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Cornell University Library 
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 Symptomatology, psychognosis, and diagno 
 
 3 1924 012 469 114 
 
SYMPTOMATOLOGY, PSYCHOGNOSIS, AND 
 DIAGNOSIS OF PSYCHOPATHIC DISEASES 
 
WORKS BY BORIS SIDIS 
 
 The Foundations of Normal and Abnormal 
 Psychology 
 
 The Psychology of Suggestion 
 
 Multiple Personality 
 
 Psychopathological Researches 
 
 An Experimental Study of Sleep 
 
 Philistine and Genius 
 
 The Psychology of Laughter 
 
 Symptomatology, Psychognosis, and Diag- 
 nosis of Psychopathic Diseases 
 
 The Causation and Treatment of Psycho- 
 pathic Diseases 
 
Coprrigrht, I9i4> by Boris Sidis 
 
 All Rights Reserved 
 
 THE GOHHAM PRESS, BOSTON, U S. A 
 
INTRODUCTION 
 
 We are getting more and more awake to the import- 
 ance of the study of the phenomena of abnormal 
 mental life. The student of normal psychology begins 
 to realize the necessity of a knowledge of the various 
 manifestations of the abnormal mind, both conscious 
 and subconscious. The phenomena that lie on the 
 borderland of what is regarded as normal mental ac- 
 tivity are of great interest and importance, because, be- 
 ing deviations or variations from the normal and the 
 familiar, they are apt to call attention to the mechanism, 
 causation, and laws that govern mental activity in gen- 
 eral, normal and abnormal, conscious and subconscious. 
 
 The normal psychologist has learned to pay attention 
 to the facts of abnormal mental life, since a knowledge 
 of them sheds a good deal of light on the various mani- 
 festations with which he himself deals, manifestations 
 which have resisted psychological analysis, such as emo- 
 tion, will, personality, and even such apparently simple 
 mental functions as associative processes and percep- 
 tion. Not that the normal psychologist has not made 
 important contributions to the understanding of all 
 those processes, but many of the studies touched the 
 surface, and did not penetrate deep Into the sub- 
 soil of mental life, into the subconscious activity 
 where all the sources of mental life have their be- 
 ing, where mental processes have their origin, and 
 whence all mental processes come to light In the focus 
 of consciousness. 
 
 The phenomena of memory are of vital importance 
 
 (0 
 
it Introduction 
 
 in normal psychology, and while a good deal of work 
 has been accomplished by the normal psychologist in this 
 subject, and some far reaching laws, such as those of 
 Ebbinghaus, have been formulated, still we are far from 
 a real understanding of this fundamental function. In 
 this respect abnormal psychology is of material help, on 
 account of the great number of variations which that 
 function presents to the psychopathologist. In fact, most 
 of the studies of recent psychopathology may be regard- 
 ed as researches in the domain of memory. From a cer- 
 tain standpoint psychopathic maladies may be regarded 
 as affections of memory. Studies in abnormal psychology 
 are thus of vital interest to the investigator in normal 
 psychology. A study of the anaesthesias, abulias, am- 
 nesias is of consequence to a right understanding of 
 memory and volitional activities ; the phenomena of dis- 
 sociation of personality or of multiple personality give 
 an insight into the labyrinth of human personality, while 
 dreams, illusions and hallucinations give a broad view 
 and clear understanding of the various elements of per- 
 ceptual processes. 
 
 If, however, abnormal psychology is of importance to 
 the normal psychologist from a purely theoretical stand- 
 point, it is certainly of the utmost consequence to the 
 medical profession. A clinical knowledge of the facts 
 of abnormal mental life should be in the curriculum of 
 every medical student. Every medical practitioner 
 should be more or less familiar with the symptoms of 
 psychopathic diseases. 
 
 We must not forget that mind and body are inti- 
 mately related. The two cannot be separated. One re- 
 acts on the other. Physical disturbances bring about 
 mental aberrations which in their turn influence physical 
 
iv Introduction 
 
 of insanity there are thousands of cases of func- 
 tional neurosis and psychopathic affections which have 
 absolutely nothing to do with insanity, affections which 
 the psychiatrist, from the very nature of his training, is 
 neither in a condition to grasp nor able to deal with. 
 
 The medical profession must realize the import- 
 ance of a working knowledge of subconscious mental af- 
 fections. More than one-half of the patients that come 
 to the general practitioner are cases of psychopathic dis- 
 orders. An early recognition and appropriate treat- 
 ment would not only vindicate the professional man, but 
 would help the patient at the right moment and prevent 
 him from becoming a chronic invalid. 
 
 I must say that many medical men, regarding them- 
 selves as belonging to the conservative type, show a 
 good deal of opposition to abnormal psychology. Thus 
 some medical men accused me of carrying on work in 
 spiritualism. Others with medical authority lecture on 
 "the limitations of Psychotherapy". Vulgar Psycho- 
 therapy is all they know of the vast domain of psycho- 
 pathology. It is but six years or so since a well known 
 medical journal rejected, without as much as a com- 
 ment, my clinical "Studies in Psychopathology," after- 
 wards published in "The Boston Medical and Surgical 
 Journal." I have not the least doubt that my present 
 volume will meet with no less opposition from similar 
 quarters, and especially with attacks by "psychologiz- 
 ing" neurologists and psychiatrists taking refuge under 
 Freud's paternal wings. 
 
 I sincerely hope that in the course of time the more 
 liberal, the more open minded and progressive men of 
 the medical profession will be more appreciative of the 
 work done in normal and abnormal psychology. The 
 
Introduction v 
 
 younger generation of medical men, I trust, will realize 
 the importance of a working knowledge, both theoreti- 
 cal and clinical, of psychopathic mental diseases. 
 
 I may say that a knowledge of psychopathic troubles 
 is of more material help to the practitioner than all his 
 studies in experimental physiology, for instance, with 
 its muscle-nerve preparations, more important than the 
 bacteriological technique with its examinations of bac- 
 teria and bacilli, toxins and autotoxins, with the endless 
 sera, often of a highly doubtful character, much ad- 
 vertised by commercial houses. Perhaps it may be well 
 to remind the medical man that a good deal of what is 
 taught in the medical schools as materia medica, or 
 pharmacology, theory and practice, should be really re- 
 garded as courses in suggestive therapeutics, given un- 
 der the guise of medicine, of virtues and properties of 
 drugs so that the physician should have faith in them 
 himself when he treats his patients. 
 
 The Nemesis of faith in the so called scholastic med- 
 ical therapeutics with its lack of psychological knowl- 
 edge is fast overtaking the medical man. The Freu- 
 dian school with its symbolical, cabalistic, occult no- 
 tions and sexual sensationalism, rivalling that of the 
 yellow press, has become the favorite in certain medical 
 quarters. Physicians innocent of all psychological 
 knowledge publish voluminous pseudoanalytic papers 
 under the impression that they furnish the last word 
 in medical psychology. The sight of some medical 
 dignitaries taking a regular bath in sexual filth, possi- 
 bly as a matter of redemption and expiation, would 
 be ludicrous, if it were not so pathetic. 
 
 It is amusing to read puerile compositions, each a mile 
 long, going into detailed description of sexual experi- 
 
vi Introduction 
 
 ences with a zeal worthy of a better cause. The Freu- 
 dians select choice cases of sexual perversion and degen- 
 eracy, much of which is of a purely suggestive character, 
 and describe them with a gusto that well displays their 
 own subconscious trend. According to Freudian 'pseu- 
 doanalytic science' the world is a madhouse of sexual 
 perversion and inversion. The Freudian gloats over his 
 sexual experiences. In order to accomplish this remark- 
 able result a whole mass of tokens, signs and symbols is 
 formulated and organized into a systematized, para- 
 noidal 'complex.' This Freudian verbigeration and rum- 
 ination some medical authorities and their followers hail 
 as the Gospel of medical psychology, a new up to date 
 German importation, known under the high sounding 
 name of psychoanalysis. Psychoanalysis is a form of 
 medical bacchanalia. Is it not the Nemesis of psychol- 
 ogy, — that mad medical dance of psychoanalytic wor- 
 shippers round the shrine of Venus and the altar of 
 Priapus ? 
 
 It would have been amusing, if it had not been fa- 
 tal to the mental and moral balance of the patients, 
 to hear some medical authorities advising their pa- 
 tients to take a 'course in psychoanalysis.' If 
 those neurological practitioners should understand 
 what a course of treatment in psychoanalysis real- 
 ly means to a nervous person, they might as well 
 advise him to commit moral suicide, or to take a course 
 in sexual profligacy. 
 
 I have seen many a patient who has become a sexual 
 ruin long before the psychoanalyst got through with his 
 sexual courses. I have known many a patient who under 
 the highly suggestive, psychoanalytic treatment has be- 
 gun to masturbate daily and has become a sexual per- 
 
Introduction vii 
 
 vert. 
 
 Psychoanalysis is a conscious and more often a sub- 
 conscious or unconscious debauching of the patient. 
 Nothing is so diabolically calculated to suggest sex- 
 ual perversion as psychoanalysis. Psychoanalysis 
 paraded as psychological investigation is not only 
 a danger to the patient, but it is a menace to 
 the community. And yet this form of mental debauch 
 commends itself to some medical authorities as a great 
 discovery in the domain of abnormal psychology! Bet- 
 ter Christian Science than psychoanalysis I 
 
 There is at present a current in psychopathology that 
 ascribes a good deal of importance to desire, to pur- 
 pose, to meaning. This current is essentially Freudian 
 in character. The representatives of this tendency 
 are not satisfied unless they read some meaning, con- 
 scious or unconscious, into the various phenomena of 
 abnormal mental life. They try to find in the abnormal 
 symptoms of psychopathic patients some mysterious sig- 
 nificance which they attempt to reveal by special inter- 
 pretation. They try to find some hidden meaning in phe- 
 nomena regarded as symbolic of unconscious trends 
 which they decipher by a special code of procedures, 
 signs and tokens. They are somewhat like the ancient 
 augurs who could read the future from the flight of 
 birds and the guts of animals. Others, carried away by 
 the same influence, but rather more cautious in their 
 speculations, attempt to find special meanings in each 
 and every symptom of psychopathic cases, and are not 
 satisfied until some meaning, however obscure and la- 
 borious, is forced out of the facts under their examina- 
 tion. 
 
 Now in all my work, carried on for years and pub- 
 
viii Introduction 
 
 lished in various works and papers^I lay special stress 
 on the fact that the phenomena of abnormal mental life 
 do not present any purpose in the present; they are repe- 
 titions, recurrences of a past, but they have no aim, no 
 purpose, no meaning in the present life existence of the 
 patient. In fact, the symptoms are pathological, just 
 because they have no purpose, no meaning in the life of 
 the patient. 
 
 The most superficial and puerile method is that of 
 tracing subconscious meanings in lapses of words, in 
 amnesias, by means of association methods. The 
 physician gives a series of words and the patient is sup- 
 posed to answer with some words which are scanned by 
 the physician as to time and quality. All kinds of sym- 
 bolical and diabolical combinations are then formed by 
 the physician who thinks he is doing great psychoanaly- 
 tic work. All he does is ingenious, cabalistic casuistry 
 worthy of mediaeval scholasticism. 
 
 When Frt\id\ Psychopathologie des Alltaffslebenswas 
 published I discussed the examples, so ingeniously work- 
 ed out by Freud, with the late Professor James of Har- 
 vard. James laughed at the puerility of Freudian asso- 
 ciations ; he threw up his hands at the psychoanalytic ab- 
 surdities, and characterized Freudian Psychopathologie 
 as 'silly and nonsensical.' Some similar opinion is main- 
 tained by Wundt, Ziehen, Oppenheim, Aschaffenburg 
 and others. Not a single psychologist or psychopath- 
 ologist of note accepts Freud's sexual phantasies and 
 Oneiromancy. 
 
 The association method used by the Freudian school, 
 in order to discover the hidden meaning that lies in the 
 subconscious or the unconscious, is arbitrary. The fol- 
 lowers of Freud are inexperienced in the actual Investi- 
 
Introduction ' ix 
 
 gations of subconscious phenomena in which suggesti- 
 bility plays such an important role. There is not a sin- 
 gle case of the Freudian school that is free from arte- 
 facts of subconscious suggestion, played between patient 
 and physician, in which the Freudian is the biggest dupe. 
 In fact, the very methods of free association and oneir- 
 omantic interpretations are of such a character that any 
 associations may be formed, according to the wish of 
 the physician. 
 
 The Freudian himself is possibly the best illustration 
 of his own theory that one may be duped by his own 
 wishes. In this respect the Freudian does live up to his 
 theory that everything can be explained by wish and its 
 ideal fulfillment. As I put it in another place 'if wishes 
 were horses beggars would ride,' — the Freudian rides 
 such horses. 
 
 On the whole, teleological psychology is ques- 
 tionable. One can find any number of purposes in men- 
 tal symptoms and associations; speculations in that di- 
 rection are often as idle as they are useless. When Har- 
 vey discovered the circulation of blood, the objection was 
 the teleology of it, what is its purpose, what is its mean- 
 ing. Harvey had to defend his theory against objec- 
 tions that claimed that he did not go deep enough into 
 the subject, as he did not give the meaning of the cir- 
 culation of blood, and, therefore, his discovery could 
 not be true. "To those who repudiate the circulation" 
 Harvey writes "because they neither see the efficient 
 nor the final cause of it, and who exclaim cut bono? I 
 have yet to reply, having hitherto taken no note of the 
 objection which they take up." 
 
 Teleology is a tradition handed down through the 
 scholastic Middle Ages from Plato and Adstotlp, 
 
X Introduction 
 
 and often comes to life in sciences that have not 
 reached their state of maturity. Not that I deny 
 the purposive element in mental life, but I do 
 claim that its sphere even in normal life is ex- 
 tremely limited, and that it is almost completely 
 absent in states of morbid psychic affections. Freud- 
 ism is a good example of it. 
 
 Morbid mental states have no meaning. In a certain 
 sense we may even say that mental states are morbid, just 
 because they have no meaning. The cure often consists 
 in the fact of either having such states completely elimi- 
 nated from the stream of mental activity, or in finding 
 for them a meaning which originally they do not pos- 
 sess. 
 
 Clinical psychopathology should not burden itself 
 with all kinds of speculations and hypotheses, but stick 
 to facts. Teleology or the finding of meanings, 
 infantile and others, the discovering of hidden purposes 
 and unconscious meaning, because of the metaphysical 
 dogma that the unconscious can only wish and form de- 
 sires which the symptom complex of the malady ex- 
 presses as the meaning of the hidden conation, is to 
 bind oneself with arbitrary speculative theories and met- 
 aphysical hypotheses. The most consistent of those spec- 
 ulators are unconscious followers of Schopenhauer who 
 puts the Unconscious Will at the basis of his meta- 
 physics. Will is at the heart of things, hence there is 
 a craving in the Unconscious which is the very essence 
 of the phenomenal manifestations of the Will. 
 
 According to Schopenhauer the phenomenal world is 
 the manifestation of the Will, of the Kantian Ding an 
 sich, of the noumenon which is beyond time, space, and 
 causality. The Unconscious in nature is the Will 
 
Introduction set 
 
 which works and manifests itself in it. The world is 
 the objectification of the Will. "The Will is the thing 
 in itself, the content of all phenomena. . . . The phe- 
 nomena are throughout necessary. . . . This follows 
 from the unrestricted validity of the principle of suffi- 
 cient reason. ... In another aspect, however, the 
 same world is for us, in all its phenomena, objectivity of 
 will . . ." This metaphysical doctrine of Will is at the 
 basis of Freudian "pseiidoanalysis." 
 
 The doctrine of will, desire and suppression, re- 
 sistance and Abwehr is a close copy of Schop- 
 enhauerian metaphysics: "In the resistance of the 
 will" says Schopenhauer "to allowing what is con- 
 trary to it to come under the examination of 
 the intellect lies the place at which madness can break 
 in upon the mind. Each new adverse event must be as- 
 similated by the intellect (the conscious, or das Bewus- 
 ste), it must receive a place in the system con- 
 nected with our will and interests whatever it 
 may have to displace that is more satisfactory. When- 
 ever this has taken place, it already pains us much less ; 
 but this operation itself is often very painful, and also 
 in general, only takes place slowly and with resistance. 
 
 "However, the health of the mind can only continue 
 so long as this is in each case properly carried out. If, on 
 the contrary in some particular case, the resistance and 
 struggles of the will against the apprehension of some 
 knowledge reaches such a degree that that operation is 
 not performed in its integrity, then certain events or 
 circumstances become for the intellect (fUr das Be- 
 wusste aher nicht fur das Unbewusste as the Freudian 
 would say) completely suppressed, because the Will can- 
 not endure the sight of them, and then, for the sake of 
 
xii Introduction 
 
 the necessary connection, the gaps that thus arise are 
 filled up at pleasure (by the activity of the uncon- 
 scious) ; thus madness appears. For the intellect has 
 given up its nature to appease the Will : the man now 
 imagines what does not exist." And here comes anothjer 
 fundamental Freudian metaphysical tenet: "Yet the 
 madness which has thus arisen is now the lethe of unen- 
 durable sufering; it was the last remedy of harassed na- 
 ture, i. e., of the Will." Freudianism is Schopenhauerian 
 metaphysics gone mad. Psychoanalysis is truly per- 
 verted 'madical' metaphysics. 
 
 In psychopathic cases the symptom complex of the 
 functioning systems, characteristic of the pathological 
 condition, has essentially no meaning in tjie present, al- 
 though the patient especially with the help of the phy- 
 sician may find some meaning as do the insane when 
 trying to account for their pathological state. The psy- 
 chopathic symptoms are survivals, relics from a prev- 
 ious epoch of the life existence of the patient. The psy- 
 chopathic sjmiptom complex is a survival from a stage 
 of experience the meaning of which is gone, and is 
 therefore entirely irrational. 
 
 It is only when we come to realize the irrationality 
 and lack of adaptation, inner and outer, of such patho- 
 logical, meaningless systems, conscious and subcon- 
 scious, that we begin to understand the psychopathic 
 character of the symptom complex. 
 
 In this respect psychopathic systems are analogous to 
 the irrational customs and myths found in various stages 
 of human culture. This point is specially misappre- 
 hended and misapplied by the Freudians. As long as one 
 attempts to force on myths a meaning, philological or 
 sexual, one is sure to go astray and to be lost in a maze of 
 
Introduction xiii 
 
 verbiage and sophistry. Myths are survivals of savage 
 thought, now meaningless and irrational. The Freudians 
 clearly reveal their absurdity by the allegorical subtle- 
 ties of their mythical, sexual psychology in which their 
 sexual fancy runs riot. 
 
