Mental Pathology and Its Relation to Normal Psychology. Gustav Störring. A course of lectures delivered at the University of Leipzig. Translated by Thomas Loveday. London: Swan, Sonnenschein, & Co. 1907. Pp. 298.

        The English title is rather modest and does not give the full scope which the author claims to encompass in his lectures. In the original German the title is "Vorlesungen über Psychopathologie in ihrer Bedeutung für die Normle Psychologie mit Einsschluss der Psychologischen Grundlagen der Erkenntnistheorie." Professor Störring's aim is not only to relate psychopathology with normal psychology, but also to furnish some psychological foundation for epistemology. The aim is certainly praiseworthy, as few psychiatrists are willing to put their work on such a broad basis.

        Störring starts with definitions of psychology and psychopathology. Psychology is defined as "the science of conscious processes" (Bewusstseinsvorgänge), and psychopathogy as "the science of morbid mental processes" (krankhafte Bewusstseinsvorgänge). He does not explain in what respect the two sciences differ. Is normal psychology the general science, and abnormal psychology a special science based on the former, or are the two of equal rank? From his lectures it appears that he treats normal psychology as the general science and relates the two sciences as physiology is to pathology; the one deals with normal, the other with abnormal mental states or processes. The author does not think it necessary even to refer to the view that psychology may be treated as the science of the self. He makes a brief reference to "the soul," and dismisses the whole matter with the contemptuous term of "metaphysical psychology."

        The division which Störring follows in his lectures is the customary tripartite division of the mind. He gives no reasons for such a classification, and the reader has to take the matter on faith. Intellect, feeling, and will are the three main functions or processes of the mind, and the main volume of lectures is divided accordingly; only the lion's share falls to the feelings. For Professor Störring seems to think that the feelings, or affects, as he likes to call them, being a disciple of Wundt, are at the very foundation of psychology and give the key to abnormal psychology. One is, therefore, not surprised to find that after defining the subject-matter of psychology and psychopathology he starts with a discussion of feelings and emotions. Feelings, according to Störring, can not be reduced to sensations; special or organic, but constitute a class sui generis. At the same time he does not tell whether the affections are special psychic states with special physiological processes, or are mental states due to general bodily conditions, defined by Wundt as reactions arising indirectly in the course of the process produced in the organism directly by external agencies. The affections, according to Störring, seem to be something general and indefinite; they accompany both peripheral and central psychophysiological processes, but themselves are neither central nor peripheral. A psychology with soul as subject is metaphysical, a psychology with unanalyzable subjective affections is empirical.

        In Storring's discussion of emotions the James-Lange theory naturally comes in for a good deal of criticism, if not rebuke. "It does not follow from them [the facts adduced by the theory] that emotions are nothing but sensations of bodily changes (blosse Empfindungen der körperlichen Veränderungen, blosse Organempfindungen). Sensations and feelings as given psychically are markedly different in quality." And, further, he  emphatically tells us that "so far as I can manage to abstract single sensations out of an emotional state, I find them to be accompanied by affective tones which do not admit of further analysis." Our view, then, is," he says in another place, "that the bodily changes which occur in these cases cause the emotions by arousing organic sensations and accompanying feeling tones. Further,  as the organic sensations form with the affective elements a qualitatively unitary state, we say all these psychical magnitudes are fused in the emotional state (affective state, Affectzustand)." "Emotions" thus "represent fusions (Verschmelzung) of organic sensations and affective elements." Now "in artificial and pathological cases these are their sole constituents, whilst in the normal emotion there are also present primary affective elements which, however, "do not determine its character." This last generalization is rather dogmatically stated, as the author does not attempt to justify it by facts; for it may be maintained that, on the one hand, "fusions of organic sensations and affective elements" play a primary role not only in artificial and pathological cases, but also in normal cases, and that, on the other hand, ideas and perceptions, with their accompanying primary affective elements or "simple feelings," are also present in artificial and pathological cases.

