THE CASE OF MISS LUCY R.
Towards the end of 1892 a friendly colleague recommended to me a young
lady whom he had been treating for chronic recurrent purulent rhinitis.
It was later found that the obstinacy of her trouble was caused by a
caries of the ethmoid. She finally complained of new symptoms which this
experienced physician could no longer refer to local affections. She had
lost all perception of smell and was almost constantly bothered by one
or two subjective sensations of smell. This she found very irksome. In
addition to this she was depressed in spirits, weak, and complained of a
heavy head, loss of appetite, and an incapacity for work.
This young lady visited me from time to time during my office hours—she
was a governess in the family of a factory superintendent living in the
suburbs of Vienna. She was an English lady of rather delicate
constitution, anemic, and with the exception of her nasal trouble was in
good health. Her first statements concurred with those of her physician.
She suffered from depression and lassitude, and was tormented by
subjective sensations of smell. Of hysterical signs, she showed a quite
distinct general analgesia without tactile impairment, the fields of
vision showed no narrowing on coarse testing with the hand, the nasal
mucous membrane was totally analgesic and reflexless, tactile sensation
was absent, and the perception of this organ was abolished for specific
as well as for other stimuli, such as ammonia or acetic acid. The
purulent nasal catarrh was then in a state of improvement.
On first attempting to understand this case the subjective sensations of
smell had to be taken as recurrent hallucinations interpreting
persistent hysterical symptoms. The depression was perhaps the affect
belonging to the trauma and there must have been an episode during which
the present subjective sensations were objective. This episode must have
been the trauma, the symbols of which recurred in memory as sensations
of smell. Perhaps it would be more correct to consider the recurring
hallucinations of smell with the accompanying depression as equivalents
of hysterical attacks. The nature of recurrent hallucinations really
makes them unfit to take the part of continuous symptoms, and this
really did not occur in this rudimentarily developed case. On the other
hand it was absolutely to be expected that the subjective sensations of
smell would show such a specialization as to be able to correspond in
its origin to a very definite and real object.
This expectation was soon fulfilled, for on being asked what odor
troubled her most she stated that it was an odor of burned pastry. I
could then assume that the odor of burned pastry really occurred in the
traumatic event. It is quite unusual to select sensations of smell as
memory symbols of traumas, but it is quite obvious why these were here
selected. She was afflicted with purulent rhinitis, hence the nose and
its perceptions were in the foreground of her attention. All I knew
about the life of the patient was that she took care of two children
whose mother died a few years ago from a grave and acute disease.
As a starting point of the analysis I decided to use the “odor of burned
pastry.” I will now relate the history of this analysis. It could have
occurred under more favorable conditions, but as a matter of fact what
should have taken place in one session was extended over a number of
them. She could only visit me during my office hours, during which I
could devote to her but little of my time. One single conversation had
to be extended for over a week as her duties did not permit her to come
to me often from such a distance, so that the conversation was
frequently broken off and resumed at the next session.
On attempting to hypnotize Miss Lucy R. she did not merge into the
somnambulic state. I therefore was obliged to forego somnambulism and
the analysis was made while she was in a state not perhaps differing
much from the normal.
I feel obliged to express myself more fully about the point of the
technique of my procedure. While visiting the Nancy clinics in 1889 I
heard Dr. Liébeault, the old master of hypnotism, say, “Yes, if we had
the means to put everybody into the somnambulic state, hypnotism would
then be the most powerful therapeutic agent.” In Bernheim’s clinic it
almost seemed that such an art really existed and that it could be
learned from Bernheim. But as soon as I tried to practice it on my own
patients I noticed that at least my powers were quite limited in this
respect. Whenever a patient did not merge into the somnambulistic state
after one to three attempts I possessed no means to force him into it.
However, the percentage of somnambulists in my experience were far below
that claimed by Bernheim.
Thus I had my choice, either to forbear using the cathartic method in
most of the cases suitable for it, or to venture the attempt without
somnambulism by using hypnotic influence in light or even doubtful
cases. It made no difference of what degree (following the accepted
scales of hypnotism) the hypnotism was which did not correspond to
somnambulism, for every direction of suggestibility is independent of
the other and nothing is prejudicial towards the evocation of catalepsy,
automatic movements and similar phenomena for the purpose of
facilitating the awakening of forgotten recollections. I soon
relinquished the habit of deciding the degree of hypnotism, as in a
great number of cases it incited the patients’ resistance, and clouded
the confidence which I needed for the more important psychic work.
