 Section 13 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 Jaunet. Lecture 13. Hysterical Stigmata, Suggestibility. The need of unity in presence of the diversity of hysterical phenomena. The problem of the stigmata. The stigma of anesthesia. The historical importance of this stigma. Its exaggeration. The two meanings of the word stigma. The psychological stigmata. The character of hystericals. Instinctive falsehood. The mental stigma of suggestibility. The distinct meaning of the word suggestion. Description of the principal facts of suggestion. The complete development of the elements contained in an idea without any participation of the will or of the personal consciousness. The distinction between real suggestion and normal phenomena. The conditions of suggestion. The systematization of images. The absence of suggestion properly so called with normal people. The weakening of consciousness. The lack of synthesis. Suggestibility as a sign of hysteria. The disappearance of suggestibility after recovery from hysteria. The examination even rapid of the numerous accidents of hysteria raises inevitable problems in our minds. The most important one. The one that always torments the human mind in all possible studies. Is the problem of unity. Of the conception of the whole. Of the essential and fundamental character. The first authors who described hystericals were always struck with the diversity and complexity of their symptoms. It is not a disease said one of them. It is a host of ailments. And you know that to express the changeableness of hysteria. Sydenham called it that Proteus that cannot be laid hold of. Sometimes it takes the form of delirium such as we have seen in somnambulisms. And we are in the domain of mental diseases. Sometimes it presents accidents of the arms and legs. Which make us think of articular and muscular lesions. Now we meet with disturbances of the stomach or lungs. And we have to deal with visceral diseases. Gastritis and pneumonias. You may understand the perplexity of the first clinicians. The best of whom came to a bore and loathed such a malady. They did not seek to take away from it its bad renown. For their scientific dissatisfaction discomposed them. Made them impatient with the subject. And inclined them to call him a simulator and a debauchee. Slow was the reaction against this tendency. Brought about by a very natural perplexity. The best answer has been to make hysteria intelligible. And above all to seek to give it some unity. By linking together those scattered accidents. By finding in all of them some fundamental features. Which serve at once to explain them. To connect them with one another. To diagnosticate and to identify them. This need of unity under diversity. Which has never been so serious as in the study of hysteria. Has enlarged with regard to this study. A problem that upon the whole exists in every medical research. The problem of the stigmata. If one admits that somnambulism, paralysis, vomiting. Are all three of them hysterical phenomena. In spite of their enormous differences. There must be something common among them. In the three patients a common character must be found. Which is with all of them the starting point of the observed symptom. And serves to diagnosticate the hysterical character of this accident. That common character is the stigma. And one may say that since the beginning of the scientific study of hysteria. All the attention of clinicians of any merit. Has been directed to the study and search of the stigma. One. Of course this stigma has varied very much. For it reflects the theories of each period on the diseases one considers. Now this essential stigma of hysteria was the convulsive attack. Now the hysterical ball. You will read with astonishment the books of the beginning of the 19th century. In which you will find that hysteria is recognized from the ball of nervous women. For about 50 years past other more important characters have become predominant. And you are aware that especially under the influence of the school of Charcot. One symptom has become the preeminent stigma. Namely anesthesia. The singling out of this symptom was in some degree an unconscious return to the past. In the middle ages people had also a kind of diagnosis to make. In order to recognize witches and those possessed as well as possible before burning them. And you know the singular method they made use of. A surgeon or an expert woman examines the body of the sufferer on all sides. Testing the sensibility with a sharp needle in order to discover the devil's claw. That insensitive patch which was a certain sign of witchcraft. They examined every nook and corner for the devil is in the habit of concealing himself in the most hidden places. And they actually tested the sensibility of the mucous membranes as well as that of the skin. The fact is really very curious and shows an instinctive medical perspicacity that has not been sufficiently celebrated. Well Charcot nearly brought us back to the time of the celebrated inquisitor Baudin. And in our clinics we are somewhat like the woman who sought for witches. We blindfold the subject, we turn his head away, rub his skin with our nail, prick it suddenly with a hidden pin, watch his answers or starts of pain. The picture has not changed. This research has allowed clinicians to establish that in many cases various anesthesia is a company most hysterical symptoms. In the case of paralysis or contractures of the limbs the phenomenon is very clear and regular. Whether in regard to cutaneous sensitiveness or better still for it is very important to muscular sensitiveness. In the case of sensorial accidents the anesthesia is very often quite distinct at the periphery. Sometimes it conceals itself by taking extremely interesting forms which the inquisitors did not know how to seek for. Such as the contraction of the visual field. In the case of visceral accidents and of certain motor disturbances which are rather agitations than paralysis. The question becomes more delicate. Often the superficial anesthesia of the region indicates the diseased organ. But to be sincere this is not always true. When we have to deal with the great mental accidents with all the innumerable forms of somnambulism the anesthesia sought for by Schalco is often to be met with but it does not constitute the absolute rule. That method which consisted in characterizing hysteria by anesthesia and by the contraction of the visual field has enabled medicine to make great progress. It has successively brought about the discovery of a crowd of unknown hysterical symptoms of special spasms, tremors, localized pains, etc. Must it continue to dominate in medicine and must anesthesia be made an essential symptom? The discussion on this point began at the very outset of the teaching of Schalco. His adversaries and they were numerous always opposed his interpretation of this symptom. The great and interminable quarrel about traumatic neuroses which began especially in Germany in connection with railway accidents rests on this question. This criticism is in great part justified for hysterical anesthesia certainly does not play in practice the absolutely preponderant role that Schalco maintained it did. First of all it is only too certain that this anesthesia is not so easy to recognize as was believed. It has as we have seen very delicate psychological characteristics that make the answers of the subject very often difficult to interpret. But above all it is very mobile, very impressionable. Now your examination alone will suffice to cause a real anesthesia to disappear. Now, and this is more serious, your manner of interrogating will create outright an anesthesia that did not exist. The study of the stigmata is made on no patients so well as on old ones, the real pillars of the hospital who have already been examined thousands of times. Then you have to deal with new patients who have not yet been touched. You recognize with astonishment that anesthesia is rarer, less important than Schalco said. On this point I apologize myself and acknowledge that under the influence of La Salpettrière I formally attributed more importance to anesthesia than I would do now. What then must be our conclusion as to the role of anesthesia as a stigma? We should understand one another and not ask the sciences of observation which are so difficult to furnish us with absolute theorems. In my opinion the two meanings of the word stigma should be separated. In the first place it has a theoretical meaning, it indicates the fundamental character, the causal character from which the rest of the disease springs. For instance, if you consider a tuberculosis lesion the real stigma will be the bacillus of Koch because we consider it, at least at the present day, as the cause of all the innumerable lesions however varied they are. It will be the same with the existence of the pale spirochete of Chaudin in syphilis if the hypothesis is corroborated. Now we must own that anesthesia does not play this role in hysteria that we do not know the microbe of that melody, that there is probably none and that we know no better its histological lesion. From this standpoint Schalco's stigma has failed. But the stigma has another meaning which is practical. It is a mere means of diagnosis. Now anesthesia accompanies two-thirds of the hysterical accidents. It has besides the character of persisting long after the disappearance of the accident. The result is that almost all the hystericals who, at present, show a serious phenomenon have had in the past one of those accidents that leave behind them as a trace, some persisting anesthesia. I examine in a subject of perplexing mental or sensorial disturbance and find traces of a hemianesthesia. It means that in the course of his life he has already had, in a greater or smaller degree, a hysterical hemiplegia. I establish with him a contraction of the visual field which he did not even know. It proves to me that he has had in a greater or smaller degree a hysterical amaurosis. It's not this recognition extremely important for the interpretation of the present accident, even if I do not believe at all that this anesthesia accounts for his accident. Very often in medicine the stigmata are not so serious as the bacillus of Koch. You examine a patient who has serious intestinal disturbances and fever. You seek on his breast for the little rosy lenticular spots, and if you find them you say, it is typhoid fever. Yet you do not know the role of those spots in the evolution of typhoid fever. I think therefore that the anesthesia of Schalkl must remain in practice a very important stigma, the search for which is in the first rank of the methods of diagnosis, but that it is not the only or fundamental symptom of hysteria. There are some troubles and symptoms which we connect with hysteria, though we do not recognize any anesthesia. We must look more deeply for other phenomena playing the role of stigmata. Two. Anesthesia pleased the physicians because this symptom is in some manner intermediate between physical and moral phenomena. They could not make up their minds to make hysteria a purely mental malady. They always declared that such was the case, but in reality they quickly forgot that declaration to consider by preference physical symptoms and measure them through physical methods. Since hysteria has become a more distinctly mental malady, it is in the mind that we must seek for the stigmata and that we have a chance to find more general stigmata coexisting with all the accidents. Scientists had long felt that there was a hysterical mental state. You know that it was the fashion to write theses on the character of hystericals. They were first brought into relief in the works of Le Grand Dudes Soul, Ballet, Mabius, Tardieu, Richet, etc. Certain curious and striking, but of course somewhat exceptional features. Our poor patients were not lucky. Formerly they were burnt as witches. Then they were accused of all possible debaucheries. Then when the manners had become gentler, one was content with saying that they were versatile to excess, remarkable for their spirit of duplicity, of falsehood, of perpetual simulation. A common feature characterises them, says Tardieu, namely instinctive simulation, the inveterate and incessant need of unceasingly lying without reason solely for the sake of lying. And this not only