Tuesday, 21 August 2018

minkowski's autism

Here's my translation of chapter 3 of (the revised and augmented edition of) Minkowski's (1953) La Schizophrénie. An English translation of Chapter 2 of the first (1927) edition has been made available by Cutting and Shepherd in their The Clinical Roots of the Schizophrenia Concept (1987 CUP), more recently reprinted in chapter 16 of Broome et al. (2013) The Maudsley Reader in Phenomenological Psychiatry. His Lived Time has also been translated (1970, Northwestern University Press; a chapter from it is also in the Broome et al volume); as has 'A contribution to the study of autism: The interrogative attitude' (co-written with Targowla) (Philosophy, Psychiatry, and Psychology 2001, 8, 4, 271-8). But what is striking that, whilst Minkowski's book on schizophrenia is surely the most profound single volume on the topic, only 1 of its 6 chapters has previously been translated, and that from an edition which he considerably revised.

Minkowski truly had a great gift for bringing complex phenomenological thought to bear on psychopathological phenomena in a way which was humane, genuinely illuminating, and conceptually clear. The vast majority of today's writing on schizophrenia and psychosis is pitiful by comparison.

Eugène Minkowski
NB: this translation is neither authorised nor authoritative! My French is but poor. If you'd like to help improve the translation please let me know! This pertains especially to the parts where, being unsure of the best translation, I've included the French in square brackets. I've left untranslated Minkowski's core terminology of 'élan vital', 'élan personnel' and 'trouble générateur'. For the time being I've followed the translator of Lived Time in rendering 'devenir ambiant' as 'ambiant becoming' (but it seems to me that something like 'environmental flux' might work better).

The chapter concerns autism - in the original sense of the term as coined by Bleuler before the first world war, i.e. as a fundamental organiser of schizophrenic psychopathology. In fact Minkowski makes it far more central to our understanding of schizophrenic psychopathology than Bleuler ever did. He also revised Bleuler's conception, and something of his (Minkowski's) own earlier conception, of autism as having to do with interiorisation and immersion in fantasy, instead offering us a concept which equally includes the organisation both of the more world-engaging, and the more simply deficient, aspects of schizophrenic psychopathology.

[p.100]


Chapter 3: Autism


A. The Content of Psychosis, and Autism 

a) The content of psychosis

We take ourself to have shown, in the previous chapter, that the notion of a 'loss of reality contact' is neither a metaphysical conception nor a pointless verbal reformulation. The concept has made it possible for us to bring to light new psychopathological data and to develop a plausible explanation for it. To continue our work we must now once again return to the origins of the concept of schizophrenia.

Freud's work had a great influence on Bleuler's thought. He says so himself in the preface to his treatise [Dementia Praecox or the Group of Schizophrenias]. The notions of the content of psychosis, complexes, and autism are a result of this influence. At that time Bleuler had Jung for a valued collaborator. In 1907 he [Jung] published the first work on psychosis inspired by psychoanalysis, the Psychology of Dementia Praecox, a work that was a milestone in our science.

The approach developed by Freud in The Interpretation of Dreams was thereby applied to the morbid manifestations of the insane.

This was certainly not the first time, in the history of psychiatry, that a connection was made between dreaming and psychosis. To proceed thus is basically as old as the world, yet it's just this circumstance that provides the opportunity for putting into relief one of the essential features of contemporary psychiatry - that is to say, the scope accorded to the affective factors in the genesis
mental disorders.

Under the influence of Descartes, it became customary to consider

[p.101]

man above all, not to say exclusively, as a thinker. It has similarly been from this point of view that psychiatrists have discussed the problems they were studying. Madness was then above all a "loss of reason". The similarity between dreams and madness was more than obvious, and these two phenomena became nothing other than a "degradation" or a "complete anarchy of thought", a veritable "vagabondage intellectuel" [...just too pleasing-sounding a phrase to translate!]. We do well to remember today that it was on the basis of this rather superficial observation that Moreau de Tours proclaimed "the identity of dreaming and madness" in 1855. (In the Annales médico-psychologiques.) [footnote 1: We find a history of the problem which interests us here in S Freud, The Interpretation of Dreams, and also in R. de Saussure (1926). 'La psychologie du rêve dans la tradition française', in R. Laforgue (ed.) Le Rêve et la Psychoanalyse. Paris: Maloine.]

This general formula, however, was not designed to satisfy contemporary psychiatry. Thus we find, as regards this problem of "dreaming and madness" [rêve et folie], two different currents emerging, both of which deepen the problem in question.

One of these currents, followed mainly by the French school, looks to find a semiotic [or symptomatological?] similarity between dreaming and certain forms of mental illness. In both cases one finds the presence of signs such as amnesia, the predominance of rapidly moving visual hallucinations, the absurdity and incoherence of thinking, etc. On the basis of the presence of such signs Lasègue concluded in 1881 that "alcoholic delirium is not a delirium [délìre], but a dream [rêve]". Régis then clarifies the concept of a dream delirium [délìre onirique], as one of the forms of mental illness with a toxic-infectious origin. This current thus became a clinical notion.

However, there has also been a discussion in France in recent years regarding delusional daydreaming [délire de rêverie] as well as morbid daydreaming [rêverie morbide]. (G. Heuyer and Borel; Claude, Borel and Robin.) This delusional daydreaming differs entirely, symptomatologically speaking, from delusional dreaming [délire onirique]. They share nothing in common. We'll consider this further, and formulate it more precisely, in the next chapter on schizophrenic attitudes [attitudes]. Here, it suffices to note that this circumstance shows that the issue of "dreaming and madness" [rêve-folie] may yet be approached in a completely different way.

[p.102]

This different way is taken by the second current [courant] we presented earlier and which, by opposing itself more and more to the universal rationalism of the past century, strives with all its might towards an affective psychiatry and an affective psychology.

It is with this that we shall principally have to deal in the following pages, and it is only so as to better highlight its scope [portée] that we want first to say a few words on the other ways our science has taken with these same issues.

Admittedly, at first sight, the dream appears full of absurdities and inconsistencies, to be nothing but a vagrancy of thought [vagabondage de la pensée]. But according to Freud this affects only the outer envelope, the manifest content, of the dream. Behind this hides something else: the dream's latent content, consisting of repressed wishes and desires, touching on the most intimate and essential fibres of the individual's being. The dream is no longer a trivial, banal and absurd event; it now has a precise meaning; it integrates itself, so to speak, into the dreamer's life. It's all about knowing how to decipher it. Freud taught us this, using his method of free association.

But why, so as to translate the desires that reside at its base, does the dream adopt this singular form which has allowed our predecessors to see in it only a vagrancy of thought?

Repressed desires constitute the latent content of the dream. But the drives in whose name the repression operated remain in play even during sleep. The clash, the conflict, is reproduced here, although in a reduced and less violent way, because of the "weakened responsibility", if one may put it like that, of the sleeping man. [Le heurt, le conflict se reproduit ici encore, quoque en plus petit, d'une façon moins violente, en raison de la "resposabilité atténuée", si on peut s'exprimer ainsi, de l'homme endormi.] Repressed desires, often ignored even by oneself when awake, emerge in dreams. They dare not, however, do so in a clear and explicit way. Censorship makes sure of this. This is why the repressed desires present themselves to sleeping consciousness under a mask that seems impenetrable and is made of symbols, vague analogies, and substitutions of people and places. A particular kind of thinking [i.e. primary process thinking] is thereby constituted. Freud's work teaches us how to decipher and understand it.

