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Moreover the turning of his interests from his art to science diabetes xtc cheap glucotrol xl 10mg mastercard, which increased as time went on diabetes in dogs and pancreatitis order 10 mg glucotrol xl otc, must have played its part in widening the gulf between himself and his contemporaries diabetes test during pregnancy what week order genuine glucotrol xl. We are in a position to understand him better blood sugar 71 generic glucotrol xl 10 mg overnight delivery, for we know from his notes what were the arts that he practised ymca diabetes prevention program cost cheap glucotrol xl 10mg with visa. In an age which was beginning to replace the authority of the Church by that of antiquity and which was not yet familiar with any form of research not based on presuppositions diabetes type 1 og 2 purchase generic glucotrol xl line, Leonardo the forerunner and by no means unworthy rival of Bacon and Copernicus was necessarily isolated. In his dissection of the dead bodies of horses and human beings, in his construction of flying machines, and in his studies on the nutrition of plants and their reactions to poisons, he certainly departed widely from the commentators on Aristotle, and came close to the despised alchemists, in whose laboratories experimental research had found some refuge at least in those unfavourable times. Leonardo Da Vinci And A Memory Of His Childhood 2245 the effect that this had on his painting was that he took up his brush with reluctance, painted less and less, left what he had begun for the most part unfinished and cared little about the ultimate fate of his works. And this was what he was blamed for by his contemporaries: to them his attitude towards his art remained a riddle. Moreover, in the case of some of the pictures, they urge, it is not so much a question of their being unfinished as of his declaring them to be so. What appears to the layman as a masterpiece is never for the creator of the work of art more than an unsatisfactory embodiment of what he intended; he has some dim notion of a perfection, whose likeness time and again he despairs of reproducing. Least of all, they claim, is it right to make the artist responsible for the ultimate fate of his works. Valid as some of these excuses may be, they still do not cover the whole state of affairs that confronts us in Leonardo. The same distressing struggle with a work, the final flight from it and the indifference to its future fate may recur in many other artists, but there is no doubt that this behaviour is shown in Leonardo in an extreme degree. Leonardo Da Vinci And A Memory Of His Childhood 2246 the slowness with which Leonardo worked was proverbial. He painted at the Last Supper in the Convent of Santa Maria delle Grazie in Milan, after the most thorough preparatory studies, for three whole years. One of his contemporaries, Matteo Bandelli, the story-writer, who at the time was a young monk in the convent, tells how Leonardo often used to climb up the scaffolding early in the morning and remain there till twilight never once laying his brush aside, and with no thought of eating or drinking. Sometimes he would remain for hours in front of the painting, merely examining it in his mind. At other times he would come straight to the convent from the court in the castle at Milan, where he was making the model of the equestrian statue for Francesco Sforza, in order to add a few strokes of the brush to a figure, and then immediately break off. This circumstance may also account for the fact that the picture was never delivered to the man who commissioned it, but instead remained with Leonardo and was taken to France by him. On the contrary, it is possible to observe a quite extraordinary profundity, a wealth of possibilities between which a decision can only be reached with hesitation, demands which can hardly be satisfied, and an inhibition in the actual execution which is not in fact to be explained even by the artist inevitably falling short of his ideal. Leonardo could not become reconciled to fresco painting, which demands rapid work while the ground is still moist, and this was the reason why he chose oil colours, the drying of which permitted him to protract the completion of the painting to suit his mood and leisure. These pigments however detached themselves from the ground on which they were applied and which separated them from the wall. Added to this, the defects in the wall, and the later fortunes of the building itself, determined what seems to be the inevitable ruin of the picture. Leonardo Da Vinci And A Memory Of His Childhood 2247 the miscarriage of a similar technical experiment appears to have caused the destruction of the Battle of Anghiari, the painting which, in competition with Michelangelo, he began to paint some time afterwards on a wall of the Sala del Consiglio in Florence, and which he also abandoned in an unfinished condition. Here it seems as if an alien interest in experimentation at first reinforced the artistic one, only to damage the work later on. The character of Leonardo the man showed some other unusual traits and apparent contradictions. At a time when everyone was trying to gain the widest scope for his activity a goal unattainable without the development of energetic aggressiveness towards other people Leonardo was notable for his quiet peaceableness and his avoidance of all antagonism and controversy. He was gentle and kindly to everyone; he declined, it is said, to eat meat, since he did not think it justifiable to deprive animals of their lives; and he took particular pleasure in buying birds in the market and setting them free. Nor did it stop him from devising the cruellest offensive weapons and from entering the service of Cesare Borgia as chief military engineer. He often gave the appearance of being indifferent to good and evil, or he insisted on measurement by a special standard. He accompanied Cesare in a position of authority during the campaign that brought the Romagna into the possession of that most ruthless and faithless of adversaries. A letter of a contemporary from India to one of the Medici alludes to this characteristic behaviour of Leonardo. What is known of Leonardo in this respect is little: but that little is full of significance. In an age which saw a struggle between sensuality without restraint and gloomy asceticism, Leonardo represented the cool repudiation of sexuality a thing that would scarcely be expected of an artist and a portrayer of feminine beauty. So resolutely do they shun everything sexual that it would seem as if Eros alone, the preserver of all living things, was not worthy material for the investigator in his pursuit of knowledge. The first indeed is an artistic one, for its outline gives it the appearance of a breast that is flabby and hangs down unpleasingly. Had he done so he would have been bound to notice that the milk flows out of a number of separate excretory ducts. Leonardo, however, drew only a single duct extending far down into the abdominal cavity and probably in his view drawing the milk from the cisterna chyli and perhaps also connected in some way with the sex organs. It must of course be taken into consideration that the study of the internal organs of the human body was at that time made extremely difficult, since the dissection of bodies was regarded as desecration of the dead and was most severely punished. Whether Leonardo, who had certainly only very little material for dissection at his disposal, knew anything at all of the existence of a lymph-reservoir in the abdominal cavity is therefore in fact highly questionable, although in his drawing he included a cavity that is no doubt intended to be something of the sort. But from his making the lactiferous duct extend still further downwards till it reaches the internal sex organs we may suspect that he was trying to represent the synchronization of the beginning of the secretion of milk and the end of pregnancy by means of visible anatomical connections as well. The vagina and something that looks like the portio uteri can no doubt be made out, but the lines indicating the uterus itself are completely confused. Thus, for instance, he was not satisfied with drawing the testis but also put in the epididymis, which he drew