in words but also in action by a kind of parade in which the imagination plays the principal part, gives birth to the most inconceivable incidents and sometimes proceeds to the most disastrous extremities. So falsehood becomes the stigma of hysteria. Do not smile. There are still many physicians who take that seriously. No doubt falsehood exists in hysteria and often it is even very amusing. I regretted very much when we studied mental disturbances not having the time to devote a lecture to the accidents of falsehood. I have known two or three subjects, one especially who were really magnificent. This poor woman has had all her life, that is for 30 years, an extravagant need of falsehood, above all of falsehood by letters. Her greatest happiness consists in devising amorous correspondence. She sends to an individual, man or woman, marvellous letters in which she states that he or she has inspired her with a sudden love when passing on the promenade. What is most wonderful is that it always takes. A gentleman answers post-restaurant and she goes on with the correspondence for months or years. What is sad is that it ended before the ascises. But the observation deserves to be published. Falsehood is, in my opinion, one of the mental accidents of the neurosis, one of the deliriums that the hysterical may have in a very serious or in an attenuated degree just as she may have some nambulisms or fugues. That is to say ambulatory fits. But it is very well known that all hystericals have not necessarily made fugues. Likewise they have not necessarily all of them the mental accident of falsehood. Its frequency has been much exaggerated. It has been so often described that in the end patients were trained to present it. Formerly Le Grand du Sole was convinced that all hystericals had red flowers in their hair and red ribbons tied to their bedsteads. At length he made them believe it. We cannot dwell on these first mental stigmata which only show the importance that must be attached to psychological disturbances. In reality the great mental stigma that modern studies have brought into evidence is the mental phenomenon of suggestion. No doubt I begin to think that the importance given to it, in particular in the last works of Babinski, is somewhat exaggerated. But it is certain that this exaggeration is as yet very slight and that suggestion is indeed one of the most fundamental stigmata of the hysterical state. But it is necessary to define this phenomenon exactly to give a distinct meaning to the word because physicians are in the habit of using it in an extremely vague manner of comprising under this word all possible mental phenomena. It is needless to recall the fundamental phenomena of suggestion. You know them very well. You cause any idea whatever to penetrate into the mind of the subject through any means you please, through sensations, signs and especially speech. Note this fact. There must be an idea. The subject must have the thought, the conception of something precise. This idea does not seem to conduct itself in him as it usually does in normal minds. When somebody puts an idea into our head this idea brings in its train it is true other thoughts which revolve around it some more or less vague images, some gestures or some incipient movement. If you speak to me of the falls of the Niagara I cannot help seeing dimly in a kind of penumbra a few fragments of that fine scenery. If I am surrounded with calm I shall be able to dwell a little on that remembrance and to call to mind a few particulars of my journey. The images I see are always dim and the words I speak I speak to myself. I always know very well that I am not actually before the falls and in reality I do not see them. If you speak to me of dancing, of balls, of rhythmical music the idea awakens in me even to this day an inclination to move my legs, feelings of rhythms. I may even go so far as to move my feet in cadence but don't be afraid nobody in a drawing room will be aware of it for the movement is very slight and is perceptible only to myself. It is thus that things happen when ideas are called up in our minds. It is quite different with really suggestible individuals. The idea seems to be transformed and to become at once another psychological phenomenon an act or a perception. In fact they almost immediately move their limbs in a manner quite visible outwardly. They really get up and dance. They walk, run, jump, struggle, cry. Instead of confining themselves to thinking the object they seem to see it in reality or to hear it. They conduct themselves before our eyes like individuals who have perceptions and not ideas. They reply to imaginary words. Their facial expression is that of a person who hears. If we question them they tell us without hesitation that they see Niagara before them and the spectacle has so much intensity that it seems completely to a face the normal vision of the things that surround them. Other ideas become connected with the first still with the same intensity and the same transformation into actions and perceptions. They seem to make a complete journey. They go along the edge of the falls, over the bridge, down the ravines. They receive the water in their face, etc. All these ideas grouped together form a very close association in their mind and it will henceforth suffice to call up one to give birth to all the others. It is no longer necessary to say the word Niagara. A mere vague noise brings about the whole dream. These associations are very important in suggestions for they determine particular reactions of the subjects to such or such excitation. Thus such a subject may have acquired the habit of convulsions or contractors of the limbs when he sees an electric apparatus or is touched with a magnet. These patients have shakes in their muscles as soon as you put the electrodes of the apparatus on their arms even if the current does not pass through. Others will experience burns or refrigerations or will feel relieved when they see gold, silver or iron plates applied to their limbs. It is that which has caused so many gross medical mistakes. Alas, what is left of the big books on the action of metallic plates, of resin plates, on the action of a breath indicated by Monsieur du Montpellier on the action of passes of the hands turned point-wise towards the subject. Another important characteristic of suggestion will manifest itself in the visceral domain. No doubt certain ideas awaken also in us certain visceral sensations. A slight nausea or vesicle sensations but all that is very slight just like the feeling of dancing. An essential tray of those patients it was said is that they make their thoughts penetrate into their viscera. The idea of vomiting brings about real vomiting an imaginary purge with pure water brings about a real diarrhea. The menses are stopped or restored with pills of mycopanis. This is again a very essential phenomenon for it seems to come close to the real accidents which are to be observed with patients in many circumstances. We may generalize the essential phenomena that take place in these different cases. The idea is always as we have already remarked with regard to somnambulisms a system of images each of which has different muscular or visceral properties. See the figure one in the first lecture. With the normal man these systems which are always very numerous stop one another and do not develop. In suggestion each idea seems to develop to the maximum to give all it contains in the way of images muscular movements and visceral phenomena. This complete development of all the elements contained in an idea is an essential characteristic of the phenomenon. But you may say this development can also be sometimes effected with us. A painter a novelist develops his ideas seeks for all their elements renders them as living as possible. It is what all of us do when we try to perform some work for then the idea brings about material movements of our limbs. The thought of looking for a book causes me really to look for it. This is quite true but in all these cases the development only takes place through a particular mechanism. An accessory force is added to the idea by the will namely attention, personality. These words represent an ensemble of very powerful tendencies which are formed in us by all our past and these tendencies are added to the idea too weak by itself to make it grow. You know the trouble, the voluntary and conscious effort that the development of his idea costs an artist. In suggestion you meet with nothing of the kind. There is no effort on the part of the subject no addition of strength from his anterior tendencies no work of his personality. On the contrary he does not seem to realize the development of what takes place within him as has often been recognized he forgets his suggestions as soon as they are ended. He seems to be very little conscious of them while they are being executed. Very often he executes them without knowing it quite subconsciously. In this connection it is very important to remark that not all the phenomena executed by subjects of this kind are suggestions. They may, like normal individuals, act out of compliance with our desire. Add to the idea the force given them by the wish to obey the rules with us by regard to their interest or the fear of punishment. One should not say that a hospital patient whom one frightens and bewilders and who hastens to execute any foolish act in order not to displease the physician is an individual beset with a suggestion. In order that there may be a suggestion it is precisely necessary that all these normal causes of development should be wanting and that the idea should seem to develop to the extreme without any participation of the will or the seriousness of the subject. Bear this definition in mind. Many authors who launched too precipitately into these psychological studies considered themselves satisfied when they had merely remarked the moral character of the phenomenon. They said that suggestion is an idea that penetrates into the mind of the subject and stops there. This is childish. As I have so often tried to show any idea entering into the mind is not a suggestion. We recognize the fact ourselves. If we show astonishment at the phenomenon of suggestion it is because we think it offers something abnormal and exceptional. The subjects themselves notice it. Their minds are not filled all day long with suggestions. They know very well how to distinguish what is suggestion in them from what is not. A patient has sometimes answered me in a vulgar but quite characteristic way Sir, I do not know the reason but the thing did not take. What do you mean? Do you understand what I said? Yes, I understood quite well. Then you do not wish to do that. You do not accept? I accept all you please. I am quite ready to obey you and I will do it if you choose. Only I tell you beforehand that the thing did not take. With the preceding definition of suggestion these answers of the patient would have no meaning. The idea, having penetrated into the mind and having been accepted should be accounted a suggestion. The patient has experienced suggestions, she knows what they are and although she accepted the new idea willingly and with absolute confidence and obedience yet she felt that things were not proceeding in the same way and that it was not a suggestion. One should not fall into this exaggeration and take away from the word suggestion all precision of meaning. As the ordinary psychological terms memory, association of ideas, belief, resolution, designate distinct facts so the word suggestion must also designate a very special fact the complete development of an idea which takes place without the will and the personal perception of the subject. Now that you have formed a precise idea of suggestion and are not likely to confound it with any other psychological phenomenon you will readily accept an inevitable consequence of this first remark namely that suggestion is no longer a commonplace and constant phenomenon it presents itself only in certain cases and under certain conditions which it is necessary to determine. Suggestion appears to us to present two great characteristics first it is a complete development second it is a development independent of certain ideas both characteristics require certain conditions it is necessary in the first place in order that an idea shall develop