 Section 4 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 4 Double Personalities The interest of the study of these rare cases First type of double existence, the Lady of Magneiche The reciprocal somnambulisms The graphic method for the representation of amnesias Second type of double existence, Felida X The dominating somnambulisms The group of complex cases A case of artificial double existence The true denomination of the different states The oscillations of mental level and the dissociation of a state of mental activity The somnambulisms which we consider as the essential phenomenon of Hysteria are apt to present a new metamorphosis The scientific interest is very great when they are so protracted and complicated as to give rise to what is called double existences, double personalities I said scientific interest rather than clinical and practical interest because this phenomenon is, upon the whole, rather rare and it is unlikely you will have to occupy yourselves with it in practice A celebrated neurologist of New York, M. Dana published in 1894 in the Psychological Review page 570 an extensive study on the most definitive cases which have been observed and he counted only 16 In the last number of his Journal of Abnormal Psychology page 186 Dr. Morton Prince gave a fine table of 20 cases of which he explained the most interesting features Let us suppose there are today 25 or 30 it is certainly the total sum of the well-known cases Such cases are not often met with in usual practice however the importance of this fact is very great Its very exaggeration allows us better to interpret the preceding states and contributes very efficaciously to instruct us on the theory of hysteria Moreover the question presents for you as it were a national interest For some reason, why I don't know it is in America that the greatest number of remarkable cases have appeared and it is American doctors, among them Magnish, Wood, Weir Mitchell, Dana and quite recently one of the greatest physicians of this town Dr. Morton Prince who have devoted to it the most remarkable studies We cannot in an elementary lesson discuss the different forms of this phenomenon and the various theories which have been presented I refer you for this subject to the recent book of Dr. Morton Prince Dissociation of a Personality, 1906 and to that of MMB, Sidus and Goodheart Multiple Personality, 1905 You will find in these works all kinds of psychological discussions in which I should not like to venture So I shall confine myself to making three typical forms known to you and to showing you in a few words in what manner these new states which presents so many interesting features are connected with the preceding somnambulisms One, the type of double existences is given us by a celebrated case more legendary than historical published in 1831 in a work of Dr. Magnish entitled, Philosophy of Sleep whose observation it appears dates still farther back since it is a question of a fact observed by Mitchell and Elliott in 1816 It shows you that this observation is very old and very vaguely known This is perhaps the reason why the fact is presented to us with a simplicity which astonishes us and which we no longer find in our observations of today By much repetition the fact must have become a great deal simplified However it may be the following is the abridged history of her who is called the Lady of Magnish A well informed, well bred young lady of a good constitution was suddenly seized without previous warning with a profound sleep which lasted several hours longer than usual On awaking she had forgotten all she knew her memory was like a tabula rasa and had preserved no notion either of words or of things It was necessary to teach her everything anew Thus she was obliged to learn again reading, writing, ciphering little by little she became familiarised with the persons and things surrounding her which were for her as if she saw them for the first time Her progress was rapid after a rather long time she was without any known cause seized with a sleep similar to that which had preceded her new life On awaking she found herself exactly in the same state in which she was before her first sleep but she had no remembrance of anything that had passed during the interval In a word, in the old state she was ignorant of the new state It was thus that she called her two lives which were continued separately and alternatively through remembrance During more than four years this young lady presented these phenomena almost periodically In one state or in the other she did not remember her double character any more than two distinct persons remember their respective natures For instance in the periods of her old state she possessed all the knowledge she acquired in her childhood and youth In her new state she knew only what she had learned during her first sleep If a person was presented to her in one of these states she did not know this person in the other state but was obliged to study and know him in both to have a thorough notion of him And it was the same with everything In her old state she had a very fine handwriting the one she had always had While in her new state her handwriting was bad, awkward as it were, childish because she had neither the time nor the means to perfect it As has been said above this succession of phenomena lasted four years and Mrs X was accustomed to it and had succeeded easily in maintaining an intercourse with her family In connection with this case I would like to avail myself of the opportunity to lay before you a graphic method which I once invented of which I make great use in my lectures before the French students This schema I believe enables us to represent to ourselves the various disturbances of memory in a very simple manner and makes their different varieties clearly perceptible to the eye No doubt you are already accustomed in your courses of medicine to the little schemata which are made use of to represent the various lesions of the organs and especially to represent the disturbances of sensibility There existed no schemata of this kind for the disturbances of memory for we have to deal with the considerable difficulty of representation There are indeed in a remembrance or in an oblivion two different things which must be represented simultaneously We must first consider the time when the remembrance exists For instance it is today that I remember the studies on double consciousness This is the date of the appearance of the remembrance We must also consider in a remembrance the past period to which it refers I remember today in 1906 that I already came in Boston in 1904 It is the period to which the remembrance refers To represent these two things simultaneously I propose to you the following schema which is described in my book on Nevorose Idéfix 1898 volume 1 page 124 The horizontal line OX in all these figures 2, 3, 4, 5 from the left to the right designates the different periods of the course of life in their order of appearance It is on this line that we inscribe the remembrances at the moment of their appearance The vertical line OY from the bottom to the top represents the same periods but as remembrance as representation At each point of the horizontal line we draw a perpendicular parallel to the vertical line which represents the remembrances Its height represents the number of remembrances one possesses at such or such a moment As this height naturally increases as life passes away and one can theoretically call up more remembrances Normal memory will be represented by this triangle whose base is the horizontal line OX and which is formed by the diagonal drawn from the point O If you have to represent oblivions, amnesias you will mark a black spot above the point representing the date at which this accident took place and the height of this black spot will be determined by the parallel line which meets on the vertical the forgotten remembrance This figure not very complicated upon the whole allows us to represent the different amnesias in a very clear and striking manner As examples and in order to accustom your eyes to these schemata which are very useful in clinical studies I put before you various figures representing the more usual forms of amnesia which you will meet with in your practice You have already studied with your masters of neurology and psychiatry The retrograde amnesia, figure two which beginning after some physical or moral shock takes away all the memories of the preceding time You note two, the continuous amnesia, figure three wiping out the remembrances of events as life goes on continuously You see that the general aspect of the schema is quite different and that it puts into evidence the differences between the two diseases of the memory We can now apply this method of representation to the double existences we were studying In figure four I have drawn a figure representing the case of the Lady of Macnish and you see that it is very characteristic It is a kind of draft board in which black and white squares alternate very exactly You will remark in fact that in this singular history the oblivions and remembrances alternate in the same way very regularly In the state called state number one the Lady of Macnish does not remember the state number two at all In the state number two she does not remember the state number one at all When she comes back to the state number one she remembers only this state and nothing more It is the same when she comes back to the state number two There is in the disease a perfect alternation which the schema illustrates very well by its draft board and which is quite peculiar to this type of patients I have proposed to call this form of somnambulisms reciprocal somnambulisms Double existences of such a simple form are very rare It very seldom occurs that the subject in his abnormal existence has entirely forgotten his normal existence and that in the latter he has likewise entirely forgotten the other period This absolute division of life into two alternating periods which do not know each other at all is quite exceptional We can connect only a small number of cases with the type of the Lady of Macnish The case of Dana is perhaps of this kind but at all events the disease lasted a much shorter time Two cases of Charcot that of Marguerite D and that of Abillon which you will find published in the last two volumes of his works and which have been reported by Monsieur Guignon Approach this form But certainly the finest modern case analogous to that of Macnish appears to me to be the history of Mary Reynolds published by Dr. Weir Mitchell in 1888 Mary Reynolds was an intelligent, calm child rather reserved and melancholy but of apparent good health The nervous disturbances began towards the age of 18 with a rather protracted syncope after which she remained for five or six weeks blind and deaf The sense of hearing returned all at once The sense of sight returned gradually and completely We need not dwell now on these sensorial disturbances which we shall study later on After a second syncope which lasted from 18 to 20 hours she awoke apparently with all her senses but she had forgotten all her former life and all the knowledge previously acquired Nothing was left her but the power of instinctively pronouncing like a child a few words without understanding them She was obliged to learn everything anew but it must be acknowledged that her education was rapid since after a few weeks she could again speak, read and write It was noticed that she learned again to write in an odd manner She handled her pen awkwardly and began to copy from the right to the left after the manner of the orientals She always kept in this second existence an inverted handwriting very different from her ordinary handwriting In this second existence her character was quite transformed She had become lively, cheerful and was no longer afraid of anything Wandered about the woods, played with dangerous animals She dealt shrewdly with and mocked at the persons who wanted to direct her and in reality no longer obeyed anybody After about ten weeks she again had one of those strange sleeps and awoke of herself in the first state She no longer had any remembrance of the period which had just elapsed but she recovered her previous knowledge and character She was slower and more melancholy than ever After some time the same accident caused her to return to the state which appeared to be the second These transitions often took place in the night during her natural sleep sometimes in the daytime and they were often painful The subject was as it were frightened by a kind