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Christopher D. Green
York University, Toronto, Ontario
ISSN 1492-3173
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By William H.R. Rivers (1920)
Posted April 2000
CHAPTER XV
THE PSYCHO-NEUROSES
The aim of the study set forth in this book is to provide a foundation for a biological theory of the psycho-neuroses. Thus far I have been attempting to establish this foundation and I can now turn to the task of formulating the theory the stability of which I have been trying to ensure.
According to this theory mental health depends on the presence of a state of equilibrium between instinctive tendencies and the forces by which they are controlled. The psycho-neuroses in general are failures in the maintenance of this equilibrium. When such a failure occurs, certain processes, some instinctive and some of the order of intelligence, come into activity as attempts to redress the balance. The special form of the psycho-neurosis depends partly on the nature of the failure and the processes by which it has come about, partly on the nature of the restorative processes which come into activity, and partly on the degree of their success. The psycho-neuroses may be regarded as attempts, successful or unsuccessful, to restore the balance between instinctive and controlling forces, attempts to solve the conflict between these warring elements.
Let us first consider the nature of the failure upon which the psycho-neuroses primarily depend. Theoretically the failure in balance and the resulting conflict might be produced in two ways -- by increase in the power of the suppressed tendencies or by weakening of the process by which they are controlled. There is little question that both factors take a part in the production of neurosis.[1] Thus, the frequency of functional [p. 120] nervous disorders about the time of puberty may be ascribed to the increased power of tendencies connected with the instinct of sex. Again, the frequency of neurosis in the recent war has certainly been due in part to the call made upon instinctive tendencies which in the usual peaceful character of our modern civilisation receive no stimulus so that the more adventurous have to resort to excessive speed, dangerous sports, big game hunting, and other similar pursuits to excite their danger-instincts, and give that spice of conflict which redeems the monotonous calm of our modern life in times of peace.
While increase in the activity of instinctive tendencies thus plays an important part in the production of neurosis, this part is, as a rule, overshadowed by the second factor -- weakening of the controlling forces. Both in peace and war the immediate factor in the production of neurosis is weakening of control by shock, strain, illness or fatigue. The chief cause of the frequency of neurosis in the war has been the excessive nature of the strains to which modern warfare exposes the soldier.
As already mentioned, the special form taken by the psycho-neurosis is to some extent dependent on the nature of the conflict and the causes to which failure in this conflict is due. Thus, the differences between the neuroses of war and those of civil life are due in large measure to differences in the nature of the instinctive tendencies which have escaped from control. The relative simplicity of the war-neuroses is due to their origin in disturbance of the relatively simple instinct of self-preservation, while the great majority of the neuroses of civil practice depend on failure of balance between the less simple sexual instinct and the very complex social forces by which this instinct is normally controlled.
Factors arising out of the nature of the failure are, however, of far less influence in determining the form of the neurosis than are the processes by which the organism attempts to amend the failure. The form taken by the neurosis depends mainly upon the nature of the process by which it is attempted to solve the conflict between the instinctive tendencies which have escaped from control, and the forces by which this control has been [p. 121] exerted. I propose in later chapters to consider some of these modes of solution in detail. In this chapter I shall deal, and that only very briefly, with two lines of activity by which attempts, one successful and the other unsuccessful, are made to redeem the failure of balance. In both these cases the organism takes the simple course of attempting to reimpose the state of suppression in a form more or less complete, by means of which the instinctive tendency has previously been held in check. In the successful attempt the neurosis, perhaps only present in an incipient form, disappears, while in the other case a definite form of neurosis develops, the special characters of which are determined in large measure by the process which is put into action in the attempt to solve the conflict.
