A CRITICISM OF BLEULER'S "THEORY OF SCHIZOPHRENIC NEGATIVISM"[169]

Bleuler's work contains a noteworthy clinical analysis of "Negativism." Besides giving a very precise and discerning summary of the various manifestations of negativism, the author presents us with a new psychological conception well worthy of attention, viz. the concept of ambivalency and of ambitendency, thus formulating the psychological axiom that every tendency is balanced by its opposite tendency (to this must be added that positive action is produced by a comparatively small leaning to one side of the scale). Similarly all other tendencies, under the stress of emotions, are balanced by their opposites—thus giving an ambivalent character to their expression. This theory rests on clinical observation of katatonic negativism, which more than proves the existence of contrasting tendencies and values. These facts are well known to psychoanalysis, where they are summed up under the concept of resistance. But this must not be taken as meaning that every positive psychic action simply calls up its opposite. One may easily gain the impression from Bleuler's work that his standpoint is that, cum grano salis, the conception or the tendency of the Schizophrenic is always accompanied by its opposite. For instance, Bleuler says:—

1. "Disposing causes of negativistic phenomena are: the ambitendency by which every impulse is accompanied by its opposite."

2. "Ambivalency, which gives two opposed emotional expressions to the same idea, and would regard that idea as positive and negative at the same time."

3. "The schizophrenic splitting of the psyche prevents any final summing up of the conflicting and corresponding psychisms, so that the unsuitable impulse can be realised just as much as the right one, and the negative thought substituted for the right one." "On this theory, negative manifestations may directly arise, since non-selected positive and negative psychisms may stand for one another," and so on.

If we investigate psychoanalytically a case of obvious ambivalency, i.e. of a more or less unexpected negative reaction instead of a positive one, we find that there is a strict sequence of psychological causes conditioning negative reaction. The tendency of this sequence is to disturb the intention of the contrasting or opposite series, that is to say, it is resistance set up by a complex. This fact, which has not yet been refuted by any other observations, seems to me to contradict the above-mentioned formulÆ. (For confirmation, see my "Psychology of Dementia PrÆcox," p. 103.) Psychoanalysis has proved conclusively that a resistance always has an intention and a meaning; that there is no such thing as a capricious playing with contrasts. The systematic character of resistance holds good, as I believe I have proved, even in schizophrenia. So long as this position, founded upon a great variety of experience, is not disproved by any other observations, the theory of negativism must adapt itself to it. Bleuler in a sense supports this when he says: "For the most part the negative reaction does not simply appear as accidental, but is actually preferred to the right one." This is an admission that negativism is of the nature of resistance. Once admit this, and the primary importance of ambivalency disappears so far as negativism is concerned. The tendency to resistance remains as the only fundamental principle. Ambivalency can in no sense be put on all fours with the "schizophrenic splitting of the psyche," but must be regarded as a concept which gives expression to the universal and ever-present inner association of pairs of opposites. (One of the most remarkable examples of this is the "contrary meaning of root-words." See Freud's "Essay on Dreams," Jahrbuch, vol. II., p. 179.) The same thing applies to ambitendency. Neither is specific of schizophrenia, but applies equally to the neuroses and the normal. All that is specific to katatonic negativism is the intentional contrast, i.e. the resistance. From this explanation we see that resistance is something different from ambivalency; it is the dynamic factor which makes manifest the everywhere latent ambivalency. What is characteristic of the diseased mind is not ambivalency but resistance. This implies the existence of a conflict between two opposite tendencies which has succeeded in raising the normally present ambivalency into a struggle of opposing components. (Freud has very aptly called this, "The separation of pairs of opposites.") In other words it is a conflict of wills, bringing about the neurotic condition of "disharmony within the self." This condition is the only "splitting of the psyche" known to us, and is not so much to be regarded as a predisposing cause, but rather as a manifestation resulting from the inner conflict—the "incompatibility of the complex" (Riklin).

Resistance, as the fundamental fact of schizophrenic dissociation, thus becomes something which, in contra-distinction to ambivalency, is not eo ipso identical with the concept of the state of feeling, but is a secondary and supplementary one, with its own special and quasi independent psychological development; and this is identical with the necessary previous history of the complex in every case. It follows that the theory of negativism coincides with the theory of the complex, as the complex is the cause of the resistance.

Bleuler summarises the causes of negativism as follows:

(a) The autistic retirement of the patient into his own phantasies.

(b) The existence of a life-wound (complex) which must be protected from injury.