of feeling of death as if I were never to return into this world When the second existence reappeared Mary Reynolds was again exactly in the state in which she had been at the end of the corresponding period with the same acquired knowledge and the same remembrances but she again forgot everything when she returned to the state number one About the age of 35 or 36 the state called number two became definitively predominant It was reproduced more often, lasted longer and at length became in a manner definitive since she remained 25 years in this state The author remarks that at the end of her life there seemed to be a kind of confusion between the two states At least the state number two which had become preponderant expanded and seemed vaguely to acquire remembrances belonging to the state number one It seemed to her that she had as it were an obscure dream-like idea of a shadowy past which she could not quite grasp You see that in general the observation of Mary Reynolds is the one which most approaches that of the Lady of McNish and which best presents the two existences quite independent of each other However, even in this case you remark at the end of life a tendency of the state number two to encroach upon state number one This will be found to be the essential characteristic of another form of double existence much more common than the first Two, I have given to this new form the name of dominating somnambulism because one of its essential features is that one of the states dominates the other In this state the subject is more active, more lively, more intelligent than in the other and what is particularly important the memory during this state is much more extended than in the other If America can boast of having presented in the person of the Lady of McNish and in that of Mary Reynolds the finest examples of the first form the history of Felida X gives now to France an unquestionable superiority Allow me to make you acquainted with Felida She is a very remarkable personage who has played a rather important part in the history of ideas Do not forget that this humble person was the educator of Tain and Ribot Her history was the great argument of which the positivist psychologists made use at the time of the heroic struggles against the spiritualistic dogmatism of Cousin's school But for Felida it is not certain that there would be a professorship of psychology of the Collège de France and that I should be here speaking to you of the mental state of hystericals It is a physician of Bordeaux who has attached his name to the history of Felida Hazan reported this astonishing history first at the Society of Surgery then at the Academy of Medicine in January 1860 He entitled his communication note on nervous sleep or hypnotism and spoke of this case in connection with the discussion of the existence of an abnormal sleep during which it would be possible to operate without pain and this communication thus incidentally made was to revolutionise psychology in 50 years Subsequent to that time Hazan understood better the interest and success of his observation He published various memoirs and even books on this subject in 1866, 1876, 1877, 1883, 1890 As I told you first Tain in his book on intelligence, then Ribot in his Diseases of Memory took possession of this history which has gone round the world and today there is a whole library written about this poor woman When Hazan first knew Felida in 1858 she was already 15 years old and had already been ill for three years since the appearance of puberty This frequently occurs in hysteria as you will see later on She had all kinds of hysteric accidents, attacks of motor agitation, disturbances of alimentation which we need not examine now All kinds of sufferings had changed her character for the worse She was a reserved melancholy and timid person She had a great number of disturbances of sensibility consisting both of pains and diffuse insensibilities Among all these miseries there appeared from time to time rather infrequently at the beginning another very strange phenomenon She seemed to faint away for a very few minutes It is the transition we have already remarked in most somnambulisms Then she would wake up suddenly become gay and active and bustle about without any anxiety or pain She no longer had those painful sensations or those insensibilities which troubled her before and she was in much better health than in the preceding period But let us immediately remark that in this apparently new state she by no means presented the characteristic disturbance of the Lady of Magnesium and of Mary Reynolds She had nothing to learn again because she had forgotten nothing She preserved a very clear remembrance of all her former life of all the sufferings she had undergone and of all she had learned before So everything went quite well but this state of comfort lasted but a short time After one to three hours she had a new syncopy and then awoke in the preceding state considered as normal which we may call according to Azan's convention the prime state On returning to this state she resumed again all her infirmities and the slow melancholy character which was her usual one But there was now one phenomenon more She had quite forgotten the few preceding hours filled by the state number two or the lively state All this period was for her as if it did not exist This caused no great inconvenience at that time since the state called number two occurred only from time to time and lasted an hour or two But little by little this state developed singularly It lasted for hours and days and as the subject was now much more active it was filled with all kinds of serious incidents You will read in Azan the strange narrative of that consultation about the first pregnancy of Felida The poor girl during her period of excitation and gaiety had given herself up to a young man who was to be her husband The awakening occurred shortly afterwards and did not leave her the least remembrance of this incident As her health was impaired and her abdomen grew bigger she naively went to consult Monsieur Azan about the strange disturbances in her health The pregnancy was evident says Azan but I did not make it known to her Some time after the state number two returned and Felida addressing herself to the physician laughingly apologized for her preceding consultation for she now knew very well what was the matter During the greater part of her life these two periods alternated and it was only in her old age that one of the two periods that is to say the better one during which the subject was more active and had a total memory encroached upon the first and filled almost the whole of her life Henceforth Felida seldom remained three or four days in her former state called normal but then her life was intolerable for she had forgotten three quarters of her existence and this gave rise to the most comical situations She feared to pass for mad and in her anguish hid herself till a new syncope restored her to her better state and now her habitual one Such are the chief features of this history which has become celebrated You may easily see where in it differs from the preceding observations The schematic figure, figure five which you can now understand gives you quite a characteristic image It is no longer a draft board on which the periods of oblivion regularly alternate with the periods of remembrance You see regularly entire light colored stripes which are broader and broader as life advances There is no black spot They are the periods of the state number two during which the memory extends over the whole of life without any amnesia On the contrary, in the intercalary stripes representing the state number one you see the series of black spots representing more and more extended amnesias affecting the periods of life which were filled by the state number two This figure clearly shows you that the two somnambulisms are not equal that one is superior to the other especially as regards the memory This is what justifies the name of dominating somnambulisms which I have given to these cases If the cases of the first kind grouped around the Lady of Magnesia are rare, this is not true of those of the second group which have Felida for type The case of l'Adam, that of Verriest 1888, of Bonhamezon 1890, of Duffet 1893, and many others could be described from the same model It is of no use to dwell upon this These cases do not present any really new psychological phenomena But it would be well to form a third group which might be called the group of complex cases in which some celebrated observations ought to be placed I allude to the complicated cases of patients who have not two forms of existence but a very great number of forms of existence as many as 9 or 10 These different psychological states offer very various relations with one another Sometimes they are quite independent of one another and present a simply reciprocal memory The subject only finds again the remembrances of the state number one when he comes back to the state number one But he by no means remembers this state when he is in the state number two or in the state number four But such patients have besides and at the same time other states are obeying another rule For instance they are apt to enter into a particular state which we shall call number three in which they not only remember the other periods but also remember the periods of the state number one and of the state number two In a word they have reciprocal somnambulisms and dominating somnambulisms One of the most remarkable cases published in France is that of Louis Viver studied from 1882 to 1889 by many authors by Le Grand du Sole Voisin, Mabide and Rabadié Buru and Bureau This boy has six different existences Each of them is characterised first by modifications of the memory affecting now one period, now another Secondly by modifications of character In one state he is gentle and industrious In another he is lazy and irascible Thirdly by modifications of sensibility and of motion In one state he is insensible and paralysed in his left side In another he is paralysed in his right side In a third he is paraplegic etc An English author Mr Arthur Meyers the brother of the well known psychologist in an article in the journal of mental science January 1886 tried to group in a table these four modifications characterising each state The most curious fact of this state is that one can by acting on this third character bring about the corresponding modifications of the other two If one cures the paralysis of his two legs one causes him to enter into the state in which he has all his sensations and movements One sees the character and the state of memory corresponding to this period reappear But these facts are especially interesting from the point of view of the artificial reproduction of somnambulisms and even of second existences We need not dwell on them today After having reported this French case let us consider some very remarkable American observations One of the most astonishing observations whose scientific value unfortunately I can hardly appreciate is that which was published in 1894 under the rather strange title of Molly Fancher the Brooklyn Enigma an authentic statement of facts in the life of Mary J. Fancher the psychological marvel of the 19th century unimpeachable testimony by many witnesses by Abraham H. Daley 1894 The history is strangely related you feel in it a kind of mystic admiration for the subject an exaggerated seeking after surprising and supernormal phenomena as far as you with some fear is to the way in which the observation has been conducted it nevertheless contains many very remarkable and interesting facts Molly Fancher who seems to have had all possible hysterical accidents, attacks, terrible contractures lasting for long years more or less complete blindness etc above all presented all the forms of somnambulism from the simplest to the most complicated ones There are in her at least five persons who have very poetical pet names Sunbeam, Idol, Rosebud Pearl, Ruby each one with her remembrances and her character the complication of this case is very amusing Lastly we have to point out the last and most remarkable of the observations of this kind the observation of Miss Beauchamp by Dr. Morton Prince one of the physicians of Boston who have most interested themselves in the development of pathological psychology and who devoted years of work to the observation of this complicated and interesting case We cannot hear enter into analysis of these complex cases which moreover are about various combinations and forms of the two simple