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In the case of children gastritis diet treatment medications order prevacid 30 mg line, therefore gastritis diet eggs discount 30mg prevacid overnight delivery, the stimulus that disturbs sleep is a mental one the wish that has not been dealt with and it is to gastritis nursing diagnosis order discount prevacid on line this that they react with the dream juice diet gastritis buy generic prevacid from india. Introductory Lectures On Psycho-Analysis 3224 (5) this gives us the most direct approach to understanding the function of dreams. In so far as a dream is a reaction to a psychical stimulus, it must be equivalent to dealing with the stimulus in such a way that it is got rid of and that sleep can continue. We do not yet know how this dealing with the stimulus by the dream is made possible dynamically, but we see already that dreams are not disturbers of sleep, as they are abusively called, but guardians of sleep which get rid of disturbances of sleep. We think we should have slept more soundly if there had been no dream, but we are wrong; in fact, without the help of the dream we should not have slept at all. It could not avoid disturbing us a little, just as the night-watchman often cannot help making a little noise while he chases away the disturbers of the peace who seek to waken us with their noise. The other, equally constant one, is that a dream does not simply give expression to a thought, but represents the wish-fulfilled as a hallucinatory experience. If this turns out to be the most universal characteristic of dreams, the fragment of dream which I reported to you earlier I saw my brother in a box [Kasten] is not to be translated my brother is restricting himself [schnarkt sich ein] but I should like my brother to restrict himself: my brother must restrict himself. It is only by means of far-reaching investigations that we shall be able to establish the fact that what instigates dreams must always be a wish and cannot be a worry or an intention or a reproach; but this will not affect the other characteristic that the dream does not simply reproduce this stimulus, but removes it, gets rid of it, deals with it, by means of a kind of experience. Introductory Lectures On Psycho-Analysis 3225 (7) On the basis of these characteristics of dreams, we can return once more to a comparison between a dream and a parapraxis. In the latter we distinguished between a disturbing purpose and a disturbed one, and the parapraxis was a compromise between them. We may replace the disturbing one by the psychical stimulus, or let us say by the wish which presses to be dealt with, since we have not learnt so far of any other psychical stimulus that disturbs sleep. One sleeps, but one nevertheless experiences the removing of a wish; one satisfies a wish, but at the same time one continues to sleep. Now these day-dreams are in fact wish-fulfilments, fulfilments of ambitions and erotic wishes which are well known to us; but they are thought, even though vividly imagined, and never experienced as hallucinations. Of the two chief characteristics of dreams, then, the less well assured is preserved here, while the other, since it depends on the state of sleep and cannot be realized in waking life, is entirely absent. Linguistic usage, therefore, has a suspicion of the fact that wish-fulfilment is a chief characteristic of dreams. Incidentally, if our experience in dreams is only a modified kind of imagining made possible by the conditions of the state of sleep that is, a nocturnal day-dreaming we can already understand how the process of constructing a dream can dispose of the nocturnal stimulus and bring satisfaction, since day dreaming too is an activity bound up with satisfaction and is only practised, indeed, on that account. Introductory Lectures On Psycho-Analysis 3226 But other usages of language express the same sense. There are familiar proverbs such as Pigs dream of acorns and geese dream of maize or What do hens dream offi Numbers of figures of speech seem to point in the same direction: lovely as a dream, I shouldnt have dreamt of such a thing, I havent imagined it in my wildest dreams. It is true that it knows of bad dreams, but a dream pure and simple is only the sweet fulfilment of a wish. Nor is there any proverb which might tell us that pigs or geese dream of being slaughtered. It is inconceivable, of course, that the wish-fulfilling characteristic of dreams should not have been noticed by writers on the subject. On the contrary, it has often been noticed; but it has not occurred to any of them to recognize this characteristic as a universal one and to make it into a corner-stone for the explanation of dreams. We can well imagine what it is that has held them back from it and we shall go into the matter later on. But consider what a large amount of light has been thrown on things by our examination of childrens dreams, and with scarcely any effort: the functions of dreams as the guardians of sleep; their origin from two concurrent purposes, one of which, the desire for sleep, remains constant, while the other strives to satisfy a psychical stimulus; proof that dreams are psychical acts with a sense; their two chief characteristics wish-fulfilment and hallucinatory experience. And in discovering all this we were al most able to forget that we were engaged on psycho-analysis. Any psychologist, knowing