THE Demonaic possession of the middle ages and of times nearer to our own
was largely hysterical in character, and generally occurred in Epidemics.
It was associated with the more superstitious and emotional side of
religious beliefs, where a real Hell fire and a personal Devil with
attendant Angels or Demons were believed in, and feared, much more intensely
and widely than they are today even amongst the ignorant and superstitious,
while suggestion and contagion played a large part in its spread, as it did
in that other and more hateful form of it known as witchcraft.
Esquirol who wrote clearly about it in his "Maladies Mentales" under the
heading of "Demonomania,"[1] spoke of it as being propagated "by contagion,
and by the force of imitation." This was illustrated in the Epidemic of
Loudun, amongst others referred to by him. This epidemic spread to
neighbouring towns menaced all the high Languedoc, but was arrested by the
wisdom of a Bishop, who did this by depriving the movement of its marvellous
elements. In this epidemic form it was in its bodily and mental
manifestations really hysteria with characteristic stigmata and convulsions.
An excellent example of this religious hysteria was presented as recently as
1857 in an epidemic at Morzines in upper Savoy. It began with two little
girls, pious and precocious, who had convulsive attacks. It spread to other
children and then to adults. Amongst the younger of those affected,
ecstasy, catalepsy, and somnambulism were seen, and later, convulsions only;
convulsive attacks returned several times a day. An attack usually began
with yawning, restless movements, the aspects of fear passing into fury with
violent and impulsive movements, with vociferations and cries that they were
lost souls in hell, the mouth-piece of the devil, etc. These attacks would
last from ten minutes to half an hour. A feature of this epidemic was the
absence of coarse and erotic speech or gestures. Between the convulsions
the victims were restless, idle and inattentive, being altered in character
for the worse. In our day such epidemics are represented, though in tamer
fashion, by Revivalism in its more noisy and extravagant eruptions. At all
times, even when such manifestations are not much if at all out of harmony
with ordinary religious feeling and action, there is a tendency to
pathological conditions. Often its subjects, in the words of Professor
James[2] "carry away a feeling of its being a miracle rather than a natural
process, voices are often heard, lights seen, or visions witnessed;
automatic motor phenomena occur; and it always seems after the surrender of
the personal will as if an extraneous higher power had flooded in and taken
possession." These are some of the more striking phenomena of mysticism, and
are also largely pathological being amongst the major symptoms of hysteria.
The history and course of our case illustrated very well this mixed
condition. It has been pointed out that the ecstasies, trances, etc., of
the mystic, while essentially pathological, have the evil effects of such
morbid manifestations modified or largely neutralized by the idealism behind
them, by that measure of true religious faith and feeling which dominates
the whole process in the case at least of the higher mystics. The ore may be
rough and very mixed, but the precious metal is there also, as it was in our
patient, though the divine influence for which she craved was perverted into
that of the "Evil one." In the individual cases described by Esquirol we
recognize a more profound mental disturbance than is shown in the epidemic
or hysterical variety. We indeed see many similar cases in our asylums
though we generally speak of them as Religious Melancholics rather than as
Demonomaniacs. In such cases recovery is slow or may not occur, the patient
passing into a state of chronic mania, or of Dementia. There are other
cases where the religious emotions and ideals are completely subordinated to
or become identified with feelings of fear or remorse, the result of fixed
ideas of a shameful, distressing or frightsome character. A good example of
this condition though essentially hysterical in its nature, is detailed by
Pierre Janet.[3] The patient, a neurotic, respectable business man
thirty-three years of age, a good husband and father, on his return from a
business journey of some weeks' duration is found to have become depressed
and taciturn, and as the days pass his melancholy deepens. At first he would
not speak, but soon when he wished to speak could not, making vain attempts
at articulation. Under the influence of medical ideas suggested to him his
symptoms simulate first Diabetes next Heart disease and his prostration
becomes profound. By and bye he passes into a state only to be described as
acute Demonomania marked by maniacal outbreaks in which he cried out and
blasphemed, lamenting in quieter intervals his powerlessness to resist the
Devil who was, he believed, actually not figuratively within him, who spoke
and blasphemed through him, prevented him sleeping, etc. After some months
he was sent to the Salpetriere where he came under the observation of
Charcot and Pierre Janet. He was cured by means of suggestion by the
latter, who also ascertained by his methods that the illness was the result
of remorse for an offence committed during the business journey which
preceded the outbreak.
