110 PRESIDENTIAL ADDRESS — SECTION F. 



" organic " symptoms. As a matter of fact, many symptoms 

 are recognisable as morbid exaggerations of slight peculiarities and 

 moods, such as most of us possess. For example, a wild 

 maniacal excitement may be considered as a pathological and 

 distorted exaggeration of irresponsible cheerfulness, and all inter- 

 mediate stages between these two can be observed in different 

 patients. There are also all kinds of transition between the 

 different disorders comprising this group. The principal represen- 

 tative is the condition known as " maniac-depressive insanity," 

 which is characterised by psychotic explosions either of an 

 abnormally elated or of an undue depressive nature, or both 

 (either in succession or mixed). Furthermore, we distinguish 

 paranoia and the graver forms of hysteria and other psycho- 

 neuroses. For my purpose of to-day, it is convenient to deal 

 with all these conditions together. 



The history of the development of these disorders varies in 

 different patients : sometimes there does not seem to be any 

 apparent outer cause at all, except the ordinary evex-yday vicissi- 

 tudes of life, and the psychosis just develops ; or there is a combin- 

 ation of factors at work which each by themselves would not 

 seem strong or important enough ; or there is one particular 

 psychic cause which can be held responsible, be it in the nature 

 of a shock, stress, or a conflict. But there is always the unmis- 

 takable personal element of the patient, a fault or an imperfec- 

 tion of his mental make-up. Hence the name germ-psychosis, 

 which implies that the possibilit}' or germ of the psychosis lies 

 dormant in the personality of the patient ; and we know that if a 

 stronger, better-balanced mind had had to face the same circum- 

 stances, or had experienced the same conflict, he would have 

 been able to cope with it and no psychosis would have been 

 the result. Since Freud started his teaching we have heard a 

 great deal about conflicts and psychic traumats, occurring in the 

 realms of the three main kinds of human instincts, namely, the 

 one for self-preservation, the one for race-preservation, and the 

 herd-instinct. Of these three, the middle one, that of sex, in its 

 widest sense, is surely not the least important. 



Science is indebted for much that is true and useful in the 

 psycho-analytical doctrines. More especially have they taught 

 us tro realise the necessity of approaching and treating psychic 

 disturbances in a much more individualising manner than we did 

 before, and to take into the fullest account the entire previous 

 history of each patient. They have also shown the great harm 

 which sometimes may be done if mental conflicts are not met 

 squarely but are evaded and allowed to remain hidden in our 

 minds and unsolved. On the other hand, numerous authors agree 

 that the role of sex-complexes in the causation of neuroses and 

 psychoses has been grossly overrated by Freud and specially by 

 many of his followers. The experience gained during the late war 

 has also shown that these conflicts may be of a very varying 

 nature, and that if stress and trouble, in the widest sense, become 

 sufficiently severe and prolonged, the very strongest minds may 

 ultimatelv break down. 



