“Everything connects increasingly with neuropathology, psychiatry, and psychology,” an excited Pavlov informed Horsley Gantt in December 1930. “What endless future work one can foresee in this direction!”1
The turn toward psychiatry flowed from longstanding interests and approaches. Pavlov’s interest in mental illness originated years before his research on conditional reflexes—dating perhaps from his exposure as a youth to the erratic behavior of his mother and two uncles, but certainly, at the latest, from his own bout with “neurosismus” and those of his friends Bystrov and Chel’tsov with more serious mental afflictions during their university years. As a scientist, he had always sought connections between his lab research and the clinic, and psychiatric terminology had infused his analysis of animal experiments since the 1910s. His interpretive style as an experimentalist—his determination to study intact organisms, his intensive explorations of individual animals, and his determination to integrate physiological law with those animals’ behavior, affect, and life experiences—had always resembled a physician’s approach to a clinical case. Finally, since psychiatry involved “illnesses of the human brain that distort the subjective world of man,” it offered rich ground for the “fusion of the psychological with the physiological, the subjective with the objective—resolving factually an issue that has so long vexed human thought.”2
Pavlov recognized that he was a novice in a complex field, but was confident that his approach to higher nervous activity held the key to a scientific psychiatry. His basic strategy was to use authoritative works by Eugen Bleuler, Ernst Kretschmer, and especially Pierre Janet to define the explanatory targets for his analyses. Targeting their descriptions of the symptoms of various mental illnesses—and often drawing on their etiological speculations—he extended his map of higher nervous processes to explain these physiologically. He was, essentially, translating selected conclusions of these leading experts into his own language of CRs.3 His specific contribution, he believed, was to provide an objective physiological explanation for the symptoms and etiologies identified by experienced clinicians who lacked his own scientific acumen and monist orientation.
During the 1920s, Pavlov had developed two basic explanations of mental illness in dogs and gradually woven them together. First, from Freud’s Anna O. and his dogs’ experience during the Leningrad flood, he had concluded that mental illness represented a “break” elicited by either an unbearable stimulus or by sharp collisions between excitation and inhibition. Depending upon the dog’s nervous type, this break damaged either the excitatory or inhibitory process, leading to a corresponding mental affliction. Second, probably influenced by his consultations with Timofeev at the Charity Home and his reading of Janet, he identified mental illnesses with chronic hypnotic states. These Pavlov attributed to “transmarginal inhibition”—that is, to chronic protective inhibition. When an impossibly challenging situation threatened to exhaust the supply of cortical material or otherwise damage the brain (to tax it beyond its abilities), transmarginal inhibition protected the cortex by shutting it down. This generalized inhibition, in turn, produced hypnotic states that gripped various points in the brain and altered pathologically the dynamics of higher nervous activity. These states represented the borderlands between wakefulness and sleep, occurred in phases, and affected various parts of the brain differently.4
By December 1927, when he addressed Russia’s Pirogov Society on the subject, Pavlov had fully integrated these two explanations of mental pathology in dogs. He suggested that cholerics broke toward excitation, falling victim to neurasthenia and its extreme form, circular psychosis; while melancholics, with their weak cortical cells, broke toward inhibition and suffered chronic inhibitory states that predisposed them to the hypnotic phases characteristic of hysteria and, in its extreme form, schizophrenia. Having long employed psychiatric terms that originated in psychiatry to characterize his dogs’ mental afflictions, he drew the obvious conclusion that this same basic analysis applied to humans as well.5
Pavlov’s turn to psychiatry in the 1930s, then, involved an intensification and systematization of his long-standing practice of interpreting dogs as people and people as dogs. He concentrated on the first phase of that dialectic on Tuesdays and Saturdays through his intensive collaboration with Maria Petrova in what he termed her Nervous Clinic for Dogs and at the Wednesday morning gatherings of coworkers, in which Petrova’s results were discussed almost every week between 1929 and 1936.
The second moment of that dialectic—analyzing humans as dogs—was institutionalized on Sundays from October 1929 through June 1930, when Pavlov observed patients at the Balinskii Clinic under the supervision of psychiatrist Petr Ostankov, and continued at his Nervous and Psychiatric clinics from September 1931 through February 1936. For years, then, once a week he spent mornings discussing physiological research on dogs at the Pavlov Wednesdays and then afternoons discussing human patients at the Pavlov Clinical Wednesdays. He rapidly reached some basic conclusions during those first nine months observing schizophrenics at the Balinskii Clinic. Every Sunday, Ostankov presented one or two patients diagnosed with schizophrenia. Pavlov began the first session by modestly assuming the status of student and asking Ostankov to “please enlighten me.” By the fourth week, however, he had identified in schizophrenics the very same hypnotic symptoms that were common among his lab dogs, and over the next weeks he rapidly deployed his conceptual map of higher nervous processes to explain those symptoms in patients.6
At a Clinical Wednesday in March 1930, he presented for comment his “Trial Excursion of a Physiologist in the Field of Psychiatry.” The symptoms of schizophrenia, he proposed, all resulted from variations and phases of a chronic hypnotic state that resulted when a cortex weakened either by heredity or experience was subjected to an “overwhelming excitation.” As in lab dogs, this elicited protective cortical inhibition (transmarginal inhibition), which resulted in a chronic hypnotic state, the various phases of which accounted for the malady’s wide range of symptoms.