[1] For a detailed account of it see the "Dictionary of Psychological
Medicine" under the heading "Demonomania."
[2] The Varieties of Religious Experience; William James p. 228.
[3] "Nevroses et Idees Fixes" Vol. I, p. 377.
In many ways our case differs from cases of this type. An important
difference was in the intermittent character of the symptoms. For a period
of two years the patient alternated between a condition of acute misery from
the delusion that the evil one had entered into her body, and one of
apparent sanity. At the end of two years she was dismissed cured, and has
remained well for several years. She differed also in the absence of
blasphemous, extravagant or obscene speech or action. The Devil never at any
time used her as the mouthpiece for devilish words or thoughts. He was
there, and as she insisted, in bodily form within her, making her intensely
miserable by his presence, and with the feeling that she was cast away from
"grace" and the privileges of the religious life. Nor were there, as in the
case above referred to shameful or remorseful complexes at the root of her
mental condition. In presenting the facts of the case, names and special
marks of identification have been altered.
Mrs. A., a widow, aged fifty-two years, was admitted to the Paisley District
Asylum in 1910 with a history of having suffered for a month previously from
mental depression said to be due to distressing delusions of a religious
character such as that she was lost, was past forgiveness and dominating and
originating all such thoughts was the belief that she was possessed by Satan
or an evil spirit, who was in bodily form within her. This delusion caused
her acute misery, and so absorbed her thoughts that she had ceased to take
any interest in her household affairs, and had even talked of suicide.
Her condition on admission and for two years subsequently was that of
recurring states of this acute mental distress, when she would rock to and
fro, moaning and crying out, often with tears over her lost and dreadful
state, and the presence in her inside of Satan or the "Evil one" whom she
said she felt within her, and who made her "repulsive." This condition was
varied with intervals of usually from one to three days of apparently
complete sanity, when though quiet and somewhat reserved in manner, she was
quite cheerful. When questioned at such times as to her delusion, she would
admit its absurdity, but refer to an uneasy sensation in the region of the
left hypochondrium, which, as she put it, surely meant that there was
something wrong there. She would be occasionally normal in this way for a
week or more, and on more than one occasion was so well as to be allowed out
on parole, but had often to be brought back next day as depressed and
delusive as ever. She was always worse in the mornings, and often improved
as the day went on. She was a stout, pleasant featured and intelligent
woman, somewhat anaemic, and with a slight bluish tinge of lips, though
beyond a lack of tone in sounds, the heart was normal. Her anaemic condition
was accounted for by her having suffered from menorrhagia for the greater
part of two years, which only stopped a few months before her admission to
the Asylum. It had during its continuance brought on breathlessness on
exertion, and what she called spasms or "grippings at the heart," no doubt
the basis of her uneasy feelings in left hypochondrium. There was a slight
enlargement of the thyroid gland, but no symptoms referable to it. None of
these physical conditions beyond the "grippings at the heart" it maybe,
appeared to have any appreciable influence on her mental condition, which as
has been noted above was normal until a month before her admission. An
interesting feature of the case was the relation between her blood pressure
and her varying mental states. Her blood pressure was taken with a Riva
Rocci Sphygmomanometer morning and evening, sometimes oftener, during the
greater part of 1912-13, and it was noted that her depressed or delusional
states were marked by a low pressure, while a high or relatively high
pressure marked her sane and cheerful states, contrary to what is usually
observed in melancholia, though similar to what is seen in agitated
melancholia and mania.[4] Thus at a pressure of 130" HGs, she was generally
very well; at or about 120" HGs she was often well; at 110" HGs or 100" HGs
she was always ill. When recovering, and few weeks before dismissal there
was a fairly steady pressure of 118" HGs to 120" HGs day after day. It had
been also noted throughout, that during a continuous period of depression,
or of well-being, the pressure kept steadily high or low day after day
according to the mental condition. There was obviously then a constant and
close relationship between her blood pressure and her mental states. At
first sight it looked as though those states were directly affected by the
varying pressure as it may have influenced the nutrition and therefore the