nothing of the postulates of psycho-analysis, might have been able to give this explanation of childrens dreams. Introductory Lectures On Psycho-Analysis 3227 If dreams of the infantile kind were the only ones, the problem would be solved and our task finished, and that without our questioning the dreamer or bringing in the unconscious or resorting to free association. We have already found repeatedly that characteristics which were claimed as being of general validity have turned out to apply only to a particular sort and number of dreams. The question for us is therefore whether the general characteristics we inferred from childrens dreams have a firmer footing, whether they also hold good of dreams which are not transparently clear and whose manifest content gives no sign of being connected with a wish left over from the previous day. It is our view that these other dreams have undergone a far-reaching distortion and for that reason cannot be judged at a first glance. We suspect too that to explain this distortion we shall need the psycho-analytic technique which we have been able to do without in the understanding we have just gained of childrens dreams. In any case, there is yet another class of dreams which are undistorted and, like childrens dreams, can easily be recognized as wish-fulfilments. These are the dreams which all through life are called up by imperative bodily needs hunger, thirst, sexual need that is, they are wish-fufilments as reactions to internal somatic stimuli. Thus I have a note of a dream dreamt by a little girl of nineteen months, which consisted of a menu, to which her own name was attached: Anna F. The little girls grandmother their combined ages came to seventy years was simultaneously obliged to go without food for a whole day on account of a disturbance due to a floating kidney. She dreamt the same night that she had been asked out and had been served with the most appetizing delicacies. Introductory Lectures On Psycho-Analysis 3228 Observations on prisoners who have been compelled to starve, and on people who have been subjected to privations on travels and explorations, teach us that under these conditions the satisfaction of their needs is regularly dreamt of. Even those of us who otherwise dreamt but rarely had long stories to tell in the morning when we exchanged our latest experiences in this world of the imagination. They were all concerned with the outside world which was now so remote from us, though they were often adapted to our actual circumstances. Eating and drinking, however, were the pivot round which our dreams most often revolved. One of us, who had a special gift for attending large luncheon parties during the night, was proud if he was able to report in the morning that he had "got through a three-course dinner". Another of us dreamt of tobacco, of whole mountains of tobacco; while a third dreamt of a ship in full sail coming in across open water. The postman brought round the mail and gave a long explanation of why we had had to wait so long for it: he had delivered it at the wrong address and had only succeeded in recovering it with great difficulty. But there was a most striking lack of imaginativeness shown by almost all the dreams I dreamt myself or heard described. Similarly, Baron Trenck, suffering torments of hunger while he was a prisoner in the fortress at Magdeburg, dreamt of being surrounded by sumptuous meals; and George Back, who took part in Franklins first expedition, when he was almost dying of starvation as a result of his fearful privations, dreamt constantly and regularly of copious meals. It is of course impossible to get rid of a fairly strong need for food or drink by means of a dream. One wakes up from a dream of this sort still feeling thirsty, and has to have a drink of real water. The effect produced by the dream is in this instance trivial from the practical point of view; but it is none the less clear that it was produced with the aim of protecting ones sleep against a stimulus that was urging one to wake up and take action. When the need is of less intensity dreams of satisfaction often help one to get over it. Introductory Lectures On Psycho-Analysis 3229 In the same way, dreams create satisfactions under the influence of sexual stimuli, but these show peculiarities which deserve mention. Since it is characteristic of the sexual instinct to be a degree less dependent on its object than hunger and thirst, the satisfaction in dreams of emission can be a real one; and in consequence of certain difficulties (which I shall have to mention later) in its relation to its object, it happens with special frequency that the real satisfaction is nevertheless attached to a dream-content which is obscure or distorted. This characteristic of dreams of emission (as Otto Rank has pointed out) makes them particularly favourable subjects for the study of dream-distortion. Furthermore, all adult dreams arising from bodily needs usually contain, in addition to the satisfaction, other material which is derived from purely psychical sources of stimulation and requires interpretation before it can be understood. Moreover I do not mean to assert that the wish-fulfilment dreams of adults which are constructed on infantile lines only appear as reactions to the imperative needs that I have mentioned. We are acquainted as well with short, clear dreams of this sort which, under