The human brain was more complex than a dog’s, of course, and so hypnotic states in humans were not fully reproduced in lab experiments—but the similarities were striking. For example, schizophrenics often failed to answer questions, but did reply if queries were put to them very softly in quiet surroundings. This was fundamentally the same as the “paradoxical phase” in lab dogs who were in an early phase of hypnosis: in these dogs, weak exciters elicited a salivary response, but strong exciters did not. Similarly, the “negativism” often observed in schizophrenics was frequently exhibited by hypnotized animals during the “ultraparadoxical phase”: when a CS was offered, the animal “stubbornly turns away,” but when the food bag was retracted the animal moved toward it. The “playfulness, foolishness,” and “outbursts of excitation” often observed in schizophrenics resulted from the inhibition of the cerebral hemispheres. This freed the subcortex from cortical control and, through the mechanism of positive induction, generated “an excitatory chaotic condition in all its centers.” A deferential Ostankov welcomed Pavlov’s analysis, suggesting that he publish it in a Russian psychiatric journal.7
Analyzing people as dogs did not render Pavlov callous toward patients. Translating into his own language the longstanding values of Timofeev’s Charity Home, he expressed horror at the “terrible, oppressive conditions” of facilities for the mentally ill. “Have mercy! Look at these schizophrenics—they have a weakened cortex, which [amid the bedlam at psychiatric institutions] is subject to unending strong exciters.” This recalled the dogs in his lab that, their cortexes weakened by trying experiments, reacted with obvious discomfort to all but the gentlest exciters. He therefore concluded his “Trial Excursion” with a plea to psychiatrists that they protect patients against such “serious blows” to their weakened cortical cells and treat them like “patients suffering from other illnesses that do not try so directly the sense of human dignity.” When he obtained his own psychiatric clinic, Pavlov had it reconstructed accordingly to allow patients “the greatest possible peace and rest for their nervous systems.”8
In his publications and presentations on psychiatry, Pavlov never commented directly about the patients he observed. They served, rather—like the psychiatric literature he read—to define the symptoms (the explanatory targets) for physiological explanations drawn entirely from his experiments upon dogs. Observations of patients did however, constantly migrate indirectly, metaphorically, to observations and interpretations of his dogs—and then, through them, back to the patients themselves. For example, in February 1935 he analyzed an experimental animal through eyes sensitized by a recent encounter with a patient suffering from “persecution delirium.” Coworker Kalinnik Abuladze had been working with Zevs, an “excitable and strong” male, and his “apparently weak” sister Svetlana. When confined together with a single bowl of food, Zevs would growl at his sister and chase her away. Svetlana died, but even five months later Zevs manifested this same aggressive behavior when feeding—“showing its teeth, barking, and so forth.” Zevs clearly suffered from an “obsession”—the image of his deceased competitor “became very implanted in Zev’s brain when he was excited by food.” Physiologically, “this is pathological inertia from a very strong exciter. The obsessive ideas of paranoids probably develop in this same way.” Observation of a human patient, then, had informed analysis of a dog, which, in turn, served as a scientific explanation of human patients.9
In the years 1930 to 1936, Pavlov’s psychiatric analyses grew increasingly far-ranging and confident as he interpreted the symptoms of the psychiatric patients he observed or read about in the texts of European authorities in the light of physiological explanations that he developed for the ever-more-plentiful pathologies generated among the dogs in his lab.
* * *
All the canine examples Pavlov invoked in his articles about psychiatry originated in Petrova’s Nervous Clinic for Dogs, usually while he sat at her side. This “clinic” specialized in the creation and treatment of canine mental illness. Petrova first attempted to break dogs by subjecting them to unbearably strong exciters (such as a jarring ratchet), by overstressing inhibition through extremely difficult differentiations, or by otherwise eliciting “collisions between excitation and inhibition.” She then identified the various pathological states that resulted by analyzing the animal’s behavior, affect, and performance in CR experiments. Finally, she treated them with sodium bromide salts and caffeine. As a practicing physician, she was familiar with the use of bromide as a sedative (Pavlov himself had taken bromide for his “neurasthenia or hysteria” in the 1880s). She and Pavlov concluded that bromide strengthened and “concentrated” inhibition, as did caffeine for excitation.
As in other lines of CR research, the data regarding the therapeutic effects of “bromidization” were often baffling. The experimenters soon decided that, when administered in combination, the effects of bromide and caffeine were heightened through mutual induction. By the early 1930s, they also concluded that a strong dose of bromide was therapeutic for a strong dog but poisonous for a weak one. Weak dogs, however, responded well to lower doses, so the response to “bromidization” became yet another diagnostic test of nervous type.
The symptoms elicited in Petrova’s dogs were interpreted in psychiatric terms and provided experimental material for Pavlov’s presentations on “Experimental Neurosis” to the First International Neurological Congress in Bern (1931), on “An Example of an Experimentally Produced Neurosis and Its Treatment in the Weak Type of Nervous System” to the Sixth Scandinavian Neurological Congress in Copenhagen (1932), and on “Types of Higher Nervous Activity in Connection with Neuroses and Psychoses and the Physiological Mechanism of Neurotic and Psychotic Symptoms” to the Second International Neurological Congress in London (1935). Pavlov deemed that last talk sufficiently important for him to travel some 2,000 miles to deliver it, although he had not fully recovered from pneumonia and was about to host the Physiological Congress in Leningrad.
The first dog to provide an extended psychiatric case study was Mirta, the star of Pavlov’s presentation to the Scandinavian Neurological Congress in 1932. In differentiation trials over two days, this weak animal was exposed to a CI for five minutes instead of the usual thirty seconds. She fell into a “state of neurosis, a chaotic state in which the results of one experiment didn’t resemble the next.” Her behavior also became “disorderly”: while being escorted to work one day, “the dog broke from her leash, ran to the experimental room and, clearly in terror, crawled on her belly right in front of the closed door. During the experiment, she clung anxiously to the experimenter and then fell asleep.”
For Pavlov, this was a clear case of a neurosis generated by the overstressing of inhibition. He reported to the neurologists in Copenhagen that Mirta’s responses to experiments reflected an “ultra-paradoxical phase” (that is, a hypnotic state in which the dog salivated to a CI and not to a CS), and that her behavior had become so strange that the kennel’s attendant reported she had “gone mad.” After Mirta had languished in this state for two months, the appropriate dosage of sodium bromide restored her health. Treatment was then discontinued and Mirta was broken again, this time by a thirty-second exposure to an extremely noisy ratchet. She was then again restored by bromide. “I do not think I am exaggerating,” Pavlov concluded at Copenhagen, “to say that these experiments bear a machine-like character.” A neurosis had been twice generated and twice cured as a result of precise knowledge and manipulation of higher nervous processes.
The poor dog’s travails had only begun. Several months later, she was broken a third time by trials requiring differentiation between two very similar speeds of the metronome. This produced a “paradoxical phase” (that is, weak and strong exciters elicited the same level of salivary response). Throughout 1933 and 1934, the experimenters used extremely demanding trials to elicit chronic “pathological inertia” (the inability to convert an unreinforced former CS into a CI and vice versa) and an “ultra-paradoxical phase,” leading Pavlov, using Kretchmer’s nosology, to diagnose Mirta as a “sensitive schizoid.”
