Dream Psychology/Chapter 4
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Chapter 4. Dream Analysis
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Perhaps we shall now begin to suspect that dream interpretation is capable of giving us hints about the structure of our psychic apparatus which we have thus far expected in vain from philosophy. We shall not, however, follow this track, but return to our original problem as soon as we have cleared up the subject of dream-disfigurement. The question has arisen how dreams with disagreeable content can be analyzed as the fulfillment of wishes. We see now that this is possible in case dream-disfigurement has taken place, in case the disagreeable content serves only as a disguise for what is wished. Keeping in mind our assumptions in regard to the two psychic instances, we may now proceed to say: disagreeable dreams, as a matter of fact, contain something which is disagreeable to the second instance, but which at the same time fulfills a wish of the first instance. They are wish dreams in the sense that every dream originates in the first instance, while the second instance acts towards the dream only in repelling, not in a creative manner. If we limit ourselves to a consideration of what the second instance contributes to the dream, we can never understand the dream. If we do so, all the riddles which the authors have found in the dream remain unsolved.
That the dream actually has a secret meaning, which turns out to be the fulfillment of a wish, must be proved afresh for every case by means of an analysis. I therefore select several dreams which have painful contents and attempt an analysis of them. They are partly dreams of hysterical subjects, which require long preliminary statements, and now and then also an examination of the psychic processes which occur in hysteria. I cannot, however, avoid this added difficulty in the exposition.
When I give a psychoneurotic patient analytical treatment, dreams are always, as I have said, the subject of our discussion. It must, therefore, give him all the psychological explanations through whose aid I myself have come to an understanding of his symptoms, and here I undergo an unsparing criticism, which is perhaps not less keen than that I must expect from my colleagues. Contradiction of the thesis that all dreams are the fulfillments of wishes is raised by my patients with perfect regularity. Here are several examples of the dream material which is offered me to refute this position.
"You always tell me that the dream is a wish fulfilled," begins a clever lady patient. "Now I shall tell you a dream in which the content is quite the opposite, in which a wish of mine is not fulfilled. How do you reconcile that with your theory? The dream is as follows:—
"I want to give a supper, but having nothing at hand except some smoked salmon, I think of going marketing, but I remember that it is Sunday afternoon, when all the shops are closed. I next try to telephone to some caterers, but the telephone is out of order.... Thus I must resign my wish to give a supper."
I answer, of course, that only the analysis can decide the meaning of this dream, although I admit that at first sight it seems sensible and coherent, and looks like the opposite of a wish-fulfillment. "But what occurrence has given rise to this dream?" I ask. "You know that the stimulus for a dream always lies among the experiences of the preceding day."
Analysis.—The husband of the patient, an upright and conscientious wholesale butcher, had told her the day before that he is growing too fat, and that he must, therefore, begin treatment for obesity. He was going to get up early, take exercise, keep to a strict diet, and above all accept no more invitations to suppers. She proceeds laughingly to relate how her husband at an inn table had made the acquaintance of an artist, who insisted upon painting his portrait because he, the painter, had never found such an expressive head. But her husband had answered in his rough way, that he was very thankful for the honor, but that he was quite convinced that a portion of the backside of a pretty young girl would please the artist better than his whole face [4a]. She said that she was at the time very much in love with her husband, and teased him a good deal. She had also asked him not to send her any caviare. What does that mean?
As a matter of fact, she had wanted for a long time to eat a caviare sandwich every forenoon, but had grudged herself the expense. Of course, she would at once get the caviare from her husband, as soon as she asked him for it. But she had begged him, on the contrary, not to send her the caviare, in order that she might tease him about it longer.
This explanation seems far-fetched to me. Unadmitted motives are in the habit of hiding behind such unsatisfactory explanations. We are reminded of subjects hypnotized by Bernheim, who carried out a posthypnotic order, and who, upon being asked for their motives, instead of answering: "I do not know why I did that," had to invent a reason that was obviously inadequate. Something similar is probably the case with the caviare of my patient. I see that she is compelled to create an unfulfilled wish in life. Her dream also shows the reproduction of the wish as accomplished. But why does she need an unfulfilled wish?
