DISSOCIATION AND DISEASE
The subconscious, I repeat, does not always exercise a helpful
influence; there are times when it may impose upon us indescribable
misery.
It is able to do this by virtue of the intimate relations existing
between the mind and the body. At this late day it is scarcely necessary
for me to undertake to demonstrate that the state of one's mind has a
great deal to do with the health of one's body. What is not so generally
known, and what all of us ought to know, is the further fact that many
diseases are directly due to distressing mental states, and in such
cases usually to subconscious mental states--that is to say, to thoughts
and emotions of which the sufferer consciously has no knowledge. The
same often holds good even with regard to maladies the symptoms of which
are almost wholly if not altogether physical, and the causes of which
one would naturally expect to find physical, likewise.
Indeed, ignorance of the tremendous rôle played by the subconscious in
the causation of disease, has in the past been responsible for many
medical shortcomings. Nor is the situation as yet much improved,
although it is rapidly improving, thanks chiefly to the labors of a
little group of scientific investigators known as psychopathologists,
or medical psychologists, who have made it their special business to
ascertain the different ways in which the subconscious may affect health
adversely, and to devise methods for coping with mentally caused
diseases.
These men are not "faith healers." They are not making any war on
medicine. They are, in fact, themselves physicians, graduates of the
best medical schools, of excellent standing in their profession, and
seeking, above all things, to increase the usefulness and precision of
medical science. Already, though their labors were begun only a few
years ago, they have effected numerous cures of a seemingly miraculous
character; but always they have effected them by utilizing natural laws
which they have discovered by the rigorous processes of scientific
experiment.
Of fundamental importance among these laws is one known as the law of
dissociation. It might almost be called the law of forgotten memories,
for to a large extent its workings depend on the interesting
circumstance, to which attention has previously been drawn, that
ideas which have faded from the conscious memory persist in the
subconsciousness. As Pierre Janet, the distinguished Frenchman and most
eminent of living psychopathologists, has tersely phrased it, "Nothing
that goes into the human mind is ever really lost."
No matter how remote, past experiences, as I have shown in earlier
chapters, can be recovered and recalled to mind by means of
crystal-vision, automatic writing, or other psychological methods of
"tapping the subconscious." Obviously we have here no absolute loss of
memory, but merely a splitting off, or "dissociation," from the field
of waking consciousness.
Now, while the memories thus dissociated and lying hidden in the
subconscious usually exercise no appreciable effect other than in the
molding of character, the enlargement of our store of knowledge, etc.,
there are conditions under which, in the case of persons predisposed by
circumstances of heredity or environment, they may give rise to all
manner of mental and physical ills.
A person, for instance, experiences a sudden fright. Time passes, the
fright is completely forgotten, or, at most, vaguely remembered. But
one day unmistakable, and sometimes exceedingly peculiar, symptoms of
disease appear. The victim, it may be, suffers from a strange obsession
or "fixed idea," or from a general "nervous breakdown," or from an
actual paralysis of some bodily organ, or from the development of
abdominal or other enlargements resembling true organic growths.
Whatever the symptoms, the mechanism of the puzzling malady is always
the same. There has been an abnormal dissociation. The ideas connected
with the original shock, although submerged beneath the threshold
of consciousness--in a word, forgotten--remain vividly alive in the
subconscious, to act as perpetual irritants of the nervous system and
in time to give rise to the appearance of the symptoms of which the
sufferer complains. Often, indeed, the dissociation is instantaneous,
and the appearance of the disease symptoms equally rapid.
In either case, the resultant malady is purely psychical in its origin,
and can be cured only by psychical, not by physical means. What is
needed is to get at the dissociated mental states--the forgotten,
disease-creating memories--and reassociate them with the upper
consciousness, or root them out completely by means of "suggestions"
skillfully applied.
This is no fanciful theory. It is the solidest kind of fact, repeatedly
tested and verified. Time and again, patients pronounced incurable by
competent physicians have been taken in hand by the psychopathologists
and, once their disease has been definitely traced to some dissociation,
have been restored to perfect health.
For the matter of that, of course, the same thing has been done to some
extent by Christian Science healers and other irregular practitioners
of "mental medicine." But the difference between all of these and the
psychopathologists is just this--that the former apply the healing
power of suggestion to all sorts of diseases, and without any
adequate understanding of its laws and limitations, whereas the
psychopathologists recognize that it is only one of several valuable
medical methods, and that it is legitimately applicable only to certain
maladies.