After these trials were completed in 1935, Mirta was employed in experiments conducted by Petrova and another coworker on the influence of alcohol on higher nervous activity. “So many talented and strong people have perished and are perishing because of alcohol!” Pavlov observed, so this was a most important subject for experiment. Five dogs of various types, both normal and neurotic, were made to imbibe alcohol regularly in various quantities and then tested for its effect upon their CRs, for evidence of addiction, and for phobias (one dog displayed symptoms judged analogous to an alcoholic’s delusions of persecution).10
“Castrate dogs of every type.” This decisive annotation in Pavlov’s lab notebook recorded Petrova’s success in convincing him fully to exploit a new method that yielded a “continual, inexhaustible source of pathological, therapeutic, and physiological facts.” Between December 1929 and December 1931, the pair castrated ten dogs; they collaborated closely in experiments upon eight of them for years. Petrova later recalled that Pavlov “repeatedly and gratefully told me that my great service consisted in my insistence on the castrates.” The fact that he spent so much time during his final years on these experiments—sitting beside her at the bench, jotting down observations in her lab notebooks, and reporting eagerly on their results almost every week at the Wednesday conferences—attested both to his continued affection for her and to his excitement about this research.11
Castration experiments made good sense to Petrova in light of contemporary medical theory. Despite occasional concessions to humoralist views, Pavlov held firm to the nervist image of the body that he had absorbed in the mid–nineteenth century, but Petrova, as a more recent medical graduate and a practitioner, had imbibed the endocrinological sensibilities that increasingly informed scientific medicine’s view of the body after Bayliss and Starling’s discovery of secretin. Castration became central to the theory and practice of early- and mid-twentieth-century endocrinology.12
Petrova was in a unique position to impress her views upon the chief. She later told the story this way: “Among the separate questions related to the study of the higher nervous activity of animals, I wanted to study also the influence upon it of the sexual hormones. I turned to Ivan Petrovich with this desire, but he tried to talk me out of it.... Yet I was persistent: I want to and that is the end of the subject. Ivan Petrovich continued to protest, and when I told him that I had for this purpose a well-studied dog, Joy, he replied: ‘And don’t you feel sorry for Joy being put to this use?’ ‘But if [the animal does not change,]’ I replied, ‘there will be nothing to regret. And if he does, then we will learn something.’”13
Since Joy was “a very valuable dog,” Petrova urged Pavlov to perform the operation himself, and “without any great enthusiasm, he finally surrendered to my convictions.” The marked effect of castration upon the animal’s CRs convinced the pair that sexual hormones played an important role in the “tonus” and balance of the nervous system. They eventually castrated and experimented upon dogs “of every nervous type”—including one particularly “talented” purebred German pointer that Petrova convinced Pavlov to name after himself (with the moniker “John”). To memorialize their efforts, the chief wrote a short epigraph in the notebook that Petrova opened as each dog went under the knife. “Don’t pout, my dear, any more; please behave just as before,” he wrote to Joy; “With gratitude in the name of science and its servants,” to John; and “Forgive me, I beg your pardon” to Mampus.14
A mongrel of “more or less balanced type,” Joy had served in the lab for five years before being castrated just before Christmas 1929. Petrova had herself worked with him for three years, establishing a series of CRs and determining that he possessed “excellent nervous activity.” The dog’s CRs were wonderfully precise and consistent: for example, his responses to various exciters obeyed perfectly the law of strength, and he easily differentiated M100 from M192. Joy’s behavior reflected this exemplary constitution: he hopped peacefully onto the stand, never slept during experiments, and consumed his food neatly (“not seizing it greedily like other dogs”).
Earlier methods of producing experimental neuroses had rarely succeeded with such well-balanced dogs—and Pavlov tended to think that these maladies arose only in extreme types—but castration quickly produced a “sharp change and chaos” in Joy’s behavior. He now hid under the stand until dragged out for experiments, often fell asleep during trials, and lost his former “cleanliness.”
Joy’s performance in experiments corresponded to this change: his CRs diminished or disappeared, he exhibited a chronic “hypnotic state with paradoxical phases,” and sometimes displayed “a sharply expressed negativism”—turning away from food when it was offered and lunging toward it when it was withdrawn. Thinking of patients he had observed in the Nervous Clinic, Pavlov speculated that Joy might be suffering from a weakening of both excitation and inhibition, and that this had freed the unruly subcortex from cortical control, producing chaotic responses that might be the basis of hysteria. In May 1930, the experimenters treated Joy with bromide, hoping to strengthen inhibition and disperse his hypnotic state. The results “surpassed all our expectations.” Joy’s responses began to normalize, and when bromide was discontinued the symptoms quickly returned. Relaxing the work schedule also helped: called to the stand only every fourth day, the dog’s “nervous balance was restored.”
When regular labors resumed, however, Joy returned to his “chaotic state” and exhibited “periodicity, circularity” between periods of normality and depression. In April 1931, Pavlov reported with satisfaction that psychiatrist Ostankov agreed that Joy’s condition was analogous to circular psychosis in humans and indicated a case of cyclophrenia (Kretschmer’s term) with alternating mania and depression. Several years later the chief diagnosed Joy as suffering from “pathological inertia” (that is, the inability of the nervous system to respond to changed circumstances—for example, to change an unreinforced former CS into a CI). This nervous condition, he concluded on the basis of experiments with Joy and other castrates, was the underlying cause of obsessive neurosis and paranoia. In 1935, Joy joined Mirta in the trials on alcohol poisoning.15
Joy’s response to castration guaranteed that others would follow. Boy, a young sanguinic, mostly Irish setter, and Hop, a weak type, mostly German pointer, were castrated in December 1930. Surprisingly, Hop responded with a marked improvement in both behavior and CRs. Previously “sleepy and a bit cowardly,” with feeble salivary responses and difficulties with differentiation, the dog’s responses to CSs increased significantly, and he became “unrecognizable in his external behavior”—strikingly energetic, sitting upright on the stand, with eyes wide open. Petrova cited approvingly the attendant’s observation that “Hop has become very brave.” Yet the animal soon descended, as had Joy, into a “circularity” between apparent health and pathology. Bromides, however, seemed to help. One and a half years after castration, Petrova reported, “this weak dog on bromide works at the same level as a strong dog, and much better than before castration.”
