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CHAPTER VI

THE PREDOMINANCE OF MOTOR PSYCHOSIS

       THIS firmness and stability of the organized system with the delusion as its nucleus were greatly in the way of the effective carrying out of suggestions, whether hypnotic or post-hypnotic. Suggestions were often altered beyond recognition; it took time before suggestions could be made more or less effective. Constant rehypnotization, repetitions of commands, insistent injunctions, numerous suggestions, were requisite to enforce with varying success some form of obedience and obtain some approximately satisfactory results. In this respect it is interesting to note the fact that suggestions of motor ideas and representations were the first ones to become amenable to control and were by far the easiest to enforce. The suggestions of purely sensory representations and ideas were, on the contrary, the most difficult to control, and even to the very last their enforcement was enacted with but partial success. Something similar is observed in the stages of hypnosis: sensori-motor suggestions are taken before purely sensory suggestions; paralysis, catalepsy, contractions, all motor and kinæsthetic illusions and hallucinations are usually very easily enforced even in the very light stages, while it is only in the deeper stages that changes of sensation and perception can be brought about. The induction of illusions and hallucinations, positive and negative, is usually effected only in the very deep stages of hypnosis. The striking feature of the present case, however, was the fact that hypnotic and post-hypnotic suggestions of acts were easily effected, while suggestions of sensory illusions and hallucinations could not be successfully developed; they at once fell a prey to the dominating delusional system and were either suppressed or modified beyond recognition. Suggestions, however, such as opening and closing the door or lighting matches, were carried out without any resistance or even modifications.

        Still more interesting is the fact that the motor suggestions have also proved more persistent in the patient's subconscious memory. Thus motor memories of fatigue experiments emerged in post-hypnotic hallucinations and were finally brought by the patient into relation with the dominant system. So persistent were these subconscious motor memories that it was by no means easy to have them dislodged from the patient's mind. The interesting fact about motor suggestions was the great ease with which they were accepted and their insistent tendency to recur.

        The ease of acceptance of motor suggestions may be ascribed to the fact that ideo-motor life is more subject to changes from slight stimulations than sensory life: motor elements enter readily into new combinations. From a biological standpoint one can see the importance of the greater ease of modifiability displayed by sensori-motor and ideo-motor elements, since in the adaptation of the organism to its environment it is these elements that are mainly employed in reaction to stimuli of the external world. From the standpoint of adaptation, a slightly appreciable difference of sensory experience may give a widely different and highly complex motor reaction.

        Psychomotor processes form the most important and largest portion of mental life. With the exception of man, all the representatives of the animal kingdom, from the lowest to the highest forms, represent but different stages in the evolution of sensori-motor life. The great majority of mankind still leads a life closely allied to animal sensori-motor states. Even in the highest and most developed forms of mental activity, motor ideas and representations are by far the most predominant. Without motor elements, ideational life is arrested. It is these sensori-motor and ideo-motor elements that constitute the "stream, the flow, the current" of our thoughts. Motor elements enter freely into combinations with all other elements of mental life. This freedom in forming new combinations and associations makes the suggestion of motor ideas and representations highly effective.

        Throughout the scale of animal life from the lowest to the highest forms, intelligence is intimately related to the degree of development of the muscular system and the delicacy of its motor adjustment. Among the lower forms of life, the Cephalopods are well equipped with powerful muscular arms capable of executing a great variety of vigorous movements. Now the Cephalopods also possess a more highly developed nervous system with a higher grade of mental functions than the rest of the Mollusca. The great activity of ants and bees is notorious and their instinctive psychic life is the richest among the Arthropoda. Note the great variety of motor adjustments of the beaver and also the intelligence that goes along with it. Birds possessed of a high degree of activity and motor adaptability are also the most intelligent of their kind, such for instance as the crow and the different species of talking birds. Notice the -activity and great agility of the fox and also the unusual cunning for which he is so celebrated. The suppleness of the dog, his quick reactions to stimulations, the resources of his motor adjustments, and the great extent of his modifiability under changing conditions, are all well known, and along with them goes a high degree of psychosis. Of all the Mammals, the Quadrumana are the most active, the most imitative and full of mimicry, and with the exception of man they are also the most intelligent. When we come to man we cannot help admiring the high complexity and extreme delicacy of his motor adjustments. Most marvellous, however, is the human hand, that divine organ which gives shape and form to works of art, to all the outward visible manifestations of civilization. The great artists and thinkers of antiquity held the human hand in great reverence. One of the great Greek philosophers did not even hesitate to declare that man's superiority over the brute was due to his hand. Finally in the wonderfully delicate motor adjustments of speech we find clearly illustrated the intimate relation between motor and psychic activities.

        Experiments prove the same truth of the predominance of motor ideas and representations in our mental life. If a series of syllables or numbers is given to memorize after one reading, five out of ten can be remembered, though with some difficulty; but if the syllables or numbers are written down at the same time, though not looked at during the writing, a far greater percentage, such as six or seven syllables, can be remembered. If the motor elements in a train of ideas are suppressed, the order of the series becomes confused, and even totally destroyed, showing that the motor ideas are important links in trains of association of ideas.

        Biologically regarded, voluntary activity―will―is the organism's power of adjustment to the conditions of the external environment. In its last psychological analysis, voluntary activity, or will, consists of representations of various modes of adaptations―that is, of motor memories, of highly complex systems of kinæsthetic representations constituting the active subject of the highly developed personality. If this be realized, then the vital importance of motor memories cannot be too highly overrated. Motor memories are at the very heart of personality. We are what we can accomplish. Extreme variability and adaptability are the main characteristic traits of intelligence, will, personality, with their motor memories as their central nuclei.