functions of the brain, and on physiological grounds it is difficult to
exclude such an influence altogether, even though we come to the conclusion
as we did that the variations followed the emotional conditions, and did not
precede or cause them. The broad general statement has been made that "each
pleasurable emotion raises the general blood pressure and increases the
blood flow through the brain and each painful emotion: brings about the
opposite result."[5] It cannot be said, however, that increased blood
pressure will give pleasurable emotion. The splanchnic area can be acted on
so as to raise the blood pressure without influencing the emotions. We know
also that when it is raised in melancholia the increased pressure is
associated with the reverse of pleasurable emotion. Still on therapeutical
as well as on other grounds it appeared to us important to determine what,
if any, influence the raising of her blood pressure by drugs or otherwise
would have on her mental state. We did this by baths, by abdominal pressure
by means of a large sand-bag laid over the abdomen, and by such drugs as
adrenalin and pituitrin. The results were disappointing so far as therapy
was concerned though of interest otherwise. The pressure was raised by all
these measures without any improvement following such as occurred when it
rose naturally. The rise by abdominal pressure was marked and occurred
quickly, but without any apparent effect on her mental condition. When it
was raised to 140"HGs under the influence of pituitrin there was marked
depression as is shown in the chart for July, 1912. Pituitrin given in m.
v. hypodermically three times a day, and after some days in larger doses by
the mouth, kept the pressure between 125" HGs and 130" HGs, but with no
corresponding mental improvement. For some days after the pituitrin was
stopped its influence seemed to persist as the pressure kept high while the
mental condition was low. One of her longest spells of continuous mental
depression which lasted for twenty-seven days, occurred while her pressure
was high under the influence of adrenalin. Digitalis, by the way, had no
influence in any way on either her blood pressure or her mental condition.
The only drug we found of any value was tinctopii in moderate doses three
times a day, but it gradually ceased to do any good.
[4] Maurice Craig, Lancet June 25, 1898.
[5] Leonard Hill, "Cerebral Circulation" p. 74.
Four charts from a very large number are given which illustrate the above
points.
It must be understood that these experiments while accurate so far as they
go, and carefully conducted under my supervision by a competent assistant,
were not made in a well appointed laboratory, but were clinical observations
made in the crowded ward of a hospital for the insane. The central
disturbance here was the result of shock from sudden and excessive fear
acting on a highly sensitive subject as will appear later. It has been
shown by Cannon[6] that such major emotions as fear, rage, or pain acting
upon the adrenal glands through the autonomic nervous system are accompanied
by an increased discharge of adrenalin into the blood, and by a passing of
stored glycogen from the liver for circulation through the body as dextrose,
the object of which is the increasing and liberation of muscular energy for
the animal's successful flight or fight. This discharge takes place very
quickly, and we are told that fright exhausts the adrenal glands, a somewhat
puzzling statement at first sight, but borne out by the experience of our
case where a fall of pressure occurred under the paralyzing effect of
extreme fear and distress continued not merely for minutes but for hours at
a time. By and bye as her distress lessened and her expression of it became
more and more automatic, there was a return to the normal adrenal discharge
and consequent normal rise in pressure. It is possible, of course, that
there may be another explanation in the inhibition of metabolism caused by
fear. Most of us have experienced the arrest of salivation and digestion
under the influence of fear or rage. This inhibition would affect the
products upon which the adrenal secretion depends, but the more likely cause
is where this fear, in this case really a recurring representation of the
original shock, acts through the autonomic nervous system on the adrenal
glands. The emotional disturbance here then was primarily of central origin,
and was certainly not originated by circulatory or visceral changes which
were secondary to it, and the facts do not support the James, Lange theory
of the emotions as it is generally understood. In this connection we may
refer very briefly to the laboratory experiments of Sherrington[7] and
Bechterew.[8] The former by spinal and vagal transection in a dog removed
"completely the sensation of the viscera, of all the skin and muscle behind
the shoulder. The procedure at the same time cuts from connection with the
organs of consciousness the whole of the circulatory apparatus of the body.