Like some people, Petrova observed, Hop’s life improved in the absence of passion: “Our castrate became significantly stronger, more energetic and playful. For Hop, unlike [stronger, better-balanced dogs], the sexual hormone, as a strong exciter, was intolerable; that is, it elicited an overexhaustion of the nervous system, which was weak to begin with. Human life, too, provides examples of how, with a weak nervous system, strong passions deprive the cortex of balance and lead to ruin.” By December 1934, however, Hop was unable to function without regular doses of bromide and caffeine, and even then could not resolve difficult tasks. He joined Mirta and Joy in the alcohol trials.16
Seeking to produce as many pathologies as possible, to explore their correlation with nervous type, to treat them, and to use them to understand mental illness in humans, the pair castrated five more dogs—generating a variety of psychiatric case studies.17
The star indeed proved to be Pavlov’s namesake John, a “marvelous young purebred” German pointer who earned his moniker and the experimenters’ assessment as a “genius” after solving one particularly difficult experimental task. “Very lively and playful, with an unusual greed for food and a highly expressed social reflex,” John had been subsequently subjected to an especially difficult set of differentiation trials with the metronome that left him in a deep hypnotic state characterized by “negativism and stereotypy.” All attempts to treat this condition failed. Castrated in March 1931, he displayed “the same circularity in work as did all our castrates.”
His star status as a pathological specimen resulted from his development of what Pavlov diagnosed as “depth phobia.” On the second floor of the Towers of Silence, between Pavlov’s study and Petrova’s clinic, was a staircase and landing. The staircase was blocked by a grate, where coworkers often tied and fed their dogs. When healthy, John had supped there peacefully, but after his “break” and descent into a chronic hypnotic state he backed away from the staircase “in great horror.” Though “greedy by nature,” he would not, even when hungry, approach food offered to him at the grate. The experimenters concluded that John’s overstressed inhibitory process—with its focus at the “sick point” created by the speed of the metronome established as a CI (M−)—had become “exaggerated” and irradiated throughout the cortex. A phobia, Pavlov reasoned, was “exaggerated inhibition,” a pathological heightening of the inhibition required for all coordinated tasks. This, he thought, was precisely the same mechanism responsible for obsessive fears and persecution delirium in humans. When the experimenters removed M− from the series of stimuli to which John was subjected during experiments, his depth phobia gradually disappeared. Three weeks later, they again subjected him to the rhythmic alternation of M+ and M−, and again he became “extraordinarily excited” and refused food offered at the grate.
Convinced that he had mastered John’s phobia experimentally, Pavlov presented this clinical case study in August 1935 to the Neurological Congress in London. “Subjectively, this is a clear state of fear, of terror”—and it could be elicited and removed at the experimenter’s will. Petrova demonstrated that same impressive control of John’s phobia later that month to delegates at the Physiological Congress in Leningrad. Shortly thereafter, when geneticists Nikolai Kol’tsov and Maria Sadovnikova-Kol’tsova visited the lab, Pavlov asked her to do so again. The demonstration, she later recalled, went brilliantly. “One had to see Ivan Petrovich during this demonstration. He was extremely excited. His face was transformed, it glowed, his eyes burned with fire.... ‘This means that we have completely mastered our subject and have understood correctly the mechanism of the phobia. Our power over the nervous system will be complete only when we learn not only to destroy, but also to repair that which is destroyed.’”18
At about this time, University of Cincinnati physiologist Gustav Eckstein arrived in Leningrad intent on writing a biography of the great Russian physiologist. Petrova demonstrated for him their prize dog, and Eckstein left a memorable description of what he witnessed:
This dog stood on Mme. Petrova’s book-strewn desk, in a blunted state of perception. Pavlov deepened the state by a brief repetition of the stimuli that had produced it—two metronomes going at different rates. The dog began to tremble; the space between its eyelids widened; saliva dripped from its mouth; there was a deepened, gasping breathing, now and then a moan; then, abruptly, the dog sank into an evasive mass on the top of the desk. After some minutes, Pavlov coaxed the dog down to the floor and into the hall. A pan of food had been placed there. Pavlov held out the food, but the dog pressed itself close against the wall, slowly moved along the wall, apparently afraid of the food. Pavlov advanced the pan toward the dog. The dog turned its head away.
“Negativism,” Pavlov blurted. Insane persons display negativism often. That dog never did get near that pan. Presently Pavlov set the pan to one side and coaxed the dog along the wall toward the door, which he opened. Beyond the door was a stairs. Instantly the behavior simulated what I saw once when I was a medical student and a four-year-old psychotic child was forced to the head of the stairs by a stupid doctor. That dog was as like that child as two creatures as widely separated could possibly be. The dog had been conditioned near the stairs, and the neurosis was associated with fear of those stairs—with the idea, I suppose, of falling down. At any rate, the dog was in an agonized state. “Depth phobia,” Pavlov announced.
With extraordinary youthfulness, Pavlov now turned to me: [speaking in German:]...“Now you have seen everything, everything.” And, like an actor, he made his exit, from the hall through the nearest door.19
Eckstein’s timing proved fortuitous: John’s phobia soon “irradiated,” becoming less impressively specific and generating fearful responses to a variety of stimuli. Some months later, Pavlov confided to a Wednesday gathering that the animal’s phobia had always been inconsistent, but had earlier been easily restored. During the Physiological Congress, the phobia happened to be present for a long time, so he could demonstrate it convincingly and even film it. Now, however, it had disappeared. The same procedures that had earlier induced the phobia now simply put the dog to sleep, which for Pavlov illustrated the protective role of inhibition. Still, John’s phobia had demonstrated the lability of pathological inhibition, which explained “many of our subjective experiences: lack of self-confidence, anxiety, suspiciousness—all can be acquired in the very same physiological manner, by the very same process of inhibition with its various qualities and phases.”20
Such analyses inspired Alexandr Evlakhov, a skeptical psychiatrist who attended the Clinical Wednesdays, to write a satirical poem about one of the castrated dogs. Titled “Mampus-Catatonic: The Tales of Maria Kapitonovna Petrova,” it began: “There once lived Mampus; A dog like any dog, a pup like any man.” Touching upon Mampus’s “doggy autism” and the “stubborn fasting” that manifested “schizophrenic negativism,” this bit of doggerel concluded:
Even if it hasn’t been twenty years
(Our Mampus is not chronic!)