with perfect accuracy. Pictures and drawings by famous artists exist which depict coitus a tergo, a latere, etc. If one wants to enjoy oneself it is usual to make oneself as comfortable as possible: this of course is true for both the primal instincts, hunger and love. Most of the peoples of antiquity took their meals in a lying position and it is normal in coitus to-day to lie down just as comfortably as did our ancestors. Lying down implies more or less a wish to stay in the desired situation for some time. His brows are wrinkled and his gaze is directed sideways with an expression of repugnance. This interchange is easiest to grasp if one recalls that the big toes lie on the inner sides of the feet. While he was still an apprentice, living in the house of his master Verrocchio, a charge of forbidden homosexual practices was brought against him, along with some other young people, which ended in his acquittal. He seems to have fallen under this suspicion because he had employed a boy of bad reputation as a model. The last of these pupils, Francesco Melzi, accompanied him to France, remained with him up to his death and was named by him as his heir. Among his biographers, to whom a psychological approach is often very alien, there is to my knowledge only one, Edmondo Solmi, who has approached the solution of the problem; but a writer who has chosen Leonardo as the hero of a great historical novel, Dmitry Sergeyevich Merezhkovsky, has made a similar reading of this unusual man the basis of his portrait and has given clear expression to his conception, not indeed in plain language, but (after the way of writers of imagination) in plastic terms. For that (line of conduct) is the way to become acquainted with the Creator of so many wonderful things, and this is the way to love so great an Inventor. For in truth great love springs from great knowledge of the beloved object, and if you know it but little you will be able to love it only a little or not at all. Leonardo da Vinci forms the second work of a great historical trilogy entitled Christ and Antichrist. It is not true that human beings delay loving or hating until they have studied and become familiar with the nature of the object to which these affects apply. On the contrary they love impulsively, from emotional motives which have nothing to do with knowledge, and whose operation is at most weakened by reflection and consideration. Leonardo, then, could only have meant that the love practised by human beings was not of the proper and unobjectionable kind: one should love in such a way as to hold back the affect, subject it to the process of reflection and only let it take its course when it has stood up to the test of thought. And at the same time we understand that he wishes to tell us that it happens so in his case and that it would be worth while for everyone else to treat love and hatred as he does. His affects were controlled and subjected to the instinct for research; he did not love and hate, but asked himself about the origin and significance of what he was to love or hate. Thus he was bound at first to appear indifferent to good and evil, beauty and ugliness. During this work of investigation love and hate threw off their positive or negative signs and were both alike transformed into intellectual interest. In reality Leonardo was not devoid of passion; he did not lack the divine spark which is directly or indirectly the driving force il primo motore behind all human activity. He had merely converted his passion into a thirst for knowledge; he then applied himself to investigation with the persistence, constancy and penetration which is derived from passion, and at the climax of intellectual labour, when knowledge had been won, he allowed the long restrained affect to break loose and to flow away freely, as a stream of water drawn from a river is allowed to flow away when its work is done. When, at the climax of a discovery, he could survey a large portion of the whole nexus, he was overcome by emotion, and in ecstatic language praised the splendour of the part of creation that he had studied, or in religious phraseology the greatness of his Creator. A conversion of psychical instinctual force into various forms of activity can perhaps no more be achieved without loss than a conversion of physical forces. The example of Leonardo teaches us how many other things we have to take into account in connection with these processes. The postponement of loving until full knowledge is acquired ends in a substitution of the latter for the former. A man who has won his way to a state of knowledge cannot properly be said to love and hate; he remains beyond love and hatred. The stormy passions of a nature that inspires and consumes, passions in which other men have enjoyed their richest experience, appear not to have touched him. A man who has begun to have an inkling of the grandeur of the universe with all its complexities and its laws readily forgets his own insignificant self. Lost in admiration and filled with true humility, he all too easily forgets that he himself is a part of those active forces and that in accordance with the scale of his personal strength the way is open for him to try to alter a small portion of the destined course of the world a world in which the small is still no less wonderful and significant than the great. It is probable that at that time he already overrated the value to the artist of these branches of knowledge.

Up till then she had spent several hours with him every day and had taken her mid-day meal with him diabetes type 2 disability buy generic glucotrol xl. But when she returned after an absence of four days diabetes mellitus type 2 article pdf order genuine glucotrol xl on line, she found him most sadly altered: so much so metabolic disease xp purchase discount glucotrol xl on line, indeed diabetes 44 communications buy cheap glucotrol xl 10 mg online, that he himself no longer wished to see her diabetes mellitus mayo clinic generic 10mg glucotrol xl with mastercard. The question of why this outburst of homosexual libido overtook the patient precisely at this period (that is 4 carb diabetic diet buy generic glucotrol xl 10 mg on line, between the dates of his appointment and of his move to Dresden) cannot be answered in the absence of more precise knowledge of the story of his life. Generally speaking, every human being oscillates all through his life between heterosexual and homosexual feelings, and any frustration or disappointment in the one direction is apt to drive him over into the other. Schreber was fifty-one years old, and he had therefore reached an age which is of critical importance in sexual life. Apart from this one fact, however, I have made use of no material in this paper that is not derived from the actual text of the Denkwurdigkeiten. But I do not think we should be justified in dismissing such a hypothesis merely on account of its inherent improbability, if it recommends itself to us on other grounds; we ought rather to inquire how far we shall get if we follow it up. For the improbability may be of a passing kind and may be due to the fact that the doubtful hypothesis has not as yet been brought into relation with any other pieces of knowledge and that it is the first hypothesis with which the problem has been approached. But for the benefit of those who are unable to hold their judgement in suspense and who regard our hypothesis as altogether untenable, it is easy to suggest a possibility which would rob it of its bewildering character. To put the matter in a more concrete form: the patient was reminded of his brother or father by the figure of the doctor, he rediscovered them in him; there will then be nothing to wonder at if, in certain circumstances, a longing for the surrogate figure reappeared in him and operated with a violence that is only to be explained in the light of its origin and primary significance. We shall therefore, I think, raise no further objections to the hypothesis that the exciting cause of the illness was the appearance in him of a feminine (that is, a passive homosexual) wishful phantasy, which took as its object the figure of his doctor. The person he longed for now became his persecutor, and the content of his wishful phantasy became the content of his persecution. It