        In one paragraph the author disposes of the problem of the relation of emotions to what are called "simple feelings." "We must distinguish the primary affective elements from the consequences of organic changes which become combined with them." Simple feelings and emotions differ. This thesis, however, is not well sustained for he soon proceeds to tell us that "although organic sensations and organic feelings do enter into 'simple feelings,' still the concomitant bodily phenomena are so weak (!) that the intensity of the sensations and affective tones they provoke plays but a small part in the whole phenomenon, whilst, as we said, in emotions these form the principle constituents. Further, it may happen that the bodily changes are of such slight intensity as to arouse no sensation at all." This slight admission practically does away with the whole thesis, inasmuch as the difference between "simple feelings" and emotions is reduced to one of massiveness and possibly to intensity of organic sensations. Simple feelings and emotions may, then, be reduced, according to Störring's own admission, to peripheral processes coming from organic conditions; in other words, simple feelings and emotions really do not differ, they are identical and take their origin in organic sensations. The very summary weakens Störring's position: "Emotions differ from simple feelings in two respects: firstly, the relative intensity in the total effect of organic sensations and organic feelings, on the one hand, and primary affective tones, on the other, is different; and second1y, qualitative differences also exist, since certain organic sensations which are present in emotions do not occur in feelings, or it may be merely because organic sensations are in 'simple feelings' disproportionately dim." The difference, then, between "simple feelings" and emotions is simply a matter of intensity, dimness, and massiveness of organic sensations present. But as such a difference may also be found between one emotion and another, there is really nothing present by which "simple feelings" can be differentiated from emotions.

        Having defined the difference between normal and morbid emotions by the presence or absence of primary affective elements, the accompaniments of ideas and percepts, Störring is left in the lurch as to how to differentiate between emotions and moods; the latter can only be differentiated from the former by the fact of "the comparatively slight excitement and the comparatively long duration." In this respect we can not help agreeing with Stout that "an emotional mood is not quite the same thing as an emotion properly so-called. An emotion properly so-called must be felt in relation to some definite object; to be angry we must be angry about something. But the general state of irritation due, let us say, to a sleepless night, has not, as such, any definite object." On the whole, the view of affective processes as expounded by Störring can not be maintained consistently.

        Störring's treatment of hallucinations follows closely the accepted views, namely, that intensified images may become sensory and perceptual,―hallucinations are "subjective sense images which strike him (the subject) as actual perception." The identification of idea, image, and sensation is one of the most fundamental psychological and psychopathological fallacies.

         Störring has a great love for generalizations, which is rather praiseworthy, but occasionally the adventuresome love of generalization is apt to lead him into rash statements. Thus he tells us that "hallucinations have far more influence than simple perceptions upon intellectual and volitional processes." This generalization is supported by a single unanalyzed hysterical case, whose conduct was so influenced by her hallucinations that the author could not change it. In the light of recent research on hysteria and subconscious manifestations, the phenomena observed by Störring are merely superficial symptoms and can not be taken on their face value. One third of life normal persons pass in sleep, and most are subject to dream hallucinations, but it can hardly be claimed that dream hallucinations have a greater influence than simple perceptions upon intellectual and volitional processes. Again, there are many cases of hallucinations in normal and intelligent people on whom the influence of the hallucinations is next to nothing. It is only when hallucinations chime in with superstitions and prejudices that the influence becomes marked. In the unbalanced and the insane the hallucinations may have a deep influence, but then it is not so much the hallucination per se that produces the effect as the genera morbid condition as a whole. 