Moreover, in mild grades of hypnotism I soon tired of hearing, after the
assurance and command, “You will sleep, sleep now!” such protests as,
“But, Doctor, I am not sleeping.” I was then forced to bring in the very
delicate distinction, saying, “I do not mean the usual sleep, I mean the
hypnotic,—you see, you are hypnotized, you cannot open your eyes”; or,
“I really don’t want you to sleep.” I, myself, am convinced that many of
my colleagues using psychotherapy know how to get out of such
difficulties more skilfully than I; they can proceed differently. I,
however, believe that if through the use of a word one can so frequently
become embarrassed, it is better to avoid the word and the
embarrassment. Wherever the first attempt did not produce either
somnambulism or a degree of hypnotism with pronounced bodily changes, I
dropped the hypnosis and demanded only “concentration,” I ordered the
patient to lie on his back and close his eyes as a means of reaching
this “concentration.” With little effort I obtained as profound a degree
of hypnotism as was possible.
But inasmuch as I forbore using somnambulism, I perhaps robbed myself of
a preliminary stipulation without which the cathartic method seems
inapplicable. For it is based on the fact that in the altered state of
consciousness the patients have at their disposal such recollections and
recognize such connections which do not apparently exist in their normal
conscious state. Wherever the somnambulic broadening of consciousness
lacks there must also be an absence of the possibility of bringing about
a causal relation which the patient cannot give to the doctor as
something known to him, and it is just the pathogenic recollections
“which are lacking from the memory of the patients in their usual
psychic states or only exist in a most condensed state” (preliminary
communication).
My memory helped me out of this embarrassment. I, myself, saw Bernheim
adduce proof that the recollections of somnambulism are only manifestly
forgotten in the waking state and can be readily reproduced by slight
urging accompanied by hand pressure which is supposed to mark another
conscious state. He, for instance, imparted to a somnambulist the
negative hallucination that he was no more present, and then attempted
to make himself noticeable to her by the most manifold and regardless
attacks, but was unsuccessful. After the patient was awakened he asked
her what he did to her during the time that she thought he was not
there. She replied very much astonished, that she knew nothing, but he
did not give in, insisting that she would recall everything; and placed
his hand on her forehead so that she should recall things, and behold,
she finally related all that she did not apparently perceive in the
somnambulic state and about which she ostensibly knew nothing in the
waking state.
This astonishing and instructive experiment was my model. I decided to
proceed on the supposition that my patients knew everything that was of
any pathogenic significance, and that all that was necessary was to
force them to impart it. When I reached a point where to the question
“Since when have you this symptom?” or, “Where does it come from?” I
receive the answer, “I really don’t know this,” I proceeded as follows:
I placed my hand on the patient’s forehead or took her head between my
hands and said, “Under the pressure of my hand it will come into your
mind. In the moment that I stop the pressure you will see something
before you, or something will pass through your mind which you must
note. It is that which we are seeking. Well, what have you seen or what
came into your mind?”
On applying this method for the first time (it was not in the case of
Miss Lucy R.) I was surprised to find just what I wanted, and I may say
that it has since hardly ever failed me, it always showed me the way to
proceed in my investigations and enabled me to conclude all such
analyses without somnambulism. Gradually I became so bold that when a
patient would answer, “I see nothing,” or “Nothing came into my mind,” I
insisted that it was impossible. They probably had the right thought but
did not believe it and repudiated it. I would repeat the procedure as
often as they wished, and every time they saw the same thing. Indeed, I
was always right; the patients had not as yet learned to let their
criticism rest. They repudiated the emerging recollection or fancy
because they considered it as a useless intruding disturbance, but after
they imparted it, it was always shown that it was the right one.
Occasionally after forcing a communication by pressing the head three or
four times I got such answer as, “Yes, I was aware of it the first time,
but did not wish to say it,” or, “I hoped that it would not be this.”
By this method it was far more laborious to broaden the alleged narrowed
consciousness than by investigating in the somnambulic state, but it
made me independent of somnambulism and afforded me an insight into the
motives which are frequently decisive for the “forgetting” of
recollections. I am in position to assert that this forgetting is often
intentional and desired. It is always only manifestly successful.
It appeared to me even more remarkable that apparently long forgotten
numbers and dates can be reproduced by a similar process, thus proving
an unexpected faithfulness of memory.
