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CHAPTER II

ORIGIN AND GROWTH OF DISSOCIATION

       I PROPOSE to present in this chapter, arranged chronologically, a connected story of the origin and development of the many phenomena which the patient presented; in other words the story of her case without reference to experimentation and with only a sufficient amount of comment to make it a clear connected whole and to show the relations and dependencies between its different parts.

        At the tender age of one and one half years J. lost her father. He had been ailing for some little time and died finally from a complication of diseases in which the heart and kidneys figured prominently. Her mother, who was very much devoted to her husband, never fully recovered from the shock of his death, and one year afterward, as a result of continual grieving and the increased work made necessary by added responsibilities, she became insane. She was taken to a State Hospital but only survived for two weeks.

        J. has two sisters, J-n-y and M., and one brother, H., who are respectively eleven, sixteen, and nineteen years older than she.

        At a very early age then we see that J. was derived of that most important of elements in the proper development of the child mind: the solicitous care and love of parents. Her sisters and brother were too old to sympathize with her in her childish ideas and so to be her companions, and not old enough to take the place of parents, so that of necessity there was much lack of sympathy between her and them.

        Starting in life with a probable hereditary taint, cared for by a brother and sisters suffering in all probability from the same taint and with whom she had little in common, she was certainly seriously handicapped in the race of life. Notwithstanding all this, however, for the first few years of her life she was apparently a normal girl, going daily to school, playing with the other children, interested in what they were interested in, happy, jovial, light-hearted, and withal much like other children of her age.

        At the age of ten years the first important event of her life occurred. She menstruated. From now on her character underwent a radical change. From being an active, happy-go-lucky child she became quiet and sedate. She was no longer interested in the play of other children, but preferred to remain at home and sew or read. Her manner became so much changed in this respect that it was a matter of comment among her associates and they often remarked on it. Unfortunately, too, at this period of her life phenomena developed which tended still further to give a morbid character to her acts and thoughts, namely, auto-erotism.¹ During this period; however; she continued in school, was bright and got on well with her studies and was comparatively happy. When she was eleven and one half years old, the first event occurred to which definitely can be traced the origin of symptoms which ultimately led to her commitment as insane. It was three and a half years ago, on New Year's eve. After she had finished her evening meal she went, as often she had done before, to call upon her next-door neighbor, a woman with whom she was quite intimate. While sitting chatting in the darkness―the lamps had not yet been lighted―this woman told her a story: it was a story of blood and death. She told her of a young man who became discouraged with life and resolved to commit suicide; of how he went to his room one evening, and, after writing a note telling of his discouragement, had cut his throat. Death not coming as fast as he had wished, he jumped from his window and ran toward the river, into which he plunged and was drowned. She told her all this and how on the following morning he was traced by the splashes of blood which he left behind in his path as the vital fluid trickled from the wound in his throat.

         Imagine for a moment the effect of such a story upon a morbid, emotional, and highly sensitive girl of eleven years of age, told in the darkness of the night in all its horrible details. Is it strange that such a gruesome yarn left its impression so deeply seared into her brain that years failed to eradicate it? Yet nature is so careful of her own that it is doubtful if this would have had any effect whatever, if it had not been for the events which immediately followed. That the story made a deep and morbid impression on her is shown, however, by the fact that during its relating she thought of the possible effects of such an action on her part.

         After finishing her visit with the neighbor she went home. It was now about nine o'clock. She went to the sitting-room and began playing on the piano, a favorite pastime of hers. While she was playing, however, the same idea recurred,―what would her folk think if she killed herself? Would her brother care if she did? 'While sitting here playing she noticed that the train returned to the station after leaving it and the bell kept ringing. (The railroad station was only a short distance from her home and the sound of the train was readily discernible.) She asked her brother H., who was sitting in the room reading, the reason for this. He was deeply engrossed in his book and at first did not answer her, but to her repeated questions finally answered crossly and told her to stop playing the piano. He had never done this before and it made J. feel very badly and shortly after when she started for bed neither he nor she said good-night.

         After getting into bed she cried about her brother's crossness to her and thought still of what effect her suicide would have on her folk. She finally fell asleep and dreamt of the suicide and also that if she should kill herself her brother would not care. This made her feel very badly.

         She was dreaming thus when she was suddenly awakened by the front door slamming and the sound of her brother's footsteps. The first idea that flashed to her mind was that her brother did not like her. She then heard her brother say to a man who kept his horse in their barn, "Is she dead?" and then, "Which way did Uncle H's folk go?" The first question immediately brought back the recollection of the suicide and the second the thought of going to the river. Then her brother locked the door and went off leaving J. in the house alone. She was much frightened and in her agitation, not knowing what had happened, she walked the floor crying. She feared that her sister J. had been killed. In this state of fear and apprehension she wished she was dead.

         It was in this state of mind, while walking the floor crying, fearful that her sister had been killed and with the remembrance of her brother's harshness still fresh in her mind, that the desire to kill herself suggested by the story of the boy's suicide came first to her mind. She had previously only thought of suicide in a general way and of the effect her death would have on her folk: she now for the first time felt an actual desire to end her life. Feeling, in her childlike way, that her brother's actions could only have been prompted by hate, and convinced that her sister was dead, she saw nothing to look forward to in life, nothing to live for.