        Storring is greatly troubled by the fact that the "intensity" of ideas and independence of the will are not sufficient to give an idea the objectivity of a percept, and so he adds "concomitant muscular and visceral sensations," which, according to him, fix the characteristics or marks of the percept. It is the well-known psychological view that muscular sensations give objective reality. "The sensations meant are such as arise from the activity of sense organs in perception." The English translation here misleads the reader by referring to "secondary sensations," and their reproduction in the percept. What Störring refers to is Nebenempfindungen, or to associated sensations, which are widely different from the phenomena known in psychology and psychopathology as secondary sensations. Störring means "Nebenempfindungen die von der Thätigkeit der Sinnesorgane bei der Wahrnehmung berühren. Solche Nebenempfindungen können natürlich ebenso reproduziert werden wie die Hauptempfindungen." In other words, along with the special visual sensation, for example, the sense organ makes movements of adaptation and adjustment; these muscular sensations are thus associated with the special visual sensations, and it is those reproduced associated sensations or Nebenempfindungen of muscular sense that constitute the external reality of the percept or of the intensified idea. The hallucination, then, is an intensified, reproduced image of a special sensation, with intensified reproduced associated images of previous muscular sensations which thus constitute the complex reproduzierte Mitempfindungen. It is the old doctrine of hallucination: a hallucination is an intensified ideational or image complex. The doctrine appears different from what we read in every text-book, on account of Störring's style of writing and exposition, further obscured by an inadequate translation. The sensational intensity of the hallucination is due to the "abnormal irritability of the cortex." The logic of facts seems to force Störring to assume some peripheral source in the origin of hallucinations, so he finally comes to the conclusion, in the analysis of one Cramer's cases, that "an idea obtains objective character by fusing with an objective impression; it acquires the impression's intensity and shares its objectivity." Similarly, illusions depend on the perceptual process of assimilation, which "consists in a sense impression reviving an associated idea and fusing with it into one perceptual whole. Thus we can distinguish an objective and a subjective element in perception, and we call it illusion when the subjective factor plays an abnormally prominent part in the process of assimilation." A close examination of Störring's illusions and hallucinations reveals the current psychological views put forth in a complicated, obscure, and confused form.

        Störring then concludes his treatment of hallucinations with a peculiar attempt to decide the question "whether there are separate centers for the correlates of sensational and ideational processes, respectively." He comes to the important conclusion that the "functions of the two are separate." This conclusion is arrived at on the strength of two hysterical cases of visual disturbances and one of Wilbrand's cases. Störring is either not acquainted with or has overlooked the subconscious side of sensory disturbances in hysteria. An attempt to decide localizations of psychic functions on the strength of hysterical cases is unlike the attempt made to study brain localizations on the strength of hypnotic experiments. It shows how difficult it is for one who has not a first-hand knowledge of subconscious activities to grasp fully the meaning of functional disturbances of hysteria and of allied mental states.

        The author's summary of the different forms of aphasia is very good. He presents the main views on the subject, and brings cases which he closely analyzes and from which he draws conclusions interesting to normal and abnormal psychology. His view of "valence" of association "paths" "is certainly interesting. "I speak of an association between ideas as having strong valence when it enables one idea to reproduce another correctly as to content and in time without retardation (relatively to the average rapidity of reproduction in the particular associational system); whilst I call the valence weak when the reproductive tendency of the first idea is not strong enough to revive the second, but requires support, say, from some third idea which has a similar connection with the second." This principle is ingeniously utilized in the explanation of pathological material of aphasia, agraphia, alexia, apraxia etc. He further finds that "in the mechanism of spontaneous speech and in that of reading this interesting condition is realized: an idea a is doubly associated with an idea c, first, through an intermediate idea b, and, secondly, directly; the association of a and c is extremely frequent; and yet a does not develop a strong tendency to direct reproduction of c, even though one may voluntarily recall c by means of a times without number and may have no direct interest in a preliminary revival of b. In the mechanism of writing, on the other hand, the direct connection attains strong valence." This is explained on the principle of valence of the various association paths of the respective activities or spontaneous speech, reading, and writing. Störring, as usual, adheres to the orthodox view of "images and brain localization."