Nothing is changed in this general trend by the fact that some psychoanalysts, like Jung, Riklin and Maeder, in moving away from the Freudian conception, no longer want to see in dreams the expression of repressed desires, but rather attribute them with a

[p.103]

much more teleological [prospectif] role. They consider the dream to be the product of creative psychical activity and see in dreams' symbolic form the expression of an emergent tendency which cannot be translated otherwise, not because it is repressed, but simply because it is not sufficiently mature or precise to adopt the form of conscious discursive thought. Here, too, we are dealing with the essential tendencies [tendances] of the individual and with the particular form in which they manifest themselves and which, being entirely different from ordinary thought, seems at first sight to be incoherent and incomprehensible.

But does such dynamic content [contenu vivant] not also hide behind the incoherent words and actions of the insane? The problem of the content of psychosis is thus posed. Dreaming and madness are brought together again, but no longer from the point of view of a symptomatological similarity and even less in terms of a mere intellectual vagabondage of thought's being [simple vagabondage intellectuel de l'être pensant]. No, this time these two phenomena are considered to express real, if particular, tendencies and desires of the living being, "seemingly incoherent" from the point of view of everyday life, but arising when [mais au fond admissible là où] the individual turns away or detaches himself from practical activity and doesn't address himself, so to speak, to anyone. Dreaming and madness are phenomena of the same order, in so far as neither of them seek to integrate themselves in an appropriate way to the surrounding reality [realité ambiante]; in this way they create their own language.

C G Jung
One of the first cases Jung described remains etched in my memory. The patient was an old "demented person" ["démente"] who had spent many years in the asylum. She predated the director, the assistants, and all the nurses. Nothing was known about her. Nobody came to see her. She herself could not provide any information about her past, her only external expression [manifestation] being the continuous and stereotyped rubbing of her hands. The skin of the palms of her hands had become as thick and hard as leather. Everyone had known her from time immemorial and had become accustomed to always seeing her in the same place, carrying out her stereotyped gestures like an automaton. Yet one of the nurses in the clinic - the oldest one - said that she remembered that, long ago in the past, the movements of the patient were wider and singularly reminiscent of those of a shoemaker at work. At that time the nurses called her "the patient who sews shoes". One day the patient died. An old cousin

[p. 104]

came to the funeral. Jung asked him if he remembered how his cousin had fallen ill. The old man searched in his memories: "Ah, yes, I remember," he replied, "the illness began as a result of an romantic disappointment [chagrin intime]; she had a boyfriend [ami] who abandoned her." - "But who was this boyfriend?" - "He was a cobbler."

Now, obviously we don't share the simplistic view of Jung's interlocutor, which consists in seeing an efficient cause of the illness in the lovesickness. Yet this doesn't prevent us from saying that the poor gestures of our patient maintained a meaning, that this last vestige of her activity is connected with an event with a heavy affective burden from her distant past, that this past survives, in spite of the years that have passed, in spite of the progressive deterioration of the personality, and animates this small flame of memory still flickering inside her.

Consider now another of Jung's patients. He is a young scholar who has published works much appreciated by his colleagues. Timid, puny and stammering, he leads a withdrawn life and seems to have found in science the supreme satisfaction that life can accord one. On the occasion of a trip to B, however, he had an outbreak of violent excitement. He performs bizarre exercises, saying that he's doing gymnastics, proclaims in a loud voice his handsomeness and extraordinary strength, as well as of a law allowing him to acquire [ainsi que d'une loi permettant d'aquérir] a very melodious voice. He had already had a similar episode which had also occurred on a trip to B. He saw himself at the head of numerous armies which he was leading to victory. For this glorious deed he obtained by way of reward the hand of the girl he had once loved. In reality, as he explained once calm had been restored, his shyness, heightened by his stuttering, had always prevented him from confessing his love to her. Now she lives, married to another, in B. He claims to have completely forgotten about this. He wants to be in B "by chance"; he just went there to get some rest.

The patient's incoherent gestures and words, which necessitated his sectioning, also now become intelligible. The content of his psychosis appears clearly before us. The mechanism of compensation is obvious.

Our young scientist can now afford the luxury of being beautiful as Apollo, strong as Hercules, eloquent as Demosthenes and of winning the hand of his beloved, which he thought he had to give up

[p.105]

in reality because of his weakness. As for the trips to B, let's just say that there are "accidents" in life that have nothing to do with real chance.

We will not go so far as to say that the psychological matters which we have just mentioned have alone determined the appearance of mental disorders. Nonetheless they constitute the dynamic content [contenu vivant], and we can't ignore the value and scope of this finding.

Another patient [fn E. Minkowski (1922). Recherches sur le rôle des complexes dans les manifestations morbides des aliénés. [The case of Marie L.] L'Encéphale, 17, 219-228 & 275-281.] becomes very violent when in a state of extreme excitement. She throws herself at the nurses and tries to tear away their keys. Seeing a bowl of black coffee on the table, she furiously throws herself on it so as to knock it over. She calls herself the Empress of Russia and speaks of going to Poland to save the Fatherland. She speaks too of going to heaven to save the world and to be reunited with her father. She thinks she's being persecuted by, amongst others, her mother and her brother. She consumes only milk and bread. Sometimes she mutters her prayers, staring at the sun, unbothered by its rays.

On recovery, the patient herself explained the disturbances she experienced during the psychotic break. Everything had a symbolic meaning for her. Black was the devil's color. Once the doctor who came to visit had an ink stain on his gown; because of this she was convinced that she had an envoy of the devil before her. For the same reason, she wanted to knock over the black coffee bowl at all costs. She was especially afraid of the colour red, for red means fire and blood - and also love. White, light blue and gold were the colours of the sky, so she could drink milk which, by the way, as she drank it, turned sky-blue. She only allowed herself to eat what grew above the earth, such as fruits. Potatoes, however, were forbidden, since the surface of the earth represented the dividing line between heaven and hell, between good and evil.

All objects had a special meaning. The keys which she wanted to seize were the keys to heaven. The spoon was a sceptre. She broke up her watch chain to completely separate heaven from earth. She had two rings. One was adorned with a ruby, and she threw it away: it was the ring of the devil. The other one had three little diamonds, and symbolized the Trinity, so she kept it.

[p.106]

For her everything related to the struggle between heaven and hell. She herself was sometimes God and, to symbolize the Trinity, she constantly kept bent three of the fingers in her hand. She said she could fly, which is why, when at home, before she entered the asylum, she tried to rush off the balcony, convinced that she would fly straight to heaven.

She then tells us of her past. She was very fond of her father who, like her, loved "ideal things". Her mother and brother were by their nature much cooler and down to earth. Hence there were frequent arguments between her parents, and also her mother's marked preference for her brother over her. Her life was not very happy. Her father lost a lot of money speculating on the Stock Exchange; her mother appropriated [sa mère sut s'approprier] what remained of their capital, as a result of which the father died miserably in hospital. For this reason, and contrary to what she would have wished, she herself received only a practical schooling. As a result she had a sense of inferiority, which she felt especially when in the company of educated people, and which, because of her growing obesity, only increased in later years. Her worship of beautiful and lofty things increased to the same degree.