forms we have studied In these complex cases a new influence usually makes itself felt which complicates matters a great deal I mean the influence of the observer himself who in the end knows his subject too well and is too well known to him Whatever precautions one may take the ideas of the observer in the end influence the development of the somnambulisms of the subject and give it an artificial complication However it may be I must add the study of these complex cases to the two simple forms I have pointed out in order to make you understand all the developments which may be taken by this strange phenomenon of multiplex personality in hystericals Three We cannot enter into the psychological study of all the problems raised by the double existences of hystericals Besides I have pointed out to you some works published in this very city in which you would find these discussions very well conducted I only wish before concluding this lecture to give you a few indications as to the direction which in my opinion these studies should take and as to a general conception of these apparently mysterious phenomena Let us take up one more observation of a double personality which differs from the preceding ones only by a singular slight detail namely that it was for a great part produced artificially Long ago in 1887 a young woman of 20 whose name was Marceline entered the hospital in a lamentable state For several months past she had not taken any food first because she obstinately refused to eat then because she immediately vomited any food or drink one forced her to swallow Besides she no longer had any function of evacuation she was incapable of urinating spontaneously and sounding alone could cause her to discharge a few drops of urine In these conditions this young woman who had reached the last stage of emaciation seemed to have but a breath of life left she remained constantly lying in her bed being incapable of standing her mental activity was as much reduced as her physical activity she was completely insensible on the whole surface of her skin and on all her mucous membranes she heard very badly and saw but exceedingly little Though she looked intelligent she replied with great indifference to the questions of her and seemed to be in a serious state of stupefaction as we did not succeed in nourishing her otherwise we had to try the effect of hypnotic practice After some attempts we easily caused her to enter into a singular state which appeared momentary and artificial but differed altogether from the habitual state in which we had constantly seen her since her entrance into the hospital She looked quite transformed physically and morally She was now capable of moving and had no longer any vomiting Lastly she urinated spontaneously without difficulty On the other hand she had become sensitive over her entire body and could hear and see perfectly She expressed herself much better with more vivacity and showed a complete memory of all her anterior life After having nourished her in this new state we thought it necessary to awaken her since this state was considered artificial She immediately fell back into her Inert, insensible unable to eat or urinate she simply presented one more disturbance Namely, according to the law of somnambulisms which you know she had quite forgotten what had happened during the preceding period Nevertheless, thanks to these artificial somnambulisms we were able to nourish her and cause her to recover her strength but it was always impossible to make her eat in the period considered normal which we always brought back by awakening her So that, tired of thus putting her to sleep at each meal, which was very long we left her for whole days in the artificial state The only result was apparently a great advantage since all day she ate well, urinated completely and presented more sensibility memory and activity One day her parents finding her in this fine artificial state considered her cured and took her out of the hospital Everything went well during the first days After a few weeks on the occasion of her menstrual period she experienced a kind of upsetting and awoke spontaneously that is to say she suddenly returned to the state of depression and stupefaction from which we had drawn her but she presented in addition a forgetfulness bearing this time on whole weeks She was very much bewildered at finding herself in her house without understanding how she had left the hospital for she did not remember the events of the preceding days Besides, she again refused to eat and could not urinate Marceline was brought back to me and in the presence of all these disturbances which were well known to me I could do nothing else but put her to sleep again or rather bring her back to her artificial state Well gentlemen things continued in this way for 15 years Marceline would come to me in order to be put to sleep enter into her alert state and then go away very happy with complete activity, sensibility and memory She would remain thus for a few weeks then either slowly or suddenly in consequence of some emotion fall back into her numbness return to the state we had considered primitive and natural with the same visceral disturbances the forgetfulness now extended over whole years and disturbed her existence completely She would hasten to come to me to get herself transformed again Things continued thus for years together till the death of the poor girl who succumbed to pulmonary tuberculosis How are the two states of Marceline to be explained? You see they are quite like what we have just described in connection with the dominant somnambulisms of Felida The latter also had two states one melancholy and incomplete in which she had great oblivions the other, alert, in which she found again all her sensibility and memory Marceline resembles her so much that I have already proposed to call her an artificial Felida We ought then to apply to her the conventions proposed by Monsieur Razan as well as by all the authors to designate these two states We ought to say that the state number one is the state of depression in which we found her at the beginning and which looked normal that the state number two, a super-added or artificial state, is the alert state with complete memory Well these denominations seem to me quite incorrect when applied to this case which I followed so long It is absurd to call state number one a state of mental depression incompatible with life, a natural state It is unlikely that this young woman has always been from the first in such a state In reality it is false She began by having in her girlhood before puberty all these sensibilities all these functions at her disposal She ate and digested very well and urinated spontaneously This is the real state number one There is no doubt on this point the state in which we saw her in the hospital with all her disturbances and insensibilities is an abnormal state brought on by illness by hysteria which has evolved since her puberty It is the state number two But what shall we do then with the state obtained through hypnotism which was produced artificially Is it a state number three? By no means In this state her functions were normal She recovered the sensibility and memory she had formally had I see no reason why we should distinguish this state from the natural state of her childhood which we called state number one It is simply a momentary cure which we brought about through processes of artificial excitation and when she falls back into the state number two it is simply because the disease begins again All this history may be represented by the following diagram Slowly without it being perceived this young girl grew worse every day She had gradually lost sensibility and memory We may represent this stage by a line which descends well below the line A B of normal activity figure six When she has been hypnotized in C she rises again to a state of almost normal activity in D Through the effect of illness she gradually redescends At first she seems to awaken a little as soon as you leave her and forgets what you have just now told her E Then two days after she wakes again F that is to say she experiences a fall into a state of hysterical anesthesia and amnesia still deeper than before G She forgets the two preceding days Then she goes down very slowly If you let her fall again by an emotion for instance they will be complete amnesia of the whole preceding period If you excite her there will be on the contrary a psychological state far more complete and a total remembrance of the preceding periods It is these falls these returns to anesthesia which give to the normal periods the aspects of somnambulisms I think it is absolutely the same with all such cases that everything has been confused through false denominations Felida also had in her childhood a state number one which now no longer exists except in her periods of alert state improperly called state number two it has been noticed with astonishment that at the end of her life this state exists almost alone it is simply because the hysteria is cured and she returns to the normal state of her girlhood which she ought always to have kept There is nothing abnormal but the state of depression with amnesia which settled gradually after her puberty and which was mistaken for a state number one because it had lasted for a long time when the subject was observed In this view things become somewhat clearer the essential phenomenon that in my opinion is at the basis of these double existences is a kind of oscillation of mental activity which falls and rises suddenly These sudden changes without sufficient transition bring about two different states of activity the one higher with a particular exercise of all the senses and functions the other lower with a great reduction of all the cerebral functions these two states separate from each other they cease to be connected together as with normal individuals through gradations and remembrances they become isolated from each other and form these two separate existences here again there is a mental dissociation more complicated than the preceding ones there is dissociation not only of an idea not only of a feeling but of one mental state of activity end of section 4 section 5 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 5 convulsive attacks fits of sleep artificial somnambulisms a great number of convulsive attacks and a fits of sleep are nothing but imperfect somnambulisms the association of ideas in the hysterogenic points the diagnosis of hysterical and epileptical fits the crisis of emotional manifestation the different fits of sleep the lethages the perseverance of thought during this sleep the crisis of reverie the artificial reproduction of hysteric accidents of attacks of fits of sleep artificial somnambulism or hypnotism the hypnogenic points the hypnotic state as a reproduction of hysteric somnambulism all the preceding examples the study of monoideic and polyideic somnambulisms the study of fugues and of double existences showed you the considerable importance assumed by somnambulisms in hysteric neurosis we should still have many forms of the same phenomenon to consider but today I wish only to dwell on certain elementary and in some manner degraded forms of somnambulism because they are common because they are to be met with every day and because it is necessary in order to understand them to be able to connect them with the more typical somnambulism of which they are only inferior forms you will understand the interest of this study if you notice that it first applies to two phenomena very important in practice convulsive attacks and fits of sleep I hasten to tell you that I do not vaguely connect all hysteric attacks and all fits of sleep with phenomena of somnambulism the words attack and sleep are vague words borrowed rather from the vulgar than from scientific language and very varied phenomena arranged under them you will soon see on the occasion of motor agitations that the hysteric attack is often constituted by an ensemble of ticks of career movements connected together in a certain manner sometimes fits of sleep are simply paralytic phenomena the subject is incapable of moving but hears and understands very well and has no intellectual disturbance so we shall meet later on with many other forms of attacks and fits of sleep but today we are to study one of the most essential forms in which these two accidents are nothing but particular aspects of certain imperfect somnambulisms one convulsive attacks which we have first to attend to are exceedingly frequent phenomena they were noted even by the