the influence of some dominant situation, arise out of what are unquestionably psychical sources of stimulation. There are, for instance, dreams of impatience: if someone has made preparations for a journey, for a theatrical performance that is important to him, for going to a lecture or paying a visit, he may dream of a premature fulfilment of his expectation; he may, during the night before the event, see himself arrived at his destination, present at the theatre, in conversation with the person he is going to visit. Or there are what are justly known as dreams of convenience, in which a person who would like to sleep longer dreams that he is already up and is washing, or is already at school, whereas he is really still sleeping and would rather get up in a dream than in reality. The wish to sleep, which we have recognized as regularly playing a part in the construction of dreams, comes into the open in these dreams and reveals itself in them as the essential dream-constructor. There is good reason for ranking the need to sleep alongside of the other great bodily needs.

See Brain electrical activity mapping chromosomal disorders gastritis high fat diet purchase prevacid pills in toronto, 281291 Auditory processing gastritis diet buy prevacid without a prescription. See Conduct disorder lead exposure and symptoms of gastritis back pain discount prevacid uk, 271272 integrated theories gastritis extreme pain prevacid 30mg on line, 2024 Cell bodies, 95, 99 lobular, 118119 localization theory, 1320 Cell doctrine, 7, 8 plasticity, 270273 non-Western attitudes, 1213 Cells, 94 postnatal, 120 nonscientific theories, 4 nerve (See Neurons) regional, 118 Brain hypothesis, 6 receptor, 177, 184 ventricular, 119120 Brain injuries. See Dopamine Chlorinated hydrocarbons, 365, 367 Conceptual apraxia, 195 Data interpretation, 7989 Cholesterol, 351 Concussions. See Galveston Orientation and Executive planning, 319 injury to, 396 Amnesia Test Explicit memory, 227228 orbitofrontal circuit, 254257 Golgi stain, 34 Expressive aphasia, 219 stroke-damage, 352 Gonadotropins, 284 Extended paraphasia. See Fetal alcohol syndrome properties of, 109 Guanfacine (Tenex), 336 Fear conditioning, 261 seizures and, 468, 472 Gunshot wounds, 373 Feelings. See Huntingtons disease clinical features, 291292 examples of, 167 Head injuries. See also Brain injuries comorbid conditions, 293 sex hormones role, 171175 adaptation, 388389 development course, 294 studies of, 167171 mild, 379385 incidence, 292 math skills, 172 impact of, 380 neuropathogenesis, 292293 meningioma incidences, 359 postconcussional syndrome, 385 treatment, 294295 sexual hormones and, 171175 postconcussive syndromes, 381 Subject Index 567 research on, 379380 obstructive, 277 Insomnia, 450 sports-related, 381382 physiological dynamics, 277 Intelligence traumatic (See Traumatic brain injury) treatment, 278, 281 aging and, 401403 Headaches. See Migraines Hyperacusis, 286 Alzheimers patients, 417418 Hematomas, 346, 377 Hypercalcemia, 286 autism and, 312 Hemianopia blindness, 203 Hyperdensity, 38 tests, 68 Hemiplegia, 386 Hyperserotonemia, 316 verbal scales of, 401 Hemispheres. See Pacemaker cells characterization, 434 Impulsiveness, 357 Karyotype, 282 clinical presentation, 435436 Infarctions, 345346 Kennard principle, 272 development, 237 aneurysms, 347 Kennedy, John F. See Diencephalon Parkinsons patients, 430 neuropathogenesis, 277 Insecticides, 365 pragmatics of, 308 568 Subject Index Language (continued) MacCracken, Henry M. See Magnetoencephalography relationship, 445447 Lobotomies, 2224 Membrane potential. See Resting potential Mirror self-misidentification syndrome, Lobular development, 118119 Memory. See Norepinephrine rehabilitation programs, 390 state of consciousness during, 452, 454 Neanderthals, 156157 websites, 8990 Noncommunicating hydrocephalus. See Necrosis, 341, 351352 Neuropsychological tests, 6779, Obstructive hydrocephalus Neglect 7576 Nondeclarative memory, 227 case study, 211 attention, 7172 amnesia and, 235236 clinical presentation, 212213 base rates, 68 brain circuitry governing, 236237 neuropathology of, 211212 concentration, 7172 characterization, 231 theories of, 213214 data interpretation, 7984 implicit priming, 235236 Neocortex, 448 defined, 68 learning and, 234235 Neologism, 311 false positives, 6768 Parkinsons patients, 430 Neoplasms. See Premotor area Object permanence, 247 Partial seizures, 444, 466467 Pneumoencephalography. See Secondary association Organs, definitions of, 13 demographics, 311312 Primary auditory cortex. See Phenylketonuria Pruning, 95, 118 motor system, 427428 Planum temporale, 163, 302 Pseudopsychopathic sociopathy. See Acquired personality changes, 430431 Plaques sociopathy Subject Index 571 Psychoactive drugs, 104 Restless leg syndrome. See Supravalvar aortic stenosis characterization, 187 protection of, 125127 Sydenhams chorea, 335 disorders of, 189 segmentation of, 120 Sylvian (lateral) fissure, 118 olfactory system, 187189 structure of, 123 Sylvian aqueduct. See Traumatic brain injury Songbirds, 109 Striatal complex, 196 Tectum, 138 Soul Striate cortex, 203 Tegmentum, 138 non-Western views, 12 Striatum, 107, 148 Telencephalon, 118, 147152 parts, Platos views, 6 Strokes. See Single-photon emission computed Subcortical motor processing, 195197, 448 Terrorism, 2829 tomography Subdural hematomas, 377 Test battery, 69 Subject Index 573 Tests Transcortical