Ivan Petrovich has opened my eyes:
When I see a pup howling at the skies
I now know it’s catatonic.21
Did Pavlov recognize the limitations of such explanations? Yes, but mostly no. He was constantly adjusting to new data and complexities, but he always identified scientific explanation fully with the mechanistic model. In an open letter of 1933 to Janet, he suggested that the physiological basis of Janet’s “sentiments d’emprise”—the sense of being possessed and persecuted—was the same “ultra-paradoxical phase” that Pavlov had identified in his lab dogs. Some thinkers, he conceded, found such explanations objectionable and absurdly mechanistic, but this reflected a basic misunderstanding of the very nature of science:
At the present time one cannot even think of presenting our psychic phenomena mechanically, in the literal sense of the word, just as one cannot even nearly do so regarding all physiological and, although to a lesser degree, chemical and even physical phenomena. A true mechanical interpretation remains the ideal of natural scientific investigation, one toward which the study of all reality—including our own—approaches only slowly. All contemporary natural science as a whole is only a long chain of partial approximations toward a mechanical explanation, with all these stages united by the higher principle of causality, determinism: there is no effect without a cause.
For Pavlov, then, his analysis of mental states admittedly represented only a distant approximation of the ultimate mechanistic explanation, a pioneering attempt in an era when the possibility was just appearing to “reduce so-called psychic phenomena to physiological” ones. Perhaps his analyses were crude, but in precisely the same way as contemporary explanations of physiological, chemical, and even physical phenomena also remained crudely, incompletely mechanistic. He was satisfied, however, that the ultimate form of explanation would prove fairly close to that which he was proposing, and he dismissed alternatives—whether Gestalt psychology or dialectical materialism—as unacceptable dualism and animism. The mechanistic model that he had imbibed as a youth remained the only form in which he could conceive of a truly scientific explanation, the unchanging ideal in his quest to integrate physiological, psychological, and psychiatric states.22
* * *
While building a bridge from dogs to people in the lab, Pavlov proceeded from people to dogs at his Nervous and Psychiatric clinics. Attached to his Physiology Division at the VIEM, these were organized to allow him, as one report put it, directly “to transfer laboratory data to the clinic,” to provide “concrete examples of the applicability for everyday [clinical] work” of Pavlov’s findings.
In 1934, these clinics were expanded, renovated, and equipped with labs. Alexander Ivanov-Smolenskii in the Psychiatric Clinic, and Boris Birman and then Sergei Davidenkov in the Nervous Clinic, oversaw patient care and an expanding research program, with constant input from Pavlov and Petrova. By 1935, the two clinics employed a total of sixty-five people, and coworkers there labored to develop methods for conducting CR experiments upon patients, elaborating Pavlovian analyses of mental illness, and testing the clinical efficacy of electronarcosis and various sleep-inducing drugs.23
The centerpiece of this venture was the Pavlovian Clinical Wednesdays, which convened every Wednesday afternoon at 2:00, two hours after the morning session on physiological issues. These sessions alternated between the Nervous Clinic on the 15th Line of Vasilevskii Island and the Psychiatric Clinic at the Balinskii Psychiatric Hospital on the 5th Line. Pavlov’s main psychiatric consultant, Ivanov-Smolenskii, had both worked in Pavlov’s lab and accumulated clinical experience in neuropathology and psychiatry, as had the other most active participants in the Clinical Wednesdays. Attending physicians at the clinics provided background information, but Pavlov and his acolytes dominated discussions. The audience also included a group of largely silent non-Pavlovian neuropathologists and psychiatrists.
The gatherings lasted two or three hours and usually involved two or three patients. As per psychiatric practice, each meeting began with the reading of the patient’s history and the physicians’ diagnosis, after which the patient was escorted in and interacted with one or more interlocutors, almost always including Pavlov. The patient then departed and the case was discussed. Pavlov took the lead, fixing on the patient’s symptoms and physicians’ diagnosis, and deploying his understanding of higher nervous processes to explain them. He often invoked results with a lab dog, his own personal experiences, and an introspective reading of his own thoughts, feelings, and actions to understand a patient and the nervous processes at work.
He usually identified quickly the patient’s nervous type and the disturbance in higher nervous processes responsible for his or her symptoms. A number of the Pavlovian clinicians in attendance were sufficiently fluent with the chief’s lexicon to offer their own analyses, and this sometimes generated disagreements, but always within Pavlov’s paradigm: Was the patient a strong or weak type? How strictly did typology determine whether the patient became an epileptic or schizophrenic? How did the interplay of excitation and inhibition differ in the neurasthenic and psychasthenic? and so forth.
The transcripts of these sessions reveal an extremely confident old man, surrounded by his disciples and authoritatively deploying the many variables developed over decades of research to generate rapid—and often quite exotic—explanations. He was, by long habit, thinking aloud, and he frequently changed his mind from one session to the next. Yet these changes almost always resulted, not from anybody else’s arguments or invocation of authoritative knowledge, but rather from his own subsequent cogitations. Despite the occasional pretense of being a mere student, Pavlov, as always, ran the show. Sometimes he conceded that his lack of clinical experience inevitably led to errors, but it was of course one thing for him to admit this and quite another for another participant to challenge his interpretations. “Few dare to contradict him,” Savich informed Babkin. “Pavlov does not now like arguments as in former days.”24
The sole dissenting voice belonged to Alexander Evlakhov, who left a detailed and lively diary of the Clinical Wednesdays. A widely read humanist, Evlakhov had been a professor of philology before turning to medicine and becoming professor of psychiatry at Azerbaijan University in the 1920s. The author of books on Pushkin, Gogol, and Tolstoy and of articles on delirium, reflexology, and the biology of creativity, he attended the Clinical Wednesdays while directing a Leningrad clinic charged, in the spirit of the day, with the diagnosis and prevention of social anomalies.
Evlakhov regarded Pavlov as a “remarkable person” and a “great man”—appealingly passionate, possessing a lively intellect, and unusually willing to admit mistakes—but also “despotic—he has no patience for and cannot stand objections.” Like Ibsen and Tolstoy, he suffered from the conceit that, as a great man, he could pronounce on any subject with authority, often generating “nonsense that good people accept as a revelation.” His partners at the Clinical Wednesdays were “sheep” and “royalists”—unimaginative sycophants who sought to curry the great man’s favor, to humor him, and to avoid his wrath. As Pavlov himself understood so little about psychiatry, he relied heavily upon Ivanov-Smolenskii, a very poor psychiatrist whose replies to Pavlov’s queries were “narrow, limited, and even psychiatrically illiterate.”25
This outsider often disagreed with diagnoses and analyses, but usually held his tongue. Unaccustomed to being challenged, Pavlov responded sharply when Evlakhov contradicted him or frustratingly complicated an issue. When, for example, he disputed an otherwise unanimous diagnosis by insisting upon what he considered a crucial psychological distinction, Pavlov dismissed him with a wave of his “crooked hands” and the comment “Here comes the psychological babble” (a remark for which Pavlov dispatched a coworker to apologize).26
The non-Pavlovian specialists in attendance were privately very critical of what they saw, but kept silent. Evlakhov recorded in his diary that throughout the Clinical Wednesdays, whenever he challenged the consensus view the specialists “who understood what was occurring either, if sitting next to me, confided in whispers their complete agreement or, at the end of the session, approached me and quietly told me the same—but not one said this in public.”27 The atmosphere at the Clinical Wednesdays was hardly conducive to genuine intellectual discourse between Pavlov and non-Pavlovian specialists. Nor was that their real purpose.