The ideas so far produced are insufficient for the interpretation of the dream. I beg for more. After a short pause, which corresponds to the overcoming of a resistance, she reports further that the day before she had made a visit to a friend, of whom she is really jealous, because her husband is always praising this woman so much. Fortunately, this friend is very lean and thin, and her husband likes well-rounded figures. Now of what did this lean friend speak? Naturally of her wish to become somewhat stouter. She also asked my patient: "When are you going to invite us again? You always have such a good table."
Now the meaning of the dream is clear. I may say to the patient: "It is just as though you had thought at the time of the request: 'Of course, I'll invite you, so you can eat yourself fat at my house and become still more pleasing to my husband. I would rather give no more suppers.' The dream then tells you that you cannot give a supper, thereby fulfilling your wish not to contribute anything to the rounding out of your friend's figure. The resolution of your husband to refuse invitations to supper for the sake of getting thin teaches you that one grows fat on the things served in company." Now only some conversation is necessary to confirm the solution. The smoked salmon in the dream has not yet been traced. "How did the salmon mentioned in the dream occur to you?" "Smoked salmon is the favorite dish of this friend," she answered. I happen to know the lady, and may corroborate this by saying that she grudges herself the salmon just as much as my patient grudges herself the caviare.
The dream admits of still another and more exact interpretation, which is necessitated only by a subordinate circumstance. The two interpretations do not contradict one another, but rather cover each other and furnish a neat example of the usual ambiguity of dreams as well as of all other psychopathological formations. We have seen that at the same time that she dreams of the denial of the wish, the patient is in reality occupied in securing an unfulfilled wish (the caviare sandwiches). Her friend, too, had expressed a wish, namely, to get fatter, and it would not surprise us if our lady had dreamt that the wish of the friend was not being fulfilled. For it is her own wish that a wish of her friend's—for increase in weight—should not be fulfilled. Instead of this, however, she dreams that one of her own wishes is not fulfilled. The dream becomes capable of a new interpretation, if in the dream she does not intend herself, but her friend, if she has put herself in the place of her friend, or, as we may say, has identified herself with her friend.
I think she has actually done this, and as a sign of this identification she has created an unfulfilled wish in reality. But what is the meaning of this hysterical identification? To clear this up a thorough exposition is necessary. Identification is a highly important factor in the mechanism of hysterical symptoms; by this means patients are enabled in their symptoms to represent not merely their own experiences, but the experiences of a great number of other persons, and can suffer, as it were, for a whole mass of people, and fill all the parts of a drama by means of their own personalities alone. It will here be objected that this is well-known hysterical imitation, the ability of hysteric subjects to copy all the symptoms which impress them when they occur in others, as though their pity were stimulated to the point of reproduction. But this only indicates the way in which the psychic process is discharged in hysterical imitation; the way in which a psychic act proceeds and the act itself are two different things. The latter is slightly more complicated than one is apt to imagine the imitation of hysterical subjects to be: it corresponds to an unconscious concluded process, as an example will show. The physician who has a female patient with a particular kind of twitching, lodged in the company of other patients in the same room of the hospital, is not surprised when some morning he learns that this peculiar hysterical attack has found imitations. He simply says to himself: The others have seen her and have done likewise: that is psychic infection. Yes, but psychic infection proceeds in somewhat the following manner: As a rule, patients know more about one another than the physician knows about each of them, and they are concerned about each other when the visit of the doctor is over. Some of them have an attack to-day: soon it is known among the rest that a letter from home, a return of lovesickness or the like, is the cause of it. Their sympathy is aroused, and the following syllogism, which does not reach consciousness, is completed in them: "If it is possible to have this kind of an attack from such causes, I too may have this kind of an attack, for I have the same reasons." If this were a cycle capable of becoming conscious, it would perhaps express itself in fear of getting the same attack; but it takes place in another psychic sphere, and, therefore, ends in the realization of the dreaded symptom. Identification is therefore not a simple imitation, but a sympathy based upon the same etiological claim; it expresses an "as though," and refers to some common quality which has remained in the unconscious.
Identification is most often used in hysteria to express sexual community. An hysterical woman identifies herself most readily—although not exclusively—with persons with whom she has had sexual relations, or who have sexual intercourse with the same persons as herself. Language takes such a conception into consideration: two lovers are "one." In the hysterical phantasy, as well as in the dream, it is sufficient for the identification if one thinks of sexual relations, whether or not they become real. The patient, then, only follows the rules of the hysterical thought processes when she gives expression to her jealousy of her friend (which, moreover, she herself admits to be unjustified, in that she puts herself in her place and identifies herself with her by creating a symptom—the denied wish). I might further clarify the process specifically as follows: She puts herself in the place of her friend in the dream, because her friend has taken her own place relation to her husband, and because she would like to take her friend's place in the esteem of her husband [4b].