Yet, a few years ago, life seemed to want to smile on her. She met a Polish man, educated and cultivated, who loved her. He spoke to her a lot about his country and often called her "my Queen" or "my Princess". Hence her idea, when psychotic, that Poland was being rebuilt and that she was becoming the Queen of Poland. And at the beginning of her episode, she wrote on the back of a business card "come right back" and held that card in front of the window, hoping that the pigeons - which she took for carrier pigeons - would carry her missive to her boyfriend in Poland. Yet this romance, in reality, was but short-lived. She broke off her engagement since her brother to whom she was very "attached" had opposed it. Since then, her life has been a series of letdowns and setbacks.

These three examples, chosen for their simplicity and reproduced here in a summary way, illustrate clearly that at which the concept of the content of psychosis aims. Here it's a matter of deciphering the meaning of the incoherent manifestations with which we are presented, bringing them back to the events with a heavy affective burden from the patient's past. These events are called, in this field of research, the complexes.

To better situate the concept of the content of psychosis, we must

[p.107]

make two important observations, in particular because this part of the Bleulerian conception has often been misinterpreted in France.

1. The content of psychosis is not the exclusive property of any single mental illness; in itself it doesn't itself imply any particular diagnosis. It is wider than the scope of schizophrenia, since there is nothing to prevent us from applying it to other clinical entities, like manic depression or general paresis or, if you will, delirium [le délire onirique]. It is therefore first and foremost a concept of general psychopathology. If, however, it has had its greatest success in the domain of schizophrenia, this is because we find ourselves here in the presence of manifestations of mental illness which outwardly could not be more 'incoherent', could not be more impenetrable to our understanding.

Preceding this, we had not even the narrowest window through which we could peek at what lived behind this word salad, these stereotypes, this mutism, this disorderly hyperkinesia that one so often finds in schizophrenics. All of this desert suddenly sprung to life, thanks to the research of Bleuler and Jung, undertaken under the influence of Freud's works. The cornerstone of the psychology of schizophrenics was thus laid, as Wilmanns says [fn. Wilmanns, Die Schizophrenie, in Zeitschr. f. die ges. Neurology u. Psychiatry. Vol. 78]. But, and I want to stress again, this is all only psychology. The presence or absence of complexes is no basis for a differential diagnosis. That must be based, for schizophrenia as for any other disorder, on the side of what is defective [sur le côté deficitaire], i.e. on the basic symptoms and pathognomonic behaviours [le comportement particulier], as have been specified by Bleuler. No single event, no single phenomenon from normal life, suffices to elaborate the notion of an illness. That can be based only on disturbances and abnormalities, and not on the psychological content of psychosis. This does not, of course, diminish the enormous significance for us of any attempt at making comprehensible the incoherent expressions of the mentally ill, at bringing their psyches closer to ours.

2. The notion of the content of psychosis does not necessarily imply

[p.108]

that such content is the cause of psychosis, nor even that of the psychogenesis of the disturbances to which it applies, let alone that of the illness which causes them [qui les conditionne]. We have already suggested this above with the examples we've given. To have discovered the psychological meaning of our patient's stereotyped movements did not mean that the complexes reflected in them were its efficient causes. We can well accept that a trouble générateur leads to such abnormal manifestations as stereotyped movements. Nothing prevents us, for example, from interpreting these movements as an expression of the élan vital, as the appearance of an elementary rhythm that is but a running on the spot, an eternal re-beginning without any progression. But this interpretation does not prevent us from using the complexes to try to understand the symbolic meaning that the same movements may have, nor from grasping why they take one form instead of another in the patient in question. Neither of these interpretations excludes or contradicts the other. Neither claim an absolute exclusivity.

Henri Bergson
It is not even possible today to say what should be given etiological pride of place. Let us once again recall here that Bleuler posits an organic factor as lying at the base of schizophrenia. He never tires of repeating it. This organic disorder is expressed, on the psychological level, first of all by a loosening of the associations (Lockerung der Assoziationen) which is the essential disorder of schizophrenia. The complexes, on the other hand, serve only to make comprehensible the meaning of the basic symptoms and of the secondary reactions, themselves being generated by the underlying schizophrenic disorder and lending each case its distinctive hue; in no sense do they create the psychosis. While diverging from the master when it comes to the psychological interpretation of the underlying disorder [trouble initial] in schizophrenia, while moving closer and closer to Bergsonian notions, we remain in full agreement with him in attributing to the complexes only a secondary role in the pathogenesis of this condition. We shall find occasion to return to this point later.

[p. 109]

b) Autism

The man who dreams sleeps, and it is the state of sleep which, by temporarily suspending
reality contact, allows more or less hidden desires to manifest as fantastic and strange dreams which at first are indecipherable. The schizophrenic, however, does not sleep, and yet his yearnings are sometimes expressed in the same way. What, then, is the mechanism which, as with sleeping for dreams, determines the peculiar form of the schizophrenic disorders, a form which we presume in some way to be analogous with dreams?

This is where the notion of autism becomes relevant. Consider what Bleuler wrote in his monograph [Dementia Praecox or the Group of Schizophrenias]:

The most severe schizophrenics, who no longer enjoy contact with the outside world, live in a world of their own. They have encased themselves with their desires and wishes which they consider fulfilled, or occupy themselves with the sufferings resultant on the persecution of which they imagine themselves the victims. They keep their contact with the outside world to the bare minimum.
This detachment from reality, along with the relative or total predominance of the inner life, we call autism.  
In the less severe cases, reality has only lost something of its emotional and logical significance. These patients still move about in the external world, but neither evidence nor logic now have any influence on their desires or delusions. Everything that is in contradiction with their complexes simply does not exist, neither for their thought nor for their feeling. 
A well-educated patient said that she had built a wall around herself in such a manner that she often had the impression that she now lived in a chimney. 
The word 'autism' expresses, in a general manner, the positive side of what Janet, from the negative side, called "loss of sense of reality." We cannot, however, accept this expression without reservation because he understands the symptom in too general a sense. The sense of reality is not entirely lacking to schizophrenics. It fails only in the presence of events and things that contradict the patient's complexes...
[p.110]
The presence of autism is not always immediately apparent. The attitude of many patients betrays nothing untoward on first sight. It is only by observing them at greater length that we can see the extent to which they are anxious to follow their own path and to remain impervious to the situations they are in. Even severely chronic patients sometimes manifest good reality contact when it comes to the matters of life to which they are indifferent. They chat and play games, but nevertheless keep their complexes to themselves. About these they don't breathe a word, and don't want them to be touched upon. We can thereby comprehend their apparent indifference toward that which is for them of the greatest importance... [fn: I. It is interesting here to recall what Kretschmer subsequently said of the anesthetic and hyperaesthetic pole of schizoid affectivity. (Chapter I [here Minkowski refers to the present book] p. 25; [see ch X of Ernst Kretschmer's Physique and Character.])]
Ernst Kretschmer
The external world, when it confronts their fantasies, must therefore sometimes appear to them to be frankly hostile. In other cases, however, this isolation from the external world is determined by factors of an entirely different order. Certain patients, especially at the beginning of their illness, consciously flee the world, because their emotional reactivity is too great; they therefore seek to avoid any causes of emotion. Indifference to the external world is then a secondary phenomenon, a consequence of a heightened emotional sensitivity. 
In many patients autism is also reflected in their external attitude. Taking an interest in nothing these patients remain motionless, keep their faces averted, looking at nothing but the wall, and pull the bedspread or blanket over their heads, so as to keep to a minimum all external excitation.