 Myths are relics of savage thought, recurrent mani- 
 festations of savage experience, surviving phases of 
 savage Weltanschauung. All the Freudian 'psychologiz- 
 ing' about myths is nothing but idle pseudoanalytic 
 fancy without the least foundation in fact. To the 
 problem — why irrational ideas survive in myths — ^An- 
 drew Lang pertinently says: "We may be asked why 
 do savages entertain irrational ideas which survive in 
 myths ? One might as well ask why they eat each other, 
 or use stones instead of metals. Their intellectual pow- 
 ers are not fully developed, and hasty analogy from our 
 own unreasoned consciousness is their chief guide. 
 Myth, in Mr. Darwin's phrase, is one of the "miserable 
 and indirect consequences of our higher faculties." All 
 the casuistry of Freudian mythology is arbitrary and 
 sophistical. The Freudians use scholastic casuistry for 
 the rationalization of what is essentially irrational. "It" 
 (the myth) says Lang, "is a jungle of foolish fancies, a 
 Walpurgis Nacht of gods and beasts and men and stars 
 and ghosts, all moving madly on a level of common 
 personality and animism, and all changing shape at ran- 
 dom, as partners are changed in some fantastic witches' 
 revel" . . . "The imagination of the savage has 
 been defined as 'midway between the conditions of a 
 healthy, prosaic, modern citizen and of a raving maniac 
 or of a patient in a fever ward.' " 
 
 Just as the irrational elements of myths are the sur- 
 vivals from a savage state of mind which has no mean- 
 
}dv Introduction 
 
 ing in the present life of civilized communities so we may 
 say that mental, subconscious, psychopathic symptom- 
 complexes are survivals of a former period of mental 
 activity; they are atavistic systems which keep on recur- 
 ring, like the type of recurring moment consciousness, 
 under appropriate circumstances and favorable condi- 
 tions, but which are now irrational, without meaning 
 and purpose. 
 
 The Freudians have invented a psychopathic Oedipus 
 complex of which they make much capital. They show 
 however by it a sad lack of psychological understand- 
 ing and a deficiency of scientific insight as well as ab- 
 sence of common sense. Neither is their analysis of the 
 Oedipus myth in any way correct nor is their interpreta- 
 tion of clinical facts in the least approaching the truth. 
 The whole of psychoanalysis is nothing but puerile, Tal- 
 mudic hair splitting sophistry. 
 
 The Oedipus complex which is kept in so much rever- 
 ence by the Freudian devotee is scientifically and clini- 
 cally false. The Oedipus myth is wrongly interpreted 
 by the Freudian sexual mythology and has absolutely 
 nothing to do with the actual condition of psychopathic 
 cases. All there is to the Oedipus "complex" is a mat- 
 ter of ordinary suggestibility to which psychopathic pa- 
 tients readily lend themselves and of which the psycho- 
 analyst is the principal dupe. 
 
 Max Miiller regards the Oedipus story as a solar 
 myth. It is, however, quite probable, as J. G. 
 Frazer points out, that there is in the myth a 
 survival from the early savage period of matriar- 
 chate or mother-kin when the right to the throne 
 was in the female line. The father exposed and 
 slaughtered the son, and the son in his turn de- 
 
Introduction xv 
 
 throned the father by force and murder. The savage 
 chiefs and kings sacrificed and killed their male children, 
 especially their first born sons, while the surviving sons 
 assassinated their fathers. The myth is a reminiscence, 
 a relic handed down from savage times of the struggle 
 for existence, going on within savage communities for 
 the tenure of kingship. The marriage with the king's 
 widow was requisite in order to obtain the right to the 
 throne. The father murdered the son, and the son, 
 when he was rescued, had to assassinate the father.. It 
 was a matter of killing or being killed. What we find 
 in the myth is another example of the working of the 
 instinct of individual and more specially of social or 
 tribal self preservation. 
 
 Father, son, and members of the royal family were 
 sacrificed as an atonement for tribal sins, they were im- 
 molated and slain as an expiation for the transgressions 
 of the community, and hence their deaths were supposed 
 to ensure the prosperity of society. The Oedipus myth 
 with its deaths of Laios, of Oedipus, of Jokaste and of 
 the children of the royal house for several generations 
 is a relic of savage practice in the struggle for self-pres- 
 ervation. 
 
 This is well brought out in the Greek myth of 
 Athamas, current in Alus, a town in Thessaly. King 
 Athamas and his family had to furnish victims as sin- 
 offerings for the whole country and thus ensure Its wel- 
 fare. The wife and children suffered exile and death in 
 various ways and king Athamas himself was ordered by 
 the oracle to be sacrificed for the good of the commun- 
 ity. The unhappy king was saved by his grandson, 
 Cytisorus. Athamas became insane, quitted his country 
 and went wandering in the wilderness. Here we have 
 
xvi Introduction 
 
 a modification of the Oedipus myth, a modification 
 which shows the real nature of such stories, namely that 
 they are relics, survivals, or recurrences of savage prac- 
 tices in the struggle of tribal self-preservation. The 
 Freudian sophistic interpretation of their 'Oedipus com- 
 plex' is as shallow as it is arbitrary, — it is pseudoanaly- 
 tic rubbish, sexual trash without any rhyme and reason. 
 
 Distasteful as it is for me to do it, I find it my duty to 
 enter a protest against the vagaries and absurdities of 
 psychoanalysis which is nothing but a pseudo-science, 
 the same as astrology, oneiromancy, palmistry and mag- 
 ic. On account of the sensational noise made by the de- 
 votees of psychoanalysis, the medical practitioner con- 
 fuses psychoanalysis with scientific and clinical psycho- 
 pathology. In condemning psychoanalysis many a clin- 
 ical man of sound good sense also unjustly condemns all 
 clinical, psychopathological research. The following 
 statement Is an extract from a letter written to me by 
 an eminent medical man who stands at the head of the 
 medical profession of this country: 
 
 "I think that the majority of men in general work 
 do not separate psychopathology from psychoanalysis. 
 Freud's theories and the whole trend of psychoanalysis 
 have been so turned into the channels of distorted and 
 perverted sexual life that it has blinded people to the 
 fact that there are many dominant phases in mental life 
 which are not sexual. The ordinary healthy minded 
 and vigorous practitioner sees a lot of motives in life 
 that are not sexual, and where everything Is turned and 
 twisted to one side, one 'complex,' he becomes indignant 
 and disgusted, and condemns the whole broad subject 
 of psychopathology." 
 
 My clinical work as well as my experimental Invest!- 
 
Introduction xvii 
 
 gations and observations prove to me conclusively that 
 not all mental processes are purposive or meaningful. 
 Mental life activities are a matter of habit, often 
 silly, and meaningless, even hurtful or patholog- 
 ical. Quite frequently the activity is carried out re- 
 flexly in response to external stimulations often detri- 
 mental to the life existence of the individual. Most of 
 the actions which have no selective value may be com- 
 pletely indifferent. 
 
 This lack of purpose and absence of meaning in 
 normal life may be regarded as being even more 
 emphatic in pathological cases. It is only para- 
 noiacs or paranoidal cases that may put a quasi- 
 meaning on their abnormal experiences, but this mean- 
 ing is entirely delusional. Of the same paranoidal type 
 may be regarded the kind of meaning put on the symp- 
 toms of psychopathic cases. Psychoanalysis is a matter 
 of suggestion played between the physician and the pa- 
 tient. Both are deluded. Psychoanalysis is sheer humbug. 
 
 We may lay it down as a law that psychopathic life 
 lacks meaning. I lay special stress on this principle, — 
 lack of meaning characteristic of psychopathic afec- 
 tions. This absence of meaning is the key to a right 
 comprehension of the facts of psychopathology and of 
 the methods of psychotherapy. 
 
 Perhaps it may be fitting here to say a few words 
 about Psychognosis. Psychognosis is not a special meth- 
 od. All I wish to convey by it is what the term means, 
 namely a study, an acquisition of a working knowl- 
 edge of the patient's soul, so to say. The best way is 
 to study the case by all kinds of methods, hypnoidal, 
 hypnotic, and especially by a close observation of the 
 waking states. The best way is not to rely on cut and 
 
xviii Introduction 
 
 dried methods, such as pedantic laboratory tests, which 
 are clumsy, awkward, and highly misleading. 
 
 It is best to live with the patient, to watch him closely 
 when he acts spontaneously, converse with him, discuss 
 with him, work with him, be with the patient day and 
 night, and labor with him for hours, as well as live with 
 him intimately for weeks and months. It is only under 
 such conditions that we come to realize the actual condi- 
 tion of the patient and can obtain a glimpse of the work- 
 ings of his mind. No cut and dried tests, reaction time 
 or association time or tests with association words, and 
 then leading the patient along lines suggested uncon- 
 sciously by the physician, or any attempt at putting the 
 case into some pigeon hole of a classification, common 
 with the neurologist and psychiatrist, such as dementia 
 praecox, psychasthenia and so forth, can lead to any 
 understanding of the case. 
 
 The best way is to study the case, know it by 
 the description of its symptoms, and dig deeply 
 into the conscious and subconscious sides of the 
 patient's character and life history. In short, we 
 must learn to know the workings of the patient's mind, 
 we must learn his ideals of life, his attitude towards 
 man and to the world, his actions and his total reactions 
 In his adaptations to his environment. In other words, 
 we must learn to understand not only the patient's phy- 
 sical, nervous, and mental condition, not only his his- 
 tory and the development of his present trouble, but we 
 must learn his personality as a whole, his attitude to 
 his external surroundings, his Weltanschauung so to 
 say. 
 
 This can only be accomplished by all methods at our 
 disposal, by hypnoidal and hypnotic states, by cxamina- 
 
Introduction xix 
 
 tion in the waking state, by constant watching and obser- 
 vation, by drawing out the patient in discussion, and by 
 closely observing him in his actions and behaviour in re- 
 gard to his family, his friends and strangers for a long 
 period of time. The knowledge thus obtained of the pa- 
 tient's psychic life is what I regard as Psychognosis. 
 Such a knowledge is indispensable for a right compre- 
 hension of the patient's condition, and is still more im- 
 portant, if we wish to cure him. In other words, psy- 
 chognosis is of importance not only from a theoretical, 
 psychopathological standpoint, but is of the utmost con- 
 sequence to a right, practical, psychotherapeutic pro- 
 cedure and treatment. 
 
 I may add that some of the chapters included in this 
 volume have been published by me in the form of arti- 
 cles in various medical and psychological journals. 
 
 Boris Sidis. 
 
 Sidis Psychotherapeutic Institute, 
 Portsmouth, New Hampshire, 
 July, igi4. 
 
CONTENTS 
 
 PARTI 
 
 SUBCONSCIOUS STATES 
 
 BORDERLAND PHENOMENA 
 
 CHAPTER PAGE 
 
 Introduction I — ^XIX 
 
 I. The Subconscious and the Conditions 
 
 of Its Manifestation 1 1 
 
 II. The Hypnoidal Twilight State 33 
 
 III, The Hypnoidal Twilight State in An- 
 
 imals and Infants 40 
 
 IV. The Hypnoidal Twilight State and 
 
 Sleep 50 
 
 V. The Primitive Rest State 54 
 
 VI. Psychognosis and the Hypnoidal Twi- 
 light State 59 
 
 VII. The Hypnotic State 64 
 
 VIII. Hypnoid States 74 
 
 IX. The Hypnoidic State 78 
 
 X. Hypnolepsy 88 
 
 PART II 
 
 PSYCHOPATHIC DISEASES 
 
 XI. The Classification of Nervous and 
 
 Mental Diseases ••••-. 97 
 
 XII. Sensory Disturbances 108 
 
 XIII. Motor, Visceral, and Circulatory Dis- 
 turbances . . ju 114 
 
CHAPTER 
 XIV. 
 
 XV. 
 XVI. 
 
 XVII. 
 XVIII. 
 
 XIX. 
 
 XX. 
 XXI. 
 
 XXII. 
 XXIII. 
 XXIV. 
 
 XXV. 
 XXVI. 
 
 CONTENTS 
 
 PAGE 
 
 Illusions 137 
 
 Hallucination and Perception 143 
 
 Hallucination, Dissociation, and 
 
 Dreams 165 
 
 Hallucination, Dreams, and Reality. . 175 
 The Vividness of Hallucinations and 
 
 Dreams 188 
 
 Vividness, Functional Psychosis, and 
 
 Hallucinations 198 
 
 Double Thinking 204 
 
 Hallucinations and Pseudo-Hallucina- 
 tions 215 
 
 Hypnotic Hallucinations 219 
 
 The Aphasias 244 
 
 Delusions 263 
 
 Amnesia, Aboulia, and Aprosexia . . . 268 
 Fixed Ideas, Morbid Impulses, and 
 
 Emotions 299 
 
 PART III 
 
 PSYCHOGNOSIS AND DIAGNOSIS 
 
 XXVII. Recurrent Mental Systems 307 
 
 XXVIII. Traits and Thresholds of Dissociated 
 
 Systems 316 
 
 XXIX. Psychognosis by Hypnosis 329 
 
 XXX. Psychognosis by Hypnoidal States. . . 351 
 
 XXXI. Somopsychosis and Psychoneurosis . . 376 
 
 XXXII. The Diagnosis of Psychopathic States 390 
 
 Appendix I. Scheme of Examination 395 
 
 Appendix II. The Hypnoidal State of Sidis .... 405 
 
CONTENTS 
 
 CHAPTER PAGE 
 
 Appendix III. The Hypothesis of Physiological 
 
 Traces and Hypnosis 422 
 
 Appendix IV. "Unconscious Intelligence" .... 432 
 Index 441 
 
PART I 
 
 SUBCONSCIOUS STATES 
 
 BORDERLAND PHENOMENA 
 
Symptomatology, Psychognosis, 
 
 and Diagnosis of Psychopathic 
 
 Diseases 
 
 CHAPTER I 
 
 THE SUBCONSCIOUS ANT) THE CONDITIONS OF ITS 
 MANIFESTATION 
 
 BEFORE we can study the manifestations of 
 psychopathic diseases it is well to review the 
 subconscious, its conditions and its principal 
 states. 
 The nervous centres of man's nervous system, if 
 classified as to function, may be divided into inferior 
 and superior. The inferior centres are characterized 
 by reflex and automatic activity. A stimulus excites 
 the peripheral aerve-endings of some sense-organ; at 
 once a nerve current is set up in the afferent nerves. 
 This current in its turn stimulates a plexus of central 
 ganglia, the nervous energy of which is set free and 
 propagated along the efferent nerves towards muscles 
 and glands ; secretions, muscular contractions or relax- 
 ations are the result. 
 
 Ingoing and outgoing nervous currents may be modi- 
 fied by the nervous centres; nervous currents may be 
 intensified, decreased in energy or even entirely inhib- 
 ited by mutual interaction. Such a modification takes 
 place according to the law formulated by Ziehen: "If 
 an excitation of a definite intensity (w) take place in 
 
 II 
 
12 Diagnosis of Psychopathic Diseases 
 
 one cortical element (fc), and another excitation of a 
 different intensity («) take place at the same time in 
 another cortical element (c) which is connected by a 
 path of conduction with (b), the two intensities of ex- 
 citation may reciprocally modify each other." 
 
 Although such modifications may frequently occui, 
 it nevertheless remains true that the inferior centres 
 are of a reflex nature. No sooner is the nervous energy 
 of a lower centre set free than at once it tends to dis- 
 charge itself into action. The physiological process of 
 setting free the nervous energy in a central ganglion, or 
 in a system of central ganglia, is accompanied in the 
 simpler, but more organized, more integrated centres 
 by sentience, sensibility, and in the more complex, but 
 less integrated, less organized centres by consciousness, 
 sensations, perceptions, images, ideas, and emotions. 
 
 Turning now to the superior or the highest nervous 
 centres, we find that they are characterized by the 
 function of choice and will. A number of impressions, 
 of sensations, of idea,s reach those higher "will" cen- 
 tres, and a critical, a sifting, a selecting, an inhibitory 
 process at once begins. Some of the mental states are 
 permitted to develop and to work themselves out with- 
 in certain limits, others are given full play, while 
 others and possibly the majority of them are rejected 
 and inhibited. Psychologically this process expresses 
 itself in the fiat or in the neget, in the "I will", or the 
 "I will not." Every one is well acquainted with the 
 will-effort, especially when having to make some im- 
 portant decision. These superior "choice and will" 
 centres, localized by Ferrier, Wundt, Bianchi and oth- 
 ers in the frontal lobes, and by others in the upper 
 layers of the cortex, on account of their selective and 
 
Subconscious Manifestation 13 
 
 inhibitory function, may be characterized as inhibitory 
 centres par excellence. 
 
 Parallel to the double system of nervous centres, the 
 inferior and the superior, we also have a double con- 
 sciousness, the inferior, the organic, the reflex con- 
 sciousness, the subconsciousness, and the superior, the 
 controlling, the choosing, the critical, the will-con- 
 sciousness. The controlling consciousness may be char- 
 acterized as the guardian consciousness of the species 
 and of the individual. 
 
 From an evolutionary, teleological standpoint we can 
 well realize the use of this guardian consciousness. The 
 external world bombards the living organism with in- 
 numerable stimuli; from all sides thousands of impres- 
 sions come crowding upon the senses of the individual. 
 Each impression has a glandular affection, a motor re- 
 action which if not counteracted may end in some pos- 
 sibly harmful or fatal result. It is not of advantage to 
 the organism to react on all impressions, coming from 
 external stimuli; hence that organism will succeed and 
 survive in the struggle for existence that possesses some 
 critical, selective, inhibitory "choice and will" centres. 
 
 The "choice and will centres" permit only a certain 
 number of impressions to take effect, the rest are inhib- 
 ited, only thpse impressions that are advantageous to the 
 life existence of the individual are allowed to take thefr 
 course ; the others are nipped in their bud. The guar- 
 dian-consciousness wards off as far as it is able all the 
 harmful blows which the stimuli of the environment in- 
 cessantly direct against the life of the individual. 
 