Successful Suppression. -- I will begin with the mode of reaction which succeeds in utilising the mechanism of suppression, the instrument so fully considered in this book, by which the organism puts out of action tendencies incompatible with more developed ends. There is good reason to believe that in many cases suppression is reinstated in a healthy manner, or at least in a manner which is compatible with health and efficiency. Thus, a frequent form of the conflict by which the neuroses of war are produced is that between the re-awakened instinct of danger with its accompaniment of fear and the ordinary standard of our social life that fear is disgraceful. There is no doubt that this conflict has often been solved during the war by the spontaneous reassertion of the mechanism of suppression so that the fear and its associated tendencies to certain lines of behaviour have been again put into abeyance. In such a case, tendencies which are incompatible with warfare and the military life are restored to their seclusion in the unconscious by the process of suppression, taking place in the unwitting manner which I have supposed to be its characteristic mode of action. I give an example from a life of profound interest in which this seems to have happened. In one of his letters from the front Frederic Keeling mentions[2] that he had never been depressed since coming out to France except on the third and fourth days [p. 122] in hospital, after he had received wounds from a shell-explosion such as must have given him a severe shock. On these days he got a fit of funk and dread of the firing-line. Later letters[3] show that the wound and shock left their mark on him, but it is clear that the manifest fear soon left him. In Keeling's case we do not know whether the disappearance took place by an unwitting process of suppression or was assisted by some witting end conscious process. In many similar cases into which I have been able to inquire, the disappearance of the fear has been greatly assisted by measures similar to those by which we treat an anxiety-state. The subject of the fears has faced the situation and brought the experience associated therewith into relation with other experience of his normal mental life. It is possible that in some cases the suppression may be effected, or at least assisted, by voluntary repression, in which the subject of the fears wittingly thrusts out of his consciousness the painful experience together with the affects and conative tendencies connected therewith. Whether this mode of solution is ever successful I do not know. I have not myself met with a case, but most of my experience has lain with failures to solve the conflict, and it will need a wider survey than has been possible to myself before we can discover whether mere witting repression ever succeeds in producing or helping the suppression of fear which seems to be the normal state of the healthy adult.
Whatever may be its mechanism, however, it seems certain that the process of suppression as a means of solving a conflict may take place in a healthy manner and produce a thoroughly efficient result.
Anxiety- or Repression-Neurosis. -- The other case which I shall consider in this chapter is that in which an unsuccessful attempt is made to reinstate the suppression by which the instinctive tendency with its accompanying affect is in health controlled. As I have already mentioned on more than one occasion, there is much reason to believe that suppression, being an instinctive process, normally takes place unwittingly. Though it is possible that in some cases the attempt wittingly to subdue [p. 123] instinctive tendencies and to banish painful experience associated therewith may be successful, it stands beyond question that this process is as a rule wholly unsuccessful. It not merely fails to still the conflict, but greatly increases its severity. The conflict from which the neurosis starts tends to produce a state of general mental discomfort which may range from mere malaise to definite depression. This discomfort and depression tend to crystallise round some unpleasant experience, either some painful or horrible incident, some fault which has been committed by the sufferer or some misfortune which has come into his life. In those who suffer thus from the effect of war-experience, one party in the original conflict is usually the re-awakened danger-instinct in some form or other with its accompanying affect of fear, but this is often wholly displaced by the affect of horror associated with some peculiarly painful incident of war, or by the affect of shame following some situation which the sufferer fears that he has failed to meet in a proper manner. Whether the dominant affect be fear, horror or shame, the sufferer strives with all his strength to banish it from his consciousness. The process of witting repression is often assisted greatly by the occupations and activities of the day, and may be apparently successful so long as occupation is able to fill the day and the fatigue it brings leads to sleep at night. But if sleep fails, the repressed content may acquire such power as wholly to gain the upper hand, and when sleep abrogates control, the repressed content finds expression in the form of painful dreams or nightmares. On these occasions the painful affect, together with the experience round which it has crystallised, dominates the mind. The disturbed sleep only exhausts the sufferer's strength and makes still more unequal the struggle between the fear, horror or shame, and the forces by which the attempt is made to subdue the ever-rising storm. The sufferer may throw himself into still greater activity or may attempt to drown the conflict by excesses of various kinds, but only succeeds in still further sapping his strength till some comparatively trivial shock, illness or wound, removes him from the possibilities of such attempts to solve the conflict. He [p. 124] becomes the victim of the fully-developed state, formerly called neurasthenia, but now, following Freud, more generally known as anxiety-neurosis from the special exaggerated anxiety, the Angst of the German language, which forms one of its most striking and characteristic symptoms.[4]
The process of witting repression plays so large a part in the development of this state that it might well be styled repression-neurosis, and if our pathological classification is to be founded on ætiology, as all such classifications should, I am coming to believe more and more that repression-neurosis is the proper term, for this mode of denotation has reference to the ætiological process upon which many of its chief manifestations depend. The state is essentially one in which the normal processes of integration and suppression have failed, in which the attempt to use wittingly a process, which, if it is to be successful, should be unwitting, has only magnified the conflict in which the morbid state has had its origin.
