Revival: Textbook of Psychiatry (1924)

Eugen Bleuler, A. A. Brill

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9781351343268
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book marked a notable advance in psychiatry in that it emphasizes sharply the contrast between the older descriptive psychiatry of Kraeplin and the newer interpretative psychiatry of the present time which utilizes the psychoanalytical principles and general biological viewpoints developed by Freud and his pupils in Europe and by Meyer, Hoch, White and others.

As an introduction to the study of clinical psychiatry the physician and the student will find the chapters dealing with the principles of psychology and psychopathalogy particularly helpful and stimulating.

Chapter I

Psychological Introduction

The Psychological Principles¹

The Psyche

The human psyche is so largely dependent in all its functions on the cerebral cortex and on this alone that it is said to be located there.² But not all functions of the cerebral cortex belong to the complex which we ordinarily call psychic.³ Thus what has been called psychic fluctuations of the vascular tone or of the secretions are cortically directed functions, which though depending on the psyche in some manner are not psychic.

Like the reflex mechanism, the purpose of the psyche is to receive external stimuli and to react to them in a manner beneficial to the individual or the genus. There are, however, great differences between the two modes of reaction. The influence exerted upon a reflex through a stimulus other than the one initiating it (or the initiating and directing group of stimuli), is so limited qualitatively and quantitatively, that we ordinarily take no account of it. On the other hand, in the psyche this influence is qualitatively and quantitatively almost unlimited. It is particularly noteworthy that not only actual stimuli play an essential part in determining the reactions, but also former stimuli, especially “experiences” and “memories”; on the other hand, such memory effects play a very slight part in the reflexes. In other words, the reflex always reacts in the same manner to the same stimulus, while the psyche has infinite possibilities of reaction, which are highly complex and plastic, that is, they differ with the same stimulus according to the particular circumstances, while those of the reflexes are simple and very stable. Thus as far as objective conditions are concerned the difference between reflex and psychic reaction is enormous in degree, but none in principle. An absolute difference is ordinarily assumed on the subjective side, whether correctly or incorrectly no one can tell (Pflueger’s spinal cord soul!) The assumption is that only psychic functions can become conscious but not reflexes.

Consciousness

Some authors consider consciousness as the very essential quality of psychic processes. It is an indefinable something, a quality of the same, in fact that quality which most clearly differentiates us from an automaton. We can imagine a machine which will perform complicated reactions but we will never ascribe consciousness to an apparatus constructed by us, that is, we cannot assume that it “knows” what it is doing, that it “feels” the influences of its environment, that it knows the “motives” of the reaction. The same idea is expressed by the word “conscious,” when we inquire whether someone has consciously or unconsciously arranged his hair.

To compare consciousness with a form which has for its content conscious processes is misleading. Nor can one do anything in psycho-pathology with such a definition as “the sum of all real or simultaneously present ideas” (Herbart), which is about what one would call the actual psyche. We cannot get along, however, without differentiating between conscious and unconscious psychic processes on the one hand, and between psychic and physical on the other.⁴

Wundt defines consciousness as the “association of the psychic structures.” This definition is also used elsewhere in the concepts referring to the “disturbances of consciousness,” where it is merely a question of a disturbance in the association of the psychisms. Consciousness in our sense cannot very well be disturbed; it is either present or absent. On the other hand, extent and clearness of consciousness are relative terms. The extent of consciousness corresponds to the number of the (actually or possibly) simultaneously existing conscious ideas, and clearness of consciousness depends on the completeness of one conscious concept or on one idea of a partially forming concept, as well as on the degree of exclusion of irrelevant ideas.

The psychism itself and not a mere quality or form of it is involved in expressions like “consciousness of time and place” for which we had better substitute “orientation as to time and place.” The expression “dual consciousness” for “dual personality” is just as inappropriate.⁵

Furthermore, one is inclined to assume consciousness in our sense, when one observes purposive actions. This is not correct, for even reflexes may be purposive; even an automaton may react differently to different situations, as in the case of automatic scales in the mint. The ability to remember a certain experience has often been considered as a sign that consciousness had been present, and it has also been said that an action performed in a twilight state has been “without consciousness.” This is also wrong.

Likewise one should not identify “conscious” and “voluntary.” The act of dressing oneself is usually voluntary, but not conscious, whereas compulsive actions are conscious, but not voluntary, that is, they are contrary to our will. And neither of these holds good in automatic actions like scratching oneself, mimicking motions, etc.; and in pathological automatisms.⁶

Concerning the Theory of Cognition⁷

Consciousness is said to differentiate psychic from physical occurrences. Two fundamentally different series of experiences have been assumed, those that refer to the “inner life,” to that which “takes place merely in time,” the conscious or the psychic, and those experiences which refer to the outer world or to that which has extent, namely, the physical.