may be presumed that the same schematic outline will turn out to be applicable to other cases of delusions of persecution. Psycho-Analytic Notes On An Autobiographical Account Of A Case Of Paranoia 2420 One such change was the replacement of Flechsig by the superior figure of God. This seems at first as though it were a sign of aggravation of the conflict, an intensification of the unbearable persecution, but it soon becomes evident that it was preparing the way for the second change and, with it, the solution of the conflict. It was impossible for Schreber to become reconciled to playing the part of a female wanton towards his doctor; but the task of providing God Himself with the voluptuous sensations that He required called up no such resistance on the part of his ego. By this means an outlet was provided which would satisfy both of the contending forces. His ego found compensation in his megalomania, while his feminine wishful phantasy made its way through and became acceptable. In textbooks of psychiatry we frequently come across statements to the effect that megalomania can develop out of delusions of persecution. The patient is primarily the victim of a delusion that he is being persecuted by powers of the greatest might. He then feels a need to account to himself for this, and in that way hits on the idea that he himself is a very exalted personage and worthy of such persecution. But to ascribe such important affective consequences to a rationalization is, as it seems to us, an entirely unpsychological proceeding; and we would consequently draw a sharp distinction between our opinion and the one which we have quoted from the textbooks. In what manner and by what means was the ascent from Flechsig to God brought aboutfi From what source did he derive the megalomania which so fortunately enabled him to become reconciled to his persecution, or, in analytical phraseology, to accept the wishful phantasy which had had to be repressedfi In the later stages of the illness the decomposition of Flechsig goes further still (193). Or rather, paranoia resolves once more into their elements the products of the condensations and identifications which are effected in the unconscious. If the persecutor Flechsig was originally a person whom Schreber loved, then God must also simply be the reappearance of some one else whom he loved, and probably some one of greater importance. Jung is probably right when he goes on to say that the decomposition follows the general lines taken by schizophrenia in that it uses a process of analysis in order to produce a watering-down effect, and is thus designed to prevent the occurrence of unduly powerful impressions. Psycho-Analytic Notes On An Autobiographical Account Of A Case Of Paranoia 2422 If we pursue this train of thought, which seems to be a legitimate one, we shall be driven to the conclusion that the other person must have been his father; this makes it all the clearer that Flechsig must have stood for his brother who, let us hope, may have been older than himself. This feeling, so far as it referred to his brother, passed, by a process of transference, on to his doctor, Flechsig; and when it was carried back on to his father a settlement of the conflict was reached. God, according to him, had succumbed to the misleading influence of Flechsig: He was incapable of learning anything by experience, and did not understand living men because He only knew how to deal with corpses; and He manifested His power in a succession of miracles which, striking though they might be, were none the less futile and silly. Psycho-Analytic Notes On An Autobiographical Account Of A Case Of Paranoia 2423 Now the father of Senatsprasident Dr. Daniel Gottlob Moritz Schreber whose memory is kept green to this day by the numerous Schreber Associations which flourish especially in Saxony; and, moreover, he was a physician. His activities in favour of promoting the harmonious upbringing of the young, of securing co-ordination between education in the home and in the school, of introducing physical culture and manual work with a view to raising the standards of health all this exerted a lasting influence upon his contemporaries. Such a father as this was by no means unsuitable for transfiguration into a God in the affectionate memory of the son from whom he had been so early separated by death. It is true that we cannot help feeling that there is an impassable gulf between the personality of God and that of any human being, however eminent he may be. The gods of the peoples of antiquity stood in a closer human relationship to them. Stegmann of Dresden for his kindness in letting me see a copy of a journal entitled Der Freund der Schreber-Vereine [The Friend of the Schreber Associations]. Schreber senior was born in 1808 and died in 1861, at the age of only fifty-three. From the source which I have already mentioned I know that our patient was at that time nineteen years old. Could more bitter scorn be shown for such a physician than by declaring that he understands nothing about living men and only knows how to deal with corpsesfi No doubt it is an essential attribute of God to perform miracles; but a physician performs miracles too; he effects miraculous cures, as his enthusiastic clients proclaim. As regards some of the other reproaches which he levelled against God, such, for instance, as that He learned nothing by experience, it is natural to suppose that they are examples of the tu quoque mechanism used by children,fi which, when they receive a reproof, flings it back unchanged upon the person who originated it. Similarly, the voices give us grounds for suspecting that the accusation of soul-murder brought against Flechsig was in the first instance a self-accusation. Although we must be prepared to find that there is a condensation here which we shall not be able to resolve, it is nevertheless worth while referring to a clue that is already in our hands. It speaks to him in human language, and thus reveals itself to him as a living being, or as the organ of a yet higher being lying behind it (9). He identifies the sun directly with God, sometimes with the lower God (Ahriman),4 and sometimes with the upper. I saw the upper God (Ormuzd), and this time not with my spiritual eyes but with my bodily ones. It was the sun, but not the sun in its ordinary aspect, as it is known to all men; it was. I can gaze at it without any difficulty and without being more than slightly dazzled by it; whereas in my healthy days it would have been as impossible for me as for anyone else to gaze at it for a minute at a time. In this instance symbolism overrides grammatical gender at least so far as German goes,fi for in most other languages the sun is masculine. We frequently come upon confirmations of this assertion in resolving the pathogenic phantasies of neurotics by psycho-analysis. I can make no more than the barest allusion to the relation of all this to cosmic myths. One of my patients, who had lost his father at a very early age, was always seeking to rediscover him in what was grand and sublime in Nature. He spontaneously put forward as an interpretation that he had become frightened because his father had looked at him while he was at work upon his mother with a sharp instrument. As long as his father was alive it showed itself in unmitigated rebelliousness and open discord, but immediately after his death it took the form of a neurosis based upon abject submission and deferred obedience to him. None of the material which in other cases of the sort is brought to light by analysis is absent in the present one: every element is hinted at in one way or another. In infantile experiences such as this the father appears as an interferer with the satisfaction which the child is trying to obtain; this is usually of an auto-erotic character, though at a later date it is often replaced in phantasy by some other satisfaction of a less inglorious kind. Considering the enormous number of delusional ideas of a hypochondriacal nature5 which the patient developed, no great importance should perhaps be attached to the fact that some of them coincide word for word with the hypochondriacal fears of masturbators. It seems to me that hypochondria stands in the same relation to paranoia as anxiety neurosis does to hysteria.