Just as for autistic affectivity, autistic thought 'follows its own laws'.
This is what we wrote in our first exposition of Bleuler's schizophrenia:

We call such thought as no longer seeks to adapt to reality and which, on the contrary, is turned away from it, autistic thought (autistisches Denken); we contrast it with the ordinary form of thought, i.e. with "realistic" thinking (realistisches Denken) which, on the contrary,

[p. 111]

is always determined by the exigencies of reality and ultimately seeks to attain a maximal pragmatic value. The processes of autistic thinking are obviously quite different from those of realistic thinking. Autistic thinking no longer seeks to be communicated to others in a comprehensible manner, nor to direct conduct in accordance with the exigencies of reality; it no longer seeks to use words in an intelligible way. It enjoys but a subjective scope; it serves but the individual himself, and only in so far as it turns him from reality; it makes free use of special terms and procedures, whereby it can make a faster, more convenient and more apt use of terms to express particular complexes. It may be useful here to remember the little mnemonic devices we often use to lighten memory's burden; the mnemonic formula is, so long as we don't reveal the key to them,  by itself completely incomprehensible to others; it has but a subjective significance.

This comparison, however, is rather insufficient and does not capture autistic thought as a morbid manifestation. The reason is simple: the formula or the mnemonic chart is always related to the explicit thought that it replaces, and thus always pursues a practical purpose, whereas the autistic thought of schizophrenics pursues no real goal; it is governed by factors residing in the depths of their psyches, and can no longer be related by the thinker to any realistic thought; it instead conforms only to itself [elle entre alors en jeu comme telle].

"I am the master key" is nonsense from the point of view of realistic thinking; but in the domain of autistic thought, this sentence can might well have the following meaning: the master key opens all
the doors of the asylum; I would like to leave the asylum; I would need to be the master key to do this. In shorthand and in the form of a categorical statement are thus expressed both a desire and the necessary conditions for its realisation. But "desires" and "conditions" maintain their true nature only where they can be opposed to reality; here, by contrast, where this criterion are missing, they are placed on the same level; the conditional may be dispensed with and be conveniently replaced by the statement quoted above.

"I am Switzerland" is a phrase incomprehensible to us; for autistic thought, however, it may well have the following meaning: Switzerland is the symbol of freedom, I would like to be free. The symbol

[p.112]

is thus put in the place of that of which it ought to be the symbol; but a symbol is not a "symbol" except in so far as it relates to reality. For such thought as is turned away from reality, the difference between symbol and what it symbolizes accordingly fades away.

Now we shall no longer be surprised if a fragment of thought replaces its own explicit expression, nor if these fragments form a sequence the meaning of which escapes us, and which are associated
one to the other by links invisible to a reality-oriented mind.

Neither shall we be surprised if neologisms are not now always nothing but "neologisms". For sometimes it becomes possible to relate them to the explicit and corresponding form of realistic thinking. A patient of Jung's talked of the "Double Polytechnic" to designate, as his analysis showed,  all the qualities that he arrogated to himself, as well as the advantages for living that such qualities offered. The mentally ill sometimes manage to constitute in this way a whole language of their own. [fn. M. Cenac (1925). De certains langages créés par des aliénés. Paris: Thèse.]

Autistic thinking may also use analogies, even vague and remote ones, to put one thing in the place of another. A mentally ill person who once had emotional hangups with regards an orchestral conductor
could thereby go and make a scene with another conductor who she didn't even know.

Autistic thought can also without inconvenience bring together in the same object, person or scene,  features relating in reality to quite different objects, persons and events; this process is but one of the forms of condensation (Verdichtung) that we so often meet in this area.

Thus we find here the same mechanisms as we find in dreams.

The fact that manifestations of realistic and autistic thinking may obtain side by side in the same schizophrenic individual does not, of course, diminish the significance of what we just wrote about the latter.

Things seem clear. Yet Bleuler complains in his Psychology [fn. E. Bleuler (1921) Naturgeschichte der Seele und ihres Bewusstwerdens, Berlin: Julius Springer.], published in 1921, to have been misunderstood by some and even proposes replacing the seemingly better chosen phrase "Autistisches Denken" [autistic thinking]

[p.113]

with that of "dereirendes Denken" [irreal thinking], "Dereirend" coming from the Latin reor, ratus sum (ratio, res, real) intended to designate thought that "disregards or deviates from reality".

Where does this misunderstanding come from which Bleuler thinks may be dispelled by choosing a new expression? We will try to answer this question in the following section.

B. Reverie and the cycle of 'élan personnel' as prototypes, in normal life, of loss of vital contact with reality. Schizophrenic difficulties with personal activity. Rich and poor autism.

Let's take a look back over our description of autism and at the examples that illustrate it. We do not find it difficult to discover the predominance of the following: the individual detaches itself from reality and turns back in on himself, or rather to the inner complexes which henceforth entirely absorb him; he thus gives preference to his imaginary world to the detriment of reality, and externalises this state of affairs, especially in serious cases, in an attitude of hostility and with even more passivity and immobility as regards the external world.

And Bleuler, in his Psychology, while seeking to clarify the notion of autism, and complaining of not being understood, gives us new examples which are basically in line with the sketch we just retraced. "Children, and also sometimes adults, seem to themselves, in their waking reverie, as heroes, inventors or great men. During sleep, in our dreams, we can fulfil the most incredible desires. Similarly, the schizophrenic's wife, in his hallucinations, is a princess." "In its pure form "dereirendes Denken" [irrealistic thinking] appears quite different from empirical thinking. In fact, here we find all the degrees of it, moving from insignificant steps of acquired associations, affecting each judgement through analogy, until we arrive at a full blossoming of the imagination, which no longer knows any limits." ["En réalité, nous trouvons tous les degrés, allant d'un éloignement insignifiant des associations acquises, tel qu'il intervient dans chaque jugement par analogie, jusqu'à un épanouissement de l'imagination, ne connaissant plus de limites."]

Thus autism becomes and remains the synonym of interiorization, and the phenomena of the dream and of dreaming, taken from everyday life, serve as its paradigms,

[p.114]

to make the ways of schizophrenics clearer. The making of this comparison [between autism and everyday dreaming] may equally be explained from an historical point of view, since it was Freud's theory, developed precisely for the purpose of dream analysis, which provided the setting off point for research on the psychology of schizophrenics.

In particular Jung, in his studies, contrasted introversion with extroversion, the first corresponding to the essential mechanism of schizophrenia, the second approaching the manner of being of the manic depressive. Schizophrenia was compared to a dream in the waking state. This way of looking at things remained in place for a long time, and the distinction between two different types, introverts and extroverts, seemed likely to reflect the predisposition to the two great groups of mental illness just mentioned.