Experience has taught them, too, that even within its proper sphere
of usefulness it often is of therapeutic value only after a searching
scientific examination of the patient's subconsciousness has brought
to light the particular dissociated states which have to be corrected
before a cure can be wrought.
Nevertheless, the range of maladies susceptible of cure by
psychopathological processes is marvelously wide, and it is no
exaggeration to say that the discovery of the influence exercised by
the subconscious in the causation of disease is one of the most vitally
significant ever made in the history of medicine.
The truth of this may readily be shown by citing a few cases
illustrating some of the manifold ways in which dissociation works
havoc in the human organism, and the extreme ingenuity displayed by the
skilled psychopathologist in overcoming its ravages.
There was brought one day to the Parisian hospital of the Salpêtrière,
the world's greatest center of psychopathological investigation, a woman
of forty, designated in the medical record of her case by the name of
Justine. She was accompanied by her husband, who explained that he
wished Doctor Janet to examine her because he feared that she had become
insane. And, in fact, she presented the aspect of a veritable maniac.
Her jet-black hair was flowing loosely over her shoulders, her eyes
were fixed and glaring, her hands trembling, the muscles of her neck
twitching, and she constantly made the most horrible grimaces. When
Doctor Janet gently sought to question her, she buried her face in her
hands, and cried:
"Oh, it is terrible to live thus! I am afraid, I am so afraid!"
"And of what, pray, are you afraid?" the physician asked.
"I am afraid of cholera."
"Is that all you are afraid of?"
"But surely it is quite enough."
Doctor Janet turned for an explanation to her husband, who shook his
head despairingly, as he replied in an undertone:
"This is the way she has been for years, doctor, only lately she has
grown much worse. She will scarcely eat anything, for fear of catching
cholera. It is difficult to persuade her to stir from the house. She
seems to think the air is full of cholera germs. She sees cholera
in everything. Tell me, doctor, is my poor Justine mad? Must we be
separated, she and I? Is it that she will have to spend the rest of her
life in an asylum?"
"Leave her here a few days," said Doctor Janet, "and I can tell you
better then."
Psychopathologists have invented some delicate tests for discriminating
infallibly between true organic insanity, which in the present state of
medical knowledge is quite incurable, and functional mental troubles
due to dissociation. Applying these, Doctor Janet soon reached the
conclusion that Justine was not really insane, and that her "phobia,"
or irrational fear, was due to some forgotten shock connected with the
disease cholera.
But, closely though he questioned her, she could recall nothing of the
sort. He then decided to try the effect of hypnotizing her, for, as all
psychopathologists are aware, hypnotism, when it is possible to use it,
is an unrivaled agency for recovering lost memories. Put into the
hypnotic state, patients easily remember incidents in their past of
which they have no conscious recollection when in the normal, waking
state. It was thus with Justine, who proved to be most hypnotizable.
"I want you," Doctor Janet told her, after she had passed into deep
hypnosis, "to try to remember whether at any time in your life you saw
a person suffering from cholera, or one who had died from cholera."
"Why, certainly I did," she promptly replied, shuddering violently.
"When was it?"
"When I was a little girl--fifteen years old."
"Tell me the circumstances."
"My mother was very poor. She had to take all sorts of work. Sometimes
she nursed sick people, and when they died she got them ready for
burial. Once two people in our neighborhood died from cholera, and I
helped her with the corpses. They made a frightful sight--one of them,
at all events. It was the body of a man, naked, and all blue and green.
Oh, frightful, frightful! What if I should catch the cholera? I shall
catch it, I know I shall! Nothing can save me!"
Her voice rose in a shriek of terror, and Doctor Janet hastened to
de-hypnotize her.
The situation was now perfectly clear to him. Evidently the sight of the
corpse, "naked, and all blue and green," had so profoundly affected the
impressionable girl as to cause a severe dissociation whereby all memory
of the shocking episode had been blotted out of her consciousness, only
to be subconsciously remembered in most minute detail.
To bring about a cure, to free her from the obsessing dread of cholera,
it was necessary to remove the gruesome subconscious memory image, and
Doctor Janet essayed to do this through suggestions given to her when
she was again hypnotized.