The insignificant choice which one has in searching for numbers and
dates especially allows us to take to our aid the familiar axiom of the
theory of aphasia, namely, that recognition is a slighter accomplishment
of memory than spontaneous recollection.
Hence to a patient who is unable to recall in what year, month or day a
certain event took place, enumerate the years during which it might have
occurred as well as the names of the twelve months and the thirty-one
days of the month, and assure him that at the right number or name his
eyes will open themselves or that he will feel which number is the
correct one. In most cases the patients really decide on a definite date
and frequently enough (as in the case of Mrs. Cäcilie N.) it could be
ascertained from existing notes of that time that the date was correctly
recognized. At other times and in different patients it was shown from
the connection of the recollected facts that the dates thus found were
incontestable. A patient, for instance, after a date was found by
enumerating for her the dates, remarked, “This is my father’s birthday,”
and added “Of course I expected this episode [about which we spoke]
because it was my father’s birthday.”
I can only slightly touch upon this theme. The conclusion which I wished
to draw from all these experiences is that the pathogenic important
experiences with all their concomitant circumstances are faithfully
retained in memory, even where they seem forgotten, as when the patient
seems unable to recall them.[14]
After this long but unavoidable digression I now return to the history
of Miss Lucy R. As aforesaid, she did not merge into somnambulism when
an attempt was made to hypnotize her, but lay calmly in a degree of mild
suggestibility, her eyes constantly closed, the features immobile, the
limbs without motion. I asked her whether she remembered on what
occasion the smell perception of burned pastry originated.—“Oh, yes, I
know it well. It was about two months ago, two days before my birthday.
I was with the children (two girls) in the school room playing and
teaching them to cook, when a letter just left by the letter carrier was
brought in. From its postmark and handwriting I recognized it as one
sent to me by my mother from Glasgow and I wished to open it and read
it. The children then came running over, pulled the letter out of my
hand and exclaimed, ‘No you must not read it now, it is probably a
congratulatory letter for your birthday and we will keep it for you
until then.’ While the children were thus playing there was a sudden
diffusion of an intense odor. The children forgot the pastry which they
were cooking and it became burned. Since then I have been troubled by
this odor, it is really always present but is more marked during
excitement.”
“Do you see this scene distinctly before you?”—“As clearly as I
experienced it.”—“What was there in it that so excited you?”—“I was
touched by the affection which the children displayed towards me.”—“But
weren’t they always so affectionate?”—“Yes, but I just got the letter
from my mother.”—“I can’t understand in what way the affection of the
little ones and the letter from the mother contrasted, a thing which you
appear to intimate.”—“I had the intention of going to my mother and my
heart became heavy at the thought of leaving those dear children.”—“What
is the matter with your mother? Was she so lonesome that she wanted you,
or was she sick just then and you expected some news?”—“No, she is
delicate but not really sick, and has a companion with her.”—“Why then
were you obliged to leave the children?”—“This house had become
unbearable to me. The housekeeper, the cook, and the French maid seemed
to be under the impression that I was too proud for my position. They
united in intriguing against me and told the grandfather of the children
all sorts of things about me, and when I complained to both gentlemen I
did not receive the support which I expected. I then tendered my
resignation to the master (father of the children) but he was very
friendly, asking me to reconsider it for two weeks before taking any
definite steps. It was while I was in that state of indecision that the
incident occurred. I thought that I would leave the house but have
remained.”—“Aside from the attachment of the children is there anything
particular which attracts you to them?”—“Yes, my mother is distantly
related to their mother and when the latter was on her death bed I
promised her to do my utmost in caring for the children, that I would
not forsake them, and be a mother to them, and this promise I broke when
offering my resignation.”
The analysis of the subjective sensation of smell seemed completed. It
was once objective and intimately connected with an experience, a small
scene, in which contrary affects conflicted, sorrow at forsaking the
children, and the mortification which despite all urged her to this
decision. Her mother’s letter naturally recalled the motives of this
decision because she thought of returning to her mother. The conflict of
the affects raised this moment to a trauma and the sensation of smell
which was connected with it remained as its symbol. The only thing to be
explained was the fact that out of all the sensory perceptions of that
scene, the perception of smell was selected as the symbol, but I was
already prepared to use the chronic nasal affliction as an explanation.
On being directly questioned she stated that just at that time she
suffered from a severe coryza and could scarcely smell anything but in
her excitement she perceived the odor of burned pastry, it penetrated
the organically motived anosmia.
