It is upon this general conception that an interesting theory and cure has been developed.^ Hysterical patients are ques- tioned as to the original cause of their troubles, and where it is more or less forgotten, light hypnosis is evoked till they can live over again and with the greatest detail and emotional in- tensity all the circumstances of the inception of their troubles, and state it or act it out with dramatic fervor. This " talking cure " opens a normal outlet of a confessional sort, although with no priestly absolution, and in many cases completely re- stores from hysteria, even though it be pronounced and has en- dured for years. The nature of these psychic causes (and in all but one of the cases reported it is a sexual shock) is such as to preclude reaction or confessing, and abnormal susceptibility, and perhaps fright, causes a changed consciousness with a highly affective content. Suppression makes it more deeply seated, involves perhaps temporary local paralysis, convulsions, or anesthesia in some other sphere, while the new symptoms and lapse of time before the new effects dissociate them from this cause, make them perhaps migratorv disturbances appearing in different spheres successively, or else they accrete into sensormotor groups and unfold as another submerged consciousness. In order to pluck out these raised sorrows it is necessary on this theory to reproduce their status nascendi with hallucinating ^Studien ueber Hysteric. Dr. I. Breuer und S. Freud. Wien, 1895.
28o THE PSYCHOLOGY OF ADOLESCENCE clearness and vividness, and to give vent and outlet through speech and natural gesture, inducing trancoidal states if ques- tionings fail, for language may be an adequate reflex. Expres- sion relieves the tension and reestablishes poise and peace.
Whether as a therapeutic theory this be more or less partial, it is highly suggestive of the need at adolescence, when all the adjustments between sex and mentation are mobilized, of shelter from all forms of shock that are so liable and may be so dis- astrous, and of the need of wise mentors and advisers whose character invites the fullest confidence to forefend the dangers of a too cryptogamic development that in our civilization are so many and great. What part of the intensity of pubescent years, of its occasional proneness to confessionism and secrecies, of its frequent eccentricities and anomalous acts, is nature's ef- fort to relieve strains of this sort, and how many of its reticences aggregate the evils of excessive repression, we do not know, but there is great reason to look to sex for the key to far more of phenomena of both body and soul at this as at other periods of life, than we had hitherto dreamed of in our philosophy.
Sidis, White, and Parker have described some exquisite symptoms which are most frequent at this age, the importance of which, unlike Janet, they do not adequately appreciate. Some of Sidis's work, nevertheless, is suggestive and important here. Especially is this true of the great stress he lays upon " reassociation or synthesis and dissociated symptoms or groups in the active, personal consciousness," and this synthesis which he is able to effect by hypnosis is therapeutic. He also rightly claims that functional psychoses and insanities, especially where disaggregation has not gone too far, should be more carefully studied by psychopathologists. He imagines dissociations somehow correlated with disaggregation of the neu- ron system in a way hardly consistent with the very timely precautions of J. V. Kries,* concerning inferences either way between psychic processes and neural structure or function. Pedagogically helpful, nevertheless, is his diagram illustrating the new rela- * Ueber die materiellen Grundlagen der Bewusstseinserscheinungen. Tubin- DISEASES OF BODY AND MIND 281 tions between consciousness and the various subconscious strata, which are so pecuHarly hable to occur at this age.
Here the waves on the upper Hne a a may stand for the usual stream of consciousness. The waves b b illustrate erup- tion into the first lower, and the waves c c into the second lower stratum. Thus ab c b a would represent a psychopathic cycle. The second, third, and fourth horizontal lines would represent various thresholds. If the b waves were omitted and the third stratum reached by leaping the second, we should have the germs of a dual personality. This, as Sidis adds, is analogous to what we find in biology, where a species is developed by eliminating intermediary variations and the survival of the last link of the series after the missing ones are gone. The above figure is reproduced here, however, chiefly to illustrate something quite different, viz., the tendency at adolescence to what may be called transliminal modes of psychic action. The horizontal lines, representing thresholds, might be multiplied, we know not how far, and new thought plexuses, which run up and down what was before a pretty well fixed series of limi- tations, may even become habitual, upper levels being sub- merged and lower ones denuded, so that psychic adolescence might be conceived as the indefinite distortion of these line levels and the gradual establishment of very different ones, so that what were at first waves illustrating dips deep down into unconsciousness become shorter waves of the a a form.^ Down 2 says " as puberty approaches attacks of mental aberration assume a special character; there is frequently un- natural introspection and a critical hyperconscientiousness be- comes prominent." He describes five good and studious children who from eleven to thirteen became moody; had con- scientious scruples as to their motives; could never make positive statements; grew anxious lest they might not have con- veyed the precise idea intended; became confused or anxious about moral standards, and detailed things in a non-sequential way. One boy was troubled when he saw a dirty beggar, man or boy, lest he should contaminate his mother by thinking of her immediately afterward. All these mental disquietudes, he says, * Psychopathological Researches, by Boris Sidis. 1902. Chapter IV. The Psychogenetic Law.