Yet the dog exhibited rage, fear, disgust, etc., under appropriate stimuli
as a normal dog might do." The conclusion reached after admitting possible
objections to them is that, "the vasomotor theory of the production of
emotion becomes, I think untenable, also that visceral presentations are
necessary to emotion." Bechterew, discussing this question as to whether the
vascular changes are anterior to the other processes, which determine the
alterations of the neuropsychic tone according to the James, Lange theory,
states that the experiments in his laboratory by Dr. Serenewsky, appear to
lead to an opposite conclusion having shown that under the effects of fear
the alteration of the neuropsychic tone is produced before the appearance of
the cardiovascular phenomena. There are no doubt objections to accepting
laboratory experiments upon inferior animals as conclusive where the psychic
part of the process in question is after all the dominant one, nor must we
forget that biochemical changes may be as important as the integrity of
nerves. We have however referred to these experiments because of their
bearing on the conclusions to be drawn from the above described clinical
facts which so far as the initiation of the emotional process is concerned
confirm them; though we feel that the bodily concomitants of the emotion are
essential to its full development, and that we owe much to James's
presentation of his theory even admitting its "slap dash"[9] character to
use his own phrase. It was to be expected that the artificially raised blood
pressure would have had some effect in improving the patient's mental
condition, and in the case of adrenalin, at any rate, some such effect
should have occurred if we are to accept the recently published conclusions
of Crilel[10] to the effect that "adrenalin causes increased brain action,"
"that brain and adrenalin action go hand in hand, that is, that the adrenal
secretion activates the brain, and that the brain activates the adrenals."
More in harmony with the clinical experiences here is the fact according to
Biedl[11] "that the adrenalin affects the intracranial and the pulmonary
vessels only slightly if at all." We presume that what is true of adrenalin
in this respect will be true of all drugs which increase blood pressure. And
while the rise of the arterial pressure generally will accelerate the flow
of blood through the brain, yet we know that the cerebral circulation is in
"all physiological conditions, but slightly variable."[12] Besides, while
that increased flow must necessarily lead to increased cerebral activity,
that activity may be pathological as well as physiological, as in our
patient, who was quite uninfluenced mentally by the rise of blood pressure
which followed the administration of those drugs. The nature and genesis of
the emotional disturbance in this case may be understood from the following
history and observations.
[6] The interrelations of emotion as suggested by W. B. Cannon. Recent
physiological researches, The American Journal of Psychology, April, 1914.
[7] The Integration of the Nervous System--Sherrington.
[8] Bechterew "La psychologic objective," p. 312.
[9] Psychological Review, Vol. I, where Prof. James admits the defective
presentation of his theory and uses the above words to express it. He gives
all due importance to the associated memories, and ideas to which are
related the incoming currents as well as all pleasure and pain tone
connected with them, etc.
[10] S. W. Crile, "The Origin and Nature of the Emotions," 1915.
[11] Biedl innere secretion--Quoted by Cannon, 2 ed. 1913.
[12] Leonard Hill--The Cerebral Circulation.
She had married happily at the age of nineteen years, had a family of eight
children, but had been a widow for about twenty years. Her husband died
suddenly abroad, where she had lived with her family for two years after his
death, and acting on the advice of her friends, she came back to this
country bringing all her children with her. This involved her in years of
struggle and anxiety to bring them up creditably, which she managed to do.