philosophers and doctors of ancient Greece it is this phenomenon that the middle ages and the renaissance reproduced in the documents relating to exorcisms modern authors such as Brighay state in their statistics that three quarters of their patients have attacks at first sight the patients who seem to have become unconscious and writhe in disorderly convulsions appear to be very different from the somnambulists we have just studied complete somnambulism was evidently characterized by a great number of intelligent manifestations the subject expressed his idea his dream by his adjusted movements which usually are to our mind the expression of reasonable thoughts the first and clearest of these expressions was speech and we had no great merit in guessing the subject of such dreams since the patient expressed it himself by language when he did not speak he had expressions of the physiognomy attitudes and especially acts the interpretation of which was very clear he was seen to get up to walk to seek for objects in a draw to make the gesture of holding a revolver and pulling the trigger to struggle with phantoms etc in a word the outer expression of the somnambulic idea was as clear as possible there is nothing of the kind in convulsive attacks in which the subject seems to writhe in great irregular apparently meaningless movements yet it is easy to prove that from many points of view these convulsive attacks approach somnambulisms these accidents though apparently constituted by uncoordinated movements have the same moral causes as somnambulisms they begin like them on the occasion of particularly affecting events genital perturbations sorrows fears etc a man begins to have crises of hysteria because he has seen his son fall from a scaffolding and die before him many girls or women begin to have attacks on the occasion of the death of a beloved person in about 10 observations the cause of the first fit is a conflagration a petroleum lamp setting the subject's dress on fire in others it is a fall from a tram car or from a bicycle a fight with comrades heart's grief reverses of fortune etc I wish to dwell only on one story that of the woman with the dog which affords a fine example of attacks displaying the form of imperfect somnambulism joined with ticks to which we shall elude later on this lady 43 years old who had always been impressionable of course was already very much upset by the death of a very dear friend she had kept only one souvenir from him a very precious souvenir an old dog now two years after his master's death the dog died in his turn on a carpet this lady in despair lay down on the carpet on which the dog had died and remained there for 60 days without consenting to accept any food or to take any care of herself from that time she began to have terrible fits of hysteria which assumed many forms you see by this example that the starting point of convulsive attacks is the same as that of the preceding somnambulisms let us go one step further and consider the occasional cause that determines the appearance of each new attack it is easy to see that here again moral causes play an important part it is true the patient maintains that the fit occurs irregularly without her knowing why and that it is brought on solely by physical causes there may be some truth in the remark that the time which has elapsed since the last attack plays a great part when patients have just had their fit of somnambulism or convulsions they cannot always begin a new attack immediately they seem to be modified and to have become less sensitive to the various moral impressions a certain time must elapse two days for one a week or a month for another before they become very impressionable and capable of recommencing the same phenomenon this is true we meet here with a very interesting periodical oscillation which we shall have to take into account at the end of this course of lectures but besides this general predisposition it is nonetheless true that a thousand accidental circumstances bring about the appearance of the fit first of all slight exterior phenomena may produce this effect the sight of a flame sometimes of a match only brings about the fit with those subjects who have been affected by a conflagration any cry or name or sentence will call it back with others our woman with the dog is admirable in this respect it is enough that a dog barks in the street she sees a cat pass by the name of one of the animals is pronounced or even certain words are pronounced the use of which she absolutely forbids as the words love affection happiness etc it is enough that a date on the calendar be mentioned before her for the fear of remembering a certain date has caused her to forbid all possible debts the least thing is enough to bring about an endless fit in which convulsions and fowlings mingle together for 15 or 20 hours is it not obvious that in all such cases there is an association of ideas between the dreaded perception and the remembrances which bring on the fit as well as the somnambulism the different terms of these systems of ideas are connected together in such a manner that they mathematically call up one another you would perhaps find it more difficult to recognize the same law if you considered attacks the starting point of which seems to be the touch of orientation of a point on the subject's body you know that formally great importance was attributed to such points which were called histrogenic points Charcot and Pietro wrote a long disquisition about them which nowadays seems to contain many errors it was admitted that the fit began with a pain or a strange sensation situated at such or such a point of the body the most frequent points with women were the lower region of the abdomen called the ovarian region on either side at this point the moment of the fit was so frequent that they even determined the theories of the ancients on hysteria you remember the absurd story invented by Plato which spread all over the world abnubulating the minds of physicians for centuries and casting a kind of shame on all such patients it was he said the over excited matrix which required satisfaction and as this satisfaction was not obtained it ascended through the body as far as the throat of the patients and choked them in fact this sensation of uneasiness which often begins in the lower part of the abdomen seems to ascend and to spread to other organs for instance it very often spreads to the epigastrium to the breasts then to the throat there it assumes rather an interesting form which was for a very long time considered as quite characteristic of hysteria the patient has the sensation of too big an object as it were a ball rising in her throat and choking her she makes an effort either to swallow or to spell this big object other points and sensations may intervene irregularly situated in the breast shoulders, eyes or head and they seem to depend on purely physical phenomena do not misunderstand the nature of such points first they never corresponded to real organic lesions or at least if there are any lesions they play no part in hysteria properly so called then in spite of appearances try to realise thoroughly that these sensations are immoral not physical and that they also depend on the ideas and emotions of the subject for you must not forget that the different regions of our body participate in all the events of our life and in all our sentiments let us consider two individuals both of them wounded in the shoulder one by an elevator, the other by an omnibus these wounds have long been cured but you can easily understand that the remembrance of a sensation in the shoulder that even the idea of the shoulder is a part of the remembrance of the accident it is enough that you touch one of these patients on the shoulder for this peculiar sensation to remind him of his accident and determine the crisis the idea of consumption the fear of the thysis is accompanied by a certain painful sensation in the summit of the left lung on the occasion of which it began the same sensation located in this spot will be the starting point of the fit in amorous emotions unless we have to deal with pure spirits there are genital sensations in the region what difficulty is there in understanding that in all these emotions of regret of love, of remorse this image of a physical sensation intervenes and plays the part of a starting point add to this the innumerable associations of ideas determined by the habits of the patient or the questions of the physician and do not forget that those pretended hystereogenic points are merely spots in which certain peculiar sensations easily arise associated with the remembrance let us now pass on to the end of the fit and you will meet with one more essential phenomenon of somnambulism the subject, after more or less protracted struggling seems to wake up all at once or gradually sets her dress to rights and almost without any difficulty gets up again and resumes her occupations here is to be noticed a great medical fact namely that the hysteric fit does not seem to bring about a great physical disturbance as the epileptic fit does the subject is not exhausted she has not the stupefied, haggard aspect of an awaking epileptic nor the irresistible need of sleep which characterizes the comitial fit our hysteric patient after howling for several hours feels rather comfortable she experiences, as it were a relaxation and declares she is much better than before the fit another characteristic phenomenon is that she attaches no importance to what has happened she is not in the least ashamed of her cries, her indecent attitudes the disorder of her acts she seems to have forgotten everything and in truth remembers only the facts previous to the fit all that has occurred after the sensations of choking and the ascent of the ball no longer exists for her this oblivion is very important no doubt it is more or less profound according as the hysteria is more or less characterized but it is a part of the disease beware of crises of violent agitation in which there is no loss of consciousness and of which the subject keeps an accurate remembrance do not inconsiderately call that hysteria it is nearly always something else in the most favorable cases you have to deal with the crisis of agitation of the psychosthenic unfortunately you have often to deal with mental disturbance as the diagnosis of which is more or less easy I would only insist on the fact that our fit of real hysteria ends with an oblivion like some nambulism itself let us now return to the facts constituting the fit itself they are first meaningless movements the patients grow stiff and seem to try still to exaggerate this extension by throwing back the head by raising the abdomen by making a bridge according to the usual expression the head is agitated in one direction or the other the eyes closed or open with an expression of terror the mouth distorted now the patients grind their teeth but without biting their tongue now they open their mouth and utter piercing cries the arms are agitated in every direction they strike at haphazard on the surrounding objects or on the breast the fists alternately close or open the breathing is loud, irregular the heart beats quickly, the face is congested without however being violet-hued as in the epileptic fit it all seems very disorderly and unintelligible there is however a comparison which at once comes to our mind and which is very clearly indicated in the old work of Prequet a fit of simple hysteria, he said is nothing but the exact repetition of the disturbances by which vivid and painful moral impressions are manifested I choose as an example what happens to a somewhat impressionable woman experiencing a sudden and vivid impression this woman at once has constriction in the epigastrium she feels some difficulty in breathing something rises to her throat and chokes her lastly she feels in all her limbs and uneasiness which causes them to fall or she feels an agitation a need of movement which causes her to contract her muscles this is the exact model of the most common hysteric accident of the most usual hysteric spasm this general conception applies very well to the greater part of convulsive fits it is easy to verify the assertion that this crisis is in fact an ensemble of emotional manifestations in many cases it is even possible to distinguish and recognize the particular emotion thus expressed certain patients plainly manifest anger they strike, scratch, bite and their cries are menacing others evidently have crises of grief and despair, their tears and moanings have quite another meaning