motor aphasia, 221 Validity, 67 apperceptive agnosia, 209 Transcortical sensory aphasia, 221 Vascular disorder. See Spatial ability; Visual clinical presentation, 332333 neuropathogenesis, 283284 processing comorbid conditions, 334 treatment, 285 Visuospatial organization, 7475 effects of, 337 Turner, Tina, 401 Visuospatial sketch pad, 238 pathogenesis, 334335 Vitalism, 4 prevalence, 333 Ultradian, 449 Vocational inventories, 69 treatment, 336337 Ultrasonography, 281 Tower of Hanoi, 326 Umami, 185 Wada technique. See Ventral processing intellectual performance and, 287288 dyslexia and, 302 Where systems. See Wechsler Memory Scale dorsal processing and, 289 Word decoding, 301 Zentralorgan, 104 emotionality and, 290 Word salad, 220. Books Published/Distributed Pattern, control, and contrast in beginning speech: A case study in the development of word form and word function. Articles Published in refereed journals, books, or proceedings Phonotactic rules in beginning speech. Revised as Early strategies for the perception and production of words and sounds. Menn In Proceedings of the 22nd annual meeting of the Berkeley Linguistic Society. The interaction of preserved pragmatics and impaired syntax in Japanese and English aphasic speech. The role of empathy in sentence production: A functional analysis of aphasic and normal elicited narratives in Japanese and English. Selective preservation of geographic names and numerical information in a patient with severe aphasia. Studying the pragmatic microstructure of aphasic and normal speech: An experimental approach. Can speech development at thirty-six months in children with hearing loss be predicted from information available in the second year of lifefi Co-Constructing Lucy: Adding a Social Perspective to the Assessment of Communicative Success in Aphasia. Encoding location in aphasic and normal speech: the interaction of pragmatics with language output processing limitations. Martha Crago, Johanne Paradis, & Lise Menn, in the Handbook of Clinical Linguistics, ed. Psychological reality, linguistic theory, and the internal structure of the lexicon. Development of techniques for comparison of aphasic syndromes in English and Japanese. Technical report, Communication Research Group, Tokyo Metropolitan Institute of Gerontology, Fall 1988 (pages unknown). Lateralized noun/verb decision: Part of speech, functor context, and two models of the concreteness effect. The microstructure of morphological development: Differences across children and across languages. In Nihon Ninchigakkai Dai 9kai Taikai Happyoronbunshu [Proceedings of 9th annual meeting of the Japan Society for Cognitive Science. A selective preservation of numbers and geographic information in a severe anomic patient: A consequence of degraded visual knowledge basefi Languages, Minds, and Brains: Papers from the NorFa Summer Schoold, Mekrijarvi, Finland, June 22-29, 1998. Healy (2001) Proceedings of the Annual meeting of the Cognitive Science Society, Edinburgh, August 2001. Language production in Japanese preschoolers with Specific Language Impairment: Testing theories. Syntactic frame and verb bias in aphasia: Plausibility judgments of undergoer-subject sentences. Conspiracy and Sabotage in the Acquisition of Phonology: Dense Data Undermine Existing Theories, Provide Scaffolding for a New One. In special issue of Language Sciences, Data and Theory: Papers in Phonology in Celebration of Charles W. Book reviews, abstracts, commentaries, notes, and encyclopedia articles published: Review of S. Other publications: Guest editor: Special Issue of Aphasiology on Comparative Aphasiology. Psychology Research Colloquium, Veterans Administration Medical Center, Boston, Dec. Time-course of fundamental frequency variations in parent-child discourse (with S. Invited discussion of presentation on Prosody in mother-infant communication, New England Child Language Association, March 1981. Invited discussion of panel on prosody, Stanford Child Language Research Forum, March 1981. Psychology Research Colloquium, Boston Veterans Administration Medical Center, July 1981. Current Studies in Agrammatism, Psycholinguistics/Language Behavior Seminar, Boston University, October 1981. Invited talk, New Hampshire Speech, Language, and Hearing Association, April 1982. Invited, Symposium on Clinical Linguistics, Linguistic Society of America and American Association for Applied Linguistics, Baltimore, Dec. Recent work from the Cross-Language Aphasia Study, presented at the University of Colorado, March 1985, and at the monthly meeting of the Chicago Linguistic Society, April 1985.