The notion of the complex is also at its apogee. The whole life of schizophrenics is, in all its manifestations, without exception understood as governed by their inner world, by their complexes, by their imaginary activities. These, by more and more removing the patients from reality, result in reactions which are bizarre, contradictory and incomprehensible from the point of view of an external examination. [contradictoires et incompréhensibles que nous constatons chez eux, en les examinant du dehors.]  To make this state of affairs clearer I made use, in my first study of schizophrenia, of a picture; I said that we can find, in the psyche of schizophrenics, a deep core, made of desires and fears, and a superficial layer which, lying between this core and reality, becomes the site of schizophrenic manifestations, variable, discordant and disappointing in their irregularity, but leading back to the elements of the deep core. [devenait le siège des manifestations schizophréniques, variables, discordantes et décevantes dans leur irrégularité, mais se laissant ramener aux éléments du noyau profond.] Kretschmer also says that schizophrenics have a surface and an essence.

With time however, the way of seeing that we have just described has shown itself to be too one-sided. It has some serious disadvantages. It easily leads to the notion that schizophrenics voluntarily flee the world, a notion a good deal more literary than clinical since, in reality, here we have to do with ill people who are to be understood as ill because they cannot do otherwise. This approach considers only one aspect of the problem. In reality schizophrenics are far from being completely passive beings, folded in on themselves, immersed in their waking reveries. They also act and this activity

[p.115]

bears a deep morbid imprint, and it is neither possible nor necessary to see this as always expressing hidden complexes. Their activity alone indicates a schizophrenic disorder and allows us to make the diagnosis, all the more so because, as we wrote above, our clinical concepts must above all register not such aspects of the psyche as remain intact, but rather the specific deficits in that presence which constitutes us. [mais le déficit spécifique en présence duquel nous nous trouvons]

To insist on the activity of schizophrenics is, in essence, to develop a truism. In reality, nobody has ignored it. The observations of Bleuler abound in examples of this kind. However, in our theoretical interpretations we have typically neglected this aspect of the problem, by immediately assimilating all schizophrenia to passivity, to internalisation, and to the dream. Today, the tendency to be a turncoat [changer le fusil d'épaule], so to speak, is becoming more and more apparent. We are witnessing a new stage of evolution, if fruitful previously [si féconde déjà auparavant], of the concept of schizophrenia. We will seek to highlight this new stage in the following pages.

Consider again the examples we gave in the first chapter when speaking of schizoidia [schizoïdie]. We will not find it difficult to see that the way in which the interpretation of schizophrenia does not exhaust the problem. We find among schizoids both introverts and extroverts, active people and dreamers, people who are determined and those who are irresolute. However, they all share a commonality in their relations with their proximal environment, and without exception all belong to the great family of the schizoids.

Here again let's cite an example. In a small and modestly furnished apartment lives, in straitened circumstances, the family of a public servant. The father's income is barely adequate for their everyday needs. One day the mother declares that she wants a piano so the children can continue with the music lessons they'd taken in the past when the financial situation had been better. The father tries to dissuade her with reasonable argument: their budget doesn't allow him to even consider such a possibility. Yet he argues in vain. She wants a piano and she will have one. She finds work sewing. She stays up all night working. And she talks of her desire no longer. But one day the father, on his way home from the office, finds to his surprise a handsome new piano. The piano is just there. It clashes with the rest of their furniture, with the whole life of the household; it's there like a stranger, like a dead thing without a future. It's mainly used by the eldest son who has just been through

[p.116]

a serious schizophrenic illness. He's certainly not a bad musician, but he now feels the need to play late into the night, thus provoking complaints from the neighbours.

For anyone familiar with these issues, there can be no doubt that here we have a schizoid manifestation. The purchase of the piano in these circumstances casts a light on the whole behaviour of the personality in relation to its surroundings. Yet there is no question here of interiorisation. The wife of our public servant is not content to imagine that she has a piano in a nice apartment where she receives princes and statesmen. No more does she perform [Elle n'exécute pas non plus des] stereotyped movements as if she were playing a piano. Finally, we do not believe that her desire must necessarily have a symbolic meaning and be motivated by a complex - for example by a formerly repressed romantic feeling for a music teacher. That is a possibility, but it's not necessary to posit it if we are to understand the particular behaviour we meet with here. She would like to have a piano, and we find nothing incomprehensible or morbid in this desire. She wants it at any cost, and she achieves her end. We should almost like to congratulate her on her perseverance. And yet something essential is missing from this whole experience. It lacks life. In these circumstances the piano is but a nuisance.  In its haughty majesty it strikes a discordant note in the modest interior into which it has been placed, and the act accomplished so tenaciously has no future, and dies of an excessive and blind rigidity.

The patient [i.e. the teacher] we described in the previous chapter, under the heading of the morbid rationalist, decides to protest against the condemning to death in America of two anarchists, a judgment that had received a lot of coverage at that time and which led to protests in favour of the two convicts. Our patient writes a letter of protest that he signs with his name, unknown to all the world; and succeeds, despite the security staff, in penetrating the American embassy, where he declares that he wants to deliver his letter to the ambassador. He is completely surprised that as a result of this both that he is taken to the police station and that he receives the blame of his superiors.

Our teacher's desire has nothing intrinsically morbid about it. It can even be seen to be in sympathy with the ideas of a whole section of society. The desire leads, however, to an act which is completely out of touch with reality, an act which could not be more "autistic".

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A young engineer, fresh out of l'École Centrale, is dismissed from his work because he made mistakes in his calculations and drawings. After several vain attempts of the same kind, he took the place of a simple 'scribe' in an insurance company. But once again he met with the same result; he makes mistakes with the receipts with which he has been tasked to deal. He returns home to his parents. There is a fast and profound decline. He sinks into complete inactivity and disinterest. His despairing parents ask him to look for a job. He does so and, on the same day, sends out 150 job applications to different addresses, without worrying whether such an approach has the least chance of success. On another day, without saying anything to his parents, he goes to Paris to look for work; in two days he walks away from the capital for 90 kilometres, arriving in such a pitiful state that he gets arrested for vagrancy, and spends several days in jail before the whole situation was cleared up.

Driven thus by a realistic idea (which is not to say by a realistic desire), the act by itself shows itself, in its realisation, and in spite of the energy spent, to be through and through autistic and schizophrenic.

Here the idea is coming to light that the concept of autism is not exhausted by reference to autistic thought and autistic affectivity. There exists furthermore autistic activity, i.e. an activity which is itself autistic. It is this perhaps which provides the key for understanding all schizophrenia. By having neglected it, we have been led to identify autism with interiorisation, with passive states of dreaming, with an absorption of the personality in the inner life, a life constituted by complexes and imaginary factors. To establish a balanced perspective we should put more emphasis on the other side of things and give autistic activity its rightful place in all our conceptions of schizoidia and schizophrenia. The unity of the concepts of complex and autism, determined by their common origin, will now seem to us more or less contingent. We can separate these concepts and then study their mutual relations.

We shall now try to do just this, by addressing again the notions that are dear to us, those of the blossoming of the personality [l'épanouissement de la personlité] and of vital contact with reality.

It does however seem important to indicate the causes of this unilateral interpretation of autism, which always reproduces itself anew.

[p.118]

We think it necessary to loosen the hold that a physiological conception of the human body often has on us. On this conception the surface of my body gets taken for the dividing line between the 'I' and the surrounding world. Autism, as a loss of contact with reality, cannot as it were be manifest only at this boundary. Hence the very natural idea that the individual who loses reality contact must fall back in on himself, not only from a psychological, but also from a physiological perspective. Which is to say that, by adopting an externally passive and immobile attitude, so that as far as possible the senses are protected from external excitement, this person lives only in his inner life.

