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Christopher D. Green
York University, Toronto, Ontario
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By William H.R. Rivers (1920)
Posted May 2000
OTHER MODES OF SOLUTION
In the last two chapters I have considered three of the more important means by which the human organism attempts to solve the conflict between re-aroused instinctive tendencies and the forces by which they are normally controlled. I have considered the healthy solution by the reinstatement of suppression, the ineffectual attempt at solution by witting repression, and the solution in which modification of an ancient form of reaction to danger is substituted for that which is the more natural mode of response in Man.
Dissociation. -- I can consider other modes of solution more briefly. The occurrence of definite dissociation with altered personality may be regarded as an attempt at solution, especially when it takes the form of the fugue with its independent activity and its independent consciousness. Sometimes the fugue is combined with an anxiety-state, in which case the attempt at solution by means of dissociation has been ineffectual, but in other cases the fugue may be the chief or only manifestation of the conflict, the patient being otherwise healthy and happy except in so far as he is disturbed by the possibilities which are always open to the subject of a fugue. In such a case the conflict finds expression in an occasional escape into another life, a life which is in effect that of another person shut off from all memory of the conditions upon which the conflict depends.
The Phobia. -- In another mode of solution by a process in which painful experience is suppressed, but yet maintains the potentiality for activity whenever conditions arise which resemble those of the experience which has been suppressed. [p. 140] The various phobias in which the suppressed experience finds expression are of a kind which makes this mode of solution unsatisfactory if the conditions which re-arouse the dreads are liable to be frequently encountered, but if they are of exceptional occurrence it is possible for the subject of a phobia to lead a normal and comfortable life, though there is always the possibility that his life may take a course which will expose him to conditions which arouse the phobia and make the solution altogether ineffectual. Thus, the sufferer from claustrophobia who has been so often mentioned in this book was but little disturbed by his dread in his life at home, but it played a large part in the production of an anxiety-neurosis when his work in France during the war exposed him to conditions which brought his phobia into activity. Similarly, the subject of a snake-phobia may be hardly disturbed by it in his own home, but the disorder may take a very serious turn if circumstances oblige him to live in a country where snakes abound.
According to Freud many phobias are due to the transference of a conflict from an object by which fear was originally aroused to that which forms the subject of the dread. If this view be right, we have an excellent example of a solution which completely disguises from the patient the real nature of his trouble. The original fear is objectified in the snake or the rat through a process of symbolisation similar to that by which similar fears find expression in the dream.
A somewhat similar, though far less satisfactory, attempt at solution is presented by a case recorded in Appendix III in which a subject of war-neurosis suffered from sudden attacks of intense depression, in the intervals of which he was relatively healthy and cheerful. There was no evidence that these attacks of depression were aroused by any conditions similar to those of the experience he was repressing, but the case bears some resemblance to a phobia in that the repressed experience only found occasional expression and left the patient more or less comfortable in the intervals.
Compulsion-Neurosis. -- Another mode of solution of the conflict between awakened instinctive tendencies and controlling forces [p. 141] is by the performance of meaningless acts such as counting, touching things, arranging objects of the environment in certain ways, etc. These acts have a compelling character, and failure to carry them out produces intense discomfort, while their unimpeded performance makes the life of their subject comparatively happy and calm so long as the acts to which he is compelled are not obvious to others and do not come into conflict with ordinary social standards. Many persons perform these compulsive acts in such a manner that they do not attract anyone's notice, and they are often regarded by the subjects themselves as natural and normal, so that they do not come under the notice of the physician, but when they are associated with other morbid manifestations, or are of a kind which conflict with social standards of conduct, the state is known as compulsion-neurosis, and the compulsions form a frequent feature of the state formerly, and still often, known as psychasthenia. In many cases it is possible to discover that these compulsive acts go back to some definite experience, usually of childhood, which has been suppressed, and it may be possible to ascertain that their special features have been determined by the nature of the forgotten experience. The compulsive acts seem, however, in many cases to be only subsidiary and comparatively unimportant features of the original experience. In these cases they may be regarded as more or less symbolic expressions of the activity of the suppressed experience. In some cases the symbolism is very near the original tendency or impulse. Thus, one of my patients had a compulsion to cut himself, which was satisfied as soon as he had drawn blood. This compulsion followed definite thoughts of, and impulses to, suicide, following the suicide of his company-commander, and cutting himself was a kind of symbolic act which gave relief. In this case there was no suppression, but the thoughts and impulses out of which the compulsion developed were clearly present in consciousness and memory.