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This retrogressive excitation chronic gastritis symptoms treatment buy cheap prevacid on-line, emanating from the organ of memory and acting on the perceptual apparatus by means of ideas gastritis best diet generic 15 mg prevacid with amex, is therefore in the normal course of things still more difficult in the case of pain than in that of visual or auditory sensations gastritis usmle purchase 15 mg prevacid otc. Since hallucinations of pain arise so easily in hysteria gastritis bloating cheap prevacid 30 mg otc, we must posit an abnormal excitability of the apparatus concerned with sensations of pain. This excitability makes its appearance not only under the spur of ideas but of peripheral stimuli in just the same way as the erethism of the vasomotors which we discussed above. It is a matter of daily observation to find that in people with normal nerves peripheral pains are brought on by pathological processes, not in themselves painful, in other organs. Thus headaches arise from relatively insignificant changes in the nose or neighbouring cavities, and again, neuralgias of the intercostal and brachial nerves from the heart, etc. If the abnormal excitability, which we have been obliged to postulate as a necessary condition of hallucinations of pain, is present in a patient, that excitability is also at the disposal, so to speak, of the irradiations that I have just mentioned. The irradiations that occur also in non- neurotic people are made more intense, and irradiations are formed of a sort which, it is true, we only find in neurotic patients but which are based on the same mechanism as the others. That its causes are psychical would have to be proved, and this is not achieved by showing that that particular kind of pain, like any other, can be produced under hypnosis as a hallucination, or that its cause can be psychical. Like erythema or one of the normal secretions, it arises both from psychical and from purely somatic causes. Are we to describe only the first kind as hysterical cases which we know have a psychical originfi If so, the commonly observed cases of ovarian neuralgia would have to be excluded from the hysterical syndrome, and this will hardly do. If a slight injury to a joint is gradually followed by a severe arthralgia, no doubt the process involves a psychical element viz. But this can hardly be expressed by saying that the hyperalgesia has been caused by ideas. It is quite unproved and improbable that general analgesia or analgesia of individual parts of the body unaccompanied by anaesthesia is caused by ideas. And even if the discoveries of Binet and Janet were to be fully confirmed to the effect that hemi- anaesthesia is determined by a peculiar psychical condition, by a splitting of the psyche, the phenomenon would be a psychogenic but not an ideogenic one, and therefore, according to Moebius, should not be termed hysterical. Studies On Hysteria 170 If, therefore, there are a large number of characteristic hysterical phenomena which we cannot suppose to be ideogenic, it would seem right to limit the application of Moebiuss thesis. We shall not define as hysterical those pathological phenomena which are caused by ideas, but only assert that a great number of hysterical phenomena, probably more than we suspect to-day, are ideogenic. But the fundamental pathological change which is present in every case and enables ideas as well as non-psychological stimuli to produce pathological effects lies in an abnormal excitability of the nervous system. Yet even though only some of the phenomena of hysteria are ideogenic, nevertheless it is precisely they that may be described as the specifically hysterical ones, and it is the investigation of them, the discovery of their psychical origin, which constitutes the most important recent step forward in the theory of the disorder. This question requires a quite different answer in the case of each of the two groups into which Moebius divides ideogenic symptoms. Those pathological phenomena which correspond in their content to the instigating idea are relatively understandable and clear. If the idea of a heard voice does not merely cause it to echo faintly in the inward ear, as it does in healthy people, but causes it to be perceived in a hallucinatory manner as a real, objective acoustic sensation, this may be equated with familiar phenomena of normal life with dreams and is quite intelligible on the hypothesis of abnormal excitability. We know that with every voluntary movement it is the idea of the result to be achieved which initiates the relevant muscular contraction; and it is not very hard to see that the idea that this contraction is impossible will impede the movement (as happens in paralysis by suggestion). The situation is otherwise with those phenomena which have no logical connection with the determining idea. Why does an idea in a sick man evoke one particular entirely irrational movement or hallucination which does not in any way correspond to itfi It may be possible at a later stage to replace the very vague statement in the text above by a more precise and significant formula. Studies On Hysteria 171 In our Preliminary Communication we felt able to say something about this causal relation on the basis of our observations. In our exposition of the subject, however, we introduced and employed without apology the concept of excitations which flow away or have to be abreacted. This concept is of fundamental importance for our theme and for the theory of the neuroses in general, and it seems to demand and to deserve a more detailed examination. Before I proceed to this, I must ask to be forgiven for taking the reader back to the basic problems of the nervous system. But any attempt at getting at the roots of a phenomenon inevitably leads in this way to basic problems which cannot be evaded. I hope therefore that the abstruseness of the following discussion may be viewed with indulgence. A transition between these is afforded by conditions of every degree of decreasing clarity. What interests us here is not the question of the purpose of sleep and its physical basis (its chemical or vasomotor determinants) but