In speaking of repression and suppression as processes by which it is attempted to solve conflicts between instinctive and controlling forces I have so far referred only to their characters as respectively witting or unwitting. I can now consider the matter from another aspect. I have dealt fully in this book with the instinctive character of suppression and have regarded it as itself a process belonging to instinct. I have now to consider more fully the nature of repression. It may be noted, in the first place, that repression is a process of which its subject is fully aware. In its most characteristic form it is definitely under his control, and is even, to a certain extent, capable of having its degree discriminated and its strength graduated. In the terminology often used in this book, it is an epicritic rather than a protopathic process, or, to use the language of orthodox psychology, it is a process which belongs to the order of intelligence as opposed to suppression which I hold to be definitely instinctive. In accordance with this [p. 125] intelligent character the patient is not merely aware of the conflict, but both the factors in the original conflict and the various symptoms which the conflict produces tend to become the subject of rationalisation, and to act as the nuclei of morbid intellectual processes, of the nature of delusions but differing therefrom in their being open to criticism and capable of being removed by knowledge and appeals to intelligence. This character of anxiety- or repression-neurosis has two very important results. One of these is the painful or unpleasant nature of the process. In several other forms of solution, and especially in that to be considered in the next chapter, in which the solution is on instinctive lines, there may be little or no mental discomfort, but anxiety- or repression-neurosis is a state in which mental depression is always present and is often both deep and intense. Consciousness tends to be filled with thoughts of a painful kind which either centre round the factors in the original conflict, or have their basis in the unpleasant nature of the symptoms in which the conflict finds expression, while other events which provide ground for grief, worry or apprehension produce these manifestations in exaggerated form.
The other result is more satisfactory. It is that the state is peculiarly amenable to treatment based on factors of an intelligent order. The patient is able to examine for himself many of the processes, such as repression and rationalisation, upon which his disorder depends, and through his power of criticism and witting control is able to influence these processes and thus do much to abolish their malign influence and set himself upon the path of recovery. The essential feature of anxiety- or repression-neurosis is that it is not only due a conflict between instinct and intelligence, but that subject of the morbid state is able wittingly to act upon factors which enter into this conflict.
Before I close this chapter I should like to point out one feature of anxiety- or repression-neurosis which helps us to understand the relation between repression and suppression. Painful experience which has been repressed and is yet capable [p. 126] of recall without any special difficulty is able to produce nightmares and other morbid symptoms which may in other cases depend on the activity of experience which has been suppressed. Repression and suppression seem here to run into one another. One possibility may be suggested for this close relation and for the failure of repression as a means of solving a conflict between instinctive tendencies and the forces by which they are controlled. I regard suppression as an instinctive process. As an instinctive process it is natural that it should be especially potent and effective in childhood, and should become less potent and effective with advancing years. Moreover, if suppression be an instinctive process, it is natural that it should occur unwittingly, and should be less successful if an attempt is made to put it into action wittingly. The symptoms which follow repression, and seem to be directly due to it, may be ascribed to the failure in the adult of a process which takes place naturally and without any special conflict in childhood. Anxiety- or repression-neurosis may be regarded as an unavailing attempt to solve a conflict by using, in an ineffective manner, a process which is only efficacious when it is exerted instinctively.
Footnotes
[1] The term "neurosis" is only used here for the sake of brevity. The distinctions which have been made by many writers between psycho-neurosis and neurosis have no sound logical basis.
[2] Keeling, Letters and Recollections, London (1918), p. 233.
[4] For a more detailed account of the genesis and nature of this form of neurosis, see Functional Nerve Disorder, edited by H. Crichton Miller, London (1920), pp. 89-98.