itself that the innumerable images of which it is composed be awakened and arrange themselves in a series in a proper manner. This is not an unimportant condition though it is not always met certain minds no longer retain images of their sensations and above all they no longer keep up the systematization of these images they are incapable of calling them up and arranging them in a series they are therefore not suggestible subjects the type of such individuals will from the first come under the name dementia it is quite plain that with an insane person the images are no longer systematized and consequently the ideas are no longer either understood or developed much hope has been cherished for the therapeutics of insanity through suggestion we are afraid this operation can be applied only to very special cases suggestion requires in order to be developed a mind relatively sane the first condition of suggestion is a certain strength of mind and some patients are not suggestible because they are so to say below suggestion like some infected patients who are incapable of having fever but ought we immediately to pass to the other extreme of opinion and to maintain that suggestion is compatible with a mind normally healthy and that it is continually met in the sanest persons this is an opinion which appears to us equally unsound despite the affirmations of certain authors we must confess that we have not succeeded in giving suggestions to people of normal good health it is useless to discuss the sense of the word health and to pretend that ideal health does not exist it were repeating the surfism of the Greeks regarding the bald headed man we speak of men generally considered normal without pathological or hereditary antecedents or personal blemishes in a neuropathic sense without actual defects medically appreciable if we take a person of that kind a kind that is numerous we must confess and if we state to him that there is a little dog at the corner of the table where he is sitting he will laugh in our face and experience no hallucination whatsoever this fact appears to us incontestable and to speak of suggestion with sane persons one is obliged to consider quite different facts effects of education habits recollections beliefs etc they are psychological phenomena which are apparently akin to suggestion but the mechanism of which is very different these facts have only gradually become automatic thanks to the patient's consent these acts even today are accepted by the individual who is aware of them and violates them with his personality the result is that such actions are not aggressive they are limited in their development by other thoughts with which they are brought into relation docile obedient persons disposed to think of others as having more intelligence and experience than themselves and on account of this apt to believe what they are taught are not suggestible persons this complete automatic development of the personality in the fashion of a parasite is not met with in the normal mind on the other hand every time that we have established in a person unmistakable suggestibility we have had no difficulty in demonstrating numerous and evident traces of mental disease more or less grave such as an excessive absence of mind or even properly called anesthesias attacks, paralysis fixed ideas we find in the past of such persons all sorts of neuropathic accidents and the simple fact that suggestibility is still persistent nowadays should impose great reserve on the physician but to prognosticating their future suggestibility with them should in fact not be considered a simple exaggeration of docility and normal belief such persons are often an either docile nor believing they have an unsteady, undisciplined disposition they themselves recognize that they do not succeed in believing I have no more confidence in anybody I have no confidence at all in you they often say to me and yet you can make them see through hallucinations all you wish they are incapable of voluntary obedience which demands strength of mind and they undergo in a sickly sort of way all automatic impulsion thus we have admitted that suggestion cannot develop in sickly minds that it demands in order to attain to its full power minds relatively sane but we have just now demonstrated that it depends on a lack of synthesis on a weakening of consciousness are not these two affirmations contradictory? a symptom may disappear in certain maladies or may remain a pathological symptom the same with suggestion it does not belong to all mental disorders but it is the sign of a particular mental disease it is necessary for its occurrence that the automatic association of the psychological elements be preserved and that the actual synthesis of the phenomena be altered or reduced it requires as its essential condition a malady of the personality it must be confessed that there is a particular disease which unites in a wonderful manner the two essential conditions of suggestion which are the preservation of automatism and the diminution of personal synthesis this is the hysterical state the study of all the accidents has constantly shown us these two characteristics in hysteria a tendency to suggestion and subconscious acts is the sign of mental disease but it is above all the sign of hysteria let us take another point of view and consider all the patients we had clinically regarded as hysterical I say that you will almost always find again in them without difficulty all the phenomena of suggestion first of all you will find them experimentally if you set aside the old quarrels and examine calmly all the subjects who have been presented as fine examples of suggestion you will first see that most of them are somnambulists do not forget in fact that it is in the hypnotic state that suggestion was first described now the hypnotic state is nothing but the reproduction of hysterical somnambulism and I do not hesitate to add in a hysterical subject next it has been shown that suggestion exists in the waking state with these same subjects susceptible of presenting hypnotism there is no need to demonstrate this diagnosis then suggestibility has been shown from time to time in individuals who were not and had not yet been hypnotized mistrust these observations you must first ascertain whether the suggestions indicated were real suggestions whether the observer with his preconceived ideas was not content with some naive obedience or alas with some comedy but if the fact is true and it is sometimes so examine the individual clinically and I assure you that you will have no difficulty in recognizing that he is hysterical for my part I have never seen a fine suggestible subject who was not clearly hysterical and inversely I have been able to make all the experiments of suggestion who on the other hand had decided more but accidents inversely this relation between suggestibility and the hysterical neurosis can be verified in the clearest manner by studying the disappearance of suggestion in fact a suggestion does not exist with everybody so you must not fancy that it constantly exists during all the life of the hysterical there are many circumstances in which the suggestibility of hysteria tends to disappear the most interesting in this connection is that it disappears completely when the disease is cured a great number of those persons after having kept for some time both the accidents and the mental dispositions that characterize this neurosis recover completely well at that moment suggestions no longer take and these subjects bear themselves in regard to suggestions like normal individuals this is a very important fact which I have already pointed out in connection with hypnotism in the last 20 years and the theoreticians who will absolutely find hypnotism and suggestion in everybody have never replied a word to this argument besides there are other circumstances in which the hysterical recovers at least partially for it is a very changeable malady in certain periods of rest of health in certain somnambulisms or in that which has been wrongly called the second state of felida we have seen that the hysterical states disappear and will likewise recognize that the suggestibility disappears this symptom only reappears in a state of depression together with all the other accidents I described long ago those women who were suggestible only 3 days a month during their menstrual period experimental suggestion has never existed with any persons but with hystericals by the side of this experiment you may place real non-experimental suggestions which occur accidentally and are often the cause of accidents we have seen those accidents with which the patients are inspired by the events of their lives and which by developing themselves to an exaggerated degree bring about attacks, paralytic accidents or singular visceral diseases Malabranche related in the 17th century the story of a woman who because she had seen a rider dragged by the foot had a disease and a paralysis in her foot we continually see facts of this kind nowadays one patient had an amorosis in her left eye because she has seen a child with scabs on its left eye and another vomits incessantly because he has nursed a cancer of the stomach in all these cases if you examine the evolution of the disease its symptoms, the accidents that preceded it I do not hesitate to assure you that you will always again find the same neurosis in a word my opinion on this point has become more and more definite suggestion is a precise and relatively rare phenomenon it presents itself experimentally or accidentally only with hystericals and inversely all hystericals when we study them from this standpoint presents this same phenomenon in a higher or lower degree if we add that as we shall see later this psychological fact plays a great role in the formation of their disease we may say that the most important mental stigma of hysteria is suggestibility we have still to ask ourselves whether there are not other mental stigmata to be added to this one end of section 13 section 14 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 Jaunet lecture 14 the hysterical stigmata the retraction of the field of consciousness the common stigmata absent mindedness the contraction of voluntary movements subconsciousness transfers and equivalences alternation the elementary phenomena of consciousness personal perception the field of consciousness its variations the retraction of the field of consciousness the common stigmata the feelings of incompleteness the need of excitation the need of attracting attention the weakness of attention emotional disturbances troubles of the will the incapacity of beginning or of stopping the lowering of the mental level the role played by suggestion in hysteria is beginning to be known and I shall no longer raise too many protestations by presenting to you suggestion as a hysterical stigma but I think it is well to go farther we should not explain the whole of this so complex disease by this single phenomenon for the present I can find myself to remarking that in the mental dispositions of these patients there are to be found other facts of at least equal importance these are the fundamental phenomena are also stigmata to my mind only I propose to you to divide them into two classes among these stigmata some deserve to be called proper they have the same properties as suggestion itself they are phenomena that exist in hysteria but scarcely exist in any other disease the others might be called common stigmata for the following reason no doubt they present to themselves among hystericals and often in a high degree but they do not exist solely among these patients and they are to be found in other mental affections in particular in the psychosthenic neuroses which are closely akin to hysteria though different from it let us dwell on the other stigmata proper which are added to suggestion and devote a few words to the common stigmata which allow us to connect with the neurosis we consider with the other disturbances of the mind one suggestion let us not forget is the development of an idea it implies a positive phenomenon the presence of an idea in the mind of the subject we cannot connect with suggestion things that take place without the subjects being at all aware of them without his realising them either consciously or subconsciously now I do not believe that everything in