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CHAPTER IV

THE SYNTHESIS OF THE DISSOCIATED STATES

       THE principle followed in this case was that of bringing together,―re-associating―what had become dissociated: synthesis of the dissociated subconscious patient was amnesic were thoroughly traced by use of hypnosis and hypnoidization, and were then united to her upper, personal consciousness, so that she is now in full possession of all of the facts. These facts, obtained from her in this way, were subsequently verified by numerous conversations with different members of her family.

        It is noteworthy in this connection, that all of her acts and sayings which had previously seemed to have no foundation in reason, but on the contrary had every appearance of being quite incoherent, could be traced in each instance to an adequate cause, and thus what appeared as chaos on the surface was reduced to order.

        The hypnotic state itself is an abnormal state, a state of dissociation, and so long as amnesia for this state was permitted to exist the patient could not be said to be well, as the very conditions were present which would favor further tendencies to dissociation, and although the individual symptoms for which she came under treatment had disappeared it was highly probable that they would reappear or that others would take their place. When dissociation has once begun, the dissociated state tends ever to gather unto itself new material and in growing to bring all its elements into systematic and ever more fixed relations with one another. This process, while enriching the subconsciousness, does so by robbing the upper consciousness, thus bringing the patient more and more fully under the control of the dissociated systems.

        In order to prevent the possibility of these untoward results the hypnotic states were dealt with in precisely the same manner as her secondary states and brought into relation with the upper consciousness.

        The results of this method were most gratifying. An immediate and marked improvement took place. The erythrophobia and the suicidal obsession, which did not yield to the influence of hypnotic suggestion, entirely disappeared and sank at once into the background. It is noteworthy also that the occipital pain, a pain of apparently purely psychic origin, also disappeared.

        It was hardly to be expected, however, that habits of thought which were of three and one half years' growth could be dissolved and made to disappear in an instant as if by magic, and as a matter of fact this did not take place, but from the time when the first re­association of subconscious states was effected to the present J. has been gradually though surely gravitating back to normal.

        The suicidal idea being the most firmly fixed and highly organized was correspondingly the most refractory and a slight tendency to its recurrence continued for some time, indicating that J. was not entirely well. It no longer occurred spontaneously as formerly, but only as the result of a definite cause: either some depressing event in her environment or as the result of fatigue. When it did recur, however, it was relatively less intense or if intense was of relatively short duration.

        At this point it will be interesting if we compare J.'s field of vision taken at this time (see Figure 19) with her field as it was when she came under observation (see Figure 17). The very great increase that has taken place is at once apparent. At the time this field was taken, all symptoms of cutaneous anæsthesia had also disappeared. This indicates a condition which I have found to be true in other cases, viz., that the extent of ancesthesia is often an index of the extent of mental dissociation.

        The improvement in J.'s emotional sphere is evidenced by a disappearance of that marked instability so characteristic of her case originally, and also of the alternating states of depression and exaltation, The latter have merged, as it were, into an emotional state of medium quality.

        Intellectually her improvement is marked by greater stability and less frequent symptoms of fatigue. It is my opinion that this condition of fatigue is very frequently the necessary precondition for the formation of dissociated states. J. rarely complains of this symptom now, but when she first came under treatment a conversation of but a few minutes was sufficient to produce it. The improvement in this particular is partly due to increased general health, but chiefly, I think, to an equalization, by re-association, of the energy of the systems of psychic neurons.

        On August 29, 1901, J. left the hospital for her home on thirty days' parole. At the expiration of this time, viz., on September 28, 1901, she was discharged. Since that time I have been in constant correspondence with her, and have every reason for believing that she is perfectly well in every way. I can do no better in closing this review of her case than to quote from a letter received from her and dated October 3, 1901. She says, in part:

I have been selling the Life of McKinley, and I sold twenty-seven books.

One of the girls took her father's horse and took me to G―e to canvas for Life of McKinley, but there had been an agent all around up there; but as it was I sold three."

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