"You will no longer think of this," he kept assuring her. "You will
forget it, absolutely, permanently."
Day after day, for weeks, he hypnotized her, and reiterated similar
commands. But she continued to be afflicted with her irrational fear,
and it finally became certain that her subconscious recollection of the
phobia-causing scene of twenty-five years before was too deeply rooted
to be destroyed by direct attack. Instead, however, of abandoning
the task as hopeless, Doctor Janet, with a shrewdness born of long
experience, made a clever change in tactics.
"You insist," he said to the hypnotized Justine, "that you cannot help
seeing in your mind's eye the corpse of the man who died. Very well,
I have no objection to that. But hereafter you must see it decently
clothed. So when it next appears to you, you will see it wearing a
bright blue-and-green uniform, the uniform of a foreign military
officer."
Happily, this suggestion "took," and Doctor Janet followed up his
advantage by suggesting that the subconscious memory image which she
regarded as that of a corpse was, in reality, the image of a living man.
This suggestion likewise being successful, he set about getting rid of
the idea "cholera," and its dire implications. Hypnotizing the patient
as usual, he demanded:
"What is this 'cholera' that troubles you so much? Do you not understand
that it is only the name of the fine gentleman in blue and green, whom
you see marching up and down? He is a Chinese general, and his name is
Cho Le Ra. Bear that well in mind."
Quite evidently there was nothing to inspire dread in the image of a
picturesque Chinese officer, General Cho Le Ra. Little by little,
as this artificial conception obtained firmer lodgment in Justine's
subconsciousness, the baneful idea which it was intended to supplant
faded away, and with its fading the abnormal fear diminished, until
at length it entirely disappeared, greatly to her joy and the warm
gratitude of her devoted husband.[39]
[39] This case and a number of other instances of forgotten
terrors giving rise to disease-symptoms are discussed in
detail in Doctor Janet's "Névroses et Idées Fixes."
Other psychopathologists, following Doctor Janet's lead, have similarly
used this method of substituting one subconscious idea for another.
Doctor John E. Donley, a well-known neurologist of Providence, Rhode
Island, and one of the few psychopathologists whom the United States has
yet produced, was once consulted by a young man of thirty-two, who said
to him:
"Doctor Donley, I hear you have been very successful in handling people
troubled with foolish notions. I'm bothered with as foolish a notion
as any one could possibly imagine. I simply can't bear to ride in a
street-car with an odd number. Even-numbered cars give me no trouble at
all, but if an odd-numbered car comes along, I've got to let it pass, no
matter how great my hurry. My friends laugh at me, but I tell you it's
no laughing matter. The thing has got on my nerves so that it is
unbearable."
"How long have you been suffering in this way?" asked Doctor Donley.
"For years. Just when it began I can't remember.
"Is it only odd-numbered cars that affect you? How about odd-numbered
houses, for instance?"
"No, no," answered the young man, "it isn't odd numbers in general. That
doesn't bother me a bit. It's just when they're painted on street-cars."
"H'm," said Doctor Donley. "Ever been in a street-car accident?"
"Never."
"Ever seen one?"
"Not that I remember."
"You are quite sure as to that?"
"Quite."
"Have you any objection to my hypnotizing you?"
"Not in the least, if it is likely to do me any good."
In another ten minutes the problem was solved. Doctor Donley from the
outset had felt confident that the young man's phobia must be connected
in some way with a street-car accident, and so it proved. Fourteen years
earlier, when walking along the street, he had seen a car strike and
seriously injure a child who unexpectedly came from behind a wagon. He
had noticed at the time that the car bore the number two hundred and
thirteen, and he remembered thinking to himself: "There is always bad
luck in thirteen." The sight of the accident gave him a marked emotional
shock, which, he said, upset him for several days.
All of this had long since passed from his waking memory, but was
distinctly recalled during hypnosis. It was clear to Doctor Donley that
the case was one of dissociation, and that the exciting cause of the
young man's unreasonable dread of odd-numbered cars was based on a
painfully vivid subconscious memory image of the consciously forgotten
tragedy. Also, it was evident that before the dread could be overcome
the distressing memory image would have to be eradicated.