' MentaJ Affections of Childhood and Youth. London, 1887, p. 93 et seq.
\^ 282 THE PSYCHOLOGY OF ADOLESCENCE are increased if there is any sexual deviation. Destructive ener- gies are vented; there is a passion for creating astonishment and consternation by mischief, great cleverness in concealing delinquencies by lies, no natural affection and no conscience; yet even these cases after the wrench of these years of transition is passed often settle down to respectable and tolerably useful lives. Some are " idiot savants " and draw, paint, reckon, re- member preternaturally well, but they may also have a passion for theft or setting fires, are cruel and have various malforma- tions. Most standard writers like Ireland, Seguin, Warner, Voisin, SoUier, Henderson, and many others, who treat of men- tal defects in the young ignore puberty.
Arno Fuchs ^ well urges that our conceptions of mentally and morally defective youth are obscured and confused be- cause writers have so generally failed to distinguish between the pre- and the post-pubertal age. He says that while the stadium of puberty is revolutionary for the normal persons, it is still more so for defectives. " Idiots animalize, imbeciles be- come violent, egoistic, coarse, and vulgar, and the weak-minded grow unsettled in their moral feelings and are without resist- ance to sensations that now erupt within them." Abnormal children often sink in the new sphere of sexual feeling or, if not this, emerge from the pubertal storms that rage through their inner being with profoundly changed characters. Thus descrip- tions and treatment, valid on one side of this line, are invalid on the other side of it, and this painstaking, judicious, and unusu- ally competent writer expressly limits himself to the earlier period and insists that both his admirable descriptions of indi- vidual cases and his methods of treatment have no application to the pubertal and subsequent stage of development. In this he sets a most suggestive example for pedagogues, as well as for experts in this field, who should learn to profit by it.
When in 1828 Kaspar Hauser mysteriously appeared at the Nuremberg gate, a well formed and featured defective in the teens, it was a challenge to German savants to explain him. He was no idiot with phenomenal memory^ no prodigy in arithmetic or music, no homo sapiens ferns, did not slaver or DISEASES OF BODY AND MIND 283 ruminate, was fairly well nourished, had no eclampsic symp- toms or stigmata of degeneration, was not ineducable or irresponsible, and it was easy to interpret his few words and acts as expressions of peculiar sagacity. The interest he excited was profound and wide-spread and he was studied as no other representative of his class has ever been.^ That he was ex- tremely conscious of the interest he excited and of the many interpretations put upon his acts and traits as an animal boy or a disguised prince, a truant schoolboy, the victim of " a crime against a human soul," as his chief defender designated his wrongs, that he was vain, egotistic, a subtle and oft-confessed liar with a passion for deception, makes him, whatever else he was, a very unique adolescent defective. Many children, thought normal before, are first found wanting at this age. They are neither silly nor half-witted, but can no longer fully profit by school. Their minds develop irregularities, their educability ceases; perhaps they need to be sifted out of school for both its good and for their own; they begin to suffer in dis- position from being teased by those more intelligent than them- selves, and become dead weights in their classes because their brief period of docility is ended. Some, as Langdon Down says, " may by careful management be tided over the climacteric period of puberty and then all may go well."