hysteria is in relation with the thought of the subject there are in these patients attitudes dispositions that not only are not intentional but that are in relation with no thought of the patients I should like to put in the first rank of these phenomena a very singular disposition of mind for which we have not even a very clear expression namely a disposition to indifference to abstraction to quite exaggerated absent mindedness the fact is this while paying attention to something we turn from some other thing to another phenomena which however reach our minds while I am paying attention to what I am reading I abstract myself from the noises in the street though I still perceive them this abstraction exists in hysteria in an astonishing degree it was noticed early that it presents itself in regard to the sensations and to ideas these patients appear to see but one thing at a time and you become aware that they have no notion of another object though it be very near the first when they speak to one person they forget that there are others in the room they forget them so entirely that they would tell all their secrets before them with indifference when they express some idea you notice that their conviction is childish it seems very strong because it rests on an astonishing ignorance objections, impossibilities, contradictions do not reach their minds in the least the same limitation was observed in their movements from the first they can perform but one action at a time the first indication you perceive disturbance with many girls is their incapacity to do in spite of their goodwill more than one errand at a time this fact may even be made in some sort experimental here is an experiment that I have described under many forms and that Monsieur Pic of Prague has developed you ask one of these patients to make a certain movement continually for instance to make on the table with her right hand the movement of playing on the piano it is agreed that she must not discontinue this little movement whatever may happen at the same time you ask her to perform some other simple acts to open her mouth to shut her mouth to recite numbers you always remark that the first movement the piano playing stops as soon as the second begins and that it only recommences at the end of this second movement yet the subject had made up her mind to continue this movement she had this idea in her head but it became impossible for her as soon as she tried to do something else it is this besides it gives a special appearance to all their accidents by the side of the positive phenomenon consisting in the development of the somnambulic idea in convulsions, in persistent emotions there was a kind of lacuna a complete oblivion of the present situation an indifference to ridicule an insensibility to fatigue all of which we should not have had in their place one would think that these subjects when one's ill forget all that is outside their present accident they do not remember having been in another state they do not conceive that one can be in another state hence that resignation that absence of effort which surprised us the exaggeration of this disposition will bring about the phenomenon of sub-consciousness a great many things will exist outside the personal consciousness you will be able to make the patients walk and act unknown to themselves if the ideas you express do not attract their attention and if they remain in that domain of absent mindedness it will result in mediumship as we saw before that the development of the ideas results in great somnambulisms can we say that this disposition to exaggerated absent mindedness is a consequence of the preceding symptom of suggestion in fact it is not so for absent mindedness is not suggested to these patients and often is not even noticed they have not the idea of this phenomenon the importance of which they do not suspect this singular absent mindedness is mostly noticed by those around them or by themselves only very late several years after it has begun to develop itself on the other hand it is difficult to understand how suggestion which is precisely the development of an idea could explain this absent mindedness which is indifference to an idea a tendency to suppression lastly suggestion itself appears to me to depend on that disposition and to be much oftener its effect than its cause it is precisely because the subjects have forgotten everything because they are no longer restrained by any sensation by any thought relative to the reality that surrounds them that they allow the ideas suggested to them to develop freely suggestion and absent mindedness do not produce each other they are two parallel stigmata one of which cannot exist without the other this special absent mindedness is a stigma peculiar to hysteria first of all you do not find it in the normal individual normal consciousness as philosophers say is always a fully illuminated point surrounded by a strong penumbra with the hysterical the penumbra is wanting this fact is brought into evidence by their quite peculiar visuals field you do not find in any normal individual that odd vision which sees very clearly in one point and sees nothing around this point nor is this absent mindedness to be met with in the same fashion in the other maladies of the mind individuals who are tired are inattentive but their minds are vaguely on the stretch no doubt they search into nothing but they have a vague notion of everything their sensibility is attenuated I grant but it is distributed over the whole of their body their vision is diminished but their visual field remains broad in a word the symptom I wish to describe to you is not inattention it is a suppression of all that is not looked at directly and I do not believe that it is to be found in this form in the other diseases of the mind so I make it a stigma proper to hysteria as suggestion itself a third phenomenon which besides depends on the preceding ones will make you understand these strange stigmata still better it is the phenomenon of transfers and equivalences I was seeking one day to cure a small localized accident to restore the motion of the right wrist with a patient whose fist was contracted you know that to succeed one must strongly direct the attention of the subject to the diseased organ which she has forgotten determined sensations in it freely in every way then when the motion has been a little restored induce the subject voluntarily to move this wrist this work is long and troublesome and has to be begun over and over again with hystericals when it has preceded for some time the result seemed marvelous the right hand had opened and moved freely in every way the patient left the laboratory very happy and proud she reentered it a few moments later in despair in such efforts she said presenting her left fist which was contracted exactly in the same way as her right fist had been a few minutes before I have cited this adventure because it struck me by the circumstances in which it occurred namely in a quite naive patient having no notion of the phenomenon and without the operator or herself having had the least idea of it beforehand you know that the result is not always like that during a certain period from 1875 to 1890 this phenomenon which is called transfer was very much sought after and often provoked artificially it was said to be brought about by the mechanical action of certain substances thus the magnet had preeminently the power of provoking transfers to cure a paralysis of the right side a big magnet was placed in the bed of the patient near her right side the paralysis was then found to disappear on that side and to become localised on the left side when the magnet was withdrawn the paralysis was made on the right side and after several oscillations of this kind it vanished other substances, metals in particular sometimes the electric current had similar effects and transferred symmetrically from one side to the other the disturbances of sensibility as well as those of motion you remember that this phenomenon was very much studied by Birke and Du Montpellier who ascribed to it very odd laws some physicians said they had found the means to make the oscillations either slow or rapid the disturbance on one side or the other etc others went even further they invented the change of the colour sensations which were transformed into their complementary colours the patients after having seen red saw green after having seen yellow they saw violet they called this polarization and by means of the magnet tried to polarise also the feelings lastly for absurdity has no limits they tried to transfer a phenomenon from one subject to the other two subjects back to back and thanks to the magnet the paralysis of the first passed into the second and after a few oscillations disappeared it became a convenient therapeutic process no doubt there are in all this many childish errors many of these observations are phenomena of suggestion and training they depend on the direction that is given to the attention of the subject this could not but be gradually recognised so that in science as in politics we saw a violent reaction the very notion of the phenomenon of transfer was suppressed and the fact that there is some little truth in it was overlooked in my opinion this passage of an accident from one side to the other is not necessarily the result of a suggestion it sometimes takes place unknown to the subject and to the operator and that very naturally it is a very particular application of a disposition which is very general with the hysterical and of which a thousand other applications are to be observed namely the disposition to equivalences hysteria in fact is a very singular melody the cure of which one never dares assert it is often easy through some psychological process or other to cause such or such a determined accident to disappear besides these accidents often disappear of themselves in consequence of an emotion of some shake or even without reason but when an accident has disappeared especially when it has disappeared too quickly we should not at once cry out victory first of all the same accident is very likely to soon reappear then the following strange thing very frequently occurs another apparently quite different accident takes the place of the first a girl of 12 presented incoversible vomiting which had brought her to a very serious state of inundation thanks to certain excitations of the sensibility during a somnambulic state I succeeded in making her eat with more sensibility in regularizing her deglutitions and she no longer vomits this seems all right but from that moment this girl until then perfectly intelligent enters into a state of mental confusion and delirium and it becomes impossible to stop this delirium without the vomiting's beginning again let us remark by the way that this singular alternation between disturbances of the stomach and deliriums is one of those that are often as observed I have noted down 5 fine examples of them but other identical facts are to be observed one patient has contractures in her limbs and when the contractures disappear mental disturbances another has hysterical coughing and alternating with it crises of sleep a man had a foot contracted in the position called virus he was cured through somewhat mysterious processes which frightened him he could now walk freely but he lost his voice for three months when his voice returned he had gastric accidents and abdominal contractures in another case the contractures of the trunk were healed and replaced by phenomena of amorosis and so on indefinitely the accidents seem to be equivalent and to have the property of bearing on one side or the other provided they exist somewhere you would think that the subject can choose but cannot do without a disturbance localised in some place or another if you understand this law of equivalence as well you will see that the transfer from the right side to the left side is but a particular case of it it is even a particularly simple form of equivalence for the sensations of the symmetrical parts are very similar and can very easily be replaced by one another no doubt in many diseases of the mind we observe instability but this quite special form of instability which replaces one definite accident to buy another apparently quite different and that suddenly and clearly is again very characteristic I