ABSTRACTS

LE CAS DE RENATA. CONTRIBUTION A L'ETUDE de l'hysterie. L. Schnyder. ARCHIVES DE PSYCHOLOGIE, Vol. xii, No. 47, pp. 201-262.

In this lengthy paper, the author records in detail the history. and analysis of an intelligent hysterical subject in the hope of throwing some light upon the mechanism of the psychoneuroses in general and of hysteria in particular. An hereditary tendency was present in this case, in that the brother of the subject suffered from a psychasthenic disorder, which rapidly improved under psychotherapy combined with rest and overfeeding. The sister, called Renata, who forms the subject of this study, was a young woman, twenty-five years of age, of a decidedly religious type. The analysis was at first strongly antagonized by the subject, and this antagonism, in the light of later developments, was shown to be a typical defense-reaction. Because of the subject's poor state of nutrition, resulting from her anorexia and vomiting, a course of rest and overfeeding was at first prescribed. While this ameliorated the physical condition, the mental state was unaffected. The data showed the following clinical history. Four years before coming under observation she began to suffer with violent headache and vomiting. As a consequence she lost in weight and finally alternating periods of depression and excitement, difficulty in thinking and insomnia were added to the disease picture. One day she suddenly developed what appeared to be a semi-hypnotic state, cried out that she was unable to move and went into an hysterical crisis, consisting of lethargy, inability and refusal to open the eyelids, repeating, "To open the eyes is to live and I am afraid to live." In these crises she was also negativistic and disoriented. For these episodes she was completely amnesic. In spite of the complaint of extreme lassitude, she was able to take long walks without the slightest sign of fatigue. Sleep was poor, and during the night she developed somnambulistic attacks, in which she would write for hours, without any memory for the condition on resuming her normal state. Psychasthenic scruples concerning purity were also present to a marked degree.

Since it appeared that an unconscious mechanism was at work in the production of the various psychoneurotic symptoms, the fragmentary words and phrases written in the somnambulistic state were successfully utilized in an attempt to tap this unconscious mental state and thus arrive at the origin of the disturbing

complex. Most of these phrases were written in English. By means of these phrases and free association procedures it was possible to fully explain the meaning of the fragmentary English terms. Thus the following data concerning the origin of the psychoneurosis were secured.

In childhood she became obsessed by ideas concerning purity, because at home she heard so much concerning the conduct of life. Through her rigid home training she was kept in ignorance of sexual matters, until finally at puberty sexual questionings of a rather obscene nature began to arise. This caused nervous disturbances, because she had been taught that vulgar thoughts and wishes were synonymous with vulgar and sexual acts. Consequently at the age of about eighteen, nervous crises began to develop, and certain English words such as "voluptuous" and "sensuality" began to obsess her. In an effort to repress these thoughts, which became more intense at night, a marked insomnia arose. Thus sleep began to be disturbed by nightmares and dreams of a sexual character, and a repulsion for her bed could be shown to possess a distinct sexual significance.

In her somnambulistic state the English words which she dictated, such as "own thinking," "talking," "eating," "feeling," could be shown to possess a sexual significance. For instance, "thinking" signified a lack of chastity, and therefore she must not think; "eating" meant a flattering of taste, and therefore she must not eat, etc. The meaning of these and other English words were twisted and transformed into a sexual significance with a dialectic worthy of a medieval philosopher. For example, she explained her refusal to eat on the basis that this would mean a gain in flesh, and thus her form would become outlined, and this meant sensuality. Physical contact likewise meant sensuality, and so she refused to dance or to kiss the members of her family.

Certain specific memories were also brought out through this free association procedure by utilizing the fragmentary phrases dictated in the somnambulistic state. A typical example is the following: The word "non-kissing" revealed the following childhood complexes. When very young, the question of marriage had for her an extraordinary attraction. She had endless reveries concerning sexual matters, the question of birth, the religious signification of marriage, etc. At the time of her communion there developed a mental conflict concerning the question as to whether she should marry or lead a chaste, religious life and, as a result, there developed depression and anxiety. At eighteen the scruples became more intense, as a consequence she attempted to shut out the external world by keeping the eyes closed and passing her time

in revery and sleep, because she hated to keep in touch with reality. Thus her somnambulism developed as a reaction of defense, for in the somnambulistic state, with its amnesia, she found a refuge from the rapidly developing psychasthenic doubts, scruples, and obsessions. Consciousness became narrowed to the performance of only the subject's actions, and thus she would pass hours without moving or days without eating. A kind of a double personality therefore arose; on the one side life with its painful realities, on the other, reveries and somnambulism with its freedom from doubts and responsibilities. She was then able at will to shut out the realities. of life, and the shut-in personality which developed finally became automatic. This mental attitude was well expressed by the patient in the words, "If you only knew what compensation I find in my disease."