than the cries of the former it is not very difficult to recognize erotic crises with the latter for they place certain scenes in a remarkable manner with the former on the contrary much oftener you have crises of fear the bewildered expression of the eyes the movements of defence of the arms stretched forward the drawing back of the body are quite characteristic besides nearly all these patients though they do not speak clearly as in some nambulisms mingle some words with their cries and you easily distinguish the ones who call gaston or oscar with tender words and the one who howls mama help in many cases indeed the phenomenon may be said to be intermediate the subject speaks a little more her movements are less incoordinate these phenomena are almost some nambulisms analogous to the preceding ones but less perfect the crisis of the woman with the dog unquestionably belongs to this mixed type for long hours together the following phenomena mingle together and succeed one another first sobs, tears streaming down her face cries of despair great movements of the arms to strike her breast and tear her hair then declamations about fate which strikes without a reason which strikes even the best without their having deserved their lot then recitals of mournful passages borrowed from such poets as la Martine or Musée vivre un jour sans elle me semble la mort même to live one day without her seemed to me death itself l'homme est un apprenti la douleur est son maître man is an apprentice grief is his master to these phenomena quite peculiar to some nambulisms were added somewhat different symptoms which we shall see later on when we study the tics of respiration namely certain moanings or certain monotonous howlings which were regularly repeated for hours together this is decidedly a type of mixed crisis in which some nambulisms exaggerated emotional manifestations and tics mingle together from all these reasons which show us the identity of the beginning and of the end the analogy of the essential manifestations we can conclude that a great number of attacks are nothing but aborted somnambulisms the idea which developed itself in somnambulisms through expressions of the physiognomy words and acts now only appears in the inferior and merely emotional form but these expressions of emotion are enlarged disfigured they seem to have become simpler coarser than in the normal state the emotions seem to have lost their intellectual aspect and to have increased in their visceral and motor expressions they appear to have fallen and become inferior 2 we shall reach an analogous conclusion by examining another equally frequent accident of hysteria namely fits of sleep you know what great curiosity this symptom has always roused for a long time people have been amazed at seeing individuals remaining quietly asleep in spite of all efforts to awake them sleeping on peacefully for hours and even days together such patients who sleep for 10 15 days sometimes for months together do not all belong to the same variety they differ in their physical aspect as well as in their moral state some seem to have a rather light sleep the subject moves from time to time changes his position mutters a few words others have much deeper sleep accompanied with complete immobility or even with a certain degree of stiffness of the limbs in the last stage this sleep assumes that aspect of lethargy which has given rise to so many superstitious fears as indicated by the word the aspect of these patients approaches that of a dead body the faces of wax and paleness without any expression the eyes are closed and when one opens them one finds that the pupils are dilated and that the eyes remain motionless the skin seems to have grown cold the visceral functions appear to have much decreased the breathing is superficial and rare the beats of the heart are hollow and difficult to perceive it appears that a certain number of patients in this state have been mistaken for corpses and that this accident has given rise to untimely interments for my part, I am always surprised when I hear of such mistakes none of the lethargic people I have had the opportunity of seeing could, in my opinion be the object of any illusion a little attention was sufficient to avoid this absurd mistake first of all, it is not true at least in the rather numerous cases I have seen that the functions stop one cannot feel the pulse one can always hear the heart if one seeks well one always finds some manifestations of the breathing besides, the temperature is not very low and the skin never gives by its contact the impression of a cadaveric skin there are even some little peculiar phenomena that seldom fail for instance that slight tremulousness of the eyelids which is typical the pupillary reflex either to light or often are still to pain the change of attitude if the mouth and nose of the breathing hindered in a word, I do not very well understand how one can mistake a hysteric patient in lethargy for a dead woman and in my opinion such mistakes imply great ignorance it is necessary however to warn you against this danger as I told you at the beginning I do not think that all hysteric fits of sleeper of the same kind any more indeed than are all attacks we shall resume this question when we have studied certain disturbances of the visceral functions of hystericals today I wish only to make you understand one of the most frequent forms of these sleeps the one which it must be acknowledged usually seems to be the least profound and serious it is to be found with those subjects who fall asleep for a few hours and who nearly keep the aspect of normal sleep I do not think that in these individuals the psychological phenomena have disappeared I do not think that their sleep is a merely physical phenomenon by many methods one can prove the existence of thoughts that continue to develop in their minds first of all a protracted and attentive observation very often shows you slight signs connected with thoughts there are a few little movements of the lips as if the subject wanted to speak or sometimes smile a few little transient expressions of the physiognomy a few little movements of the hands in certain cases you have quite the impression that the patient chatters inwardly and that but little is wanting for you to be able to understand him by means of certain processes which we cannot study in detail one can sometimes put oneself in relation with such subjects by merely touching them, speaking to them it is possible to attract their attention and then one can question them and obtain certain answers sometimes in the most favorable cases the subject will answer by speaking sometimes he will answer by slight signs of the fingers or face if you take his hand and ask him to press it in order to say yes sometimes you obtain nothing but movements of the eyebrows a slight lowering of the eyebrows will mean yes their rising will mean no and you can thus penetrate a little into his thought lastly in other and more frequent cases you will be able after the crisis of sleep to find again the recollection of it in states of artificially provoked somnambulism about which I shall tell you a few words at the end of this lesson by using these various means you can ascertain that the immobility of such patients is much less physical than moral some have in their mind the fixed idea of sleep or death and they realize outwardly the attitude they are thinking of but many others have ideas that are not in the least connected with the sleep they are seized with a profound reverie in which they contemplate scenes that present themselves before them or indulge in an endless inwards chattering a girl of sixteen who has been terrified by a bull coming to attack her has crises of sleep with perfect immobility during which she is appalled by the hallucination of the bull another aged thirty-two in despair at the death of a friend relates to herself dismal stories about her own death they are going to put candles near my bed they are putting me in a little deal coffin my friends are bringing white flowers to put on my little coffin which is there, placed on two chairs and she talks thus endlessly a man of twenty-five has been much upset by an accusation brought against him by a fellow workman when he meets with this individual he becomes motionless like one petrified and at last he slips to the ground and lies as if asleep for hours together talking inwardly about the accusation brought against him he fancies his before his employer and defends himself in every way, arguing in a complicated manner as if he were before a court of justice it is useless to remind you of the fact that we could make concerning these sleeps all the remarks we have made about the beginning and the end of the fits they are likewise originated by an affecting event and the same part is played by the provocative circumstances which by an association of ideas recall the initial event you have just seen an example in which sleep is provoked by the sight of the person who brought the accusation we could resume the same discussion about certain special points which have been called hypnogenic points in my opinion these points do not act at all for physical but for moral reasons because the sensations they bring about are associated with the affecting idea at the end of these fits of sleep there occurs the same awakening with indifference and especially the same oblivion exactly as insomnambulisms you see therefore that these new phenomena do not differ very much from the preceding ones however you remember that in insomnambulisms there were intelligible words complex acts and expressive movements in attacks the words and acts had disappeared in the fits of sleep which we are now considering in movements or convulsions it seems therefore that all the phenomena of insomnambulism have disappeared but these missing phenomena are not in my opinion essential phenomena what was most important in insomnambulism was as I told you an idea persisting in consciousness and developing to an exaggerated degree the development is complete if it manifests itself by emotional expressions by words and acts it is much less complete if nothing remains in insomnambulism namely the emotional agitation yet the idea may still persist and pervade immeasurably the consciousness of the patient without manifesting itself by anything outwardly the subject is then invaded by a kind of meditation from which nothing can distract him he perceives no phenomenon foreign to his dream and this is the reason why he cannot be awakened by any means whatever and takes on the appearance of being in a profound sleep so we were right in saying that this form of hysteric accident is not in insomnambulism of which it was only the last degree I should not like to conclude this study of hysteric insomnambulism without indicating to you in its proper place if not a new form at least an important characteristic of all the preceding forms a very curious property of hysteric accidents which no doubt is not absolutely peculiar to them but which carried to this degree is rare is that they can be artificially reproduced in most diseases the accidents are not at our disposal to take only one striking example we are not at all masters of an epileptic fit we cannot stop it at will nor can we reproduce it or make it reappear when we please let us take for example an individual who has been affected with epilepsy for 10 or 20 years and who very frequently has the most decided epileptic fits well if we wished for any reason in the interest of the patient himself to study his epileptic fit if we wished that a fit might take place in the presence in the laboratory where we have the time and the means to examine its details accurately we could not as you know realize this wish we can take the patient before us try him in every way but he will present no pathological phenomenon he will not be impressionable at all he will not have the shadow of an epileptic fit an hour afterwards when we are gone and without our knowing why he will suddenly fall and have a great epileptic fit it is a disease on which experimentation has no hold formally it was so with three fourths of the diseases nowadays owing to the discoveries of physiology, of microbiology and sometimes of psychology we begin to be able to reproduce in the laboratory some of the diseases we want to study you know that it was a revolution when Pasteur demonstrated that the cattle plague the carbuncle could be given to an animal when one pleased it is the beginning of medical science and sometimes of therapeutics to be able thus to bring