 Section 0 of the Major Symptoms of Hysteria. This is a LibriVox recording. All LibriVox recordings are in the public domain. For more information or to volunteer, please visit LibriVox.org. The Major Symptoms of Hysteria by Pierre Genet Pref. On the occasion of the inauguration of the newer, the magnificent buildings of the Medical School of Harvard University in Boston, President Elliott and Dr. J. J. Putnam, Professor of the Diseases of the Nervous System, asked me to deliver before the students some lectures about pathological psychology. I greatly appreciated this honour and tried to sum up before the American students some elementary psychological researches about a well-known disease, Hysteria, in order to show them how the study of the mental state of the patient can sometimes be useful to explain many disturbances and to give some unity to apparently discordant symptoms. So the following 15 lectures were given in the Harvard Medical School between the 15th of October and the end of November 1906. Some of these lectures were also delivered in Johns Hopkins University at Baltimore at the request of Professor J. M. Baldwin and in the Medical School of Columbia University in New York at that of Professor Alan Starr. I avail myself of the opportunity of this publication to offer my best thanks to these professors and their colleagues for their invitation and hearty welcome. Let me too thank here my friend Monsieur Edouard Philippi for the very useful help he gave me in drawing up these lectures in a foreign language. Boston, Massachusetts, November 25, 1906. End of Section 0. Section 1 of the Major Symptoms of Hysteria. This is a LibriVox recording. All LibriVox recordings are in the public domain. For more information or to volunteer, please visit LibriVox.org. The Major Symptoms of Hysteria by Pierre Jeunet. Lecture 1. The Problem of Hysteria. The interest and importance of studying Hysteria, the philosophical and the medical point of view, brief account of the evolution of the studies about this disease, the necessity for the psychological study of the neuroses, the psychological type of Hysteria. Gentlemen, President Elliott and the professors of the great University of Harvard have determined to celebrate the opening of the new buildings of your medical school by putting into practice a beautiful and great thought. They have determined to invite to come among them foreign professors and have begged them to expose before you the ideas and teachings they give in other countries. It is a mode of teaching which is very often used in American universities but unfortunately is rarely applied in France. It may have the most beautiful results for the teaching of youth, for the development of science and for the union of the various nations which is in our time the great aim of all true civilizations. Unhappily the application of this beautiful method is very difficult for all depends on the choice of that foreign professor called momentarily to teach among you. No doubt I can congratulate myself very much upon the choice which has been made. It is for me a great honor. It gives me an opportunity to see again a town of which I am very fond and to try to diffuse among you some ideas to which I hold. But I dare not congratulate you upon this choice, for I am afraid my ignorance of your methods of teaching and above all my ignorance of your tongue will make these lectures very hard to understand and very painful to hear. First I make you my apologies. Then I wish you may overcome this bad luck and forget as much as possible the incorrectness and strangeness of my language. This done, let us all do our best. You to understand me tolerably well and to draw from these lectures some notions of what interests French students. I to speak nearly intelligible English and to give you as favorable an impression as possible of the psychological study of nervous diseases in the French universities. One. With the approval of President Elliott and of Professor James J. Putnam I have chosen as the subject of these lectures the study of that nervous and mental disease called hysteria. The reason of this choice is that from many points of view this study seems to me pretty well to answer the wish of the professors who called me. When a foreign professor is asked to express his ideas in another country he is expected to expose one of the most characteristic studies of his native land. Just as when we have landed in a new country we seek to taste the dishes that characterize its cookery. Well it seems to me that what has been most characteristic in France for a score of years in the study of nervous diseases is the development of pathological psychology. No doubt the clinic and anatomic study of these same diseases is very honorably represented by French names but this study has developed in the same way in other countries and I think you have not much for which to envy us in this matter. Psychological studies, properly so called especially the studies of psychological measures have developed in Germany and in America more than in France and it is not here near Professor Münsterberg's laboratory that it would be well to come and deliver a lecture on this subject. But it seems to me that in France under the influence of two of my masters whose names I like to recall Charcot and Professor Ribot was realized an interesting union between two studies which were for the most part separated before. Beautiful natural experiences have been borrowed from mental pathology that strongly illuminate the problems of psychology. On the other hand notions of experimental psychology have been made use of in order to understand and sometimes to treat patients mental disturbances. I should be happy to make you feel how interesting is this new study which seems to me to have very good prospects. Among these studies of pathological psychology I determined on taking that of a particular nervous disease, hysteria. I think it is by this one that one should begin nowadays for this we have historical and scientific reasons. Look back to the time of the first works of Charcot, Ribot and their pupils. Cast a glance at the innumerable works which 20 years ago determined that current of researchers. Remember the names of Méné, Pietre, Paul Richet, Charles Richet, Biney, Féré, Marie, Grasse, Gilles de la Trourette, Brissot and in foreign countries of Delbeuf, Mibius, Breuer, Freud Morton, Prince, etc. Remark what was by a kind of singular common understanding the subject of all their works. No doubt they seemed like Professor Ribot to speak of all possible mental diseases and to seek for mental disturbances in all the forms in which they present themselves. Now and then it is true they devoted a few lines to idiocy or insanity but if you read their books again you will see that whatever the matter is maladies de la mémoire, maladies de la volonté, maladies de la personnalité they always speak of localised amnesias of alternating memory which in reality are only to be met among hysterical somnambulisms. Of irresistible suggestions, hypnotic catalepsy which are as I will try to prove to you nothing but hysterical phenomena of total modifications of the personality divided into two successive or simultaneous persons which is again the dissociation of consciousness in the hysteric. Besides all these works, pathological psychology owes very much to the considerable movement concerning hypnotism which took place during a few years. It is certain that the works of Charcot, Bernheim, Forl and so many others had the greatest influence on the development of this new science but now that the quarrels of other times are somewhat appeased everybody will probably recognise a fact which I hope also to be able to prove to you namely that in reality it is only among hysterical patients that this hypnotism is to be found in any marked degree. I will not raise now the difficult problem of deciding whether all the people who can be hypnotised must be called hystericals but I believe almost every good observer will agree with me that the best studies about the clearest cases of artificially induced somnambulism and about its psychological properties were made on hysterical subjects. Consider even the somewhat adventurous authors who have sought to draw attention to particularly strange phenomena and who, by the curiosity they have raised, have had a share in the development of the same researchers. Remember the studies on psychic polarisation, on transfer, on marked points suggestions, suggestions à point de repel, on unconscious acts, etc. These studies have always had for their starting point hysteric phenomena as equivalences and anesthesias. In a word, if any interest is given to the development of that pathological psychology which has been growing these 20 years, it ought to be recognised that this interest has for its object a special disease, hysteria. No doubt such exclusive fondness for this study was rather exaggerated and all the psychologists who, for some time, in imitation of the masters studied the hysteric were somewhat like the sheep of our panures. It was an exaggeration to think that pathological psychology could not be studied on other patients. Dr. Ferrer was somewhat mistaken when he called hystericals the frogs of experimental psychology. As in physiology, the frog is not an absolutely necessary animal for our experiments, so the hysteric patient is not the only one worthy of psychological researchers. We are even certain today that the hysterics offer many drawbacks and many studies have been made on other diseases. However, it is true that there were certain practical reasons justifying this choice at the beginning of this kind of studies and these practical reasons are still the same for you. The psychology of the hysteric patient, though full of difficulties and obscurities, is surely simple. It is a question of measure. All I want to say is that we are nowadays quite unable to understand to express in formulas and in laws what an insane person feels. We can hardly connect together by general laws the different facts observed in melancholic delirium or in the delirium of persecution. On the contrary, the various accidents of hysteria, though so different in appearance, are easily brought close to one another owing to common characters. We can dimly see some general laws about the formula for which we hesitate, but of whose existence we have a suspicion. That is, after all, the reason that explains the character of the discussion about hysteria nowadays. While nobody endeavours to give or to discuss a general definition comprising all the phenomena of epilepsy or melancholia, there are now a great number of authors who propose to explain in a few words, in a single definition, all the pathology of hysteria. In short, I was right in saying to you that the psychology of this disease seems now to be simpler than the conception of other mental diseases. It is the reason why I told you that the psychology of this disease is simple. To this primordial reason are added practical reasons. The hysteric are patients who are easily managed, who talk willingly, who are not dangerous, on whom we can experiment without any great fear, and who, lastly, like to be observed, and readily lend themselves to examination. Such are the reasons why the first studies were devoted to this kind of patients, and in following the historical order we also follow the practical order, which leads us to begin with the simplest and easiest disease. Two. Do not think, however, that this choice of the study of the hysteric is only justified by an historical chance and by reasons of convenience. The study of these patients, if happily it is a rather easy one, is at the same time very important, both from the philosophical and scientific, and from the medical and practical point of view. I am convinced that in our times every well-educated man wishing to have an opinion on moral and philosophical problems ought to know something of this singular mental disease, for it has played a considerable part in the history of all religions and superstitions, and it still plays a very important part in the most attractive moral questions. A great French alienist, Moreau de Tour, was in the habit of saying that all the great things accomplished in the world have been accomplished by mad people. It is perhaps somewhat exaggerated, but it is nevertheless true that most great creeds have spread by means of the emotion caused by surprising phenomena, which have always