During all these years of widowhood and stress she was mentally well, and
latterly she described her life as a happy one surrounded as she was by an
affectionate and well doing family. She had been brought up in a puritan
household. Her father and her husband had been deeply and consistently
religious though strict in their belief and observance of the letter. This
upbringing favoured a natural tendency towards religious mysticism which was
also promoted by the creed of the church to which she latterly belonged, and
of which she was a deaconess. In this church the "gift of tongues" and of
"prophesying" was recognized as a part of its heritage, and as she informed
me in one of her normal times, she occasionally spoke or prophesied in the
public assemblies of the congregation. I gathered that her utterances were
generally but a word or two of exhortation or pious aspiration, given
expression to in a moment of exaltation. From her description of her state
at such times, she was carried out of herself, was oblivious for the moment
of the presence and actions of those about her, was in short in a state of
ecstasy when she "prophesied." A natural tendency to self-depreciation, and
to ideas of unworthiness asserted themselves outside of those periods of
exaltation, which were generally followed by doubts as to her fitness to
take part in such work, and by the feeling as she expressed it "that she had
presumed as she was unworthy," and that God would be angry with her for her
presumption. Throughout her religious life she had been always lacking in
"assurance." Latterly this feeling had grown in her and was evidently part
of a deeper feeling of mental depression, as she began to think often, and
with a feeling of dread that she had been surely too happy these later years
which stood in such contrast to the poverty, struggles and disappointments
of the early years of her widowhood. This was her mental condition for some
little time before her attack of acute mental disturbance which began one
night a month before admission to the asylum. She went to bed feeling ill
and shivering as if from a chill. In the middle of the night she woke up in
a fright from a vivid dream the contents of which merged in a strong
sensation as of a hand being pressed on her shoulder. She described the
sensation as being that of a positive feeling of pressure, and with it came
a feeling of dread, and the conviction that it was the hand of Satan, so
that she cried out aloud to him to go out of the house, as it was blessed,
referring to the fact, as is the custom in her church that the minister had
blessed the house when she went to live in it. She thought of calling to
her daughter who was asleep near her, but did not, and after a time fell
asleep again being "comforted by the feeling that the Lord would take care
of her." Next morning the effects of the "chill" had passed off, but there
was left a more or less constant feeling of vague dread and fear of death,
and with this a haunting idea born of this strongly felt hallucination of
external touch that Satan was within her. The feelings of dread and fear
grew steadily and became too strong for her faith in the Lord taking care of
her, and very quickly her obsession as to possession by Satan, became the
definite delusion it was on admission to the asylum. Hallucinations of what
might be termed internal touch leading to this idea of possession, are not
unknown in the annals of mysticism of the more morbid types of it. Indeed
the more ecstatic the mystic becomes, the more he merges himself in his
feelings and tends to develop hallucinatory sensations. He is possessed, and
desires to be possessed, fortunately for him, by the Divine and not the evil
spirit. Hallucinations of external touch are as might be expected more
rare, though not uncommon we understand in the more abnormal types, and
occur in people supposed to be normal. Havelock Ellis tells of a "Farmer's
daughter who dreamt that she saw a brother, dead some years, with blood
streaming from his fingers. She awoke in a fright and was comforting herself
with the thought that it was only a dream when she felt a hand grip her
shoulder three times in succession. There was no one in the room, the door
was locked and no explanation seemed possible to her. She was very
frightened, got up at once, dressed, and spent the rest of that night
downstairs working. She was so convinced that a real hand had touched her,
that although it seemed impossible, she asked her brothers if they had not
been playing a trick on her. The nervous shock was considerable, and she was
unable to sleep well for some weeks afterwards." The writer's[13]
explanation is:--"it is well recognized that involuntary muscular twitches
may occur in the shoulder, especially after it has become subject to
pressure, and that in some cases such contractions may simulate a touch." In
illustration of this he quotes from the Psychical Society's Report on the
"Census of Hallucination" the case of an overworked, and overworried man
who, a few minutes after leaving a car, had the vivid feeling that someone
had touched him on the shoulder, though on turning round he had found no one
near. He then remembered that on the car he had been leaning on an iron
bolt, and therefore what he had experienced was doubtless a spontaneous