Rationalisation. -- This is a process by which the solution of a conflict is frequently attempted. As already mentioned, this process enters largely into the composition of anxiety- or [p. 142] repression-neurosis, but it may form the most prominent feature of a psycho-neurosis, and, as we shall see presently, it is the leading feature of one of the most clearly-defined psychoses. The process of rationalisation often plays a large part in the production of states, as means of escape from conflict, which, being more compatible with health, can hardly be included under either head.
It is hardly surprising that the process of rationalisation should often centre round the relation of the patient to medicine, the social institution which has to do with disease. In searching for something by means of which to explain his troubles, the patient is apt to fix upon the advice and measures given or recommended by his physician or physicians. He argues more or less correctly that if his troubles had been taken in time and corrected when they were slight, the task of getting well would have been comparatively easy. He concludes that his illness is due in the main to mistakes made by his medical advisers, who allowed the faulty trends to remain in activity or even enhanced their evil effects by the measures they recommended. Since the advice and measures which are thus held to blame come in the majority of cases from practitioners of the orthodox art of medicine, this mode of solving the conflict often takes the form of a violent reaction against the medical profession. In this situation the patient is liable to become the prey of quackery, or he may become a disciple of one or other of the systems which, at any rate until lately, have recognised more adequately than orthodox medicine the principles of psycho-therapy. Such a movement as Christian Science owes its success, partly to its recognition of certain truths which physicians have been slow to learn, partly to its providing a nucleus for the rationalisations by which patients are so often apt to explain their morbid state. If at the same time the new doctrines give the opportunity for wide application and proselytism, the patient will be provided with an interest in life, the absence of which may have previously formed one of the conditions of his illness. The success of Christian Science, the New Thought, and other similar cults is due in the first [p. 143] place to the materialism of orthodox medicine and its failure to recognise the vast importance of the mental element in disease, but these movements would never have attained their success if they had not furnished the basis for systems of rationalisation by means of which sufferers from psycho-neurosis have been enabled to escape from the conflicts to which their troubles were in the first place due.
Hypochondriasis. -- In some cases the patient may solve his conflict in a manner more painful to himself by becoming unduly interested in the various pains and discomforts of his morbid state. His absorption in these allows him to escape from the deeper conflicts to which the symptoms upon which he dwells so insistingly are ultimately due. He becomes a hypochondriac, and such hypochondriasis is only one of tile many means by which the process of rationalisation enables escape from conflict.
Alcohol and Psycho-neurosis. -- Another frequent mode of attempting to solve a conflict is by taking alcohol or some other drug. Alcohol produces its effects by removing or lowering the efficiency of the highest levels of mental activity. Where, as in some cases, it appears to increase mental accomplishment, this is almost certainly due to removal of inhibiting forces, such as anxiety, which interfere with success. Its more noxious effects are directly due to weakening of control, and, probably without exception, the altered behaviour which follows the taking of excessive amounts of alcohol can be traced to the overaction of instinctive or other early tendencies normally kept under control by the higher levels of mental activity.
It is a striking feature of anxiety-neurosis that its subjects are especially liable to have their behaviour influenced by alcohol. This altered behaviour can be explained by the more complete abrogation of controlling factors already weakened by the pathological process producing the neurosis. The more morbid effects of alcohol fit easily into the scheme of the relation between instinctive and controlling forces which I have put forward in this book.
Another interest of alcohol in relation to our subject is that it [p. 144] and other substances which inhibit the higher controlling levels are frequently used in the attempt to still the conflict between instinctive tendencies and controlling forces. The immediate success which follows their use is due to the removal or lessening of the anxiety and depression which are among the first indications of the anxiety state, thus making possible the proper performance of duties which are being prejudiced by this anxiety and depression. The failure which sooner or later follows the attempt to solve a conflict by resort to alcohol is due to the fact that the injurious action of this substance only reinforces the weakening influence of strain and fatigue, while it may set up the habit which we call dipsomania. The nature of this process is now so fully recognised by those with special experience that modern treatment depends on making the patient understand the nature and history of his trouble. By solving the original conflict in some other manner scope is given for the breaking of the habit which has been the outcome of the crude solution attempted by the sufferer.