The contradiction to my theory of dreams in the case of another female patient, the most witty among all my dreamers, was solved in a simpler manner, although according to the scheme that the non-fulfillment of one wish signifies the fulfillment of another. I had one day explained to her that the dream is a wish of fulfillment. The next day she brought me a dream to the effect that she was traveling with her mother-in-law to their common summer resort. Now I knew that she had struggled violently against spending the summer in the neighborhood of her mother-in-law. I also knew that she had luckily avoided her mother-in-law by renting an estate in a far-distant country resort. Now the dream reversed this wished-for solution; was not this in the flattest contradiction to my theory of wish-fulfillment in the dream? Certainly, it was only necessary to draw the inferences from this dream in order to get at its interpretation. According to this dream, I was in the wrong. It was thus her wish that I should be in the wrong, and this wish the dream showed her as fulfilled. But the wish that I should be in the wrong, which was fulfilled in the theme of the country home, referred to a more serious matter. At that time I had made up my mind, from the material furnished by her analysis, that something of significance for her illness must have occurred at a certain time in her life. She had denied it because it was not present in her memory. We soon came to see that I was in the right. Her wish that I should be in the wrong, which is transformed into the dream, thus corresponded to the justifiable wish that those things, which at the time had only been suspected, had never occurred at all.
Without an analysis, and merely by means of an assumption, I took the liberty of interpreting a little occurrence in the case of a friend, who had been my colleague through the eight classes of the Gymnasium. He once heard a lecture of mine delivered to a small assemblage, on the novel subject of the dream as the fulfillment of a wish. He went home, dreamt that he had lost all his suits—he was a lawyer—and then complained to me about it. I took refuge in the evasion: "One can't win all one's suits," but I thought to myself: "If for eight years I sat as Primus on the first bench, while he moved around somewhere in the middle of the class, may he not naturally have had a wish from his boyhood days that I, too, might for once completely disgrace myself?"
In the same way another dream of a more gloomy character was offered me by a female patient as a contradiction to my theory of the wish-dream. The patient, a young girl, began as follows: "You remember that my sister has now only one boy, Charles: she lost the elder one, Otto, while I was still at her house. Otto was my favorite; it was I who really brought him up. I like the other little fellow, too, but of course not nearly as much as the dead one. Now I dreamt last night that I saw Charles lying dead before me. He was lying in his little coffin, his hands folded: there were candles all about, and, in short, it was just like the time of little Otto's death, which shocked me so profoundly. Now tell me, what does this mean? You know me: am I really bad enough to wish my sister to lose the only child she has left? Or does the dream mean that I wish Charles to be dead rather than Otto, whom I like so much better?"
I assured her that this interpretation was impossible. After some reflection I was able to give her the interpretation of the dream, which I subsequently made her confirm.
Having become an orphan at an early age, the girl had been brought up in the house of a much older sister, and had met among the friends and visitors who came to the house, a man who made a lasting impression upon her heart. It looked for a time as though these barely expressed relations were to end in marriage, but this happy culmination was frustrated by the sister, whose motives have never found a complete explanation. After the break, the man who was loved by our patient avoided the house: she herself became independent some time after little Otto's death, to whom her affection had now turned. But she did not succeed in freeing herself from the inclination for her sister's friend in which she had become involved. Her pride commanded her to avoid him; but it was impossible for her to transfer her love to the other suitors who presented themselves in order. Whenever the man whom she loved, who was a member of the literary profession, announced a lecture anywhere, she was sure to be found in the audience; she also seized every other opportunity to see him from a distance unobserved by him. I remembered that on the day before she had told me that the Professor was going to a certain concert, and that she was also going there, in order to enjoy the sight of him. This was on the day of the dream; and the concert was to take place on the day on which she told me the dream. I could now easily see the correct interpretation, and I asked her whether she could think of any event which had happened after the death of little Otto. She answered immediately: "Certainly; at that time the Professor returned after a long absence, and I saw him once more beside the coffin of little Otto." It was exactly as I had expected. I interpreted the dream in the following manner: "If now the other boy were to die, the same thing would be repeated. You would spend the day with your sister, the Professor would surely come in order to offer condolence, and you would see him again under the same circumstances as at that time. The dream signifies nothing but this wish of yours to see him again, against which you are fighting inwardly. I know that you are carrying the ticket for to-day's concert in your bag. Your dream is a dream of impatience; it has anticipated the meeting which is to take place to-day by several hours."