muscular contraction excited by the pressure. Touches felt on awakening in
correspondence with a dream are not so very uncommon. We think as to this
likely enough explanation, that whatever the local sensation may have been,
or however slight, as it probably was, it could only give rise to an
hallucination of having been touched by some external personality when it
was absorbed into, and became a part of a considerable emotional disturbance
as in the case of the girl above referred to, and of my patient, in both
cases associated with a frightsome dream. The illness of the latter began
with a dream, and its continuance was in our opinion, largely due to dreams
of a painful character. During the whole period of her residence it was
noted that she dreamt a great deal, and that they were terrifying or
alarming dreams, and that her bad days were generally preceded by a bad
dream. Notes of her dreams were regularly made, at one time for ten
consecutive nights, and only three of them were so far as she remembered
free from dreams. All of her dreams she described as "awful." Many of them
were of being mixed up with objectionable people who behaved roughly and
used profane language, but, and of this she was very certain, who never
talked or acted obscenely. She frequently dreamt of being on high
precipitous places from which she was either falling, or could not get away
from. She described one vivid dream during which she suffered great misery,
and awoke from in great distress. She dreamt that she was listening to a
preacher with open Bible in his hand, that he spoke about Peter whom he was
accusing of disobedience; a number of people were present but she saw
particularly only one man who looked very happy; the sermon ended, and she
awoke in "agony," this feeling being due, she said, to the conviction
present with her, that the sermon, and the man's happiness were intended to
show her how much she had lost since she was cut off from "grace" by Satan
dwelling in her body. Again she dreamt of a near relative whom she heard
singing, "And they all speak in tongues to magnify the Lord." This brought
sorrow to her of which she was conscious during the dream and after she
awoke as she thought Satan was putting this before her to show her what she
had lost. In another dream she saw three unpleasant looking men talking
together. The worst looking of them of Jewish appearance, came close to her
face, and argued with her about the evil spirit. She said "he was in her
body," and he answered "away with him." She fell asleep and dreamt the same
dream again. These dreams were obviously governed by her dread and fear as
to her religious position. The following one is somewhat different:--"A big
brown beast came up to her and pressed against her face; she slept again and
dreamt she was in a big ship sailing in black and dirty water; that she
tried hard to get out of the ship, but could not, and awoke in great
distress." We presume Freudians would find in the latent content of all
these dreams, particularly in this last one, evidence in favour of their
positions, though to us they reveal only, in the blurred and broken way
dreams do, the prevailing trend of thoughts governed by morbid religious
fears and garbed in the phraseology and symbolism of a judaic faith. The
sameness of their ending and meaning to her being obviously due to their
relation to the dream which ushered in her illness to which indeed most of
them were closely related in geneses and content. No doubt Freudian
psychoanalysis would be able to carry her memory back into the region of
long forgotten infantile or early sex memories where, as in every normal
human being they lie, the shadowy outlines of instinctive feelings whose
roots are in a far away, phylogenetic past, having apart from suggestion no
role as factors in the production of morbid fears or fancies. The
fantastical and too often repulsive dream interpretations of this school
forcibly remind us of the words of Lord Bacon, "With regard to the
interpretation of natural dreams it is a thing that has been laboriously
handled by many writers, but it is full of follies." All kinds of trivial
incidents of childhood and early youth are stored up by all of us, and are
recalled in sudden and unexpected ways, but not because of any relaxation of
a supposed "censor," nor necessarily because of any content of a sex nature,
but because they are more often than not associated with fear, chief of the
coarser emotions, and a more primitive and more enduring emotion than any of
those connected with reproduction, and more alien to the organism than sex
memories even of a perverse order, their resurrection being due to some
subtle association between the present and the past, generally a sensory
one, visual or auditory most frequently. In our own case the earliest
recollections of childhood are so associated and recollected. Sunshine
amongst trees, and birds singing bring back to us at very long intervals a
country scene where as a child we were frightened by threats of a "bogie
man." The only childish incidents which unexpectedly recur with us were
associated with childish fears and disappointments of a usual and ordinary
character never with morbid elements or emotional complexes which were
repressed or censored in the Freudian sense, and in this we are not
singular.
[13]"The World of Dreams," p. 182.
