia, 15'1. f.
Terminology, pseudo-understanding through T., 35 f.
Terror effects, 366
T.-psychoses, 398 f.
T.-Basedow, '1.39
-vide: Shock
Theories, theoretical, 530 if., 586 ff., 771 ff., 776 ff.
Theoretical thinking, 10 f., 17 f., 33 f., 771, 547 ff.
-vide: Causal knowledge
-vide: Extra-conscious mechanism
Theory of Being and methodology, 41 ff., 747 ff.
-vide: Being, Being, dogma of; Ontology, Unity (complex), System, Idea,
Absolutes
Therapy, therapeutic aims, 830 if.
Possibilities and causal knowledge, 461 f.
physical therapy, 83'1. ff.
psychotherapy, 834 ff.
general medical therapy and psychotherapy, 795 ff.
therapy and eugenics, 83'1. f.
-vide: Psychotherapy, P /therapist, Therapy, Physician,
Illness and Practice
Thermic hallucinations, 90
Thought, compulsive; formal compulsive thinking, 134 f.
-vide: Compulsion, 'Made'
Thought disorder in Huntington's Chorea, '1.03
Thoughts, 'implanted', 'made', 'T.-withdrawal', I'1.'1. ff., 586
'breaking-off', 686
pressure of T., flight of ideas, '1.09 ff., '1.13
flight of ideas in fatigue, 465
voiced thoughts, 98
Thought and judgment, 194 ff.
autistic thinking, )28
deductive thinking, 16 f.
compulsive thinking-vide: Compulsion
theoretical thinking, 547 fr.
causal psyc~ological thinking, 304 f.
-vide: Theories
Thought retardation and flight of idea, '1.09 ff.
Thyroid diseases, 470 ff.
-vide: Endocrine illnesses
Time, knowledge of time, passage of time, 79 ff., 8'1. ff.
abnormal experience of T., 83 if.
disturbances of T.-perception as a defective performance, 171
vital time, time-events, '1.01, 540 ff.
derivation of disturbed time-experience from disturbed basic event, 540 If.,
544 f .
in compulsive disorder, 540 f.
temporal and metaphysical reality, 107
Torpor-reduced consciousness, 147 f., 4'1.0, 593 if.
In organic cerebral illness, 479
-vide: Twilight-states, Consciousness, clouding of
Total constitution, 644
GENERAL INDEX
Total presentation of the material, psychopathology textbooks, 39 if.

the task of this book, 44 if., 747 if., 769 f.
-vide: Unity (complex)
.
Town and country, distribution of Illnesses, 72.2.
Tradition and heredity, 709 if.
significance of tradition in ?ur knowledge of man, S14, SIS
-vide: Social sciences, Philosophy
Tradition and progressive psychiatry, SS6
'Training analysis', S 1 3 .
.
Training education existential commumcatlon, 800 f.
Transcen'dence, phil~sophical transcending, 757, 7~2. f . .
h
-vide: Encompassing, Being, Awareness of Bemg, Phllosop y
.
Transcortical aphasia, 187 if.
Transforming heredity 501 f., 52.0 if., and see: Degeneration, 505 f.
Transitions between phenomena, 59,70,687 .
blurring by transition, 653 if., 659 (personality or process)
Transitivismus (Wemicke), 64
Trauma, psychic, 315 if., 383 if., 404 f., 698
healing eifect of T., 386, 3~3 f. .
-vide: Aifects, Psychogemc reactions
Treatment, methods of T., 830 if.
decision of pt. to have T., S~ f.
. .
-vide: Psychotherapy, Practice, PhYSICian
Trends in psychopathology, 16 if., 844 If.
T.B. of lung, psychic changes, 470 f.
Twilight states, types, 595 f.
Ganser syndrome, 391 f., 407
recovery of memories, 76, 147 if.
-vide: Hypnosis
Twinresearch, 52.4 if.
Typology, types, methods, 560 if.
T. in characterology, 434 if.
ideal T., 434 f., 560 f.
real T., 438 f.
body.build T. and character T., 2.65 if., 641 if.
T. in constitution theory, 636 if., 641 if., 656 if.
T. in eidology, 62.0 if.
T. in nosology, 563 if.
Umgreifend-vide: Encompassing
Unconscious-various meaning of U., I I if.
-vide: Extra-conscious, 139 if., 306 f.
understandability of U., 306
.
-vide: Dream symbol, psychoanalYSIS
theory of U. in Psychoanalysis, 537 if.
The collective U., 333 f., 338 f., 361 f., 709 f.
.
understandability of the U. somatic events in psychic connectIOns, 2.42. if.
-vide: Body, Body and psyche
consciousness and U. reciprocal movement, 345 if.
isolation and dissociation, 347
-vide: Dissociation
self-reflection, 347 if.
.
sequence of transformation, 349
the U. in connection with volitional and Involuntary events, 351 if.
consciousness and the U. in the life history-attitude to U. 695 f., 701 f., 837 f.
Unconsciousness, 138 if.
U. in epilepsy, 148
Understanding, modes of U., 302. If.
source of U., 314 If.
GENERAL INDEX
CI
viewpoints, examples of U., 316 if.