         In about a half-hour her brother returned, but he did not as yet know anything definite about the accident and went out, leaving J. alone again a prey to the tyranny of her own thoughts.

         When he returned the second time he had learned that while J's cousin L. had been out driving she had been struck by the train and run over. He made fun of J. for "taking on" so and told her that her sister J-n-y was at Uncle H's. Her sister returned at 2.30 o'clock. J. was much worried, however, until she returned, despite her brother's assurances.

         These are the events which served to make permanent the damage done by the old woman's story and the effects of which I propose to trace through the following three and one half years of J's life.

         During the next fourteen months nothing of consequence occurred. The events just recorded, however, had done their work well. The idea of suicide had been grafted into J's mind, there to grow, to elaborate itself, and to wax strong, its origin lost in the depths of the subconscious, for J. no longer thought of the story of the old woman. That had long since passed from her mind.

         Here is the first definite symptom of mental dissociation in the case. The story of the suicide and the events that followed had been sufficient to produce the idea of suicide in J's mind, and then sinking from view into the depths of the subconscious they became lost as dissociated states. Separated from the stream of the upper consciousness they are lost to view by the patient, and their causal connection with her disturbed mental state is not in the least suspected.

         Lost to view, apparently forever, we still find ample evidence of their existence in their effects on J's everyday life. The slightest difficulty that arose was sufficient to bring the thought of suicide to her mind, and if her sister J-n-y opposed her in anything we often hear her replying in some such way as this: "Well, maybe you'll be sorry. I shall kill myself. Which would you rather do, have me kill myself or let me do that?"

         That the suicide idea was still comparatively weak, however, had not as yet gathered unto itself sufficient strength to make its demands imperative, as subsequently happened, is shown by the fact that throughout this period of fourteen months J. never once attempted to kil1 herself, although she often thought of how she would do it, and when would be the best time.

         At the end of this period, in the month of March, J. had a difficulty with her brother H. She upbraided him for the way in which he managed her parents' estate, in which she had an interest as heir, under the law. He told her that if she did not like his way of doing she could get out. This made her very angry, and she went to her grandmother's and stayed for several days.

         One night while at her grandmother's, and after she had gone to bed. she kept thinking about the trouble she had had with her brother, and about: what as she supposed was his mismanagement of the estate. Then the events of the railroad accident came to her mind and with them the reasons she had at that time for thinking that her brother hated her. With these recollections was associated the old idea of suicide. While she was turning all these things over in her mind the idea suddenly flashed upon her that she would kill her brother. She thought of how she would do this, and concluded that she would use his revolver, as she knew where it was kept, and that it was loaded. She felt confident that she could accomplish her purpose by going to his room at night, as he was a very sound sleeper.

        This is the first occasion on which the idea of homicide ever occurred to her; an idea, the origin of which, like that of the suicide idea, became immediately dissociated, passing into the depths of the subconscious.

         Although the events surrounding the origin of this idea were not nearly so startling as those surrounding the origin of the suicide idea, yet it must be remembered that the habit of dissociation had already been formed. The soil was in a favorable condition for the growth of additional dissociated ideas.

         Further than this we see that a somewhat different principle is involved in the origin of the homicide idea from that which governed the origin of the suicide idea. The latter was directly suggested by the old woman's story and the events which followed, while the former came about rather as a contrast idea. The genesis of the homicide idea was purely subjective, and not, as in the case of the suicide idea, due to objective agencies in the patient's environment. The homicide idea followed the suicide idea on the well known principle of association of ideas by contrast.

         During the following year no particular event of importance occurred. The suicide and homicide ideas held the field and gained considerably in strength. In fact, they forced themselves on her attention at all times and in all places, and finally came to occupy her mind almost continuously.

         The suicide idea frequently gave origin to such expressions as it had formerly, but the homicide idea she kept carefully to herself.

         That the suicide idea in particular gained in strength and became more imperative to its demands for recognition is evidenced by the fact that once during this period she made an abortive attempt at self-destruction. She started for the river fully intending to jump in and drown herself, but changed her mind, however, only after she reached the river's bank.

         During this period certain other symptoms developed which are of great significance. She became very forgetful; so much so in fact that the commonest acts of her life were much interfered with. If her sister J-n-y would send her for something in an adjoining room she would often forget while on her way what it was, or even go to the wrong room, so quickly would her sister's instructions slip from her. This was such a constant feature of her condition that her sister used often to say, "Well! you'd forget your head if it wasn't tied on," and "Why J., you act as if you didn't know what you were about half the time."

         The tendency to dissociation was becoming more and more marked. Dissociation was actual1y taking place. The soil was being prepared for the growth of dissociated systems conditioned by the events which followed.

         Just one year after J's trouble with her brother she met and became attached to G., a young man who had just been employed at her uncle's mills. This was an event of some importance, largely, as we shall see later, because her attachment was bitterly opposed by the members of her family.