been due to hysteric people. In the development of every great religion, ancient and in modern times, there have always been strange persons who raised the admiration of the crowd because their nature seemed to be different from human nature. Their manner of thinking was not the same as that of others. They also had extraordinary oblivions or remembrances. They had visions, they saw or heard what others could not see or hear. They were illumined by odd convictions. Not only did they think, but they also felt in another way than the bulk of mankind. They had an extraordinary delicacy of certain senses joined to extravagant insensibilities which enabled them to bear the most dreadful tortures within difference or even with delight. Not only did they feel, but they also lived otherwise than other people. They could do without sleep or sleep for months together. They lived without eating or drinking, without satisfying their natural needs. Is it not such persons who have always excited the religious admiration of peoples, whether symbols, prophets, pythoneses of Delphi or Ephesus or saints of the Middle Ages or ecstatics or illuminates. Now they were considered as worthy of admiration and beatified. Now they were called witches or demoniacs and burnt. But at the bottom they always caused astonishment and they played a great part in the development of dogmas and creeds. Well, all these phenomena, as you know already, are the usual symptoms of hysteria and there is not from this point of view which has played so great a part in history. If I am not mistaken, it is still exactly the same now. We have changed only in appearance. We beatify but few saints and we burn but few demoniacs, yet we have not forgotten them. They have become our somnambulists and mediums and every time we want to throw some light on the mysteries of our destiny to penetrate into the unknown faculties of the human mind, to whom do we appeal? Whom do we take as a subject of observation? Is it an ordinary person, a person in good health, whom we ask to foresee the future or to talk with the dead? No, it is a neuropathic patient, insensible to the things of this world but whose sensibility is overexcited in a certain direction. Medically speaking, it is a hysteric person. Understand me well. I do not mean at all to tell you that these studies are warped by this, any more than I deny the sanctity of a personage of the Middle Ages whom I diagnosticate as hysteric. A hysterical person may be a saint. A hysterical person may have a wonderful lucidity. That is undeniable. I only want you to be warned of what happens when you have to judge facts of this kind. When we have to appreciate facts which are out of our habitual observation and look wonderful, it is a material point to know well in what conditions they present to themselves. Now, in the question we are considering, one of these conditions, the most serious one, is the mental state of the persons in whom such facts are observable. So you must know that such persons are hystericals and be accustomed to the laws ruling the minds of hystericals. Perhaps there may be some cases in which this ascertainment does not diminish the interest taken in the phenomenon, but believe me, it mostly takes away a great part of the wonderful. To judge these moral and philosophical problems, it is indispensable to study thoroughly this disease of the mind. This remark is truer still if you consider the subject from a medical and practical point of view. You who have chosen the medical career and will have to attend patients belonging to every class of society, bear in mind that you will constantly meet with neuropathic phenomena connected with this group of neuroses and that you will commit the most dangerous mistakes if you are not very well accustomed to the aspects and evolution of hysteria. It was the fashion for a certain time to say that hysteria was a very rare disease. You know that it had a bad reputation that a kind of dishonour was attached to this word and that people tried to persuade themselves that this shameful disease was not a frequent occurrence. By a kind of international irony, people were willing to admit after the innumerable studies made by French physicians that hysteria was frequent only among French women which astonished nobody in account of their bad reputation. Do not believe this nonsense. American women are terribly like French women. I was not astonished, therefore, when two years ago at the Chicago County Hospital and at the Boston City Hospital some kind fellow physicians immediately showed me hysteric women humorously adding that they were quite the same as those of La Salpatrière. The difference of races is also one of those silly things which the human mind has much difficulty in getting rid of. All civilised nations are now the same. We have the same mind and the same body who recognised the same miseries. If the hysterical seemed to be less numerous in other countries it is first because physicians did not recognise them then because they would not give them their real appellation. When medical instruction is more general in this matter, when prejudices have vanished, it will probably be acknowledged that in this matter as in many others, the other nations have no reason for envying France. So you will often meet with hysterical people. We will call them neurasthenic for the family if you like. I don't care. I only wish that you should at least know what is the matter. You must be able quickly to recognise this disease in order to foresee its evolution to provide against its dangers and immediately to begin a rational treatment. This early diagnosis is much more important still from another point of view. It will keep you, allow me to tell you plainly from making blunders. It is perhaps not very serious not to recognise a hysterical accident and not to treat it. But what is always very serious is to mistake a hysterical accident for another one and to treat it for what it is not. You cannot imagine the medical blunders and too often also the medical crimes committed in this way. One of the greatest difficulties in the medical art and one of the greatest misfortunes of patients is that hysterical diseases are only well characterised from the moral point of view which usually is not examined at all. That they are very badly characterised from the physical point of view and that they are uncommonly similar to all kinds of medical or surgical affections for which they are easily mistaken. Contractures, paralysis, anesthesias, various pains especially when they are seated in the viscera may simulate anything. And then you have the legion of false tuberculosis of the lungs of false tumours of the stomach of false intestinal obstructions and above all of false uterine of ovarian tumours. As to the viscera also exists as to the limbs and the organs of the senses. Some hysterical disturbances are mistaken for lesions of the bones of the ruckus for muscular or tenderness lesions. Then the physician interposes, frightens the family agitates the patient to the utmost and prescribes extraordinary diets perturbing the life and exhausting the strength of the sick person. Finally the surgeon is called in. Do not try to count the number of arms cut off of muscles of the neck incised for cricks of bones broken for mere cramps of bellies cut open for phantom tumours and especially of women made barren for pretended ovarian tumours. Humanity ought indeed to do homage to Charcot for having prevented a greater depopulation. These things no doubt have decreased but they are still done every day. Not long ago I saw a patient who had had an eye excised and the optic nerve cut out for mere neuropathic pains. If I could only pay more attention and interest to the knowledge of this disease contribute to diminish the number of these medical crimes I should already have attained a very important result. 3. In order to be able to enter upon the study of hysteria in a profitable way allow me before I end the introduction to summarise in a few words the history of the studies which have been made on this disease. We are not isolated in our studies we come after generations of other students and we always ought to be in our own researchers to try to see our way exactly. We ought to see at what point of medical history we are standing what has been done and well done before us what we have not to begin again. We ought to realise the difficulties that stopped our predecessors in order to add our efforts to theirs and to make some steps forward in the way they have laid down for us. The history of these studies would be a very long one for they began in the remotest antiquity. Democratus already has his theory about hysteria but I think that we can summarise this long history in a few words by establishing a few great divisions and I propose to you to adopt three great divisions. At first this history was anecdotical and descriptive. It is a period of curiosity and of somewhat uneasy and uncritical admiration. It is the period of sibles, witches, convulsionists of all kinds and of miscellanies of surprising facts about convulsions, somnambulisms, resurrections of lethargic people extraordinary fastings miraculous wounds etc. The second period which in reality began very late only in the 19th century might be called the clinical period then physicians sought above all to give a medical character to this disease to distinguish it from other maladies and to recognise the phenomena that appertain to it. It is a kind of clearing away and classification The third period which is quite contemporary deserves to be called the psychological period. For right or wrong it is among mental phenomena that for these 30 years the interpretation has been sort of these innumerable phenomena which our first ancestors had only described and which their successors contented themselves with classifying. Later perhaps there will come an anatomical and physiological period but in my opinion it does not yet exist. A word only about each of these great stages. In the first it is sufficient to remind you of the names of Plato, Hippocrates, Celsus, Calienus, Aetius of the authors who in the middle ages described possessions, careers, epidemics of torrentism. Among them are Ambroise Paré and Fernell. A little later we have to cite Charles Le Poit who gave in the 17th century one of the best descriptions. Sydenham who made known the hysterical nail coughing, vomiting and edema. Roland 1758 who supported the opinion of Sydenham and was one of the first to maintain that there were hysteric men. Witt 1767, Sauvage 1760, Astruc 1761 and Poem 1760-1782 who discussed this strange problem. This descriptive period was in fact disturbed by a purile and dangerous conception which viciated all the studies and made any attempt at an interpretation impossible. You know the old reverie of Plato in the Temeos. The matrix is an animal which longs to generate children. When it remains barren for a long time after puberty it finds it difficult to bear. It feels wroth. It goes about the whole body, closing the issues for the air, stopping the respiration, putting the body into extreme dangers and occasioning various diseases until desire and love, bringing man and woman together, make a fruit and gather it as from a tree. This pretty little story was for half a score of centuries the only interpretation of hysteria and still originated all the foolish ideas expressed by Louisier de Villiers in 1860. You may guess the part played in this respect by the abdominal pain seated at the level of ovaries, by the movements of the hysterical nail, by the suffocations of the patients during their fits. As hysteria required and uterus, its existence was not admitted in men and the first serious discussions bore on the existence of masculine hysteria. The recognition of this disease in men changed the old conception of hysteria and determined an ensemble of more precise clinical researchers. Without pretending to any chronological precision, we place at the beginning of the 19th century the inauguration of the second and truly clinical period. It is sufficient to remind you of the names of Georges 1821, of Huffeland in Germany 1836, of Brachet and of Landousie in France 1845, of Duchende Boulogne 1855, of Le Grand du Sole 1860. But I must insist on the beautiful book of the English physician Brody 1837, who described the sensitive and motor disturbances in the articulations and who has given his name to an hysterical accident the