One incident highlighted for Evlakhov the lack of intellectual seriousness and even basic honesty among Pavlov’s advisors on psychiatry. Pavlov was attempting to distinguish between the underlying nervous pathologies responsible for schizophrenia and the condition of alternating “light manic depression” that Kretschmer termed “cyclothymia.” Having observed a series of schizophrenics, he directed Ivanov-Smolenskii to arrange for him to examine a cyclothymic. So at the Wednesday meeting of April 4, 1934, Andrei Chistovich, one of the physicians at the Psychiatric Clinic, presented the case of Patient Z. Chistovich reported that this thirty-two-year-old engineer and graduate of Leningrad Construction Institute had always been shy and sensitive, but had manifested no mental illness until difficulties at work had produced intense feelings of worthlessness and depression. This condition had appeared most recently in January 1934, after which Z was hospitalized. The patient had since improved and now wanted to be released. Choosing his words carefully, Chistovich labeled it a case of “reactive depression” (one feature of cyclothymia).
What did that term mean?, Pavlov asked. That the patient was in a cyclothymic state, responded Ivanov-Smolenskii. “But there was no cycle,” Pavlov rejoined, so how could it be a circular psychosis? Sure there was, Ivanov-Smolenskii responded: Z had first been depressed in the summer of 1932 and then again in January 1934. Pavlov was now confused: those two episodes may well have been due to specific life circumstances, and, in any case, fluctuations also occurred among neurasthenics. “I always see weak people who, when life becomes harder, become upset, cry, and let things go—and then it passes.” Here, though, Ivanov-Smolenskii insisted, these symptoms were much more pronounced: the patient “frequently cries and complains about depression.”
The more Chistovich and Ivanov-Smolenskii attempted to convince Pavlov, the more skeptical he became. Evlakhov, too, was dubious, and seized the opportunity to embarrass the “royalists” in front of their king. Questioning Z, Evlakhov and Pavlov established that he was suffering neither from circular cycles (there were only the two episodes) nor from any deep-seated internal sense of worthlessness, and that he had long been extremely withdrawn. Z was a schizoid, Evlakhov announced triumphantly, and Ivanov-Smolenskii backtracked to partially salvage his original diagnosis: it was “very difficult here to draw a boundary between the schizoid and depressive constitutions.” A frustrated Pavlov responded sarcastically: “How can you possibly speak about a schizoid constitution in that way? So far as I understand (and I, gentlemen, studied under you!), you usually point to this very same withdrawal as part of a schizoid constitution, but now it turns out that it can also be characteristic of cyclothymics.” The session ended on a sour note.
The other shoe dropped afterward in the hallway. Chistovich collared Evlakhov: “Why,” he asked confidentially, “did you strike at our weak spot? Having prepared the patient, we ourselves saw and discussed his schizoid characteristics, and, you know, it was really clear that he is a schizoid who will become a schizophrenic.” Fedorov and Vinogradov now joined them, laughingly confessing to the conspiracy. Acting on Pavlov’s request, Ivanov-Smolenskii had instructed them to “find a circular [psychotic].” Unable to locate a “pure” specimen and convinced that Z was schizoid, they had conferred with Ivanov-Smolenskii, who decided that they would nevertheless “‘consider’ him a circular psychotic and demonstrate him to Ivan Petrovich as such.” Vinogradov added another insider insight: in his desperate attempt to support this knowingly false diagnosis during the session, Ivanov-Smolenskii had told Pavlov that the patient had been weeping, but in fact the patient had “never even thought about crying—and everybody knew this, but none of us could say anything because, you know, that would have caught him in a lie.” This episode speaks volumes about the professional ethics of Pavlov’s “eyes and ears” in psychiatry, their attitude toward his excursion into psychiatry, and the cynicism and narrow pragmatism with which they related to the chief.28
Pavlov’s first encounter with a patient suffering from hysteria led him to develop his concept of two signal systems, which added a new dimension to his typology of humans. Patient S manifested a number of obsessions, including the fear that he would go insane. A host of physical symptoms seemed to have no organic basis (supporting the diagnosis of hysteria). He had been treated with rest, hydrotherapy, psychotherapy, and hypnosis. At the Clinical Wednesday of December 9, 1931, Birman hypnotized the patient, who responded appropriately to commands that he move his feet. Pavlov fastened on the fact that here the movement had been stimulated by words.29
This encounter led Pavlov to ponder “the special qualities of the human brain,” and during winter break he consulted texts by Bleuler, Janet, and Kretschmer on hysteria, and also read Kretschmer’s Physique and Character (1921), which offered a constitutional, typological analysis of mental illnesses. When the Wednesdays resumed in late January 1932, the chief commented repeatedly on these readings—synthesizing the experts’ description of the symptoms of hysteria, offering a physiological explanation of them at meetings in February and March, and, when Patient S was presented again at the Clinical Wednesday of March 23, introducing his concept of the “two signal systems.” Within three weeks, he completed an article that incorporated this concept into an analysis of hysteria.