The study of other languages that have different means of mapping orthography onto phonology is still at a relatively early stage blood sugar 99 generic glucotrol xl 10mg otc, but it is likely to greatly enhance our understanding of reading mechanisms diabetes diet kerala style order generic glucotrol xl on-line. The findings suggest that the neuropsychological mechanisms involved in reading are universal signs ng diabetes discount 10 mg glucotrol xl, although there are obviously some differences related to the unique features of different orthographies diabetes 86 purchase glucotrol xl canada. First diabetes insipidus koiralla cheap glucotrol xl 10mg with mastercard, there are lexical effects for nonwords and regularity effects for words diabetes ii buy glucotrol xl uk, and therefore reading cannot be a simple case of automatic graphemeto-phoneme conversion for nonwords, and automatic direct access for all words. Second, any model must also be able to account for the pattern of dissociations found in dyslexia. While surface and phonological dyslexia indicate that two reading mechanisms are necessary, other disorders suggest that these alone will not suffice. At first sight it is not obvious how a single-route model could explain these dissociations at all. Another is to show how word-neighbourhoods can affect pronunciation and how pseudowords can be pronounced in a single-route model. More recently, a connectionist model of reading has been developed that takes the single-route, analogy-based approach to the limit. The revised dual-route model We can save the dual-route model by making it more complex. Morton and Patterson (1980) and Patterson and Morton (1985) described a threeroute model (see Figure 7. First, there is a nonlexical route for assembling pronunciations from sublexical grapheme-phoneme conversion. A standard grapheme-phoneme conversion mechanism is supplemented with a body subsystem that makes use of information about correspondences between orthographic and phonological rimes. The lexical effects on nonwords and regularity effects on words are explained in this model by cross-talk between the lexical and non-lexical routes. Two types of interaction are possible: interference during retrieval, and conflict in resolving multiple phonological forms after retrieval. Surface dyslexia is the loss of the ability to make direct contact with the orthographic lexicon, and phonological dyslexia is the loss of the indirect route. First, we have to argue that these patients can only read through the lexical-semantic route. While accounting for the symptoms that resemble phonological dyslexia, it still does not explain the semantic paralexias. One possibility is that this route is used normally, but not always successfully, and that it needs additional information (such as from the non-lexical and non- semantic direct route) to succeed. It gets us to the right semantic area, but not necessarily to the exact item, hence giving paralexias. An alternative idea is that paralexias are due to additional damage to the semantic system itself. Hence a complex pattern of impairments is still necessary to explain deep dyslexia, and there is no reason to suggest that these are not dissociable. Multi-route models are becoming increasingly complicated as we find out more about the reading process (for example, see Carr & Pollatsek, 1985). A recent idea is that multiple levels of spellingto-sound correspondences combine in determining the pronunciation of a word. Such an approach develops earlier models that make use of knowledge at multiple levels, such as Brown (1987), Patterson and Morton (1985), and Shallice, Warrington, and McCarthy (1983). The most recent version of the dual-route model is the dual-route cascaded model of Coltheart, Curtis, Atkins, and Haller (1993), and Coltheart and Rastle (1994). This model maintains the basic architecture of the dual-route model, but makes use of cascaded processing. As soon as there is any activation at the letter level, activation is passed on to the word level. This means that the model makes immediate use of all levels of spelling-sound correspondence, as in the multiplelevels model. The lexical route is divided into one part that goes through the semantic system and one that does not. In the summation model (Hillis & Caramazza, 1991b; Howard & Franklin, 1988), the only direct route is reading through semantics. It is difficult to distinguish between these variants of the original dual-route model, although the three- route version provides the more explicit account of the dissociations observed in dyslexia. Many aspects of the dual-route model have been subsumed by the triangle model that serves as the basis of connectionist models of reading. The situation is complicated even more by the apparent co-occurrence of the loss of particular word meanings in dementia and surface dyslexia (see later). The analogy model the analogy model arose in the late 1970s when the extent of lexical effects on nonword reading and differences between words became apparent (Glushko, 1979; Henderson, 1982; Kay & Marcel, 1981; Marcel, 1980). It is a form of single-route model that provides an explicit mechanism for how we pronounce nonwords. When a word (or nonword) is presented, it activates its neighbours, and these all influence its pronunciation. Although attractive in the way they deal with regularity and neighbourhood effects, early versions of analogy models suffered from a number of problems. First, the models did not make clear how the input is segmented in an appropriate way. Second, the models make incorrect predictions about how some nonwords should be pronounced. Analogy theory also appears to make incorrect predictions about how long it takes us to make regularization errors (Patterson & Morton, 1985). Finally, it is not clear how analogy models account for the dissociations found in acquired dyslexia. Nevertheless, in some ways the analogy model was a precursor of connectionist models of reading. Connectionist models the original Seidenberg and McClelland (1989) model has evolved in response to criticisms that I will examine after describing the original model. This first model simulated one route of a more general model of lexical processing (see Figure 7. Reading and speech involve three types of code: orthographic, meaning, and phonological. As in the revised dual-route model, there is a route from orthography to phonology by way of semantics. The key feature of the model is that there is however only one other route from orthography to phonology; there is no route involving grapheme- phoneme correspondence rules. Seidenberg and McClelland (1989) just simulated the orthographic-to-phonology part of the overall triangle model. Each of the units in these layers has an activation level, and each unit is connected to all the units in the next level by a weighted connection, which can be either excitatory or inhibitory. An important characteristic of this type of model is that the weights on these connections are not set by the modellers, but are learned. This network learns to associate a phonological input with an orthographic input by being given repeated exposure to word-pronunciation pairs. This involves slowly reducing the discrepancy between the desired and actual outputs of the network by changing the weights on the connections. Phonemes and graphemes were encoded as a set of triples, so that each grapheme or phoneme was specified with its flanking grapheme or phoneme. A non-local representation was used: the graphemic representations were encoded as a pattern of activation across the orthographic units rather than corresponding directly to particular graphemes. The training corpus comprised all 2897 uninflected monosyllabic words of at least three or more letters in the English language present in the Kucera and Francis (1967) word corpus. Each trial consisted of the presentation of a letter string that was converted into the appropriate pattern of activation over the orthographic units. In the training phase, words were presented a number of times with a probability proportional to the logarithm of their frequency. This means that the ease with which a word is learned by the network, and the effect it has on similar words, depends to some extent on its frequency. About 150,000 learning trials were needed to minimize the differences between the desired and actual outputs. After training, the network was tested by presenting letter strings and computing the orthographic and phonological error scores. The error score is a measure of the average difference between the actual and desired output of each of the output units, across all patterns. Phonological error scores were generated by applying input to the orthographic units and measured by the output of the phonological units; they were interpreted as reflecting performance on a naming task. Orthographic error scores were generated by comparing the pattern of activation input to the orthographic units with the pattern produced through feedback from the hidden units, and were interpreted as a measure reflecting the performance of the model in a lexical decision task. Seidenberg and McClelland showed that the model fitted human data on a wide range of inputs. Note that the Seidenberg and McClelland model uses a single mechanism to read nonwords and exception words. There is only one set of hidden units, and only one process is used to name regular, exception, and novel items. As the model uses a distributed representation, there is no one-to-one correspondence between hidden units and lexical items; each word is represented by a pattern of activation over the hidden units. According to this model, lexical memory does not consist of entries for individual words. Lexical processing therefore involves the activation of information, and is not an all-or-none event. Besner, Twilley, McCann, and Seergobin (1990) provided a detailed critique of the Seidenberg and McClelland model, although a reply by Seidenberg and McClelland (1990) answered some of these points. In reply, Seidenberg and McClelland (1990) pointed out that their model was trained on only 2987 words, as opposed to the 30,000 words that people know, and that this may be responsible for the difference. The model did not perform as well as people do on nonwords, in particular on nonwords that contain unusual spelling patterns. Forster (1994) evaluated the assumptions behind connectionist modelling of visual word recognition. He made the point that showing that a network model can successfully learn to perform a complex task such as reading does not mean that that is the way humans actually do it. Finally, Norris (1994b) argued that a major stumbling block for the Seidenberg and McClelland model was that it could not account for the ability of readers to shift strategically between reliance on lexical and sublexical information. Phonological representations were based on phonemes with phonotactic constraints (that constrain which sounds occur together in the language), and orthographic representations were based on graphemes with graphotactic constraints (that constrain which letters occur together in the language). A mathematical analysis showed that a response to a letter string input is a function that depends positively on the frequency of exposure to the pattern, positively to the sum of the frequencies of its friends, and negatively to the sum of the frequencies of its enemies. The response to a letter string is non-linear, in that there are diminishing returns: for example, regular words are so good they gain little extra benefit from frequency.