         About this time she began to have trouble with her eyes. She suffered considerable from severe headaches almost every evening, largely as a consequence of having to use them so much at school. She was accordingly sent to N. to consult an ophthalmologist, who prescribed a pair of glasses for her which helped her for a time.

         The next July she was sent by her folk to visit her Aunt B., who lived in the pleasant little village of G. on Long Island Sound. She was sent here ostensibly because of the condition of her health, in reality, however, to break off her relations with G.

         While here she suffered a great deal from headaches and consulted a physician who told her, as near as she can recollect, that she had astigmatism and inflammation of the eye muscles, but that back of it all there was some brain trouble.

         She stayed in G. until the holidays, at which time she returned to her home for a period of six weeks. During these six weeks we see the strongest evidence of the strength to which the suicidal idea had attained in four distinct attempts at self-destruction, each of which was much more desperate in character than the one already described.

         Once she took about a half-ounce from a bottle labelled "poison" and which afterwards proved to be laudanum. This made her very sick and she vomited. Again she drank from a bottle taken from the medicine closet but no effect seems to have been produced. Twice she started to take chloroform but on both occasions was interrupted and her attempt thereby frustrated.

         During all this time, however, her mind was almost constantly occupied by the idea of suicide, especially when she was left alone in the house, as frequently happened.

         During this period of six weeks the third important event in the history of J's case occurred. One evening unknown to her folk she attended a party with G. while there a young man, jealous of his intended, who persisted in dancing with some one else, shot himself in the head and fell dead. Although J. did not see the tragedy she heard the shot fired and was much shocked by it and afterward by seeing the dead man's body, bathed in its own blood, lying on the floor in the room where she had left her wraps.

         J. was greatly shocked (psychical traumatism) by the occurrence. On that particular evening she was so nervous that G. remarked the fact on his way home with her, and we shall have occasion from now on to note the serious effects which this unfortunate affair had upon her. It is certainly not to be wondered at that the effects were serious. It would be strange, indeed, if such a shock could be experienced by one in her condition without a deep impression being left.

         A few days afterward J. wandered into the barn of one of the neighbors, and unexpectedly came upon a farm hand in the act of killing a calf. She had often seen such sights before, and had never experienced any particular emotion at them, but on this occasion she was much disturbed. The sight of the blood frightened her and made her feel uncomfortable and strange. In fact she experienced much the same feelings as upon the occasion of the suicide. This experience was repeated shortly after on the occasion of her cleaning and dressing a couple of chickens.

         In these experiences we see the beginning effects of the shock she had received in the fear which it had engendered at the sight of blood. We shall shortly see, however, that these effects are to be more far-reaching and serious in character.

         About this time J.'s aunt B., with whom she had stopped at G., moved to N. and J. went with her. While there her aunt had the poor taste to tell her of the circumstances surrounding the death of her mother in an asylum.

         Shortly after her arrival at N., during the latter part of January, she suffered from a severe attack of nosebleed. During this attack everything appeared red to her. She expresses it by saying that it appeared to her just as !f she were looking through a red glass. This symptom disappeared when the nosebleed stopped, only to reappear with a subsequent attack. This sensation of red was disagreeable and accompanied more or less by a feeling of fear―erythrophobia. From this time on this sensation (as though she were looking through a red glass) appeared, especially when her head ached, and as she suffered from this source a great deal the sensation was naturally present a considerable portion of the time.

         In February following she was quite ill with a severe attack of la grippe which kept her confined to her bed for two weeks. During this period also the red sensation recurred from time to time.

         The first day out of bed after her illness, she was quite weak, and went and lay down on a sofa in an upstairs room. While lying there her mind reverted to the occasion of the suicide, and again the red sensation made its appearance. In connection with the events of the party, she also thought of how her folk had scolded her for attending it, and of her uncle's threat to place her in a convent if she did not behave better. These thoughts worried her greatly. She arose from the sofa, but immediately felt faint and dizzy and fell to the floor, striking her head on the occipital region (physical traumatism). Her fainting was probably caused, in part at least, by the pain of menstruating. (She not infrequently used to faint away during her menstrual period.)

         The fall was so severe as to render her unconscious and she lay on the floor until her aunt came upstairs and found her and put her to bed. When she came to she immediately began fighting her aunt and was apparently quite out of her head. During that afternoon she came to herself for two or three hours only, lapsing again into her previous condition and continuing thus for the following three and one half days.

         During all this time she acted strangely, often did not know where she was or recognize those about her. On the third day of the attack she was taken home, and on the afternoon of the fifth day suddenly came to herself, with absolutely no recollection of what had occurred. The last thing she remembered was lying on the sofa in her aunt's house at N. From then on everything was a complete blank, even her journey home having left no trace in her memory.

         This was the first attack of what we shall hereafter call her secondary state, a condition from which she rallies with absolutely no recollection of the events that occurred during its ascendancy.

         That the blow which produced this state of affairs was a severe one is shown by the fact that she was rendered unconscious by it, and further that when she came to her head was paining severely in the occipital region and the point where she struck was sore and tender to the touch for some time afterwards. The fall also caused an epistaxis which continued intermittently for four days―the most severe nose-bleed she had ever had.

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