Masselon ^ emphasizes the incapacity to systematize ideas and the effacement of images. The three chief traits of ado- lescent mental enfeeblement, according to this writer, are the re- tardation of psychic processes, the progressive effacement of memory, and the weakening of the power of mental synthesis. Aboulia, he describes, as due to weakening of desires. Nega- tivism often alternates with docility. The twelve cases that he fully describes well illustrate the fundamental nature of the above characterization. Sollier^ bases his classification of idiots and imbeciles on the degree of attention and deems its impor- ^ For the fullest summary of this case and the voluminous literature upon it, see A. V. d. Linde: Kaspar Hauser; Fine neugeschichtliche Legende. Wies- baden, 1887, 2 vols.; and the True Story of Kaspar Hauser, by the Duchess of Cleveland. London, 1893; also, The Story of K. H., by E. E. Evans. London, ' Psychologic des dements pr^coces. (These de Paris.) Paris, 1902.
' Psychologic de I'Idiot ct dc I'Imbecilc. Paris, 1901.
284 THE PSYCHOLOGY OF ADOLESCENCE tance cardinal. Its preoccupation and instability is inversely as educability and discipHnability. —.
Many crimes and immoralities of early adolescence are from I a blind impulse on which consciousness does not act at all. In the psychic evolution of the sexual impulse there is often at I first a period of general perturbation before the brain reacts! on the sex organi. In idiots and in cases of retarded develop- i ment this sta:ge may be distinct and prolonged. Itard watched with the greatest interest for the first manifestation of this in- stinct in the young savage of Aveyron ^ whom his studies have made so famous among feral men. Congenitally good- natured, he developed periods of turbulence, agitation, and almost desperation, when he would break out in tempests of rage, scream, bite, scratch, bleed at the nose and ears, and could be only slowly and with great difficulty tranquilized. At times he showed preference for the female sex and would sit beside some one and take her hand, but as his general excitement grew he would move away to another. Other idiots at this period stroke or lick the hair, embrace the head and take out hairpins; one held a girl down in a frenzy of erotic excitement but at- tempted nothing more, being ignorant of the ways and means of satisfaction. Beginning with fifteen there is a marked increase in the number of congenital idiots who are sent to asy- lums owing to the increase of general perturbations which be- come dangerous at this age. This diffused excitement is often attended by orgasms but with no knowledge of sex. There is activity and general disturbance reacting into depression. I have myself received written accounts of four weak-minded boys between eighteen and twenty-one described as nearly nor- mal but with entire failure of development in the sexual organs. In two of these cases spells of great excitability and of apathy were described as having developed since the normal age of puberty. This stage may, as Marro suggests, correspond to that of prepuberty.
Many psychiatric studies have seemed to establish a " neu- rosis of anxiety " as a quite distinct symptom group of psychic abnormality. It has a vast variety of expressions and is readily associated with somatic disturbances like palpitation, sweating, dizziness, tremors, congestion, paresthesias. The attacks of * Itard. Rapports et memoires sur le sauvage d'Aveyrori. Paris, 1893.
DISEASES OF BODY AND MIND 285 anxiety may supervene slowly or very suddenly, and may be mild or very acute. rFreud^ was the first to ihsisftlia^^^ forms of morbid anxiety were closely associated with the vita sexiialis, and always arose in cases of retention of the libido. This might occur in adolescents and was common where sex- uality was excessively or abnormally frustrated or restrained, whether after or before normal experiences. Lowenfeld ^ doubted this on the basis of six cases, and Binschwanger does not ascribe very great prominence to sexual causes. Gattel,^ however, made a very careful individual study of one hundred cases and concludes that anxiety always results from some of the many forms of retention, whether overrestraint, abstinence, or imperfect exercise of the function, and that neurasthenia on the other hand is always due to the opposite cause of excess and especially to masturbation. These troubles occurred at the age of greatest reproductive activity, and as would be expected, the anxiety neurosis was relatively more common in women than in men. »If this be true, a normal sexuality, wide as are itsl indi vidua! dinerences, is necessary to steady life between these ' two grave disturbances, either of which may originate in the in- dividual without the aid of hereditary predisposition, and if the sexual life is absolutely normal the physician must be slow to diagnose a real neurosis. Perhaps no recent studies suggest so strongly the fundamental importance for health of all vital and \ .social functions of normal sexual life. I \__>Magnan's lowest group^ of -sexual perverts he cails~spiTral:^ I knew a young dement in a Baltimore hospital, whose intelli- gence was almost entirely obliterated, who grew more and more perturbed through the week, but was always quiet and docile after the Sunday visit of his wife, and whose whole condition was determined by the degree of sexual tension, of the nature of which he seemed to have lost all knowledge. In normal adolescence, if entirely uninstructed, the evolution of this func- tion begins as something entirely new in the experience of the individual, but so strong that it w^ill more or less dominate the life. At first it is a widely irradiated physiological increase of activity, then come local voluptuous sensations due to spon- * Neurol. Centralblatt, i8q2.
