There remain two other points in connection with hysteria which merit discussion in the light of the war experiences: (1) the part played by sex factors, (2) the theory of intrapsychic conflicts. Both these points, as all know, have been stressed by Freud and others of his school.

Although Freud's views as to the exact part played by sex factors in hysteria have undergone considerable modification from the time of his original formulation nearly twenty-five years ago, yet even in his more recent formulations the sex element is regarded as essential in the etiological mechanism of hysteria: "The hysterical symptom corresponds to a return to a manner of sexual gratification which was real in infantile life and which has since been repressed." - "The hysterical symptom can assume the representation of various unconscious non-sexual impulses but cannot dispense with a sexual significance." 2

It seems quite probable that, in relation to a certain variety of clinical material - especially such as would be most likely, in times of peace, to come to the attention of a nerve specialist devoted, like Freud, to psychoanalytic practice - the idea of the universality of sex factors is well founded. The sphere of sex, under ordinary conditions, might even a priori be regarded as the main if not the sole source of "concealed, illicit, morally untenable motives" postulated by me as the mainspring of hysterical conduct. But the war experience has shown even to loyal adherents of Freud that hysterical manifestations can be actuated by motives other than sexual. In medico-legal practice, even in peace times, neurologists have seen but too often hysterical manifestations ("traumatic neuroses ") arise on the basis of exaggerated claims for indemnity, sick benefit, accident insurance, workmen's compensation, etc., without the intervention of sex motives.

1 A. B. Jones and L. J. Llewellyn. Malingering. Philadelphia, 1918.

2 S. Freud. Sammlung kleiner Schriften zur Neurosenlehre. Zweite Folge, 1909. Quoted by O. Pfister. The Psychoanalytic Method. English translation by C. R. Payne, New York, 1917.

It seems, therefore, justifiable to conclude that an illicit motive is an essential part of the mental mechanism of hysteria; but such motive need not be of a sexual nature, although undoubtedly it very often is.

Turning now to the subject of intrapsychic conflicts, it will be remembered that the manifestations of hysteria are regarded by some as a sort of compromise resulting from a conflict between repressed, subconscious wishes and the patient's conscious tendencies representing the better part of his "split-up personality."

I can confirm, from such observations as I have been able to make, the existence of a conflict. But it has seemed to me to be, for the most part if not entirely, a conflict rather between the patient's desire to shirk, loaf, avoid exposure to danger, gain unearned compensation, etc., and pressure from external sources the object of which might be to expose his motives and the unreal nature of his disability, to bring on him the opprobrium of his comrades, to render him liable to legal prosecution, etc. In other words, I was unable, in the great majority of cases, to detect any pricking of conscience, evidences of regret at being a burden rather than a help to their country in ite great emergency, any struggle between a nobler and baser parts of self, but rather lack of evidence of the existence of a nobler self in these cases.

This brings us to the subject of the hysterical personality.