Table of Contents
THE present researches form a series of cases the investigation of which is undertaken with the object of studying the problems presented by the phenomena of functional psychosis. Out of a mass of material we have selected a few cases typical of many others, each case standing for a type. As much as possible we have tried to avoid theories and principles and give simply a resume of the facts and experiments. The more general aspects of these cases and the conclusions flowing from similar observations and experiments are relegated to another work soon to appear under the title of Principles of Psychology and Psychopathology. The cases are more in the nature of laboratory researches, each case standing on its own individual merits; they are all, however, intimately interconnected, representing various phases and stages of the processes of mental dissociation.
The methods of work of this series, as well as of the series to come, have all of them been developed in the psychopathological laboratory,―the researches being carried on in the laboratory or at other places under its direction.
The first study of the series presents an investigation of the main phenomena observed in dissociative states of functional psychosis. An account is given of some of the methods of bringing about a synthesis of subconscious dissociated systems. The study specially relates to psychomotor reactions of subconscious systems. Different methods are worked out to obtain subconscious reactions to stimulations. The extent and intelligence of the dissociated subconscious systems are tapped in various ways. The results clearly reveal the nature of the phenomena of functional psychosis. Psychologically, functional psychosis is coextensive with the whole domain of the subconscious. Physiologically, functional psychosis is correlated not with organic neuron degeneration, but with functional disaggregation of whole systems of neuron-aggregates. In functional psychosis, the function apparently lost and destroyed is found to be present in the subconscious,―the loss of function is purely dissociative. The activity is preserved and the system is really unaffected,―it is only dissociated from other functioning systems.
If the psychomotor manifestations of the pathological process of neuron disaggregation and neuron degeneration be formed into a series, then the first stages of this process constitute the phenomena of functional psychosis concomitant with the pathological conditions in which only the associations, the interrelations of neuron systems are affected by dissociation,―the neurons, the dissociated aggregates themselves remain unaffected. The whole domain of the subconscious belongs to these stages of disaggregation in the course of the pathological process, such as the phenomena of hypnosis, of somnambulism, of motor and sensory automatisms, of the so-called" hysterical" sensori-motor disturbances of various organs, the functions of which are found on examination in the regions of the subconscious over which the personal consciousness has lost control by reason of neuron disaggregation or dissociation. Here belong the phenomena of double and multiple consciousness, the various forms of amnesias, the lost content of which can be revealed in the strata of subconscious life. The domain of functional psychosis also includes the phenomena of the different forms of socalled "psychic epilepsy." Here also belongs the great class of psychomotor manifestations known as "degeneracies," such as the phobias, impulsions, obsessions, fixed ideas, and a still greater class of psychic derangements,―a class that opens to the psychopathologist almost an infinite vista for investigation, namely, the functional insanites, forms of functional psychosis which simulate and apparently closely reproduce different types of insanity.
With the further progress of the pathological process the neuron itself becomes affected. In the early stages of the process of neuron degeneration, the function of the neuron is interfered with, although restitution is still possible. These stages include the vast domain of functional neuropathic disturbances, such as paralysis agitans, choreas, idiopathic epilepsy, and the neuropathic insanities, such as the various neuropathic forms of manias and melancholias, of periodical and circular insanities, of dementia pręcox, of paranoias, and so on.
Finally, in the last stages of the process of degeneration, the neuron is destroyed and restitution is no longer possible. Tabes, general paresis, syringomyelia, the chronic insanities, amyotrophic lateral sclerosis, acute ascending paralysis, multiple sclerosis, secondary dementia―that sad terminus of the chronic insanities,―and many other nervous and mental affections in which the body cell of the neuron-cytoplasm and nucleus―has become destroyed, all belong to the last stages of the pathological process of neuron degeneration, stages which for lack of a better name may be termed necrotic neuropathies. The whole pathological process, with its stages and concomitant psychomotor manifestations, may thus be conveniently subdivided into three great classes, one passing into the other by imperceptible degrees: functional psychosis, functional neuropathy, and necrotic neuropathy.
At the same time, as already pointed out in a former study, the important fact must be kept clearly in view that various groups and systems of neurons may reach different degrees of disaggregation and degeneration, may be simultaneously in different stages of the one continuous descending pathological process. Communities, clusters, or constellations of neuron-aggregates may be in the upper levels of the psychopathic state, in the first stages of functional psychosis; others in the deeper levels or further stages of the same state; others may be in various stages of the functional neuropathic state; while still others may have reached the last stages of the necrotic neuropathic conditions. The fact that various systems of neurons are often in different stages of disaggregation or degeneration frequently gives rise to a mixed and complex symptomatology, the malady presenting psychomotor manifestations belonging to different stages of the descending pathological process. The psychomotor manifestations may thus vary endlessly, like colors in the kaleidoscope. From this standpoint it may be said that the symptomatic side of the disease, the total psychomotor aspect of the pathological process, is a function of location, number, and degree of dissociation or degeneration. The total complex of psychomotor manifestations depends on the location and number of neuron-aggregates involved, and on the stage or degree of the pathological process of disaggregation, dissociation, or degeneration. In other words the psychomotor manifestations depend on three main factors; location, member of neuron aggregates, or quantity of functioning neuron energy, depth of level descended, or intensity of the process of neuron energy liberation; and also on a fourth factor, which may be regarded as secondary, namely, dissociation, whether this dissociation takes place among the neuron systems in the early stages, or in the parenchyma of the neuron in the later stages of the process of degeneration.