        From aphasia the author passes to the amnesias, and he rightly refuses to differentiate the two on the basis of organic and functional derangements. In aphasia we deal with elementary processes of frequent repetition, while in the amnesias we deal with mental processes of high complexity. Störring deals first with the Dämmerzustände of epilepsy, psychic epilepsy, and hysteria. (The term "mental fog" used by the translator for Dämmerzustände is not a very happy one.) In his discussion of psychic epilepsy he takes it for granted that the states are of an epileptic nature, evidently not being aware of the fact that many of the Dämmerzustände known as psychic epilepsy are not at all of an epileptic character. According to Starring, there is in psychic epilepsy and its Dämmerzustände a modification of organic sensibility "which is the explanation of the amnesic phenomena." In other words, Störring arrives at the interesting generalization that memory is a function of organic sensations, the concausæ of reproduction"; memory changes with the modification of organic sensibility. Space does not permit discussing this in full and pointing out its unpsychological character, its many shortcomings, its lack of conformity with facts. As the subject has been discussed by me in my previous works, the ground need not be gone over here again. It is enough to refer to the fact established by many investigations in my laboratory, a fact which has since been confirmed by other investigators, that many Dämmerzustände of psychic epilepsy are of a purely subconscious nature and have nothing to do with epilepsy proper and its changes of organic sensibility. The whole argument of Störring's is an ignoratio elenchi. Epilepsy with its modifications of organic sensibility is not necessarily connected with "psychoepileptic Dämmerzustände." Moreover, there may be changes of organic sensibility, as in many intestinal and other severe bodily maladies, without the least change in memory, and there may be profound changes in memory without the least changes in organic sensibility, such as in the amnesias brought about by traumatic conditions and by states of dissociation. Organic sensations are neither causæ nor concausæ of memory.

        When we come to the so-called Dämmerzustände, or, rather, subconscious states of hysteria, the author displays a want of knowledge and a lack of appreciation of facts as should be expected of the doctrinaire, dogmatic, reasoning spirit so highly characteristic of people who cull their knowledge of facts from articles and books. Störring has evidently no direct experience of subconscious states, artificial or spontaneous, and he theorizes dogmatically on cases he has read in Janet, Breuer, and Freud, and a few other original investigators.

        The derangement of affectivity (Die Störrung des Gefühlslebens) seems to the author the most characteristic manifestation of hysteria. "It consists, firstly, in great instability of affective states, and, secondly, in abnormal intensity of the concomitant bodily phenomena, more particularly―and so far as I know, this point has never been emphasized before―of those accompanying reproduced affective states (reproduzierte Gefühlszustände) which are themselves abnormally intense in consequence." Störring is evidently not aware of the fact that recurrence of mental states characteristic of dissociated states in general has been put by psychopathologists at the very foundation of psychopathology. Störring reminds one of the man who has just invented gunpowder. The interesting point is that Störring does not understand the importance of recurrent states, and when he comes to hysterical anesthesias, the most elementary phenomena of functional psychosis, he breaks down helplessly, confessing "we can not tell how precisely they originate." He falls back on Janet's hypothesis of "hysterical narrowing of consciousness," a hypothesis the full significance of which the author does not realize.

        When we come to the phenomena of multiple personality, we find him to be at sea, floundering about helplessly, making wild statements and fanciful hypotheses. He tells us that "the facts which have led some authors to assume a splitting of consciousness into parts are comprehensible without that assumption. The phenomena of double and multiple personality are simply a matter of alteration of organic sensibility. "We saw in the last lecture how a modification of organic sensations affects memory, namely, by introducing an alteration in the concausæ of reproduction. In the same way it makes the phenomena of double consciousness perfectly intelligible. When one abnormal state is after a normal interval succeeded by another abnormal state, in which there is a similar alteration of organic sensibility, then, as we have seen, the events of the first abnormal state can be recalled. But that is not so in the normal, interval. During the normal interval there is partial amnesia for the events of the first abnormal condition, owing to an essential modification of the concausæ of reproduction. In the subsequent abnormal state memory is restored, because the general conscious complex is once more the same as it was in the first state." As a matter of fact, organic sensibility has nothing to do with memory, and in the cases of double and multiple personality studied by me there was not present the least trace of changes of organic sensibility. Thus in the Hanna case, the most typical case of double personality, since no hypnotic suggestions were present to mar the manifestations, the organic sensibility of the two personalities was essentially the same. The phenomena of simultaneous disintegration of consciousness or of coexistent, but dissociated, consciousnesses or personalities, are explained by the same affective states, so that there is no need to assume "splitting of consciousness." The author gets here so far away from facts and his explanations are so confused and obscure that there is no need to trouble the reader with a criticism of his theories.