But the notion of vital contact with reality, and here it is necessary to especially stress the word "vital", has nothing to do with physiology. As we said earlier, neither the blind, nor the deaf-mute, nor the tetraplegic, loses such reality contact. On the other hand, people with schizophrenia do lose it, without their having the slightest impairment of sensation or movement. It must therefore constitute a quite different matter. And if some schizophrenics transcribe, so to speak, this loss of contact in the language of physiology, by minimising their movements and perceptions - by adopting, in a word, a passivity that allows them to absorb themselves more in their inner world - this, obviously, should not necessarily be considered to be a schizophrenic illness's only mode of expression.

As we saw earlier, schizophrenia may also manifest directly in the human personality's activity. But here matters appear rather differently. A man's action tends towards a purpose which, by its nature, is always outside of him, since by the work [l'oeuvre] he does a man always transcends himself. He cuts out, if one may put it like this, a slice of the the world and associates it intimately with his person. As long as he fixes this goal he makes it one both with himself and with all the external forces he uses to reach it. Here the dividing line between the 'me' and the 'not me' [le 'moi' et le 'non-moi'] is no longer the surface of the body, for it obtains elsewhere, away from that surface. (Please ignore here the spatial language which can only render such relations as are here in play very imperfectly.) This line may, however, also become rigid, opaque and impenetrable - it can turn into a veritable piece of armour.

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It is here that we meet with loss of vital contact with reality. This loss presents itself in what, on a superficial examination, looks like a different manner than that which we saw in the passive individual. But the disturbance is basically the same in both cases. There is therefore no reason to separate them from each other. "Reality" is far from always synonymous with "external world" and therefore it seems wrong to want to equate at all costs lost reality contact with internalisation.

While I'm hammering a nail with a hammer, I become one with these objects. The external world now begins further away. If I bang this nail down just for the sake of banging it down, and not so as to hang a painting there that I can look at afterwards, if I continue my work despite learning that the painting I wanted to hang has been broken or that my nail is seriously damaging the wall, if I now only act so as to execute my decision at all costs, if finally, despite hearing my son cry and call for help from the next room, I do not interrupt my work, then I shall in all these cases at least warrant the designation 'schizoid'.

Consider now another scene. Sitting in my chair, with my eyes closed, I'm immersed in my thoughts on schizophrenia and already imagine my work being met with unanimous approval. Just then my wife comes to put a hammer in my hand, asking me to fix a loose nail, for otherwise the painting hanging on it risks falling on the childrens' heads. Now I experience the hammer as a foreign body, as something harking from the external world. If I don't move, I will again warrant being treated by my wife as schizoid, and rightly so.

In both situations we basically meet with a failure of the same order. We can't do better than describe this failure using the concept of lost or inadequate vital contact with reality. The only difference is that, in the first situation, we're dealing with a man in action and with relations with the environment determined precisely by his activity, while, in the second case, we encounter a man who is externally passive and immersed in his thoughts. The latter seems for the moment to have a more intense inner life,

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but in the end their behaviour in relation to the world is the same. One is absorbed in his scientific reverie, the other in action, yet both in the same way forget about the rest of the world.

This example is obviously only an illustration. Yet it serves as an introduction to a closer examination of the problem. An incursion into the field of normal psychology once again becomes necessary.

Passive states of internalisation, dreaming or daydreaming do not exhaust autism. Autistic activity requires a special study. This requires us to say what we mean by "activity". We will not take as a starting point for this study the notion of voluntary movement. This notion, one of the bases of the physiological science of motor skills, is basically a product of abstraction, developed for the purposes of this science, and only of this science. Voluntary movement represents what remains of our activity after we have cut it off from what is most essential in it - by which we mean its continuous progression and the goals toward which we move that it never tires of setting for itself. Never in actual life do we desire to do something as useless as lifting a leg or bending an arm. 

It will also not serve us well to study either isolated volitions or the will as these phenomena are conceived of by traditional psychology. Have we not seen above, with the wife of the public servant, that an "excess of will" may by itself already have a schizoid character? What matters above all here is the way in which goals and acts follow and relate to one another, the way they express themselves and adapt to environmental changes, their desirability, the degree of their malleability at the time of execution, etc. In a nutshell we must take, as the subject of our studies, human nature in its vital dynamism. 

We consider it useful to introduce, for this purpose, the concept of a cycle of personal activity [cycle de l'activity personnelle]. Here is what we're envisaging. We demonstrated, when speaking of syntony, how we are capable of penetrating environmental happenings, confusing ourselves with them, vibrating in unison with them under their influence. This however is only one aspect of life; it doesn't exhaust it. What stands and becomes evident against this background of harmony is the 'élan personnel'. A rupture occurs between us and the world; we don't want to just be confused with it and even less to conform to it, we wish instead to 

[p.121]

assert our personality, to exteriorise our most personal self, to leave behind a personal imprint, to impose ourself on an infinite world, to produce new things, to create. That is, we also oppose ourselves to the world and feel a loss of contact with it [sentons s'évanouir le contact avec lui]. The more our élan is intense and individual, the greater the tension between the self and its surroundings.

Thus it would seem that a schizoid factor is involved [y est ainsi contenu]. Such oppositionality, however, has its limits. The élan leads to creative activity [oeuvre] (in the widest sense of the term) and this, however revolutionary it appears, will only have a value if it is yet addressed to someone and if it seeks integration with reality. The creative work [oeuvre], in standing apart from us, can cause a more or less significant disruption in ambient becoming, but the equilibrium establishes itself anew. Becoming continues to roll on with its powerful waves, as it did in the past. There are limits here that élan personnel never exceeds; where the voice of élan personnel becomes too powerful and is taken literally, there, in a word, where one wants only to create something absolutely personal, the work doesn't become more and more revolutionary or original; no, it deteriorates and becomes nothing but the gesture of a poor crank or mentally ill person; life passes on by taking no notice. But these limits of which we're speaking here: who truly has sufficient intelligence to provide a precise formula for them? They escape discursive thought; it is intuition (syntony) that guides us in life to this point of view.

Yet this is not all. Once we've completed our work [oeuvre], we relax; reality contact is recovered; we again feel the need to merge with reality, to have it penetrate us, to draw new energy from it. We grant ourselves a moment of rest, rest which is neither idleness nor inactivity, nor a temporary interruption of work as recommended by mental hygiene, but which, on the contrary, is rich in living content; we let ourselves be rocked by the waves of becoming, we drink deep from living sources, we taste the sublime sensation of being one with them. Then the élan personnel awakens again, it puts into its crucible the elements it just drew from the fount of reality, it rises up, in all its dramatic power, [il refond dans son creuset les éléments qu'il vient de puiser à la source de la réalité, il s'élève, dans toute sa puissance dramatique] and seeks finally to integrate itself anew, to produce a new creation [oeuvre].

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And then the cycle begins again, and continues repeating indefinitely, for as long as a breath of spiritual life still flutters in us. For we always want to go further, further even than death itself [par delà la mort même]. The work accomplished has no value, for our personal becoming, except in so far as it prepares for future work, except in so far as it allows us to hope to do better one day. The very meaning of the Good, the Beautiful and the True: isn't it to always aim for the Best?