Now once the neuropathic stages are reached, whether they be the early or the last ones, whether they be the functional neuropathies. or the necrotic neuropathies, the functions of the affected neuron-aggregates are gone and lost, temporarily or permanently, according to the stages of the process. In any of the neuropathic stages of the pathological process the disturbed, arrested, or lost functions are not present in the subconscious. The neuropathies, functional and necrotic, are essentially organic in character. Unlike functional psychosis, the neuropathies have no subconscious "equivalents." The functions of the neuron-aggregates that have entered. the neuropathic stages of the pathological process of neuron degeneration are also lost subconsciously. Hence in the neuropathies, even in the early functional stages, no synthesis is possible, because no corresponding subconscious states are present. The neuropathies have no subconsciousness.
The phenomena of functional psychosis form the borderland between the neuropathies of limited neuron-aggregate degenerations on the one hand and neuropathic insanities on the other. Functional psychosis is the common ground of neurology and psychiatry. The joint efforts of the neurologist and the psychiatrist, directed towards a thorough investigation of these phenomena, will, no doubt, shed additional light both on psychiatry and neurology, and will help to open up an important domain of psychomotor manifestations apparently of obscure origin, but which the weight of facts and the whole trend of psychopathological research seem clearly to refer to definite conditions of dissociated mental systems with concomitant disaggregation of neuron-aggregates.
The psychiatrist who deals with highly complex phenomena of neuron degeneration, such as the different forms of mental alienation, will, from a study of functional psychosis, get a deeper insight into neuropathic psychosis. From a practical therapeutic standpoint, a thorough knowledge of functional psychosis means also the possibility of restitution, of cure. Both from a theoretical and practical point of view, the psychiatrist should lay special stress on the study and investigation of functional psychosis in general and of functional insanity in particular. Functional psychosis, functional insanities, should become a special research field of the psychopathologist. Functional psychosis is specially characterized by psychophysiological disaggregation where synthesis is still possible. The only way of restoring the disturbed equilibrium is to bring about a synthesis of the disaggregated groups with the functioning systems of the upper active personality. Such a synthesis is here brought about by the method of intermediary states. This method was utilized with great success in other cases presenting phenomena of functional psychosis. The subconscious psychomotor reactions and the process of synthesis of disaggregated systems are certainly not unimportant subjects in the domain of psychopathology.
The second study, that of alcoholic amnesia, deals with the bringing out of subconscious memories. Mental experiences of a moment-consciousness, however low and degenerate, are not lost, but present in the subconscious in a diffused dissociated form and can be brought out in hypnoidal states induced by the method of hypnoidization. The patient is practically in his waking state and the subconscious memories surge up in fragments. The study at the same time tends to show that amnesia in general, and alcoholic amnesia in particular, does not necessarily imply a state of unconsciousness.
The study coming next in order traces the growth and development of a persistent dissociated subconscious system and the disturbances brought about by its periodic eruptions into the upper strata of mental life. The case with its psychic manifestations would have ordinarily been classified under the term of "psychic epilepsy." This term, though ambiguous, may be accepted, if understood not in the sense of epileptic origin or, as it is put, " psychic equivalent" of epilepsy, but as epileptoid disturbances of a purely mental character due to dissociative states of functional neuropsychosis; in the same way as, for instance, psychic anęsthesias of functional diseases are not equivalents of organic neuron degenerations. Functional psychosis often simulates, mimics closely forms of diseases of purely organic nature. It may be said that in the pathological world one meets with manifestations somewhat akin to the phenomena of mimicry observed in the biological world, such, for instance, as the mimicry of colored markings found among the different species of Lepidoptera which, according to Darwin, belong not only to distinct genera, but also to distinct families. The phenomena of "psychic" epilepsy are of the nature of post-hypnotic automatisms. This point of view is corroborated by extensive researches in other cases which will appear shortly in the series. From a theoretical standpoint it may be said that all these phenomena under investigation are the manifestations of reproduction of dissociated moments-consciousness of the desultory type. The various types of moments-consciousness and their different forms of reproduction are not discussed here; they are worked out in detail in the Principles.