To accomplish this, Doctor Donley resorted to the method of
substitution, suggesting to the patient, while still under hypnotic
influence, that he was quite mistaken in supposing that the street-car
had seriously injured the little girl; that, on the contrary, it had
scarcely touched her.
The result, after only eight days' treatment, was effectually to replace
the painful memory image with one free from distressing associations. As
by magic, the young man shook off his absurd phobia. No longer, when he
had to take a car, did he stand on street corners, sometimes for an
hour at a time, waiting anxiously for a car with an even number to
appear.[40]
[40] This case and several others similarly illustrative of
the disease-creating power of emotional disturbances are
discussed by Doctor Donley in "Psychotherapeutics," a book of
composite authorship.
Bizarre as these cases must seem, they are actually typical of a
widespread malady that causes an amount of suffering only appreciable by
the sufferers themselves. In every land there are thousands of men and
women afflicted with obsessions equally strange and equally distressing,
yet amenable to treatment by the methods of psychopathology.
Often, in order to effect a cure, it is not necessary to make use of the
roundabout device just described. Direct suggestion--a strongly negative
command imposed in the hypnotic state--is frequently sufficient.
Often, besides, it is not necessary to use hypnotism at all, a cure
resulting if only the psychopathologist can dig down to the root of the
trouble, and, by recalling to conscious recollection the lost memory
image, reassociate it with the rest of the contents of the upper
consciousness.
Particularly interesting in this connection, as being illustrative also
of an ingenious method of "mind tunnelling" nowadays frequently employed
to get at forgotten memories, is a case reported by Doctor A. A. Brill,
a New York psychopathologist. His patient was a young woman who applied
to be treated for extreme nervousness. She had been perfectly well until
three months before, when, she said, she had begun to suffer from a
complication of disorders, including insomnia, loss of appetite,
constant headache, irritability, and stomach trouble. No physical cause
for her condition could be detected, and Doctor Brill suspected that it
was due to some secret anxiety, but the patient earnestly assured him
that she "had nothing on her mind."
To get at the facts which he suspected she was consciously or
unconsciously concealing from him, Doctor Brill decided to make use of
what is known as the "association-reaction method of mental diagnosis,"
a cumbersome and formidable term for a really simple process.
Everybody knows that if a man is suddenly asked a question bearing on
matters which personally concern him and which he is anxious to keep
entirely to himself, he is apt to "react" to the question in a way that
will betray the true state of affairs. He may blush or stammer before
replying, may reply evasively, may find it impossible to reply at all.
If he is a man of uncommon self-control, and not to be taken off his
guard, the reply may come smoothly enough, and to all appearance without
hesitation. Nevertheless, experiment has shown that, even in such
cases, there is an appreciable difference in the time, if not in the
character, of the replies he makes to emotion-arousing questions, as
compared with the time it takes him to reply to questions that have
no special significance to him. The same holds good in the case
of questions evoking within him memories--albeit perhaps wholly
subconscious memories--of happenings that may be no longer, but once
were, of keen emotional import to him.
Out of the discovery of this fact the association-reaction method has
been evolved. The specialist using it reads slowly to his patient a list
of one hundred words or more, and requests him, as he hears each, to
respond with the first word that comes into his mind. Seemingly the list
of stimulus words is chosen at random; actually it is so constructed
that some of the words are likely to stir into activity the subconscious
memories of which the physician is in search. If they do this the fact
will be disclosed in the time of his reaction-words--the words he utters
in reply--as measured by a chronoscope or stop-watch; or in their
character, as noted down by the specialist.
Of course, it is necessary for the physician to select words having, or
likely to have, emotional significance to the particular patient; and as
a guide in the selection, strange though it may seem, nothing is more
useful than the patient's dreams. For it has been definitely established
that dreams are far from being the haphazard products of imagination
they are generally supposed to be; that on the contrary, no matter
how trivial or nonsensical they seem, they always have an emotional
foundation corresponding with some present or past reality; and that
usually they mask matters of distinct significance to the dreamer.
As a preliminary, then, in the treatment of his nervous patient, Doctor
Brill asked her to write out her dreams and bring them to him.
"But," she said, "I never dream, except when I am troubled by
indigestion, and then my dreams are so absurd that they are not worth
telling."
"Never mind," was his reply. "Whenever you do happen to have a dream,
report it to me."