A Case Of Paranoia Running Counter To the Psycho-Analytic Theory Of the Disease 3059 In these circumstances the simplest thing would have been to abandon the theory that the delusion of persecution invariably depends on homosexuality blood glucose test fasting purchase glucotrol xl 10 mg overnight delivery, and at the same time to abandon everything that followed from that theory diabetes mellitus definition webmd order cheap glucotrol xl line. Either the theory must be given up or else diabetes mellitus ziekenhuis order glucotrol xl 10 mg on-line, in view of this departure from our expectations blood glucose 59 buy glucotrol xl pills in toronto, we must side with the lawyer and assume that this was no paranoic combination but an actual experience which had been correctly interpreted blood glucose 350 order 10 mg glucotrol xl overnight delivery. But I saw another way out diabetes prevention 60 discount glucotrol xl express, by which a final verdict could for the moment be postponed. I recollected how often wrong views have been taken about people who are ill psychically, simply because the physician has not studied them thoroughly enough and has thus not learnt enough about them. I therefore said that I could not form an immediate opinion, and asked the patient to call on me a second time, when she could relate her story again at greater length and add any subsidiary details that might have been omitted. The story told me by the patient on this second occasion did not conflict with the previous one, but the additional details she supplied resolved all doubts and difficulties. It was on the second occasion that the had been disturbed by the suspicious noise: in her original story she had suppressed, or omitted to mention, the first visit because it had no longer seemed of importance to her. Nothing noteworthy had happened during this first visit, but something did happen on the day after it. While they were talking in low voices the patient suddenly felt convinced that he was telling her about their adventure of the previous day indeed, that the two of them had for some time been having a love-affair, which she had hitherto overlooked. For the time being, in fact, he succeeded in freeing her from her delusion, and she regained enough confidence to repeat her visit to his rooms a short time I believe it was a few weeks afterwards. A Case Of Paranoia Running Counter To the Psycho-Analytic Theory Of the Disease 3060 In the first place, this new information removes any doubts as to the pathological nature of her suspicion. It is easy to see that the white-haired elderly superior was a substitute for her mother, that in spite of his youth her lover had been put in the place of her father, and that it was the strength of her mother-complex which had driven the patient to suspect a love-relationship between these ill-matched partners, however unlikely such a relation might be. Moreover, this disposes of the apparent contradiction to the expectation, based on psycho-analytic theory, that the development of a delusion of persecution will turn out to be determined by an over-powerful homosexual attachment. The original persecutor the agency whose influence the patient wishes to escape is here again not a man but a woman. If in the attempt to emancipate herself she falls a victim to a neurosis it implies the presence of a mother- complex which is as a rule over-powerful, and is certainly unmastered. The manifestation of the neurotic reaction will always be determined, however, not by her present-day relation to her actual mother but by her infantile relations to her earliest image of her mother. A Case Of Paranoia Running Counter To the Psycho-Analytic Theory Of the Disease 3061 We know that our patient had been fatherless for many years: we may also assume that she would not have kept away from men up to the age of thirty if she had not been supported by a powerful emotional attachment to her mother. This support became a heavy yoke when her libido began to turn to a man in response to his insistent wooing. She tried to free herself, to throw off her homosexual attachment; and her disposition, which need not be discussed here, enabled this to occur in the form of a paranoic delusion. As such she could have been overcome, had it not been that the mother-complex retained power enough to carry out its purpose of keeping the patient at a distance from men. Thus, at the end of the first phase of the conflict the patient had become estranged from her mother without having definitely gone over to the man. In the later developments the mother did not reappear, but we may safely insist that in this phase the lover had not become the persecutor directly but via the mother and in virtue of his relationship to the mother, who had played the leading part in the first delusion. One would think that the resistance was now definitely overcome, that the girl who until now had been bound to her mother had succeeded in coming to love a man. But after the second visit a new delusion appeared, which, by making ingenious use of some accidental circumstances, destroyed this love and thus successfully carried through the purpose of the mother-complex. It still seems strange that a woman should protect herself against loving a man by means of a paranoic delusion; but before examining this state of things more closely, let us glance at the accidental circumstances that formed the basis of this second delusion, the one aimed exclusively against the man. A Case Of Paranoia Running Counter To the Psycho-Analytic Theory Of the Disease 3062 Lying partly undressed on the sofa beside her lover, she heard a noise like a click or beat. She did not know its cause, but she arrived at an interpretation of it after meeting two men on the staircase, one of whom was carrying something that looked like a covered box. She became convinced that someone acting on instructions from her lover had watched and photographed her during their intimate tete a tete. I do not for a moment imagine, of course, that if the unlucky noise had not occurred the delusion would not have been formed; on the contrary, something inevitable is to be seen behind this accidental circumstance, something which was bound to assert itself compulsively in the patient, just as when she supposed that there was a liason between her lover and the elderly superior, her mother-substitute. Among the store of unconscious phantasies of all neurotics, and probably of all human beings, there is one which is seldom absent and which can be disclosed by analysis: this is the phantasy of watching sexual intercourse between the parents. The accidental noise was thus merely playing the part of a provoking factor which activated the typical phantasy of overhearing which is a component of the parental complex. As Otto Rank has remarked to me, such noises are on the contrary an indispensible part of the phantasy of listening, and they reproduce either the sounds which betray parental intercourse or those by which the listening child fears to betray itself. We can see by what means the girl had freed herself from her homosexual dependence on her mother. It was by means of a small piece of regression: instead of choosing her mother as a love-object, she identified herself with her she herself became her mother. The possibility of this regression points to the narcissistic origin of her homosexual object-choice and thus to the paranoic disposition in her. We do not, however, ask our readers to follow us, since the absence of any deeper analytic investigation makes it impossible in this case to go beyond a certain degree