(c) The misconception of the environment and of its meaning.

(d) The directly hostile relation to environment.

(e) The pathological irritability of schizophrenics.

(f) The "press of ideas," and other aggravations of action and thought.

(g) Sexuality with its ambivalency on the emotional plane is often one of the roots of negative reaction.

(a) Autistic withdrawal into one's own phantasies[170] is what I formerly designated as the obvious overgrowth of the phantasies of the complex. The strengthening of the complex is coincident with the increase of the resistance.

(b) The life-wound (Lebenswund) is the complex which, as a matter of course, is present in every case of schizophrenia, and of necessity always carries with it the phenomena of autism or auto-erotism (introversion), for complexes and involuntary egocentricity are inseparable reciprocities. Points (a) and (b) are therefore identical. (Cf. "Psychology of Dementia PrÆcox," chapters ii. and iii.)

(c) It is proved that the misconception of environment is an assimilation of the complex.

(d) The hostile relation to environment is the maximum of resistance as psychoanalysis clearly shows. (d) goes with (a).

(e) "Irritability" proves itself psychoanalytically to be one of the commonest results of the complex. I designated it complex-sensibility. Its generalised form (if one may use such an expression) manifests itself as a damming up of the affect (= damming of the libido), consequent on increased resistance. So-called neurasthenia is a classical example of this.

(f) Under the term "press of ideas," and similar intellectual troubles, may be classified the "want of clearness and logic of the schizophrenic thinking," which Bleuler considers a predisposing cause. I have, as I may presume is known, expressed myself with much reserve on what he regards as the premeditation of the schizophrenic adjustment. Further and wider experience has taught me that the laws of the Freudian psychology of dreams and the theory of the neuroses must be turned towards the obscurities of schizophrenic thinking. The painfulness of the elaborated complex necessitates a censorship of its expression.[171] This principle has to be applied to schizophrenic disturbance in thinking; and until it has been proved that this principle is not applicable to schizophrenia, there is no justification for setting up a new principle; i.e. to postulate that schizophrenic disturbance of ideas is something primary. Investigations of hypnagogic activity, as well as association reactions in states of concentrated attention, give psychical results which up to now are indistinguishable from the mental conditions in schizophrenia. For example excessive relaxation of attention suffices to conjure up images as like as two peas to the phantasies and expressions of schizophrenia. It will be remembered that I have attributed the notorious disturbances of attention in schizophrenia to the special character of the complex; an idea which my experience since 1906 have further confirmed. There are good reasons for believing specific schizophrenic thought-disturbance to be the result of a complex.

Now as regards the symptoms of thought-pressure, it is first and foremost a thought-compulsion, which, as Freud has shown, is first a thought-complex and secondly a sexualisation of the thought. Then to the symptom of thought-pressure there is superadded at least a demoniac impulse such as may be observed in every vigorous release or production of libido.

Thought-pressure, on closer examination, is seen to be a result of schizophrenic introversion, which necessarily leads to a sexualisation of the thought; i.e. to an autonomy of the complex.[172]

(g) The transition to sexuality appears from the psychoanalytical standpoint difficult to understand. If we consider that the development of resistance coincides in every case with the history of the complex we must ask ourselves: Is the complex sexual or not? (It goes without saying thatwe must understand sexuality in its proper sense of psycho-sexuality.) To this question psychoanalysis gives the invariable answer: Resistance always springs from a peculiar sexual development. The latter leads in the well-known manner to conflict, i.e. to the complex. Every case of schizophrenia which has so far been analysed confirms this. It can therefore claim at least to be a working hypothesis, and one to be followed up. In the present state of our knowledge, it is therefore not easy to see why Bleuler only allows to sexuality a quasi-determining influence on the phenomena of negativism; for psychoanalysis demonstrates that the cause of negativism is resistance; and that with schizophrenia, as with all other neuroses, this arises from the peculiar sexual development.

It can scarcely be doubted to-day that schizophrenia, with its preponderance of the mechanisms of introversion, possesses the same mechanism as any other "psycho-neurosis." In my opinion, at any rate, its peculiar symptoms (apart from the clinical and anatomical standpoints) are only to be studied by psychoanalysis, i.e. when the investigation is mainly directed to the genetic impetus. I have, therefore, endeavoured to indicate how Bleuler's hypothesis stands in the light of the theory of complexes; I feel myself bound to emphasise the complex-theory in this relation, and am not disposed to surrender this conception, which is as illuminating as it was difficult to evolve.