Paranoia. -- I have so far dealt only with the psycho-neuroses and I must now briefly consider the psychoses or insanities as attempts to solve conflicts between instinctive tendencies and the forces by which they are normally controlled. One of the most characteristic of the modes of solution of this order is paranoia. In this disease, which often seems to start from a state of inferiority, real or supposed, the sufferer enters upon an elaborate process of rationalisation, partly to explain his inferiority, partly to still the conflicts to which certain forms of inferiority render their subjects peculiarly liable. The usual course of such a paranoia is from suspicions and forebodings arising out of inferiority to explanations which tend towards delusions of grandeur. The course of the disorder appears to be that the rationalisations, developed by the subject to explain his inferiority, become so intimately connected with the affective basis of his trouble that they attain a reality and effectiveness which greatly relieve, or even wholly remove, the painfulness of the conflict. The state produced furnishes a solution of the conflict which seems wholly satisfactory to the patient [p. 145] himself. In the case of paranoia the results of the rationalisation are so out of harmony with the ideals and traditions of the society to which the sufferer belongs that they are called delusions, and if the delusions led to conduct incompatible with social standards, their subject is called insane. If, on the other hand, the process of rationalisation produces beliefs in the sufferer which differ from those of the majority of his fellows, intellectually rather than morally or socially, and lead to behaviour which is not obviously out of harmony with the general standards of conduct of the community, we call the product of rationalisation a fad or a crank. Beliefs of this kind furnish a vast number of gradations which pass insensibly from states which everyone would regard as healthy and normal to others not differing appreciably from paranoia in so far as their psychological, as distinguished from their social, character is concerned. The crank and the paranoiac may be regarded as two definite types of person who have resorted to rationalisation in the attempt to solve the conflict between instinctive tendencies and social forces.
Dementia Præcox. -- Another frequent method by which it is attempted to solve, or rather to escape from, a conflict, is by means of day-dreams in which the subject of the conflict fancies all kinds of situation in which he is playing a part different from that in which he is, in fact, placed by his conflict. When this mode of attempted solution is adopted by persons with low powers of resistance, it is apt to produce the definite hallucinatory and delusional states which make some of the chief forms of dementia præcox. The occurrence of this mode of solution, as a means of escaping from the conflicts aroused by warfare, has not only produced a vast number of cases which conform to the generally accepted class of dementia præcox, but cases have been frequent in which this mode of solution has produced minor degrees of a similar disorder, which would have been called dementia præcox without hesitation in civil practice, but which have run a course very different from that civil experience would have led one to expect. In these forms of insanity, as in paranoia, there is often some inferiority, real or [p. 146] imaginary, which puts the subject of the conflict at a disadvantage in relation to his fellows.
Disintegrative Psychosis. -- In some cases the conflict is so severe, or the resistive power of the organism so slight, that the mental balance breaks down completely. The older psychiatry regarded such a complete breakdown, which it labelled acute mania, as the expression of a mere disorderly jumble of disintegrated mental process, but if we look on the whole situation as a means of reacting to the conflict between suppressed instinctive tendencies and controlling forces, it becomes a question whether the acute psychosis, with all its apparent disorder, is not merely the expression of a victory of the instinctive forces running riot after their escape from a lifelong period of suppression and control. There is little question that if we knew the complete life-history of a person suffering from acute mania, his ravings, which, without this knowledge, seem to be mere wild incoherence, would be found to have a sense, though one perhaps disguised by disorder of expression and omission of many of the links by which the associations would normally be expressed. The view that a psychosis of this kind is due to the complete abrogation of the control, which is normally exerted over the lower instinctive tendencies, is rendered probable by the study of the exaltation and excitement which make up its milder forms. All gradations may be seen between the apparently meaningless ravings of acute mania and such mild examples of exaltation as convert an ordinarily subdued and reticent person into a talkative and excitable busybody, who in such a state reveals thoughts and tendencies of thought which in health he would not allow himself to entertain.
All the gradations of mania may be regarded as merely different degrees of expression of modes of thought and behaviour which, owing to their incompatibility with social traditions and ethical standards, are in health subdued and suppressed. It may be noted that a case of acute mania provides a natural means of psycho-analysis in which all kinds of suppressed experience and tendencies come to the surface spontaneously. It fails in general to be capable of utilisation in diagnosis or [p. 147] treatment, partly because it often goes too deep and reveals tendencies which would only become intelligible if we knew the intermediate steps in the process by which the tendencies came under control; partly because the patient is unable to provide the clues which would enable the physician to piece together the disjointed fragments which find their way to the surface.