of probability. The patient mentioned in her first interview with me that she had immediately demanded an explanation of the noise, and had been told that it was probably the ticking of the small clock on the writing-desk. It seems to me much more likely that at first she did not react to the noise at all, and that it became significant only after she met the two men on the staircase. But as I never met the man and could not continue the analysis of the woman, my hypothesis cannot be proved. I do not believe that the clock ever ticked or that there was any noise to be heard at all. And it was this that she subsequently projected as a perception of an external object. A hysterical woman patient of mine once related to me a short arousal dream to which she could bring no spontaneous associations. Nobody had knocked at the door, but during the previous nights she had been awakened by distressing sensations of pollutions: she thus had a motive for awakening as soon as she felt the first sign of genital excitation. In the case of our paranoic patient, I should substitute for the accidental noise a similar process of projection. I certainly cannot guarantee that in the course of our short acquaintance the patient, who was reluctantly yielding to compulsion, gave me a truthful account of all that had taken place during the two meetings of the lovers. But an isolated contraction of the clitoris would be in keeping with her statement that no contact of the genitals had taken place. A Case Of Paranoia Running Counter To the Psycho-Analytic Theory Of the Disease 3064 Let us consider again the outstanding fact that the patient protected herself against her love for a man by means of a paranoic delusion. The key to the understanding of this is to be found in the history of the development of the delusion. But now, on this paranoic basis, the advance from a female to a male object was accomplished. Such an advance is unusual in paranoia; as a rule we find that the victim of persecution remains fixated to the same persons, and therefore to the same sex to which his love-objects belonged before the paranoic transformation took place. But neurotic disorder does not preclude an advance of this kind, and our observation may be typical of many others. There are many similar processes occurring outside paranoia which have not yet been looked at from this point of view, amongst them some which are very familiar. But within the limits of phantasy he achieves the progress which is denied him, and he succeeds in replacing mother and sister by extraneous objects. Since the veto of the censorship does not come into action with these objects, he can become conscious in his phantasies of his choice of these substitute-figures. These then are phenomena of an attempted advance from the new ground which has as a rule been regressively acquired; and we may set alongside them the efforts made in some neuroses to regain a position of the libido which was once held and subsequently lost. Indeed we can hardly draw any conceptual distinction between these two classes of phenomena. We are too apt to think that the conflict underlying a neurosis is brought to an end when the symptom has been formed. The symptom itself becomes an object of this struggle; certain trends anxious to preserve it conflict with others which strive to remove it and to re-establish the status quo ante. Methods are often sought of rendering the symptom nugatory by trying to regain along other lines of approach what has been lost and is now withheld by the symptom. This inertia is indeed most peculiar; it is not a general one, but is highly specialized; it is not even all-powerful within its own field, but fights against tendencies towards progress and recovery which remain active even after the formation of neurotic symptoms. If we search for the starting-point of this special inertia, we discover that it is the manifestation of very early linkages linkages which it is hard to resolve between instincts and impressions and the objects involved in those impressions. These linkages have the effect of bringing the development of the instincts concerned to a standstill. We cannot but feel that no event has ever destroyed so much that is precious in the common possessions of humanity, confused so many of the clearest intelligences, or so thoroughly debased what is highest. Science herself has lost her passionless impartiality; her deeply embittered servants seek for weapons from her with which to contribute towards the struggle with the enemy. Anthropologists feel driven to declare him inferior and degenerate, psychiatrists issue a diagnosis of his disease of mind or spirit. Probably, however, our sense of these immediate evils is disproportionately strong, and we are not entitled to compare them with the evils of other times which we have not experienced. The individual who is not himself a combatant and so a cog in the gigantic machine of war feels bewildered in his orientation, and inhibited in his powers and activities. I believe that he will welcome any indication, however slight, which will make it easier for him to find his bearings within himself at least. I propose to pick out two among the factors which are responsible for the mental distress felt by non- combatants, against which it is such a heavy task to struggle, and to treat of them here: the disillusionment which this war has evoked, and the altered attitude towards death which this like every other war forces upon us. Thoughts For the Times On War And Death 3068 When I speak of disillusionment, everyone will know at once what I mean. One need not be a sentimentalist; one may perceive the biological and psychological necessity for suffering in the economy of human life, and yet condemn war both in its means and ends and long for the cessation of all wars. We have told ourselves, no doubt, that wars can never cease so long as nations live under such widely differing conditions, so long as the value of individual life is so variously assessed among them, and so long as the animosities which divide them represent such powerful motive forces in the mind. We were prepared to find that wars between the primitive and the civilized peoples, between the races who are divided by the colour of their skin wars, even, against and among the nationalities of Europe whose civilization is little developed or has been lost would occupy mankind for some time to come. We had expected the great world-dominating nations of white race upon whom the leadership of the human species has fallen, who were known to have world-wide interests as their concern, to whose creative powers were due not only our technical advances towards the control of nature but the artistic and scientific standards of civilization we had expected these peoples to succeed in discovering another way of settling misunderstandings and conflicts of interest. Within each of these nations high norms of moral conduct were laid down for the individual, to which his manner of life was bound to conform if he desired to take part in a civilized community. These ordinances, often too stringent, demanded a great deal of him much self-restraint, much renunciation of instinctual satisfaction. He was above all forbidden to make use of the immense advantages to be gained by the practice of lying and deception in the competition with his fellow-men. The civilized states regarded these moral standards as the basis of their existence. They took serious steps if anyone ventured to tamper with them, and often declared it improper even to subject them to examination by a critical intelligence.