Laughingly she promised to comply, and one day brought him the
following:
"I dreamed that I was in a lonely country place and was anxious to reach
my home, but could not get there. Every time I made a move there was a
wall in the way--it looked like a street full of walls. My legs were as
heavy as lead; I could only walk very slowly as if I were very weak or
very old. Then there was a flock of chickens, but that seemed to be in
a crowded city street, and they--the chickens--ran after me, and the
biggest of all said something like: 'Come with me into the dark.'"
"There," she said, "that is my dream, and if you can make head or tail
of it, it is more than I can. It is so ridiculous that I am ashamed to
tell it."
But Doctor Brill was already at work drawing up a test list, with the
more striking words of the dream sprinkled through it. Twice he read the
list to her, noting not only the time of her responses, but also their
character.
He was immediately impressed by the fact that certain of the dream
words--such as "chicken," "street," and "dark" had caused a noticeable
time variation; and that she had also given in her responses words that
would not ordinarily be associated with the test words. Especially
peculiar was the association of "mystery" and "marriage" with the word
"dark." The suspicion formed in his mind that a disappointment in love
might be at the bottom of all her disease symptoms. But he did not at
once give voice to this idea; instead, he sought to obtain corroboration
from her own lips without her appreciating his purpose, by means of
another method of "mind tunnelling" known as the method of free
association.
"I want you," he said to her, "to concentrate your attention on the word
'chicken,' and state the thoughts that come to you in connection with
it."
Her reply, given after a few moments of silent meditation, was:
"I remember now that I could see only the biggest chicken; all the
others seemed blurred; it was unusually big and had a very long neck and
it spoke to me. The street in which I saw it recalls where I used to go
to school--the block was always crowded with school children."
She paused, and began to blush and laugh.
"Go on," said Doctor Brill encouragingly. "What next?"
"Why, it recalls the happy school days when I was young and had no
worries. I even had a beau, a boy who attended the same school. We used
to meet after school hours and walk home together. He was lanky and
thin, and the girls used to tease me about him. Whenever they saw him
coming, they said: 'Belle, here comes your chicken.' That was his
nickname among the boys."
Stopping suddenly, she exclaimed:
"Doctor Brill, it couldn't be possible that the chicken with the long
neck, that I saw in my dream, was my old beau!"
"It begins to look very much like it," he smiled. "Have you seen him
lately?"
"Not for months."
"And before then?"
Little by little the whole story came out. They had kept up their
acquaintance after the school days were long gone. Three times he had
asked her to marry him, but each time she had refused, because although
she "liked" him she was not at all sure that she "loved" him. At last
she had decided that the next time he proposed she would accept. But he
had not proposed again. And shortly before she became ill she had heard
that he was paying attentions to another young lady.
"I take it," interposed Doctor Brill, "that he is not so well off as he
might be, and that this had something to do with your refusing to marry
him."
"What makes you say that?"
"In your dream I note that you state: 'Every time I made a move there
was a wall in the way; it looked like a street full of walls.' A street
full of walls might easily signify Wall Street--hence money. That has
been the real obstacle, has it not?"
She confessed that he was right.
He then explained that the one great cause of her ills was her
insistent, if subconscious, brooding over the disappointment she had
experienced, and that her cure depended upon her ability to overcome
this mental attitude. Realizing for the first time, as a result of the
dream analysis, that she was really in love with the man she had three
times declined to wed, she soon solved the problem. Only a hint was
needed to transform him into a suitor once more, and within a very few
months they were happily married.[41]
[41] Doctor Brill has reported and discussed this case in his
recently published "Psychoanalysis," pp. 48-54.
Sometimes direct questioning is sufficient to enable the physician
to get at the underlying mental cause of trouble. Take, for example,
another case successfully treated by Doctor Donley.
The patient was a woman of thirty-five who was troubled by a constant
and involuntary hacking, which sounded as though she were trying to
clear her throat. Drugs, local applications, and electricity had been
tried at intervals during more than four years, but to no purpose. On
inquiry, it was found that the trouble had set in about five years
before, when the patient, who was a mill hand, had suffered from a sore
throat. The physician whom she then consulted told her that she had a
bad case of tonsilitis, and that her tonsils would have to be burned
out.