the question of the essential distinction between the two conditions. We can give no direct information about the deepest, dreamless sleep, for the very reason that all observations and experiences are excluded by the state of total unconsciousness. But as regards the neighbouring condition of sleep accompanied by dreams, the following assertions can be made. In the first place, when in that condition we intend to make voluntary movements of walking, speaking, etc. In the second place, sensory stimuli are perhaps perceived (for they often make their way into dreams) but they are not apperceived, i. Again, ideas that emerge do not, as in waking life, activate all the ideas which are connected with them and which are present in potential consciousness; a great number of the latter remain unexcited. Thus, association is defective and incomplete, We may safely assume that in the deepest sleep this severance of connections between the psychical elements is carried still further and becomes total. Studies On Hysteria 172 On the other hand, when we are fully awake every act of will initiates the corresponding movement; sense-impressions become conscious perceptions; and ideas are associated with the whole store present in potential consciousness. In that condition the brain functions as a unit with complete internal connections. We shall perhaps only be describing these facts in other words if we say that in sleep the paths of connection and conduction in the brain are not traversable by excitations of the psychical elements (fi The existence of these two different conditions of the paths of conduction can, it seems, only be made intelligible if we suppose that in waking life those paths are in a state of tonic excitation (what Exner calls intercellular tetanus), that this intracerebral excitation is what determines their conductive capability, and that the diminution and disappearance of that excitation is what sets up the state of sleep. We ought not to think of a cerebral path of conduction as resembling a telephone wire which is only excited electrically at the moment at which it has to function (that is, in the present context, when it has to transmit a signal). We ought to liken it to a telephone line through which there is a constant flow of galvanic current and which can no longer be excited if that current ceases. Or better, let us imagine a widely- ramified electrical system for lighting and the transmission of motor power; what is expected of this system is that simple establishment of a contact shall be able to set any lamp or machine in operation. To make this possible, so that everything shall be ready to work, there must be a certain tension present throughout the entire network of lines of conduction, and the dynamo engine must expend a given quantity of energy for this purpose. In just the same way there is a certain amount of excitation present in the conductive paths of the brain when it is at rest but awake and prepared to work. For the mere existence of a system of associative fibres proves that these sensory nerve-cells also send out excitation into the nerve-fibres. If excitation from two sensory cells flows into a nerve-fibre that connects them whether per continuitatem or per contiguitatem then a state of tension must exist in it. This state of tension has the same relation to the excitation flowing away in, for instance, a peripheral motor fibre as hydrostatic pressure has to the living force of flowing water or as electric tension has to an electric current. If all the nerve-cells are in a state of mean excitation and are exciting their nerve-processes, the whole immense network forms a single reservoir of nervous tension. Apart then from a potential energy which lies quiescent in the chemical substance of the cell and an unknown form of kinetic energy which is discharged when the fibres are in a state of excitation, we must assume the existence of yet another quiescent state of nervous excitation: tonic excitation or nervous tension. Studies On Hysteria 173 Let us imagine a man in a state of intense expectation, which is not, however, directed to any particular sensory field. We may rightly suppose that in such a brain all the paths of conduction are at the maximum of their conductive capability that they are in a state of tonic excitation. It is a significant fact that in ordinary language we speak of such a state as one of tension. Experience teaches us what a strain this state is and how fatiguing, though no actual motor or psychical work is performed in it. This is an exceptional state, which, precisely on account of the great consumption of energy involved, cannot be tolerated for long. But even the normal state of being wide awake calls for an amount of intracerebral excitation varying between limits that are not very widely separated. Every diminishing degree of wakefulness down to drowsiness and true sleep is accompanied by correspondingly lower degrees of excitation.

