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Mental Dissociation in Alcoholic Amnesia

WILLIAM A. WHITE

CHAPTER I

AMNESIA AND HYPNOIDAL STATES

       THE whole subject of amnesia, whether of alcoholic or other origin, is so little understood and of so much importance that I believe any contribution to its psychopathology, however slight, will be welcomed. I have, therefore, decided to present the following case, though fully realizing that it can only be considered as suggestive in its implications.

        Mr. X., a middle-aged gentleman, not addicted to the use of alcoholics, but only occasionally indulging in a social glass, inadvertently drank too much, and as a consequence suffered from amnesia for a period of three hours, during which he was intoxicated. The following is his account of all he could remember of the events leading up to and including the period of intoxication, upon the occasion of his relating them to me.

        In September, 1898, at about 11 A.M., he met a gentleman in the City; he was introduced, talked, and began drinking Manhattan cocktails. About noon he suggested having lunch and they went together to a dining-room, but before eating drank another cocktail. Mr. X. by this time was feeling rather "shaky." After lunch, which consisted of corned beef, cabbage, and apple-pie, they had cigars, and the gentleman proposed they go to his office, where they had more cigars, and then started for a drive. Mr. X. telephoned for a team to meet them at the Hotel B. They went there and found the team, got in, returned to the restaurant, and had another cocktail. From there they drove over a bridge―not sure of the name of the street they drove on, it was the other side of the railroad tracks,―made two or three stops for drinks and came to a place where there were a number of cars―he thinks it must have been the town of U. As it was getting late by this time they turned about and drove back towards home on R. street very fast, and reached F. street about 6.30 P.M. Here Mr. X's friend got out and Mr. X. drove down F. street to C. street, and turned in the direction of the bridge, after which he recalls no more until he heard a pounding like some one pounding on a door and some one said: "Are you sick? It is time to close up." He awoke in one of the closets of the A. hotel. He adjusted his clothing and got out. He thought it must be about closing time, viz., midnight; but when he reached the street it was only 9.30 P.M. He hurriedly went home, took a dose of compound licorice powder, and went to bed. When he awoke, his first thought was: "Where are the horses?" He could recall nothing about them and was apprehensive that an accident had occurred, although he felt all right. He examined his clothing and found no evidences of an accident in their appearance. He went to S's livery-stable and asked how the team got home, and they told him that he (Mr. X.) drove it home. The man smiled and said he seemed to be asleep when he returned; that he jumped from the box when he arrived, said nothing to anyone, and walked off. His idea is that when he got off the box at the stable he must have gone to the hotel to the closet, but the A. hotel was not on his way home from the stable, and the C. hotel was right next to the stable.

        The entire period from 6.30 P.M. to about 9.30 P.M., or the time he was awakened in the hotel, about three hours, is effaced from his memory. I felt convinced, however, that it would be possible to obtain a complete recollection for this period, as it was quite impossible for him to have been unconscious during it.

        The various things which he must have done-walking about the streets, going to the hotel-must have been intelligent acts, or otherwise they would have attracted attention and excited comment. The acts must also have been of a too complicated nature to be designated as automatic. In other words, instead of being in a condition of unconsciousness he must have been in a condition of other consciousness for which in his ordinary waking state he was amnesic.

        With reference to this matter of confusing amnesia with unconsciousness, let me quote from Van Gieson and Sidis, who say very justly: "From the fact of amnesia, unconsciousness is inferred, because the two are thought to be identical.

        "From the mere fact of amnesia or of total ‘oblivion,' we have no right to infer even a diminished or semi-conscious state. A very high and intense state of consciousness may become dissociated from the rest of conscious life, and be incapable of reproduction in the synthesis of memory. The phenomena of double or multiple personality and of post­hypnotic states may serve as good examples. From a psychological standpoint, memory, objectively considered, is a present mental reproduction and recognition of one's past conscious experience, and the loss of the first two conditions, of reproduction and recognition, does not in the least imply the non-existence of that conscious experience. In short, amnesia is not identical with unconsciousness."¹

        If Mr. X. was not unconscious during this period of three hours, he must then retain the memories of what he did in his subconsciousness, and I decided to employ a modification of the method of hypnoidization for determining this.

