o 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 ser