about the outbreak of a disease at will well this character is developed to the highest degree in hysteric neuroses and it applies especially to the somnambulisms of which I have just spoken notice first that it is a constant symptom of mono-ideic somnambulisms we have only to awaken in a more or less precise manner in the mind of the subject the idea whose development fills up the somnambulism to cause the latter to reappear sometimes to awaken such an idea it is necessary to recall it completely to describe it to dwell on the images that constitute it sometimes it is sufficient to make a sign to call up a term associated with that idea for the rest of the somnambulism to develop owing to the automatic association which you know speak of Pauline to that young woman who wanted to imitate her by throwing herself out of the window she will think of the suicide of her niece, go towards the window and begin all the scene over again questioniren on the death of her mother you will see one of the following different phenomena either as we have noted she understands the question only partially answers us vaguely has no accurate remembrances relating to her mother's death nor even to her illness or if you insist a great deal if you remind her of facts characteristic of the agony the subject will lose her composure be agitated and cease to hear us or see surrounding objects she will soon be absorbed in her dream and then will recite in a declamatory tone the details of the agony we spoke of and begin to play the scene of the death and of her own attempt at suicide under an engine the somnambulism has begun again what we have just said applies to all the other forms of somnambulism to polyideic somnambulism in which the dream when once begun is transformed by the appearance of new circumstances to fugues themselves which we can make the patients recommence by dwelling on the dominant idea many of the fugues of young are were in some manner experimental his comrades provoked them by calling through their chatter the stories of travels which had impressed the patient nay more the fact is but little known double existences can be experimentally reproduced allow me to recall this remarkable observation on which I have often insisted already that of Marceline whom we have just studied in our preceding lecture this patient as you know was transformed by hypnotism and kept during 15 years two existences the former with depression, anesthesias, amnesias anorexia, etc. brought about by the hysteria and the latter with rather good health normal sensations and memory determined by artificial excitation she had really become a sort of artificial felida and she shows us that double existence itself can be reproduced by artificial means what I have just told you of somnambulism is still true with respect to those incomplete forms of somnambulism which we have just studied under the name of emotional fits and fits of sleep with reverie those who described the hysterogenic and hypnogenic points had insisted on the following character namely that at any moment you could by the excitation of these points cause the patient to fall back into the attack or sleep one fell into convulsions as soon as her lower abdomen was pressed, the other into a fit of sleep when one of her breasts was touched we know now what these phenomena mean they belong to the same group with the preceding ones the sensation provoked is again a signal related with the group of psychological phenomena of the crisis I shall only recall the essential fact namely that we can make these phenomena reappear artificially the states thus artificially reproduced the somnambulisms especially are not long in being a little modified after a certain time they are no longer quite identical with the original natural phenomena the reason of this is as we saw when we studied polyideic somnambulisms that new ideas may develop in this state stopping it an idea that plays a great part is the idea of the experimenter who has artificially provoked the state the latter is more and more capable of introducing himself into the somnambulism of the subject at first he can only be understood by the subject if he speaks to her of ideas related to the somnambulic dream but he is soon himself a part of the dream and is heard and understood if he speaks of anything whatever the greater and greater influence the subject is not long in transforming the somnambulism in giving it a form and laws that are often strange and simply result from the habits of the experimenter one teaches his subject always to say the, thou during the somnambulic state whereas she says you in the normal state another accustomed her to fall profoundly asleep when her eyes are touched and to wake up when her vertex is touched such phenomena were formally presented as laws of somnambulism and gave rise at the time of Chalco and at discussions thus is formed in some subjects an artificial somnambulism which has been given the name of hypnotism this hypnotism raises one last serious question which we cannot treat in detail and on which I can find myself to giving you my personal opinion is this hypnotism something distinct from hysteric somnambulism is it something peculiar an abnormal state independent of hysteria you remember what great battles have been fought on that point for my part I do not hesitate and these are the principal reasons for my opinion first considered in itself the hypnotic state has never any character which cannot be found in natural hysteric somnambulism the modifications it offers are very easily explained as the result of education secondly if you examine the subjects with whom this state can be obtained you will be convinced that they are mostly hysteric patients having already had somnambulism in some form or another or for the remaining part hysteric patients having presented other accidents but having the mental state characteristic of hysteria thirdly you can verify if you examine matters without preconceived ideas the fact that subjects troubled with other diseases than hysteria epileptics for instance psychosthenics tormented by the mania of doubt lunatics affected with systematic delirium are not at all hypnotisable and that one will never be able to reproduce in them a real somnambulic state with complete consecutive amnesia fourthly and I find that this remark very important this artificial somnambulism is healed and disappears in the same manner as natural somnambulism a subject whose hysteria decreases who tends towards recovery whose mental state changes ceases to be hypnotisable fifthly and lastly these two states are so analogous to each other that you can pass from the one to the other by imperceptible transitions you can enter into a relation with an individual in natural somnambulism first speak to him of his dream get him to listen to you then direct his thoughts and afterwards put him into the hypnotic state at will inversely the hypnotic state if you do not sufficiently direct the mind of the subject can be transformed into a state of independent dream into a state of hysterical somnambulism in a word it seems there is no reason for making a special place for the hypnotic state it is a somnambulism analogous to the preceding one and differs from it only in that it is obtained artificially instead of developing spontaneously so we have passed in review the different forms of somnambulic accidents that characterize hysteria and constitute more than half of the accidents of this neurosis end of section 5 section 6 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 6 motor agitations contractures disturbances in the motor functions of the limbs apparent exaggeration of motion the phenomenon of ticks rhythmical careers the absence of will, of consciousness, anesthesia the diagnosis the tremors the contractures clinical importance of this accident the part played by mental phenomena the degradation of the movements in these hysterical accidents hysteric neuroses the history of which we are pursuing very often present accidents of quite another nature which at first sight seem to be different from somnambulisms these accidents do not affect the whole of the body and of the mind like the former they seem only to disturb certain functions and in particular the accidents we consider today appear only to disturb the motor functions of the limbs in spite of the disturbances seated in the arm or leg the mind may appear at least in certain cases absolutely intact while in somnambulisms the delirium seemed to be general in the second place motor disturbances which we now consider are not momentary but they are lasting instead of appearing like attacks and somnambulisms at determinate moments and disappearing in the interval they may last for a long time for days and months together no matter what the state of the subject may be they may exist during the fits and also exist in the interval so you see that the phenomena are apparently pretty different yet most physicians especially since the end of the last century do not hesitate to connect this ensemble of motor disturbances with the same neurosis with hysteria perhaps we shall be able to justify this diagnosis later on by showing that the mental disturbances at bottom about the same as in somnambulisms for the present we cannot ground our argumentation on this still unknown character and we are obliged to justify the diagnosis of these disturbances of motion by mere clinical remarks we observe only that they present themselves in the same subjects and in the same conditions as the preceding somnambulisms the patients we shall describe to you today who have had these perversions of motion these agitations or paralysis are the same whom we already know they had a short time before monoid egg somnambulisms, fumes or fits they can still if we choose enter into those hypnotic states which we consider as the reproduction of spontaneous somnambulisms in them these various accidents alternate with one another after a fit they may have spasms or paralysis inversely these disturbances of motion may disappear in a new fit or a new somnambulism no doubt these are not absolutely irrefutable reasons and it will be necessary to complete the diagnosis when we know better the nature of these motor phenomena but after all these reasons are sufficient to induce us while pursuing the study of the hysteric to enter into the examination of these phenomena which these patients often present the motor disturbances that have the preceding characteristic are very various and irregular we could range them into two large groups first phenomena of at least apparent exaggeration of motion to exceed the will of the patient and to develop inopportunely and without his consent and second phenomena of deficiency in which on the contrary motion seems to fail and not to obey the will and consciousness of the subject in the first group which we designate under the general name of motor agitations are to be ranged ticks careers and contractures in the second the strange functional paralysis or paralysis dependent on ideas today we shall study in the first group one you all know the commonplace phenomenon of ticks which is to be met under so many circumstances I advise you to keep the French word because I do not find in the English language a good translation you must not fancy that all ticks are hysteric there are some epileptic ticks and even often a psychosthenic ticks but to confine ourselves to our preceding diagnosis there are some ticks that are to be met who have already had all the preceding forms of somnambulism and that alternate with these somnambulisms these ticks are essentially constituted by little movements of the face head or limbs which appear at random without any relation either to the present circumstances or to the consciousness of the patients this name is generally reserved for rather sudden little movements of short duration and other terms are used when the same involuntary movements have a greater extent these little muscular shakes may present themselves in all parts of the body you may especially notice them in the face they constitute grimaces of a thousand kinds affecting the eyes, the nose, the mouth the patient pucks his forehead in various ways raises or lowers his eyebrows winks, looks sideways by starts he makes his nostrils tremble closes or opens them too much a very interesting patient whom we shall study with more detail today blows violently through his left nostril others seem to wipe their noses or to sneeze their lips suddenly draw to the one side or the other stretch forward or shrink backward or else are