knee of Brody. We must accord a good place to the work of Brichet 1859. It was the first general work of real value and it prepared the way for the contemporary studies. Lastly, you know that the most eminent representative of that period is Charcot who in every way gave more precision to the clinical knowledge of hysteria. With these studies I connected the distinction between the epileptic and the hysterical fit which was for a long time considered impossible. The diagnosis of apoplexies, cerebral lesions, meningitis, of hysterical mutisms and fits of sleep. The separation between hysterical anorexies, gastralges and dysneas, and the organic diseases which are apparently seated in the same viscera. It is chiefly to the patient's studies of our predecessors that we owe the discovery and diagnosis of the different motor accidents of hysteria of the articular disturbances analogous to the knee of Brody of the contractures of the paralysis limited to one limb. Discussions relating to these motor accidents their comparison with the diverse organic paralysis researches on the traumatic neuroses filled as you know the career of Charcot. In all these studies there was no room yet for an interpretation of the disease and Charcot felt thoroughly the necessity of an interpretation of this kind. It was indispensable not only in order to explain things mysterious but chiefly to give a unity capable of linking together those innumerable symptoms that looked so heterogeneous. Laseg had already said that manifestations apparently the most disorderly have not the individual character one supposes and they are not inexplicable exceptions. Nothing is left to chance, said Charcot. On the contrary all happens according to rules always the same common to private and hospital practice applicable to all countries, to all times, to all races. He naturally sought to discover this determinism and these general laws of hysteria carried along by his habits as a clinician he has I think sought these general laws too much in the physiological domain which led him to a certain number of regrettable errors. In opposition to his school other studies and in particular those of Michel Bernheim in Nancy have shown that this unity of hysteria this interpretation of the symptoms it presents would be much more surely found in the domain of the moral phenomena. The contest of the two schools was the occasion of the development of psychological pathology of which I have spoken to you and brought on the beginning of the third period the psychological period of the studies in hysteria. This period which has already lasted for about 20 years is still difficult to judge. It seems to me however that its first clear results though interesting are still very incomplete and that I ought to warn you against their attractive simplicity. A certain number of authors have been seduced by the psychological explanation it seemed to them that the mere words moral and thought were enough to explain everything and as people generally like simple explanations physicians are too disposed nowadays to be content with a vaguely mental explanation. Hysteria they say is a psychic disease it is the disease of suggestion taken in a vague sense. It consists in disturbances which the patients persuade themselves that they have. It is the disease of persuasion. Many physicians think that when they have expressed a few formulas of this kind nothing remains to be said. There is some truth in this view for it brings into relief the psychic character of the affection but it is quite insufficient. We should in my opinion retain something of the precise method of Chalcor of the search after the determination and the laws of Hysteria and apply it only to the psychological fact instead of always seeking for this determinism in physical facts. We must therefore use a certain preciseness in the description and study of the moral phenomena of Hysteria. The description of such a disease is very difficult first because the symptoms are exceedingly numerous. You know that formally Sydenham called it a Proteus an ever-changing melody but the description is also difficult because the disease is not clearly defined because its limits unfortunately are very vague. It is easy to see that many contemporary authors do not quite agree about what they describe under the name of Hysteria and that some have a much broader conception of the disease than others. This indecision generally surprises young people. You think that in science things are perfectly definite and you are very much astonished to find indecision in your masters. In reality definiteness does not exist in natural phenomena. It exists but in our systematic descriptions. It is the men of science who cut separate pieces out of a hole that nature has made continuous. Do you believe that animal species are sharply distinguished from one another? Look at the quarrels of naturalists about the limits of the classes about the animals of transition which may it will be connected with one class or another. Remember the doctrine of evolution and the origin of species of Darwin. This is still truer in regard to diseases which in reality have not the distinctness we invent. Physicians it is true may agree in certain cases when there is a distinctly visible objective phenomenon characterising such or such a lesion. Histologic analysis will serve to define a syphilitic lesion. In other cases the presence of a microscopic organism will be a guiding mark and the recognition of the bacillus of Koch will define a tuberculous lesion. But unfortunately we have nothing of the kind at our disposal to define the diseases of the mind. Save the case of general paralysis there is no anatomical means to distinguish a patient laboring under the mania of persecution from the one who is affected with melancholia or neuropathy. When you have found the microbe of hysteria you will be able to transform all my descriptions and to make them much more accurate. Nowadays there is evidently a hypothetical, conventional part in the description and definition of a mental disease. Nobody I think felt so clearly the necessity of such hypotheses and conventions as Charcot when he exposed what he called the method of types. When one wishes to describe a nervous disease one must not fancy that one may comprise in its description all possible subjects. There are always some indistinct phenomena some aberrant cases some contradictory symptoms. In this case if one tried to satisfy everybody one would satisfy nobody by seeking to be too true one would be unintelligible. One must determine on making a necessary hypothesis which characterizes the teaching and the opinion of a master. One must choose among the innumerable cases of the disease that which in one's personal experience appears to be the most important that which presents the most definite phenomena the most distinct from other maladies the most frequent with patients of the same kind the most intelligible. This patient becomes a type which one describes by preference though one knows very well that all the others are not absolutely like it but because one supposes that they deserve the same name and the measure in which they resemble it. This is what I shall try to do before you in describing the major symptoms of hysteria. This word major indicates well that I do not pretend to describe all possible hystericals or all the shades these symptoms may present but that I only wish to show you what in my hypothesis characterizes the typical symptoms of hysteria. Such symptomatic and hyperthetic descriptions have the inconvenience of being transitory of disappearing very soon after us but it would be a singular illusion to seek to do something eternal. One has already obtained a great result when one has done something momentarily intelligible and useful. Sharco, whose method I cited to you applied it in a rather exaggerated degree in his description of hysteria. He described a type of hysterical which disappeared with him. Nobody nowadays any longer describes the attack of hysteria as Sharco did. I think, however, that his description did serve us to many a generation of students. It brought about an enormous scientific movement which we continue by discussing it. No doubt our types of hysterical phenomena are ephemeral like his. We wish they may have the same usefulness for some time. If I succeed in presenting to you a few simple types intelligible for you of the mental state that is called somnambulism of the mental state that brings about the functional paralysis and insensibilities I shall, I hope, have interested you in these studies of pathological psychology indispensable nowadays to the understanding of philosophical and moral problems. I shall have helped you a little to play later on your part as physicians for a physician should attend to the thought of his patient. I shall thus have accomplished, partially at least, the wishes formed by your masters of Harvard school when they did me the great honour to call me among them. End of section 1. Section 2 of the major symptoms of hysteria This is a LibriVox recording. All LibriVox recordings are in the public domain. For more information or to volunteer please contact LibriVox.org The major symptoms of hysteria by Pierre Jeannet Lecture 2 Monoidex Somnambulisms. Somnambulism is the typical form of hysterical accidents, description of some cases of monoidex somnambulisms, their essential psychological characters, the emancipation the dissociation of an idea of a partial system of thoughts in somnambulism. The several conceptions of an illness are characterised by the choice of the symptoms described first and considered as the most important ones. During a long time hysteria was considered as a chiefly physical disease and consequently convulsions in all appearance deprived of intelligence were put on the first line. Hysteria was, above all, a convulsive illness whose most important symptom was the fit. Charcot has still continued that tradition and you know the pains he took to explain all that illness in taking as a starting point the convulsive attack. His theory is nowadays considered very artificial and his schematic conception of the attacks tends to fall into oblivion. That lack of success are easily explained through his error of the starting point. The hysterical fit of convulsions far from being a simple phenomenon is, on the contrary, a very variable and complex symptom. The convulsions have all sorts of meaning. Sometimes they are in connection with sensations or ideas and very complicated states of consciousness. Sometimes they are nearly deprived of consciousness. In certain cases they are linked to habits and grimaces or depend upon moving agitation in connection with certain temporary paralysis. It may be said that for some rather aged patients whose illness has lasted a long time the convulsive attack sums up all the hysterical accidents they have had since the beginning of the disease. The attack I consider is a complex phenomenon that ought to be studied rather at the end of a course of lectures than at the beginning. To characterise at once the spirit of my teaching and to make you understand how to construe that nervous affection from the moral point of view I ask you to put in the first line as the most typical, the most characteristic symptom of hysteria, a moral symptom, that is, somnambulism. The fit of somnambulism which appears spontaneously in hystericals. This is a new medical conception which I consider an important one. Somnambulism has been too long considered as a rare phenomenon impossible to explain that adds itself to the habitual troubles of neuropaths. To me, somnambulism is, on the contrary, extremely frequent under various forms that may more or less conceal it. Somnambulism does not add itself to all sorts of neuropathic troubles. It constitutes the material point of a peculiar neurosis, hysteria. If one understands somnambulism well, one is, I believe, capable of understanding all hysterical phases that are more or less constructed on the same model. But among the various somnambulisms a type must be chosen to be first studied. Here we will not choose the form that occurs most frequently, but the necessity of teaching will induce us to choose the simplest form and the easiest to understand. This simple form of somnambulism deserves to be called mono-ideic, and that name will, I hope, be justified by this lecture. Thus we have to examine together the typical forms of mono-ideic somnambulism. We