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Since then I have ceased to chronic gastritis journal discount 30 mg prevacid understand Janets writings; but I think he has unnecessarily forfeited much credit gastritis medication list discount prevacid 15 mg online. Thus neurotic symptoms have a sense gastritis diet 7 day order prevacid 15mg without prescription, like parapraxes and dreams gastritis symptoms constipation discount 15mg prevacid otc, and, like them, have a connection with the life of those who produce them. I should now like to make this important discovery plainer to you by a few examples. I can indeed only assert, I cannot prove, that it is always and in every instance so. But for certain reasons I shall choose these examples from cases not of hysteria but of another, highly remarkable neurosis which is fundamentally very much akin to it and about which I have a few introductory remarks to make. Introductory Lectures On Psycho-Analysis 3339 this neurosis, known as obsessional neurosis, is not so popular as the universally familiar hysteria. It is not, if I may express myself thus, so obtrusively noisy, it behaves more like a private affair of the patients, it dispenses almost entirely with somatic phenomena, and creates all its symptoms in the mental sphere. Obsessional neurosis and hysteria are the forms of neurotic illness upon the study of which psycho- analysis was first built, and in the treatment of which, too, our therapy celebrates its triumphs. But obsessional neurosis, in which the puzzling leap from the mental to the physical plays no part, has actually, through the efforts of psycho-analysis, become more perspicuous and familiar to us than hysteria, and we have learnt that it displays certain extreme characteristics of the nature of neurosis far more glaringly. Obsessional neurosis is shown in the patients being occupied with thoughts in which he is in fact not interested, in his being aware of impulses in himself which appear very strange to him and in his being led to actions the performance of which give him no enjoyment, but which it is quite impossible for him to omit. The thoughts (obsessions) may be senseless in themselves, or merely a matter of indifference to the subject; often they are completely silly, and invariably they are the starting-point of a strenuous mental activity, which exhausts the patient and to which he only surrenders himself most unwillingly. He is obliged against his will to brood and speculate as though it were a question of his most important vital problems. The impulses which the patient is aware of in himself may also make a childish and senseless impression; but as a rule they have a content of the most frightful kind, tempting him, for instance, to commit serious crimes, so that he not merely disavows them as alien to himself, but flies from them in horror and protects him. At the same time, these impulse never literally never force their way through to performance; the outcome lies always in victory for the flight and the precautions. What the patient actually carries out his so called obsessional actions are very harmless and certainly trivial things, for the most part repetitions or ceremonial elaborations of the activities of ordinary life. But these necessary activities (such as going to bed, washing, dressing or going for a walk) become extremely tedious and almost insoluble tasks. In different forms and cases of obsessional neurosis the pathological ideas, impulses and actions are not combined in equal proportions; it is the rule, rather, that one or other of these factors dominates the picture and gives its name to the illness, but the common element in all these forms is sufficiently unmistakable. The most extravagant psychiatric imagination would not, I think, have succeeded in constructing anything like it; and if one did not see it before one every day one would never bring oneself to believe in it. Do not suppose, however, that you will help the patient in the least by calling on him to take a new line, to cease to occupy himself with such foolish thoughts and to do something sensible instead of his childish pranks. He would like to do so himself, for he is completely clear in his head, shares your opinion of his obsessional symptoms and even puts it forward to you spontaneously. What is carried into action in an obsessional neurosis is sustained by an energy to which we probably know nothing comparable in normal mental life. There is only one thing he can do: he can make displacements, and ex changes, he can replace one foolish idea by another somewhat milder, he can proceed from one precaution or prohibition to another, instead of one ceremonial he can perform another. The ability to displace any symptom into something far removed from its original conformation is a main characteristic of his illness. Moreover it is a striking fact that in his condition the contradictions (polarities) with which mental life is interlaced emerge especially sharply differentiated. Alongside of obsessions with a positive and negative content, doubt makes itself felt in the intellectual field and little by little it begins to gnaw even at what is usually most certain. The whole position ends up in an ever-increasing degree of indecision, loss of energy and restriction of freedom. At the same time, the obsessional neurotic starts off with a very energetic disposition, he is often extraordinarily self-willed and as a rule he has intellectual gifts above the average. He has usually reached a satisfactorily high level of ethical development; he exhibits over- conscientiousness, and is more than ordinarily correct in his behaviour. You can imagine that no small amount of work is needed before one can make ones way any distance into this contradictory hotch-potch of character-traits and symptoms. And to begin with we aim at nothing whatever else than understanding a few of the symptoms and being able to interpret them. Introductory Lectures On Psycho-Analysis 3341 Perhaps you would like to know in advance, having in mind our earlier talks, what attitude contemporary psychiatry adopts towards the problems of obsessional neurosis. Psychiatry gives names to the different obsessions but says nothing further about them. On the other hand it insists that those who suffer from these symptoms are degenerates. This gives small satisfaction; in fact it is a judgement of value a condemnation instead of an explanation. We are supposed to think that every possible sort of eccentricity may arise in de generates. Well, it is true that we must regard those who develop such symptoms as somewhat different in their nature from other people. But we may ask: are they more degenerate than other neurotics-than hysterical patients, for instance, or those who fall ill of psychosesfi Indeed, we may doubt whether there is any justification for it at all, when we learn that such symptoms occur too in distinguished people of particularly high capacities, capacities important for the world at large. It is true that, thanks to their own discretion and to the untruthfulness of their biographers, we learn little that is intimate about the great men who are our models; but it may nevertheless happen that one of them, like Emile Zola, may be a fanatic for the truth, and we then learn from him of the many strange obsessional habits to which he was a life-long victim. Introductory Lectures On Psycho-Analysis 3342 Psychiatry has found a way out by speaking of degeneres superieurs. But we have found from psycho-analysis that it is possible to get permanently rid of these strange obsessional symptoms, just as of other complaints and just as in people who are not degenerate. I shall give you only two examples of the analysis of an obsessional symptom: one an old observation which I cannot find a better one to replace, and another recently met with. I limit myself to this small number, because it is impossible in such reports to avoid being very diffuse and entering into every detail. A lady, nearly thirty years of age, who suffered from the most severe obsessional manifestations and whom I might perhaps have helped if a malicious chance had not brought my work to nothing I may be able to tell you more about this later on performed (among others) the following remarkable obsessional action many times a day. She ran from her room into another neighbouring one, took up a particular position there beside a table that stood in the middle, rang the bell for her housemaid, sent her on some indifferent errand or let her go without one, and then ran back into her own room. This was certainly not a very distressing symptom, but was nevertheless calculated to excite curiosity. The explanation was reached in the most unequivocal and unobjectionable manner, free from any possible contribution on the doctors part. I cannot see how I could possibly have formed any suspicion of the sense of this obsessional action or could have offered any suggestion on how it was to be interpreted. More than ten years before, she had married a man very much older than herself, and on the wedding-night he was impotent. Many times during the night he had come running from his room into hers to try once more, but every time without success. Next morning he had said angrily: I should feel ashamed in front of the housemaid when she makes the bed, took up a bottle of red ink that happened to be in the room and poured its contents over the sheet, but not on the exact place where a stain would have been appropriate. I could not understand at first what this recollection had to do with the obsessional action in question; the only resemblance I could find was in the repeated running from one room into the other, and perhaps also in the entrance of the housemaid. My patient then led me up to the table in the second room and showed me a big stain on the tablecloth. She further explained that she took up her position in relation to the table in such a way that the maid who had been sent for could not fail to see the stain. There could no longer be any doubt of the intimate connection between the scene on her wedding-night and her present obsessional action, though all kinds of other things remained to be learnt. Introductory Lectures On Psycho-Analysis 3343 It was clear, in the first place, that the patient was identifying herself with her husband; she was playing his part by imitating his running from one room into the other. Further, to carry on the analogy, we must agree that the bed and the sheet were re placed by the table and the tablecloth. This might seem arbitrary, but surely we have not studied dream-symbolism to no purpose. Table and bed together stand for marriage, so that the one can easily take the place of the other. It already seems proved that the obsessional action had a sense; it appears to have been a representation, a repetition, of the significant scene. If we examine the relation between the two more closely, we shall probably obtain information about something that goes further about the intention of the obsessional action. Its kernel was obviously the summoning of the housemaid, before whose eyes the patient displayed the stain, in contrast to her husbands remark that he would feel ashamed in front of the maid.