Tuesday showed no gain. Wednesday she said she had moved her leg again. (She had been trying to do so and had relaxed.) I had her lie back and close her eyes and try to remember the gap between the assault and being home in bed. She could get nothing but a vision of her mother. She said, "I feel mother has something to do with my not telling."

Thursday, May 2, while lying back with her eyes closed, she suddenly said, "I know."

When she had told this she moved her legs slightly. She continued, and said that he took her home to the gate. She staggered along the path and crawled up the back steps. When her mother let her in she sat in a chair in the kitchen awhile and then went to bed.

Friday, May 3, the patient can lift her right leg but not her left. She cannot stand as yet. She remembered further details.

"Didn't you tell your mother?" I asked.

"I have the feeling I told her," she said. "It seems as if I got up and went down stairs. I remember being on the couch. His wife came in and was questioning mother about it. It worked me all up to see her. But mother said it was all nervousness."

After a long pause, she exclaimed, "I know, I told mother. She said people thought things so much they finally got to think so in reality. She wouldn't believe me.

The patient can move her left leg now, but cannot stand. Saturday she stood a little but was wobbly. She Isaid that it was hard to tell her mother but when she had and wasn't believed, she shut right up.

"It seems as if every time I spoke of it mother poohpoohed it, and said I had dreamed it, till finally I thought I really had dreamed it. I remember seeing him and I thought of it, but I thought of what mother had said and I tried to put it out of my mind. Just how long it took I don't know."

The first time she saw the man again was about a week afterwards. She was sitting on the piazza with her mother and he and his wife came over for a few moments and sat with them. As they were coming up the path her mother

gave her a look as much as to say, "you stay." She did so, but was so weak and faint she felt if she should stand up she would faint away. She didn't speak and never looked at him when she could help it. She was trembling all over and felt sick. After that she saw him as usual and finally her memory of what he had done, went. It kept getting fainter and fainter until it had gone completely. It seems it must have taken her about three months to forget the incident.

Improvement during the next few days was rapid. Wednesday she was walking about the wards alone. Tuesday night she dreamed something, "but," she said, "I can't tell what. I woke up saying 'I shan't tell anything more. Friday she said she had dreamed another distressing dream. "I was walking and somebody kept bringing up different reasons why I shouldn't walk, but I kept on." The reasons were like pictures. "It seemed like a woman standing in front of me, showing these pictures, and then saying, 'now you can't walk.' I woke crying. I thought of mother."

She continued to gain, however, and was discharged from the hospital May 11, apparently recovered.

Now we can understand the meaning of the interference of the image of her mother with the recovery of this second submerged complex. With a cowardice almost incredible her mother had refused to believe her story and had done her best to help her crowd it out of her mind.

This repression was no instantaneous affair, however, but was a matter requiring months. Probably if there had not been already repressed, a nucleus of the same sort for it to attach itself to, repression at this time would have been impossible. But there was a successfully deeply buried sexual complex already existing in the subconscious which coalesced more or less with the more recent, and even more distressing, experience, and helped to keep it under. That these two experiences had coalesced in the subconscious is made probable by the fused fashion in which they first partially presented themselves to consciousness at the beginning of the analysis. With her mother's help, then, and with the complex already there waiting to welcome a similar companion, a further repression actually was achieved. But the price paid was rather high. When, about two

years afterwards, a girl happened to speak lightly, as schoolgirls will, of a sexual topic, she was so abnormally sensitive to any mention of anything sexual she became sick, and on that account left school for good.

Furthermore, it started her on a still hunt after her father. It is highly probable that her suspicions as to his faithfulness, too, were untrue, being based on insufficient evidence. True or not, however, she believed her father bad in a sexual sense, and hated him accordingly. And in addition to all this she could not feel for her mother, much as she loved her and was dominated by her, that respect necessary for satisfactory family relations.

In one very important respect, both her father and mother were unable to control her. In her desire to go with Dick, a questionable character, she absolutely defied them.