shall then expose its essentially psychological character, and we shall end by trying to sum up in a simple and general conception the character of these somnambulisms in order to compare gradually that first conception with those we shall draw from the study of other hysterical phenomena. One. What then exactly is a somnambulist? Popular observation has answered long ago. It is an individual who thinks and acts while he is asleep. Without a doubt that answer is not very clear, for we don't know very well what sleep is. That answer means only that the person spoken of thinks and acts in an odd way, from that of other people, and that at the same time that person is in some way like a person asleep. You will find nowhere a more beautiful description of this popular conception of somnambulism than in Shakespeare's tragedy, Macbeth. Doctor. I have two nights watched with you, but can perceive no truth in your report. When was it she last walked? Gentlewoman. Since His Majesty went into the field I have seen her rise from her bed, throw her nightgown upon her, walk her closet, take forth paper, fold it, write a pond, read it, afterwards seal it, and again return to bed. It all this while in a most fast sleep. Doctor. A great perturbation in nature to receive at once the benefit of sleep and do the effects of watching. In this slumbery agitation, besides her walking and other actual performances, what at any time have you heard her say? Gentlewoman. That's her, which I will not report after her. Doctor, you may to me, and as most me to should. Gentlewoman. Neither to you nor anyone having no witness to confirm my speech. Interlady Macbeth with a taper. Lo, you hear she comes. This is her very guise, and upon my life, fast asleep. Observe her, stand close. Doctor. How came she by that light? Gentlewoman. She has light by her continually. This is her command. Doctor, you see her eyes are open. Gentlewoman. But their senses shut. Doctor, what is it she does now? Look how she rubs her hands. Gentlewoman. It is an accustomed action with her to seem thus washing her hands. I have known her continuing this a quarter of an hour. Lady Macbeth, yet he is a spot. Doctor. Ah, she speaks. I will sit down what comes from her to satisfy my remembrance the more strongly. Lady Macbeth. Out, damned spot. Out, I say, one, two. Why, then, it is time to doot. Hell is murky. Fire, my lord, fire. A soldier and a feared. What need we fear who knows it when none can call our power to account? Yet who would have thought the old man to have had so much blood in him? Doctor, do you mark that? Lady Macbeth. The Thane of Fife had a wife. Where is she now? What, will these hands near be clean? No more of that, my lord. No more of that. You mar all with this starting. Doctor, go to, go to. You have known what you should not. Gentlewoman. She has spoke what she should not. I am sure of that. Heaven knows what she has known. Lady Macbeth. Here is the smell of the blood still. All the perfumes of Arabia will not sweeten this little hand. Oh, oh, oh. Doctor, what a sigh is there. The heart is sorely charged. Gentlewoman. I would not have such a heart in my bosom for the dignity of the whole body. Doctor, well, well, well. Gentlewoman, pray God it be, sir. Doctor. This disease is beyond my practice. Yet I have known those which have walked in their sleep who have died wholeily in their beds. Lady Macbeth. Wash your hands. Put on your nightgown. Look not so pale. I tell you yet again, bank was buried. He cannot come out on scrape. Doctor, even so. Lady Macbeth. To bed, to bed. There is knocking at the gate. Come, come, come, come. Give me your hand. To bed, to bed, to bed. Exit. Doctor. Will she go now to bed? Gentlewoman, directly. Doctor. Foul whisperings are abroad. Unnatural deeds do breed unnatural troubles. Infected minds to their deaf pillows will discharge their secrets. More needs she the divine than the physician. God. God, forgive us all. Look after her. She is so annoying and still keep eyes upon her. So good night. My mind she has mated and amazed my sight. I think, but dare not speak. Gentlewoman, good night, good doctor. Exeunt. Our modern examples are much less dramatic, but they may be compared as to their most striking features. Let me cite a certain number of cases to impress upon your minds the idea of this phenomenon, which to me is a very important one. Here is a first instance. A young woman 29 years old called Gibb. Intelligent. Sensitive. Here is one day abruptly some disastrous news. Her niece who lives next door has just died in dreadful circumstances. She rushes out and comes unhappily in time to see the body of the young girl lying in the street. She had thrown herself out of the window in a fit of delirium. Gibb, although very much moved, remains to all appearance calm, helping to make everything ready for the funeral. She goes to the funeral in a very natural way. But from that time she grows more and more gloomy, her health fails, and we may notice the beginning of the singular symptoms we are going to speak of. Nearly every day, at night and during the day, she enters into a strange state. She looks as if she were in a dream. She speaks softly with an absent person. She calls Pauline, the name of her lately deceased niece, and tells her that she admires her fate, her courage, that her death has been a beautiful one. She rises, goes to the windows and opens them, then shuts them again, tries them one after another, climbs on the window, and if her friends did not stop her, she would, without any doubt, throw herself out of the window. She must be stopped, looked after incessantly, till she shakes herself, rubs her eyes, and resumes her ordinary business as if nothing had happened. The curious case I have lately observed is that of He, which I have related with more particulars in another of my works. That woman, a hysterical 35 years old, was taking a walk in the zoological garden during her menstrual period when she was frightened by a lioness that, as it was reported, seemed ready to rush upon her. When she came back to the hospital, she had a fit of delirium that lasted for eight days. After some interruption she again had fits of the same odd delirium. In these crises she runs on all fours, roars, rushes on people, trying to bite them. And although she was anorexic before her attack and could eat very little, now she pounces on all sorts of food, picks it up with her teeth and devours bits of paper and small objects she finds on the floor. In a word, she acts a comedy wherein she believes herself to be a lioness. I say that she acts a comedy for it becomes certain that she studies her part and that she often replaces real actors by metaphors. For instance, she looks in a drawer for photographs, generally children's portraits and tries to eat them up. Without any doubt, as she is unable to devour real persons, she devours them in effigy. I won't insist on the form here borrowed by the idea rooted in her mind. It is one of those changes in personality brought about by a suggestion or an invading idea which are already well known. At the same time we may observe in here when she is awake a very complete amnesia that spreads not only upon the delirium but also upon the walk at the zoological garden. Third observation a man of thirty-two, some, presents a still more singular case. He usually remains in bed for both his legs are paralyzed. We won't occupy ourselves with that paralysis today, although it is a very odd one. In the middle of the night he rises slowly, jumps lightly out of bed for the paralysis we have just spoken of has quite vanished, takes his pillow and hugs it. We know by his countenance and by his words that he mistakes this pillow for his child and he believes he is saving his child from the hands of his mother-in-law. Then bearing that weight he tries to slip out of the room, opens the door and runs out through the courtyard. Climbing along the gutter he gets to the house top carrying his pillow and running all about to the buildings of the hospital with marvellous agility. One must take great care to catch him and use all sorts of cautions to get him down for he wakes with a stupefied air and as soon as he is awake both his legs are paralyzed again and he gets carried to his bed. He does not understand what you are speaking about and cannot comprehend how it happens that people were obliged to go to the top of the house in order to look for a poor man who has been paralysed in his bed for months. A fourth and last observation for I insist upon relating to you a great number of instructive examples. We come back to the common story of a young girl twenty years old called Irene whom despair caused by her mother's death has made ill. I remember that this woman's death has been very moving and dramatic. The poor woman who had reached the last stage of consumption lived alone with her daughter in a poor garret. Death came slowly with suffocation, blood vomiting and all its frightful procession of symptoms. The girl struggled hopelessly against the impossible. She watched her mother during sixty nights. Working at her sewing machine to earn a few pennies necessary to sustain their lives. After the mother's death she revived the corpse to call the breath back again. Then as she put the limbs upright the body fell to the floor and it took infinite exertion to lift it again into the bed. You may picture to yourself all that frightful scene. Sometime after the funeral curious and impressive symptoms began it was one of the most splendid cases of somnambulism I ever saw. The crises last for hours and they show a splendid dramatic performance for no actress could rehearse scenes with such perfection. The young girl has the singular habit of acting again all the events that took place at her mother's death without forgetting the least detail. Sometimes she only speaks relating all that happened with great volubility putting questions and answers in turn or asking questions only and seeming to listen for the answer. Sometimes she only sees the sight looking with fright and face and staring on the various scenes and acting according to what she sees. She finds all hallucinations, words and acts and seems to play a very singular drama. When in her drama death has taken place she carries on the same idea and makes everything ready for her own suicide. She discusses it aloud seems to speak with her mother to receive advice from her. She fancies she will try to be run over by a locomotive. That detail is also a recollection of a real event of her life. She fancies she is on the way and stretches herself out on the floor of the room looking for death with mingled dread and impatience. She poses and wears on her face expressions really worthy of admiration which remain fixed during several minutes. The train arrives before her staring eyes she utters a terrible shriek and falls back motionless as if she were dead. She soon gets up and begins acting over again one of the preceding scenes. In fact one of the characteristics of these somnambulisms is that they repeat themselves indefinitely. Not only the different attacks are always exactly alike. Repeating the same movements, expressions and words but in the course of the same attack when it has lasted a certain time the same scene may be repeated again exactly in the same way five or ten times. At last the agitation seems to wear out. The dream grows less clear and gradually or suddenly according to the cases the patient comes back to her normal consciousness takes up her ordinary business quite undisturbed by what has happened. I could tell you many more of these examples for all the events of life may be reflected in one of these scenes. This patient acts over again a scene wherein he has been bitten by a dog. That one reproduces in his dream the emotion he had when he was wounded by the falling of the lift. This little girl fancies a scene of her school life in which she was severely punished. That young girl reflects a scene of ravishment. A young boy repeats a quarrel in the street. Another man lives through a chapter he has read in a novel where thieves get through a lattice window and bind him tightly to his bed. This kind of delirium may vary over and over again in a thousand different ways. It is however very characteristic and in all mental pathology you will not find another delirium that may be compared with it. It is then necessary to study carefully the psychological character of which it is made up. For the precise