The fourth study consists of two parts: the first1 reviews and discusses phenomena of mental dissociation in an interesting case of depressive delusional states; the second gives experimental data. The main interest centres round the formation of a highly organized and remarkably stable delusional system with its characteristic power of assimilation. The manifestations of affective personalities and the process of their elimination, fusion, and synthesis as well as their relation to the dominant delusional system, the persistence of the dissociated groups and their insistent recurrence make the study of some value to the psychologist and psychopathologist. Finally, the course of dissolution of the dominant system and the elimination and fusion of the affective personalities make the research interesting not only from a theoretical, but also from a practical standpoint.
The fifth study is on mental dissociation observed in a case presenting limited psychomotor disturbances. The dissociated subconscious systems may possess as content some moments of the life activity of the organism as a whole; in that case the state of dissociation may give rise to the phenomena of so-called "psychic" epilepsy of the sensory or of the motor type. The content, however, may be limited and refer only to the activity or function of some particular organ. In such a case the result is that the central functionally affected neuron system gives rise to more or less profound disturbances in the psychomotor activity of the special organ. Specific peripheral sensori-motor derangements―anęsthesia, paręsthesia, hyperęsthesia, hypoęsthesia, paralysis, contractures, convulsions―may arise, all having the distinct features of functional psychosis. These traits of functional psychosis, traced under many different conditions and followed through various phases, are certainly of great value to the science of abnormal psychology.
The last study,2 that of dissociated states in psychomotor epilepsy, deals with the growth and development of a whole system presenting psychomotor disturbances apparently of an epileptic character. The pyschomotor manifestations or attacks are traced to dissociated mental states. The attacks, however, on examination, are found to be not of an epileptic nature, but of the character of functional psychosis. As in the third study, the phenomena prove to belong to the type of "psychic" epilepsy in the sense of epileptoid manifestations of functional psychosis. The peculiarity of the case under investigation is that the psychomotor manifestations approach closely to the typical psychomotor derangements of organic epilepsy. The touchy spot of the subconscious system, the aura, serving as the trigger of the detached system characteristic of the reproduced moment, the impulsive form and vigor of onset of the psychomotor manifestations, all present to the student of psychology and psychopathology many points of interest. Finally, the method of bringing the buried subconscious memories to the foreground of consciousness, the progress of synthesis of the detached systems and groups and the greater stability of that synthesis by means of the method of hypnoidization, forming an organic union of the disaggregated systems, and from a practical standpoint resulting in the disappearance of the attacks, are all points of scientific value to the psychologist and psychopathologist. These points are all the more valuable as they are fully corroborated by other investigations and cases worked on parallel lines and on similar principles.
Throughout the researches the processes both of disintegration and synthesis are followed out. Great stress is laid on re-association, or synthesis of dissociated systems and groups in the active personal consciousness. The processes and modes of synthesis should be closely observed and experimented upon, because they often reveal the character of the constituent elements of the psychic phenomena under investigation, and give an insight into the nature of the synthetized psychic compound. The psychologist and the psychopathologist, like the physicist and the chemist, are interested not only in the processes of decomposition and analysis, but also in those of recomposition and synthesis. Synthesis verifies analysis. Moreover, if the psychologist and the psychopathologist are interested in the processes of synthesis of disintegrated systems from a purely theoretical standpoint, the physician and the psychiatrist find in the modes and processes of synthesis a very important practical aspect. For from a therapeutic standpoint synthesis is cure.
We sincerely hope that the psychologist, psychopathologist, psychiatrist, and the medical man of science who may happen to be interested in this line of research will realize the obstacles and difficulties encountered in the investigations of psychopathic cases, and thus come to realize the necessary shortcomings pertinent to the very nature of psychopathological research work.
It seems to us fit to open this series with a brief discussion concerning the difficulties, methods, and nature of psychopathological research, since a knowledge of them is of vital importance to the student of psychopathology in general and to that of psychiatry in particular, and also because in many quarters they have given rise to mistaken notions about the phenomena of mental life and to fallacious views regarding' the nature of the methods employed in psychopathological investigations.
We wish to take this opportunity to make our acknowledgments to the former Pathological Institute of the New York State Hospitals founded by the first President of the New York State Commission in Lunacy, Dr. Carlos F. MacDonald, where, under the liberal conditions provided by the former Director, Dr. Ira van Gieson, this line of research was developed, and this series of experiments was conducted. The newly appointed head of the State Commission in Lunacy, in his destruction of the work of the Pathological Institute, has officially "abolished" this line of psychopathological research. We wish here to express our gratitude to the Trustees of the New York Infirmary for Women and Children, and especially to Dr. Alexander Lambert, for their establishing a Psychopathic Hospital and Laboratory where this line of research is continued, and under whose auspices this series is published.
NEW YORK, 1902
_____________1. Read in extract before the New York Neurological Society, May, 1902.
2. Read before the American Neurological Association, June, 1902.