But the spontaneous nature of the Oedipus complex in children cannot be seriously shaken even by this factor blood sugar after eating order generic glucotrol xl pills. When other children appear on the scene the Oedipus complex is enlarged into a family complex blood glucose 52 buy glucotrol xl 10 mg mastercard. This diabetes symptoms groin itch glucotrol xl 10 mg on line, with fresh support from the egoistic sense of injury diabetes 55 generic 10 mg glucotrol xl overnight delivery, gives grounds for receiving the new brothers or sisters with repugnance and for unhesitatingly getting rid of them by a wish blood glucose fasting test order glucotrol xl 10mg online. It is even true that as a rule children are far readier to give verbal expression to these feelings of hate than to those arising from the parental complex diabetes type 1 pathophysiology purchase glucotrol xl 10 mg fast delivery. If a wish of this kind is fulfilled and the undesired addition to the family is removed again shortly afterwards by death, we can discover from a later analysis what an important experience this death has been to the child, even though it need not have remained fixed in his memory. A child who has been put into second place by the birth of a brother or sister, and who is now for the first time almost isolated from his mother, does not easily forgive her this loss of place; feelings which in an adult would be described as greatly embittered arise in him and are often the basis of a permanent estrangement. He may take his sister as a love-object by way of substitute for his faithless mother. Where there are several brothers, all of them courting a younger sister, situations of hostile rivalry, which are so important for later life, arise already in the nursery. A little girl may find in her elder brother a substitute for her father who no longer takes an affectionate interest in her as he did in her earliest years. Or she may take a younger sister as a substitute for the baby she has vainly wished for from her father. This and very much else of a similar nature will be shown to you by the direct observation of children and by the consideration of clearly retained memories from childhood uninfluenced by analysis. From this you will conclude among other things that the position of a child in the family order is a factor of extreme importance in determining the shape of his later life and should deserve consideration in every life-history. But, what is more important, in view of this information which can be so easily obtained, you will not be able to recall without a smile the pronouncements of science in explanation of the prohibition of incest. It has been said that sexual inclination is diverted from members of the same family who are of the opposite sex by the fact of having lived together from childhood; or, again, that a biological purpose of avoiding inbreeding is represented psychically by an innate horror of incest. In all this the fact is entirely overlooked that such an inexorable prohibition of it in law and custom would not be needed if there were any reliable natural barriers against the temptation to incest. Among the primitive races still living to-day, among savages, the prohibitions against incest are even very much stricter than among ourselves, and Theodor Reik has only recently shown in a brilliant work that the puberty rites of savages, which represent a re-birth, have the sense of releasing the boy from his incestuous bond with his mother and of reconciling him with his father. Introductory Lectures On Psycho-Analysis 3401 Mythology will teach you that incest, which is supposed to be so much detested by humans, is unhesitatingly allowed to the gods. And you may learn from ancient history that incestuous sister marriage was a sanctified injunction upon the person of the Ruler (among the Egyptian Pharaohs and the Incas of Peru). It may be remarked in passing that they are also the two great crimes proscribed by totemism, the first socio-religious institution of mankind. But let us now turn from the direct observation of children to the analytic examination of adults who have become neurotic. It shows that each of these neurotics has himself been an Oedipus or, what comes to the same thing, has, as a reaction to the complex, become a Hamlet. The analytic account of the Oedipus complex is, of course, a magnification and coarsening of the infantile sketch. The hatred of the father, the death-wishes against him, are no longer hinted at timidly, the affection for the mother admits that its aim is to possess her as a woman. Should we really attribute such blatant and extreme emotional impulses to the tender years of childhood, or is analysis deceiving us by an admixture of some new factorfi Whenever someone gives an account of a past event, even if he is a historian, we must take into account what he unintentionally puts back into the past from the present or from some intermediate time, thus falsifying his picture of it. We can easily see, too, that hatred of the father is reinforced by a number of factors arising from later times and circumstances and that the sexual desires towards the mother are cast into forms which must have been alien as yet to a child. But it would be a vain effort to seek to explain the whole Oedipus complex by retrospective phantasying and to attach it to later times. Its infantile core and more or less of its accessories remain as they were confirmed by the direct observation of children. Introductory Lectures On Psycho-Analysis 3402 the clinical fact which meets us behind the form of the Oedipus complex as it is established by analysis is of the highest practical significance. We learn that at puberty, when the sexual instinct first makes its demands in full strength, the old familiar incestuous objects are taken up again and freshly cathected with libido. The infantile object-choice was only a feeble one, but it was a prelude, pointing the direction for the object-choice at puberty. At this point, then, very intense emotional processes come into play, following the direction of the Oedipus complex or reacting against it, processes which, however, since their premisses have become intolerable, must to a large extent remain apart from consciousness. From this time onwards, the human individual has to devote himself to the great task of detaching himself from his parents, and not until that task is achieved can he cease to be a child and become a member of the social community. For the son this task consists in detaching his libidinal wishes from his mother and employing them for the choice of a real outside love-object, and in reconciling himself with his father if he has remained in opposition to him, or in freeing himself from his pressure if, as a reaction to his infantile rebelliousness, he has become subservient to him. These tasks are set to everyone; and it is remarkable how seldom they are dealt with in an ideal manner that is, in one which is correct both psychologically and socially. In this sense the Oedipus complex may justly be regarded as the nucleus of the neuroses. As you may imagine, Gentlemen, I have passed very cursorily over a great number of considerations of both practical and theoretical importance connected with the Oedipus complex. Among its remoter connections I will only give you a further hint that it has turned out to have a highly important effect on literary production. In a valuable work Otto Rank has shown that dramatists of every period have chosen their material in the main from the Oedipus and incest complex and its variations and disguises. Nor should it be allowed to pass unnoticed that the two criminal wishes of the Oedipus complex were recognized as the true representatives of the uninhibited life of the instincts long before the time of psycho-analysis. Among the writings of the Encyclopaedist Diderot you will find a celebrated dialogue, Le neveu Rameau, which was rendered into German by no less a person than Goethe. The reminder of dreams given to us by the mother and wife of Oedipus must not be allowed to remain fruitless. Do you recall the out come of our dream-analyses how the wishes that construct dreams are so often of a perverse or incestuous nature or reveal an unsuspected hostility to those who are nearest and dearest to the dreamerfi They are allocations of the libido and object-cathexes which date from early infancy and have long since been abandoned as far as conscious life is concerned, but which prove still to be present at night-time and to be capable of functioning in a certain sense. Since, however, everyone, and not only neurotics, experiences these perverse, incestuous and murderous dreams, we may conclude that people who are normal to-day have passed along a path of development that has led through the perversions and object-cathexes of the Oedipus complex, that that is the path of normal development and that neurotics merely exhibit to us in a magnified and coarsened form what the analysis of dreams reveals to us in healthy people as well. And this is one of the reasons why I dealt with the study of dreams before that of neurotic symptoms. I should now like to bring to your attention the significance of this fact in the causation of the neuroses. We are, I think, in agreement with the theories of general pathology in assuming that a development of this kind involves two dangers first, of inhibition, and secondly, of regression. That is to say, in view of the general