The relationship between these two forms of experiences is differently conceived. Most suitable for the naive mind is the conception of Dualism, which assumes a carrier of consciousness independent of the body. One sees the body remaining after death, while all psychic manifestations disappear with the cessation of life. The “soul,” used here according to the earlier views, representing not only the psychic, but a fusion with the term life, has separated itself from the body. That it has not simply been resolved into nothingness is shown by its reappearance in dreams, in waking hallucinations, and in the illusions of those who survived. And that the observer’s own soul can free itself from his body is shown by his dream experiences, during which, regardless of time and space, he perceives things which are far removed from his motionless body.

Dualism is an essential constituent of religions; it has been attacked for thousands of years and is at present still rejected by most scientists. Its most important fundamental elements, the dream experiences, and the apparitions of spirits, have proven illusory, and what is more, it has been shown that the psychic functions of man are in all respects dependent upon the brain. On the other hand, it is self-evident, even if one does not always bear it in mind, that in reality the physical world cannot at all be as we perceive and imagine it, and finally, every certain proof is lacking that it even exists.

Thus monistic views have been formed regarding the relationship of the two series. They can be divided approximately into three categories:

The first of these categories, of which Spinoza is the foremost representative, assumes a “substance,” whose two attributes are extension (physical series) and thought (psychic series). However, from the viewpoint of the cognitive theory, it is faulty. Substance, physical and psychic attributes (in modern terms matter, force and consciousness) cannot be placed side by side in this manner. For direct perception is possible only in regard to conscious (psychic) processes. From a part of these we form conclusions (with some probability) concerning external influences, which we call forces. From the grouping of forces we construct the idea of matter, which needs not necessarily have a corresponding reality. But there is still another difficulty in this theory: It has to conceive everything as conscious whereas we observe consciousness only in beings similar to us and cannot conceive of an elementary consciousness without content, which is really connected with a nervous center. To be sure, nowhere in evolution do we see a point where consciousness may be said to have appeared in man? in the amoeba? or in the atom?⁸ And the ubiquity of consciousness is so readily accepted just because one cannot conceive of something principally new suddenly appearing in evolution. There is really no basis whatsoever for the assumption that the psychic and the physical are so very different. We neither know what the psychic nor what the physical processes are, and consequently nothing about their relationship or difference. To be sure, for the being endowed with feeling, consciousness is something very special and the only thing of importance. It is a matter of entire indifference to us whether the world exists, the only thing of importance being whether that which is conscious, our ego, is happy or unhappy.

The second form of monism starts from the idea that all proofs for the existence of an external world are false conclusions, and that consequently the physical world exists only in our ideas (Idealism) or, in so far as we conceive it (“esse = percipi”). Even if this view could be carried through with logical consistency, it would not be able to acquire a more general acceptance. For in the first place, it is incorrect to deny the outer world simply because it is impossible to prove its existence. Anyhow one is always forced to act as if it exists. The philosopher who claims to believe in the existence only of ideas would have no reason for disseminating his views if his pupils were only creations of his own imagination. No matter how certain it were that a rock in the road had existence only in my imagination, I would still have to go out of its way if I wished to avoid something unpleasant. If I wish to get rid of the feeling of hunger, there is nothing for me to do except to eat, whether food has reality or not. Practically therefore, idealism will lead to an impossibility. Theoretically, however, it leads to a conclusion which no one likes to accept, to Solipsism. For our fellow beings are part only of the outer world, and if the outer world exists only in my ideas, then there are no other beings beside myself. I am not only the whole world but also the only human being. This conclusion is unavoidable. The attempt to escape solipsism through the assumption of an absolute ego is a sophism. Even if an absolute ego were to imagine the world, it would not be my world, the world which I imagine, not to mention the fact that such an absolute ego cannot be imagined and that the whole assumption is entirely without foundation.