'Miinchen med. Wis. Abh., 1895, No. 13.
•Die sexuale Ursache der Neurasthenic in den Neurosen, 1898.
286 THE PSYCHOLOGY OF ADOLESCENCE taneous activity of hitherto unused organs, while it is pure sen- suousness as a general psychic tonus, but as yet without knowl- edge. Instinct has not yet associated these gratifications defi- nitely with the other sex. I believe that it is in this stage of development that sexual perversions of certain classes are rooted. Indeed it seems hardly going beyond the facts of sex fetishism now well established by Moll, K. Ebbing, Tarnowski, and others, to draw the momentous inference that the sexual glow may come to he associated with almost any act or object v^ whatever and give it an unique and otJierwise inexplicable prominence in the life of the individual, and that even the Platonic love of the eternally good, beautiful, and true is possible because of this early stage of indetermination and plasticity. This hypothesis I suggest as the key to many such phenomena to be later described.
Venturl ^ described two forms of pubertal perversions which he deems true insanity. The first is cortical chorea due to defective genital development, manifested in erotic delirious impulsiveness, fixed ideas, melancholia and mania, pyromania, neurasthenia, doubt and agaraphobia. This he thought closely related to absence or undue delay of seminal discharge, defect- ive ovulation, and particularly to onanism. The second is hebephrenia, which occurs later, between eighteen and twenty- three, and reflects difificult psychic evolution and irregular emancipation of social life and is often attended by katatonic symptoms.
Dr. Edes ^ thinks the " New England invalid " a some- what unique type and that her troubles arise from a relative im- pairment or non-development of the reproductive functions or organs. No specialist can escape such a case, for she has an ailment for every organ. After the surgeon has removed all he can, she returns to the general practitioner, needing only to be " built up." It is hard enough for him to hear her tale of symptoms, but for the members of her own household to hear the tensions, borings, thrillings, accusations of selfishness, and the more trying confessions of repentance, ostentatious resig- nation of one doomed to be eternally misunderstood, the craving for sympathy, etc., there is no escape or consolation. Dr.
* Le degenerazioni sessuali. Turin, 1892, p. 320 et seq.
'The New England Invalid. Shattuck Lecture, 1885, by R. T. Edes, M. D.
DISEASES OF BODY AND MIND 287 Edes classifies one thousand of his patients as follows: Ma- lingerers, exaggerators, constitutional neurotics, hysterically ex- citable, neuromuscular, confirmed neurominetics, tense neuras- thenics, limp neurasthenics, melancholies, and his characteriza- tion of each class is of interest and value, not merely as a medical treatise, but as a culture study. A large proportion of these cases are teachers and older pupils; they study not to know but to pass examinations, not because they are interested, but because others have done so; their aim is for the glorification of their sex, that they may show that girls are equal to boys and see in the curriculum an enemy to be put behind. Sometimes such patients seem to grow^ proud of their own cases, and love to recite their symptoms as if to defy the doctor to cure them, until he may develop the tact to make them think that their restoration would be still more phenomenal and inter- esting.