        The readiness of psychomotor elements and groups to enter into ever new combinations gives rise to the formation of a great wealth of associations which help to make the labile psychomotor groups and systems stable and easy of recall. In fact it may be said that the ease of recall is proportionate to the mass of associated kinæsthetic memories. If under the action of adverse conditions associations are dropped or lost, many more still remain to recall the affected system, some of the functional bonds of which have become loosened. The great wealth of associations formed by motor memories brings about their ease of recall, also their recurrence in consciousness even under unfavorable conditions of dissociation. The great modifiability and variability of systems of motor memories requisite in the adaptation of the organism to the varying condition of its environment make the ever greater instability of motor memories an imperative necessity in the struggle for existence.

        Forming the predominant elements, both as to intensity and mass, of the most complex, relatively stable, though ceaselessly shifting groups and systems constituting the highly developed organization of the personal self, the motor elements, presentative and representative, are also the first to become involved in the process of dissociation. In the various forms of nervous and mental diseases, under different conditions of intoxication and auto-intoxication, in the traumas caused by shock, physical or psychic, the delicate movements of adjustments are the first to become affected, dissociations of systems of motor representations are first to occur with their concomitant motor derangements.

        The instability of motor memories and of psychomotor elements in general may be brought into relation with the fact of the early affection of muscular and kinæsthetic sensibilities, and with the predominance of sensori-motor over purely sensory symptoms so frequently occurring in the course of nervous diseases. With this may be correlated the significant fact referred to by Mosso, that "all substances which slowly destroy the organism must produce phenomena analogous to those of curari, since the motor nerves, according to our researches, have less vitality than the sensory." It would be more correct to substitute for "motor" the term "sensori-motor," because muscular and kinæsthetic sensibilities are also involved in the same process of degeneration. It may also be observed in passing, that cellular kinoplasm with the "kinocentrum," the centrosome and its archoplasmic structures, possibly the most primitive motor organoids of the cell, similarly manifest a high degree of variability and instability.

        Motor memories may be regarded as the labile elements of consciousness; they become easily and frequently dissociated and dropped into the subconscious, but for that very reason they are also very easily reproduced or regenerated. In this respect motor memories follow the general biological law of organic regeneration: Organs that are easily and frequently lost in the struggle for existence are also easily regenerated, as, for instance, the legs and claws of Crustacea or the tentacles of the starfish and the octopus. Dissociated systems of motor memories often become regenerated and under pathological conditions when synthesis is impossible they may even recur with great insistence, giving rise to the most uncontrollable types of insistent ideas and impulses and to various forms of so-called "psychic epilepsy," especially of the motor type, closely mimicking typical organic epilepsy. Dissociated subconscious systems, like rudimentary aborted organs, are very persistent and often very injurious to the organism. The recurrence of the subconsciously-submerged dissociated systems has its parallel in the biological phenomena of reversion, or atavism. The development, growth, and recurrent persistence of a subconscious dissociated system is like a malignant sarcomatous neoplasm the cells of which present a reversion to the embryonic type.

        In the present case, this greater ease with which suggestions of motor ideas and representations predominated and persisted in consciousness was specially prominent from the very nature of the mental malady, of the hypochondriacal systematized delusion. Ideas and representations derived from the special senses and the great mass of sensations coming from the functions of the internal organs, from the viscera, especially from the sympathetic system, all of which play an important rôle in the formation of moods, affections, and sensations, have become more firmly and rigidly systematized and organized into the body of the central delusion than the freer and more mobile psychomotor elements.

        This fact, that the psychomotor elements, motor ideas and representations, enter more easily into combinations and form extensive associative systems, makes them easier of recall and hence apparently more persistent in memory. From an educational standpoint, one realizes the importance of this fact of persistent recurrence and great ease of recall of motor memories. Children learn and remember things best, not by abstract notions, not by looking at objects and hearing of things, but by acting out whatever is taught them. Not only is the interest increased on that account and knowledge made more vital and better assimilated, but the content acquired is also far better retained and more easily remembered; it emerges with greater ease and is at the child's command at any time, because of the nature of the interwoven motor memories. In the training of the mentally defective, the best method followed is that of motor instruction; the best way of teaching the mentally defective is to have the ideas acted out and from the actions get at the meaning, even if it be only automatically, of what is requisite to be learned. As a matter of fact, even the perfectly normal and well balanced mind gets at the meaning of things by handling them, by having the attributes of the object and the processes of the work to be learned acted out. Acting forms the greater part of man's life.

        In giving suggestions intended to be persistent and lasting, their character should be motor rather than sensory; the suggestion given should be associated with kinæsthetic sensations and motor ideas. I have often found that when a suggestion is not taken, even though insisting on it, this same suggestion will be effective, if the subject is made to repeat it. The auditory sensory stimulations were not sufficient; when, however, kinæsthetic sensations and motor ideas were interwoven into the suggestion, it became effective, and without any insistence on the suggestion. When given under such conditions, the suggestion was usually carried out without any opposition.

        For therapeutic purposes it is certainly of importance to have the suggestion as stable as possible. To effect this, the best way is to utilize this fact of persistence of sensori-motor and ideo-motor elements, of the greater ease of recall characteristic of kinæsthetic sensations and ideas. The patient should be made to repeat orally the given suggestion, or to write it out, and, if possible, to act it out. Motor and kinæsthetic sensations and memories make suggestions durable.

        It is, of course, preferable that the associated motor memories should not be of a passive, but of an active character. To guide and move the patient's limb, for instance, is not as good as when he carries out the acts of his own accord. In other words, active kinæsthetic associations are most potent in suggestion. Along with other methods, the use of kinæsthetic associations is of the greatest value in the process of formation and also of disintegration of a stably organized system.

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