Greatly frightened, she had hurried home, refusing to submit to the
operation. In a few days the tonsilar symptoms disappeared, and she
returned to work. But she was attacked a second time three weeks later,
and visited another doctor, to be informed that her tonsils were so
badly diseased that it would be well to have them removed by cutting.
Again she refused to submit to an operation, but the fear of cutting,
added to her previous fear, now revived, of burning out her tonsils,
threw her into a highly nervous state. She then began to experience an
unpleasant stinging, tickling feeling in her throat, which she tried to
remove by hacking. As the tickling continued, the hacking became more
and more frequent, and by the time she came under Doctor Donley's
observation had taken on the character of a "tic," or uncontrollable
muscular movement.
These facts in the early history of the case, the patient herself
remembered only vaguely. But she confessed that she was still tormented
by a haunting fear of a possible future burning or cutting of her
tonsils. Finding her exceedingly suggestible, Doctor Donley made no
attempt to hypnotize her. He merely requested her to close her eyes,
remain perfectly passive, and listen attentively to him.
"She was then told, with much emphasis," he says, in describing the
treatment, "that her tonsils were perfectly healthy, that no cutting or
burning ever was or ever would be required; that the tickling sensation
in her throat arose from the constant fixation of attention upon this
part; that she would feel no more desire to hack because her supposed
reason for hacking had ceased to exist, and finally, that when she
should open her eyes she would feel better than she had in a good many
years.
"Much emphasis was placed upon this feeling of health, because it was
desired to leave her on the crest of a pleasurable emotion, which of
itself has a very great suggestive value. What had been predicted in her
regard actually occurred. When she sat up, her tic had disappeared, and
she expressed herself as feeling quite grateful and happy. The treatment
lasted an hour, and except for two slight recurrences easily removed by
waking suggestion, this patient has had no further difficulty."[42]
[42] Quoted from "Psychotherapeutics: A Symposium," p. 152.
Unfortunately, such an easy solution of problems like this is
comparatively rare, particularly when, as in this instance, a physical
trouble is superadded to the mental. Often--a fact which cannot be
emphasized too strongly--it happens that, in dissociational cases,
physical symptoms so far predominate as to lead to totally wrong
diagnosis, even by experienced physicians. This results, as was hinted
above, from the power inherent in subconscious "fixed ideas" of
producing an endless variety of disturbances simulating true organic
diseases, it may be diseases remediable only through surgical
operations.
As a consequence, innumerable operations have been performed on patients
who should have been given, not surgical but psychopathological
treatment. I have in mind as I write a case of this kind that was
called to my attention by a friend who participated in the lamentable
affair.
A middle-aged woman entered one of the Boston hospitals and complained
of severe abdominal pains, which she attributed to cancer of the stomach
or intestines. She was obviously greatly frightened, and suffering
intense agony. A diagnosis of appendicitis was made, and an immediate
operation deemed imperative.
But, to the surprise of the surgeons, the appendix was found to be in a
normal condition. At once they directed their attention to the other
abdominal organs, examining them one by one. None showed any sign of
disease. Finally, with a rueful smile, one of the surgeons straightened
up, and, touching a finger to his head, said:
"The trouble with this poor woman, gentlemen, is here, not in the region
that we have been exploring. But we should not undeceive her. We will
remove the appendix, on general principles, and that will probably be
all that is needed to cure the trouble in her head."
Under the circumstances, it was excellent advice. But how much better
it would have been for the unfortunate woman, whose life was thus
endangered by the surgeon's knife, if it had been recognized from the
beginning that her malady was only a "hysterical simulation" of the
symptoms of appendicitis. Some day, when physicians generally make
themselves acquainted with the diagnostic methods of psychopathology,
blunders like this will be, as they ought to be, most exceptional.
In point both of diagnosis and treatment, again, psychopathological
knowledge is indispensable to the correct handling of such cases as the
following, reported by Doctor Janet.[43] It is, I am ready to concede,
an unusual case, but it is unusual only because it presents a complex of
symptoms commonly found singly or in simpler combination.
[43] In "Névroses et Idées Fixes," vol. i, pp. 1-68.
It would be impossible to estimate with any accuracy the number of
persons who, afflicted only in scant degree like this poor Marcelle,
have been obliged to drag out an existence worse than death, either in
the care of their friends or immured in an institution, simply because
their medical attendants, ignorant of the workings of the law of
dissociation, have been unable to fathom the true nature of their ills
and adopt adequate curative measures.
