Psychotherapy

PSYCHOTHERAPY (psych, treatment), the systematic use of psychological means for treating diseases. By psychological means are meant all systematic statements and generally the entire behavior of the physician insofar as it is guided by the conscious intention to evoke in the patient's psyche certain predetermined contents (impressions, emotions, evaluations), as well as volitional tendencies, reactions, skills, which could compensate for the pathological disorder and alleviate suffering. Understood in a broader sense, psychotherapy also includes the organization of various measures aimed at changing the external environment for the purpose of improving and strengthening the personality (rationalization of rest, distraction, change of profession, etc.). The inclusion of psychotherapy in the number of officially recognized treatment methods dates to the beginning of the 20th century. Since then, the energetic development of psychotherapeutic methods has progressed. But in fact, in the form mainly of suggestive psychotherapy (suggestion), attempts at psychological influence on various pathological processes were also applied in previous decades. However, general medical views were for a long time little favorable to the development of psychotherapy. The science of the second half of the 19th century, with its successes in pathological anatomy and topological diagnosis of nervous diseases, postulating for each pathological disorder an essential material substrate (vulgar materialism), was in general extremely skeptical about the possibility of those purely dynamic disturbances which are well known to modern science under the name of psychotendencies. Furthermore, in connection with the improvement of specialized research methods (percussion, auscultation, chemical analyses), medical thinking became concentrated almost exclusively on the pathology of organs. Accordingly, therapy acquired an increasingly pronounced character of localist organoid therapy. The old principle 'to treat not the disease, but the patient,' despite its theoretical recognition, did not play a leading role in the practical activity of the clinician. Only gradually, with the development of the doctrine of temperaments and constitutions, did the idea of the 'holistic organism' become strengthened, however, at this time insufficient attention was still paid to the neuropsychic factor and its important regulatory role. But over time, even from the ranks of internists, observations increasingly appeared emphasizing the essential significance of the 'psychogenic factor' in the etiology and pathoplasticity of diseases of internal organs (Strümpel and others.). Along with this, the doctrine of 'neuroses and psychoneuroses' rapidly developed, and the number of well-verified facts of cures through hypnosis multiplied. A whole series of everyday observations on the pathogenic effect of psychological situations, on the one hand, and the relief of pathological disorders on the basis of psychological influence on the other, increasingly concentrated interest on themselves. Phenomena of this category also became objects of laboratory research. The study of emotions in their influence on blood circulation, respiration, perspiration, etc., began. The works of Geyer (Neuer) on psychological secretion of gastric juice, Glaser on the calcium content in blood and its fluctuations from psychological causes, numerous other studies and finally the works of I. P. Pavlov—all this created a new era in human pathology. The old philosophical question about the influence of the psyche on the soma was posed anew and resolved anew. The known experiments of Cannon on the fluctuation of adrenaline content in blood under the influence of emotions had decisive significance. Psychogenesis as an undoubted fact gradually emerged from the thicket of mysterious casuistry, and accordingly the problem of scientific psychotherapy was fundamentally posed as the universally recognized possibility of the influence of psychological factors not only on individual pathological symptoms, but on the pathological processes themselves in their essential foundations. However, the original concept of psychogenesis had to rise to yet another step. In connection with developing constitutionalogy, the doctrine of characters was outlined and the problem of the personality as a constitutional factor in pathogenesis and pathoplasticity of clinical pictures was posed. Despite the extreme indefiniteness and insufficiency of all these new inquiries (associated with the names of Kretschmer, Krause, Spranger, Klages, Kranefeld, Freud, Adler and many others), nevertheless a general agreement was achieved in one

PSYCHOTHERAPY

at point 822, it was established that not only individual psychological states (for example, this or that emotion) influence somatic (particularly vegetative) functions, but that the entire personality as a system of human goals is reflected in a whole range of mental, nervous, and somatic formations, both giving rise to pathological deviations and creating the basis for psychotherapeutic mechanisms. From this moment, Psychotherapy acquired its true object of action—the personality of the patient, since it has effective significance in the pathogenesis and pathoplasticity of painful deviations. And since a complete explanation of the disruption of any particular function can only be obtained by starting from the way of reaction characteristic of this personality as a whole, then this or that psychotherapeutic method proves to be more or less effective, depending on whether it is applied mechanically to a separate function (in its artificial isolation) or encompasses the entire personality in its 'biological prerequisites and its social essence. This cardinal requirement—action on the whole, not on individual symptoms—is far from being satisfied to the same degree by various methods of modern Psychotherapy, since the latter are applied in isolation by adepts of warring psychotherapeutic schools. However, this requirement is gaining ever greater and greater authority in modern Psychotherapy. Taking into account the individual characteristics of the patient, explaining the clinical picture from the uniqueness of the reactions of this particular person, and finally, therapeutic (psychological) action on the personality (even in the fight against single and 'private' functional disorders)—these are the most popular slogans of the progressive movement in which modern psychotherapeutic work finds itself on its theoretical front. This principle has force not only in the therapy of purely psychogenic disorders, but also in the treatment of those psychogenic 'superstructures' with which any disease abounds, and it must immediately manifest its guiding influence at the very first contact of the physician with the patient. To be more precise, in any medical specialty, before every practical physician there first arises the need to form an idea of the temperament and character of the patient, in order to be able to fulfill first of all the most elementary requirement of medical practice: do no harm (primum non nocere). Meanwhile, insufficient knowledge of the ways of reaction of this particular personality, incomplete accounting of its suggestibility, the degree of its anxious attitudes toward illness, many of its prejudices, etc., leads to a whole series of antipsychotherapeutic mistakes, causing psychotraumatic pictures described in recent times under the name of iatrogenic disorders. An unintentionally pessimistic remark, an imprudent explanation, a medical term not sufficiently understood by the majority often awaken depressing emotions, lower the tone of the personality and its resistance to pathogenic influences (see Physician, physician as a cause of diseases). From this same point of view (of the interests of the patient's personality), special attention should be paid to the patient's patient listening to complaints, medical questioning and the taking of anamnesis. Here, from the very beginning, a completely conscious and consistent psychotherapeutic attitude is necessary (A. B. Zalkind). Attentive listening not only provides the necessary material for characterological observations, on the basis of which the entire further Psychotherapy is planned, but it contains one important psychotherapeutic mechanism, elementary though it may be in significance—the patient is given the opportunity to react to his psychological tension. Complete knowledge of the personality requires b. ch. a great deal of time. A comprehensive 'psychotherapeutic diagnosis' is formed as a result of many successive sessions. Therefore, Psychotherapy is one of the most painstaking and difficult therapeutic methods. The difficulty increases as treatment rises from purely symptomatic and deepens into the complex causal structure of the neurosis. In this respect, various methods of Psychotherapy differ substantially from one another. Passing from the simplest to the more complex, we distinguish in modern Psychotherapy the following directions and schools: 1) suggestive Psychotherapy, or treatment by suggestion, with its 'special case—hypnosis (hypnotherapy) (see Suggestion, Hypnotism); 2) rationalistic (intellectual) Psychotherapy, or treatment by explanation and persuasion; 3) psychoanalytic Psychotherapy, or psychoanalysis (see) in its various modifications; 4) individual-psychological Psychotherapy (Alfred Adler's method); 5) labor therapy, which is adjacent to Psychotherapy and has grown into an independent method. When Psychotherapy is entirely occupied with action on a single individual, one speaks of individual Psychotherapy; when treatment is directed at a whole group of patients—of collective Psychotherapy. Suggestive Psychotherapy (resp. hypnotherapy) consists in the fact that 1) the patient in a waking state or in various degrees of hypnosis is told in categorical form about the disappearance of his pathological phenomena either immediately or at a specified time (direct suggestion, see Suggestion); 2) the patient is told that some procedure prescribed for him will bring healing (indirect suggestion). This simplest method can give favorable results only on condition of sufficient suggestibility and a not-too-complex structure of the pathological syndrome. The greatest effect is achieved in so-called massive monosymptomatic diseases, however with the indispensable absence of any persistent goal-setting attitudes, which sometimes serve as a decisive obstacle to suggestion. Representing action on irrational, vague (archaic) mechanisms, this method is indicated for a corresponding (vaguely emotional) pathogenesis of the disease. The predominant area of application of suggestive Psychotherapy: vegetative disorders of the vascular system, the gastro-intestinal tract, the bladder, the sexual system, the skin, etc. Further indications are not too severe forms of alcoholism, drug addiction, states of anxious expectation (for example, expectation and fear of insomnia, public speaking, etc.). Suggestive Psychotherapy also is beneficial in persisting as if by inertia (after a somatic illness) functional disorders (pain, uncertainty of movement, etc.). Finally, the hypnotic state itself (sleep without any further suggestions) can serve as a means of general sedation in excitement and tension after severe mental traumas, in insomnia, etc. Some authors relate to suggestive therapy in general and to hypnotism in particular in sharply negative terms. The opinion has been expressed that this method cultivates precisely those mental mechanisms on the basis of which 'neurotic' pictures themselves arise and persist (tendency to autosuggestion, to automatisms, etc.). As a general position (but with reservations), this criticism should be recognized as correct. Generally speaking, suggestive Psychotherapy is a purely symptomatic procedure. Its essential deficiency (with stereotyped application) is the ignoring of the personality as a whole. However, the practice of life shows that often one cannot do without this method, especially in cases requiring urgent help (acutely arising psychogenic stupor, psychogenic paralyses, aphonia, etc.). Furthermore, by ridding the patient by suggestive means of some extremely pathological condition or bad habit (for example, habitual alcoholism) in cases where it is impossible to apply other measures, we ultimately not only do not weaken, but substantially increase the energy of the patient, returning him to the path of self-activity and his own initiative. It is always useful to supplement suggestive Psychotherapy with other methods (explanation, labor therapy, etc.). It is not superfluous always to include in the text of suggestions that the will of the patient will not only not be weakened, but will be considerably strengthened, and that the patient 'obeys' these particular suggestions because this fully corresponds to his own intentions (as is indeed the case with voluntary and conscious recourse to a hypnotist, for example in alcoholism, masturbation and other pathological habits).—In specifically psychiatric practice, suggestive Psychotherapy plays almost no role. Attempts to influence delusions, hallucinations, etc. should be regarded as a misunderstanding. Relative success can be achieved in psychogenic depressions. Here, however, it is not the method itself that plays a role, but rather the communication with the physician, support, etc. Psychasthenic syndromes of the constitutional type (obsessive states) are less accessible to suggestive therapy. All reports of the favorable influence of hypnosis on genuine epilepsy are based on diagnostic errors and do not deserve trust. To a much greater degree than suggestive Psychotherapy, rationalistic (intellectual) Psychotherapy is interested in the personality of the patient. The founder of this method Dubois (Dubois) fundamentally denied suggestion in the name of the dignity, activity, and logical self-activity of the patient. Considering neuroses to be the result of errors of judgment and ignorance, he built a therapeutic system, the essence of which consists in, by means of skillfully selected evidence, making the patient abandon 'misconceptions' and come to correct conclusions. The technique of treatment consists in systematic conversations.

The patient is convinced, for example, that his palpitations depend entirely on anxiety, excessive fixation of attention, etc. The calmness that occurs under the influence of explanation gives a corresponding therapeutic effect. The mechanism of action is not always so simple. One often has to use concepts new to the patient, teaching him a series of scientific, social, and philosophical truths. Dubois believed that the method he developed is entirely based on purely intellectual influence on the personality. Adhering to Dubois, Déjerine also recognized the important role of emotional factors. A representative of this school is also Babinski. The strong point of rational psychotherapy is the activation of the patient. The disadvantage is the extreme difficulty of purely rational influence on the numerous, more deeply rooted affective anomalies, the 'illogicality' of which is mostly clear to the patient himself and does not require explanation. The theoretical position of Dubois itself is incorrect, since he proceeds from the assumption of some abstract person, consisting entirely of bare intellect, a kind of logical machine, detached from any historical and social reality. It is now recognized by all that in the rational psychotherapy as conducted by Dubois, there were many purely suggestive elements associated with the charm of the personality of its founder. But there is no reason to reject his method because of Dubois's errors. The scope of rational psychotherapy can be significantly expanded and filled with new, extremely diverse content. A monument to the activity of Dubois remains his classic book 'Psychoneuroses and their mental treatment.' The view of hypnosis as a passive method that weakens the energy of the personality, expressed with particular decisiveness by Dubois, met with a response from various quarters. Coué made an unsuccessful attempt to combine suggestion with an active principle, expressed in the fact that the patient, consciously and systematically repeating certain