Again and again, association tests, as prescribed by Jung, and repeated
examinations of a psychological character were made without our being able
to obtain the slightest indication of their being erotic or similar
influences of the slightest value as factors in the causation of her mental
disturbance. The chief value of Jung's Tests we have found to be the
suggestion of lines of inquiry or the confirmation of evidence obtained in
other ways. The results here were negative and in that confirmed what we
knew from the history and character of our patient as a pure minded woman of
blameless life. She was constitutionally timid, and all her life liable to
doubts and fears of a morbid type. As an instance of this she told us that
when twelve years of age while influenced by the death of her step-mother,
which had just taken place, one morning early her father went out to his
work leaving her in bed, and alone in the house. Immediately after he left
she heard or more likely thought she heard, someone lift the latch of the
door, as if to come in, but though no one came in she was left in a state of
great fear, so marked that for long afterwards she dreaded being left alone,
and still remembers vividly her feelings during that experience. This
temperament she carried into her religious life which as we have seen was
marked by fears and doubts. "No one will deny that fear is the type of
asthenic manifestations. Yet is it not the mother of phantoms of numberless
superstitions, of altogether irrational and chimerical religious
practices."[14] The strength and character of her beliefs as well as the
religious teachings and influences to which she had been subjected from her
earliest years, all tended to develop the mystical in a temperament ready
for the dissociation necessary to enable the mystic to attain to that
ecstasy or absorption in something outside and beyond the self which is the
essence of that state. Why the ecstasy which she knew and desired should
pass into its opposite is not difficult to understand when the above history
is considered.
[14] Ribot "The Creative Imagination." p. 34.
The shock which originated the attack gave form and reality to fears and
doubts which had been assailing her for some time, and to the influence of
which she was specially liable at this time by the lowered physiological
tension, the result of her previous menorrhagia, and by the fact that the
comparative ease and comfort of her later life had given her opportunities
for introspection absent during her previous life of struggle for and
interest in others. She was then scrupulous, timid and superstitious, a
mystical, a psychopathic temperament, taking her place all the same with
John Bunyan and other chief of sinners whose self-depreciation and
absorption in the struggle for salvation from sin and the power of the
Devil, though morbid in character was not pathological. But when Satan
became not merely a spirit influencing her, but had entered bodily into her,
the border was crossed, and she was to herself literally possessed, and
became filled with fear, a fear pathological in action, dominating her
mentally and physically during her dissociated states. Once initiated it is
not difficult to see how these dissociated states which recurred so
regularly and persisted so long were kept up by her temperament, and her
constantly recurring dreams of a terrifying or depressing character, which
were, as we have already indicated, but representations of the original
shock. The following quotation applies closely to her case. "On this view an
intense, sudden painful experience, especially if the significance of it can
be dimly felt, but not understood, may persist long and latently
unassimilated by the central consciousness and without fusion with it,
almost as if it were a foreign body in the psychic system."[15] Professor
James has termed the pathological emotion an objectless emotion, but as
Professor Dewey puts it "from its own standpoint it is not objectless; it
goes on at once to supply itself with an object, with a rational excuse for
being."[16] Here the sensations in the left hypochondrium which she had
described as "grippings at the heart," became the object which, under the
influence of the initial shock with its unusual and alarming sensations and
feelings, she interpreted as she did.
[15] Stanley Hall on Fear--The American Journal of Psychology, April 1914.
[16] Psychological Review, Vol. I, page 562.
Her recovery was very gradual and marked by many relapses. In her treatment
as in our ideas as to the causation of the disorder, we put the accent on
the psychic rather than on the physical factors. We did not however
underrate the latter but constantly sought to improve her bodily health and
condition. When at her worst in 1911 her weight, taken monthly, was round
about one hundred and sixty pounds. In 1912 it went up from one hundred and
sixty-six to one hundred and eighty-eight pounds and averaged one hundred
and seventy-six pounds. But as in the case of her blood pressure, the rise
was due largely to her mental improvement. It may be of interest to note
here that during and after a somewhat severe attack of diarrhoea with
hemorrhage from the bowels, her mental condition was better than usual, as
might even have been expected considering the mental distraction the attack
involved.
We were satisfied that we could have shortened materially the duration of
her illness--two years,--by hypnotic suggestion, but unfortunately her
friends objected to this mode of treatment. Suggestion in the waking state
had been abundantly used, but with little apparent effect of an immediate
kind.