continually bitten the upper lip as well as the lower one the ticks of the neck have been brought in to notice by being described under the name of psychic stiff neck involuntarily and suddenly the patient inclines his head towards one shoulder or throws it back or bends it forward or turns it on its axis he repeats these movements every two or three seconds in a way which it is impossible to explain or justify by any present reason I do not speak now of the ticks related to the visceral functions such as the alimentation or breathing ticks I at once pass on to the ticks of the limbs in these the arms the hands seem to have taken strange habits they rise suddenly or move backwards the shoulders are shaken convulsively the legs instead of regularly performing the act of walking every moment interrupted by a strange little shake of the knee or foot or toes these little movements which have innumerable forms of course impede every action of the arms and when they occur in the waking state they often make walking almost impossible let us proceed at once in order not to interrupt the description to the same kind of involuntary and useless movements that have a greater extent and for that reason have been called careers this distinction is not essential at the bottom and must not prevent us from putting all the motor agitations in the same group the first careers that physicians decidedly connected with hysteria were the rhythmical careers thus called because the movements were repeated regularly at determinant intervals like those of a pendulum this kind of rhythmical movements occurs very often in the hysteric fit it constitutes those complications of the simple fit which I have pointed out to you very often the patients without recovering consciousness cease their emotional manifestations to indulge in some odd and perfectly regular gymnastics one of the most common places the salute which Sharko described the patient lying on her bed sits up bends her head and body forward sometimes low enough to touch her knees as if she were making a salute then suddenly throws herself back till her head falls on her bed after a moment she begins again she may thus make this salute 20 or 40 times a minute for hours together others have maliatory movements of the arm or leg you would think they strike regularly with a hammer others again have saltatory movements either when lying or when standing they appear to jump or dance regularly besides these definite classified movements there are hundreds of others which have no definite name this one clinches her fists and suddenly brings them together towards the middle of her body then separates them and begins again indefinitely another turns her right wrist or fixed to a wheel and so forth indefinitely in all such acts there is always the same rhythmical regularity Sharko quoted in reference to this the sentence in Hamlet though this be madness yet there's method in it and wished a ballet master might observe and write down the strange and regular movements of the patients these movements have their maximum of strength and rhythmical regularity during the fit but it is characteristic of the motor agitations we speak of that they may very well persist in the interval of the fits the patient speaks correctly he is in possession of the whole of his consciousness has all his recollections can even execute movements with his unharmed limbs but he continues to make the rotary movement with his right hand and bring his two hands into contact or separate them though the more distinct hysteric career is thus characterized by a rhythm you must not fancy that every other career in which there is no rhythm is necessarily outside the great neurosis that was believed formally but this two simple diagnosis had to be reformed no doubt a very irregular career consisting in characterless shakes of the arms and legs occurring without any kind of regularity amidst voluntary movements is usually the common career called career of Sydenham with which we have not to deal if however such a career appears in adults or young people after their puberty you must be on your guard for such careers though a rhythmic a young woman 31 years old terrified by an explosion in a factory where she worked presented for more than 10 years deliriums, fits somnambulisms of all kinds which were unquestionably hysteric amidst these various accidents taking their place or alternating with them she had very long periods of career this career of all the limbs and of the head presented no kind of rhythm and yet we do not hesitate to maintain that it was a hysteric phenomenon in the other accidents of the patient we have noted about 20 quite typical observations of this kind which clearly show that the arrhythmic career must be counted among the possible forms of hysteric motor agitation its diagnosis then depends not only on the previous and simultaneous accidents but also on the mental state which accompanies it and on which we must now insist 2 whatever may be the ticks or career movements that these patients present a number of psychological characteristics accompanying them which characteristics are the easier to discern as these motor accidents continue during the waking state and it is possible to question the subject about what he feels when the movement thus exists during the waking state one can better realise the mental state that accompanies it first of all the will of the subject has no influence on it of course the subject asserts that he does not want at all to make this movement he does not insist that he would very much like to be rid of it but he cannot stop it any more than he can produce it the efforts of his will appear powerless by making great efforts he cannot most disturb the rhythmical movement make it less regular complicated with shakes of the rest of his body the movement is not stopped and begins again more regularly when the subject gives up his efforts of will consciousness does not seem to have a great hold on this phenomenon either the subject seems to be scarcely aware of his tic or his career very often he performs it without knowing it even when he is attentive he feels it but little or even not at all when he shuts his eyes he may very well declare that now his arm no longer moves at all while the movement continues with perfect regularity we see those phenomena of insensibility appear here which will play a greater and greater part in hysteric accidents when treating of somnambulism we spoke but little of insensibility in the first place when the somnambulism as at an end this disturbance may fail entirely a somnambulist is not necessarily insensible in the waking state he is merely amnesic it is amnesia that is the stigma of somnambulism and not anesthesia then during the somnambulism itself there is it is true a certain anesthesia but it is very peculiar and only affects the phenomena which are not connected with the subject's dreams when we come to motor disturbances that insensibility which is called hysteric anesthesia begins to intervene it may present itself in two ways sometimes it is systematic and bears only on the movement that constitutes the tick or the career the subject does not feel that he moves his forehead or that he strikes his bed regularly with his hand but he feels the other things and in particular is able to tell you that somebody seizes his hand while he is performing the career movement notice this systematic anesthesia becomes more and more important sometimes the anesthesia is more important and the whole of the limbs affected with a tick or a career is insensible for instance one of the subjects to whom I alluded used to turn his right hand in a circle and had a seesaw movement in his right foot the whole of his right side was nearly insensible these anesthesias this kind of unconsciousness must play a certain part in the diagnosis you will not meet again with the same characteristics in the same degree in ticks of another nature particularly in the ticks of the psychosthenic with the latter the tick while appearing involuntary is accompanied by a great deal of consciousness and attention the subject performs his tick when he thinks of it when he directs his attention to the organ and tries to keep it motionless it seems that with these patients attention increases the tick instead of diminishing it inversely you may observe that distraction sometimes has a good effect forgets his disease and his mind is absorbed by something else he leaves off performing his tick you see that with him the tick is conscious that it is in connection with thoughts the subject possesses there is therefore no anesthesia in this case the subject feels his movement very well and all that passes in the diseased limb with the hysteric the movement is impeded by attention it develops becomes more complete and regular in a state of distraction it is much often are accompanied with anesthesia these characteristics which serve to make the diagnosis also enable us better to understand the nature of the phenomenon in fact the tick and the korea movement are much more intellectual phenomena than they appear to be we notice many mental phenomena at their beginning exactly as at the beginning of somnambulism one has had an accident to his face or eye another a pain in his teeth the man who constantly blew through one of his nostrils had had for a long time a scab in his nose upon a bleeding at the nose all the patients who have had mental stiff necks have had some moral impression relating to a movement of the head a girl I am attending now felt very dull at home she worked all day long by a window that looked out into the street her strongest desire was to leave her monotonous work and go out into the street at which she constantly looked at every moment she lifted her eyes from her work and turned her head to the left in order to see what was going on in the street she gradually felt that her head constantly turned to the left and even maintained that her hat was too heavy on that side an absurd diagnosis the application of a plaster bandage had singularly aggravated her state and now she has a bad mental stiff neck on her right side these ideas, these more or less definite mental phenomena which existed at the beginning persist throughout the development of the tic or the korea let us return to a singular story which I have often related it tells how the rhythmic career of that girl of 16 had begun who kept on turning her right wrist and regularly raising and lowering her right foot one evening on the eve of the quarter day she had heard her parents who were poor work people bewailing their poverty and the difficulty they had in paying their landlord she was very much moved and from that time she had at night a kind of somnambulism during which she tumbled and tossed in her bed and repeated aloud I must work, I must work now what was the work of this girl she had a singular trade which was to make doll's eyes and for this purpose she worked a lathe by trading a pedal with her foot and turning a flywheel with her right hand during her nocturnal somnambulism she made this movement of the hand and of the foot but this movement was evidently accompanied with a corresponding state of consciousness which she repeated aloud I must work a simple somnambulic action like all those we have studied on a waking she no longer has any recollection or consciousness of her dream but the movement continues exactly the same on her right side is it not likely that it is still accompanied with a state of consciousness of the same kind we can make this state of consciousness evident by certain experiments which we know now how to effect by hypnotizing the subjects you find again dreams that account very well for the continuation of the tic for instance a young woman comes to complain of a pretended vertigo it appears that in the street every hundred steps she feels herself as it were precipitated forward that she suddenly takes a leap and has often fallen while taking it what a strange vertigo in a state of induced somnambulism she relates to us what follows once she went to her parents who sharply reproached her for her irregular conduct on going out of their house she took a resolution that simplifies many things she made up her mind to commit suicide and in a dream of course for she was happily for her hysteric to a high degree she fancied she had got upon the parapet on the bank of the Sen took a leap and was awakened by a fall to the ground in all such cases the existence of a system of images that works unknown to the subject is undeniable the difficulty is greater in the case of