 In the normal condition of man the superior and 
 inferior centres work in perfect harmony; the upper 
 and lower centres and their concomitant forms of 
 
14 Diagnosis of Psychopathic Diseases 
 
 consciousness are a unity, forming one conscious, ac- 
 tive personality. Under certain conditions tlie two 
 systems of nerve-centres may become dissociated. The 
 superior centres, with their critical, controlling con- 
 sciousness may become inhibited, or cut off, split off 
 from the rest of the nervous system with its reflex con- 
 sciousness which i? thus laid bare, open to the influence 
 of external stimuli or suggestions. The inferior reflex 
 consciousness constitutes the subconscious. The sub- 
 conscious is the highway of suggestibility. The sub- 
 conscious is manifested or laid bare by inhibition of the 
 inhibitory centres, or in other words, by a disaggrega- 
 tion of the superior from the inferior centres, followed 
 by an increase of ideo-sensory, ideo-motor, and sensory- 
 secretory reflex excitability. Psychologically regarded, 
 inhibition of the controlling, waking consciousness re- 
 sults in the uncovering of the reflex consciousness, the 
 revelation of the subconscious.* 
 
 To get at subconscious states definite conditions 
 must be strictly observed, no matter what the method 
 of procedure is. 
 
 The first and general condition of experimentation 
 on the subconscious is fixation of attention. I ask the 
 patient or subject to look at some particular point 
 chosen by me, the time of fixation usually varying from 
 two to five seconds. Fixation of attention is an import- 
 ant condition of access to the subconscious. 
 
 The next condition is distraction of attention. The 
 
 *By tile subconscious is meant all processes of intelligence which 
 are subjectively known as conscious, but which under special con- 
 ditions fall outside the range of awareness, or of the knowledge of 
 the individual. The subconscious is essentially a consciousness, a 
 consciousness other than the personal consciousness. See "The 
 Psychology of Suggestion," "Multiple Personality," "The Founda- 
 tions of Normal and Abnormal Psychology," and Appendix IV. 
 
Subconscious Manifestation 15 
 
 subject or patient has for a brief time, varying from 
 a few minutes to hours, to fix his attention on some 
 irrelevant point, spot, thing that has no connection 
 with the material of the experiments or with the mat- 
 ter under investigation. 
 
 In all my experiments on the subconscious I have al- 
 ways had to guard against variety of impressions. 
 Slight noises, coming from the adjoining rooms of the 
 laboratory, are distinctly unfavorable to the experi- 
 ments. There must be monotony. The subjects have 
 to be accustomed to the conditions and objects in the 
 room. A new impression, however slight, always 
 proves a disturbance. 
 
 Limitation of voluntary movements is another im- 
 portant condition. While fixing their attention the pa- 
 tients or subjects have to keep as quiet as possible ; oth- 
 erwise they are disturbed, the attention begins to wan- 
 der, and the work has to be abandoned for the time be- 
 ing. The subjects should be asked to make themselves 
 as comfortable as possible, so they should not have to 
 change their position during the investigation, and have 
 their limbs relaxed. The condition of limitation of 
 voluntary movements must be strictly observed. 
 
 Limitation of the field of consciousness may also be 
 considered as one of the important conditions of in- 
 vestigation of the subconscious. This condition is in 
 fact a result of the former ones, namely, fixation of the 
 attention, monotony, and limitation of voluntary move- 
 ments. For when these last conditions are present, 
 the field of consciousness becomes contracted and lim- 
 ited to a few sensations and ideas. Cqntraction of the 
 field of consciousness may, however, be effected where 
 the other conditions are absent. A sudden, Solent 
 
1 6 Diagnosis of Psychopathic Diseases 
 
 impression may instantly effect an enormous shrinkage 
 of the field of consciousness, and then the other condi- 
 tions will naturally follow, or rather coexist. Con- 
 sciousness will reverberate with this one violent sense 
 impression and will thus attend to the latter only. 
 There will also be monotony; since a sudden violent 
 sense impression tolerates few neighbors, and drives 
 out fresh incomers. Voluntary movements become 
 limited, the body becomes paralyzed and relaxed. 
 
 Work on the subconscious can not be successfully 
 carried on without the condition of inhibition. I 
 ask the subject when he concentrates his attention and 
 fixes it on a dot or object that he should try, as much as 
 it is in his power, to banish all ideas, images which 
 have no connection with the object in the focus of con- 
 sciousness, that he should make his mind a perfect 
 blank, and inhibit ideas, associations which may arise be- 
 fore his mind's eye and claim attention. This condi- 
 tion, of course, is rather a hard task for the subject or 
 patient to comply with, still it is observed as far as it 
 is possible. 
 
 The very last, but not the least condition, in the ex- 
 periments is immediate execution. The subject has to 
 perform the act required by the nature of the experi- 
 ment as soon as he perceives the signal. 
 
 We may now make a synopsis of the conditions 
 necessary for reaching the subconscious strata of the 
 mind in the normal waking state : 
 
 ( 1 ) Fixation of the attention. 
 
 (2) Distraction of the attention. 
 
 ( 3 ) Monotony. 
 
 (4) Limitation of voluntary movements. 
 
 ( 5 ) Contraction of the field of consciousness. 
 
Subconscious Manifestation 17 
 
 (6) Inhibition. 
 
 (7) Immediate execution. 
 
 The conditions of distraction of attention and im- 
 mediate execution are requisite for suggestibility in the 
 fully waking states. The induction of more or less 
 stable subconscious states is brought about under per- 
 sistent action of five factors : 
 
 (i) Fixation of attention. 
 
 (2) Monotony. 
 
 (3) Limitation of voluntary movements. 
 
 (4) Contraction of the field of consciousness. 
 
 (5) Inhibition,* 
 
 It should be clearly understood that the factor of 
 limitation of voluntary movements means essentially 
 bodily relaxation. 
 
 The study of subconscious states is of recent origin, 
 but it is now daily growing in importance. The me- 
 chanism of the human mind, the more elementary 
 psychic processes are not directly given to the imme- 
 diate introspective knowledge of self-consciousness, 
 the results alone are given. It is the subconsciousness 
 that one must look to in order to grasp the full mean- 
 ing of the workings of the mind. 
 
 In experimenting on the subconscious in the normal 
 waking state we may use two methods: 
 
 (I) The method of conscious impressions. 
 
 (II) The method of subconscious impressions. 
 
 (I) By the method of conscious impression we en- 
 deavor to reach the subconscious through the medium 
 of impressions of which the subject is fully conscious. 
 This m£thod may in its turn be subdivided into : 
 
 (a) The method of indeterminate action. 
 
 *These conditions will be described in greater detail further on. 
 
1 8 Diagnosis of Psychopathic Diseases 
 
 (b) The method of determinate action. 
 
 (a) When working with the method of indeterm- 
 inate action we allow the subject, within certain limits, 
 of course, to do or write anything that enters into his 
 mind at the moment the experimentation is over. In 
 studying, for instance, the suggestibility of the sub- 
 conscious we may direct our efforts to find out, say, the 
 suggestiveness of different conditions such as the influ- 
 ence of the earliest or latest impressions of certain 
 stimuli, or the effect of a series of successive frequent 
 or coexistent stimuli. 
 
 (b) The method of determinate action, or that of 
 choice. When working with this method we limit the 
 subject to a definite number of actions. Thus in study- 
 ing the suggestibility of the normal individual, we may 
 seek to determine the influence of the factor of strange, 
 unfamiliar things and actions or that of abnormal posi- 
 tion and so on. 
 
 (II) The method of subconscious Impressions con- 
 sists In arranging the experiments so as to influence the 
 subconscious, but In such a way that the subject should 
 not be conscious of the impressions. This method may 
 be divided into: 
 
 (a) The method of choice distraction. 
 
 (b) The method of guesses or of subconscious im- 
 pressions. 
 
 (a) By means of the method of choice we distract 
 the patient's attention engaging It In some other direc- 
 tion, meanwhile Influencing the subconscious in the de- 
 termination of the subject's choice. The mechanism of 
 these experiments may be arranged somewhat like the 
 following : 
 
 A series of complicated patterns is made on slips of 
 
Subconscious Manifestation 19 
 
 paper, each slip having a different pattern. The subject 
 has to look at the drawing of the pattern for about ten 
 seconds. The slip is then withdrawn and he has to re- 
 produce the drawing from memory — an extremely dif- 
 ficult task. In my experiments on the subconscious it 
 took the subject about fifteen seconds and more before 
 he could make anything bearing the slightest resem- 
 blance to the figure shown to him. When the subject is 
 through with his drawing, a cardboard with a series of 
 numerals is shown to him, he chooses any numeral he 
 pleases. 
 
 Now on the margin of each slip is also a numeral, so 
 that when the subject studies his pattern for reproduc- 
 tion, the number impresses itself subconsciously oh his 
 mind. Even, if at first, he notes the numeral, he soon 
 ignores it, thinking that it is the number of the draw- 
 ing in the series. He soon overlooks it ; he does not see 
 it consciously any more, but sees it subconsciously. In 
 my experiments conducted by this method, the subjects 
 had not the slightest suspicion of the real purpose of 
 the research. They were sure that the whole matter 
 was concerning imitation of the patterns and that the 
 choosing of the numeral on the cardboard was but a 
 device "to break up the attention," in passing from one 
 pattern to another. The subjects were so intensely 
 absorbed in the contemplation and then in the reproduc- 
 tion of the drawing which was extremely complicated, 
 that they wholly disregarded the marginal numbers.* 
 
 (b) The method of subconscious impressions helps 
 us to determine the relations of the subconscious to the 
 
 *The number of choices influenced by the marginal number seen 
 subconsciously is noted down and the total number of choices is de- 
 termined. 
 
20 Diagnosis of Psychopathic Diseases 
 
 subject's self-consciousness. The mechanism of the 
 method is simple, though important. We give the sub- 
 ject an impression that lies outside the range of his 
 field of conscious sensibility, and ask him to guess the 
 particular or general character of the stimulus or im- 
 pression. We take a series of ten cards and tell the 
 subject that on each of them there is a letter or nu- 
 meral. We then put each card outside the field of his 
 vision and ask the subject to look at it for some time 
 and then to guess the character, particular or general. 
 If letter a, for example, is shown to him and he guesses 
 it correctly, then he guesses both the particular and 
 general character, so that we may say that every cor- 
 rect particular guess is also a correct general guess. If 
 he guesses a wrong letter, say b, he guesses correctly 
 the general character only; if, however, instead of the 
 letter he gives a numeral, say 6, then he fails completely. 
 If we eliminate the chance element, we have the number 
 of cases due to subconscious vision.* 
 
 Perhaps it may be well to mention a method of ap- 
 
 *To eliminate the chance element and to find the percentage of 
 correct guesses, both general and particular, due to subconscious 
 vision, let y be the correct general subconscious guesses ; let, again, x 
 represent the correct particular guesses due to subconscious vision, 
 p and />i the general and particular chance guesses. We have the 
 following formulas (m and n being given by experiment) : 
 
 (P+y) — m (i) 
 
 (.Pt+x) = n (2) 
 
 (/'-t-3')'.are all the correct general guesses as mere general; (,pi-\-x), 
 again, in the second equation are the correct particular guesses as 
 particular. From (i), we have, 
 
 y=^m—p (3) 
 
 These are all the correct general guesses. Now, in equation (3), 
 p is SO per cent., because each guess has only one alternative, letter 
 or figure; in 100 observations, />=So; hence 3i=m — 50. 
 
 Since there are only ten characters to guess in each particular case 
 therefore in a hundred cases the chance element in equation [2] is 
 ten, or /> = 10 and x = n — 10. 
 
Subconscious Manifestation 21 
 
 proaching the subconscious or as It is put in reaching 
 tlie so called "suppressed complexes." This consists 
 in giving the patient or subject a series of words and 
 by observing the quality of the answers as well as the 
 time of the reply made or the association time, the 
 character of the "suppressed comiplex" is supposed to 
 be reached, if the association time is found to be 
 lengthened. The same can be done with the galvano- 
 metric reflex. When a special "complex" associated 
 with a suppressed emotion is reached there is a greater 
 galvanometric deflection. The same is claimed to be 
 accomplished with other graphic records, such as 
 sphygmographic, pneumographic, or plethysmograph- 
 ic records. Judging from what Pavlow has written to 
 me that he and his collaborators are at work on the 
 higher nerve activity of the brain of the dog, accord- 
 ing to the methods of conditional reflexes, then it may 
 be possible to study man's mental life or his reac- 
 tions, hpwever complicated, from observed glandular 
 secretions. This fantastic prospect is at present as yet 
 in the distant future. 
 
 I myself have done a good deal of work with all the 
 graphic mfethods, sphygmographic, plethysmographic, 
 pneumographic, and galvanometric* I have taken sev- 
 
 *In my work on galvanometric deflections carried out with Dr. 
 H. T. Kalmus at the Research Laboratory of the Massachusetts 
 Institute of Technology and at my Psychopathological Laboratory 
 we come to the following conclusion : 
 
 "Our experiments clearly point to the fact that active physiologi- 
 cal, sensory, and emotional processes, with the exception of pure 
 ideational ones, initiated in a living organism bring about electro- 
 motive forces with consequent galvanometric deflections." 
 
 In my galvanometric work with Dr. L. Nelson performed on vari- 
 ous animals, on man, frogs, rabbits and cats we arrive at the fol- 
 lowing conclusions: 
 
 I. Galvanometric deflections are brought about by psycho- 
 
22 Diagnosis of Psychopathic Diseases 
 
 eral thousand tracings of each in normal and abnormal 
 cases. / can say without hesitation that from a clinical 
 standpoint their worth is nil. They are good as charts, 
 as curves, as pictures and illustrations for the eye after 
 the data are acquired, but as a guide for psy- 
 chognostic or diagnostic purposes they are all worth- 
 less. 
 
 Similarly with the association method. Noth- 
 ing is more misleading and clumsy than the asso- 
 
 physiological processes (but not by purely ideational processes) 
 under the influence of various stimulations. 
 
 2. These galvanic deflections termed by us "galvanic reactions" 
 are not due to variations of resistance, whether of skin or of body. 
 
 3. The galvanic reaction is the result of variations of electro- 
 motive forces produced by the psycho-physiological processes set 
 into activity by the agency of external or internal stimulations. 
 
 4. The causation of the galvanic reactions cannot be referred to 
 circulation, nor can it be referred to secretory currents, whether of 
 skin-glands or of other glandular organs. 
 
 S- The central nervous system and the sympathetic nervous sys- 
 tem are alike excluded as factors concerned in the manifestation of 
 the galvanic reaction. 
 
 6. The galvanic reaction is a muscular cutaneous phenomenon due 
 to the influence of various agencies, emotional, sensory, physiologi- 
 cal, chemical, thermal, electrical or mechanical. 
 
 7. The galvanic reaction is chiefly brought about by the muscles 
 and glands within the circuit. 
 
 8. Prolonged active peristalsis gives rise to galvanic deflections 
 which are due to the contraction of the muscles and the action of 
 glands involved in the process of peristalsis. 
 
 9. The galvanic reaction diminishes and even completely disap- 
 pears with the repetition of the same kind of stimulation. 
 
 10. This fall or complete disappearance of the galvanic reaction 
 with the repetition of stimulation is usually due to a decrease of 
 sensitivity in regard to the same repeated stimulation. 
 
 11. The fall however of the galvanic reaction may also be brought 
 about by the action of a prolonged stimulation resulting in a 
 gradual fatigue of the muscles in the circuit. 
 
 12. The heart-beat, like the contractions of any of the other 
 muscles, gives rise to galvanic deflections. 
 
 Neither from a practical clinical standpoint nor from a purely 
 theoretical, psychopathological standpoint can we say that the gal- 
 vanometer is of any value. We can no more study mental states 
 with a galvanometer than we can investigate ideas and feelings with 
 a microscope or telescope. The trouble with the medical man is 
 that he wishes to examine mental states as he examines urine, 
 
Subconscious Manifestation 23 
 
 ciation words, the replies, and the time taken. Some 
 people may amuse or deceive themselves with it, but as 
 to the insight which it gives into the delicate working 
 of the human mind in general and of mental troubles 
 in particular the value may be said without hesitation 
 to be less than nothing. The results are misleading 
 and deceptive. The late Professor James was fully 
 right when he characterized this kind of psychological 
 work as "Brass Psychology." 
 
 We can come more closely to the subconscious, in 
 an imperfect way though, through dream states. 
 Dream states belong to the region of the subconscious, 
 but they reach our knowledge in a distorted and vague 
 form, they rapidly fade away and melt under the light 
 and warmth of the waking consciousness. It is a rare 
 thing to remember fully a dream, as a rule but mere 
 shreds remain, and often even these soon disappear or 
 are totally absent on awakening. Still we must make 
 the best we can of what is directly given to us. 
 
 Dreams may be studied either by the memorial 
 method of self observation, by the statistical method, 
 and by experimentation. There are five methods : 
 
 ( 1 ) The memorial method of self-observation. 
 
 (2) The statistical method. 
 
 (3) The psycho-physical method. 
 
 (4) The psycho-physiological method. 
 
 sputum, blood, or bodily reflexes. This_ cannot be done in the case 
 of mental states. There_ is no physical instrument with which 
 mental states can be examined and studied. The sooner the medical 
 man learns it, the less will he be carried away or be deceived by 
 some new wonderful instruments for discovering hidden thoughts 
 or measuring and photographing ideas and feelings. Introspection 
 and observation, supplemented by the physician's or psychopatholo- 
 gist's introspective interpretation, will ever remain the tool of the 
 psychologist and psychopathologist. 
 
24 Diagnosis of Psychopathic Diseases 
 
 (5) The method of psychic stimulation. 
 
 (i) The memorial method consists in giving as 
 complete an account of the dream from memory as it 
 is possible. The dream is written down immediately 
 after awakening, otherwise the whole may fade away 
 altogether. Since many dreams occur during night and 
 disappear, giving place to other qualitatively different 
 states, and thus no memory is retained of those dreams 
 on awakening in the morning, it is advisable for one 
 who undertakes such an investigation to put near his 
 bed a match, pencil, and paper, so that should he wake 
 up any time during the night he may write down the 
 dream immediately while he is yet in condition to catch 
 a glimpse of the positive images left by the dream 
 shadows. 
 
 (2) The statistical method consists in collecting 
 dreams from many observers, classifying the dreams, 
 comparing notes, and drawing conclusions. One, how- 
 ever, must use such material with great precaution as 
 not all observers are trustworthy in such accounts. We 
 must find out whether the records were taken immedi- 
 ately after the dreams, otherwise the facts must be re- 
 jected, or put at least under the heading of doubtful 
 cases, since in such records later images from waking 
 states may in all probability have been interpolated. 
 