As plausible as this sounded it did not satisfy me; there seemed to be
something lacking. There was no acceptable reason wherefore this series
of excitements and this conflict of affects should have led to hysteria.
Why did it not all remain on a normal psychological basis? In other
words, what justified the conversion under discussion? Why did she not
recall the scenes themselves instead of the sensations connected with
them which she preferred as symbols for her recollection? Such questions
might seem superfluous and impertinent when dealing with old hysterias
in whom the mechanism of conversion was habitual, but this girl first
acquired hysteria through this trauma, or at least through this slight
distress.
From the analysis of similar cases I already knew that where hysteria is
to be newly acquired one psychic determinant is indispensible; namely,
that some presentation must intentionally be repressed from
consciousness and excluded from associative elaboration.
In this intentional repression I also find the reason for the conversion
of the sum of excitement, be it partial or total. The sum of excitement
which is not to enter into psychic association more readily finds the
wrong road to bodily innervation. The reason for the repression itself
could only be a disagreeable feeling, the incompatibility of one of the
repressible ideas with the ruling presentation-mass of the ego. The
repressed presentation then avenges itself by becoming pathogenic.
From this I concluded that Miss Lucy R. merged into that moment of
hysterical conversion, which must have been under the determinations of
that trauma which she intentionally left in the darkness and which she
took pains to forget. On considering her attachment for the children and
her sensitiveness towards the other persons of the household, there
remained but one interpretation which I was bold enough to impart to
her. I told her that I did not believe that all these things were simply
due to her affection for the children, but that I thought that she was
rather in love with her master, perhaps unwittingly, that she really
nurtured the hope of taking the place of the mother, and it was for that
reason that she became so sensitive towards the servants with whom she
had lived peacefully for years. She feared lest they would notice
something of her hope and scoff at her.
She answered in her laconic manner: “Yes, I believe it is so.”—“But if
you knew that you were in love with the master, why did you not tell me
so?”—“But I did not know it, or rather, I did not wish to know it. I
wished to crowd it out of my mind, never to think of it, and of late I
have been successful.”[15]
“Why did you not wish to admit it to yourself? Were you ashamed because
you loved a man?”—“O, no, I am not unreasonably prudish; one is
certainly not responsible for one’s own feelings. I only felt chagrined
because it was my employer in whose service I was and in whose house I
lived, and toward whom I could not feel as independent as towards
another. What is more, I am a poor girl and he is a rich man of a
prominent family, and if anybody should have had any inkling about my
feelings they would have ridiculed me.”
After this I encountered no resistances in elucidating the origin of
this affection. She told me that the first years of her life in that
house were passed uneventfully. She fulfilled her duties without
thinking about unrealizable wishes. One day, however, the serious, and
very busy and hitherto very reserved master, engaged her in conversation
about the exigencies of rearing the children. He became milder and more
cordial than usual, he told her how much he counted on her in the
bringing up of his orphaned children, and looked at her rather
peculiarly. It was in this moment that she began to love him, and gladly
occupied herself with the pleasing hopes which she conceived during that
conversation. However, as this was not followed by anything else, and
despite her waiting and persevering no other confidential heart-to-heart
talk followed, she decided to crowd it out of her mind. She quite agreed
with me that the look in connection with the conversation was probably
intended for the memory of his deceased wife. She was also perfectly
convinced that her love was hopeless.
After this conversation I expected a decided change in her condition but
for a time it did not take place. She continued depressed and moody—a
course of hydrotherapy which I ordered for her at the same time
refreshed her somewhat mornings. The odor of burned pastry did not
entirely disappear; though it became rarer and feebler it appeared only,
as she said, when she was very much excited.
The continuation of this memory symbol led me to believe that besides
the principal scene it represented many smaller side traumas and I
therefore investigated everything that might have been in any way
connected with the scene of the burned pastry. We thus passed through
the theme of family friction, the behavior of the grandfather and
others, and with that the sensation of burned odor gradually
disappeared. Just then there was a lengthy interruption occasioned by a
new nasal affliction which led to the discovery of the caries of the
ethmoid.
On her return she informed me that she received many Christmas presents
from both gentlemen as well as from the household servants, as if they
were trying to appease her and wipe away the recollection of the
conflicts of the last months. These frank advances made no impression on
her.
On questioning her on another occasion about the odor of burned pastry
she stated that it had entirely disappeared, but instead she was now
bothered by another and similar odor like the smoke of a cigar. This
odor really existed before; it was only concealed by the odor of the
pastry but now appeared by itself.