think it results from a general disposition of the hysterical mind which urges it to move in its entirety to one side while neglecting the rest of the body and mind then to move in its ensemble in another direction while forgetting the first this is connected with the preceding phenomenon of suggestion and constitutes the last of the stigmata peculiarity hysteria that I wish to point out to you 2 can we summarise these three stigmata, suggestion, absent mindedness and alternation into a single general idea that will enable us to conceive the essential character which manifests itself in these mental troubles I proposed formally to characterise this mental state by an expression that is perhaps singular but that may be serviceable you will find it in my work on the psychological automatics in 1889 and in my book on the mental state of hystericals 1894 which was very well translated into English by Mrs C Rowland Cawson in 1901 I proposed to summarise this somewhat peculiar mental state by the words retraction of the field of consciousness let us try to understand the meaning of this general expression the word consciousness which we use continually in studies on the mental state of our patients is an extremely vague word which means many different things when we use it in particular to designate the knowledge the subject has of himself, of his sensations and acts it means a rather complicated psychological operation and not an elementary and irreducible operation as is generally believed if I say for instance I feel a pain, I feel that I move my arm they take place in my mind rather complicated phenomena which we can analyse in the following manner in the first place there occurs somewhere in my brain on the occasion of an outer excitation a small fact both physiological and psychological which corresponds to a phenomenon of pain to an elementary sensation of motion the great physiologist Herzen said that the brain may be compared to a spacious hall filled with innumerable small electric lamps from time to time certain little lamps kindle here and there this is what is designated by the isolated words sensation of pain sensation of vision, sensation of motion in the scheme I have drawn figure 21 each separate little cross of the upper line designates one of those little phenomena v, v prime, v double prime when it is a question of the vision t, t prime, t double prime when it is a question of the sensations of touch and so on but the complete consciousness which is expressed by the words I see I feel a movement is not completely represented by this little elementary phenomenon it contains a new term the word I which designates something very complicated the question here is of the idea of personality of my whole person it is the union of present sensations different from the little sensation considered from all past impressions from the imagination of future phenomena it is the notion of my body my capacities of my name of my social position of the part I play in the world it is an ensemble of moral, political, religious thoughts it is a world of ideas the most considerable perhaps that we can ever know for we are far from having made the tour of the domain of personality there are then in the I feel two things in presence of each other a small new psychological fact a little flame lighting up feel and an enormous mass of thoughts we constitute it into a system I these two things mingle combine and to say I feel is to say that the already enormous personality has seized upon and absorbed that little new sensation which has just been produced if we dared and it is not altogether absurd we should say that the I is a living animal extremely voracious a sort of amoeba which sends out tentacles to seize and absorb a very small creature which has just been born at its side after having represented in the first line of our scheme of the elementary sensations or affective states or simply subconscious phenomena we represent secondly a reunion a synthesis of all these elementary phenomena which are combined among themselves and particularly combined with the vast and prior notion of personality it is only after this sort of assimilation that we can truly say I feel I formally proposed to designate this new operation by the name of personal perception pp for it is indeed a perception that is to say a clearer and more complex consciousness the word personal will prevent confounding this operation with the outward perception of which we do not treat here and will recall to mind that its essential character is the addition of the notion of personality this figure is of course quite theoretical for it supposes an absurd thing namely that a man becomes at a given moment conscious of what it assimilates to his personality all the elementary sensations that are born in all his senses think what enormous masses of phenomena must spring up in us constantly from all the points of our body from the crowd of impressions made on our skin on our mucus membranes on the organs of our senses by all the outer and inner phenomena it is certain that a man never perceives them all there are always even in the most normal man a quantity of impressions that are born in one point of the skin after the brain determine a few reflexes awaken perhaps a few little states of elementary consciousness contribute no doubt to his general state of well-being or discomfort but are not clearly perceived by his personality a part only of these elementary sensations gives rise to complete and personal perception what is the number of those elementary phenomena that rise to complete consciousness of how many elementary sensations can be simultaneously have the complete consciousness this is what I proposed to call the problem of the extent of the field of consciousness by analogy as you see with the extent of the visual field this problem is not clearly resolved and psychologists have proposed very different figures the only essential and certain thing is that this extent of the field of consciousness varies very much with individuals and their states of mind an orchestral conductor hearing simultaneously all the instruments and following by reading or by memory the score of the opera unites in each of his states of consciousness an immense number of facts the individual who when asleep dreams and the patient during a crisis of ecstasy have on the contrary in their conscious thought a very limited number of facts I think there are on this point perpetual and very nice variations of our mental state if you understand this psychological conception well you can easily apply it to the preceding phenomenon that we have just noted with our hysterical patients their first moral stigma suggestion already shows us the isolation of the ideal it is because there is no reaction between the various impressions that each word each emotion each remembrance takes an inordinate development which we call suggestibility suggestion it is always said depends on the absence of control but control is nothing but the struggle the competition of the various psychological states united in the same consciousness if it is wanting it is because the mind is too narrow to contain several ideas opposing one another the second characteristic exaggerated absent mindedness that abstraction bringing on all the blanks of consciousness is but another aspect of the same phenomenon our schema gives us the formula perfectly let us suppose figure 22 an individual who cannot see at a given moment more than three elementary sensations such as v v prime a he will leave all the rest in his subconsciousness at another moment he will be able to turn to t t prime v m v prime a at the first moment he will look at and listen to a person who speaks to him without troubling about the tactile sensations which continue to assail him at the second moment he will look at an object while touching it and appreciate the contact without having consciousness of the surrounding noises at the third moment he will write a dictation having the perception of the sound of the voice of the vision and of the muscular movements but forgetting and neglecting all the other elementary sensations as t t prime t double prime m prime m double prime v v double prime a prime a double prime this individual is absent minded and this figure 22 is an attempt to schematize what is called normal absent mindedness let us suppose that the field of consciousness becomes still more contracted the patient can no longer perceive more than two elementary sensations at once of necessity too he reserves this small share of perception for the sensations which seem to him whether right or wrong, the most important the sensations of sight and hearing to have consciousness of what is seen or heard is of paramount necessity and he neglects to perceive the tactile and muscular sensations thinking he can do without them figure 23 at the outset he might perhaps still turn to them and take them into his field of personal perception at least for a moment but the chance not presenting itself the bad psychological habit is slowly formed nothing is more serious more obstinate than these moral habits there is a crowd of maladies that are only psychological ticks one day the patient, for he has truly become one now, is examined by the physician the latter pinches his left arm and asks him if he feels it and the patient to his great surprise is obliged to confess that he can no longer feel consciously and the neglected sensations have escaped his personal perception he has become anaesthetic you may easily understand that the same notion of the contraction of the field of consciousness equally sums up the last phenomenon that of alternations it is because the field of consciousness remains contracted that you could never add one phenomenon on one side without taking one away from another side if you force the subject by attracting his attention to recover the sensibility of the left side what causes it on the right side if you obtain the total tactile sensibility the reduction of the visual field increases so much that the subject becomes momentarily blind a thing we have observed a number of times without having foreseen it if you wish to enlarge the visual field the tactile anesthesia will increase the feebleness of these patients thinking continues and they lose on one side what they seem to have regained on another I am therefore inclined to think that this notion of the retraction of the field of consciousness summarises the preceding stigmata and we may say that their fundamental mental state is characterised by a special moral weakness consisting in the lack of power on the part of the feeble subject to gather, to condense his psychological phenomena and assimilate them to his personality 3 formally I stopped at this point my description of the hysterical mental state implying that all the other disturbances of their character could be connected to the preceding ones it no longer seems to me absolutely true today the hysteric melody is not absolutely isolated like other mental disturbances it is a special form which constitutes a part of a much more considerable group and which is more or less distinguished from the other diseases belonging to this group the patients we consider are first and above all neuropaths individuals whose central nervous system is weakened then they are hystericals when their enfeeblement takes a particular form I even affirm that they are more or less hysterical according as their melody takes a more or less decided turn in this determinate direction the result is that besides the properly hysterical stigmaata they have general vague disturbances at once psychological and physiological which belong to all neuropathic individuals we cannot enter into the enumeration of these disturbances which besides would be more interesting in connection with other subjects just indicate them shortly under the title of common stigmaata which you understand now I will point out to you in this connection certain feelings that play a role in the popular conception of hysteria these subjects feel weak dissatisfied with themselves their actions ideas feelings appear to them reduced covered with a kind of veil they are therefore perpetually tormented by a vague ennui which they cannot overcome ennui is the great stigma of all neuropaths you must not believe that it depends on surroundings the neuropath