thought to be too nervous for school, especially as she could not sleep for hours after her mother attempted to teach her. In reality this child was not nervous at all. She was neither apprehensive, nor fidgety, nor irritable, nor of a difficult temperament. She had stayed awake by suggestion, because her parents had let her see that they were afraid of it. The matter was explained to child and parents, and in consequence of the step thus taken the child has attended school. She remained perfectly well ever since.1

The seeming excessive reactivity of people who feel emotions deeply is not direct, but merely because the emotion gives a more imperative aspect to the notions in consequence of which they act. If the action is intemperate it is not so much because the emotion is so as because the ideation is not adequate to form proper judgments.

Hysterical Phobia. For instance: A boy of 8 (Case 87) was sent to me because he was subject to " fits," previously diagnosed epileptic, which consisted of sudden attacks of fright, and the imperative desire to rush away. I soon discovered that this was due to his fear of wild animals, induced by the general timorousness inculcated by a foolish mother, who developed in him a timidity which was the source of his impulse to run away. A simple explanatory talk and some psychomotor (9) exercises showed the boy how to obtain control; and after the interview he recovered completely from the consequences of his morbid fears. This case illustrates the fact that even in children a realization of the situation is the important thing. It is only when a patient can intelligently interpret the symptoms of a psychogenetic (10) disorder that he is in a position to cause them to disappear. The patient does not get well from the analysis, but because of the psychic procedure adopted therefrom. The reason this boy ran away was because he thought there was a wild beast; both the emotion of fear and the action of running away were natural enough from the premises. The fearsomeness of his surroundings had been inculcated by the attitude of an unwise mother.

Emotions. The most incommoding, and often dangerous, of 1 The case is fully described in my paper "Psychogenetic Disorders of Childhood," in American Journal of Medical Sciences, 1912, and in Journal of Abnormal Psychology, 1912.

all the emotions is fear. In the case of the boy just related, it was the induced fear which caused him to rush away. The whole psychology of fear would take too long to amplify here; but as it is the foundation of most of the disturbances known as psychoneuroses (11) to which the neurotic child is most subject, it is necessary to consider its prevention. Perhaps this is best done by an illustration and the commentary upon that.

The formation of a night-terror (12) was nipped in the bud in the case of a boy aged three and three-quarters (Case 88). For several weeks he had been visiting the zoological garden every afternoon in the company of a French maid of exceptionally forceful character, and apparently free from the superstitiousness of the average nurse. For a long time all went well, until one evening he began to cry in bed soon after he was left for the night. At this unusual occurrence I mounted the stairs and inquired the cause of the boy's trouble. He said there were lions in the house, and that he did not want to stay alone as he was afraid they would eat him. The source of the idea had been that the lions had roared more loudly than usual on that particular afternoon, and he had been much impressed, standing for some time quite motionless before the cage, though unterrified. I soon convinced the boy that the lions had to remain in their cages and could not get out, hence there were none in the house, so that there was no occasion for fear. Of course, it was first necessary to give him the feeling of security gained by embracing me, and secondly to begin the conversation by talking of something else. In this way the state of terror was dismissed and the feeling of protection was induced before we returned to the subject of the lions. Then we made rather a joke of the funny roaring of the lions before we had finished, and he finally lay down with the solemn purpose to go to sleep and think, as I had suggested, of the cars and motors passing outside his open window. It was all a very simple substitution (13), but it was the prevention of what might have become a serious fearpsychosis (14) if injudiciously handled.

When the fears are already formed the resources of a good neurologist should be invoked in order to disperse them. I give an illustration.

A girl of 16 (Case 89) was referred by Doctor Litchfield, of Pittsburgh, November, 1913, on account of great nervousness

for years. She had never been regularly to school until the fall, when she had been sent to boarding-school after convalescing from appendectomy, but had become so nervous that she had to return in two days. Inquiry showed that she would frequently wake in the night very much afraid unless she were soothed by some one sleeping with her, so that she could never sleep alone. Further inquiries showed that a servant had told terrifying stories to her sister as a child; the horrors this brought ran through a family of three children, but they passed away from all of them except this patient. She had been much indulged between the ages of 3 and 6, and had been somewhat spoiled since, owing to a supposed weak heart, and had always been considered a weakly child. Her father and an aunt had been timorous as children; the latter, for nine years, had not dared to be alone for a moment.