I was not very much pleased with the success of my treatment. What
occurred here is what a mere symptomatic treatment is generally blamed
for, namely, that it removes one symptom only to make room for another.
Nevertheless, I immediately set forth to remove this new memory symbol
by analysis.
This time I did not know whence this subjective sensation of smell
originated, nor on what important occasion it was objective. On being
questioned she said, “They constantly smoke at home, I really don’t know
whether the smell which I feel has any particular significance.” I then
proposed that she should try to recall things under the pressure of my
hands. I have already mentioned that her recollections were plastically
vivid, that she was a “visual.” Indeed under the pressure of my hands a
picture came into her mind—at first only slowly and fragmentarily. It
was the dining room of the house in which she waited with the children
for the arrival of the gentlemen from the factory for dinner.—“Now we
are all at the table, the gentlemen, the French maid, the housekeeper,
the children and I. It is the same as usual.”—“Just keep on looking at
that picture. It will soon become developed and specialized.”—“Yes,
there is a guest, the chief accountant, an old gentleman who loves the
children like his own grandchildren, but he dines with us so frequently
that it is nothing unusual.”—“Just have patience, keep on looking at the
picture, something will certainly happen.”—“Nothing happens. We leave
the table, the children take leave and go with us up to the second floor
as usual.”—“Well?”—“It really is something unusual, I now recognize the
scene. As the children take leave the chief accountant attempts to kiss
them, but my master jumps up and shouts at him, ‘Don’t kiss the
children!’ I then experienced a stitch in the heart, and as the
gentlemen were smoking, this odor remained in my memory.”
This, therefore, was the second, deeper seated scene causing the trauma
and leaving the memory symbol. But why was this scene so effective? I
then asked her which scene happened first, this one or the one with the
burned pastry?—“The last scene happened first by almost two
months.”—“Why did you feel the stitch at the father’s interference? The
reproof was not meant for you.”—“It was really not right to rebuke an
old gentleman in such manner who was a dear friend and a guest, it could
have been said quietly.”—“Then you were really affected by your master’s
impetuosity? Were you perhaps ashamed of him, or have you thought, ‘If
he could become so impetuous to an old friend guest over such a trifle,
how would he act towards me if I were his wife?’”—“No, that is not
it.”—“But still it was about his impetuosity?”—“Yes, about the kissing
of the children, he never liked that.” Under the pressure of my hands
there emerged a still older scene which was the real effective trauma
and which bestowed on the scene with the chief accountant the traumatic
effectivity.
A few months before a lady friend visited the house and on leaving
kissed both children on the lips. The father, who was present,
controlled himself and said nothing to the lady, but when she left he
was very angry at the unfortunate governess. He said that he held her
responsible for this kissing; that it was her duty not to tolerate it;
that she was neglecting her duties in allowing such things, and that if
it ever happened again he would entrust the education of his children to
some one else. This occurred while she believed herself loved and waited
for a repetition of that serious and friendly talk. This episode
shattered all her hopes. She thought: “If he can upbraid and threaten me
on account of such a trifle, of which I am entirely innocent, I must
have been mistaken, he never entertained any tenderer feelings towards
me, else he would have been considerate.”—It was evidently this painful
scene that came to her as the father reprimanded the chief accountant
for attempting to kiss the children.
On being visited by Miss Lucy R. two days after the last analysis I had
to ask her what pleasant things happened to her. She looked as though
transformed, she smiled and held her head aloft. For a moment I thought
that after all I probably mistook the conditions and that the governess
of the children had now become the bride of the master. But she soon
dissipated all my suppositions, saying, “Nothing new happened. You
really do not know me. You have always seen me while I was sick and
depressed. I am otherwise always cheerful. On awaking yesterday morning
my burden was gone and since then I feel well.”—“What do you think of
your chances in the house?”—“I am perfectly clear about that. I know
that I have none, and I am not going to be unhappy about it.”—“Will you
now be able to get along with the others in the house?”—“I believe so,
because most of the trouble was due to my sensitiveness.”—“Do you still
love the master?”—“Certainly I love him, but that does not bother me
much. One can think and feel as one wishes.”
I now examined her nose and found that the pain and the reflex
sensations had almost completely reappeared. She could distinguish
odors, but she was uncertain when they were very intense. What part the
nasal trouble played in the anosmia I must leave undecided.