In order to disguise her wish she had obviously selected a situation in which wishes of that sort are commonly suppressed—a situation which is so filled with sorrow that love is not thought of. And yet, it is very easily probable that even in the actual situation at the bier of the second, more dearly loved boy, which the dream copied faithfully, she had not been able to suppress her feelings of affection for the visitor whom she had missed for so long a time.
A different explanation was found in the case of a similar dream of another female patient, who was distinguished in her earlier years by her quick wit and her cheerful demeanors and who still showed these qualities at least in the notion, which occurred to her in the course of treatment. In connection with a longer dream, it seemed to this lady that she saw her fifteen-year-old daughter lying dead before her in a box. She was strongly inclined to convert this dream-image into an objection to the theory of wish-fulfillment, but herself suspected that the detail of the box must lead to a different conception of the dream. [4c] In the course of the analysis it occurred to her that on the evening before, the conversation of the company had turned upon the English word "box," and upon the numerous translations of it into German, such as box, theater box, chest, box on the ear, &c. From other components of the same dream it is now possible to add that the lady had guessed the relationship between the English word "box" and the German BÃ¼chse, and had then been haunted by the memory that BÃ¼chse (as well as "box") is used in vulgar speech to designate the female genital organ. It was therefore possible, making a certain allowance for her notions on the subject of topographical anatomy, to assume that the child in the box signified a child in the womb of the mother. At this stage of the explanation she no longer denied that the picture of the dream really corresponded to one of her wishes. Like so many other young women, she was by no means happy when she became pregnant, and admitted to me more than once the wish that her child might die before its birth; in a fit of anger following a violent scene with her husband she had even struck her abdomen with her fists in order to hit the child within. The dead child was, therefore, really the fulfillment of a wish, but a wish which had been put aside for fifteen years, and it is not surprising that the fulfillment of the wish was no longer recognized after so long an interval. For there had been many changes meanwhile.
The group of dreams to which the two last mentioned belong, having as content the death of beloved relatives, will be considered again under the head of "Typical Dreams." I shall there be able to show by new examples that in spite of their undesirable content, all these dreams must be interpreted as wish-fulfillments. For the following dream, which again was told me in order to deter me from a hasty generalization of the theory of wishing in dreams, I am indebted, not to a patient, but to an intelligent jurist of my acquaintance. "I dream," my informant tells me, "that I am walking in front of my house with a lady on my arm. Here a closed wagon is waiting, a gentleman steps up to me, gives his authority as an agent of the police, and demands that I should follow him. I only ask for time in which to arrange my affairs. Can you possibly suppose this is a wish of mine to be arrested?" "Of course not," I must admit. "Do you happen to know upon what charge you were arrested?" "Yes; I believe for infanticide." "Infanticide? But you know that only a mother can commit this crime upon her newly born child?" "That is true." [4d] "And under what circumstances did you dream; what happened on the evening before?" "I would rather not tell you that; it is a delicate matter." "But I must have it, otherwise we must forgo the interpretation of the dream." "Well, then, I will tell you. I spent the night, not at home, but at the house of a lady who means very much to me. When we awoke in the morning, something again passed between us. Then I went to sleep again, and dreamt what I have told you." "The woman is married?" "Yes." "And you do not wish her to conceive a child?" "No; that might betray us." "Then you do not practice normal coitus?" "I take the precaution to withdraw before ejaculation." "Am I permitted to assume that you did this trick several times during the night, and that in the morning you were not quite sure whether you had succeeded?" "That might be the case." "Then your dream is the fulfillment of a wish. By means of it you secure the assurance that you have not begotten a child, or, what amounts to the same thing, that you have killed a child. I can easily demonstrate the connecting links. Do you remember, a few days ago we were talking about the distress of matrimony (Ehenot), and about the inconsistency of permitting the practice of coitus as long as no impregnation takes place, while every delinquency after the ovum and the semen meet and