formulas, instills in himself the belief that his health improves with each day. Coué's method has met with completely justified criticism, since in it 1) there is a complete absence of any analysis of the origin of the disease and 2) the treatment itself has a crude mechanistic character. Even earlier, from the practice of hypnosis, the so-called cathartic method was formed (see). As a psychotherapeutic method, catharsis consists in making the patient in a light hypnotic state remember the 'traumatic experience' that caused the neurosis, to relive the trauma as if anew, and, more or less violently 'reacting' to it, to free himself in this way from the 'frustrated affect.' First applied by Janet, and later by O. Foht and Brodmann, this method in the hands of Breuer and Freud served as the beginning of the entire doctrine of psychoanalysis (see). At present, psychocatharsis is applied mainly by Frank, Simmel, and to some extent by Schultz (Frank, Simmel, H. Schultz). The area of its application is severe hysterical reactions (attacks) and in particular the so-called traumatic neurosis, since there are no obvious goal-setting tendencies present. The basis of psychocatharsis is the incorrect assumption that every neurosis is necessarily based on some single specific trauma in the anamnesis. A further flaw of this method is that it is by no means proven that the recalling of pathogenic moments has a beneficial effect in all cases. It is undoubtedly true that 'repression' of sharp affective experiences is by no means always harmful, and their awareness is by no means always useful (Kretschmer); repression and forgetting can represent fruitful, psychobiologically adequate acts. Cases are observed where a new experience of the trauma leads to an aggravation of the neurosis. Psychoanalytic psychotherapy (see Psychoanalysis) was formed from psychocatharsis by: 1) abandoning hypnosis and replacing it with the 'method of free associations' and 2) by constructing a new theory of the pathogenesis of neuroses, which reduces to an incorrect development from early childhood of emotions and psychosexual drives. On this basis, two 'psychoneuroses' are formed, which, according to Freud, are the true objects of psychoanalysis: these are hysteria and obsessive-compulsive neurosis. The mechanism of cure is based mainly on the reinterpretation of neurotic symptoms, i.e., the unconditional interpretation of them as symbols reflecting repressed infantile drives and pathological fixations of 'libidinal' energy, and on the 'transference' of these early-infantile tendencies (positive or negative) onto the analyst-physician, after which these unconscious drives (erotic fixations, passive or aggressive tendencies, etc.), having vividly manifested themselves in relation to the analyst and been discussed with the patient, lose their strength, after which the patient, relieved and enlightened, has the opportunity to direct his energy toward healthy life tasks. Based mainly on the mechanisms of 1) awareness of the meaning of symptoms (deciphering symbols) and 2) transference, analytic psychotherapy in successful cases, however, contains several other therapeutic moments: 1) the habit of rationally evaluating and differentiating one's experiences, rather than yielding to them spontaneously as an integral part of one's inner being; 2) the habit of contemplating many distressing facts emerging from the depths of the psyche without any sensation or drama, as something universal, not narrowly individual; 3) finally, according to analysts, the very scheduling of daily analytical sessions at a strictly fixed time naturally leads to a more proper distribution of time, creates the necessary routine for the patient, which is so important for the disorganized psyche of neurotics and psychopaths. An important feature of analytic psychotherapy is the principled abstention from any pedagogy, psychogogy, moral evaluations, etc., in consequence of which the patient during sessions of 'free association' has the opportunity to be himself, showing complete truthfulness and sincerity (which is an indispensable condition for uncovering the hidden motives of behavior, and consequently the 'motives of the neurosis'). Some followers of Freud—Jung, Stekel (Jung, Stekel), and others—however, add purely educational moments to the analysis—explanations, indications, etc. (On the theoretical foundations of the method—see Psychoanalysis.) The method mentioned presents great difficulties of a theoretical and practical nature. The revival of forgotten material and repressed complexes is not always justified, as in the case of psychocatharsis. One cannot also recognize the universality of the method on which its adherents insist. In practical terms, the long duration of treatment, sometimes lasting many months, is extremely difficult. It is undoubtedly true that in many cases of severe hysteria that began in early age, good results are achieved. However, what has been said applies mainly only to the conditions of Western European bourgeois existence, on the soil of which hysterical goal-setting tendencies flourish luxuriantly. In our conditions, where hysteria quickly disappears, the need for psychoanalysis correspondingly decreases. There is no doubt that hysterical reactions are accessible to many other psychotherapeutic methods (even suggestion) and that the main condition for effectiveness is the contact with the physician, which