 The first two methods bring us indirectly in relation 
 with the subconscious. The other three methods bring 
 us in more direct touch with subconscious life activities. 
 
 (3) The psycho-physical method or that of physi- 
 cal stimulation is the artificial production of dreams by 
 means of physical stimulation of the special senses. 
 The experimenter watches his subject while asleep and 
 applies different stimuli to his peripheral sense-organs. 
 
csuoconsctous iviamjesianon 25 
 
 He pinches, pricks, squeezes the hand, leg, cheek or 
 some other portion of the subject's body, he lights 
 matches before the subject's eyes, drops water on his 
 face, gives him something to smell, agreeable or dis- 
 agreeable ; makes him taste different substances and so 
 on. Dreams are awakened by the stimulations the 
 summation of which finally arouses the subject. In 
 fact, some of the dreams occur during the short period 
 of awakening. The subject tells his dream which is at 
 once recorded by the experimenter. 
 
 (4) The psycho-physiological method or that of 
 physiological stimulation consists in the artificial exci- 
 tation of dreams by means of some stimulants, drugs 
 taken before falling asleep. The dreams may be in- 
 duced by anaesthetics, chloroform or ether, or by drugs 
 such as chloral, veronal, medinal and other hypnotics. 
 
 (5) The method of psychic stimulation is the arou- 
 sal of dreams by means of psychic stimuli, such as 
 words. When the subject is in a deep sleep the experi- 
 menter in a low voice calls out some words or phrases. 
 At first the subject does not seem to hear, but the 
 words summate themselves at last, and the subject 
 sometimes awakens with a start. Meanwhile the sub- 
 ject frequently has dreams formed by the floating 
 images aroused by the speech. As soon as he wakes 
 up he is to give an account of the dream, if any was 
 formed. It is advisable, while making such experi- 
 ments, to use words and phrases that are of intense 
 interest to the subject, or words that are familiar to 
 him, his own name, or the name of those who 
 are near and dear to him, also names, words and 
 phrases to which he is used to respond promptly. This 
 may bring him out of his deep sleep, bv.t may not have 
 
26 Diagnosis of Psychopathic Diseases 
 
 sufficient power to awaken him fully. The words or 
 phrases will thus be enabled to arouse images which 
 will be formed into dreams, following the summation 
 of the stimuli. We should bring the subject out of his 
 deep sleep by degrees. 
 
 By means of the induction of the hypnotic state or 
 by the induction of the hypnoidal state, or the twilight 
 state we can come in direct touch with the subconscious. 
 
 The methods of hypnotization are various, but 
 all of them must conform to the conditions of sugges- 
 tibility. We can hypnotize subjects or patients by hav- 
 ing fixed their attention on some bright object, by 
 fixating attention on the expectation of some sudden 
 bright light, on a glass, a crystal, or on some object held 
 before the patient's eyes. The patient is also told to 
 concentrate his attention on the sounds of suggestion 
 of sleep given by the hypnotizer. 
 
 The hypnotic state can also be induced by passes. 
 The patient concentrates his whole attention on the 
 passes made over him. While the patient is concen- 
 trating his attention there should not be distracting 
 noises. He should listen to the hypnotizer's monoton- 
 ous voice or to some monotonously sounding apparatus. 
 
 Any monotonous stimulation in fact will do, such as 
 monotonous stroking or patting; uniform alternation of 
 light and shade, such as flickering, or uniform alterna- 
 tion of sound, uniform movement, swinging, rocking, 
 or rotating will bring about the effect of plunging the 
 patient into a hypnotic state. The patient's voluntary 
 movements should be restricted, he should keep quiet 
 and as much as possible, have his limbs completely re- 
 laxed. At the same time the patient's field of conscious- 
 ness should be limited. Ideas should be banished as 
 
Subconscious Manifestation 27 
 
 much as possible. A state of monoideism should be in- 
 duced. The subject should only think of "sleep, sleep, 
 sleep." In short, all ideas and reasoning should be in- 
 hibited. 
 
 Sometimes all this can be brought about by a sudden 
 strong stimulus unexpected by the patient. The intense 
 emotion of fear aroused in the patient fixes the patient's 
 mind on the stimulus which paralyses his consciousness 
 and his motor adjustments. The patient falls into a 
 state of physical and mental relaxation with a monoton- 
 ous consciousness, Into a state of physical and mental In- 
 hibition. These procedures produce that peculiar state 
 known as hypnosis in which the subconscious comes to 
 the foreground. 
 
 I have for many years employed a method which 
 gives uniformly excellent results. I wish to attract the 
 attention of the medical profession to this method of 
 hypnoidization, as it is not only of theoretical import- 
 ance for the purposes of psychopathologlcal analysis, 
 but it is possibly of still greater value for practical 
 therapeutic purposes. 
 
 In 'The Psychology of Suggestion' and in other 
 works I have pointed out the following conditions of 
 normal and abnormal suggestibility: 
 
28 Diagnosis of fsycnopatntc uiseases 
 
 NOBMAL SUGQBSTfflnilTT. ABNORMAL SUQGBSTIBILITT. 
 
 1. Fixation of attention. 1. Fixation of attention. 
 
 2. Distraction. 2. 
 
 3. Monotony. 3. Monotony. 
 
 4. Limitation of voluntary move- 4. Limitation of voluntary move- 
 
 ments, ments. 
 
 5. Limitation of the field of con- 5. Limitation of the field of con- 
 
 sciousness, sciousness. 
 
 6. Inhibition. 6. Inhibition. 
 
 7. Immediate execution of the sug- 7. 
 
 gestion. 
 
 In the same work I come to the conclusion as 
 the result of the investigation that "the nature of ab- 
 normal suggestibility is a disaggregation of conscious- 
 ness, a slit, a scar, produced in the mind that may ex- 
 tend wider and deeper, ending at last in a total dis- 
 junction of the waiting, guiding, controlling conscious- 
 ness from the reflex consciousness. . . . Normal 
 suggestibility is of like nature, — it is a cleft in the 
 mind, only here the cleft is not so deep, not so lasting, 
 as it is in hypnosis or in the state of abnormal suggesti- 
 bility; the split is here but momentary, evanescent, 
 fleeting, disappearing at the very moment of its ap- 
 pearance." 
 
 We have also shown that the laws of normal and ab- 
 normal suggestibility may be stated as follows : 
 
 "Normal suggestibility varies as indirect suggestion 
 and inversely as direct suggestion. 
 
 "Abnormal suggestibility varies as direct suggestion 
 and inversely as indirect suggestion." 
 
 The general law of suggestibility is : 
 
 "Suggestibility varies as the amount of disaggrega- 
 tion, and inversely as the unification of consciousness." 
 
 It is on these general laws and nature of relation of 
 the personal consciousness to the subconscious that I 
 have based my method of hypnoidization. In order 
 
Subconscious Manifestation 29 
 
 to reach the dissociated mental states we have to lay 
 bare the subconscious, and this can be effected by the 
 conditions requisite for the induction of normal or ab- 
 normal suggestibility, conditions which bring about a 
 disaggregation of consciousness. In cases, therefore, 
 \Yhere hypnosis is not practicable and the subconscious 
 has to be reached, we can effect a disaggregation of 
 consciousness and thus produce an allied, subconscious 
 state by putting the patient under the conditions of 
 normal suggestibility: fixation of attention, distraction, 
 monotony, limitation of the voluntary movements, lim- 
 itation of the field of vision, inhibition, and immediate 
 execution. 
 
 This is precisely what the method of hypnoidiza- 
 tion consists in: "The patient is asked to close 
 his eyes and keep as quiet as possible, without, how- 
 ever, 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 (or to the monotonous beats 
 of a metronome) When the reading is over, the pa- 
 tient, with his eyes shut, is asked to repeat it and tell 
 what comes into his mind during the reading, or during 
 the repetition, or immediately after it. Sometimes the 
 patient is simply asked to tell the nature of ideas and 
 images that have entered his mind." This should be 
 carried out in a quiet place, and the room, if pos- 
 sible, should be darkened so as not to disturb the pa- 
 tient and bring him out of the state in which he has 
 been put. 
 
 As modifications of the same method, the patient is 
 asked to fixate his attention on some object while at the 
 same time listening to the beats of a metronome; the 
 patient's eyes are then closed; he is to keep very quiet. 
 
30 Diagnosis of Psychopathic Diseases 
 
 while the metronome or some other monotonous stimu- 
 lus is kept on going. After some time, when his res- 
 pirations and pulse are found somewhat lowered, and 
 he declares that he thinks of nothing in particular, he is 
 asked to concentrate his attention on a subject closely 
 relating to the symptoms of the malady or to the sub- 
 merged subconscious states. 
 
 The patient again may be asked to keep quiet, 
 to move or change position as little as possible, and he is 
 then required to look steadily into a glass of water on 
 a white background, with a light shining through the 
 contents of the glass ; a mechanism producing monoto- 
 nous sounds is set going, and after a time, when the pa- 
 tient is observed to have become unusually quiet, he is 
 asked to tell what he thinks in regard to a subject relat- 
 ing to his symptoms. He may be asked to write the 
 stray ideas down, if speaking aloud disturbs the in- 
 duced states favorable to the emergence of the disso- 
 ciated mental states. 
 
 In some cases it is sufficient to put the patient in a 
 quiet condition; have his eyes shut and command 
 him to think hard of the particular dissociated states. 
 
 The method of guessing has been for years utilized by 
 my collaborators and myself as a clinical method for 
 coming in contact with the subconscious, dissociated 
 systems of which the patient remained unaware in his 
 otherwise normal waking consciousness. The patient 
 is put in a chair, or on a lounge, is told to be quiet and 
 have his eyes shut. He is then told to concentrate 
 his attention on some of the more prominent symptoms 
 of his trouble and tell immediately any idea, phrase, 
 sentence, picture or image that may at that moment 
 enter his mind. In this way we obtain scraps from his 
 
Subconscious Manifestation 31 
 
 subconscious life activity, on fitting them together we 
 have something to start with in the psychognosis of the 
 cases. 
 
 I further combined this method with the methods 
 of studying the patient's dreams. The patient's dreams 
 are near the surface of his everyday waking con- 
 sciousness, and since they are experiences coming from 
 his subconscious life activity, I could, by the method 
 of guesses, obtain the dreams which the patient exper- 
 ienced and which have often proved to be chips of ex- 
 perience which went to form his present mental make- 
 up, and have been the cause of his present disease with 
 all its characteristic symptoms. The patient often 
 lived through in his dreams the events which caused 
 his psychopathic malady. The experiences are usually 
 obtained in chips, scraps, and bits. By piecing them 
 together we penetrate more and more deeply into the 
 patient's subconscious mental activity. This method 
 of guesses together with the method of studying the 
 dream activity yield, along with other methods, such as 
 the direct observation of the dream activity and along 
 with the hypnotic state, good material for psychognostic 
 purposes. 
 
 My clinical and laboratory researches led me, how- 
 ever, by degrees to the discovery of the hypnoidal 
 state which I have since found to be of the ut- 
 most ccmsequence for psychognostic and psychother- 
 apeutic purposes. In fact I found that in most 
 of the cases what I thought to be a state of waking con- 
 sciousness was in reality a hypnoidal state. In direct- 
 ing the patient to close his eyes and keep quiet and con- 
 centrate his thoughts on a definite symptom, dream or 
 event in his life, I found that the patient passed into ^ 
 
32 Diagnosis of Psychopathic Diseases 
 
 hypnoidal condition. This led me to the formulation 
 of the method of hypnoidization, or the induction of 
 hypnoidal states. 
 
CHAPTER II 
 
 THE HYPNOIDAL TWILIGHT STATE 
 
 BY the method of hypnoidization we pro- 
 duce a peculiar state which, for the lack of a 
 better term, I designate as "hypnoidal," twi- 
 light state. What is the hypnoidal state? 
 The hypnoidal state is essentially a borderland state. 
 The subject is apparently awake and seems to be in full 
 possession of all his powers, and still he is more closely 
 in touch with the dissociated experiences than he is 
 otherwise in the full waking state. Perhaps the sub- 
 waking state would possibly be an apt term for the 
 hypnoidal condition. The subject seems to hover be- 
 tween the conscious and the subconscious, somewhat in 
 the same way as in the half-drowsy condition we hover 
 between wakefulness and sleep. 
 
 The hypnoidal state is not a stable condition, it keeps 
 on fluctuating from moment to moment; now falling 
 more deeply into a subconscious condition in which out- 
 lived experiences are easily aroused, or again rising to 
 the level of waking States. In such conditions the pa- 
 tient often tells you "something has come . . . , 
 but it is gone." The hypnoidal state has changed, it 
 has become lighter, and the dissociated' moments have 
 become again submerged. There is a constant struggle 
 going on in the hunting out of the stray dissociated 
 systems. 
 
 The state brought about by hypnoidization is essen- 
 tially a transient, evanescent, mental disaggregation of 
 
 33 
 
34 Diagnosis of Psychopathic Diseases 
 
 the personal consciousness from the reflex subconscious- 
 ness. The hypnoidal state borders closely on light hyp- 
 nosis; and still it is not exactly a hypnotic state and may 
 be regarded as an intermediate state. In a series of ex- 
 periments on the nature of sleep of lower animals as 
 well as of infants and adults, the facts tend to indicate 
 that the hypnoidal state is intermediary between hyp- 
 nosis and sleep on the one hand and the waking state on 
 the other. 
 
 The hypnoidal state may either lead to sleep or to 
 hypnosis. 
 
 The close relationship of the hypnoidal state and of 
 hypnosis is sometimes forcibly brought to the attention 
 of the experimenter. Some patients while in the hyp- 
 noidal state are observed to become unusually quiet, 
 less talkative, become relaxed, and after a time a dis- 
 tinctly cataleptic condition of the extremities may be 
 observed. The patient has apparently passed into hyp- 
 nosis. In most of the cases the hypnosis is of 
 brief duration, while in a few cases the hypnosis may 
 become lasting and deep. On the other hand, in many 
 cases the subject falls into a sleeping state without as 
 much as touching on hypnosis. 
 
 The hjrpnoidal state is an intermediary state, inter- 
 mediate between the waking state, sleep and hyp- 
 nosis. 'Subwaking' may possibly be an appropriate de- 
 scriptive term of the character of the hypnoidal state. 
 The subwaking, hypnoidal state, like sleep and hyp- 
 nosis, may be of various depth and duration; it may 
 range from the fully waking consciousness, and again 
 may closely approach and even merge into sleep or hyp- 
 nosis. The same patient may at various times reach 
 different levels, and hence subconscious experiences 
 
The Hypnoidal Twilight Utate 35 
 
 which are inaccessible at one time may become revealed 
 at some subsequent time, when the patient happens to 
 go into a deeper level of the hypnoidal state. 
 
 On account of the instability of the hypnoidal state 
 and because of the continuous fluctuation and variation 
 of the depth of its level, the subconscious dissociated 
 experiences comie up in bits and scraps and often may 
 lack the sense of familiarity and recognition. The pa- 
 tient often loses the train of subconscious associations; 
 there is a constant struggle to maintain this highly un- 
 stable hypnoidal state, and one has again and again 
 to return to the same subconscious train started into 
 activity for a brief interval of time. One must pick his 
 way among streams of disturbing associations before 
 the dissociated subconscious experiences can be synthe- 
 tized into a whole, reproducing representatively the 
 original experience that has given rise to the whole 
 train of symptoms. 
 
 The hypnoidal state may sometimes reproduce the 
 original experience which, at first struggling up in a 
 broken, distorted form and finally becoming synthe- 
 tized, gives rise to a full attack. The symptoms of the 
 malady turn out to be portions, bits and chips of past 
 experiences which have become dissociated, subconsci- 
 ous, giving rise to a disaggregated subconsciousness. 
 The method of hypnoidization and the hypnoidal states 
 induced by it enable us to trace the history and etiology 
 of the symptoms and also to efiect a synthesis and a 
 cure. 
 
 Any arrangem'ent of external circumstances tending 
 to produce monotony and limitation of voluntary 
 movements brings about a subconscious state of sug- 
 gestibility in which mental life can be afiected with 
 
36 Diagnosis of Psychopathic Diseases 
 
 ease. I And that in that subconscious state, conscious- 
 ness is vaguer than in the waking state, and memory is 
 more difiused, so that experiences apparently forgot- 
 ten come in bits and scraps to the foreground of con- 
 sciousness. Emotional excitement becomes calmed, 
 voluntary activity is somewhat passive, and suggestions 
 meet with little resistance. The induced subconscious 
 state is a rest state, a state of physical and mental re- 
 laxation. It is a state of rest and relaxation that is 
 specially amenable to psychotherapeutic influences. 
 The important results obtained by me lied me to a 
 closer study of what I then thought was a peculiar men- 
 tal state designated by me as the twilight subwaking, 
 or the hypnoidal state. 
 
 The subwaking, or hypnoidal state is essentially an 
 intermediary twilight state belonging apparently to 
 the borderland of mental life. On the one hand, 
 the hypnoidal state closely touches on the waking 
 condition; on the other, it merges into sleep and 
 hjrpnosis. A close study of the hypnoidal state 
 shows that it differs from the hypnotic state 
 proper and that it can by no means be identi- 
 fied even with light hypnosis. In my years of 
 work on patients and subjects, I have observed the 
 presence of the hypnoidal state before the development 
 of hypnosis and also before the onset of sleep. When 
 again the hypnotic or sleep state passes into waking, 
 the hypnoidal state reappears. The hypnoidal state 
 then may be regarded as an intermediate and transi- 
 tional state. 
 
 A somewhat related state has been long known in 
 psychological literature as the hypnagogic state which 
 precedes the oncome of sleep and is rich in hallucina- 
 
The Hypnoidal Twilight State 37 
 
 tions known under the term of hypnagogic hallucina- 
 tions. In coming out of sleep, a closely-related state 
 may be observed, a state which I have termed hyp- 
 napagogic. In both states, hypnagogic and hypnapa- 
 gogic, dream-hallucinations hold sway. 
 
 The hypnagogic and hypnapagogic* states do not be- 
 long to light hypnosis, as it can hardly be claimed that 
 men fall into light hypnosis twice or possibly more than 
 that every day of their life. We do not go into light 
 hypnosis with every nap we take. We do, however, go 
 into the hypnoidal state when we pass into sleep or come 
 out of sleep. Every drowsy state has the hypnoidal 
 state as one of its constituents ; every sleep state is pre- 
 ceded and followed by the hypnoidal state. 
 