basic forms of meaning, 340 if.
basic laws of U., 355 if.
-vide: Characterology, Opposites
static and genetic U., 2.7 f., 30 7
U. and explaining, 2.7 f., 302. if., 306 f.
U. and speech, 185 if.
self-evidence of U., U. and interpreting, 303, 307, 314,355 if., 7 1 5 f.
'as if' U., pseudo-U., 306 f., 539 f.
-vide: Psychoanalysis
rational and empathic U., 30 4
U. of expression, 2.53 if., 307
aims of meaningful psychopathology, in working through historical material, 3 I 5 ff.
7II f.
U. and causal investigation, 71 I f.
U. and psychoanalysis, 359 if., 537 if., 773 ff.
existential illumination and psychology of meaning, 776 if.
limits of U., 30 5 if., 363, 430 if., 543 If., 694, 704 if., 754 if.
-vide: Un-understandable
cultural U. 307 f.
existential U. 308 f., 3 II if., 775 f.
-vide, Existence itself, Existence, illumination of
metaphysical U., 309 f.
-vide: Metaphysics
U. and values, 309 f.
U. as illumination or unmasking, 359 f.
U. of the life history, 694 if.
-vide: Psychology as characterology, 42.8,43 1 if.
intermediate position of U., 310 if., 430 If., 776 f.
inconclusiveness of U., 305 f., 357 f.
-vide: Existence, illumination of, Philosophy, Psychology
Understanding, static and genetic, 2.7 f.
Unitary psychosis, 564 if.
Unity, the idea of U. and knowledge, 38, 747 if.
basic philosophic attitude, 756 if.
the Encompassing, which we are, unity of the whole, 759 ff.
-vide: Unity (complex), Idea
relative unity, unity of the Bios, 01 fE, 677 f., 633 fE, 644 f.
body-psyche unity, 3 f., 2.2.2. if., 634 f.
eidos, 617 if.
disease-unit, 463 if.
experience of the unity of the self, changes of, I2.4 if.
unification from opposites of psychic reality by synthesis and choice, 34 1 ff.
abnormal phenomena, 343 ff.
tendency to dissolution and unification, 39 8 f.
urge to unity, 760
-vide: Idea, Unity (complex) Man, the EncompaSSing, U. of constitution, 633 if., 644 f.
Unity (complex) the idea of the whole in a general psychopathology, 38 if.
intention of this book, 'II if. '
the plan of this book, 45 if.
retrospect, 747 if., 76S
need for a synthesis, 748 ff.
multiplicity of the complex unities, 750 if.
the encompassing whole, 759 If.
basic philosophic attitude, 75 6 ff.
-vide: Idea, Unity, Absolutes, Theory, Analysis
Unmask or illuminate, 359 f.
Unmasking in psychoanalysis, 359 if.
Unnoticed, the unconscious as the unnoticed, I I if., 30 5 if.
cii
GENERAL INDEX
Un-understandability, un-understandable, encountering the U., the limit of understanding