a fœtus is formed is punished as a crime? In connection with this, we also recalled the mediÃ¦val controversy about the moment of time at which the soul is really lodged in the fœtus, since the concept of murder becomes admissible only from that point on. Doubtless you also know the gruesome poem by Lenau, which puts infanticide and the prevention of children on the same plane." "Strangely enough, I had happened to think of Lenau during the afternoon." "Another echo of your dream. And now I shall demonstrate to you another subordinate wish-fulfillment in your dream. You walk in front of your house with the lady on your arm. So you take her home, instead of spending the night at her house, as you do in actuality. The fact that the wish-fulfillment, which is the essence of the dream, disguises itself in such an unpleasant form, has perhaps more than one reason. From my essay on the etiology of anxiety neuroses, you will see that I note interrupted coitus as one of the factors which cause the development of neurotic fear. It would be consistent with this that if after repeated cohabitation of the kind mentioned you should be left in an uncomfortable mood, which now becomes an element in the composition of your dream. You also make use of this unpleasant state of mind to conceal the wish-fulfillment. Furthermore, the mention of infanticide has not yet been explained. Why does this crime, which is peculiar to females, occur to you?" "I shall confess to you that I was involved in such an affair years ago. Through my fault a girl tried to protect herself from the consequences of a liaison with me by securing an abortion. I had nothing to do with carrying out the plan, but I was naturally for a long time worried lest the affair might be discovered." "I understand; this recollection furnished a second reason why the supposition that you had done your trick badly must have been painful to you."
A young physician, who had heard this dream of my colleague when it was told, must have felt implicated by it, for he hastened to imitate it in a dream of his own, applying its mode of thinking to another subject. The day before he had handed in a declaration of his income, which was perfectly honest, because he had little to declare. He dreamt that an acquaintance of his came from a meeting of the tax commission and informed him that all the other declarations of income had passed uncontested, but that his own had awakened general suspicion, and that he would be punished with a heavy fine. The dream is a poorly-concealed fulfillment of the wish to be known as a physician with a large income. It likewise recalls the story of the young girl who was advised against accepting her suitor because he was a man of quick temper who would surely treat her to blows after they were married.
The answer of the girl was: "I wish he would strike me!" Her wish to be married is so strong that she takes into the bargain the discomfort which is said to be connected with matrimony, and which is predicted for her, and even raises it to a wish.
If I group the very frequently occurring dreams of this sort, which seem flatly to contradict my theory, in that they contain the denial of a wish or some occurrence decidedly unwished for, under the head of "counter wish-dreams," I observe that they may all be referred to two principles, of which one has not yet been mentioned, although it plays a large part in the dreams of human beings. One of the motives inspiring these dreams is the wish that I should appear in the wrong. These dreams regularly occur in the course of my treatment if the patient shows a resistance against me, and I can count with a large degree of certainty upon causing such a dream after I have once explained to the patient my theory that the dream is a wish-fulfillment. [4e] I may even expect this to be the case in a dream merely in order to fulfill the wish that I may appear in the wrong. The last dream which I shall tell from those occurring in the course of treatment again shows this very thing. A young girl who has struggled hard to continue my treatment, against the will of her relatives and the authorities whom she had consulted, dreams as follows: She is forbidden at home to come to me any more. She then reminds me of the promise I made her to treat her for nothing if necessary, and I say to her: "I can show no consideration in money matters."
It is not at all easy in this case to demonstrate the fulfillment of a wish, but in all cases of this kind there is a second problem, the solution of which helps also to solve the first. Where does she get the words which she puts into my mouth? Of course I have never told her anything like that, but one of her brothers, the very one who has the greatest influence over her, has been kind enough to make this remark about me. It is then the purpose of the dream that this brother should remain in the right; and she does not try to justify this brother merely in the dream; it is her purpose in life and the motive for her being ill.