 Hypnosis may be regarded as belonging to ab- 
 normal mental states, while the hypnoidal state is more 
 closely allied to waking and sleep and, as such, belongs 
 to the normal, physiological, mental states. At first, I 
 regarded the hypnoidal state as peculiar, but as I pro- 
 ceeded with my observations and experiments I could 
 not help coming to the conclusion that the hypnoidal 
 state is found in all the representatives of animal life 
 and is as normal as waking and sleep. 
 
 The hypnoidal state may be said to partake not only 
 of the nature of waking and sleep, but also to possess 
 some characteristics of hypnosis, namely, suggestibility. 
 It is clear that from the very nature of its mixed symp- 
 tomatology the hypnoidal state is variable and highly 
 unstable. The hypnoidal state may be regarded more 
 in the light of an equivalent of sleep. Like sleep, the 
 hypnoidal state has many levels of depth. It differs, 
 
 ♦Hypnagogic states are hallucinatory dream states appearing just 
 before falling asleep, hypnapagogic are hallucinatory dream states 
 experienced just before waking. 
 
38 
 
 Diagnosis of Psychopathic Diseases 
 
 however, from sleep in the rapidity of oscillation from 
 level to level. 
 
 In the experiments of various investigators, the 
 depth of sleep is found to be represented by a 
 rapidly rising curve during the first couple of hours 
 and by a gradually descending curve during the rest of 
 the hours of sleep. 
 
 Michelson measured the depth of sleep by the in- 
 tensity of sound stimuli that can awaken the sleeper. 
 The stimulus was the fall of a ball of a definite mass 
 through a definite distance. Plotting the hours of 
 sleep on the abscissa and the sound stimuli in thousands 
 of grammocentimeters, he finds the curve of sleep falls 
 rapidly after the first hour. 
 
 1234*5675 
 
 Kohlschijtter, who also worked with sound stimuli, 
 represents the sleep curve as follows: 
 
 01Z54.;67S 
 
The Hypnoidal Twilight State 
 
 39 
 
 Sante de Sanctis and Nevroz worked with the aes- 
 thesiometer on the senses of touch and pressure; they 
 found that the sleep curve should be represented as fol- 
 lows: 
 
 No such regularity of curve can be found in the 
 hypnoidal state. The depth of the hypnoidal state 
 changes very rapidly, and with it the passive condi- 
 tion and suggestibility of the patient. 
 
CHAPTER III 
 
 THE HYPNOIDAL TWILIGHT STATE IN ANIMALS AND 
 INFANTS 
 
 I FIND in my experiments on the induction of the 
 intermediary hypnoidal states in man that the 
 conditions of monotony, limitation of voluntary 
 movements, limitation of the field of consciousness 
 are of the utmost consequence. In my experimtents on 
 animals I followed the same line of work and as far as 
 possible reproduced the same conditions. I tried to 
 limit the incoming sensory impressions, to limit the 
 voluntary movements, relax them as much as possible 
 and produce a monotonous state by the continuous 
 inhibition of new and varied stimulations. After nar- 
 rowing down the animal's psycho-physiological activity 
 I invariably found that when I succeeded in maintaining 
 closely the same conditions which have been found 
 favorable in human subjects for the induction of sub- 
 waking states, the animal uniformly fell into a passive 
 condition closely analogous to the subwaking state and 
 in many instances into a deep sleep. 
 
 The condition of the animal was often strikingly 
 similar to the one observed in the human subject. The 
 respiration and pulse were lowered, while mental activ- 
 ity in the higher animals, alertness of sensory and mo- 
 tor reactions to external stimulations in the lower ani- 
 mals became greatly reduced and even completely sup- 
 pressed. In the higher animals, such as dogs, a tran- 
 sitory cataleptic state, a state in which the voluntary 
 
 40 
 
Hypnoidal State in Animals and Infants 41 
 
 muscles retained the position given to them, could be 
 observed accompanied by a disturbance of respiration 
 and heart-beat. 
 
 The slight disturbance then subsided and calmness 
 supervened. The calm lasted but a brief period of 
 time and the disturbances reappeared. The latter were 
 once more succeeded by calm which ended by a full wak- 
 ing state or by a deep sleep. In other words, the ex- 
 periments, allow me to draw the conclusion that I had 
 here the typical manifestations observed under the same 
 conditions in the human subjects. I found here the 
 manifestations characteristic of the intermediary hyp- 
 noidal states, the animal now passing into waking and 
 now falling into sleep. 
 
 In the series of experiments carried out on frogs 
 I find present the conditions of monotony and limita- 
 tion of voluntary movements as well as of limitation of 
 what may be regarded In the frog as consciousness, or 
 of the limitation of the activity of the sensorium by cut- 
 ting off the regularly incoming sensory stimulations. As 
 a result we find something analogous to what we should 
 have expected In the human subject under like condi- 
 tions, namely, the presence of peculiar passive states, — 
 that Is all that we are thus far justified in saying of 
 them, observed and described by experimenters who do 
 not have the possibility of getting the subjective ex- 
 perlencb of the animal under observation. 
 
 What we find in the state of the frog Is a condition 
 somewhat analogous to what we have found in our 
 experiments in the human subjects namely the pres- 
 ence of intermediary states of the subwaking hypnoidal 
 type. The symptoms observed differ somewhat, but 
 in general they may be regarded as alike, We find ^ 
 
42 Diagnosis of Psychopathic Diseases 
 
 passive state with cataleptic manifestations. The state 
 varies from catalepsy to relaxation, or what may be 
 regarded as lethargy, and again from passivity to ac- 
 tivity, from sluggish to very lively reactions in re- 
 sponse to external stimulations. We have therefore 
 here, manifestations which remind one of like wlani- 
 festations in the human subject, namely, subwaking 
 hypnoidal states which are on the borderland of wak- 
 ing, h)T)nosis, and sleep. 
 
 Of course, we should not expect to find that frogs 
 which stand so low in the scale of vertebrates would 
 manifest phenomena of the higher vertebrates, but we 
 should expect that some similar phenomena, though 
 otherwise widely different, would be present. This is 
 precisely what we find in the frog. We find the general 
 characteristics, though rather vague, of what is after- 
 wards fully developed in man as the subwaking, hyp- 
 noidal state. 
 
 We must remember besides that the hypnoidal state 
 is very unstable and its manifestations, having the char- 
 acteristics of waking-state, sleep, and hypnosis greatly 
 vary in different individuals, and at different times in 
 the same individual. We should therefore expect that 
 the hypnoidal state would show still more radical dif- 
 ferences from the typical in the various species of ani- 
 mals, especially in those that stand so far apart from 
 each other as frog and man. What is surprising to mle 
 is not the variation and great difference of the hypnoi- 
 dal state in the frog as contrasted with that of man, 
 but that the difference is really not far greater, consid- 
 ering the gap that exists between the two organisms. In 
 fact, the similarity is far more striking than the dif- 
 ference between the hypnoidal states of the two con- 
 
Hypnoidal State in Animals and Infants 43 
 
 trasted organizations so widely apart in the scale of 
 evolution. 
 
 My view then is that the phenomena observed in the 
 frog are hypnoidal in character. The phenomena 
 themselves as well as the conditions under which they 
 are induced warrant my view of the hypnoidal nature 
 of the states. 
 
 In this respect we can well understand the apparent 
 disagreement of the early observers on the subject. 
 Czermak and Danielewsky regard the phenomena as 
 being of the hypnotic order, Heubel regards them as 
 being more of sleep states, while Preyer views them as 
 being the results of fright which give in the waking 
 state cataleptic manifestations closely similar to those 
 observed in hypnosis. Verworn who regards the phe- 
 nomena as "Lagecorrectionen" due to central inhibi- 
 tions really does not conflict with any of the views. It 
 is simply a general physiological hypothesis which may 
 be in accord with any view, a physiological hypothesis 
 which niay or may not be true; it is a hypothesis far 
 removed from the special facts and should be tested 
 on its own merits. 
 
 My point of view is not a matter of hypothesis, 
 but describes and explains the phenomena in terms 
 of states having similar manifestations and produced 
 under the same conditions, states which are more 
 developed and stand out more pronounced in high- 
 er animals. These states possess many of the char- 
 acteristics of the waking state, sleep, and hypnosis. 
 Hence the reason why the early observers regarded the 
 phenomena as waking states, others considered them as 
 hypnosis, while other investigators regarded the phe- 
 nomena as sleep states. 
 
44 Diagnosis of Psychopathic Diseases 
 
 As a matter of fact the phenomena and the conditions 
 under which they are induced make the ^iew highly 
 probable that the different investigators are not far 
 from the truth, but not being acquainted with the 
 peculiar hypnoidal states described, they observed the 
 phenomena in too one sided terms, in terms of sleep,, 
 or hypnosis, or of waking states. In reality the phe- 
 nomena and conditions under which they are induced 
 point strongly to the fact that the states are hypnoidal 
 in character, states which partake at once of all the 
 three apparently contradictory manifestations, — wak- 
 ing, sleep, and hypnosis. Now the manifestation of 
 the waking-state, now the symptoms of sleep, and 
 now again those of hypnosis predominate. 
 
 The state induced in the frog under the conditions of 
 monotony, limitation, and inhibition is a variety of the 
 subwaking, hypnoidal states. This induced hypnoidal 
 state, being intermediary in character, may either par- 
 take of the catalepsy of hypnosis strongly modified and 
 manifesting itself differently in the frog than in the 
 human subject, or may again go over into the passive 
 state of "sleep" or some state analogous to it. 
 
 It is perhaps of importance to call attention to the 
 significant fact that the first stages induced in the frog 
 are rather of an unstable character, — the frog when 
 put on its back and kept down for but a short time falls 
 into an apparently cataleptic state of short duration. 
 The animal soon rights itself and is fully awake as 
 before. This instability Is very characteristic. Now 
 the hypnoidal states are characterized by this funda- 
 miental trait of instability. It is only when the condi- 
 tion of monotony, limitations of voluntary movements 
 and inhibition are sufficiently prolonged, that the cata- 
 
Hypnoidal State in Animals and Infants 45 
 
 lepsy becomes more or less fixed for some period of 
 time ; and when this passes off, and the conditions un- 
 der which the frog is kept are continued still further, 
 it is only then that the frog sinks into a passive state 
 which may last indefinitely, unless brought out of it by 
 some strong stimulation. It seems to me then, that if 
 we take all this into consideration, we cannot possibly 
 describe the state in which the frog is put, in other 
 terms than what we have on other occasions discovered 
 to be the intermediary, subwaking, hypnoidal state. 
 
 The experiments on guinea-pigs gave results some- 
 what similar to those of the frogs, though the cata- 
 leptic states were not so pronounced, — in fact they 
 were transient. Still the induction of sleep was brought 
 about under conditions of monotony, limitation, and in- 
 hibition. It was far more difficult to bring about rest or 
 passive states in guinea-pigs than in frogs, on account 
 of the great liveliness and ceaseless activity of the pigs. 
 
 At times anaesthetics were resorted to in order to fa- 
 cilitate the production of hypnoidal states. It may be 
 objected that the anaesthetics somewhat modified the 
 result, because it may be claimed that the sleep-states 
 induced were really due to the anaesthetics used. Thw 
 objection however can be easily obviated by the re- 
 joinder that the action of the anaesthetic was only to 
 reduce the extraordinary activity and restlessness of 
 the animal and thus make it easier to induce sleep. 
 
 The sleep-states themselves were really produced un- 
 der the same conditions as were the ones induced in 
 frogs and in ray human subjects. In fact even when 
 the guinea-pigs were really lively and active it was suf- 
 ficient to subject them to the conditions described, when 
 they gradually fell into a state very much of the char- 
 
4-6 Diagnosis of Psychopathic Diseases 
 
 acter of hypnoidal states and sleep. The phenomena 
 though were not so well marked as in the frogs. 
 
 A set of experiments were carried out by me on 
 birds and chickens with similar surprising results. The 
 birds were subjected to the general conditions of hyp- 
 hoidization. In all the subjects the manifestations of 
 the hypnoidal state were clearly observed. 
 
 In the experiments on kittens we find the phe- 
 nomena of the subwaking states somewhat more de- 
 veloped than in the guinea-pigs or in the frogs. The 
 cataleptic phenomena are not so pronounced as they 
 are in the frog, but the manifestations of the subwak- 
 ing states approach m'ore closely the manifestations ob- 
 served by me in human subjects. The state is more 
 hypnoidal in character, there is present the transient 
 scarcely perceptible catalepsy which appears for but a 
 moment, giving way immediately either to sleep, or to 
 the waking state. 
 
 Of course, we should not expect to meet with 
 a typical, fully developed suggestibility or somnam- 
 bulistic state in guinea-pigs or in kittens, considfer- 
 ing the fact that even in man, the imbecile, the 
 idiot, and the mentally obtuse hardly go into any such 
 a state. It requires a mind of a highly organized con- 
 stitution to get into a state of abnormal suggestibility 
 and of somnambulism with their accompanying mani- 
 festations. What, however, we do find is the charac- 
 teristic instability of the manifestations of the inter- 
 mediaily, subwaking, hypnoidal states, having some bf 
 the most general somatic s3miptoms of hypnosis, sudi 
 as slight catalepsy, but leading into a passive condition 
 on the intensification of the state. The state in which 
 the anittial is plunged under the Condition of monotony 
 
Hypnoidal State in Animals and Infants 47 
 
 and limitation is hypnoidal, leading towards sleep. 
 
 Dogs are subject to the same conditions of sleep 
 states as is the case with other animals experimented 
 upon. The experiments on dogs bring out the fact 
 that the conditions requisite to induce hypnoidal states 
 in men also hold good in the case of dogs. The 
 hypnoidal states, both in falling into, as well as rising 
 from sleep, are far more pronounced in the dog than 
 in the lower animals experimented upon; the states 
 themselves come up far more closely to similar states 
 observed in man under the same conditions of monot- 
 ony, limitations, and inhibition than they do in other 
 animals, such as the frog, the guinea-pig, the cat. 
 
 Phylogenetically regarded, 'the hypnoidal is the pri- 
 mitive "rest state" out of which sleep and hypnosis 
 have become differentiated. The lower the animal 
 the more insecure, the more unstable are its "rest 
 states." The animal must be on the alert in its rest, 
 and "deep" if at all, with its eyes open, so to say. It 
 must be quick to wake and run from danger, or if it 
 cannot get away, it must "freeze and feign death." In 
 other words, it must be able for the sake of protection 
 to fall into a state of catalepsy. Hence the rest states 
 must partake oi waking, sleep, and hypnosis, that is, 
 must be essentially hypnoidal in character. 
 
 The experiments on dogs are more instructive than 
 the ones carried out on other animals, because they 
 clearly bring out the general principle of monotony 
 and limitation in the causation of sleep. Diminution 
 in the variability of the volume of sensory impressions 
 brings about the hypnoidal state as well as that of 
 sleep. 
 
 The Qcperijnents on animals were followed by ex- 
 
48 Diagnosis of Psychopathic Diseases 
 
 periments on children. The subjects were of different 
 ages ranging from infants a few days old, to children 
 twelve and thirteen years of age. 
 
 It is well known that children usually fall asleep 
 more easily than adults; they sleep longer and also 
 more soundly. This is specially the case with young 
 children and particularly with infants. We know that 
 an infant passes most of its time in sleep, when it does 
 not eat. We should expect therefore that the material 
 would readily lend itself to our present purpose of ex- 
 perimentation, — ^to the induction of sleep states. 
 
 As a matter of fact, I find that in a number of my 
 cases dealing with children it is no difficult task to put 
 them to sleep, or to induce some form of subwaking 
 state, hypnoidal or other closely allied to it. The child 
 easily falls into a subwaking, hypnoidal state. When 
 trying to put children to sleep I have often obtained a 
 hypnotic condition, and on the other hand when at- 
 tempting to put my little patients into a hypnotic state 
 I have only succeeded in putting them to sleep. Be- 
 fore going, however, into either the hypnotic or sleep 
 state, I observed, by close examination, the presence of 
 the hypnoidal state, induced under the conditions of 
 monotony and limitation of voluntary movements. 
 
 Since limitation of the voluntary activity, limitation 
 of the field of consciousness, and inhibition all help to 
 a greater monotony, we may characterize the whole 
 set of conditions requisite for the induction of sleep as 
 the conditions of monotony. In children, especially in 
 infants in whom voluntary activity and the field of con- 
 sciousness are undeveloped and limited, we should ex- 
 pect the child would form a far better soil than the 
 adult for the induction of the intermediary subwaking 
 
Hypnoidal State in Animals and Infants 49 
 
 states and sleep. This is precisely what we find to be 
 the case. 
 
 Moreover, the mind of the child, and more partic- 
 ularly that of the infant, specially depends on muscular 
 activity and on the wealth of incoming sensory impres- 
 sions. That is why the child and the infant take such 
 delight in motor activity,^— in tasting, testing, and 
 handling things. If now the motor activity is limited 
 and the maih source of sensory imipressions, such as 
 sight is restricted, and if the environment is kept in a 
 state of monotony, such as darkness and lack of audi- 
 tory stimulation, or monotony is brought about by con- 
 tinuous noise and buzzing of some instruments pro- 
 ducing a uniform noise, the child, on account of the 
 poverty of its inner mental life, easily falls into a sub- 
 waking, twilight hypnoidal state, and then into sleep. 
 
 Thus we find that in infants, and children, as in low- 
 er animals, sleep, hypnosis, and twilight hypnoidal states 
 are intimately related. 
 
CHAPTER IV 
 
 THE HYPNOIDAL TWILIGHT STATE AND SLEEP 
 
 MONOTONY and limitation of voluntary 
 movements work in one direction — ^they 
 tend to raise the thresholds of psycho-mo- 
 tor reactions, they cooperate in the induc- 
 tion of sleep. These conditions are usually brought 
 about naturally in the course of the daily or nightly life 
 activity of the individual organism, or the conditions 
 may be produced artificially. In both cases the result 
 is the same — ^the organism falls asleep. In the life of 
 higher animals the two cases may often combine. When 
 the individual has fagged out his life interests in his 
 active relations with his surroundings, when the stimuli 
 have become monotonous to him, and his activity with 
 its correlative motor consciousness has become limited 
 and lowered, he makes artificial arrangements for the 
 intensification of the conditions of monotony and lim- 
 itation of voluntary activity. He seeks for a dark nook, 
 closes his eyes to exclude as much as possible all extrane- 
 ous disturbing stimulations and tries to lie down quietly 
 and comfortably, restricts his voluntary movements, 
 breaks his connection with the external world, and goes 
 to sleep. The organism falls into sleep, when the thresh- 
 olds rise, wakes and rises when the thresholds fall.* 
 
 Looked at from a physiological standpoint and ex- 
 pressed in terms of energy, of the "cell energy," sleep 
 
 *By threshold is meant the just perceptible stimulus requisite to set 
 a system into activity. 
 