analysis of this simple delirium will perhaps be the starting point whence we shall proceed to explain two innumerable studies have been written to analyse the preceding state in every particular. I shall only sum up the very clear result of those studies and I shall do it by following that state from its starting point to the return of normal life. There is a first very important period but on it we cannot yet dwell. It is the moment when somnambulism begins the change from the normal to the second state. When the change is sudden there is seems a loss of consciousness, a half faint. When the change is slow one may easily observe the abasement of mental activity. The patient pays no more attention to exterior events, he understands less and less what you tell him and he answers with difficulty as absent minded works more slowly or interrupts his work. In short voluntary activity and close application seem to disappear to give place to the expansion of the dream. When the dream begins there is a very striking and important characteristic namely the perfection and the intensity of its development. All the phenomena in connection with the dream seem enormously increased. Undoubtedly we all take expressions and attitudes in connection with our thought but our expressions look shabby and incomplete in comparison with the marvels of plasticity we may sometimes observe in somnambulism. Some of the patients as we have already remarked neither speak nor move but remain fixed in an expressive attitude. That form of mono-ideic somnambulism is called catalepsy. We have no time to dwell on all its various forms. We will only point out the perfect expression of those living statues that have often inspired superstitious wonder. We may learn by different means what images fill his consciousness and we may see that he has not our dull memory of things but that he sees the object he speaks of and really hears, feels, touches them exactly as if they were real. The unfolding of hallucinations is incomparable and except in some crises of alcoholic delirium that are a little like hysteria we shall never find in lunacy such abundance and such copiousness in the hallucinations of all senses. When the patient speaks he has a fluency of elocution and even an eloquence that seems superior to his normal powers because he gives himself entirely up to the idea he means to express. When he acts he has a precision and quickness in his movements and he is a wonderful actor of him and here again he surpasses his usual powers. The patient we just spoke of the one who believed he was rescuing his child by carrying his pillow ran on the house top with more agility than he would have shown in his normal state even if he had not been palsy-stricken. One of my patients who does not know how to write writes during her somnambulism it is no wonder and there is no mystery about the case. In the somnambulic state that woman remembered the writing she had learnt at school as a child and had to all appearance forgotten 30 years ago. The development of the somnambulic delirium is not only intense it is also perfectly regular. The patient repeats the same words at the same moments makes the same gestures at the same place every time he begins his performance over again. He seems to have on that point a marvellous memory. When he has appropriated his somnambulism to a given room he remembers all that he did at each different spot. He knows from what draw he took the photos he pretends to eat up, in what table he found a bit of wood that he used as a pistol he goes directly to that spot, unhesitating knowing exactly what he expects to find there. Sometimes in the course of various somnambulisms the patient instead of beginning his history over again takes up his delirium at the exact point where he last stopped and seems to remember perfectly at what point he broke off in his last delirium. You recollect one of Sharco's somnambulists who believed himself a journalist and who wrote a novel. He waked after writing two or three pages which were taken away from him. In the next crisis he began his novel exactly at the point where he had broken off. You see what an important part regularity and memory play in these scenes. Inversely the patient's liberty or power of will seem to have no share in these crises for the scene is never altered in the way the patient could wish. This negative character will become even more striking if we study somnambulism from another point of view. In contrast with the brilliant unfolding of some phenomena we discover with amazement strange mental blanks. The same patient who looks as if he had very precise sensations since he can walk on the house's top, look for objects in a drawer and see very clearly the bed where in his fancy his mother lies dying. This same patient seems unable to grasp anything else. This is what first struck popular observation. Speak to them and they do not answer. Try by all sorts of means to make your presence felt. They do not seem to feel it. The objects you thrust before their eyes do not in the least alter their dream and do not in the least stop it. As the doctor remarks in the case of Lady Macbeth their eyes seem open but they are shut to all impressions that are not connected with their dream. To make yourself heard you must dream with the patient and speak to him only words in accordance with his delirium. As the patient perceives nothing except the idea he has possessed of he remembers nothing except that one idea. He knows not where he is. He has quite forgotten the changes that have taken place since the time he speaks of. He often does not even know his name. His memory as well as his sensations is shut up in a narrow circle. The somnambulism is ended. The patient comes back to consciousness. We may then notice new characteristics and see how they add themselves to the preceding ones. The patient resumes his former sensations. The memory he has lost comes back. He knows his name, knows also where he is and remembers all the events of his life. He has to all appearance his former character and personality. But the wonderful thing is that in this new personality somnambulism has left a gap. He appears to have forgotten all that preceding period that Amaze does to such a point by its dramatic character. He is not disturbed by it. He knows the ridiculous acts he has just accomplished. He wonders sometimes at the untidiness of the room of which he is himself the cause and cannot understand how it came about. If you question him, try to awaken his memory by direct questions. Either of two things may happen. In describing with too much accuracy what the patient has just done in his delirium, he will either revive his memory so vividly that he will fall back again into the preceding state, be wholly taken up by that recollection, and act the whole scene over again. Or as more frequently happens, he will be unable to recall to his mind the lost memory. He does not understand what you mean. All the preceding scene which in reality is so lively and persistent in his memory since it will begin over again or will enter in the next crisis seems at that moment quite out of his consciousness. These are the chief psychological characteristics that come out in somnambulism. During the crisis itself, two opposite characteristics manifest themselves. First, a huge unfolding of all the phenomena connected with a certain delirium. Second, an absence of every sensation and every memory that is not connected with that delirium. After the crisis, during the state that appears as normal, two other characteristics appear opposite to all appearance. The return of consciousness of sensations and normal memory, and the entire forgetfulness of all that is connected with the somnambulism. Let us remember all these notions that here seem very simple and we shall afterwards see them unfolded in every hysterical phenomenon. Three, the facts and the laws of somnambulism we have just described have been well known for a long time and usually they made up all that was studied about this curious state. But I believe we must notice another interesting fact in order to understand better the whole of the monoideic somnambulism. This fact is usually more or less concealed and very apparent and conspicuous in certain cases. Let us take up the case of that young girl, Irene, who acts during her somnambulism the scene of her mother's death with such apparent precision. Let us watch her during the intervals of her fits during the period in which she seems to be normal. We shall soon notice that even at that time she is different from what she was before. Her relatives when she was conveyed to the hospital said to us she has grown callous and insensible. She has soon forgotten her mother's death and does not seem to remember her illness. That remark seems amazing. It is however true that this young girl is unable to tell us what brought about her illness for the good reason that she has quite forgotten the dramatic event that happened three months ago. I know very well my mother must be dead, she says. Since I have been told so several times since I see her no more and since I am in mourning but I really feel astonished at it. When did she die? What did she die from? Was I not by her to take care of her? There is something I do not understand. Why, loving her as I did do I not feel more sorrow for her death? I can't grieve. I feel as if her absence was nothing to me, as if she were travelling and would soon come back. The same thing happens if you put to her questions about any of the events that happened during those three months before her mother's death. If you ask her about the illness, the mishaps, the nightly staying up, anxieties about money, the quarrels with her drunken father all these things have quite vanished from her mind. If we had had time to dwell upon that case we should have seen these many curious instances. The filial love, the feeling of affection she had felt for her mother have quite vanished. It looks as if there was a gap as well in the feelings as in the memory. But I shall insist only on one point. The loss of memory bears not only as is generally believed on the period of somnambulism on the scene of delirium. The loss of memory bears also on the event that has given birth to that delirium on all the facts that are connected with it on the feelings that are related to it. This very important remark may be extended to all the other cases I have related. He, who has the delirium in which she fancies herself a lioness, has not only forgotten this period of somnambulism but also the walk in the zoological garden, that first cause of her delirium. Some who carries his pillow on the house top, believing that he is rescuing his child from the clutches of his mother-in-law does not remember his quarrels with that woman, although those quarrels were the starting point of the actual disease. I have noted down in this connection a very singular observation in which this retrograde amnesia accompanying somnambulism is well brought into evidence. A young girl, 19 years old, Lee, has fits of somnambulism in which she speaks about thieves, about a fire, and calls to her help a certain Lucien. When awakened, she knows nothing about all this and when you speak to her of what she said she pretends that in her life there is no event in which any part was played by thieves, by a fire, or by Lucien. As she had come alone to the hospital we had no other information and were compelled to believe that she had an imaginary delirium. Six months afterwards only, some relatives who had come from the country to see her told us of an event that happened three years before and was the starting point of her nervous crises. She was a servant in a country seat which one night was robbed and set on fire by thieves and she was rescued by a gardener called Lucien. It is astonishing that this young girl could have utterly forgotten such an important event and that she was never able to speak about it, when she related to the physician the story of her life and the beginning of the disease. It is worthy of note that the forgetfulness of this fact coincides with the development of that extraordinary memory on the same subject that filled her somnambulism. Without any doubt the forgetfulness of the idea which plays the greatest part in the monoideic somnambulism is not always so clear, so perfect. But I believe this forgetfulness always exists more or less concealed and the profundity of the forgetfulness