Reviews – The expression of emotions in disease

The preponderating importance of emotion, using the term in its psychological meaning of feeling or affection as contrasted with sensation, and including within it all affective states, in the composition of character and the multitudinous expressions of human personality in conduct, has long been recognized in normal psychology, but the dominating influence of affective states in the clinical pictures presented by the insane is not so generally admitted. Doubtless the confused state of our knowledge and the opposing tenets of many widely-quoted authorities as to the nature of affectivity have helped to obscure the truth, so greatly in fact that, to take only one example, according to the strict letter of the law of England, knowledge of the nature and quality of an act is still the sole criterion of responsibility. That there should be this obscurity, however, springs, in the very nature of things, from the recondite quality of the emotions. The sweep of the intelligence, the richness of memorial images and their power of voluntary recall, and the range, intensity, and duration of sensorial impressions, are all more or less within the limits of calculation and, in some directions, of mathematical statement; but affective reactions are so multitudinous, so elusive, so susceptible of concealment, and, as Wundt has shown, so inaccessible to observation, that their scientific investigation and classification from objective data is a matter of the greatest difficulty. In normal psychology the old intellectualistic views by which the feelings were regarded as “confused intelligence” still persist in opposition to the physiological or biological doctrines of James, Lange, Maudsley, Mercier, Ribot, and others. Now, it is precisely on such controversial questions as these that careful observation of the expressions of the emotions in morbid disintegrations or alterations of the personality in the insane, hysterical, and neurasthenic is likely to shed much light. In this field, Janet, Freud, Loewenfeld, and others have done distinguished work, and to these names must be added that of Professor Bleuler of Zurich, whose small book on affectivity, suggestibility, and paranoia¹ has lately appeared….

Turning to the question of the fundamental mechanism in paranoia Professor Bleuler is, on the other hand, opposed to those who refer the various delusions of persecution or of grandeur, the striking egotism or ego-centric character, and the pathognomonic morbid suspicion of paranoiacs to an abnormal affective constitution, but he regards them as intellectually determined, differing from the mistakes of the sane only by reason of their incorrigibility. This incorrigibility, however, is the very crux criticorum; and though Professor Bleuler states that the ego-centric character, for example, is due to “the circumstance that in the foreground of his mind there is continually present an affectively-accentuated idea complex,” the reason of this is still to seek at any rate according to Professor Bleuler's theory, and is to be found, we suspect, in most cases in the affective character. We say in most cases because it may very well be that, as Professor Bleuler hints, cases essentially different are at present included within the category of paranoia. Doubtless the various factors which he instances as likely to induce the incorrigible frame of mind, anatomical, chemical, or “functional” conditions, or the fact of a “Riss im Leben” play their part; but this is, we believe, because they find in the affective character their point of application. The whole question is encompassed with difficulties, but Professor Bleuler's masterly exposition of an exceedingly intricate subject will commend itself to all readers