and causal explanation, 305 ff., 310 ff., 363
The U. as the extra-conscious and as possible existence itself, 308, 310 f., 345, 355 f.,
357, 363, 430 ff.
extra-conscious and causal connections, 457 ff., 530 ff.
-vide: extra-conscious, causal understanding, Limits, Enigma, Existence itself
the U. and morbid psychic life, as starting point, 778 f., 8~8 f.
basic differentiation-for schizophrenia, 577 ff., 584
U. in primary delusion, 98 f.
-vide: Delusion, Incorrigibility
U. in process, 704 ff.
-vide: Process, Personality, Change
tendency to 'understand' the process, 704 ff.
metaphysical interpretation, 309 f., 778 f.
Uprooting, 718
Urge, drive, will, II7 ff., 317 ff.
movement, urge to activity, urge to talk, II8 f.
urge for expression, presentation, communication, activity, 2.53 f.
intellectual urge, 2.87
Vagabond, tramp, 2.79,678,72.5 f., 72.7
literature, 72.7
Value, Value judgment, appraisal, observation and value judgment, 16 f.
understanding and V. 310 f.
surrendering to V. 32.0
distortion of V.-experience; 'Falsification of value-scale', 32.4 f.
Polarity of V., 341
disease concept as a V.-concept; V-concept and statistical norm, 780 ff.
Variation-statistics (genetics), 507 f.
-vide: anlage
Vegetative nervous system, 2.31 f., 2.41, 470ff.
V. and hypnosis, 2.34 f.
Modes of reaction, 2.31
'V. life-cycle', 2.45 f.
disturbances-'disease of civilisation', 717
Veranlagung
-vide: Anlage
Verbigeration, 192.
Verhaltnisblodsinn
-vide: Relative mental defect
Verstehen (see understanding)
Viscosity-viscous (type) 438, 654
-vide: Temperament
Vision, fantastic visual phenomena, 70 ff., 67 ff.
false perceptions, 70 ff.
pseudo-hallucinations, 68 f.
Vitality, vital, 88 ff., 485 f.
vital sensations, 9 I ff.
changed vital feelings (depression), 110
disturbance in vital basic events (v. Gebsattel), theory of, 540 ff.
loss of regulation and of performance 198 ff., ~Ol ff.
dynamic/organic theories, 532. ff.
vital drives, 319 ff.
-vide: Energy, Cycle, Body-awareness, Eidology
V. in the life-history, 701 ff.
Voice disorder, ~37
'Voices', 75
Volition, Volitional, V. awareness and act, II7
interplay between volitional and involuntary events, disturbances, 3SI ff.
GENERAL INDEX
volitional reflex reinforcement, 42.5

inv~luntary i~itation (suggestion), 377 ff.
Vorbelreden-Vlde: Conversation with patients-Talking past the point
Wahn (see Delusion)
Waking up and falling asleep, 146 f.
disturbances, 2.33
false perceptions while waking-up, 146
Wandering tendencies, 2.79
Wandertrieb (see Wandering tendencies)
War and psychosis, 718 f.
war psychosis, 369, 389 ff., 72.3
Weather, dependence on, influence of, 464
Weight fluctuations, 2.47 f.
'Weltanschauung' (world outlook), 2.93 ff.
specific 'W' of patients, I I 5 ff., 2.90, 2.94 ff.
W. in psychotherapy, 772. ff., 802. ff., 813 f., 819 f.
W. and therapeutic aim, 802. ff.
W. in psychopathology, 17 f.
'Werdenshemmung',82.
inhibition on becoming, 540 ff.
Weltuntergangserlebnis'-vide: 'Cosmic experiences'
W~ole, the-vide: Unity, complex
W~ll, aw~reness of (volitional awareness) and movement, 179 ff.
Will, baSIC concepts, (urge, drive, will)
volitional experiences, 177 ff.
philosophical, 762.
-vide: Freedom, Choice, Decision
inhibition-awareness of, 118,417
Will in character-building, 437 ff.
volition~l.state, weakness of will, strong willed, 440 f.
dual volitional attitude, hysterical will 406
the will to be ill, 42.4 f., 445
'
appeal to pts.' will in therapy, 837 f.
'free will' in criminals, 794 f.
influenced volitional acts, 12.3 f.
-vide: 'Made', Freedom
Wis~-fulfilment, I?sychoses of (purposive psychoses), 387 ff., 389 ff.
Wishful paranOia, 413
-vide: Prison psychoses
\Vitches, 736
Women poisoners, 394
Work, work performance, method of investigation, 166 f., 2.05 ff., 465, 597 711
work-curve, 2.06, 6~1
'
work.psychology, 2.51, 2.87 ff., 72.1
work-therapy, 7~I, 838, 841
W. (~reative) as self-realisation in life history, 69 6 f.
crea~lve wor~ of patients, individual findings, 2.90 ff.
-Vide: RealltY,719 '
Worker, autobiography, 7II
working-class and psychosis, 72.3
'Working through' the illness, 416 ff.
World, concept of, IIf., 2.80 ff., 2.93 ff., 32.5 ff.
c<?mm.on world, shared world, 13
h~storlcal and psychopathological W., 2.80 ff.
historical and biological W., 709 ff.
normal and abnormal W., 2.81 f.
schizophrenic W., 2.82. f.
W. of compulsive patient, 2.84 f.
ciii
civ
GENERAL INDEX
World (conta.)
W. of pt. with flight ofideas, 286 f.
the individual within W., 274 ff., 318, 32~ ff., 724 f.
-vide: Environment, Existence, human, Reality
creation ofW. and works, 213 f., 696 f.
the W. as the Encompassing, 7~9, 76 3. 77 1
knowledge of the W. as an interpretation, 2j)3
-vide: Environment, Alienation, Existence (human), Consciousness of existence
Writing-vide: Graphology
Yawning, 270 ff., 272
'Yoga' practice, 380 f., 729. 802 f., 806
-vide: Autogenic training