How, Pavlov asked, does an organism orient itself to the external world? Two mechanisms comprised the “first signal system” common to humans and other animals: subcortical responses to unconditional stimuli and cortical responses to primary signals (conditional stimuli). As humans evolved, they developed also a “second signal system” grounded in the frontal lobes and governed by the word—by language and speech. This second signal system was responsible for abstraction and generalization of the information received through the first signal system, and provided a higher, specifically human form of adaptation—that is, of “science, both in the form of common human empiricism and in its specialized form.”30
Humans, then, differed among themselves along two axes: first, in their place within the Hippocratic typology that divided all animals according to differences in their first signal system, and second, by the relative strength of their first and second signal systems. “Artists” leaned toward the sensory input of the first signal system, while “thinkers” favored the analytical input of the second signal system. So, writers, musicians, and painters “comprehend reality as a whole, in full, as a living reality without any divisions,” while thinkers “break it apart, kill it, so to speak, making of it a temporary skeleton and then only gradually recomposing it anew and trying to restore it to life, in which they do not always succeed.” The two signal systems were balanced in most average people and in such rare geniuses as Da Vinci and Goethe, but the vast majority of “great men” owed their achievements to a pronounced imbalance. The great artist Tolstoy understood little about science, and the great thinker Darwin little about art. Crediting Kretschmer and Janet with superb descriptions of the mentally ill, but criticizing their failure to analyze these maladies rigorously, Pavlov suggested that each possessed a predominant first signal system and was “more of an artist than a thinker.” They described reality well, but analyzed and systematized poorly. Clearly with himself in mind, he added: “The thinker can use the works of the artist.”31
Pavlov now revised his typology of mental illnesses, structuring it around these two axes. Neurasthenia was a defect in the first signal system, and so existed in both dogs and humans. Hysteria and psychasthenia, however, were specifically human maladies; the former resulted from a break toward the first signal system, the latter toward the second. At the Clinical Wednesday meeting of October 26, 1932, he asked his collaborators to begin describing patients as either artistic or thinker types, and these categories became a common feature of discussions.32
Now satisfied that “there are no symptoms in hysteria that are inaccessible to physiological analysis,” Pavlov quickly incorporated his notion of signal systems into an article on that condition. The hysteric was a weak type with an imbalance toward the first signal system who had suffered a break due to some combination of inborn constitution and life experiences that overstrained the cortical cells. This led to transmarginal inhibition, a chronic inhibitory state, and various hypnotic phases that rendered the hysteric highly susceptible to suggestion and autosuggestion. The hysteric’s weak second signal system collapsed during the break, as did cortical control over the subcortex, resulting in daydreaming, fantasies, emotionality, and a much-diminished sense of self. (Here Pavlov was basically translating Janet’s observations into his own physiological language.) The hysteric’s inhibited cortex developed isolated, chronically excited “sick points” which attracted any excitatory impulses, leading easily to obsessions and phobias. The constant activity of these sick points also (through negative induction) deepened the sway of inhibition over other parts of the cortex, producing such symptoms as hyperkinesis and hypertonia. Pavlov now revised his earlier physiological explanation of the Christian martyrs who bore crucifixion with a peaceful smile. These he now considered hysterics who exemplified “the power of autosuggestion, that is, the force of the concentrated excitation of a certain region of the cortex, accompanied by the powerful inhibition of the other spheres of the cortex that represent, so to speak, the core interests of the entire organism, its wholeness, its existence.”33
Based upon this logic and his reading of Janet’s works, he quickly concluded that psychasthenia was the mirror image of hysteria, the result of a “thinker type” who broke toward the second signal system. This explained the psychasthenic’s characteristic lack of affect and “lack of a sense of reality, the constant sense of life’s lack of completeness, complete incapacity in life, together with constant fruitless and distorted philosophizing in the former of obsessive ideas and phobias.” In the true psychasthenic, “the emotive fund is absent and the first signal system does not work.” So, as Janet had indicated, the psychasthenic “likes philosophy” and “is entirely unadapted to life.” By October 1933, Davidenkov was following the chief’s lead, introducing a psychasthenic patient, “K,” by pointing out that “he is not an artistic type, but rather an intellectual one.” A delighted Pavlov exclaimed: “This is how it happens: affect and the first signal system in the one case, and the purely intellectual on the other.... [K is] a marvelous type—no artist could portray [a psychasthenic] so realistically as does the patient himself!” Did K have any enthusiasms in life?, he queried hopefully. “Apparently philosophy,” responded a resident clinician. Everything fit.34
These, then, were the insights that Pavlov was so determined to present to the London Neurological Congress in August 1935: his conception of the two signal systems, and the analysis of hysteria and psychasthenia that flowed from it; the explanation of various pathological symptoms such as narcolepsy, catalepsy, and Janet’s “sentiments d’emprise” as the results of paradoxical and ultra-paradoxical hypnotic phases; and his success with Petrova in eliciting and treating John’s depth phobia.
* * *
Izvestiia and the Soviet popular press touted the therapeutic benefits that would certainly result from this research, and Pavlov was deluged by letters from patients and their families. Overwhelmed, he prevailed upon Izvestiia to publish a short note explaining that he was not a “medical miracle worker,” that the five or ten letters he received daily were often so moving that it would be “unconscionable” not to reply, but that doing so would leave him no time for his work. “Therefore, I fervently ask that people surmount this sad misunderstanding.”35
Pavlov recognized that he had little to offer therapeutically. He often recommended rest and bromide, and his experiments with dogs suggested that the higher nervous system could be strengthened by training, but prognosis depended upon nervous type. Psychoanalysis might help a hysteric who had only one “sick point,” since talk therapy might “link this isolated point with other centers if the patient’s nervous system is sufficiently strong to withstand the blow of the exposure of the earlier trauma.” But this was only a partial solution, and Freud was mistaken to believe that psychoanalysis was useful in all cases. More frequently, psychoanalysis sentenced the sufferer to a long, painful, pointless journey that “leads both patient and physician the devil knows where.”36
The most promising therapy, he thought, was to rest the patient’s overstrained cortical cells—and he enthusiastically pursued the treatment of schizophrenia through “physiological sleep.” Sleep therapy had enjoyed a vogue in the United States and Europe in the second half of the nineteenth century, when prolonged sleep was induced by hypnosis, ether, chloroform, bromide, alcohol, and opium. Janet had given it his ringing endorsement in Psychological Healing (1919), a book with which Pavlov was quite familiar. Here the French psychologist reviewed this technique’s positive results in treating epilepsy, obsession, melancholia, and especially hysteria. Like hypnosis, in his view, sleep therapy had been discarded for no good reason—out of a general “disrespect for fatigue.”37