        This method, as described by Dr. Sidis,² to whom we are indebted for it, is as follows:

        "The patient is asked to close his eyes and keep as quiet as possible, without, however, making any special effort to put himself in such a state. He is then asked to attend to some stimulus, such as reading or singing. When the reading is over, the patient, with his eyes still shut, is asked to repeat it, and tell what came into his mind during the reading, during the repetition, or after it. Sometimes, as when the song stimulus is used, the patient is simply asked to tell the nature of ideas and images that entered into his mind at that time or soon after." By this method we are enabled to distract, draw off, completely occupy, in fact remove, as it were, the personal consciousness of the patient, and thus allow the subconsciousness to act unhampered by the inhibitions of the upper self. The personal or upper consciousness of the patient being fully occupied, by close attention to the stimuli used, fails for the nonce to exercise its inhibitory control over the subconsciousness, which in its turn, finding itself thus relieved from censorship, acts spontaneously.³

        I had Mr. X. sit in a room only dimly lighted and very quiet, in a semi-reclining position, and then, assuring him that the memories would return (influence of suggestion), asked him to fix his attention on the events just related, more particularly at that point where memory ceased, and see if he could not recall additional facts. This modification of the method of hypnoidization was first used by Dr. Sidis and myself in the M. case. I asked him to think of the events related, so as to exclude extraneous thoughts as far as possible and to assist any latent tendency that might be present to recall events associated with the forgotten occurrences. I obtained the following results:

        He sees the stable more plainly than before and imagines going in and throwing the lines aside and jumping off the box; he then comes out and walks along to C. street, and then to the A. hotel and goes to the closet.

        Effort continued: Laughs because he sees himself catch a tree for support; runs for the tree, for he felt as if he was going to fall; the tree was in front of Mr. M.'s; from the tree he ran to the hotel.

        Effort continued: Smiling; does not recall going from the hotel to the closet, but recalls being very anxious to go there; after there, he was very sick and vomited, and went to sleep sitting there and did not awake until some one knocked on the partition between the closets, because he had locked the door to the closet and it could not be opened.

        At this point he told me what he had previously forgotten, viz., that S. (the liveryman) told him that some one telephoned him that the man who had his cobs out was driving down C. street asleep on the box.

        Effort continued and directed by me: I tried to get him to recall the events immediately after his friend got out of the carriage and he turned down C. street, but he failed. I now tried to get him to recall the events' when he arrived at the stable. He seems to be asleep on the box; while going along he pulls the horses up suddenly to let a wagon from a side street go by, and then goes on along a street that is all torn up and goes to the stable and jumps off the box.

        This experience was not as well recognized as the former ones recalled, but when questioned about the recognition element felt sure that it was himself, but his answers evidenced some hesitancy. However, as we conversed about it he said it was all plain to him now as he could see himself in blue clothes, with his hat pulled over his eyes, driving along holding the reins carelessly.

        Effort continued: Does not recall any of the persons or faces he came in contact with during this period; he now tries to.

        Some one was in the stable when he arrived, but he did not notice who it was. He knows that when he left the stable he felt glad that it was dusk; the lights were being lit and the streets were pretty well deserted―probably between 6:30 and 7 P.M. He says he went right along without looking to the right or left, and therefore can recall no faces, as he was in a hurry to get to the hotel.

        Sees stable of S. lighted up; never in there before when it was illuminated; some one came to take his horses, but he does not know who; no one spoke to him.

        I asked him to try and recall why, when he left S's, he went to the A. hotel rather than the C. hotel which was much nearer. He says because when he left the stable he wanted to defecate, and chose the A. hotel because he was more familiar with the toilet there than at the C. house.

        When he staggered about the tree, he was seized with the first inclination to vomit, and then was anxious to get to the hotel for a double reason. He vomited in the cuspidor while sitting in the toilet.

        My associate, Dr. Gillespie, who was present during my examination, says that he told him about having vomited before when relating the circumstances connected with his intoxication to him.

        Says as he sat in the toilet he moaned constantly, and that is probably what led the man to knock on the partition.

        Told me he stopped at F's café after he got in the carriage, but Dr. Gillespie said Mr. X. told him once before he had F. bring out two cocktails. This he now recalls, but did not when he first recounted it to me.

        Again very undecided whether his recollection of driving through C. street asleep on the box is a true memory of what he himself passed through or not. Recognition element somewhat in abeyance―much confused. After his friend left the carriage he turned into C. street, and then a blank (asleep ?); when the team interrupted him he awoke, then a blank (asleep?) until he entered the stable.

        I told him that if he had been asleep on these two occasions he would recall the sensation of being awakened; this he did for the first blank. The team that drove in front of him caused his horses to stop; he did not stop them, but opened his eyes and looked around. He cannot, however, recall the sensation of awakening from the second blank.

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