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What are some of the concepts discussed in the book?

What are some of the concepts discussed in the book?

What is the book about?

What is the book about?

KARL JASPERS

Trans/ated from the German by

With a new foreword by

THE JOHNS HOPKINS UNIVERSITY PRESS

FOREWORD TO THE 1997 EDITION

For those who would understand psychiatry, this book is indispensable.

rCl'Ord for this hook is availahle from the British Lihrary.

FOREWORD TO THE 1997 EDITION

FOREWORD TO THE 1997 EDITION

FOREWORD TO THE 1997 EDITION

FOREWORD TO THE 1997 EDITION

FOREWORD TO THE 1997 EDITION

FOREWORD TO THE 1997 EDITION

Jaspers, K. The Phenomenological Approach in Psychopathology. British Jou,

FOREWORD TO THE 1997 EDITION

Shepherd, M. The Sciences and General Psychopathology. In M. Shepherd

intangible subject matter of this difficult field allows. By a remarkable paradox,

a critical introduction to continental psychiatry and for the creation of a

ment of Philosophy, we decided to go our own way, keeping the other

To the second and third editions (extracts, 1919 and 19 22 )

... We trail around with us a great number of vague generalities. I have

To the fourth edition (1942)

The intention of this book has remained unchanged. Its working-out

Now ([946) in Heidelberg.

To the seventh edition (1959)

Part Three: The Causal Connections of Psychic Life

Part Four: The Conception of the Psychic Life as a Whole

Part One: Individual Psychic Phenomena

XIV. BIOGRAPHICAL STUDY (BIOGRAPHIK)

SUBJECTIVE PHENOMENA OF MORBID PSYCHIC LIFE (PHENOMENOLOGIE)

Section I: Abnormal psychic phenomena

XIII. THE HUMAN SPECIES (EIDOLOGIE)

Part Five: The Abnormal Psyche in Society and History

THE OBJECTIVE PERFORMANCES OF PSYCHIC LIFE (LJ:iISTUNGSPSYCHOLOGIE)

Section I: Individual performances

Expression of the psyche through body and movement(Ausdruckspsychologie)

Part Two: Meaningful Psychic Connections

Section I: Normal mechanisms

Part Six: The Human Being as a Whole

DETAILED ANALYSIS OF CONTENTS

DETAILED ANALYSIS OF CONTENTS

s. What a general psychopathology has to do: a survey of this

I. The boundaries of general psychopathology

Psychiatry as clinical practice and psychopathology as a science

2.. Some basic concepts

(a) Conscious critique of methods in place of dogmatism.

(g) Technical lay-out

(3) References to the literature

Man and animal.

(A) Psychopathology and culture

Part One: Individual Psychic Phenomena

3. Prejudice and presupposition

(I) Philosophical prejudice

(3) Somatic prejudice

SUBJECTIVE PHENOMENA OF MORBID PSYCHIC LIFE

SECTION ONE: ABNORMAL PSYCHIC PHENOMENA