 50 
 
The Hypnoidal Twilight State and Steep 5 1 
 
 may be regarded as the onset of fatigue, as the onset of 
 exhaustion of the levels of dynamic energy in response 
 to external stimuli. Each particular stimulus has its 
 maximum amount of energy which can be drawn upon, 
 under ordinary conditions of daily life. As the special 
 stimulus approaches its limit, it works under greater 
 and greater difficulties, draws less and less energy, and 
 finally ceases to awaken any response, — the threshold 
 is raised to its maximum and the organism, as far as 
 that special stimulus is concerned, is no longer awake, — 
 the organism is asleep. 
 
 In the course of its daily activity the same takes 
 place in regard to most of the objects, to most or 
 to all of the stimuli that constitute the external 
 world of the organism. The stimuli of the ex- 
 ternal world have drawn all that was permitted to 
 them on their bank accounts, so to say, and the account 
 for the time being Is closed. Nothing more is permitted 
 to go out. No stimulus of ordinary life is permitted to 
 draw over and above a certain amount. There must 
 always be ready capital for unusual situations, for emer- 
 gencies. When the stimuli have drawn their due, and 
 the organism Is left with its reserve energy, liberation 
 of energy with its accompanying waking states ceases. 
 The organism Is no longer awake to the stimuli and is 
 asleep. 
 
 As in the waking states the katabollc processes pre- 
 dominate, so in sleep the reserve processes, the anabolic, 
 take the upper hand. The organism begins to recuperr 
 ate its losses and fills up the accounts drawn upon by 
 the stimuli of the external environment, when In active 
 relation with them. With the Increase of the income 
 of energy the raised thresholds begin to fall until a 
 
52 Diagnosis of Psychopathic Diseases 
 
 point is reached when the stimuli once moire overstep the 
 lowered thresholds and once more gain access to the 
 stores of life-energy, — the organism awakes and enters 
 into active relations with the environment. 
 
 Regarded then from various standpoints, sleep is a 
 rise of moments thesholds under conditions of monot- 
 ony and limitation of voluntary movements. In this 
 respect sleep strongly contrasts with hypnosis. In 
 hypnosis the individual is especially accessible to any 
 kind of suggestions coming from the external world, 
 the psychomotor reactions are greatly lightened and 
 are released by the suggestions or external stimluli with 
 great facility, far greater than in the waking state. 
 This great facility is often expressed by the statement 
 that in hypnosis the inhibitions are removed. 
 
 What specially characterizes hypnosis is the fact of 
 fall of thresholds, present in individuals, with a predis- 
 position to states of dissociation; in sleep on the con- 
 trary we have found from our study, the general char- 
 acteristic is the rise of psychomotor thresholds. 
 
 In passing from the waking state into the subwaking 
 hypnoidal state the individual may either pass into hyp- 
 nosis with its dissociated states and lowered psychomo- 
 tor thresholds, or may go into sleep with raised psycho- 
 motor thresholds. The process of redistribution of thres- 
 holds in the hypnoidal states brings about a fall of 
 thresholds, due to predisposition to and further cultiva- 
 tion of dissociations, the result is hypnosis; when the re- 
 distribution in the twilight states brings about a rise 
 of thresholds, the result is sleep. 
 
 The sleep states of higher animals are developed 
 out of undifferentiated, intermediary, subwaking, hyp- 
 noidal-like states found in the resting states of the low- 
 
The Hypnoidal Twilight State and Sleep 53 
 
 er representatives of animal life. The hypnoidal state 
 is the primitive rest state out of which sleep arises. 
 Briefly put, the hypnoidal state is the germ of sleep. 
 
CHAPTER V 
 
 THE PRIMITIVE REST-STATE 
 
 THE long series of experiments carried out on 
 frogs, rabbits, guinea-pigs, kittens, dogs, in- 
 fants and adults clearly prove that the hyp- 
 noidal state is by no means confined to man, 
 but is also present in animals. This is very important 
 as it shows indubitably how widely spread the hypnoidal 
 state is throughout the domain of animal life. More- 
 over, the experiments clearly prove that the further 
 down we descend in the scale of animal organization, 
 the more prominent, the more essential, does the hyp- 
 noidal state become. 
 
 The conclusion is forced upon me that the hypnoidal 
 state is the primitive rest-state out of which sleep has 
 arisen in the later stages of evolution. We may say that 
 sleep and hypnosis take their origin in the hypnoidal 
 state. Sleep and hypnosis are highly differentiated 
 states; they have evolved out of the primitive, undif- 
 ferentiated, hypnoidal state which is essentially a sub- 
 waking rest-state characteristic of early and lowly-or- 
 *ganized animal life. The hypnoidal state is the prim- 
 ordial sleep-state. 
 
 The development of the hypnoidal state into sleep 
 has proven itself useful in the struggle for existence of 
 the higher animals; it has, therefore, become fixed as 
 the rest-state characteristic of the higher representatives 
 of animal life. Hypnosis, as well as other trance-states, 
 variations of the primitive, hypnoidal rest-state, have 
 become eliminated as useless and possibly harmful to 
 the normal life adjustments of the higher animals and 
 
 54 
 
The Primitive Rest-State 55 
 
 can only be induced under artificial conditions in but a 
 fraction of the human race. The hypnoidal state is the 
 normal rest-state of the lower vertebrates and inverte- 
 brates. The rest- or sleep-state of the lower animals is 
 a sort of a passive waking state, — a subwaking state 
 which has survived in man as the hypnoidal state. Of 
 course, the state has been largely modified in man by 
 the course of evolution, but it can still be clearly de- 
 tected, just as the tail of the simian can be discerned in 
 the human coccyx, or as the structure of the prehensi- 
 ble hand of the quadrumana can be still clearly traced in 
 the foot of man. Waking, hypnoidal and sleep-states 
 may be termed normal states, while hypnosis and vari- 
 ous other trance-states may be termed subnormal states. 
 
 The hypnoidal state is normal, it is present in all the 
 representatives of animal life. Sleep, hypnosis, and 
 trance-states are variations of the fundamental hypnoi- 
 dal state. The sleep-state has proven useful and has be- 
 come normal in the highfer animals, while hypnosis and 
 the various forms of trance-states, likewise variations 
 of the fundamental hypnoidal states and characteristic 
 of man, have not proven of vital value and have fallen 
 below the normal stream of consciousness with its con- 
 comitant adaptive reactions. 
 
 The hypnoidal state is necessarily brief, variable 
 and unstable. They who have observed the rest-states 
 of the lower metazoa can form a clear idea of the na- 
 ture as well as of the biological significance of the hyp- 
 noidal state in the life of the lower animals. The ani- 
 mal is at rest for a brief period of time as long as it 
 remains undisturbed by external conditions of its en- 
 vironment, or by internal conditions, such as hunger, 
 sexual impulses or other internal disturbances. Soon 
 
56 
 
 Diagnosis of Psychopathic Diseases 
 
 the animal begins to move, sluggishly at first, and then 
 more quickly, and, if there are no disturbing stimula- 
 tions, comes to rest, to be again disturbed from its 
 rest-equilibrium by the varying conditions of its envi- 
 ronment. The resting state is brief, irregular, in fits 
 so to say, and differs from the waking state in but a 
 slight relaxation and in comparatively slow reactions 
 to stimulations and in a passive condition of the mus- 
 cular system. Respiration becomes a little more regu- 
 lar and diminished in rate, the heart beat is slightly de- 
 creased and general katabolic activity is somewhat re- 
 duced. 
 
 The relation of the hypnoidal state to waking, sleep, 
 hypnosis and other subconscious states may be repre- 
 sented by the following diagram: 
 
 WaiCi'ng 
 
 8' 
 
 
 Kypnoid 
 
 al 
 
 eSlttf 
 
 \t 
 
The Primitive Rest-State 57 
 
 The animal, however, is quite alive to what is going 
 on all around. The animal rests watching for danger. 
 The resting and active states alternate periodically, if 
 possible, but usually quite irregularly. The resting 
 state is but a passive condition in which the animal miay 
 be considered to hover between waking and what we 
 describe in the case of the higher animals as sleep. 
 Sleep in its proper sense does not exist among the low- 
 er representatives of animal life. 
 
 This state of hovering between waking and sleep- 
 ing, the characteristic of the hypnoidal state, is no 
 doubt of paramount importance in the life-existence of 
 the lower animals, considering the numerous dangers 
 to which they are continually exposed. The animal 
 must always be on the watch, either for food or for 
 foe. It can only rest or "sleep" with its eyes wide 
 open. The hypnoidal "sleep" can be best character- 
 ized as a subwaking rest-state. 
 
 I demonstrated in my experiments that the animal 
 while in the hypnoidal, subwaking rest-state is apt to 
 fall into a cataleptic state, especially when the move- 
 ments are suddenly and forcibly inhibited. This cata- 
 leptic state, which reminds one of the hypnotic state, 
 may be observed in the lower animals, such as the frog, 
 the snake, the lobster, the bird and, to a slighter de- 
 gree, even in the higher animals, such as the guinea 
 pig, the cat, the dog; especially in the young ones, such 
 as the kitten, the puppy and the infant. 
 
 There is little doubt that the cataleptic state into 
 which animals fall during the hypnoidal rest-state is of 
 some protective value in their life. The animal "freez- 
 es," "feigns death" and is thus either enabled to remain 
 undetected by the animal on which it feeds or, what is 
 
58 Diagnosis of Psychopathic Diseases 
 
 still more important, is enabled to remain unnoticed by 
 its enemy and thus escape certain death. The subwak- 
 ing, hypnoidal state may be regarded as the fundamen- 
 tal rest-state of lower animals and is characterized by 
 a mixed symptomatology of waking, sleep, and hyp- 
 nosis. 
 
 The hypnoidal state is found in man but in a rudi- 
 mentary condition; it is a vestige of man's primitive, 
 animal ancestors. The hypnoidal state is brief, varia- 
 ble, and forms the entrance and exit of repose, the por- 
 tals of sleep. The primordial rest-state has shrunk to 
 a transitory, momentary stage in the alternation of 
 waking and sleep. The subwaking, hypnoidal rest-state 
 shrinks with the increase of security of life. 
 
 From a therapeutic standpoint the hypnoidal state 
 has proven to be an efficacious agency in effecting cures 
 in psychopathic cases often of a severe character. The 
 great value of the hypnoidal state consists in the fact 
 of its being a most powerful instrument in tracing the 
 past history of the case, in learning the evolution of 
 the symptoms of the disease and in the discovery of 
 the early germs of the fully developed symptom com- 
 plex under observation and treatment.* The study of 
 the evolution of the malady, tracing its roots down to 
 early child life, thus getting a full knowledge of the 
 patient or the subject is termed by me Psychognosis. 
 
 *Dr. Leo Hirschlaff, of Berlin, in a recent communication tells 
 us of the great psychotherapeutic value of the rest-state (a form of 
 hypnoidal state). He has even invented a couple of instruments for 
 the induction of that state,— the Jiesychiscope and the respiration 
 metronome. 
 
CHAPTER VI 
 
 PSYCHOGNOSIS AND THE HYPNOIDAL TWILIGHT STATE 
 
 IN the hypnoidal state chips of former outlived ex- 
 periences come under certain conditions to the sur- 
 face of consciousness. What these conditions are 
 we have described in this work. We can only add 
 that in the hypnoidal states lost memories can be repro- 
 duced. The patient is put under conditions favorable 
 to the induction of hypnoidization and is asked to make 
 mental efforts to bring up the lost psychic content. Once 
 the patient discovers the successful working of this meth- 
 od, he begins to notice auto-hypnoidization, thus bring- 
 ing to light many hidden memories and finally bringing 
 about a synthesis of the dissociated subconscious mo- 
 ments. 
 
 Memories in hypnoidal states may be induced 
 spontaneously without the patient actually intending it 
 and sometimes under the influence of mental strain, ex- 
 citement, or effort. The hypnoidal states may come 
 up in a rush, as if hampering flood gates have 
 broken down, and become associated and synthetized 
 with the present functioning moment, with the present 
 state of self-consciousness. 
 
 I shall give here an account of the hypnoidal 
 states as first observed by me in the classic case of the 
 Rev. T. C. Hanna. When in the hypnoidal state 
 any scene or word or name came up before his 
 mind, it was completely wantihg in the elements of 
 recognition and familiarity. A name, for example, 
 
 59 
 
6o Diagnosis of Psychopathic Diseases 
 
 came up before his mind; when asked of what he was 
 thinking, he would simply give the name, but when we 
 pushed our inquiry further and asked as to the meaning 
 of the word, he replied he did not know. When told it 
 was the name of a person or of an object, he was great- 
 ly surprised that what appeared to him as a combination 
 of "nonsense syllables," arbitrarily arising in his mind 
 should have a definite meaning. When he was asked 
 if he had any vague feeling of ever having heard the 
 word before, he invariably replied in the negative. 
 
 Still more remarkable was the fact that at times, in 
 the hypnoidal states, an entire scene or event arose be- 
 fore his mind; he could describe the scene or the event 
 of his former life-experience exactly as he saw it in his 
 mind's eye ; he could describe minutely all the details and 
 yet he had not the slightest trace of recognition that the 
 incident was a former experience of his own. It was to 
 him like arbitrary combinations of images and ideas, 
 somewhat in the way as they take place in our waking 
 reveries or in the dream states of sleep. 
 
 As an example of such hypnoidal states, we may men- 
 tion the mental condition of the patient during the re- 
 cital of a Hebrew passage. Being a minister and having 
 studied Hebrew at Yale, Mr. Hanna in his secondary 
 state was tested with texts from the Hebrew Bible, texts 
 with which he had been familiar in his previous life. 
 What happened was striking in the extreme. During the 
 recital of the Hebrew phrase, a flood of Hebrew pass- 
 ages came into his mind. He recited them aloud in that 
 solenm intonation in which the Hebrew Bible had been 
 studied by him in college. When asked the meaning 
 of the phrases, he was at a loss, he had not the slight- 
 est notion what that all meant. It was to him a sort 
 
Psychognosis and Hypnoidal Twilight State 6i 
 
 of "speaking with tongues' "-affair, a mere conglom- 
 eration of meaningless syllables, mere gibberish. As 
 in the phenomenon of "speaking with tongues" the pa- 
 tient was frightened at the sudden outburst of a flood 
 of meaningless jargon. 
 
 Moreover, the memory for the part read to 
 him was not bad, he was able to repeat each word and 
 sometimes a couple of words and even a' phrase as it 
 came from the reader of the text. The texts brought 
 up in the hypnoidal state were gone from his memory 
 as soon as he delivered them, only a few distorted 
 words could be gotten out of him; the rest vanished 
 from his memory. 
 
 It was also of importance to notice that instead of 
 imitating the reader who recited the texts to him, 
 as one should expect in a case of imitating unknown 
 words and phrases, the patient had a different inflection 
 and a widely different pronunciation from those of the 
 reader. They were resurrected memories of a buried 
 personality, memories which lightning-like flashed on 
 and vanished from the patient's mind. 
 
 The unexpected sudden change in tone and manner of 
 the patient's recital of the Hebrew phrases which in the 
 hypnoidal state arose from the patient's subconscious- 
 ness were striking in the extreme. His voice became 
 strong and sonorous, he recited impressively, as though 
 from the pulpit. It seemed as if the words and phrases 
 burst forth spontaneously and involuntarily in a mo- 
 ment of inspiration. 
 
 As an instance of another hypnoidal state we may 
 mention rfie following: Miss C. to whom the patient 
 was greatly devoted in his former life, and whom he 
 married after the complete cure and restoration of his 
 
62 Diagnosis of Psychopathic Diseases 
 
 former personality, was a perfect stranger to the sec- 
 ondary personality. In one of the experimlents this 
 young lady was directed to take the patient's hand and 
 sing a hymn which the young man had heard in his 
 former, primary, personal existence, but had not heard 
 since the injury. 
 
 The patient was told to remain quiet and listen 
 attentively to the hymn. During the song the pa- 
 tient remained passive, his whole attention was con- 
 centrated on the song. When the hymn was fin- 
 ished, he was asked whether he had ever heard any- 
 thing like it before, he looked at us in bewilderment. 
 When asked what had come into his mind during the 
 singing, he gave two words which turned out to be 
 names of people. The patient did not know the mean- 
 ing of the words and certainly did not suspect that 
 they were names. We learned from the family that 
 the names were those of choir-singers whom he knew 
 some three years ago. The names flashed from the 
 subconscious on the patient's memory, but without the 
 slightest sense of recognition. 
 
 I bring the experiments from the Hanna-case, be- 
 cause of its extreme form of dissociation the character- 
 istics of the hypnoidal state stand out clear and distinct, 
 more so than they do in other cases in which the state 
 of dissociation is comparatively slight. In the ordi- 
 nary psychopathic cases the hypnoidal state does not 
 present such a complete lack of recognition, still the 
 memories appearing in such states are vague, frag- 
 mentary, being apparently devoid of all meaning, "per- 
 fect nonsense" as the patient often puts it, and as such 
 tend to fade, like the shadowy experiences of the 
 dream states, into oblivion. 
 
Psychognosis and Hypnoidal Twilight State 63 
 
 The chance phrases however are not accidental oc- 
 currences, they refer to the patient's former experiences, 
 and give an insight into the very depths of the patient's 
 subconscious life-activity. The hypnoidal state, the state 
 in which all those vague, fragmentary, subconscious 
 memories occur is one of the most potent instruments of 
 Psychopathology and Psychotherapeutics. 
 