In the early 1920s, Jakob Klasi, a pupil of Bleuler and a psychiatrist at the Burghölzli Clinic in Zurich, claimed some success treating schizophrenics with sleep induced by Somnifen. Since the prognosis for schizophrenics was so bleak, this therapy enjoyed some popularity in subsequent years. Prolonged use of Somnifen, however, could cause circulatory collapse and death, so the director of the Burghölzli, Hans Maier, collaborated with pharmacologist Max Cloëtta on the so-called Cloetta Mixture, which, they claimed, safely induced prolonged sleep. Another Burghölzli psychiatrist reported in 1935 that sleep induced with this mixture produced remissions in schizophrenic patients with no dangerous side effects.38
At two Wednesday Clinical conferences in early March 1935, Pavlov shared letters from Moscow psychiatrist Mark Sereiskii about his use of the Cloetta Mixture to induce prolonged sleep and noticeable improvement in schizophrenics. Pavlov hypothesized that the ten-day pharmaceutical sleep described by Sereiskii would powerfully reinforce a patient’s protective response to cortical exhaustion. Worried about the side effects of the Cloetta Mixture, he dispatched Ivanov-Smolenskii to Moscow to meet Sereiskii and examine his patients. He reported back to the Clinical Wednesday of October 9, 1935, that a contact in Sereiskii’s clinic had informed him that, of the twelve or thirteen patients treated, three were cured, three had died, and the others showed little if any improvement.39
By this time, the Pavlovians had acquired a supply of the Cloetta Mixture, and the chief decided to test it on patients while Petrova and other clinicians monitored for ill effects. “This is a pure experiment,” he explained, “and I want to analyze it as in our laboratory. That is, I want to receive information about all twelve patients, to know well the state of each before the experiment and then to know what comes of them afterwards, are their symptoms getting worse or better.... Then, if there are significant consequences, it will be possible to determine for whom this is suitable [and] for whom it is not.”40
Beginning in early January 1936, the twelve patients were administered the mixture over ten days. At Clinical Wednesdays on February 12 and 19, Pavlov interviewed four of these patients and heard reports about two others.41 Most encouraging were results with one patient, Semen, an eighteen-year-old factory worker of peasant origin whom Pavlov had himself examined before treatment. He did not fit neatly into any clinical category, but Pavlov had earlier diagnosed him as an early-stage schizophrenic. Semen did not think himself ill, but complained of constant drowsiness and of accusing voices “from the ether.” As a member of the Communist Youth, he professed atheism and spoke of arguing with his religious family and even of burning icons (Pavlov’s horrified response to this was struck from the published record). Yet Semen also warned his sister about the physical proximity of the devil, crossed himself constantly, and referred to himself as an archangel.
For Pavlov, everything was “entirely clear.” Semen was a weak type whose feeble cortex had broken under the strain of hard work and the wrenching imposition of official atheism. “He is from a religious family, with strong religious ideas, but the Young Communist League begins by saying that there is no god, so there is a great ‘break,’ of which he is now victim.” (This, of course, was a play on words, a reference to Stalin’s Great Break of 1929–1932.) Semen’s chronic drowsiness reflected his cortex’s need for rest, and his delirium expressed the hypnotic state that had resulted from transmarginal inhibition. During their encounter, Pavlov explained all this to Semen, including his own belief that religion was a natural human instinct that served to comfort and protect weak people. He was himself a committed rationalist who had “finished with religion” in his teens, but he bore no hostility toward it. Clearly, he suggested, it would be healthier for Semen to adopt that same attitude.
Now, several months later in February 1936, Chistovich reported that Semen’s symptoms had disappeared after sleep therapy. Having slept twelve solid days, he felt “great” and experienced no hallucinations. The patient confirmed all this during a brief encounter with Pavlov, who expressed cautious optimism about the initial results of these trials.42
In public, however, he was less reserved. Based upon preliminary observations of patients in the sleep trials, he informed Izvestiia in early February 1936 that he was on the verge of a breakthrough. Responding to the naming of a new psychiatric clinic after him, Pavlov gratefully consented to this hopeful sign that his research was attracting the attention of physicians to the mentally ill. “We are now repeating experiments conducted in Zurich and Moscow on treating schizophrenics with continuous pharmaceutical sleep—experiments, I dare say, partially elicited by the physiological analysis of catatonia—and we are stunned by their positive results. There now appears a well-founded hope that this will yield a universal method of treating schizophrenia.”43 Having dispatched this letter, he eagerly awaited the awakening of more schizophrenic patients from their deep slumber.
Pavlov’s research always included an introspective dimension. Studying nervous types, he had classified himself as an “unrestrained choleric”—as a strong type with a relative deficit in inhibition. That explained his great energy, determination, and explosive temper. Ruminating about the disjunction between Garsik’s inborn qualities and his behavior and affect, he had solved the mystery of how he himself, an unbalanced nervous type, had become a successful scientist—a man skilled at a task, the perception of reality, that required nervous balance. The explanation, he decided, resided in the interplay of heredity and experience, in the interaction between powerful inborn excitation (freedom) and the inhibition (discipline) acquired during the grueling 1880s. That also explained his scientific style, with its characteristic interplay of (free-excitatory) hypotheses and (disciplined-inhibitory) criticism of his own ideas.
His study of psychiatry was similarly self-referential. “I am inclined, constantly observing myself, to compare my internal experiences with the results of our study of conditional reflexes,” he confided to his coworkers. He introduced his analysis of one dog at the Wednesday session of February 1934 with a reference to these “personal self-observations,” which facilitated both his analysis of dogs and his attempt “to understand my own wishes, decisions, and thoughts.”44
Classifying himself according to the relative strength of the two signal systems, he was undoubtedly a “thinker type”: “I am absolutely no artist, everything is concentrated in the second signal system.” In a meeting of October 1934 he adopted Kretschmer’s psychiatric lexicon to label himself a “cycloid.” Cycloids were “strong people” lacking an inborn balance between excitatory and inhibitory processes. Slipping in and out of the first person, he explained:
Understandably, all the regularity of life, all the normal system of behavior is based upon my having a balance in my work and rest, in the excitatory and inhibitory processes. When the strong person lacks such a balance, then, engrossed in some task, he draws excessively upon his resources and powers, and finally bursts, becomes extremely exhausted, reaches the point where he is fed up with everything, and there then comes a very long period of restoration. The cycloid type is a cyclically unbalanced strong type.45
Maiorov began to quibble—surely not all strong types were excitable and not all excitable types were cycloid. But Pavlov set him straight: “I am an excitable type and, of course, a typical cycloid; I constantly endure periods of strong excitation followed always by a weak, weepy mood, lack of faith in myself, doubts. So, it is just a matter of degree.”46
Here, then, were two more important insights into self. His highly regularized style of life was necessary to compensate for his lack of inborn balance, enabling him to achieve self-control despite a constitutional tendency toward disorder. And the Beast of Doubt that haunted him so relentlessly could perhaps be explained as the subjective product of his own typological mood swings.