feels dull everywhere and always for no impression any longer brings about with him lively thoughts that make him pleased with himself these general sentiments of dissatisfaction these sentiments of incompleteness as I have christened them elsewhere almost always give to the patient a peculiar attitude or conduct either he is sunk in despondency and exhibits a dullful air or he seeks everywhere for something that can draw him out of this state now he has but very few means at his disposal to rouse himself to come out of such a painful state either he will use physical and moral processes of excitation walking jumping crying or he will appeal to other persons and will incessantly ask them to excite him to revive him through encouragements through praises and especially through devotion and love you see what will result from these needs these patients will be at the same time plaintive and agitated they will commit all kinds of eccentricities because eccentricity excites them and draws attention to them they must needs attract attention to themselves in order that people may take an interest in them, speak to them, praise and above all love them this need of attracting attention of being praised and loved is one of the things that have been most remarked in my opinion it has always been wrongly interpreted first of all it is a clinical error to ascribe this character to hysteria it sometimes exists in a very high degree with hystericals but it is by no means a stigma peculiar to this malady it exists as well in the psychosthenic the amorous manias of doubters and of patients laboring under obsessions their mania of jealousy their need of attracting attention to themselves are often much stronger and especially more enduring than with hystericals this remark has very often caused errors of diagnosis besides these feelings of incompleteness we might enumerate with our hystericals as with all neurosthenics what so ever the innumerable lapses of all the mental functions we note in the intelligence a certain apparent vivacity associated with the fundamental state of laziness and especially of reverie these patients pay attention to nothing can bear no mental work hysteria like all neuroses begins among girls with the cessation of their studies and the complete incapacity of learning anything in fact this incapacity of attention brings with it as a consequence of memory events are not fixed in the mind whereas old remembrances relating to periods previous to the malady are well preserved and are even reproduced with an exaggerated automatism recent events pass without leaving any trace it is a disturbance of the memory which I have described under the name of continuous amnesia it is frequent with hystericals but it is not proper to them and it must be considered only as a common stigma the same alterations are found in the feelings which are weakened the subjects who seem so emotional in reality feel nothing vividly they are indifferent to all new feelings and can find themselves to reproducing with an automatic exaggeration of few old feelings always the same their emotions which seem so violent are not just that is to say they are not un rapport with the event that seems to call them up you always hear the same cries the same declamations whether the question is of a surprise or a happy or an unfortunate event lastly the disturbances of their will are well known the patients no longer will or rather they can no longer do anything they can no longer make up their minds to anything hesitating definitely before the least thing I think even that they can no longer make up their minds to sleep and in many cases the so serious insomnia of neuropaths is a phenomenon of abulia for they cannot even make up their minds whether they will remain asleep of course it is especially new actions that will become difficult and for a long time the patients go on with old actions without being able to stop before they enter a state in which they no longer do anything this incapacity of beginning an act or an effort of attention and this incapacity of stopping it when it is once begun bring about the most serious disturbances most of the accidents might easily have been stopped at the outset we begin to dream because we wish to do so it is so pleasant we begin to eat sparingly in order to be thin to have a small waist and not to look like mama we begin an annoyance get into tantrums but we were provoked to it all this as the patients will themselves confess might have been very easily stopped at the beginning but the act continues more and more automatically and the patient can no longer stop it herself it becomes a delirium an anorexia and an attack when I have begun something we heard a patient say I must go on with it I cannot stop I would break the windows kill myself I fall into an idea as down a precipice and the declivity is hard to climb again no doubt you will find all these phenomena of a bulia with all neuropaths but that is not a reason for neglecting them with hystericals they constitute with them common stigmata which adds themselves to their proper stigmata and besides often assume a particular aspect under the influence of the latter it is easy to summarize in a word these general disturbances of neuropaths it is a mental depression characterized by the disappearance of the higher functions of the mind with the preservation and often with an exaggeration of the lower functions it is a lowering of the mental level so we may say in short that hystericals present to us the following stigmata a depression a lowering of the mental level which takes the special form of a retraction of the field of consciousness section 15 of 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 Jaunet lecture 15 general definitions review of the typical symptoms of hysteria the positive and negative phenomena in somnambulism with amnesia in agitations with paralysis and anesthesias the general idea of the contraction of the field of consciousness and of the lowering of the mental level definitions of hysteria their congruency psychological definitions the need of precision in these definitions definitions of hysteria as a disease by suggestion discussion of these definitions fixed ideas without relation to the medical form of the accident psychological laws unknown to the patient the conditions of suggestion hysteria as a form of mental depression characterized by the contraction of the field of personal consciousness and a tendency to the dissociation and emancipation of the system of ideas and functions that constitute personality the laws of localization the part played by the difficulty of the function by psychological automatism by the anterior weakening of the function by the localization of the emotion in these lectures on the great symptoms of hysteria I have tried to present a rapid picture not of all the symptoms of hysteria but of the essential ones in order that you might form a just idea of a singular malady of which everybody speaks and which but few physicians know well I have only presented to you the typical cases and forms around which it is easy for you to group the degraded forms and confused aspects which most diseases offer in practice we must try now to sum up these descriptions and to derive from them some general conception of the whole disease one allow me first to remind you in a few words of the essential pictures you should keep before your eyes in order to form a general idea of the hysterical disease we have studied somnambulism together I no longer say hysterical somnambulism for there is no more any somnambulism for us outside of hysteria we have studied it under its simple and typical form of polyideic somnambulism then in its more complete forms of fugues of polyideic somnambulisms of artificial somnambulisms you remember that we have always recognized in it the exaggerated development of an idea of a feeling of a psychological state in a word of a system of thoughts which takes place outside the memory under the normal consciousness this dissociation of a psychological system is manifested not only by the preceding development but also by amnesia bearing not only on the somnambulic period but even in remarkable cases on the whole of the idea and of the feeling when later we studied various accidents bearing on the movements of the limbs we recognized that small systems of movements and sometimes great systems rich and old constituting real functions develop themselves without control to an exaggerated degree and give rise to ticks and careers of various kinds this lack of control is manifested through negative phenomena closely connected with the preceding ones paralysis and anesthesias which seem to play here the same role as the amnesias of somnambulism when we came to the sensorial functions we saw the same agitations under the forms of ticks of pains and of hallucinations accompanied with certain losses of control which constitute various anesthesias bearing on the special senses as well as on the general sensibilities in connection with these anesthesias we remarked more clearly than we had done in connection with the preceding phenomena the real nature of these amnesias of these paralysis in a word of these disappearances of functions the function is far from being destroyed it continues to exist and often even develops to an exaggerated degree it is only suppressed from one very special standpoint it is no longer at the disposal of the will or the consciousness of the subject surprising as it is we recognized the same facts not only in the complex function of speech but even in the visceral functions the refusal to eat, vomiting hysterical disneyers are not diseases of the stomach or lungs they consist in a kind of emancipation of the cerebral and psychological function relative to these organs there is now an exaggeration independent of the function again and more often a disappearance from consciousness of these organic wants and of the acts that are connected with them finally in our last lectures we sought in the very character of these patients in the status of their minds a fundamental stigmata allowing us to recognize and understand the malady we succeeded in bringing into evidence on the one hand stigmata proper to hysteria suggestion, absent mindedness carried to unconsciousness alternation which we summarized in the general idea of retraction of the field of consciousness and on the other hand general stigmata the absence of attention and the feeling and of will which are connected with depression with the lowering of the mental level this is a clinical picture that must suffice us in practice if we remember these chief facts by comparing with them the complex and less clear cases that practice presents to us we shall succeed in appreciating the hysterical disease fairly justly while avoiding many prejudices and errors that are still very common nowadays unfortunately the human mind is not so easily content it is fond of dangers and quarrels and we feel the need of formulating concerning hysterical disease general conceptions, interpretations definitions which are much more exposed to criticism and error it seems to me that it is in some way a medical fashion to give definitions on hysteria already in the old book of brashé in 1847 there were at the beginning about 50 formulas passed in review though Laseg said that hysteria could never be defined and that the attempt should not be made since that declaration everybody has tried to define it I have discussed in my little book on hysteria about 10 definitions and I have been foolish enough to present a new one of course physicians have continued to define it and since that time 10 others also have been proposed we must obey the fashion by saying a few words about these definitions let us try to derive from them without attaching too great importance to the terms a general idea that suffices us in practice 2 I am wrong in laughing at the definitions of hysteria and observing to you their abundance which in these matters is not a proof of truth these definitions have evolved they have made visible progress and though they appear numerous nowadays they come so close to one another that they blend together do not forget that we are speaking of medicine and that this is rather a special domain less calm and serene than high mathematics you should not ask too much of the virtue of a physician or