        All forms of amnesias are explained by changes of organic sensations, and by intense affective states which inhibit ideas "rising on the threshold of consciousness." Störring's hypothesis is in gross contradiction to the facts. In the many cases of amnesia studied in my laboratory no changes of organic sensibi1ity were observed that could in any way be correlated with the amnesias under investigation: Other investigators found the same result. Again, in hypnosis and in artificially induced somnambulism amnesia is induced at the mere suggestion of the experimenter; organic sensibility has absolutely nothing to do with it. The amnesia again can be removed at the mere gesture of the experimenter. Many, if not all, of the hysterical or functional amnesias are just that type, and there is no question of affective changes or of modifications of organic sensibility.

        Störring attacks Janet's and Binet's "assumption of unconscious sensations and ideas" (unbewusste Empfindungen), and assumes the hypothesis of "dimly conscious states" (dunkelbewusste psychische Grösse). He attacks a man of straw. No psychopathologist of note who has a firsthand acquaintance with the facts would for a moment maintain the assumption of unconscious ideas. Störring does not understand the central point of modern psychopathology, namely, the demonstration not of "unconscious," but of subconscious, or of what my friend Dr. Prince terms, to avoid all misconception, coconscious mental states, mental states which are dissociated, but nonetheless conscious.

        Störring's discussion of imperative or insistent ideas is very much on  a par with his discussion of amnesias and phenomena of double and multiple personality. The affective states which are supposed to bring about amnesias are called in here to bring about the opposite effect, namely, to cause a hyperamnesia and fix the idea in consciousness. Störring thus manages to get the utmost out of the affective states. The affective states are worked for all other abnormal mental states. The same tune with slight variations serves for all occasions. Paranoia, manic-depressive states, dementia præcox, melancholia, and allied psychoses, all find their explanation in the affective tones of organic sensations.

        We may possibly refer to Störring's theory of the physiological correlate of feeling tone. He favors the view maintained by many psychologists since the time of Spinoza that "pleasure (Lust) is concomitant with an increase, unpleasure (?) (displeasure, Unlust) with an abatement, of vital functions." Agreeable and disagreeable would probably express better the writer's meaning, because pleasure is more related to pain. Now, according to Störring there may be three possibilities: "Pleasure (Lust) may be connected either with intake of potential energy, or with transformation of potential into kinetic energy; or with a definite ratio of kinetic to potential energy." He accepts the second possibility. Störring does not refer to one of our foremost American psychologists, Marshall, who many years ago worked out in a separate volume a similar theory based on rich material of facts and with a deep psychological insight into mental life. It seems that Störring is not acquainted with the works of English and American investigators, a fault not uncommon among German writers. It is interesting that the whole theory is based on a single fact, namely, on one experiment performed on the muscle of a curarized frog. "The curve resulting from supramaximal stimulations is markedly differentiated from the rest by an earlier and more rapid fall and by the shorter duration of the twitch." In face of the extreme complexity and difficulty of the problem psychologists will hardly be satisfied with a physiological demonstration of the curarized muscle of the frog.

        In spite of all its defects the book is valuable, stimulating, and highly suggestive, as it is the first attempt of its kind to correlate normal and abnormal psychology. One great merit of Störring lectures is the comprehensiveness with which he attempts to discuss the morbid mental states in their relation to psychology and even to epistemology, and although he fails in many respects, the attempt is certainly of the utmost importance to the psychologist and psychopathologist; his work should be in the hands of every student who is interested in the correlation of normal and abnormal psychology.

BORIS SIDIS
 BROOKLINE, MASS.

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