CHAPTER VII 
 
 THE HYPNOTIC STATE 
 
 THE hypnotic state was studied by me many 
 years ago in my "Psychology of Sugges- 
 tion." I give here a few brief statements 
 sufficient for our present purposes: The 
 hypnotic state requires the following conditions : 
 
 (I) The first condition is that of fixation of atten- 
 tion. Thus Braid used to hypnotize his subjects by fix- 
 ing their attention on some brilliant object or point. 
 He considered a steady attention indispensable, if hyp- 
 nosis were to be obtained; the subject must look stead- 
 ily at the object, he must think only of the thing he is 
 fixating, and must not allow his attention to be diverted 
 from it. The ability to direct one's thought in one 
 particular direction is very favorable to hypnosis. 
 They who cannot fix their attention, who are absent- 
 minded, introspective or scatter-brained or hopelessly 
 stupid cannot be hypnotized. 
 
 (II) Monotony of impressions is another condi- 
 tion of the hypnotic state. The subject must be put 
 into a relatively uniform environment and subjected 
 to a series of monotonous stimulations. My method 
 of hypnotization consists in forming monotonons sur- 
 roundings; the light is lowered, a profound silence 
 reigns in the room; then monotonously stroking the 
 skin of the subject's forehead and in a low, mufHed, 
 monotonous voice go on saying: "sleep, sleep, sleep" 
 until the subject falls into a hypnotic state. 
 
 6f 
 
The Hypnotic State 65 
 
 (III) Limitation of voluntary movements is also a 
 condition of hypnosis. The subject sits down on a 
 chair in a comfortable position and is asked to be as 
 motionless as possible. The Subject is directed to ab- 
 stain from all sorts of movements, not to move his 
 limbs, not even to wink if possible; in fact, not even 
 to attempt the slightest motion of the limbs, not even 
 to think of a change of position. Muscular activity 
 must remain completely relaxed. 
 
 (IV) Limitation of the field of consciousness must 
 be brought about in order to induce hypnosis. The 
 consciousness of the subject should be narrowed to one 
 idea of sleep. Wundt defines the very nature of hyp- 
 nosis as limitation of the field of consciousness ; and to 
 a certain extent he is justified in his assertion. We 
 know that a strong emotion narrows down the field of 
 consciousness. We often find that people under in- 
 tense excitement lose their senses, so to say; their mind 
 seems to be paralyzed, or rather to say the one idea 
 accompanied by the intense emotion banishes all other 
 ideas and a state of monoideism is thus effected. Peo- 
 ple are often run over by carriages, automobiles, on 
 account of sudden great fright. The one idea of dan- 
 ger, the emotion of fright, reverberates in the mind 
 like a sudden powerful clap of thunder, confusing and 
 stunning all other ideas and emotions. The mind is 
 brought into a contracted cataleptic state, the field of 
 consciousness is narrowed down to one idea, to one 
 emotion, to a single point. This mode of hypnotiza- 
 tion in which this particular condition is specially em- 
 phasized is successful with people of an intensely emo- 
 tional nature, but who are not introspective in charac- 
 ter. 
 
66 Diagnosis of Psychopathic Diseases 
 
 (V) Inhibition is another important condition in 
 the induction of the hypnotic state. The subject must 
 inhibit all ideas, all images, all emotions that may arise 
 in his mind. The subject must think, only of the bril- 
 liant point, of the tips of the hypnotizer's fingers, of 
 the passes, of the idea of falling asleep. The subject 
 must be able to inhibit all movements, all tendencies to 
 action, all desires and cravings. 
 
 All such conditions bring about that particular state 
 of abnormal suggestibility known as the hypnotic state. 
 Hypnotization produces a deep cleft in the mind of the 
 subject, a cleft by which the waking, controlling con- 
 sciousness becomes separated from the great stream of 
 conscious life-activity. That is why we have the 
 strange accounts of hypnotic subjects, especially of 
 those who were on the verge of somnambulism, that 
 during hypnosis they were indifferent to the actions of 
 their body, the latter acted by itself; that they were 
 mere spectators of all the experiments performed on 
 them; that it seemed to them that "they themselves," 
 their personality, retreated far, far away. The hyp- 
 notic state is specially characterized by the fact that 
 associations and dissociations of muscular, sensory, 
 glandular, neural, ideational, emotional and will ac- 
 tivities can be brought about. 
 
 Hypnotic trance is again characterized by the extent 
 of memories which may be widened or contracted. Mo- 
 tor, sensory, glandular, ideational, emotional, memory- 
 changes may be effected, and transformations of per- 
 sonality may be brought about. 
 
 We must however emphasize the fact which is too 
 often forgotten that all such changes are really and ulti- 
 mately dependent on the changes produced by sugges- 
 
The Hypnotic State 6^ 
 
 tion in the ideas and beliefs of the subject, all the other 
 changes are produced indirectly. The modification is 
 essentially central, ideational, and emotional. 
 
 The emotion of belief is specially affected. The hyp- 
 notized subject is a person in whom faith can be stirred 
 to its very depths. The will is affected. The subject 
 must be of an obedient temperament. The waking, 
 controlling, critical consciousness is practically suspend- 
 ed in the hypnotic state. As I expressed it in another 
 place : "Hypnosis with its allied states can modify, un- 
 dermine, create belief, and important modifications may 
 be brought about in the total mass of representative life 
 activity." 
 
 When the patient sinks into a deeper and deeper 
 hypnotic condition, when the state is so profound as 
 to verge on somnambulism, the wakiiig, controlling 
 consciousness hangs on a thread, so to say, to the rest 
 of organic life ; and when that thread too is cut off by 
 suggestion, the waking guiding consciousness loses all 
 contact with the stream of life. 
 
 Some writers attempt to explain hypnosis by the fan- 
 ciful theory that the hypnotic state is due to the awak- 
 ening of so-called "complexes" or mental experiences 
 of childhood. Where the maternal complexes predom- 
 inate there the tendency is hypnotization by patting, 
 petting, quieting and so on, while where the complexes 
 of the more stern father predominate there the tendency 
 is present to hypnotization by command and authority. 
 
 This theory assumes suggestibility as a basal fact, but 
 refers it back to infancy. To push back or "repress" 
 an unexplainable fact into infancy is not to explain the 
 fact. What sort of experiences in childhood gives rise 
 to suggestibility? Is suggestibility an acquired state 
 
68 Diagnosis of Psychopathic Diseases 
 
 or is it a condition fundamentally characteristic of hu- 
 man nature? Psychological studies go to confirm the 
 fact that suggestibility is a fundamental trait of human 
 nature as much as is association of ideas. All that we 
 can say is that certain experiences predispose to certain 
 lines of suggestions, but suggestibility itself is a funda- 
 mental characteristic of man, both in his individual and 
 social capacity, whether infant, child, adult, man, or 
 woman. 
 
 Once, however, we assume suggestibility the whole 
 parental theory is useless, there is no need of drag- 
 ging in father and mother in order to fit them on 
 Procrustes' bed of some fad theory. The facts of hyp- 
 nosis can be far better explained by the fundamental 
 fact of suggestibility which under conditions of remov- 
 al of the critical, controlling consciousness stands re- 
 vealed as the essential characteristic of the subconscious. 
 Alcoholic drinks, various drugs, intense emotions, and 
 even a blow on the head may do the same thing. 
 
 Moreover, the adherents of the theoryshow little ac- 
 quaintance with the most elementary facts of hypnosis. 
 The sensori-motor manifestations such as catalepsy, rig- 
 idity, of which the patient or subject is not capable in his 
 waking state, the increase of motor activity in certain 
 directions which the subject is unable to perform in his 
 waking state, the anaesthesias and hyperaesthesias which 
 the subject cannot manifest in his normal condition, the 
 hallucinations, the transformations of personality, the 
 extreme mimicry which the hypnotic somnambulist man- 
 ifests, a condition of which he is absolutely incapable 
 in his waking condition, the amnesias characteristic of 
 deep hypnosis, the post-hypnotic suggestions that can 
 be delayed for many days, weeks, and months, the 
 
riie Hypnotic State 69 
 
 presence of dissociated states which subconsciously keep 
 the suggestions, states that can be manifested as hyp- 
 noid or co-conscious states of which the subject remains 
 unaware, all these phenomena and a host of others are 
 completely ignored by the paternal, sexual, or incest 
 theory. 
 
 They who have studied closely the phenomena 
 of hypnosis cannot help coming to the conclusion that 
 hypnosis is a state of dissociation brought about under 
 special psychological and physiological conditions, such 
 as concentration of attention, monotony of stimulation, 
 inhibition of psychomotor activities. In this respect most 
 of the students in normal and abnormal psychology, 
 though they may differ widely in other respects, agree 
 that the hypnotic state is an inhibition of the upper 
 consciousness, or the inhibition of "the organ of ap- 
 perception" as Wundt puts the same view. Recently 
 other writers came to a similar conclusion. Hypnosis is 
 a cerebral dissociation brought about by the factors of 
 concentration of attention and monotony of stimulation. 
 
 The hypnotic state is a state of increased suggesti- 
 bility, it is a reflex consciousness. A changed physiologi- 
 cal state must be assumed in hypnosis. This change con- 
 sists in the disaggregation of the superior from the in- 
 ferior centres, in the segregation of the controlling con- 
 sciousness from the reflex consciousness. Strong persist- 
 ent impressions or suggestions made directly on the re- 
 flex consciousness of the inferior centres may modify 
 their functional disposition, produce sensory, motor, and 
 glandular changes and thus affect trophic functions. Dis- 
 aggregation, dissociation is what specially characterizes 
 the hypnotic state. 
 
 In the hypnotic state the subconscious is laid bare 
 
70 Diagnosis of Psychopathic Diseases 
 
 to the influence of the external environment. We get 
 access through the subconscious to man's sensory, mo- 
 tor, and glandular activities, affecting his ideas, feelings 
 and emotions. We can thus produce profound changes 
 in man's life. The hypnotic consciousness is a reflex 
 consciousness, unprotected by the reasoning, critical, 
 controlling consciousness. Once the subconscious is freed 
 from the controlling, guardian consciousness, profound 
 modifications may be effected in man's mental consti- 
 tution. 
 
 From a practical therapeutic standpoint hypnosis is of 
 the utmost importance. Whenever it is possible the hyp- 
 notic state should be used for the alleviation of nervous 
 and mental suffering. Not to avail oneself of hypnosis 
 in the treatment of mental troubles and claim the omni- 
 potence of some other method as a panacea for mental 
 affections is to show undue enthusiasm not justified by 
 experience. Many psychopathic cases have been treated 
 by me and cured permanently by means of hypnosis 
 alone. Some of the cases were of severe character, and 
 the employment of other states and methods would 
 have required months, if not years of treatment with 
 possibly no chance of recovery, on account of the drag- 
 ging character of the treatment. Treated by hypnosis 
 the patients became permanently well after a few treat- 
 ments. 
 
 Some severe cases that went into a deep state bene- 
 fited after the very first treatment, and became per- 
 manently cured after three or four treatments. This 
 can hardly be afllirmed of any method no matter how 
 enthusiastic one may be about it. Whenever therefore 
 it is possible to obtain a deep hypnosis the latter should 
 by all means be used. Hypnosis is a powerful instru- 
 
The Hypnotic State 71 
 
 merit in the armamentarium of Psychotherapy and the 
 medical man who wishes to get successful results should 
 cultivate its use. 
 
 It is greatly to be deplored that the use of hypnosis is 
 abandoned by some medical enthusiasts for some new 
 theory and is regarded with neglect and even with scorn. 
 It is acting too deliberately in the interest of some hob- 
 by, to cut oneself from the use of one of the most pow- 
 erful weapons of controlling the aberrations of the 
 subconscious, the source of psychopathic maladies. 
 
 The hypnotic state is of no less importance from the 
 standpoint of psychognosis, that is, from the standpoint 
 of the finding out the patient's condition, learning the 
 history of the case and following the evolution of the 
 mental malady from its earliest beginnings. We can 
 trace the various symptoms of the disease down to the 
 very roots of early childhood and watch the stages of 
 the development of the malady, since in some Interest- 
 ing and instructive cases the patient can be actually 
 made to live over the experiences that have gradually 
 developed the present morbid condition. The most dif- 
 ficult, the most inaccessible recesses of the subconscious 
 life can be searched in the hypnotic state. 
 
 It is foolhardiness and mental blindness on the part 
 of the physician to deprive himself of such an efficient 
 instrument of research. It is to play into the hands of 
 various superstitions and prejudices of the vulgar and 
 the Christian Science sectarians, as well as of other 
 would be "scientists" who claim that the hypnotic state 
 causes infinite harm to the human soul. As far as I am 
 concerned, and I may possibly say it also for some of my 
 colleagues who have devoted years to the study of hyp- 
 notic state and its effects, hypnosis is one of the greatest 
 
72 Diagnosis of Psychopathic Diseases 
 
 discoveries made in the domain of Psychopathology. It 
 is much to be regretted that medical men who devote 
 their life to Psychopathology should disparage the use 
 of hypnosis for psychognostic purposes. Hypnosis 
 yields us one of the most powerful searchlights for the 
 psychognosis of the subconscious. 
 
 At the same time we must point out an important 
 fact often overlooked by investigators of hypnosis. The 
 hypnotic consciousness is reflex in character. This led 
 to the misunderstanding that the time element of the 
 actions such as simple reaction time or association and 
 choice time must necessarily be shortened. This, how- 
 ever, is not correct, the act or the idea suggested may be 
 carried out, although the time which they take may 
 even be lengthened. 
 
 Some investigators have shown that reaction time 
 is increased in hypnosis, while others come to the con- 
 clusion that reaction time is decreased. As a matter 
 of fact in some subjects there may be a lengthening and 
 in others there may be a shortening of the reaction. The 
 results are by no means contradictory. We must bear in 
 mind the fact that we deal here with a state of high sug- 
 gestibility. While certain suggestions meet with no re- 
 sistance others meet with increased resistance, due to 
 the same factor of suggestibility. Such in reality we 
 find the facts to be. Some subjects show a marked in- 
 crease of reaction time, some show a decrease, and some 
 show almost no variation. 
 
 They who have had long experience with hypnosis ex- 
 pect no other results. It would have been far more diffi- 
 cult to understand the hypnotic states had there been a 
 uniform lengthening or shortening of reaction time in 
 hypnosis. The thresholds of the mental systems of the 
 
The Hypnotic State 73 
 
 hypnotic consciousness are not uniformly reduced, but, 
 they vary in different directions, some fall, others rise, 
 while again other systems remain unchanged. 
 
 The heightening of thresholds of many systems in 
 hypnosis is brought as an argument against the employ- 
 ment of the hypnotic state for psychognostic and psy- 
 chotherapeutic purposes. This however should not be 
 in the way of the experienced physician. A physician 
 who finds difficulty in overcoming the rise of thresholds 
 and the increase of resistance should give up his prac- 
 tice. As a matter of fact there is always a way of low- 
 ering the thresholds of mental systems in the hypnotic 
 state. 
 
CHAPTER VIII 
 
 HYPNOID STATES 
 
 HYPNOID states consist of the presence of 
 two or more fully independent complex 
 mental systems. Such states are found in 
 the phenomena of automatic writing, shell 
 hearing, crystal gazing in the various forms of coex- 
 istent double and multiple personalities and various 
 other subconscious conditions.* 
 
 In automatic writing the patient is in his usual state. 
 He may be carrying on a conversation with some one, 
 while at the same time, his hand in which a pencil is 
 placed, begins and continues writing sentences, descrip- 
 tions or entire essays and chapters in a well formu- 
 lated and lucid manner, the subject's upper or prin- 
 cipal consciousness knowing absolutely nothing of what 
 the hand had written. 
 
 During the time of the automatic writing the hand is 
 anaesthetic, but only in relation to the patient's upper 
 consciousness. There is a well organized system of con- 
 sciousness controlling the automatic writing, since the 
 hand itself may register responses to questions not un 
 derstood and sometimes not even heard by the subject. 
 Likewise, if the hand is pricked, although the subject 
 himself does not feel the prick, the hand will neverthe- 
 less make marks to indicate the number of pricks. Im- 
 
 *The various forms of double multiple personality have been 
 described in "Multiple Personality." See Dr. Morton Prince's 
 "The Dissociation of a Personality." 
 
 74 
 
Hypnoid States 75 
 
 mediately after the automatic writing ceases sensibility 
 returns to the anaesthetic hand. 
 
 All stages and forms of automatic writing are ob- 
 served from mere scratches to highly complicated dis- 
 courses. In fully developed cases the handwriting is of 
 a spasmodic character, as though executed with single 
 rapid strokes. 
 
 Hypnoid or coexistent functioning, though disaggre- 
 gated states, may be cultivated with some success by 
 normal healthy individuals. In some the dissociation 
 is complete, in others it is but partial and the subject is 
 conscious of what is going on, but he feels that he 
 has no control over the writing nor is it his conscious- 
 ness that has formulated the writing. 
 
 Instead of writing there may be automatic speaking. 
 The phenomena are known under the name of speaking 
 with tongues. The speaking may range as in the case 
 of automatic writing from the simplest to the most com- 
 plex, from the automatic volubility of meaningless syl- 
 lables appearing as a new tongue or language, to a con- 
 nected recital of intelligible phrases. 
 
 The phenomlena of crystal gazing belong to the 
 same category and may be classed with hypnoid states. 
 The vision, the hallucinatory experience appears to 
 rise from the subconscious and seems to develop inde- 
 pendently of the subject's consciousness. The subject 
 takes cognizance of what is presented to him by the 
 dissociated mental state which develops on the basis of 
 some peripheral sensory experience. 
 
 It is possible to bring forth subconscious experiences 
 by developing in the subject visual hallucinations. The 
 subject looks into a reflecting shining surface, a crystal, 
 a mirror, a glass of water. The subconscious self 
 
76 Diagnosis of Psychopathic Diseases 
 
 brings out visual perceptions which appear as halluci- 
 nations to the upper self. The upper self sees the pic- 
 tures projected by the subconscious self in the same 
 way as the automatic writer reads the product of the 
 automatic writing. 
 
 The subject may for example perform a certain 
 action such as misplacing an article or reading 
 something unconsciously of which there is no recollec- 
 tion. Now the gazing into the crystal may bring 
 out these past experiences as visual hallucinations. Oc- 
 casionally the subconscious self may so develop in the 
 phenomena of automatic writing or crystal gazing that 
 automatic actions rriay be manifested and the patient 
 falls temporarily into a complete subconscious state. 
 
 We can also develop a form of auditory hallucina- 
 tion by bringing various experiences out of the subcon- 
 scious. This can be accomplished by sounding or vi- 
 brating objects. The subject listens tntently to the 
 monotonous sounds, and experiences, lost to the subject's 
 upper consciousness, but retained by the subconscious, 
 which come in the form of auditory hallucinations. 
 