is also achieved without psychoanalysis. As for obsessive-compulsive neurosis, psychoanalysis does not bring the expected benefit, except for more superficial obsessive fears (phobias), where the increase in psychological tone caused by 'transference' often gives a good therapeutic effect (for a general criticism of the foundations of this method—see Psychoanalysis). While psychoanalysis is essentially biologically oriented, individual-psychological psychotherapy is based on the anomalies of the social setting of the neurotic. Denying any significance to biological drives (in particular psychosexual ones), the founder of this method Adler concentrated all his attention on the drive of the personality toward its self-assertion, toward power, superiority (the group of drives 'ego'). The obstacle to satisfying this drive is some inferiority of an organ (or the entire organism), weakness of some function, or childhood impressions (economic, social) of an oppressive nature. Striving for domination and at the same time feeling one's weakness, the nervous child and the neurotic use various unconscious 'stratagems' to create more satisfactory conditions for their well-being, to compensate for the unbearable feeling of inferiority, to attract attention, indulgence, or love by any means, even at the cost of suffering, crime, suicide, renunciation of elementary joys of life. Thus various variants of the 'neurotic character' arise, bizarre combinations of aggressiveness and passivity alongside numerous neuro-somatic and psychopathological syndromes, which the personality cultivates as a 'fictitious goal' or line of behavior, the only possible one for the compensation and overcompensation of the feeling of inner degradation and inferiority. The entire energy of the neurotic is thus directed not toward real goals, for which the healthy human collective fights.

A neurotic detached from the collective leads a useless purely individual existence, mistakenly thinking that there is no other way out for him except disease, eccentricity, psychosis, etc. Individual psychotherapy consists in analyzing the origin of the feeling of inferiority, in establishing the 'arrangements' with which the neurotic occupies his entire life, and in systematically indicating more correct and perfect paths of adaptation to life and to influence upon it, and ultimately in the necessity of returning to the collective as an ordinary worker who does not feel humiliation ('worthlessness') but also does not demand any privileges, flattery, etc. Here therapy in its formal foundations and in its technique (if not considering the premises) is akin to the rationalist therapy of Dubois. For Adler, as already stated, it is characteristic to ignore the biological foundations of personality. The psychic life of the subject is reduced only to the combination of various strategic maneuvers aimed at occupying some advantageous position, which would satisfy the 'will to power', hampered by the feeling of inferiority. In a whole series of cases, the 'teleological' structure of neurosis proposed by Adler is partially justified. The corresponding clarification can also have a therapeutic effect. However, it is erroneous to attribute universality to the 'mechanisms' of Adler, which in his opinion explain almost every psychosis, psychopathy, criminality, all neurotic reactions without exception, and all peculiarities of human behavior. In addition to the above-mentioned methods of psychotherapy aimed at the individual, methods of mass psychotherapy have also been proposed, the essence of which is that treatment is conducted on a whole group of patients. This method arose as a technique which, during hypnosis, saves the doctor's time and at the same time contributes to the increase of suggestibility under the influence of a kind of 'psychic resonance' formed in collectives. Collective hypnosis was conducted many decades ago in Sweden by Wetterstrand, in our country by Bekhterev and many others. For a time, mass suggestion was widely used in narcological dispensaries in the treatment of smokers, alcoholics, etc. But besides suggestive psychotherapy, mass influence by other means is also possible and quite appropriate. This includes reading lectures and conducting conversations on basic psychotherapeutic topics (for example, about the influence of the psyche on the somatic, about the formation of habits, etc.). It is extremely important to raise the sanitary culture of patients through such conversations, which has both psychotherapeutic and psychohygienic significance. Furthermore, mass psychotherapy is also expressed in the organization of a therapeutic regime in hospitals and sanatoriums, as a result of which patients influence each other in a favorable manner as if automatically; here, in the activities of educational circles, in common walks, excursions, sports grounds, conditions are created for the development of healthy habits and the education of collective emotions, socialist purposefulness, etc. Mass psychotherapy is especially effective for cultivating activity. It is advisable to combine it with physical culture and sports. Indecisiveness, tendency to vacillations and doubts are smoothed out when the patient as if absorbs the rhythms and pace of his comrades, developing in himself speed, accuracy and completeness of motor reactions. The so-called rhythmic gymnastics also acts in this direction, which has recently been the