Much more common than the idealistic monism is the materialistic monism, the materialistic theory of cognition. It starts from the fact that we always see psychic functions bound to matter, in particular to nervous centres, that they change with this matter, and that the laws of the central nervous processes, so far as they come into consideration, are also the psychic laws. From this it concludes that the psyche is a function of the brain. At present this is the only view which can be carried out theoretically and practically without contradictions, in the form of the so-called hypothesis of identity, which assumes that central nervous functions are “seen from within” and become “conscious” if they occur in definite relationships. This view is almost the only one which modern science, and in particular psychiatry, takes into consideration, in fact it is even accepted by those who theoretically advance another view. Of course, this theory, too, is impossible to prove, but the hypothesis that the psychic functions are brain functions has a better foundation than most assumptions which are accepted as self-evident in the sciences. But it is by no means necessary as a basis for any mental science, including psychiatry, in so far as we are not concerned with studying the psychic functions in connection with the brain. This theory, too, is being zealously attacked, primarily on religious grounds. Perhaps with the exception of its earlier periods Christian thought has been altogether dualistic. But the essential content of the Christian doctrine could be just as easily reconciled with materialism as with dualism; as a matter of fact the more favored idealism would encounter more difficulties. Our confession of faith contains the doctrine of the resurrection of the body. If the theory of materialism is correct, then with the resurrection of the body the soul must also eo ipso be resurrected at the final judgment. Difficulties arise only in connection with secondary doctrines like those of purgatory, the existence of bodiless souls, etc. Moreover, partly as a result of unclear thinking and partly from rancor, the materialism of the cognitive theory is usually identified with ethical materialism, which, regardless of morality and consideration for other people, egoistically strives merely for “material” goods, by which is meant money, position, good food, drink, and women. But the materialism of the cognitive theory has nothing in common with such ideas except its name. One may accept any view of the cognitive theory and still be either good or bad. But on the basis of the materialistic view, one can deduct a utilitarian ethics by strict logical reasoning, which is superior to all other, which professes to have originated from revelation or the categorical imperative, or from other incomprehensible eternal laws, and which at the same time can be fashioned by every one according to his own desire.

Many modern scientists hold to the theory of psycho-physical parallelism. This theory starts from the idea that both series are so heterogeneous in principle that one cannot act upon the other. To explain this relationship nevertheless, Ceulincex assumed that if the psyche wished to perform a physical movement, it was accomplished in each case by an interposition of divine power, and that every time a stimulus strikes the sensory organs the corresponding sensation is produced in the psyche (Occasionalism). Leibniz, as is well known, held the view that these two series (which were complicated by his theory of monads) were so arranged by preestablished harmony, since the beginning of creation, that they run an entirely uniform course like two ideal watches, so that every act of the will has a corresponding equivalent movement, and every stimulus on the senses a corresponding equivalent sensation. But this theory of psycho-physical parallelism contains one great error: For if the physical series cannot react upon the psychic then it can reveal neither its existence nor its nature to our psyche. It is then quite useless to assume that the outer world exists, at any rate it surely does not exist as we think we perceive it, and then there is no perception, but only hallucination.

The concept of parallelism could still have some meaning within monistic conceptions (Spinoza) inasmuch as the conscious side of the substance has knowledge of the physical part which is really substantially identical with it.

Many view psycho-physical parallelism simply as a confirmation of our ignorance regarding the relationship which undeniably exists between the psychic and physical; sometimes,—and this is particularly true of experimental psychology,—with the secondary thought that we must examine what processes correspond to each other in the two series. This view is also possible, but the name, which is otherwise used quite differently, easily leads to confusion. Some clinicians, without realizing it, get still further away from the original idea, when, for instance, they consider hysteria as a disturbance of the psycho-physical parallelism, because the psychic reaction to the experiences becomes too strong or too weak. Here, of course, the physical “parallel processes” in the brain certainly correspond to the psychic phenomena. In this case therefore the expression is highly misleading.

Wundt has assumed a peculiar view concerning the psycho-physical parallellism. Like many others, he does not only limit the psychic series to the brain functions, but also makes the psychic go beyond the physical, by assuming that certain synthetic functions of our mind take place in the brain without parallel processes. This is an inconsistency which is not only impossible to prove, but which, among other things, is opposed by the fact that we have an analogous synthesis in the physical sphere. Many reflex processes are the result of a whole group of stimuli, which act only as a unit. Likewise the performance of a complicated machine is not equal to the simple sum of the effect of the individual constituents, at least if sum and constituents have the same meaning as in Wundt’s synthesis.

In the dispute between idealism and materialism one senses an uncertainty regarding the value of...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Translator’s Preface
• Introduction
• Contents
• Chapter I Psychological Introduction
• Chapter II General Psychopathology
• Chapter III Physical Symptoms
• Chapter IV The Manifestations of Mental Diseases
• Chapter V The Course of Mental Diseases
• Chapter VI The Borderlines of Insanity
• Chapter VII Classification of Mental Diseases
• Chapter VIII The Recognition of Insanity
• Chapter IX Differential Diagnosis
• Chapter X Causes of Mental Diseases
• Chapter XI The Treatment of Mental Diseases in General
• Chapter XII The Significance of Psychiatry
• Chapter XIII The Individual Mental Diseases
• XIV Oligophrenias (Psychic Inhibitions of Development)