The other motive for counter wish-dreams is so clear that there is danger of overlooking it, as for some time happened in my own case. In the sexual make-up of many people there is a masochistic component, which has arisen through the conversion of the aggressive, sadistic component into its opposite. Such people are called "ideal" masochists, if they seek pleasure not in the bodily pain which may be inflicted upon them, but in humiliation and in chastisement of the soul. It is obvious that such persons can have counter wish-dreams and disagreeable dreams, which, however, for them are nothing but wish-fulfillment, affording satisfaction for their masochistic inclinations. Here is such a dream. A young man, who has in earlier years tormented his elder brother, towards whom he was homosexually inclined, but who had undergone a complete change of character, has the following dream, which consists of three parts: (1) He is "insulted" by his brother. (2) Two adults are caressing each other with homosexual intentions. (3) His brother has sold the enterprise whose management the young man reserved for his own future. He awakens from the last-mentioned dream with the most unpleasant feelings, and yet it is a masochistic wish-dream, which might be translated: It would serve me quite right if my brother were to make that sale against my interest, as a punishment for all the torments which he has suffered at my hands.
I hope that the above discussion and examples will suffice—until further objection can be raised—to make it seem credible that even dreams with a painful content are to be analyzed as the fulfillments of wishes. Nor will it seem a matter of chance that in the course of interpretation one always happens upon subjects of which one does not like to speak or think. The disagreeable sensation which such dreams arouse is simply identical with the antipathy which endeavors—usually with success—to restrain us from the treatment or discussion of such subjects, and which must be overcome by all of us, if, in spite of its unpleasantness, we find it necessary to take the matter in hand. But this disagreeable sensation, which occurs also in dreams, does not preclude the existence of a wish; every one has wishes which he would not like to tell to others, which he does not want to admit even to himself. We are, on other grounds, justified in connecting the disagreeable character of all these dreams with the fact of dream disfigurement, and in concluding that these dreams are distorted, and that the wish-fulfillment in them is disguised until recognition is impossible for no other reason than that a repugnance, a will to suppress, exists in relation to the subject-matter of the dream or in relation to the wish which the dream creates. Dream disfigurement, then, turns out in reality to be an act of the censor. We shall take into consideration everything which the analysis of disagreeable dreams has brought to light if we reword our formula as follows: The dream is the (disguised) fulfillment of a (suppressed, repressed) wish.
Now there still remain as a particular species of dreams with painful content, dreams of anxiety, the inclusion of which under dreams of wishing will find least acceptance with the uninitiated. But I can settle the problem of anxiety dreams in very short order; for what they may reveal is not a new aspect of the dream problem; it is a question in their case of understanding neurotic anxiety in general. The fear which we experience in the dream is only seemingly explained by the dream content. If we subject the content of the dream to analysis, we become aware that the dream fear is no more justified by the dream content than the fear in a phobia is justified by the idea upon which the phobia depends. For example, it is true that it is possible to fall out of a window, and that some care must be exercised when one is near a window, but it is inexplicable why the anxiety in the corresponding phobia is so great, and why it follows its victims to an extent so much greater than is warranted by its origin. The same explanation, then, which applies to the phobia applies also to the dream of anxiety. In both cases the anxiety is only superficially attached to the idea which accompanies it and comes from another source.
On account of the intimate relation of dream fear to neurotic fear, discussion of the former obliges me to refer to the latter. In a little essay on "The Anxiety Neurosis," [4f] I maintained that neurotic fear has its origin in the sexual life, and corresponds to a libido which has been turned away from its object and has not succeeded in being applied. From this formula, which has since proved its validity more and more clearly, we may deduce the conclusion that the content of anxiety dreams is of a sexual nature, the libido belonging to which content has been transformed into fear.
^ : To sit for the painter. Goethe: "And if he has no backside, how can the nobleman sit?"
^ : I myself regret the introduction of such passages from the psychopathology of hysteria, which, because of their fragmentary representation and of being torn from all connection with the subject, cannot have a very enlightening influence. If these passages are capable of throwing light upon the intimate relations between the dream and the psychoneuroses, they have served the purpose for which I have taken them up.
^ : Something like the smoked salmon in the dream of the deferred supper.
^ : It often happens that a dream is told incompletely, and that a recollection of the omitted portions appear only in the course of the analysis. These portions subsequently fitted in, regularly furnish the key to the interpretation. Cf. below, about forgetting in dreams.
^ : Similar "counter wish-dreams" have been repeatedly reported to me within the last few years by my pupils who thus reacted to their first encounter with the "wish theory of the dream."
^ : See Selected Papers on Hysteria and other Psychoneuroses, p. 133, translated by A.A. Brill, Journal of Nervous and Mental Diseases, Monograph Series.