A Study of Primary Somatic Factors in Compulsive and Obsessive Neuroses1

Until the introduction of modern methods of mental analysis the compulsive and obsessive neurotic lived a comparatively hopeless life of invalidism. One system of physical and suggestive therapeutics after another was tried. The neurotic by force of will, which was reinforced by each new hope, succeeded in staying or occasionally unwrapping the defense formulas of the compulsive or obsessive state. But not for long did the obsessive false thinking remain repressed or sidetracked. Sooner or later the old mental crippling returned, and the patient sought new remedies or new Lourdes. But with the advent of psychoanalysis the chronic grip of this type of neurosis was for the first time unclasped more or less permanently, —though not quite completely. It may now be rather definitely stated that no compulsive neurotic is completely cured, even less so than any other form of psychoneurosis. We are told the reason is that the basic defect is really so infantile that its roots may not be fully eradicated. This explanation is not quite sufficient nor true, for before the neurosis as such put in an appearance there were in evidence certain instinctive defects upon which the neurosis was engrafted, or, better, the neurosis was a developmental unfoldment of this somatic defect. Just what these innate constitutional defects are, has been the subject of intensive inquiry. They have been made the more patent and obvious, however, since precise psychoanalysis has unearthed the infantile plan of instinctive life. These congenital or inheritable traits of personality differ considerably from each other though the neuroses in their manifestations may be fairly comparable in their fluorescence. Although one may not say that there is a constant pattern-plan of constitutional make up for this more definite entity of a neurosis, it may be defined in general terms. We are, nevertheless,