hope that he will confine himself to repeating the definition of a predecessor even if he does not cite his name what would be left for him he must need to change something in these definitions but a single word in order to appear to innovate which in medicine is indispensable I do not exaggerate in telling you that nowadays 3 fourths of the definitions of hysteria are nearly identical thus I shall perhaps surprise you by telling you that there is no opposition between the definitions that gloriously entitle themselves physiological and those that modestly call themselves psychological no doubt there would be a great difference if these authors had seen really seen a lesion characteristic of the neurosis and if they had connected the evolution of the disease with this lesion never fear one can make nowadays a so-called physiological definition at smaller cost it is enough to take the most commonplace logical definitions and replace their terms with words vaguely borrowed from the language of anatomy and the current physiological hypotheses instead of saying the function of languages separated from the personality one will proudly say the center of speech has no longer any communication with the higher centers of association instead of saying the mental synthesis appears to be diminished one will say the higher center of association is benumbed and the feat will be done by you in this connection to read the last book of Monsieur Jose Ingenieuros published at Buenos Aires in 1906 in the first chapter which I do not understand very well on account of my imperfect knowledge of Spanish he shows that many of the definitions of modern physicians are equivalent and I am quite of his opinion so there is an ensemble of points on which all the authors agree and it is those which we shall have to bring into evidence Charcot used to say that hysteria is an entirely psychic malady this opinion was discussed at his time there were still some remainders of the old uterine and genital theories there were still some attempts to connect hysteria with various nervous lesions Dr Bastien's book in England a very interesting book is very courageous he had the pretension to localize different hysterical accidents in different corners of the medulla of the bulb or of the lower centers of the encephalon that there is no truth in those old definitions that hysteria will not be recognized later as resulting from some unknown disturbance of the secretion of a vascular gland or from some lesion of a nowadays badly defined nervous system I should not dare assert but one thing is certain namely that for 20 years everybody has departed from this view of the matter and that the psychological conception has the mastery I again observe to you that I consider the pretended physiological definitions as mere translations of the psychological ideas this point is almost agreed on by everyone but now difficulties begin of what kind of psychological disturbance is it a question we should not under pretence of psychology confusedly link hysteria with the vague group of mental diseases and the old nervous ismos on this point the work of a distinguished physician Dr Du Bois of Bern interesting from other standpoints is in my opinion absolutely pernicious the psychological interpretation should not suppress what is good what is excellent in our ancestors works now the last century produced a monumental work namely clinical work with infinite patience and penetration all those great clinicians introduced order into a real chaos they ranged the diseases in groups they enabled us to recognize these groups improvements should consist in consolidating this edifice and not in throwing it down to say under pretence of psychology that a sonnambulism is identical with any delirium that hysterical vomiting is a mere derangement to be confounded with manias of doubt or with melancholias or even perhaps with the ticks of idiots is to go 200 years back and it would be much better to suppress the psychological interpretation and to be content with the clinical description consequently and making hysteria a psychological affection we do not intend at all as Monsieur Grasse seemed to believe to confound it with some sort of other or mental malady we even say that it is nowadays the most characteristic disturbance of all and that it is important to distinguish it well the first psychological notion that appears to me to result with the greatest clearness from all the contemporary works is a notion relative to the importance of ideas in certain hysterical accidents Chalcault studying the paralysis had shown that the disease is not produced by a real accident but by the idea of this accident it is not necessary that the carriage wheel should really have passed over the patient it is enough if he has the idea that the wheel passed over his legs this remark is easy to generalise there are such kinds of fixed ideas in somnambulisms and fumes the idea of one's mother's death the idea of visiting tropical countries etc there are such ideas in systematic contractures for instance when a patient seems to hold her feet stretched because she thinks herself on the cross there are such ideas in visceral disturbances and I have shown you the observation of a patient who died of hunger because she had the fixed idea of the turnips she had eaten when at school these remarks have been well made on every side it has also been established that with hystericals ideas have a greater importance and above all a greater bodily action than with the normal man they seem to penetrate more deeply into the organism and to bring about motor and visceral modifications it is a point which was again emphasised by messieurs rematiers and roux in a recent paper they devoted to hysterical vomiting what characterises hystericals they said is less the fact of accepting some idea or other than the action exercised by this idea on their stomachs or intestines at the same time the studies on suggestion which have been very numerous have allowed clinicians to realise experimentally through the action of ideas many phenomena analogous to hysterical accidents so it may be said that the most common conceptions of hysteria turn on this character maybius in 1888 after shalco said we may consider hysterical all morbid modifications of the body that are caused by representations strumpel in 1892 bernheim, obbenheim and more recently babinski have repeated each of them of course with a slight change in the words quite similar definitions a phenomenon is hysterical said babinski when it can be produced through suggestion and cured through persuasion let us take no account of the end of the sentence the treatment and cure are delicate things much might be said on those cures through persuasion let us only retain the beginning hysteria is defined by suggestion it is absolutely the conception of shalco and maybius hysteria through fixed ideas and hysteria through representation this word suggestion which besides one takes care not to define is taken simply in the sense attached to it by all the preceding authors namely that of a too powerful idea acting on the body in an abnormal manner it is easy to remark here a unity of a great number of contemporary conceptions three I do not object very much to the preceding definitions if more precision were given to the meaning of the word suggestion these definitions would be agreed on by everybody besides these definitions bring back all the accidents of the neurosis to a symptom we have put in the first rank among the stigmata to the suggestibility so they are very scientific and useful it is one of the first results of all the psychological work that has been done on hysteria however I had already discussed them in 1894 and still think them insufficient as my arguments have been very little contradicted I will try to formulate them more clearly in the first place I believe that this conception of hysteria is more just in theory than in practice it rather summarizes a systematic interpretation than a clinical observation it is we who have repeated that the accidents seem to be brought about by ideas it is not quite exact that we always observe these ideas in a few cases and they are always the ones that are repeated the patient it is true has the idea that he is paralyzed I thought he says that my leg was crushed I had the idea that my leg no longer existed the consecutive paralysis with anaesthesia of the limb seems to be the exact translation of his idea but it is a singular exaggeration to apply this indifferently to all hysterical accidents and to say unreservedly with Monsieur Bernheim the hysterical realizes his accident just as he conceives it this is to come back to a kind of contemptuous accusation against the patient formally the physician said to the patient you are paralyzed you have crises of sleep because you are willing to have these accidents now it is recognized that he is not willing to have them but it is still maintained that he thinks of them you have such or such a crisis with such or such an accident because you think of it I say that this is not true there are many hystericals who do not think of the accidents they have first of all with some patients the accidents develop insidiously unknown to them they become anaesthetic paralytic anorexic amorotic without in the least suspecting it clinical practice shows you this every day what shall we do then with the observations already cited by Laseg in which it is the physician who reveals to the subject an anesthesia or the blindness of one eye which he was not aware of in other cases it is incontestable that the accident develops with details with an evolution that the patient does not know whatever Monsieur Bernheim may say about it I do not admit at all that hystericals have at will, paralysis with or without anesthesias I do not admit that these patients know what happens in their somnambulisms that they combine the disease beforehand if these patients have fixed ideas and I acknowledge that this is very frequent it should be well remarked that these fixed ideas have no relation to the medical form of their accident one has the fixed idea of her mother's death it is not at all the fixed idea of somnambulism and of its laws another has a fixed idea relative of the flight of his wife who robbed him it is not the fixed idea of dumbness much oftener than is believed the accident develops independently of the ideas of the subject whether the subject does not think of it or thinks of something else I should like to present in the second place an argument which is still weak but the importance of which will grow more and more it relates to the physiological and psychological laws of hysterical accidents laws of which we are ignorant like us when we see a crowd of accidents evolve according to these laws which we painfully describe we cannot say that they are due to auto-suggestion I remind you of the laws of somnambulism which in my opinion are capital somnambulism is followed by an amnesia which bears not only on the abnormal period but often also on the idea itself that fills it and on all the feelings connected with it this amnesia disappears and currently lost remembrances are restored when the subject comes back into the same somnambulism in the case of Iren which I take as a type there is in the waking state an amnesia not only of the crisis but also of her mother's death of the three preceding months and of all that is connected with her affection for her mother and during the fits all these remembrances are perfect to the subjects who show us applications of these laws and in my opinion they are very numerous have they the idea of having such an oblivion in connection with their somnambulism are very unlikely they would much rather have the contrary idea that of being obsessed by their remembrance like the psychosthenics the more hysterical paralysis are studied the more laws of a similar kind will be discovered I have observed to you that the accidents bear on functions it is true that these functions often us to appear to be identical with those which the vulgar have themselves recognized the function of alimentation the function of walk the function of the movements of the hand in this case you will tell me the paralysis might very well be brought about by an idea since the popular idea coincides with the very limits of the paralysis this is true in general