Marcelle, as Doctor Janet calls her, was only nineteen years old when
she began to astonish her relatives by developing what they were at
first disposed to regard as nothing but an eccentric form of laziness.
She would constantly ask them to give her objects--a book, her crochet
work, a plate--which she could easily have got for herself by stretching
out her hand and picking them up. To all expostulations, she would
calmly reply:
"I can't help it. I can't use my hands as I once did, and that's all
there is to it."
"You can't use your hands! What nonsense! You can use them to eat with,
well enough, and you are crocheting most of the time."
"Oh, but that's different."
"What's the difference? Tell us."
But Marcelle could not, or would not, tell them, and from joking with
her the family soon passed to a state of wrath, endeavoring in every
way to overcome her "stupid obstinacy." Their anger in turn gave way to
fear, when, one night, noticing a glimmer of light in her room, they
entered, and found her standing, fully dressed, before the bed.
"But what is this!" they exclaimed, in amazement. "Why don't you get
your clothes off and go to bed?"
"Because," she cried, "I can't undress!"
And, all arguments proving vain, it was necessary for her sister to
disrobe her as though she were a tiny child. Next day a consultation was
held, and it was decided to take her to the Salpêtrière.
"She doesn't seem insane," her mother explained, when applying to have
her admitted. "She talks sensibly about most things. Can it be that she
is really suffering from some kind of paralysis?"
"Most assuredly," was the reply, "and we will do our best to discover
what it is and cure it."
This turned out to be no easy matter. Doctor Janet, into whose care she
came, had no difficulty in determining that the specific malady which
afflicted her was an extreme form of "aboulia," a disease involving
temporary paralysis of the will, and thereby preventing all muscular
movement. But it was one thing to make a diagnosis, and another to
effect a cure.
Presently, too, indications of mental disturbance developed. Doctor
Janet had discovered that by distracting her attention he could induce
her to rise, extend her hands, and perform other acts that were
impossible to her when she concentrated her attention on them. He
utilized this as an argument to try and persuade her that she could
always control her limbs if she only made sufficient effort.
"But you are quite wrong," she calmly informed him. "I have not left my
chair, I have not put out my hand."
"Most assuredly you have. You know very well I did not give you that
piece of crochet work. How, then, does it come into your hands?"
"I did not pick it up."
"Who did, then?"
"Somebody else--somebody acting in me."
A little later arose another complication. She refused to eat, and it
became necessary to administer food to her forcibly. She kept saying to
herself:
"You must die, you must die as soon as possible. You must not eat, you
have no need of eating. You must not speak, you have no voice, you are
paralyzed."
"Why do you say this?" Doctor Janet one day asked her.
"Why do I say what?"
He repeated her words.
"But I have said nothing of the sort."
"Oh, yes, you have."
"No, no, no--it was not I; it was somebody else acting in me."
Again that phrase--"somebody else acting in me." Greatly impressed,
Doctor Janet threw her into deep hypnosis. Now, an unexpected and most
pathetic passage of personal history came to light. A year before,
Marcelle had had a secret love affair, her lover had deserted her, she
had determined to commit suicide. Failing to do this, she had, none the
less--overwhelmed by the shock of the desertion, and giving herself
wholly to grief and chagrin, which she felt obliged to allow no one to
perceive--gradually passed into a dissociated, dreamlike state, in which
she subconsciously pictured herself to herself either as no longer
existing or as about to perish.
Hence her "aboulia," hence the "somebody else acting in me," hence the
refusal to take food. To Doctor Janet the situation was now almost as
clear as the light of day--so, likewise, was the course which he would
need to follow to restore the sufferer to her "real self," and rid her
of all disease symptoms.
The dissociation, to put it briefly, had in this case been so complete
as to cause an actual disruption of the sense of personality. Nor is
this malady of "loss of personality" as rare as one might be tempted to
think. I could mention many cases not unlike that of Marcelle's, and
some far surpassing it in astounding developments. There is, for
example, the singular case of BCA. But this is so remarkable, so weirdly
fascinating, and so instructive that it deserves to be treated, as I
shall treat it in the next chapter, entirely by itself.