Thus the vomiting and anorexia, had purely a psychic origin. She retained food only if she were fed while in the somnambulistic state, because in this state she was free from the peculiar somatic sensations which she associated with eating. In addition, it could be shown that problems concerning sexuality always constituted the source of her phobias. For example her aversion for pointed objects had a phallic significance. A violent hemicrania, on analysis, was also shown to be a defense reaction, because when she had the pain, she could not at the time think of the responsibilities of life. The phenomena of conversion in the sense of Freud and of Uebertragung were quite marked. The dreams were also sexual symbols, such as wishes for marriage, embarrassment, dreams of nakedness, etc. Recovery finally took place, principally through a utilization of free expression of her repressed thoughts and mental conflicts, the key to which was furnished by her dreams and by the automatic writing done in the somnambulistic state.

The author's discussion of the condition and his attitude towards the Freudian psychology is interesting, if not convincing. Here is the case of an intelligent young woman who developed a psychoneurotic disturbance with severe anorexia, due, as already shown, to unconscious mechanisms, pre-eminently of a sexual nature. A difficulty of judgment arose, caused by her childhood errors concerning sexual matters and thus she became incapable of struggling with the realities of life. Therefore she attempted to shut out these realities by living in a wish world of unreality, of dreams, reveries and somnambulism, which formed a real haven of refuge for the struggles of her psychoneurotic symptoms, mechanism which is found in so many hysterics. Thus hysteria so frequently shows an infantile mental reaction, because the symptoms are defense responses to the difficulties and realities of adult

a

life. The repression of the childhood sexual fantasies proved disastrous and upset the mental equilibrium.

Sexuality, however, according to the author, is not always the determining agent and psychoanalysis is frequently only a means of diagnosis and examination. The sexual conflicts in childhood may not be the cause of the hysteria, but merely serve to form an hysterical character. In this case, as in many others, there was not a simple psychic trauma, but rather a continual emotional situation, made up of a defective attitude towards life. By means of this insufficiency of childhood mentality, the individual becomes unable to completely adapt himself to these realities of life. While certain unconscious complexes may furnish the key to individual symptoms, they do not explain the entire psychoneurosis. Psychoanalysis removes symptoms, only when at the same time we explain the symptoms to the patient and reassure him. This result is partly forced and partly due to the added suggestive therapy involved in the treatment. Psychoanalysis is not indispensable for the treatment of the psychoneuroses. The study of the mentality of the subject, of his antecedents, of determing causes rather than the unravelling of unconscious complexes, is more simple and valuable.

The author objects to symbolic interpretations, and yet in his discussion of the dreams, the reveries and the fragmentary words written in the somnambulistic state, he is continually interpreting them in a sense that seems to signify symbolisms. Psychoanalysis for him is not a therapeutic procedure, but merely a means of tapping unconscious complexes, of utility for the solution of certain psychopathological difficulties. He disclaims his faith in the therapeutic value of psychoanalysis, yet has used it in conjunction with other procedures in the treatment and study of his case. I. H. CORIAT.

LES DYSPSYCHIES.

1912, No. 3, p. 222.

Maurice Dide.

L'ENCEPHALE, Vol. vii,

The designation dyspsychia is suggested for all mental states presenting a disharmony of the intellectual faculties irrespective of etiology or pathogenesis.

As outlined by the author this term would be applicable to the following general states: (a) Disorders of judgment in which the subject is unable to assign to the various elements within the conscious field their relative place. Such undue stress upon certain of the psychic factors may lead to delirium of interpretation,

and may be the basis of many a so-called sensorial illusion. (b) Disturbances of voluntary attention (usually a diminution, while automatic attention may be either increased or decreased). (c) Anomalies in the associative course of ideas; these depend largely upon disordered voluntary attention.

Hallucinations, when present are purely episodic in character. Kynesthetic changes form the substratum for the objective manifestations of the various dyspsychias.

The dyspsychias are usually light and transitory. They present no mental confusion even in their severest form. In cases of chronic evolution exacerbations and remissions are the rule, but the intellect remains unimpaired. Disorders of memory, when present, are due to insufficient reproduction rather than to improper registration or conservation.

Dyspsychias may be remittent, intermittent, or mixed. The delirious interpretations, the impulsions, and obsessions, amnesia, melancholia and hysteria form the essential dyspsychias. Hysteria is essentially a failure of psychic synthesis: cerebral activity is dissociated so that certain of its elements appear beyond recall at a given moment, only to appear to surface at some other, when the main consciousness is obscured in turn.

J. S. VAN TESLAAR.

LES DELIRES HALLUCINATOIRES CHRONIQUES. René Masselon. L'ENCEPHALE, Vol. vii, 1912. No. 2, pp. 135-150; No. 3, 254-262.

The author finds that the new Kraepelinian theories concerning hallucinatory delirium are untenable in the light of clinical experience. He maintains that the analogies between the delirium of interpretation and the systematic hallucinatory delirium, the occurrence of intermediary states which link these two condition to paranoid dementia, furthermore, the fact that these various psychopathic states develop upon a common background justifies the grouping together of all these different states into one great class, paranoia. The various constitutional psychoses thus brought together are to be distinguished from the acquired psychoses of which dementia praecox is the most significant type.

While certain close analogies bring together all the psychoses. which develop upon a paranoiac temperament a certain number of equally important particularities divide each from the rest and give it a place of its own within the group of paranoiac disorders. The following varieties are distinguished: