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11. A Case of Hysteria: Theory and Practice in the Two Wars (1941)

John Rickman Karnac Books ePub

GOOD fortune sometimes sends us a case which aptly illustrates some view of illness we are interested in; occasionally we find one which enables us to make a brief historical review of our theories. Such is the case of a soldier of 28 who received superficial gunshot wounds of the right arm and leg on active service and thus incommoded made his way to the coast during the retreat wandering about for five days unable to get treatment. After a few weeks in hospital he recovered from his wounds and went ,6n sick-leave. On returning to his depot he developed a glove anaesthesia in the arm below the wound and hysterical paralysis. This condition continued for many months during which he was morose and dejected. When seen he had an evasive manner and spoke in clipped speech with ’Yes, sir.— No, sir.—I’ll answer any question you put, sir/ volunteering no information.

Viewed in terms of the last war’s psycho-pathology we would say that there was a break in the representation of the limb as an active thing in the mind, because, in the struggle between the impulse to duty and that of self-preservation (the fear of injury or of extinction in active service) self-preservation had won: he had no occasion to experience the fear while protected by his hysterical paralysis. Though it came on after leave and on return to duty, he was unaware of the relevance of this factor in its causation because—the symptom having solved it—he was now unconscious of the conflict in his mind. That he was an unstable fellow lends support to the view that the dissociative mechanism of escape from conflict is often found in those with some hereditary degeneration; his evasive manner might be ascribed to a psychopathic disposition due to the same cause. The fact that he had seen active service in the Far East and only broke under the strain of the battle in Flanders also shows that even trained regulars can be pounded into dissociation if the threat to life be severe enough. Treatment would have followed within the framework of reference of the psycho-pathology. Since rest, massage and electricity had failed, his esprit de corps would have been stimulated, his sense of shame touched on, under hypnosis he might have been shown the limb in movement so that that break in the representation in the higher centres would have been bridged. It would be possible to extend the theoretical exposition with other views and evidence, This man of marriageable years roved through life single, refusing promotion so as to keep the equal camaraderie of his friends, unspoiled by differences of rank. But self-love, heightened by danger and stimulated by the injury, awakened fears of other injuries and threats from the infantile past and pulled him away even from loyal companionship. Regression, once begun, ended in the focusing of all attention on the flaccid limb. ’It is all I can think about’, he said. It would not be discordant to common knowledge among psycho-pathologists to see in the helpless right arm both a symbol and a visitation of punishment. He is impotent to defend himself; guilt now contributes to the maintenance of the symptom since with it he must leave his companions, just as a sense of guilt must have contributed to its origin when he failed them on return to duty. And further by being thus incapacitated he stays in England. The regressive pull to home and security would tend to keep him ill Tor the duration’.

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15. Guilt and the Dynamics of Psychological Disorder in the Individual (1948)

John Rickman Karnac Books ePub

I N this session of the Conference we shall hear the topic assigned to us discussed from several aspects, medical, legal, ecclesiastical and philosophical. Within each of these disciplines there is, as is well known, diversity of opinion, which is a healthy sign; between these disciplines there is even greater diversity, probably because the method of profess-narapproach to persons suffering from guilt is different in each of these learned disciplines. What I shall say from the viewpoint of a psycho-pathologist will be an attempt at a combination of not altogether incompatible opinions.

In addition to the doctor’s general responsibility for the physical and mental welfare of his patient, the psycho- pathologists have, since the early pioneering days of Freud, a common method of work which is shared, so far as I know, by no other profession: they listen to whatever the patient may say in free association about his pains, griefs, dreams, aspirations or joys; they regard no two ideas as irrelevant to one another if the patient has brought them—however unwittingly or however unwillingly—into the same stream of associations. Thus the psycho-pathologist sees guilt in a wide context of personal experiences: not in relation to religious beliefs and ethical codes as the clergy inevitably do, not in relation to abstractions as the philosophers choose to do, but as the patients find and feel it within themselves.

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11. On the development of professional and unprofessional attitudes

John Rickman Karnac Books ePub

Doctors are not the only professionals who find themselves faced with unprofessional rivals, and it should be possible to discover general features of this situation, whether the direction of the activity be the administration of medicine, the drawing up of a deed or an audit, the building of a house or a bridge, the planning of a campaign or the cure of souls.

The present-day professions may be arranged in a series according as they are related to the laws of nature on the one hand or to the customs of men on the other. Thus, we have at one extreme the physicians with their close connection with the disciplines of biochemistry and biology, and at the other extreme the accountants and lawyers whose minds are turned to the intricacies arising from the interplay of human interests, and who have not such a direct connection with science as have the physicians and engineers. This serial classification of the professions shows us at a glance that the criterion used in this paper to distinguish the mental qualities of the unprofessional practitioner cannot be employed with an equal ease in the case of all professions, for they do not all rest on a similar mental basis or share a common history.

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15. A study of Quaker beliefs

John Rickman Karnac Books ePub

Recent discoveries have thrown light on some aspects of religious belief which had hitherto been obscure. For about a quarter of a century psychoanalysts have been in possession of hypotheses which have enabled us to connect the majority of religious systems with other and better-known mental phenomena of health and illness. But there were certain religious beliefs and practices which were difficult to “place”. Chief among these was Quakerism. In the last ten years, however, our knowledge of certain fundamental processes has progressed, largely owing to the researches of Melanie Klein, who has applied Freud’s discoveries to the investigation of the minds of young children (Klein, 1932), so that we are now enabled to bring some light to the study of even this obscure problem.

In this paper my concern is far more to extend the application of scientific hypotheses and to increase the number of connections between the phenomena of religion and those of the rest of human life, than to make an ambitious attempt to discover “Transcendental Truth” about Quakerism or anything else.

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2. A Psychological Factor in the Aetiology of Descensus Uteri, Laceration of the Perineum and Vaginismus (1926)

John Rickman Karnac Books ePub

GYNAECOLOGY is chiefly concerned with the physical condition and position of the genital organs. Sometimes psychoanalysis is able to contribute an interpretation of the phenomena in terms of libido and explain the present conditions in terms of the patient’s past love attachments and his capacity to renounce infantile sexuality for an exogamous genital gratification. The physiology of use must be supplemented by a ’physiology of pleasure’ (Ferenczi).

In the psycho-analytical literature we read of the genitaliz-ation of other organs and learn something of the changes so produced, but little has been said of the changes in the genitals themselves when not acting as the central erotic organ of the body’ Recent investigations have led me to think that weakness of the pelvic floor and of the suspending ligaments of the uterus may be evidence that the genital stage has not been reached or maintained, and that loss of ’tone’ in these tissues is a sign of ’degenitalization’. A case to illustrate this point.

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