is in proportion to the depth, the serious nature of the somnambulism itself. According to my belief the somnambulism is followed by an amnesia which is retrograde and which bears not only on the somnambulism itself but also on all the facts, the memories related to it. I beg the observers who can study such cases of somnambulism to notice with great care these troubles of memory added to the disease. How can we understand, how can we picture to ourselves the whole of these facts? What is the essential point which can sum up the observations? I propose to you the following psychological interpretation. An idea, the memory of an event for instance, the thought of a ferocious animal the thought of a mother's death all these form groups of psychological facts closely connected with one another. There are certain kinds of systems comprising all sorts of pictures and all sorts of tendencies to certain movements but with a strong unity. These systems in our minds have their strength and their law of development that are peculiar to them. They have also a great tendency to be kept within bounds by another power. Allow me to represent to you this system of psychological facts which constitutes an idea by a system of points connected together by some lines forming a sort of polygon, figure one. The point S represents the sight of the face of the dead mother, the point V is the sound of her voice and another point M is the feeling of the movements made to carry up the body and so on. This polygon is like the system of thoughts which are developed in the mind and in the brain of our patient Iran. Each point is connected with the others so one cannot excite the first without giving birth to the second and the entire system has a tendency to develop itself to the utmost. But at the same time in healthy minds these systems pertaining to each idea are connected with an infinitely wider system of which they are only apart. The system of our entire consciousness of our entire individuality. The remembrance of the mother's death and resurrection Iran feels for her mother with all the memories that are connected with it forms only a part of the whole consciousness of the young girl with all its memories and other tendencies. Let this large circle P near the little polygon represent the whole personality of the girl, the memory of all that happened in her previous life. Normally in good health the little system must be connected with the large one and must in great part depend on it. Generally the partial system remains the total system. It is called up only when the whole consciousness is willing and within the limits in which this consciousness allows it. Now to picture to ourselves what has taken place during somnambulism we may adopt a simple provisional resume. Things happen as if an idea a partial system of thoughts emancipated itself became independent and developed itself on its own account. The result is on one hand that it develops far too much and on the other hand that consciousness appears no longer to control it. That general remark may still seem to you very vague and very difficult to understand. Nevertheless I wished to point it out to you in a few words. First because it emerges very clearly out of the study of the first phenomenon of hysteria. Secondly because it will service as a clue to understand a thousand other cases of the neurosis. Don't trouble about the obscurity of that first remark after you have repeated it exactly in the same way in regard to a thousand different phenomena it will not be long before you find yourself understanding it clearly. End of section two. Section three of the major symptoms of hysteria. This is a LibriVox recording. All LibriVox recordings are in the public domain. For more information or to volunteer please visit LibriVox.org. The major symptoms of hysteria by Pierre Genet. Lecture three Fugues and Polyidex Somnambulisms Transformations and exaggerations of the first Somnambulisms Several cases of Fugues The Laws of Fugues The Diagnosis of Hysterical Fugues Differences between Fugues and Monoidex Somnambulisms The Characters of Polyidex Somnambulisms and their relations to the simpler forms The Emancipation of Feelings and Emotions A great many hysteric accidents are directly connected with the kind of Somnambulism we have just studied. There are slight transformations of the same phenomenon. Sometimes Somnambulism increases develops in a particular direction sometimes it diminishes keeps back only a few symptoms and it is sometimes difficult to know it again. But the phenomena are still of the same kind. They must be explained in the same manner and if we wish to understand hysteria well it is very important we should know the possible transformations of that fundamental state of Somnambulism. Today and in our next lecture we shall study the exaggerations and developments that multiply to a very high degree our first Monoidex Somnambulism. The first fact we meet with in this direction is one of the most wonderful phenomena of hysteria, the study of which has already attracted many authors. This fact is the hysterical mania of running away that we call ambulatory automatism, flights or better fugues if we may keep the French word. 1. We shall begin as we are wont to by showing you a certain number of clinical cases as if the patients were here before your eyes. We shall thus more easily acquire the knowledge of the clinical characters and of the general idea that is to be derived from them. Here is a splendid case of hysterical fugue remarkable for its simplicity. You can find the entire description of it in the Gazette d'Hôpito where I published it with Professor Raymond on the 2nd of July 1895. The subject is a man, P, 30 years old, employed in a railway station in a town in the east of France. Although an active and clever fellow he was a little eccentric and had already led a somewhat adventurous life. In his youth he had had frequent fits of somnambulism, sometimes in the day but mostly at night. Moreover the tendency to somnambulism is to be found in his family since his brother was also a nocturnal somnambulist who got out of his bed while asleep to work at his exercises. One day, like a patient we have spoken he carried his pillow on the housetop mistaking it for a little baby. If I dwell upon these previous somnambulisms similar to those we have already described it is because they form a link between the first phenomena we have spoken of and those we shall describe today. This man, P, was also very easily affected, predisposed to fixed ideas. One day in the notary's office where he worked he was slightly suspected though not accused of stealing a trifle. He fell ill and was very distressed. Night and day he discussed that suspicion and although everybody tried to prove to him how trifling it was he could not remain in that office. Moreover he had a tendency to exaggerated fears. He had left Lorraine after its annexation to Germany and during many years he was haunted by the fear of the German police whom he always believed to be running after him. All those details have their importance. You must not forget thus to inquire into the previous character of your patients. Such an inquiry will often enable you to understand very well the neuropathic diseases that come on later. However that may be the man we are talking of had also an adventurous turn of mind. He started with the crevaux mission on an expedition to South Africa and was sent back to France on account of his health. Then he enlisted under the orders of De Bratza who was starting for Gabon. There we must also notice he was very much debilitated by diseases peculiar to hot climates and continued long after his return to have fits of the aigu. This also is serious enough to prepare the way for the ensuing mental weakness. On his return to France at the age of twenty he got a situation in a railway company and was soon in easy circumstances. He married and had a child he dearly loved. His wife was again pregnant when the following incident took place. Although he led a quiet and rather happy life he was uneasy in his mind and gave himself up to intellectual labours too hard for a man who had no great acquirements. To his work in the railway office he added bookkeeping and what is more he drew up a geographical account of Gabon from the notes he had taken and this work gave him much trouble. He was made uneasy in his mind by family quarrels. His brother who was jealous of him had just quarrelled with him and had charged him with shameful and dishonest acts. The charge was groundless and nobody around him troubled about it but we know how easily upset able he was in that quarter and how he lost his head at the mere idea of a charge of that kind. It is in these conditions that we come to the third of February 1895. He was alone at Nancy his wife having left him for a few days. He had just ended a chapter of his work on Gabon and to take a little rest he went to a coffee house where he was well known. During the afternoon a part of which he spent with some friends at this coffee house in playing billiards he drank a cup of coffee, two glasses of beer and a small glass of vermouth which the coffee housekeeper wished him to taste. He told us himself all these circumstances which he remembers quite well. He also knows that one of his neighbors came to the coffee house and invited him to dinner as he was alone at home. He accepted the invitation so everything was as it should be and he has a very exact memory of all that happened then. He left that coffee house about five ready to go and dine with his friend but a few yards off while crossing the stunning last bridge over the railway line just as he got to the middle that also he perfectly remembers he felt a violent pain in his head as if he had been struck on the posterior part of his head. I point out these sensations to you without being able to dwell on them for they have not as yet been sufficiently accounted for but it is necessary you should know they often occur in the same conditions with neuropathic patients. The blow in the oxopot is very often characteristic of great fits, of great changes of personality. It is just what happened in this case for immediately after that something must have changed in the mental state of our patient as he has entirely lost the memory of all that happened afterwards on that Sunday, the 3rd of February 1895 and on the following days. When he comes back to consciousness or rather when he resumes the thread of his recollections the circumstances are changed to an extravagant degree. His first recollection is the following. He was lying in a field covered with snow, half dead and amazed to find himself in that place. He got up painfully found a road with a tramway line walked along that line and finally got, not without difficulty, to a town quite unknown to him near a railway station. It was the south station at Brussels. It was 11 o'clock in the evening and the date he read in a newspaper was the 12th of February. In short he had felt a shock on the head at Nancy on the 3rd of February and awoke in the neighbourhood of Brussels on the 12th. All that had happened in the meantime, how he accomplished that singular journey he does not in the least know. He telegraphed to ask for assistance. He was taken care of and conveyed to Paris to the Salpêtrière where we studied his case. I will not now explain to you how we revived his recollections. It would imply notions on hysteria that you have not yet acquired. I shall only tell you that we contrived to know what happened during those nine days and that we may now add it to the story of his fugue. On the Stanislas bridge after he had felt the blow on the head he felt himself overwhelmed with fear at the thought of the charge brought against him by his brother so that he went home in great anxiety. A few slight occurrences, too long to tell, increased the feeling of guilt and in the evening which he spent in wandering about the streets without going to his neighbours for dinner he constantly pondered on the way to escape those accusations and on the means of running away. He returned home where he took some money and went to sleep in a hotel in the suburbs instead of remaining quietly at home. He rose early and avoiding the railway went on foot through the fields to Champignol. When he had arrived there he went to the railway station where he was not known and took a ticket for Pagni on the Moselle. From Pagni he walked to Longuie still