The cycle of élan personnel  poses as complex a problem, with respect to the psychopathology of schizophrenia, as do dreaming and daydreaming [Le cycle de l'élan personnel pose des problèmes autrement complexes, par rapport à la psychopathologie de la schizophrénie, que ne le font le rêve et la rêverie]. But once seen the problem may no more be evaded. It's altogether far too intriguing for that. We make no claim to solve it here. It's enough that we make a start, enough that we hope to do better one day.

That continuous movement of ambient becoming does not cease to fully immerse the élan personnel in the various stages of its life cycle. Beyond the fundamental opposition between the "I" and the ambient becoming, it makes them into a unity. For that reason, here we have nothing but [Tout en lui, pour cette raison, est] continuity, mobility, relativity, life, progress.

It is in this intimate contact with ambient becoming that a rupture may obtain. Syntonic factors may be lacking. This results in various forms of schizophrenic degradation to a subject's activity.

This problem is not entirely new to us. Read again the above discussion of morbid rationalism. We find there in nuce the problem now under consideration. Our teacher wants to reflect and produce a personal work. But he takes to the letter the opposition that exists in any élan between self and not-self. He rationalizes. So as not to spoil his thinking he no longer reads at all, and avoids all contact with his peers. Furthermore, the result of his reflections is a theory which posits that consciousness flows from the action of acids on nerve endings, a theory which is meaningless and without practical significance.

This is by no means the only example. We gave plenty of others in the above pages, and it's time to see if we can bring a little more order to the discussion.

In cases such as that of the public servant's wife, we aptly speak of actes sans lendemain [perhaps: acts which no longer express purposeful activity]. Here the fixed goal obstructs the horizon and, despite the energy expended, dies as a result of its excessive fixity. In life, every goal has only relative value for us, it is

[p.123]

but a step, one rung, above which we always look further. Banging a nail in a wall, just for the pleasure of it and without thinking of the picture which could be hung on it, seems a real degradation of personal activity.

One of our friends, a schizoid, who we talked about in the first chapter, said to us one day, "When I made a decision, it was necessary that I executed it at all costs, even if during the execution I realise that I'm wrong and that trouble will inevitably result for me from the decision I've taken. But I decided it, so I have to do it." In a very similar manner, a schizophrenic once said to us:
"When I want something, I want it passionately. I'd walk over dead bodies to achieve it." This individual remains stuck with a fixed goal, isolated within himself from the ambient reality, deaf to reality's calls during the execution of the act. The act here has lost its malleability, its relativity, its natural vitality. It has acquired an absolute value and rendered the individual paralyzed and blind. Whoever, whilst hammering a nail, even if he is doing so to hang a painting, is so identified with the task that he doesn't react when he hears a child call for help from the next room, or continues with the work despite being told that the nail is seriously damaging the wall, is certainly not short on autistic characteristics. The ambient world, with what it implicates by way of the necessity of constantly reprioritising the new phenomena it presents, is gone. It's a a frozen act which we now have in front of us.

Our teacher feels the need, as have so many others, to protest the condemnation of communists. Our engineer bows to the authority of his parents and goes off in search of work. But neither of them remember the necessity of choosing the method whereby the act can be integrated with reality, elevated above its purely autistic value, and given realistic scope. Furthermore, they lead to monstrous consequences. As we understand it this amounts to short-circuits (Kretschmer) or to irrelevant or approximate answers [Ce seraient là pour nous des actes à court-circuit (Kretschmer) ou des actes à côté].

One of our patients, in describing his life, told us: "I always had a taste for literary matters. I even tried to write and published a few literary studies. Then I gave up publishing my works; I now wrote them for myself. I would even have given up on writing my thoughts, but unfixed thought easily becomes smoke and escapes us." Another patient told us one day:

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"I have to go shopping, I arrive at the store which I've chosen in advance, and then find that, whilst I've not forgotten my plan, I don't go into the store, for nothing pushes me in." Here we have to do with acts which stop half-way, acts which no longer look to be exteriorised, which don't seek fulfilment. [qui ne cherchent pas à aboutir]

The subdivisions which we just established obviously have only a relative character [Les subdivisions que nous venons d'établir n'ont évidenement qu'une valeur toute relative].  A frozen act, like a short-circuiting act, is almost inevitably condemned to remain without a future. Conversely, an act without a future is always more or less fixed and immobile. However we wanted here to briefly indicate these varieties so as to show that personal activity, enveloped in all parts by ambient becoming, and during all its various phases, can be detected in the failure of reality contact [Nous avons cependant tenu à indiquer brièvement ces variétés pour montrer que l'activité personelle, enveloppée de toutes parts par le devenir ambiant, pouvait se ressentir de la défaillance du contact avec la réalité au cours des diverses phases de sa réalisation]. But what is important to us here above all, what we are trying to bring out, beyond these differences in nuance, is the essential character of the degradation suffered by such personal activity as is deprived of normal reality contact, and to show thereby that the study of autism, hitherto too easily assimilated to internalisation, must be completed with a chapter dealing with autistic activity.

Taking up the point of view adopted here enables us to consider further peculiarities of schizophrenic comportment.

Schizophrenics and schizoids very often don't know what it is to rest - as rest was defined above. This feature of life doesn't seem to exist in their psyches. Is this not also an expression of pure syntony, consisting in a particular gift, allowing them to merge with the universe in an atmosphere of complete calm and harmony, finding there a source of joy, which whilst fleeting is yet so deep? No; the schizophrenic does not have the necessary sensibility to savour such relaxation. Or he does nothing, becoming completely inactive, and here we find an emptiness in him, a cold and lugubrious emptiness constituting the opposite of repose. Or he fastens onto an idea, onto an imaginary scenario, onto an always-repeated gesture. Or finally, and this is the point of particular interest here: deprived of the ability to appreciate the positive value of a moment of free time, he seeks to fill every moment with his activity, without allowing the slightest moment of respite, without leaving the tiniest amount of free space. In no way do we here derive the impression of someone busily going about his business, but rather

[p.125]

that of extreme tension and, at the same time, of a stagnant pond. The teacher, of whom we've already spoken more than once, "passes all his actions and all his words through the sieve of his principles. He wants his acts be organised at every moment and to have his mind constantly occupied". He also looks to occupy himself constantly with intense work. Furthermore, before sitting down to eat, he draws up in advance a plan of the thoughts with which he is to be occupied during the meal. And he weighs up every word that he speaks and answers his parents' questions only when he considers it particularly important. Along with M. Rogues de Fursac I've proposed that this trend to make one's own self the field of such incessant activity be called active egocentrism [égocentrisme actif].

We find, in the actively schizoid individual, if to a lesser degree, the same need to fill every moment with activity, although here the activity provides a greater return. The syntonic [i.e. mentally healthy] individual seeks repose because he knows how to savour it, even when he's not expressly tired; he likes his holidays. The schizoid individual may break off his work when he runs out of strength, but never truly rests; he just doesn't know what that would be. A confrère said to me one day, on seeing me set off for a walk: "Do explain to me what pleasure you find in going for a walk; it's something I've never been able to understand; I've never felt the desire for it, never felt the need to take time for relaxation." Another confrère decided to take a four week break from his work and his laboratory. There was a very significant reason for this: it was his honeymoon. He piled all his notes and files into his suitcase to avoid wasting any time on the journey. But this wasn't enough. He came home after eight days, declaring that he couldn't live without working.

