in some way or other will have much to do with determining the character of the symptoms with which we are all familiar.  So many factors are concerned in the production of these secondary characters that it is difficult to assign to the symptoms their true value or to decide whether they possess much value at all with regard to the fundamental disturbance which constituted the primary illness.  So often they appear to be mere rationalizations, mere false judgments on the part of the patient; they thus form subjects for investigation rather than fundamental constituents of the illness.

We, therefore, must not accept the outward and visible signs at their face value but attempt to discover what past experiences in the life of the patient have led to such disturbance of function, to such a change in his mental activity.

It will possibly be of some assistance to provide one or two examples in order to demonstrate the importance of the past experiences as agents capable of producing such alterations.

The first case will illustrate the results produced by the development of a dominant emotional tendency during early childhood.  The patient up to the fifth year of her life had been an ordinary, normal child, attached to her mother, fond of her nurse, interested in her toys.  During the next two years she endured much bad treatment at the hands of a new nurse which produced such an impression on her that she felt she was a changed child.  This nurse, described to me by the patient as a handsome woman, having met the inevitable man, used frequently to meet him clandestinely.  The child was neglected, was sometimes left alone, on one occasion in a graveyard, but she was forbidden to mention the subject to any one under threats of being carried away by a “bogey-man.”  The child became very frightened by this, to such an extent that one night she had a severe nightmare in which a “bogey-man” came to carry her away.  At the end of two years a profound change had taken place in her which she now describes thus:  “I was a changed child; I was separated from my mother and could no longer confide in her nor did I wish to do things for her as I had done before; I could not enjoy my toys; I had no confidence in myself; I was not like other children.”  And from that time on, as girl and as woman, she has never felt that she has been like others of her sex.  Such a condition, being started and confined by repetition, interfered with her free development and it was remarkable how many incidents occurred in her life to confirm the disability, but the germ of her serious breakdown thirty years later was laid in her fifth and sixth years.