The embarrassing psychic conflict characteristic of neurotic patients is frequently exhibited. Freud considers it an attempt of the ego to defend itself from painful memories, but it does not necessarily result in complete dissociation or splitting of the personality. Just how the "repression" contributes to the development of the hysterical symptoms, and how these symptomatic manifestations connect with the pathogenic experiences causing the psychic trauma, is not clear. It must be hypothetically assumed, and the correctness of the theory demonstrated by the results obtained from psychoanalytic therapy, as the cure of the symptoms must be traced over the same route to the suppressed idea.

However completely the painful ideas may have been driven out from the conscious memory, the nervous mechanism conserving them, at the expense of a great amount of psychic pain to the patient, still exists in the subconsciousness as a suppressed wish, ready to functionate in a disguised and distorted manner, accompanied by the same painful sensations that were produced by the original experience, and from which the patient believed he was relieved by the process of repression. The cure is effected, under such conditions, by convincing the conscious personality of the patient that he was wrong in rejecting the pathogenic wish, which he may ac-cept entirely or in part, or the wish may be directed to a higher goal, in channels free from objection to the conscious ego, by a process of sublimation; or the rejection may be regarded as the right disposition of the wish, in which case the automatic mechanism of the complex conserving the repressed wish may become so changed that it becomes an indifferent functionating complex, or one conserving entirely different associations.

Thus the cure of the patient is effected, and he becomes master of himself.

Freud has explained with repeated emphasis that the effectivity of psychoanalytic therapy depends upon a reproduction of the emotional excitement accompanied by the original traumatic experience. If the patient is reproducing the traumatic scene to the physician, the process has no curative effect if, by some peculiar chance, there is no development of emotion. How he gets the adult to reproduce the emotions caused by infantile and childhood "sexual traumas" is not clear to me. At any rate, he regards the emotional processes as being that upon which the illness of the patient and the restoration to health are dependent. The illness of the patient results because the emotion developed in the pathogenic situation was prevented from escaping normally, and hysterical symptoms are due to the fact that these "imprisoned" emotions undergo a series of abnormal changes. They are conserved as an ever present source of psychical disturbance, and are transferred into bodily innervations and inhibitions, which present themselves as the physical symptoms of the disease.

Since it is the "reproduction of the emotional excitement accompanied by the original experience" upon which Freud depends to effect his cures, I see in his method nothing but a process of nagging his patient about "sexual incidents of life," by which means the emotions are deeply stirred or aroused, and in this particularly suggestible moment he appears pleased to have discovered "a psychic trauma," which was no doubt produced by his process of torture, and the assurance given to the patient that an important step in the cure of her hysteria had been accomplished gave her a feeling of relief until the next hour of digging into the sexual incidents of her early life should be resumed.

Under the guise of religion I have frequently witnessed a stirring of the emotions in hysterical subjects, and noticed the effectiveness of the suggestions of the pulpit orator in producing a state of extreme delight in such subjects, and in sending them away with a feeling of well-being in the extreme. I can see nothing but the same method of using suggestion in disguise by Freud's process of holding the patient's attention, day after day for a year or more, to ideas concerning her sexual experiences, consisting of impulses and "wishes" during early childhood, as well as adult life, and finally succeeding in so embarrassing the unstable personality that she bursts into tears, or exhibits other marked manifestations of emotion, thus obtaining relief from the "psychoanalysis" for that day, as she is assured that another step in the "cure" is effected.

One of the strongest arguments in favor of my opinion that hysteria and other neurotic manifestations are the result of an environment of early childhood, which was responsible for the repressed personality or the retardation of the normal psychic and physical development, is found in the following quotation from Freud:1

" The former value of the person should not be overlooked in the disease, and you should refuse a patient who does not possess a certain degree of education, and whose character is not in a measure reliable. We must not forget that there are also healthy persons who are good for nothing, and that, if they show only a mere touch of the neurosis, one is only too much inclined to blame the disease for incapacitating such inferior persons."

Showing the limited scope of the measure, as advocated by Freud and set forth in his writings, I quote again:

"If one wishes to take a safe course, he should limit his selection to persons of a normal state, for in psychoanalytic procedures it is from the normal that we seize upon the morbid. Psychoses, con-fusional states, and marked (I might say toxic) depressions are unsuitable for analysis, at least as it is practiced today."

1 Hysteria and Other Psychoneuroses. - Translation by Brill, page 181.

He, however, further remarks:

"I do not think it at all impossible that, with the proper changes in the procedure, it will be possible to disregard this contraindication, and thus claim a psychotherapy for the psychoses."