avoiding with the greatest care the persons who he fancied were running after him and in fact he did avoid them very well for his disappearance had been noticed and he was sought after with great anxiety. At Longuie he took the train to Luxembourg and then to Arlen and to Brussels still with the rooted idea of taking refuge in a foreign country under a false name in order to escape pursuit. At Brussels he first went to a good hotel and spent his days in seeking the means of earning a few pence but he did not succeed and the small means dwindled away. He took lodgings in a very shabby room then in one of those asylums where poor people are lodged at night. There a good man had pity on him and gave him a letter of introduction to a charitable foundation. That letter played afterwards an important part for he found it again in his pocket after waking up and it enabled him at the time of his recovery to retrace the former events and to recollect what had happened. But on the day it was given to him so that he fell into the most terrible poverty. He was on the point of enlisting for the Dutch Indies but happily he was not accepted. Fancy that unhappy man in the midst of a crisis of some nambulism sailing for India. Exhausted with fatigue and want of food he stretched himself on the snow in the fields with the vague idea that he was about to die. Here something very extraordinary happened something very interesting as a psychological fact. As he thought he was at the point of death he could not help changing the bent of his thoughts and in spite of himself he thought that he would like to see his family before he died stretched out in the snow. You must notice that the thought of his family had never entered his mind during the last days. The appearance of this idea had an unexpected result. He immediately said to himself but after all why am I dying here far from my family? He got up. He was awake. You know what happened afterwards. I want only to point out to you that enormous change in the mental state brought about by an idea. The fact is so interesting that we must observe it a second time in another case I have studied. It is also a very strange one. I will only sum up the more important facts. If you care to read this entertaining observation you will find it at full length in the second volume of my work on neuroses and fixed ideas. Here I shall only state the facts that are interesting for us today. The subject is a boy of 17, Ru, son of a neuropathic mother rather nervous himself who already had when he was 10 years old ticks and contractures in the neck of which we shall speak in one of our following lectures. At 13 he often went to a small public house visited by old sailors. They would urge him to drink and when he was somewhat flustered they would fill his imagination with beautiful tales in which deserts, palm trees, lions, camels and negroes were pictured in a most wonderful and alluring way. The young boy was very much struck by those pictures particularly as he was half tipsy. However when his drunkenness was over the story seemed to be quite forgotten. He never spoke of travels and on the contrary led a very sedentary life for he had chosen the placid occupation of a grosser's boy and he only sought to rise in that honourable career. Now there come on quite unforeseen accidents almost always on the occasion of some fatigue or a fit of drunkenness. He then felt transformed, forgot to return home and thought no more of his family. He would leave Paris, walking straight ahead and go to a more or less great distance through the forest of Saint-Germain or as far as the department of the Orne. Sometimes he walked alone at other times he rambled with some tramps begging along the roads. He had but one idea left in his head namely to get to the sea enlist in a ship and sail away towards those enchanting countries of Africa. His journeys ended rather badly. He would awake suddenly drenched half-starving either on the high road or in an asylum without ever being able to understand what had happened without any memory of his journey and with the most ardent wish to go back to his family and his grocery. I would dwell on only one of his fumes which is particularly amusing and was of extraordinary duration for it lasted three months. He had left Paris about the 15th of May and had walked to the neighbourhood of Malin. This time he was thinking about the means of succeeding in his scheme and of getting safely to the Mediterranean. Until then he had failed owing to fatigue and misery. The question was to find means of living as he went along. A bright idea had occurred to him not far from Malin, at Moray there are canals that go more or less straight to the south of France and in those canals there are ships laden with goods. He succeeded in being accepted as a servant before. His work was terrible. Now he had to shovel the coal now to haul the rope in company with a donkey called Cadet, his only friend. He was badly fed, often beaten, exhausted with fatigue but, though you would scarcely believe it, he was radiant with happiness. He thought only of one thing of the joy of drawing nearer to the sea. Unhappily in Overnure the boat stopped and he was forced to leave it and continue his journey on foot to the island. In order not to be resourceless he hired himself as a helper to an old China-mender. They went slowly along working on the road. Then one evening an unlooked-for event took place again. The day's work had been a success. The two companions had earned seven francs. The old China-mender stopped and said to our, my boy, we deserve a good supper and we will keep today's feast. It is the 15th of August. He scarcely said, the 15th of August? Why, it is the feast of the Virgin Mary, the anniversary of my mother's name-day. He had scarcely uttered these words when he appeared to be quite changed. He looked all around him with astonishment and turning to his companion said, but who are you? And what am I doing here with you? The poor man was amazed and was quite unable to make the boy understand the situation. The latter still believed himself in Paris in all memory of the preceding months. They had to go to the village mayor's where, with great difficulty, the matter was made more or less clear. The mayor telegraphed to Paris and the prodigal child was sent back home. He is not that name which suddenly evoked the memory of his mother and awakened him likewise a pretty conclusion of a fugue. The same particular is to be found in this final observation which I will relate in a few words. A young man of 29, a worker at a notary's office, had made a fugue of the same kind as the preceding ones and impelled by a fixed idea had gone as far as Algeria. He found himself adorant sitting on the terrace of a coffee-house quietly reading his newspaper when his eyes fell on a singular piece of news. The newspaper related the story of the sudden disappearance of a young notary's clerk aged 29 of such a name and wondered what had become of him. I am that young man. What can have happened? And he awoke without remembering his freak in the least. You see that the three observations are very much alike. It was formally thought that such cases were very rare and that they each had particular characters. In reality it is not so and we could easily collect twenty very typical instances quite similar to the three we have just described and in which you would easily recognize the same features. Two Let us then try and find the characteristic feature of the observations we know. You have noticed yourselves while listening to me how obvious the analogy is between the phenomena called hysterical fugues and the mono-edeic somnambulisms we lately studied. In a general way the essential characters are the same and we could without difficulty apply to the former the four laws we applied to the latter. First, during the abnormal states there is a certain idea a certain system of thoughts that develops to an exaggerated degree. It is evident that P for instance constantly thinks during the eight days his fugue lasts of the charge brought against him by his brother of the consequences it may have for him and of the means of eluding capture. It is obvious that the young R ponders during three months over the means of getting to the Mediterranean and the hope of finding a ship there and sailing for Africa. Such thoughts are disproportionate to the situation of a railway officer, the father of a family and to that of a grocer's boy. They bring about certain acts, they add to the endurance of those people who travel on foot work and bear hardships without difficulty. The second law applies equally well during the abnormal state the other thoughts relating to the former life the family, the social position, the personality appear to be suppressed. It is very likely that during their fugues those people assume false names and create for themselves fictitious personalities. You will find with regard to this last detail an interesting observation in the paper of Mr. H. Coriat of Boston published in the third number of the Journal of Abnormal Psychology 1906 page 109. The important point is that these people have lost the memory of their real personality. This seems strongly confirmed by the phenomenon of the awakening. When some chance occurrence brings back to their mind a thought about their family their real name, their former self they fall into another system of ideas and wake up. This proves conclusively that during the abnormal state chance had not roused that category of recollections. Outside of the time of the fit or of the abnormal state and during the period considered as normal you already guess it is not entirely so the two inverse laws apply the recollections of the fugue have vanished and that to an extraordinary extent but at the same time the thoughts and feelings connected with an idea that predominated due to the fact have disappeared more or less completely. I have already pointed out to you that young R was a model grocer's boy taking much interest in the sugar and coffee trade dreaming only of the pleasure of going on Sundays with his mother to the Saint-Cruis-Faire and having none of the tastes of an adventurous sailor. He does not continually feel this longing for travels and even grieves very much when you speak to him about his fugues. He is afraid they may begin again since he comes of himself to the hospital in order to get advice and be rid of them. I insist on that point if the boy really had all the time a taste for travels beyond the seas a taste which after all he might have he would not feel troubled about his fugues. He would resign himself in the idea that if they were successful they might prove profitable to him but he is far from doing so for during his normal life his feelings are not the same as during the period of his fugue you may observe the same fact in the railway clerk P when he is awake he does not speak at all in the same way of the charge his brother brought against him not only does he realize perfectly that there is no truth in it but he also feels that it is of no importance. He feels it is not worthwhile to upset his home and spoil his situation. There is obviously something in this that recalls the amnesia of her mother's death we have noticed in Irène and the disappearance of her feelings of love. Lastly during the state considered as normal you find the development of the psychological phenomena that was suppressed during the period of the crisis recollection of the entire existence perception of all present occurrences exact notion of personality in short you see that the four characteristic laws of somnambulism apply to such cases if to this you add that these fugues present themselves in individuals who have already had as I told you in the case the fits of somnambulism or if you remark that such individuals are apt to present somnambulic states later on as happened with rule it seems still more justifiable to bring the two phenomena together and say that upon the whole fugues are kinds of hysteric somnambulisms. We must insist a little while upon this summary and this diagnosis in my opinion these fugues must be ranked among hysterical somnambulisms for two reasons first because they represent to us all the major characteristics already known of hysterical somnambulism in the next lecture you will learn a new characteristic of this somnambulism that it may be artificially reproduced and that in this artificially induced somnambulism the memory of the