The pleasure-pain threshold is easily upset and depression or hilarity may be excessive and unbalanced. While we re- serve adolescent suicide for more special treatment in the next chapter, we must not fail to note here the frequency of the melancholy that chiefly predisposes to it. This in general may be conceived as due to two groups of causes, first trouble, disease from objective influences. Misfortunes may follow so fast as to kill the joy of life in the most healthful and buoyant tempera- ments. The second cause is hereditary weakness or predispo- sition. Where this is not too controlling it may appear in the early discouragement that easily loses heart and gives up the battle of life with very inadequate cause, but this may be so fateful and dominant that the love of life succumbs with no trace of objective motivation. As hyperemia or melancholy is no longer regarded as a morbid entity but a symptom with a wide variety of morbid accompaniments, that may reach morbid intensity, we have no good statistical data concerning its fre- quency, and various forms of it are discussed in several chapters of this work. It must suffice here to note that in its milder forms no psychic symptom is more common at some stages of adolescence and that its liability is increased in a marked degree at the early teens, although it reaches morbid intensity more often later in life. In youth it has certain marked features, 288 THE PSYCHOLOGY OF ADOLESCENCE especially in suddenness and intensity of onset. Its impulsive and passionate forms predominate, and reactions to sanity are far more probable with health and heredity in favor of re- covery, and less so if the latter is the chief causative factor. Youth is easily plunged into despair, but reemerges with resili- ence if the stock and blood are good. Degrees and symptoms that would be grave in mature life are not only more easily cured, but, other things being equal, are less hopeless.
In his careful study of the subject, Mairet^ argued that lypemaniac stupidity in certain cases can have absolutely no other cause than puberty, especially when its onset is during this period. This malady is usually to be found in nervous acci- dents and in troubles of general nutrition and circulation. Its symptoms are very variable, but in the vast majority of cases there is maniacal agitation, sensory perversion, fears, visual hallucinations, etc. He notes the frequency of cases where ex- cited and active states suddenly supervene after a period of stupidity. The insanity of pubescence involves arrest of in- tellectual development and the maniacal symptoms may be either choreic, impulsive, or hysterical. The stupid form is often complicated in its prodromal stage with chloro-anemia, and sometimes connected with physical fatigue, palpitation, and cerebral erethism, anomalies of character, alternations of ex- citement and depression. Its debut is sometimes sudden, febrile, and delusional, and then a stage of stupor often follows in which the muscles are relaxed, circulation sluggish, the tem- perature low, menstruation suspended, and sensation dull. In this state abrupt outbreaks of perturbation may occur with great incoherence. The choreic form may be simple or hallucinatory. In these cases the mania is not subordinated to the chorea as has been usually assumed, but rather both are branches of the same trunk, the former acting on the mind, the latter on the muscles; both alike are caused by puberty, which is at least the chief pathogenetic agent and which gives to these morbid symptoms its own peculiar physiognomy. Its onset is usually sudden.
A single case of a young man in some respects typical, and * Folic de la Puberty. Am. Med. Psych., 1888, p. 337, 368; 1889, pp. 27, 34, DISEASES OF BODY AND MIND for the account of which I am indebted to Dr. C. P. Bancroft, of the New Hampshire Asylum, must here suffice to illustrate the resiliency of youth against heavy odds. The melancholy began shortly before he was twenty, and eighteen months prior to commitment. There was an history of insanity in both 20 290 THE PSYCHOLOGY OF ADOLESCENCE parental lines; he had attempted suicide both with a razor and with Paris green. Later every possible suicidal effort was made — refusing food, cutting his throat, dashing his head against the wall, throwing himself down a lightshaft — but all without fatal effect, or even serious injury. Slowly he began to respond to dietic and medical treatment. The recovery progressed rapidly. The first picture represents his state No- vember I, in the height of the attack, the second December 1 6, when improvement began, the third convalescence, and the last January 31, when he was discharged recovered.
Neurasthenia was first characterized and named by a bril- liant American physician who was prematurely cut off at the point of his highest promise.^ European experts, who have lately widely enlarged our knowledge of it, grant his priority, and often speak of it as especially an American disease. Cowles,^ who has given us several careful studies, describes it. as morbid irritability, depression, weakness, introspection, ap- prehension, and inattention, in which often the sense of fatigue is itself fatigued so that the victims of it constantly overdo, be- cause this usual check is gone. It is a kind of pathological fatigue following civilization and the intense and competitive life of struggle. It may be due to regressive metabolism caused by the accumulation of autotoxins and ptomaines, and it is to be treated by rest-cures, heightened elimination, and abundant and nutritive food. Kaan ^ has shown how impera- tive ideas and anxiety, a sense of inner conflict and emotional perturbation, may be due to neurasthenia, and that although this state has no hallucinations and may last a lifetime, it never issues in dementia. It is most often connected with fears of storms, water, height, dread of standing, being poisoned, con- tact, impotence, of doing improper things, especially of an ob-