tendency of biological processes to variation, it is bound to be the case that not every preparatory phase will be passed through with equal success and completely superseded: portions of the function will be permanently held back at these early stages, and the total picture of development will be qualified by some amount of developmental inhibition. When, as often happened at early periods of human history, a whole people left their place of domicile and sought a new one, we may be certain that the whole of them did not arrive at the new location. Apart from other losses, it must regularly have happened that small groups or bands of the migrants halted on the way and settled at these stopping places while the main body went further. Or, as you know, to turn to a nearer comparison, in the highest mammals the male sex-glands, which are originally situated deep in the abdominal cavity, start upon a migration at a particular stage of intra-uterine life, which brings them almost directly under the skin of the pelvic extremity. As a consequence of this migration, we find in a number of male individuals that one of these paired organs has remained behind in the pelvic cavity, or that it has become permanently lodged in what is known as the inguinal canal, through which both organs must pass in the course of their migration, or at least that this canal has remained open, though it should normally close up after the sex- glands have completed their change of situation. But I also discovered soon afterwards that nerve-cells of this kind are present outside the grey matter the whole way to what is known as the spinal ganglion of the posterior root; and from this I inferred that the cells of these masses of ganglia had migrated from the spinal cord along the roots of the nerves. But in this small fish the whole path of their migration was demonstrated by the cells that had remained behind. Introductory Lectures On Psycho-Analysis 3404 If you go into the matter more closely, you will have no difficulty in detecting the weak points in these comparisons. I will therefore declare without more ado that I regard it as possible in the case of every particular sexual trend that some portions of it have stayed behind at earlier stages of its development, even though other portions may have reached their final goal. You will recognize here that we are picturing every such trend as a current which has been continuous since the beginning of life but which we have divided up, to some extent artificially, into separate successive advances. Your impression that these ideas stand in need of greater clarification is justified; but to attempt it would take us too far afield. Let me further make it clear that we propose to describe the lagging behind of a part trend at an earlier stage as a fixation a fixation, that is, of the instinct. The second danger in a development by stages of this sort lies in the fact that the portions which have proceeded further may also easily return retrogressively to one of these earlier stages what we describe as a regression. The trend will find itself led into a regression of this kind if the exercise of its function that is, the attainment of its aim of satisfaction is met, in its later or more highly developed form, by powerful external obstacles. It is plausible to suppose that fixation and regression are not independent of each other. The stronger the fixations on its path of development, the more readily will the function evade external difficulties by regressing to the fixations the more incapable, therefore, does the developed function turn out to be of resisting external obstacles in its course. Consider that, if a people which is in movement has left strong detachments behind at the stopping-places on its migration, it is likely that the more advanced parties will be inclined to retreat to these stopping-places if they have been defeated or have come up against a superior enemy. But they will also be in the greater danger of being defeated the more of their number they have left behind on their migration. Introductory Lectures On Psycho-Analysis 3405 It is important for your understanding of the neuroses that you should not leave this relation between fixation and regression out of sight. This will give you a firmer footing in facing the question of how the neuroses are caused the question of the aetiology of the neuroses which we shall shortly have to meet. After what you have learnt of the development of the libidinal function, you will be prepared to hear that there are regressions of two sorts: a return to the objects first cathected by the libido, which, as we know, are of an incestuous nature, and a return of the sexual organization as a whole to earlier stages. Both sorts are found in the transference neuroses and play a great part in their mechanism. In particular, a return to the first incestuous objects of the libido is a feature that is found in neurotics with positively fatiguing regularity. There is much more to be said about regressions of the libido itself when we take into account as well another group of neuroses, the narcissistic ones, which for the time being we do not intend to do. These disorders give us access to other developmental processes of the libidinal function which we have not yet mentioned, and show us correspondingly new sorts of regression as well. But above all I think I ought to warn you now not to confuse regression with repression and help you to form a clear idea of the relations between the two processes. Repression, as you will recall, is the process by which an act which is admissible to consciousness, one, therefore, which belongs to the system Pcs. And we equally speak of repression if the unconscious mental act is altogether forbidden access to the neighbouring preconscious system and is turned back at the threshold by the censorship. Thus the concept of repression involves no relation to sexuality: I must ask you to take special note of that. By this we intend to say that it is concerned with the psychical regions which we have assumed to exist, or, if we drop this clumsy working hypothesis, with the construction of the mental apparatus out of distinct psychical systems. If we give it its general sense of a return from a higher to a lower stage of development then repression too can be subsumed under the concept of regression, for it too can be described as a return to an earlier and deeper stage in the development of a psychical act. In the case of repression, however, this retrogressive movement does not concern us, since we also speak of repression, in the dynamic sense, when a psychical act is held back at the lower, unconscious, stage. The fact is that repression is a topographico- dynamic concept, while regression is a purely descriptive one. What we have hitherto spoken of as regression, however, and have related to fixation, has meant exclusively a return of the libido to earlier stopping places in its development something, that is, entirely different in its nature from repression and entirely independent of it. Nor can we call regression of the libido a purely psychical process and we cannot tell where we should localize it in the mental apparatus. And though it is true that it exercises the most powerful influence on mental life, yet the most prominent factor in it is the organic one. So let us turn to clinical material in order to find applications of it that will be a little more impressive. Hysteria and obsessional neurosis are, as you know, the two chief representatives of the group of transference neuroses. Now it is true that in hysteria there is a regression of the libido to the primary incestuous sexual objects and that this occurs quite regularly; but there is as good as no regression to an earlier stage of the sexual organization. To offset this, the chief part in the mechanism of hysteria is played by repression. If I might venture to complete what we already know for certain about this neurosis by making a construction, I might explain the position thus. The unification of the component instincts under the primacy of the genitals has been accomplished; but its results come up against the resistance of the preconscious system which is linked with consciousness. Thus the genital organization holds good for the unconscious, but not in the same way for the preconscious; and this rejection on the part of the preconscious brings about a picture which has certain resemblances to the state of things before genital primacy. Of the two kinds of regression of the libido, that to an earlier phase of the sexual organization is by far the more striking.

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References

• Alperin N, Mazda M, Lichtor T, Lee SH. From cerebrospinal fluid pulsation to noninvasive intracranial compliance and pressure measured by MRI flow studies. Curr Med Imaging Rev 2006;2:117-129.
• Su LD, Atayde-Perez A, Sheldon S, et al. Inflammatory myofibroblastic tumor: cytogenetic evidence supporting clonal origin. Mod Pathol 1998;11(4):364-368.
• Danino AM, Hariss PG, Servant JM. Early management, with a minimal initial hospitalization length, of a major self-inflicted rifle wounds to the face by a single latissimus dorsi free musculocutaneous flap: a 10-year experience. Open Access J Plast Surg 2009;9:218-230.
• Altman DI, Powers WJ, Perlman JM, et al. Cerebral blood flow requirement for brain viability in newborn infants is lower than in adults. Ann Neurol 1988;24:218-26.