The whole treatment extended over a period of nine weeks. Four months
later I accidentally met the patient at one of our summer resorts—she
was cheerful and stated that her health continued to be good.
EPICRISIS.
I would not underestimate the aforesaid case even though it only
represents a young and light hysteria presenting but few symptoms.
Moreover, it seems to me instructive that even such a slight neurotic
affliction requires so many psychic determinants, and on a more
exhaustive consideration of this history I am tempted to put it down as
an illustration of that form of hysteria which even persons not burdened
by heredity may acquire if their experiences favor it. It should be well
noted that I do not speak of a hysteria which may be independent of all
predisposition; such form does not probably exist, but we speak of such
a predisposition only after the person became hysterical, as nothing
pointed to it before this. A neuropathic disposition as commonly
understood is something different. It is determined even before the
disease by a number of hereditary burdens, or a sum of individual
psychic abnormalities. As far as I know none of these moments could be
demonstrated in the case of Miss Lucy R. Her hysteria could therefore be
called acquired and presupposes nothing except probably a very marked
susceptibility to acquire hysteria, a characteristic about which we know
hardly anything. The chief importance in such cases lies in the nature
of the trauma, to be sure in connection with the reaction of the person
to the trauma. It is an indispensable condition for the acquirement of
hysteria that there should arise a relation of incompatibility between
the ego and some of its approaching presentations. I hope to be able to
show in another place how a variety of neurotic disturbances originate
from the different procedures which the “ego” pursues in order to free
itself from that incompatibility. The hysterical form of defence, for
which a special adaptation is required, consists in converting the
excitement into physical innervation. The gain brought about by this
process is the crowding out of the unbearable presentation from the ego
consciousness, which then contains instead the physical reminiscences
produced by conversion—in our case the subjective sensation of smell—and
suffers from the affect which is more or less distinctly adherent to
these reminiscences. The situation thus produced is no longer
changeable, for changing and conversion annihilate the conflict which
helped towards the adjustment of the affect. Thus the mechanism
producing hysteria corresponds on the one hand to an act of moral faint
heartedness, on the other hand it presents itself as a protective
arrangement at the command of the ego. There are many cases in which it
must be admitted that the defense of the increased excitement through
the production of hysteria may actually have been most expedient, but
more frequently one will naturally come to the conclusion that a greater
measure of moral courage would have been an advantage to the individual.
Accordingly the real traumatic moment is that, in which the conflict
thrusts itself upon the ego and the latter decides to banish it. Such
banishment does not annihilate the opposing presentation but merely
crowds it into the unconscious. This process, occurring for the first
time, forms a nucleus and point of crystallization for the formation of
a new psychic group separated from the ego, around which, in the course
of time, everything collects in accord with the opposing presentation.
The splitting of consciousness in such cases of acquired hysteria is
thus a desired and intentional one, and is often initiated by at least
one arbitrary act. But literally, something different happens than the
individual expects, he would wish to eliminate a presentation as though
it never came to pass but only succeeds in isolating it psychically.
The traumatic moment in the history of our patient corresponds to the
scene created by the master on account of the kissing of the children.
For the time being this scene remained without any palpable effects,
perhaps it initiated the depression and sensitiveness, but I leave this
open;—the hysterical symptoms, however, commenced later in moments which
can be designated as “auxiliary,” and which may be characterized by the
fact that in them there is a simultaneous flowing together of both
separated groups just as in the broadened somnambulic consciousness. The
first of these moments in which the conversion took place in Miss Lucy
R., was the scene at the table when the chief accountant attempted to
kiss the children. The traumatic memory helped along, and she acted as
though she had not entirely banished her attachment for her master. In
other cases we find that these different moments come together and the
conversion occurs directly under the influence of the trauma.
The second auxiliary moment repeated almost precisely the mechanism of
the first. A strong impression transitorily reestablished the unity of
consciousness and the conversion takes the same route opened to it in
the first. It is interesting to note that the symptom occurring second
concealed the first so that it could not be distinctly perceived until
the second was eliminated. The reversal of the succession of events to
which also the analysis must be adapted seems to me quite remarkable. In
a whole series of cases I found that the symptoms which came later
covered the first, and only the last thing in the analysis contained the
key to the whole.
The therapy here consisted in forcing the union of the dissociated
psychic groups with the ego consciousness. It is remarkable that the
success did not run parallel with the accomplished work, the cure
resulted suddenly only after the last part was accomplished.