Finally, sometimes, the élan personnel, detached from the surrounding ambiance, entirely halts and falls apart. The schizophrenic falls into the void.

The engineer we spoke of earlier, after those bizarre steps he took to find a job, was taken to a sanatorium. There we observed him for several months. We detected no hallucinations, no delusions and, despite repeated examinations, no signs of an inner life. Here we meet with the terrifying prospect of complete disinterest. He spends his time in his bedroom, sitting on a chair or walking up and down.

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He cares for nothing, no longer takes a newspaper in his hand [ne prend plus un journal dans la main], expresses no desires, speaks spontaneously to no-one. We should have loved to find even just a small flame of life in him, even one with a morbid hue. But in vain. We find no oases in this desert, find nothing to hang onto, or to bring our soul, even a little bit, into sync with his. We see nothing but emptiness in front of us. He does nothing, absolutely nothing, and I truly end up believing that he no longer thinks on anything. Yet his attitude [attitude] remains polite [correcte]; we find in him neither negativism nor hostility to the environment. Thus the supervisor who sees him at the table d'hôte can say of him: "He says nothing and does not move, but he is kind."

When we talk to him, he answers. The associations are short, but one wouldn't say of him that he is thought disordered. We also find no linguistic peculiarities in his utterances. His sentences are correct. His answers are relevant. When we insist, he tries to justify his attitude:

"He finds it preferable to no longer do anything, since his past attempts were unsuccessful. This is his definitive conclusion. As a consequence he's less concerned about the future than before. Little by little he has detached from everything. Can't one continue thus indefinitely, without coming to much? [Ne peut-on pas aussi s'en occuper indéfiniment, sans que ça vous avance à grand'chose?]  Any new attempt cannot but be doomed to failure. Past experience proves the point. There's no point insisting on it. [Il n'est guère indiqué d'insister.] His bosses fired him: they certainly had good reasons to do so. Moreover, there are many comrades and workers who, obliged to work eight hour days in all weathers, would envy his fate. And his grandfather: doesn't he live like him, inactive, at the fireside?"

He doesn't see just how miserable his life has become. His élan vital is broken and this disturbance is reflected in his thinking. His syllogistic logic basically now pursues a single goal: using the past to gainsay the future. He no longer has any temporal perspective, no orientation toward the future. He builds only on unhappy past experiences, forgetting that his grandfather is eighty and he twenty-eight, that his comrades would prefer any work over the life he leads. For his life is nothingness.

The case itself is trivial. But the most banal cases -

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are they not the most instructive? The disturbance to activity emerges here with all the necessary clarity. It dominates the whole clinical picture and seems to constitute the primary and essential disturbance of the illness. The élan vital is paralyzed, as if broken forever. No wind rises to stir this motionless surface. Sometimes we seem to see a ripple, but it's just an illusion, just a lifeless idea that enervates the subject's motoric life and terminates with a short-circuiting act, as we saw above.

From all this results the terrifying impression of absolute emptiness which we'll discuss further later.

Is there something behind all of this? Perhaps. But perhaps too there is nothing. Kretschmer, speaking of schizoid patients, tells of a surface and a depth. He compares some of them to "Roman villas which have their shutters shut in the hot sun, but inside, in the half-light, there are parties and banquets". But he tells us that in other cases there's just nothing behind this "silent facade" but "ruins and dust", just monotonous emptiness, just the icy breath of affective dementia.

It is the last type of case which we have thought it important to treat of in this section. Hitherto they've been a little too neglected. Under that initial influence exercised by the attractive concept of complexes, we were inclined to find them everywhere, underlying all the schizophrenic symptoms, without exception, and to build on them the whole theory of affective disturbance [à batir sur eux toute la théorie de l'affection]. Cases which wouldn't conform to this design were gladly set aside as of little interest. But any great discovery, after the initial enthusiasm it commands, knows how to later go on to set limits for itself. It knows how to make room for such other ideas as may be no less fertile than it. That's why we wanted to talk here about autochthonous autistic activity [l'activité primitivement autiste] and to sketch some of its characteristics. We only have to refer to Bleuler's masterful work to find a multitude of similar cases. However, Bleuler perhaps neglected, without himself noticing it - and not in his descriptions, but in his definition, of autism - the particular aspect of it which we have called 'autistic activity'. From this, one presumes, arise some of the misunderstandings of which he complained.

We believe that we have remedied this lacuna by showing, in the previous pages, that we know, in normal life,

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in addition to the dream and the daydream, of at least one phenomenon capable of providing the starting point for the study of the loss of reality contact: i.e. the cycle of élan personnel.

This allows us to distinguish two forms of autism. We designate them rich autism and poor autism, expressions suggested to us in a conversation by D. Santenoise.

The first takes the dream for its prototype. It is characterized above all by the creation of an imaginary world. Here, complexes play a leading role. They determine the content of the symptoms (but do not, even here, constitute the cause of the condition), as well as such variations in the patient's reactions as, so long as we only observe them from outside, often remain incomprehensible to us. Often, in these patients, we find, from an early age, a marked tendency toward daydreaming.

But normal men are not all imaginative: they are more so or less so. So too with the mentally ill. To construct and then live in an imaginary world is not within everyone's talent. Not all schizophrenics turn away from reality seeking refuge in castles in the air. Some, on the contrary, seem to engage in continuous activity; however, they do so in a deeply morbid way. What was said above - about the cycle which our élan personnel goes through - now becomes relevant. The subtle and elusive links that connect this élan, at every moment, to ambient becoming, now appear broken, like a door swinging right off its hinges. That intuition is lacking which normally guides our activity and keeps it within such limits as cannot be violated with impunity. The élan personnel then appears in its frightening nakedness; the schizophrenic plants his act or his work in the external world without being concerned about that world's exigencies - as if, basically, it didn't exist at all. Despite this activity, or rather precisely because of it, we will talk here too, as we did with imaginative schizophrenics, of the loss of contact with reality. But what we have here is poor autism, just as in cases where the élan personnel stops and completely breaks down.

If now someone asked which of the two autisms we should privilege when developing an understanding of the essential nature of schizophrenic disorders, we would respond, without the slightest hesitation: poor autism. Rich autism, the imaginary world,

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the complex: all these notions aim at that within the morbid personality which is still normal. One can't sufficiently stress the significance of this dynamic perspective; such notions have completely overturned earlier conceptions of psychiatry by teaching us that the incoherent manifestations of the insane can have a psychological content, a precise and living meaning. However, for this very same reason they can't serve to found a clinical concept. If we wish to specify an illness, then we must instead consider the deficient aspect of the affected personality. It is this aspect which must be defined first.

Poor autism shows us schizophrenic disturbance in its pure form, so to speak. This is why we privilege it, and must then look for such vital psychical forces as are spared and which, mobilised by compensatory mechanisms, sometimes even excessively hypertrophy themselves, so as to fill the hole dug by the primitive disturbance. But it is through this "hole" that we must first venture, if we're truly to be talking here of an illness. The schizophrenic dreamer is not schizophrenic because he's a dreamer; instead he's first a schizophrenic and then a dreamer. Since there is, strictly speaking, no such thing as morbid daydreaming, there is none here [Car il n'y a pas de rêverie morbide à proprement parler, il ne peut pas y en avoir]; there are only more or less modified, more or less impaired, elements of daydream which persist in the morbid personality.

But this already concerns the subject of the next chapter.