great uncoordinated careers in which all the motor functions seem to take apart it is no longer merely a special thought a system of images that seems to develop outside of consciousness it is a function in its entirety the function of moving the arm or leg that seems to emancipate itself let us notice for the present this phenomenon which appears to us for the first time it will become clearer and clearer through new studies 3 indeed the problem raised by such dissociated motor activities working separately outside of consciousness becomes singularly complicated when we examine other forms they may assume which are among the most important phenomena of hysteria are referred to tremors and contractures in a very great number of cases hystericals have other disturbances of motility than ticks and careers their limbs are affected with a strange agitation differing from the preceding ones for example they are seized with tremors the arm has regular little oscillations of an average rate of 5 to 9 a second these oscillations are nearly continual there are some subjects with whom they never stop either when they rest or when they move there are some others with whom these tremors are intermittent disappearing at the time of voluntary activity and increasing at the time of diversion and rest but it is not possible to establish any rule for you often observe the reverse in the form of intentional trembling analogous to that of disseminated sclerosis the subject almost motionless when at rest begins to tremble when he seeks to perform a movement figure 7 these tremors occur under various conditions sometimes gradually after paralytic phenomena very often suddenly after an emotion one of the finest cases I have observed is that of a workman who in consequence of the breaking of a scaffolding remained suspended at the height of a sixth floor others began to tremble after a fright after receiving bad news one of my observations the tremor which began in the right arm was consequent on a dream the subject fancied he was pushing back an assassin with his right arm in some rare cases you can find behind the tremors as behind the ticks the existence of a fixed idea separated from consciousness a woman who presented an intense tremor of the right hand at last confessed that this tremor had appeared in consequence of her having long practiced automatic writing in order to question spirits it was enough to put a pencil in her right hand for the tremor to cease and to be transformed into writing so we had certainly to deal with a kind of tick with an incomplete subconscious action which assumed the appearance of a tremor but in most cases there is nothing behind the tremor but a vague emotive state and a kind of transformation of the motor function of the limb it is what we observe in a higher degree in the exceedingly serious phenomenon of hysteric contractures you know that the history of this phenomenon may be said to begin with the lessons of Brody 1837 Lectures illustrative of certain local nervous affections then we have the works of Coulson 1851, of Padgett 1877, of Charcot of La Segue, of Paul Richet this history corresponds to the evolution of the greatest problems of medicine for physicians have been led gradually to separate the hysteric contractures from all the particular medullary and nervous affections with which they were formally confounded it amounts to saying that this problem is connected with everything in medicine this contracture is a state of moderate contraction of an ensemble of muscles which maintains a limb in a determinate position and that in an involuntary, unconscious and indefinite manner such contractures can be observed on absolutely all the muscles of the body and in each region which I can only point out to you in the eyes they determine the spasm of the orbicularis and the occlusion of the eyelids at the mouth they are located very often on only one side and they bring on the distortion of the face in both cases they must be carefully distinguished from paralytic phenomena which they simulate from the ptosis of the eyelids which fall passively instead of contracting and from the paralysis of one side of the face which equally causes the face to deviate to the opposite side you know the importance of the ptosis of the eyelids and of the unilateral paralysis of the face the diagnosis of capital importance the contracture may be seated in the neck, back abdomen or thorax and in each place new problems arise here it simulates diseases of the vertebrae deviations of the vertebral column here it transforms the breathing and causes you to believe there is pulmonary disease in other cases it assumes the appearance of all possible tumors of the abdomen it is these contractures which originate the great medical errors of which hysteria is the occasion as regards the limbs we have the contractures of the legs, of the hip with the important problem of the white tumor of the knee and of tuberculous cox algae I think the most expert physician ought never to boast that he will make no mistake when he has to decide between hysteric cox algae and tuberculous cox algae as regards the arms difficulty is not so serious in general and yet you must beware of false luxations of the shoulder of arthritis and of cysts of the elbow or wrist there is not a more important clinical problem than that of contractures curiously enough we also meet here with an important psychological problem with a question that is certainly one of the most obscure of pathological psychology it is obvious that a certain number of the phenomena connected with these contractures are very clear first we know that contractures are consequent like all hysteric phenomena on thoughts and emotional phenomena a shock has no action in this direction except when it determines great phenomena of imagination I will explain myself an individual has his legs in a state of contracture because he says a carriage ran over them after verification it is found that the carriage passed beside him and that he felt nothing at all a real shock would do less than this imaginary shock according to all the observations that have been made the production of a contracture requires exactly as does that of a somnambulism some emotion, some fear for the future some terror, some dream etc it is the same with the cure of these contractures in certain cases they persist indefinitely I have two cases which lasted for 30 years in other cases they are suddenly cured through influences that are incomprehensible if one does not take into account imagination and emotion these diseases are among those which make the fortune of religious relics and miraculous springs when you hear a story about a cripple with hard shriveled legs twisted under his body who was rolled to the spring in a low carriage and got up again bearing away his carriage on his shoulders you need not have the least hesitation in pronouncing the case one of hysteric contractures if you are fond of erudition I recommend you to read the admirable book of Carré de Mont-Giron on the miracles wrought in the cemetery of Saint-Médale on the tomb of Dican Paris 1737 it is also a phenomena of this kind that physicians have cured in determinate conditions by all sorts of processes by the electric current by magnets, by the application of metallic plates, by merely speaking to the patients so there are a great many psychological phenomena as well at the end as at the beginning of contractures you also meet with some during the time the phenomenon itself lasts first of all the contractor is more frequently systematic at least at its beginning than is generally believed the limb is not stiff in every position depending on the unequal strength of the different muscles it keeps a particular attitude requiring a certain harmony of permanent contractions a woman has seen in the hospital an individual who has died of tetanus she reproduces his attitude and keeps her head thrown back another of whom I have often spoken constantly keeps both her feet extended in the position of Christ on the cross she has moreover a religious delirium in which she thinks herself crucified she has crises of synambulism and catalepsy in which her trunk arms and head remain for hours together absolutely in the attitude they must have in a crucified person during these crises the entire attitude decidedly corresponds to a delirium and to thoughts when in the interval of the crisis the feet alone keep the contractor it is very likely that something of the delirium persists from another point of view we may notice that the contractor varies with certain psychological facts if the subject is very quiet if nobody touches her contractured limb and if she herself does not try to make a voluntary movement we may see that the contractor decreases and that the limb unbends lastly we may observe in contractures many forms of insensibility the subject does not feel the fatigue of this permanent contracture it does not feel anything at all in her contractured limb in a word you see that we may notice in contractures a great number of facts analogous to those we have observed in ticks and careers showing us a kind of abnormal functioning of a psychological system which in some way or other has become independent I must however add that we meet here with a new difficulty the germ of which indeed was already to be found in careers and tremors let us try with our sound limbs to copy the attitude of a rhythmic career and register our movements accurately you will find that you are much more awkward than a hysteric person and that unless you have practiced specially to this end you cannot obtain the same regularity try to keep your arm in the position of a hysteric contracture and describe the movement of the arm you will remark that you have not the same perseverance or courage as the patient after a short time your arm trembles and is displaced while the hysteric contracture has not changed if therefore we suppose there is a psychic action in this hysteric phenomena it must be acknowledged that this action is not identical with ours but that it is performed in other conditions here is my hypothesis think of it what you please the actions that are manifested by muscular movements present different degrees of perfection corresponding to the development and systematization of the consciousness that accompanies them these degrees of perfection are manifested first of all by the psychological characteristics of the action delicacy, harmony, usefulness of the act but it is also manifested by properties of the movements themselves the muscular movement of a draughtsman's hand is not the same as the muscular movement of a dog's or a crocodile's paw there are some particular physiological properties accompanying the perfection of the act some are known the rapidity of the contraction is much greater and in particular the rapidity of the decontraction of the fall of the muscle is much more considerable in the muscles of the lower animals the contraction takes place slowly and disappears slowly we see also the same modifications of the muscular contraction brought about by fatigue by repetition muscular contraction changes become slower has a long period of decontraction as in the case of lower animals I even think excuse the temerity of these suppositions that there must be in these different muscles and in these different states of activity of the muscle and anatomical differences great stress has been laid recently on the two organs that exist in the muscular fiber the fibrils which gives short contractions and the sarcoplasm which gives long and permanent contractions the latter predominates in the smooth fibres of the viscera the former in the striated muscles of the voluntary movements I suppose that it will be possible later on to observe some modifications in the proportion of these two substances in the muscles of different animals in the state of evolution and in the different states of the same muscles in rest or in fatigue for instance now action by becoming unconscious in hysterics by separating from consciousness loses something of its dignity retrogrades in a manner and assumes an appearance that recalls the action of the visceral muscles the action of the lower animals and the movements of the fatigued muscles as if the activity of the sarcoplasm prevailed over that of the fibrils this is what in my opinion gives to the subconscious actions of the hysteric those abnormal characteristics we saw in tremors and contractures it is this general idea that prepares us for the examination of the phenomenon of hysteric paralysis end of section 6