Her fears are either of fires or burglars, and they only occur when in bed or asleep; she whines when dreaming and wakes frightened. She never screams, but clutches her companion desperately for reassurance. She is sure she wants to get rid of this trouble. She cannot remember the first occasion of fear. Noises, such as creaking floors, make her think there is some one in the house; although she knows positively there is not, she cannot make herself believe it. She is ashamed of the emotion and will go to bed alone, although terrified, if there is some one else up-stairs, but not unless; but will wait until her mother comes. She imagines a burglar might hurt her if pushed to it.

Analysis shows that there is no definite fear of what he might do to her, but that the fear is of the unknown, and although it might help her to know it, it might be too terrible. Her agitation upon speaking of this she attributes to her shame of being "babyish." I explain there is no shame in what one cannot help, but she cannot recover until an understanding is gained through analyzing the situation. She is not less frightened when away from home, but any person in the room will tranquillize her fear upon wakening if she can touch her. The night fear is quite different from any fears in the daytime.

After the analysis she was asked to go home and write out her impressions of the situation, which she did as follows:

The earliest instance I can remember was about eight years ago when my nurse sat in the next room while I went to sleep. For five

or six years afterward some one was with me when I was going to sleep. If I woke up in the middle of the night-which I usually did-I would be terrified and go into mother's bed, with her, in the next room. It is only within the last few months that she has been sleeping in the same room with me the entire night. Before that I always went to bed in the room next hers, but rarely remained there all night. I cannot ever remember having the nurse put me to bed and then leave me to go to sleep by myself. She was always in the next room. It made very little difference whether my mother, nurse, or sister were with me. I preferred mother, but would have any one rather than be alone. I was always worse in our city home than in our country home, because I thought there would more likely be burglars in the city than way off in the country. I would go to sleep more quickly in the country, but would always have some one with me. As long as I can remember I have dreaded the night. I always lie awake a long time after going to bed fighting with my terror of burglars. Every sound made me think of them, and I used to hold my ears shut so that I could not hear the floor creak, and try to go to sleep in that way. So when I thought of those long, sleepless hours I would wish there was no such thing as night.

Her dread is mingled with self-contempt at her "silly babyishness." Three dreams were obtained. The first and second were of a burglar entering a window. The analysis showed only that the intruder aimed to shoot her sister, who was standing up behind her; a dream of fears of elevators led to no pertinent associations (15).

As the dream analysis was so unfruitful I believed it best to proceed at once to reconditioning of the psychological reactions (16). This was attempted in the first place by studying the child's power of understanding of what I gave her to read about the psychology of fear, and by making clear to her what she could not understand alone. In the second place, she was given exercises in mental concentration, and as she became more proficient in these, was urged to apply them to the study of her own feelings of nocturnal apprehensions. The principle she was made to grasp was that fear, and shame of her fears, prevented her from facing and examining them, which was the essential preliminary to the understanding which would make them disappear. In ten days she returned home, not yet able to sleep alone, but beginning to obtain mastery. A month later her mother wrote me that she was entirely well, and when she awak

ened in the night would quietly turn over and go to sleep without troubling any one. She was physically and in mental health better than at any time in her life.

This child has been at school now two years, and is quite normal.

Concerning Shame and Anxiety.-Shame plays a large part in this case; but shame is merely social or moral dread, and, physiologically speaking, must be treated just as is fear.

When the moral factor is very strongly present, and the physical agitation is decided, the condition is termed anxiety. A great deal has been recently written about the victims of chronic anxiety; but most of the writers are too narrow in their conception in relation to the fear or shame which is its basis, and have often strained their explanations to fit a preconceived theory. In this respect the work of Doctor Boris Sidis, in this country, and of Doctor Pierre Janet and of Professor Déjérine, in France, are notable exceptions. Upon the foundation of anxiety are frequently developed scruples and little manias (17) or even tricks of manner, expression, and gesture. The grimaces which children make sometimes have this foundation.

They are immediately due to a sensation of discomfort. When this is more purely intellectual it gives rise to a feeling of incompleteness or inadequacy to a situation. When focussed upon some particular idea the feeling of inadequacy may give rise to an obsession (18) concerning the difficulty presented. This besetment is always accompanied by a certain morbid dread known as phobia (19). These various symptoms have the same psychological foundation, and very frequently alternate in the same patient. These manifestations are termed by Janet psychasthenia. Again the best understanding of the situation is furnished by an example, although the well-developed disease is unusual in children, as the manifold symptoms require an intellectual bent which few children possess.

Multiple Manias.-A boy of 14 (Case 90). He was not doing well at school; he would take hours to dress in the morning, and would go away and dream by the hour. Analysis of the situation showed that his condition was the result of reactions caused when the child was only three and one-half years of age. He had been the only child, much petted and loved. When he was two and a half years old a little brother was born, and he