first abnormal stage of the fit of natural somnambulism reappears entirely this new characteristic which we shall study a little later and which I simply allude to can be still found exactly in the fugues of the ceremony. Long after the awakening of his last fugue when he seems to have no remembrance at all of what happened the young Rue can be put into artificial somnambulism and can then relate to us with amusing preciseness all his adventures in the ship laden with coal and his friendship with the donkey Cadet hauling the rope with him when all these characteristics and especially the last one are to be found in a fugue it seems to me difficult to class this phenomenon apart from this somnambulism without complicating and confusing all the psychological classifications it is only when the phenomenon which seems to use similar to a fugue presents other characteristics which must be studied that you can frame for it another classification the second reason we must insist upon is that fugues of this kind exactly characterised usually appear in the life of some subjects who have already or who will have later on other phenomena connected with the accidents we know as hysterical ones in one word this kind of fugues appears usually in hysterical people this last point has called forth a number of interesting debates you must read for these discussions a paper by Dr. J. M. Courtney of Boston in the Journal of Abnormal Psychology in August 1906 page 123 this author quotes a number of fugues which seem to have appeared in subjects who were formally affected by epileptic fits in a word in epileptic subjects you must discuss with great care the observations you must examine whether these fugues have exactly the same character as the preceding ones it is necessary too to determine exactly the diagnosis of the fits which preceded the fugues the diagnosis of epilepsy as for me I cannot help saying that I often doubt these diagnoses that I am not sure of the diagnosis of epilepsy in all the cases used by Dr. Courtney in his interesting paper but in the end if you find a genuine case of fugue with all the preceding characteristics in a subject who is on the other hand an epileptic what do you conclude? the neuroses are not definite entities which exclude one another there are only certain classifications of facts in my opinion you must only conclude that this subject usually severely ill usually falling into serious epileptic fits has once had a less severe attack which is connected with hysterical rather than with epileptical phenomena this is rather frequent and is not inconsistent with the important comparison we've made just now of the phenomena of a fugue and those of hysterical somnambulism however we must not delude ourselves we must recognize differences first during the abnormal state the idea that develops has certainly not the same power as during monoideic somnambulism true it directs the conduct but it does not bring on the hallucinations and deliriums that it produced in the preceding case when Irene had the idea of committing suicide and of getting herself crushed by a locomotive she had not patience enough to go to the railway track and compass a real suicide she immediately had the hallucination of the railway track and without more ado lay down on the floor of the room remember that difference there is no real hallucination in the fugue the development of the idea is less intense secondly the idea is not absolutely isolated as in somnambulism this is the most characteristic fact our great somnambulus do not see or hear anything but what concerns the idea rooted in their mind and it could not be otherwise for if Irene saw the beds in the room if she heard my voice she would not believe herself alone on a railway track on the contrary the patients who make fugues need a great many perceptions and recollections to enable them to travel without any mishaps what is most wonderful in fugues is that these individuals contrive not to be stopped by the police at the very beginning of their journey in fact they are mad people in full delirium nevertheless they take railway tickets they dine and sleep in hotels they speak to a great number of people we are it is true sometimes told that they were thought a little odd that they looked preoccupied and dreamy but after all they are not recognized as mad people whereas Irene could not take two steps in the street when she was dreaming of her mother's death without being immediately taken to the asylum so you see that the range of consciousness is not at all the same that the mind is not distinctly reduced to a single idea we can make the same remark concerning the state called normal the oblivion of the fugue is total but the oblivion of the directive idea and of the feeling connected with it is by far less distinct and the restoration of the normal self is much more complete in short the difference could I believe be explained in the following remark a fugue lasts much longer than the monohidex somnambulism while the latter lasts a few hours at most the former lasts for months together it is necessary for a fugue to be able to last so long that the state should approach the normal state and that the character of somnambulism should be attenuated three in order to understand that degradation that transformation of monohidex somnambulism into the hysterical fugue we must study states of mind which are in some manner intermediate for us to understand the transformations of typical somnambulism I mean polyidex somnambulism which are opposed to the first as their name shows by the multiplicity of the ideas that fill them one instance will be enough to make you understand how somnambulism can pass from one idea to several here is an hysterical woman Lege who has led a very eventful life and has had several very dramatic adventures capable of upsetting her mind and filling her head with those fixed ideas that lead to somnambulisms one day at the period of her menstrual discharge she had searched her lover's desk and found a letter that confirmed her suspicions showing her that he had deceived her she fell into a great passion her menstrual discharge was stopped of course and she had a crisis of delirium in the form of monohidex somnambulism during which she acted the scene over again another day as she was taking a walk with her lover she had been surprised by a violent storm and frightened by a very loud thunder clap her lover it appears had not proved courageous and had not been equal to the task either of reassuring her or of finding a shelter for her she got terribly angry with him had a violent crisis of somnambulism during which she heard the thunder clap fainted and then made a scene with her lover that again is quite simple and conformable to the rule now a third story one day again at the period of her menstrual discharge she stole a revolver placed herself in ambuscade on the roadside and saw a carriage pass by in which was her lover with her rival she shot at them and fell back in a crisis of delirium other adventures happened to her the result of which was the same after all these accidents she was admitted into the hospital and nearly every day on the slightest occasion she falls into crises of delirium these crises begin at hazard by the recital or by the acting of the disease of one of her adventures she has a haggard look trembles and puts her hands before her face with an expression of violent terror she shuts her eyes as if before flashes of lightning and acts the scene of the storm then suddenly without awakening her face takes on another expression she seems to be looking for keys breaks open drawers, reads letters utter shrieks of fury lastly her hands grasp an imaginary revolver she looks out at the window with her naked air pulls the trigger and falls back in a fainting fit these three scenes and others quite like them begin over and over again indefinitely succeeding one another but not always in the same order they may last for hours together that is again a somnambulic state the mind is likewise concentrated on one idea and remains closed to external things but the ideas are manifold and bring on different comedies during which the perceptions and memories are not the same the unity of the somnambulism is broken there is something foreign to the idea itself that has unified those three or four ideas and has gathered them into one crisis the same character may be observed though with somewhat greater complication in another form of polyideic somnambulism I take as a starting point the rather simple observation of a young girl 20 years old, Ra this young girl as it appears found a situation at a tavern keepers the man was very brutal and beat and abused in every way she got to look upon him with abhorrence and fell into crises of delirium during which she acted over again the scenes she had lived through in the tavern the principal one was a scene of rape she shrieked and resisted the brutal fellow that is a monoideic somnambulism but as she runs about the room she finds a broom immediately she takes it and keeping on her face the same look of terror she begins to sweep the room without seeming to think in the least of the scene of the rape another time it appears she found a wheelbarrow and rolled it about the yard for hours it is clear that the act of rolling the wheelbarrow is not connected with the thought of the rape this is as you see a second form of polyideic somnambulism in which the ideas are not modified by the memory of previous somnambulisms but by the impression determined by outward objects which the subject still perceives I could show you as a third form somnambulisms in which the change of ideas seems to take place more easily still simply through an association of ideas read again the amusing observation about the somnambulist of Menet already described in 1874 that man had a very varied somnambulism during which in turn he acted scenes of military life then played music or fancied himself a servant according to the impressions he received one idea awakened by an association develops into a comedy it awakens another then a third one indefinitely somnambulisms are thus very complicated sometimes and apparently filled with a great many different ideas but we must then ask ourselves what makes the unity of these somnambulisms can we still apply here the general conception which was simple in the cases of monoidic somnambulism we summed up those states in a few words there is a simple idea a system of images which is separated from the totality of consciousness and has an independent development it brings about two things a blank in the general consciousness which is represented by an amnesia and an exaggerated and independent development of the emancipated idea now we find nothing of the kind here we do not find one distinct idea one precise system that has emancipated itself from consciousness a great many different ideas seem to characterize the somnambulism I think for my part that the difficulty lies on the surface and that at the bottom the phenomena remain the same the psychological systems that exist in our consciousness are very numerous and they do not all present themselves in the same form no doubt one of the simplest systems is the idea relative to an event the idea of one's mother's death is a well-defined system which can be suppressed clearly or can develop separately but there are other vega systems a great number of which we shall have to study I only point out to you for the present the system of thoughts and of tendencies that is called a feeling or an emotion it is not so clear as an idea but nevertheless it exists with some unity the feeling that arises from the fear of an ignominious charge the feeling of curiosity for distant countries the feeling of love and jealousy towards a lover the feeling of bondage to a hated master these are systems of thoughts that it is not always easy to express in words that are not ideas properly so called that may on the contrary many different ideas but that nevertheless possess a mental unity well in polyideic somnambulism and infugues it is upon this more serious feeling that the dissociation has born it is a feeling in its entirety a more or less precise feeling that has separated from general consciousness and that develops in an independent way giving birth to these odd deliriums a certain complexity differentiates these phenomena from somnambulism but we apply to them the same general law and the same interpretation end of section 3