One could imagine that her convulsions, which started a few months after Dick's death, were the immediate result of dreaming about him, with a pathological power possible through releasing the pent up energy, so to speak, of the repressed sexual complexes. One could conceive the mechanism of this as being both physiological and psychological inasmuch as the lower centers might be conceived as disassociated, and so released from this inhibiting power of the higher centers, and psychologically as being due to sub-conscious, dream-like desires, which acted like a match to gun-powder. That was the view taken, and the progress of the patient seemed to justify it. The recovery, however, was only apparent, except for the worst symptoms, the contracture and the convulsions which have never returned, but, as we shall see, there were other repressions which remained to be released, and which manifested themselves in symptoms, the clearing up of which will be reported in the next paper.

(To be continued.)

PSYCHOGENIC DISORDERS IN CHILDHOOD1

BY TOM A. WILLIAMS, M.B., C.M. (EDIN., WASHINGTON, D.C.) Corresponding Member, Society of Neurology and Society of Psychology of Paris, etc.

I

T is remarkable that amidst the abundant psychological study of the development of children so little attention has been paid to those factors of abnormal reactions which are psychogenetic. The invocation of heredity, period of growth, reflex irritation, etc., has been too ready. The "nervousness" postulated has been called hysteria, chorea, neurasthenia, and what not, without real search for its origin; for the generalities indulged in are, when analyzed, explanations of no meaning, showing only the vagueness of the observers' conceptions regarding pathogenesis. Even the photographic minuteness of a Janet failed to take account of the psychopathology of a child; for he went the length of declaring that the synthesis he called psychasthenia could hardly occur below the age of eight, and was rare in children at all.

Even now that serious analysis of adult cases is finding that the origin of psychoneuroses can often be traced into childhood, it is remarkable how few observations of neurotic children themselves have been made. It is in order to contribute to the filling of this gap in psychopathological data that this contribution is made.

It is the more especially pertinent in that in the cases observed I have not discovered the etiological factor of the type so often referred to as essential by many psychoanalysts. The affective situations which have promoted the psychological perturbation of my patients do not appear to have been connected with the psycho-sexual relations, but, on the contrary, to have been the creation of experiences discolored by association with an unwise timorousness injected by parents into the child's allopsychic life.

I have classified the cases into hysterical and psychas

1 Read before the Third Annual Meeting of the American Psychopathological Association at Boston, May, 1912.

thenic in accordance with the principles laid down, following Janet, in a former article.1

In practice, this classification is useful; but I am not sure that these types essentially differ as regards genesis; although, to use a mode of expression fashionable nowadays, in "make-up" the two types are antipodal.

TICS AND PHOBIAS OF PSYCHASTHENIC FORM IN A
GIRL OF EIGHT

A girl aged eight, an only child, was sent to a Washington sanitarium because of numerous grimaces and gestures. These led her attendants to believe she suffered from chorea, to give her large doses of arsenic, and to isolate her from her friends, while overfeeding her. At the end of a month she returned to the country, the morbid movements having ceased, but suffering from insomnia and unable to go to school, in the belief of the parents, because of her "nervousness," which was especially conspicuous when reading and studying were required. When she was nine I was asked to see her by her uncle, Dr. Perrie of Lyons Creek, Md., in the hope that something further could be done.

I found a well-nourished, self-contained, sensible child, without apparent shyness, over-forwardness, or hyper-excitability. But she was apt to talk rather fast and stammered now and then. I soon discovered that she was fond of play and the companionship of which she had been deprived, to compensate for which she made believe that the objects and person of her play were real. So rigorously was she protected that the conceptions of lying and stealing were hardly clear to her. She had been very strictly managed and scolded and repressed a good deal. She was once whipped for persistent dawdling on her way home from school. She did not remember other corporal punishments. Her life, however, was not felt to be unhappy, for she was very obedient, and was not galled by the good manners expected of her. However, she wanted to grow up, hated people to call her little, and she disliked the spoiling which was a tendency of her father before her sickness. Although she did not repine at staying from school, she wished to learn to read and 1 JOURNAL OF ABNORMAL PSYCHOLOGY, 1909, Types Among Psychoneuroses.