subject of a whole series of scientific works. Psychotherapy of somatic disorders, despite its importance, is still insufficiently developed. Here a joint research work of a psychoneurologist with doctors of a number of other specialties is foreseen. Psychotherapy in heart diseases is applied in the form of rational psychotherapy and suggestion. The heart patient perhaps needs psychotherapy more than anyone else, since the consciousness of having a diseased heart in itself acts oppressively on the psyche. The lack of medical culture makes the patient see the risk of sudden death in every heart disease. Nowhere are iatrogenic accumulations as widespread as in this area, which by the way also receive nourishment from the terms 'vice', 'angina pectoris', 'degeneration of the heart', etc. From a psychotherapeutic point of view, great foresight is necessary in every prohibition to work, to take exercise, in every prescription of prolonged bed rest, etc. In bronchial asthma, digestive disorders (gastrointestinal hypochondriacs), the influence of the psyche has enormous importance. There are numerous cases of favorable results of psychotherapy in such sufferings, which for many years were subjected to spa and even surgical treatment. A whole series of such facts served as the occasion for compiling an extensive monograph under the editorship of O. Schwarz 'Psychogenesis and Psychotherapy of Somatic Symptoms' (Psychogenese u. Psychotherapie korperlicher Symptome, 1925), where corresponding light was shed on cardiovascular, pulmonary, gastrointestinal, gynecological, andrological, ophthalmic and other diseases. Various particularities of psychogenesis require corresponding variants of psychic influence. Generally speaking, here still prevails an unsystematic, random eclecticism or else a fanatical propaganda of some special method considered as a panacea. The question closely related to internal medicine about 'organ neuroses' is currently the subject of vigorous development (Bergmann). The need for a comparative evaluation of psychotherapeutic methods, for the development of indications and contraindications, for the discussion of a whole series of theoretical and practical questions led to the convening of several psychotherapeutic congresses in Germany (1926, 1932-in Baden-Baden and Hayheim). The reports of these congresses represent extensive and interesting material, however, unfortunately, testifying that: 1) representatives of various schools still occupy irreconcilable positions and therefore in the West to this day scientific psychotherapy as a coherent system does not yet exist; 2) that the vast majority of psychotherapeutic quests is marked by clearly idealistic, and often mystical tendencies. Soviet healthcare and Soviet reality at present provide a favorable soil for the development of the basic problems of psychotherapy, closely connected with the preventive and psychohygienic possibilities of our era. It is important to note that the 'neuroses' and 'psychogenopathies' observed in our labor force prove to be significantly less severe than was observed in the prerevolutionary period, and that accordingly a much smaller number of cases requires the deep individual processing of the patient which characterizes the work of the psychotherapist in the West (psychoanalysis and individual psychology). Psychotherapy in the conditions of our unified dispensaries, sanatoriums and to some extent resorts is reduced almost exclusively to explanation and persuasion, shown in superficially hypochondriacal syndromes, to collective conversations, sanitary education, cultural education, physical culture, occupational therapy, excursions, etc. But in more severe cases, Soviet psychotherapy also uses (with necessary limitations and corrections) the heritage of European science: suggestion and hypnosis, explanation, 'free associations' of analysts, etc. The profile of the psychotherapist is being formed in our country against the background of the basic principle of psychotherapy: after a thorough examination of the patient to encompass his entire organism, his psychic structure and to influence this unity from the side of his higher functions-his psyche as a personality, located in specific conditions of the era, profession, way of life, etc. The prerequisite is the historical knowledge of the development of this person, if possible a complete account of all factors and influences that contributed to his formation, taking into account the negative etiological moments and psychic traumas, relating either to the past or to the current situation, insofar as this individual, for one reason or another, qualitatively or quantitatively lags behind his collective in his pace. Into the profile of the psychotherapist as an obligatory trait enters as lively as possible an interest in therapeutic problems in general, in therapy as a practice, and not exclusively only the research attitude of the theoretical physician. Furthermore, along with solid neurological and psychiatric training, a thorough knowledge of psychophysiology is required. Finally, personal participation in public activity is absolutely essential, which on the one hand makes it possible to directly observe the living conditions of patients, the nature of conflict situations that cause in predisposed subjects neurotic deviations, and on the other-to study the extensive compensatory possibilities offered by life at its current stage.