simply because the popular ideas are true the great divisions of the functions correspond to the great divisions of the organs and the popular analysis has been correct that is all but there are some cases in which the popular analysis proves ignorant and in which hysterical paralysis analyzes the functions much better than good sense does why are the disturbances of speech accompanied with right sided hemiplegia why are there cases of hemianopsia how is it that there are distinct paralysis of monocular vision and of binocular vision why are there disturbances of accommodation if you pass on to contractures do you really believe that the patient has the idea of rigidity without fatigue without increase of temperature that he has the idea of that modification of the reactions of that slowness of the muscular shake I am convinced for my part that hysterical contracture has its own laws quite peculiar to it presenting us as I told you a degradation of the contraction of the striated muscles all this is outside of the thought of the subject as I told you at the beginning it will be later a matter of astonishment that physicians should have attributed to the caprice of the subject all the psychological and physiological laws that will be discovered in these various accidents lastly I insist on a third argument these definitions have a meaning only on condition that the words fixed idea and suggestion are used in a particular sense this sense should be that with hystericals ideas do not conduct themselves as with everybody it is of no use for me to represent to myself that I am asleep I do not therefore sleep these authors imply tacitly that these ideas act in a special manner on the mind and organism I answer that it is this special action that is the essential point it is this action that constitutes hysteria and you have not the right to make a definition in which you tacitly imply what is essential begin by defining what you call suggestion and afterwards you may say if you choose and if it is true that hysteria is a disease due to suggestion but to define suggestion you will be obliged to introduce into your definition certain new notions which are precisely those I asked for for you will be obliged to recognize that these ideas present themselves in special conditions that they develop out of measure because they meet with no counter poise in the mind because they are isolated owing to a strange absent mindedness of the subject in a word you will recognize the other stigmata absent mindedness and the retraction of the field of consciousness you have once admitted this retraction of the field of consciousness as one of the conditions of suggestion itself why should you maintain that it can produce nothing but suggestions why should you not admit that this disease of the mind may be manifested by something else if this retraction has given too much power to certain ideas does it not produce on the other hand some blanks can it not isolate and emancipate one function and suppress another from consciousness we then arrive at another group of definitions in which I range mine they are definitions in my opinion more profound into which enter the phenomena of dissociation of consciousness such as is observed in all hysterical disturbances suggestion itself is but a case of this dissociation of consciousness there are many others beside the one in some nambulisms in automatic words in emotional attacks in all the functional paralysis many authors, Gurny, Myers Laurent, Breuer and Freud Benedict, Oppenheim, Jolly Pick, Morton Prince have thought like me that a place should be made for the disposition to somnambulism was not the somnambulic attack for us the type of hysterical accidents in 1889 the disposition to this dissociation and at the same time the formation of states of consciousness which we propose to collect under the name of hypnoid states constitutes the fundamental phenomenon of this neurosis said Messier Breuer and Freud of Vienna in 1893 the point which seems to me to be the most delicate in this definition is to indicate to what depth this dissociation reaches in reality we might say that the dementias themselves are dissociations of thought and of the motor functions we must remember that in hysteria the functions do not dissolve entirely that they continue to subsist emancipated with their systematization what is dissolved is personality the system of grouping of the different functions around the same personality I maintain to this day that if hysteria is a mental malady it is not a mental malady like any other impairing the social sentiments or destroying the constitution of ideas it is a malady of the personal synthesis and I will take up again very slightly modified the formula I have already presented hysteria is a form of mental depression characterized by the retraction of the field of personal consciousness and a tendency to the dissociation and emancipation of the systems of ideas and functions that constitute personality five let us leave two general discussions and come back to a more clinical conception of things the most important problem is not for me to understand what hysteria in general is but to account for the practical evolution of the accidents with such or such a person the difficulty we meet with then is a difficulty of localization how is it that with one person the hysteria bears on the arm with another on the stomach and that with a third it only reaches a system of ideas which it turns into a somnambulism it is on this search for an interpretation proper to each subject that one should dwell to my mind much more than on general quarrels of definition the starting point of hysteria is the same as that of most great neuroses it is a depression an exhaustion of the higher functions of the enkevalon all the psychological operations do not present as I repeat the same difficulty there are some operations that are easy for all kinds of reasons first because they are simple and only require the union of a small number of elements second because they are old because their systematization was the work of our ancestors and is inscribed in strongly constituted organs there are some other functions that are difficult because on the one hand they are very complex because they necessitate the systematization of an infinite number of elements and because on the other hand they are very new and require a present synthesis not yet inscribed in the organism now our nervous strength which we do not know at all presents oscillations when it is high we easily accomplish the operations of the second group we have an extended consciousness we turn back from no new study or action but there are many circumstances in which this nervous tension is lowered especially with those hereditarily disposed there are some physiological periods puberty for instance at which the vital forces seem to be busy elsewhere and to leave no great resource to the brain there are diseases that through a thousand mechanisms through local lesions, through intoxication through microbian infection lower our nervous tension even in normal functioning physical or intellectual fatigue is enough to produce momentarily the same result lastly the fact is more difficult to understand but incontestable, emotion is characterized by this lowering of the nervous strength very likely in emotion there is a great expense of nervous strength necessitated by the new problem suddenly set and the emotional disturbance must come close to that of fatigue however it may be our patients have been exhausted through one of the preceding causes if hereditarily predisposed they are enfeebled by puberty or they succumb to intoxication, fatigue or emotion the diminution the lowering of the nervous tension about a general lowering of all the functions and especially of the highest this is what takes place in the psychosthenic neuroses in which the localization on a special point exists in a rather slight degree with hystericals in consequence of particular dispositions the lowering of the nervous strength produces in some manner a superficial retraction there is as it were an autonomy consciousness which is no longer able to perform two complex operations gives up some of them there is it is true a general enfeeblement which manifests itself through the common stigmata but there is above all a localization of the mental insufficiency on such or such particular function so we find again in hysteria the problem of localization which is of great importance in this disease no doubt in a certain number of cases the localization is effected through suggestion an idea suggested from without attracts the thinking in one direction or another and brings about in some ways according to laws the subject does not know such or such automatic functioning and such or such a loss of function this is only a particular case the localization may also be effected through a process akin to suggestion but which is not identical with it according to the laws of psychological automatism I have often drawn your attention to those individuals who having had an accident in certain circumstances and having been cured always recommends the same accident in emotion though it has no relation with the first the man who was wounded by a railroad engine has a delirium in which he sees an engine coming towards him this is quite simple eleven years afterwards he sees his wife die and he recommends the engine delirium another has the tick of blowing through one of his nostrils because he had a scab in his nose in consequence of a bleeding at the nose he recovers from his tick but he recommends it now because he loses his fortune because his child is ill etc third law the dissociation simply bears on a function that for some reason or other has remained weak and disturbed many of our patients become dumb after an emotion but they were formally inclined to stammer their speech was quite insufficient a girl's right leg becomes paralyzed the reason is that in her childhood her right leg was affected with rachitis in the case of another girl the paralysis of a leg is due to the fact that in her childhood the leg was affected with a white tumor and remained long in bandage this remark relates specially to the very numerous cases of associated hysteria a disease of any kind bearing on viscera often an organic lesion of the medulla or of the brain in febals or disturbs some function and it is on this function that the hysteric emancipation is localised so in certain cases hysteria makes conspicuous some light symptoms of organic diseases of the nervous system quite at the beginning by exaggerating them beyond all measure the fact for instance was frequently observed in the cases of turbetic vomiting associated with hysteric vomiting fourth law the function that disappears is the most complicated and the most difficult for the subject this law applies chiefly to professional and social paralysis finally fifth law we remark a very curious fact which we recognise without always being able to account for it the dissociation bears on the function that was in full activity at the moment of a great emotion there are here some physiological laws that cause the chief disturbance to bear on this function that make it probably through an association of ideas through an evocation of the emotion the most difficult for the subject it is the study of these laws it is the search for these conditions that constitute the important part of the study of hysteria these are the definitions of general definitions they are premature discussions which bear on purely verbal differences retained from these lessons the importance that attaches to the study of the psychological functions the necessity of analysing in each particular case the mental state of the patient if these lectures have inspired you with some interest for this kind of studies if they can contribute to developing your beautiful country the researchers of pathological psychology beside the researchers of experimental psychology are brilliantly represented I think you will not have lost too much time in trying to understand a barbarous language for my part I deeply feel your kind attention and reception and I am proud of having had for a few days the honour of teaching you and of being the colleague of the masters of Harvard University end of section 15 end of the major symptoms of hysteria by Pierre Jaunet