 In the many forms of psychopathic anaesthesia of 
 considerable persistence and extent, hypnoid states may 
 be developed; the anaesthetic hand for instance will 
 react to various stimuli, handle different things, give 
 intelligent answers in automatic writing to questions 
 not directly heard by the patient. These phenomena 
 can be brought out by various experimental proce- 
 dures. 
 
 Most of the cases of functional derangement and 
 mental dissociation, such as the various forms of func- 
 tional psychosis or psychoneurosis fall under the cate- 
 gory of hypnoid states. Various forms of sensory, mo- 
 
Hypnoid States 77 
 
 tor, gastric, emotional, and other disturbances, when 
 of a functional psychopathic character are often due to 
 subconscious systems dissociated from the patient's 
 consciousness and manifesting their activity in the up- 
 per waking life. 
 
 The patient is aware of the distressing results, but has 
 no suspicion of the active subconscious processes that 
 give rise to such manifestations. The dissociated sys- 
 tem forms a center of activity that falls outside the do- 
 main of the patient's upper consciousness, the results 
 alone appearing in the patient's waking li^e. 
 
 Hypnoid states are co-existent, "co-conscious" states 
 and may develop into co-existent, "co-conscious" per- 
 sonalities. 
 
CHAPTER IX 
 
 THE HYPNOIDIC STATE 
 
 THE hypnoidic state is the formation of a 
 ^M«jj-personality with a more or less defi- 
 nite character, a personality that is inaccessi- 
 ble to direct suggestion. The hypnoidic state, 
 however, is amenable to indirect suggestion. By means 
 of indirect suggestion it is even possible entirely to re- 
 move this hypnoidic personality, and have it replaced 
 by another which may soon vanish to give room to 
 another personality widely different in character and 
 memories. Hypnoidic personalities rise like bubbles 
 from the subconscious and vanish. They may however 
 become well organized, stable and permanent. 
 
 Hypnoidic states consist in the recurrence of outlived 
 phases of the patient's personal life. The hypnoidic 
 state forms a ^M^ji-individuality, the upper conscious- 
 ness of the patient being removed. Memories which 
 the upper self is unable to recall and which seem to be 
 altogether effaced suddenly rise to the surface of con- 
 sciousness as the upper layers of mental activity are 
 removed. 
 
 In hypnosis the removal of the waking conscious- 
 ness is followed by a state of high reflex suggesti- 
 bility, which is characteristic of the indefinite nature of 
 the secondary self. In the hypnoidic state such sug- 
 gestibility is absent, because another ^waii-personality 
 emerges having a more or less definite character, a per- 
 sonality which is not amenable to direct suggestion. By 
 
 78 
 
The Hypnoidic State 79 
 
 means of indirect suggestion it is possible to remove 
 this personality and replace it by another which may 
 again be treated in the same way. 
 
 Hypnoid states present phenomena of two or of 
 more co-existent, dissociated, co-conscious mental sys- 
 tems ; hypnoidic states present phenomena of mental al- 
 ternation. Instead of the simultaneity of two or more 
 independent functioning systems of the hypnoid states, 
 we find in the hypnoidic states alternation of two or 
 more independently functioning systems. When one is 
 present the other is absent or is dormant subconsciously. 
 
 The interrelation of the alternating states may be of 
 such a character that they may be completely unknown 
 to one another ; or they may be known to one, but not 
 to the other. Thus the first series of states may not 
 know the second series, nor the second the first; or 
 while the first series does not know of the second, the 
 second series does know the first. In the first case the 
 dissociation is complete, in the second case, the dissocia- 
 tion is fully present in the primary series, but not in the 
 secondary. 
 
 Suppose, for the sake of illustration, conscious- 
 ness consists of moments A, B, C, D, E, etc., then 
 in the case where the states are unknown, the primary 
 series consists say of A, B, while the secondary series 
 consists of C, D, E, F, both series are independent and 
 dissociated and as such are unknown to each other. In 
 the case, however, where the secondary knows the pri- 
 mary, but not the reverse, then the secondary consists 
 of all the functioning moments while the primary con- 
 sists only of A, B, and as such it does not know the 
 rest of the moments C, D, E, F, etc. 
 
 The secondary states may be wide ^nd extensive 
 
8o Diagnosis of Psychopathic Diseases 
 
 enough as to include the primary states, or they may be 
 narrow as to exclude them. In the former case the 
 secondary states may be regarded as more or less com- 
 plete states, while the primary states are the incomplete 
 ones. Frequently, however, both primary and second- 
 ary states are incomplete, and while they may have in 
 common many of the lower automatic and secondary re- 
 flex psychic activities, they lack common elements of 
 conscious memory, and hence there is no recollection 
 of one series by the other. 
 
 The whole series of primary states represents a 
 flowing synthetic organic unity with recognition and 
 recollection of all the primary states; while all the sec- 
 ondary states form another independent, but also an or- 
 ganic unity having recognition and memory for all the 
 secondary states that enter into the flowing unit. In 
 other words, two personalities are formed which to all 
 intents and purposes may be regarded as independent of 
 each other and having two separate centres of syn- 
 thesis giving rise to the cyclical phenomena known as a 
 double consciousness. 
 
 If the cycle appears but once, we have monocyclical 
 bimorphosis, if the cycle is repeated, the condition is 
 polycyclical bimorphosis. 
 
 There is, however, no reason why the separate series 
 should be limited to two, although this is the most com- 
 mon occurrence. There may be many separate series, 
 with as many independent foci of synthesis giving rise 
 to as many different Individualities. In such a case we 
 have the phenomena of multiple consciousness or of 
 multiple personality, in short, the phenomena of poly- 
 morphosis. If the cycle occurs but once, then the poly- 
 morphosis may be said to be monocyclical, if the cycle 
 
The Hypnoidic State 8 1 
 
 is repeated the polymorphosis is polycyclical. 
 
 The formed personalities in polymorphosis act as in- 
 dependent individual beings and enter into relations, 
 conversations, and discussions, the whole presenting a 
 dramatic play in which many personages take active 
 part, successively as well as simultaneously. Such, for 
 instance, are those functional cases of multiple person- 
 ality, reported by many writers, cases which to a certain 
 extent may be reproduced artificially. These many per- 
 sonalities may fuse and form a new personality with all 
 the contents of memory belonging to them, and as such, 
 may have recognition of all of them, or may entirely 
 lack all recognition of theni. 
 
 The hypnoidic states may develop into distinct indi- 
 vidualities which may become sharply defined in char- 
 acter with strong claims of independent personalities. 
 They are jealous of their independence and strenuous- 
 ly resist attempts at fusion. The ^wa^i-personality 
 formed puts forth claims of being an independent in- 
 dividual, not even related to the patient's personality 
 of which it is really a constituent. In such cases we us- 
 ually find one or two predominating personalities 
 which present a high degree of stability and individ- 
 uality, while the rest are unstable, they come and go 
 and get character and individuality by insistent ques- 
 tioning and indirect suggestions given to them by out- 
 side people and their surroundings. 
 
 There is no doubt that the very interplay of the prin- 
 cipal dominating personalities as well as of the subordi- 
 nate ones is in itself an important factor in the strength- 
 ening of the various crystallized individualities, which 
 at first may come into being in a rather amorphous con- 
 dition. The interrelation of these different quasi-indi- 
 
82 Diagnosis of Psychopathic Diseases 
 
 vidualities^ though seemingly so insistently and aggres- 
 sively independent, is really a very intimate one, they 
 are all chips of the same block. 
 
 A hypnoidic state or fully developed independent 
 personality may be formed of the whole or part of the 
 content of the principal personality, but it does not rec- 
 ognize the source from which the' content is really de- 
 rived. The personalities, however, may become so far 
 dissociated as to possess even different contents so that 
 one cannot reproduce that of another; they are in short, 
 crystallized and organized of different elements, and 
 go to form different individualized moments-conscious- 
 ness, which as far as time relationship is concerned may 
 stand in relation of co-existence, or succession, or even 
 both. 
 
 The character of the hypnoidic individuality is often 
 some oudived phase of the patient's personal life. Such 
 states may also be induced in hypnosis, but then the 
 artificially produced hypnoidic state is vague and ill 
 defined. More frequently the hypnoidic state may be 
 fully brought about in post-hypnotic states. I could 
 effect an analogous state in my somnambulic sub- 
 jects by post-hypnotic suggestion. The difference be- 
 tween the post-hypnotic and the true spontaneous hyp- 
 noidic state consists in the relation of the subject to ex- 
 ternal impressions. In the post-hypnotic state the sub- 
 ject receives external impressions directly and refers 
 them to some external source. He hears, sees, feels, 
 perceives things that happen around him, ,and fre- 
 quently carries on animated conversations on dif- 
 ferent topics. Even in the case of post-hypnotic nega- 
 tive hallucinations, the patient is still fully alive to oth- 
 er not inhibited sense impressions that reach him from 
 
The Hypnoidic State 83 
 
 all sides. 
 
 Quite different is the true hypnoidic state. The 
 sense-organs of the patient are closed to the im- 
 pressions of external stimuli. He does not perceive 
 anything that takes place around him. His environ- 
 ment is that of the past, and in it he lives and moves. 
 Shut up within one of his past lives, he remains insen- 
 sible to the world of his objective present. 
 
 If by chance any impressions do reach the subject, 
 they are at once worked into his present hallucinatory 
 life experience. If the patient is touched, squeezed, prick- 
 ed, he feels nothing at all; he is totally anaesthetic and 
 analgesic, and still within his "vision" he may be ex- 
 tremely sensitive to pain, shiver from cold, complain 
 of fatigue, and undergo tortures of pricking sensations 
 caused by a strong gale blowing icicles into his face. Of 
 such a nature were the visions in the case of Hanna. 
 
 The patient hears none of the conversation carried 
 on in his presence. When the patient is spoken to on 
 subjects not directly related to his resurrected life-ex- 
 perience, he makes no reply; he simply does not hear. 
 Only when he is addressed on something relating to 
 the experience he is passing through, it is only then 
 that he makes a reply. He does not realize, however, 
 that it is some one else whe speaks to him ; his replies to 
 questions are to him either answers to his own thoughts 
 or sometimes — a case very rare — he seems to converse 
 with some imaginary person within his hypnoidic state. 
 
 No direct suggestions are taken by the hypnoidic 
 personality. The personality is fully rational in rela- 
 tion to the environment in which it lives. Thus, in one 
 of his hypnoidic states Rev. Thomas C. Hanna lived 
 through a terrible accident that happened to him once. 
 
84 Diagnosis of Psychopathic Diseases 
 
 He was on Mount Jewett, Pa. The wind blew high. 
 Lightning rent the sky, thunder crashed overhead. The 
 gale gained strength and became a tempest. Broken 
 branches and trees were falling on all sides. "There 
 is an old woman with a child!" he exclaimed. "Oh, 
 it is terrible ! it is terrible 1" he moaned. "We must run ! 
 we must run 1 I must drag the woman. Thunder I It 
 is terrible ! Save the woman. I am so cold ! My heart 
 is so weak ! Oh, it is terrible 1 We must run 1 we must 
 run !" 
 
 To my question whether he *• knew Miss C. the 
 answer of the hypnoidic personality was highly inter- 
 esting and instructive. "Don't know her yet — ac- 
 quainted with her a year later. From Mount Jewett 
 to her is a year." (This was found to be correct). 
 When I suggested to him that his friend S. was with 
 him, he laughed me to scorn. "That is impossible !" 
 he exclaimed; "S. is many miles away from here." I 
 asked for the date. He gave the date in which the 
 event took place. "It is August now," he said. When 
 I insisted that it was May (the actual time when the 
 vision occurred), the hypnoidic personality became im- 
 patient, raised its hand, struck the bed with great 
 force, and exclaimed: "I am sure it is now August. 
 You can not make me crazy 1" 
 
 All that time the patient was sitting up in his bed, 
 with his eyes firmly shut, blind and deaf to all impres- 
 sions that had no relation to the "vision." By indirect 
 leading questions this particular personality gradually 
 dwindled away, and lo 1 a new personality appeared on 
 the scene — a boy-personality. 
 
 The Rev. Thomas C. Hanna became a boy of thir- 
 teen. The scenery changed completely. He was on 
 
The Hypnoidic State 85 
 
 Umbrella Island. It was sunset, it was "beautiful." He 
 was expected for supper, but he was on the water, row- 
 ing and fishing. 
 
 On awakening from his hypnoidic state, the patient 
 remembered the "vision" very clearly; he could repro- 
 duce it, as if it were indelibly impressed on his mind. 
 He could not recogni;ze the experiences of his vision as 
 events that had taken place in his past life ; he did not 
 know that I or any one else conversed with him and led 
 him to give answers; nor did he remember any of the 
 many statements to my indirect questioning he had made 
 in his hypnoidic state. He could not remember the an- 
 swers he gave me to the suggestion that his friend S. 
 was with him; he did not know anything of the quar- 
 rel we had about the date; nor did he remember any- 
 thing of the interesting Information he gave me about 
 the events of his life such as the date of his acquaintance 
 with Miss C. He could only remember and that with 
 extraordinary clearness and distinctness everything that 
 directly related to the "vision" Itself. 
 
 Similarly in other cases, such as that of R., M. and F. 
 states closely analogous were studied by me. They all 
 manifested alternating, unstable personalities of a hyp- 
 noidic type. 
 
 When left to Itself the hypnoidic personality tends 
 to disappear, to fall back into the undifferentiated mass 
 of consciousness of the subconscious self; for the hyp- 
 noidic personality Is unstable in its nature. Unstable, 
 however, as ^the hypnoidic personality Is, It is In closer 
 contact with the subconscious life than Is the waking 
 self. The hypnoidic personality is In possession of facts, 
 experiences, memories, of which the upper, central con- 
 sciousness is ignorant. 
 
86 
 
 Diagnosis of Psychopathic Diseases 
 
 The following table gives the essential characteris- 
 tics of the various states : 
 
 (I) HTPNOIDAIi 
 
 Statbs. 
 
 (II) Htpnoidic 
 
 States. 
 
 (Ill) Htpnoid 
 
 States. 
 
 1. They can be art!- 1. Hypnoldlc states are 1. They can be artt- 
 
 flclally induced by rarely artificially flclally Induced In 
 
 the method of induced; they are trance states or 
 
 hypnoldlzation. usually spontane- may arise spon- 
 
 ous. taneously. 
 
 2. The upper con- 
 sciousness takes 
 direct cognizance 
 of the hypnoldal 
 states in the mo- 
 ment of their ap- 
 pearance. A pro- 
 longation of them 
 tends to the disap- 
 pearance of the 
 waking conscious- 
 ness. 
 
 2. Hypnoidic states 
 are not directly 
 cognized by the 
 upper conscious- 
 ness ; the latter is 
 always absent 
 when the hypnoidic 
 states are present. 
 
 2. Hypnoid states 
 may or may not be 
 cognizant by what 
 we call the nor- 
 mal consciousness. 
 These states are 
 always co-con- 
 scious, and are 
 usually present 
 alongside the up- 
 per normal con- 
 sciousness o f 
 which they are in- 
 dependent. 
 
 3. The experience of 3. The experience of 3. The experiences are 
 
 hypnoldal states the hypnoidic state usually vivid. 
 
 is vague, shadowy is very vivid, 
 
 and fluctuating. 
 
 4. Hypnoldal states 4. Hypnoidic states 4. Hypnoid states may 
 
 possess mere bits, 
 chips of past ex- 
 periences. 
 
 form complete sys- 
 tems of experi- 
 ences, whole per- 
 sonalities. 
 
 be parts of former 
 mental states, but 
 soon tend to Inde- 
 pendent mental 
 content. 
 
 5. Hypnoldal states 
 are normal, ves- 
 tiges of a primi- 
 tive rest-state. 
 
 5. Hypnoidic states are 5. Hypnoid states are 
 
 hallucljjatory, 
 dominant, subcon- 
 sciously formed 
 personalities o f 
 the alternating 
 type. 
 
 often hallucina- 
 tory, and when 
 fully developed 
 become parasitic 
 subconscioiis or co- 
 conscious person- 
 alties. 
 
 Hypnoidic states are of a nature entirely differ- 
 ent from the hypnoid and hypnoldal states which are 
 
The Hypnoidic State 87 
 
 fragmentary, sudden intrusions of isolated subconscious 
 moments consciousness into the upper regions of the 
 waking personality, and can be induced by post-hypnotic 
 suggestion, as well as by methods of hypnoidization. 
 Like the hypnoid and hypnoidal, the hypnoidic states 
 have as their nuclei, past, long outlived experiences, but, 
 unlike the hypnoid and hypnoidal states, they are not 
 fragmentary, dissociated, mental dust. The hypnoidic 
 states arfe systematized, hallucinatory, resurrected, sub- 
 conscious personalities. 
 
 In all states, hypnoid, hypnoidic and hypnoidal, we 
 find, however, one common trait, and that is the emerg- 
 ence of memories or of mental systems that may be 
 known and recalled, whether directly or indirectly, by 
 the primary self. 
 
CHAPTER X 
 
 HYPNOLEPSY 
 
 IN cases of double and multiple personality of the 
 alternating type a state of hypnolepsy is present. 
 In all cases of mental alternation one state does not 
 directly merge into the other. Between the two 
 there is a state of unconsciousness or of deep sleep, how- 
 ever short it may be. The two alternating function- 
 ing systems are separated by an interval of apparent un- 
 consciousness or of deep sleep. At first the interval is 
 long, extending over a period of many minutes, or even 
 hours, but gradually, with the repetition of the alterna- 
 tion, this interval becomes shorter and shorter, and is 
 finally reduced to but a few seconds. 
 
 In the first cycles of double and multiple personality 
 none of tlie personalities are well organized; each of 
 the leading personalities can maintain itself above 
 the threshold of self-consciousness for but a short time 
 only. With the disintegration of the latter another per- 
 sonality begins to rise, reaches the threshold of self-con- 
 sciousness and begins to function; the personality not 
 being well organized the process of formation and rise 
 requires a considerable time. As the cycles of alternation 
 are more and more repeated the alternating personalities 
 become well organized and the time between the submer- 
 gence of one and the emergence of the other becomes 
 considerably reduced. Still the process must occupy some 
 fraction of time, however short. Hence the intermediary 
 state of deep sleep, the state of unconsciousness. In 
 
 88 
 
Hypnolepsy 89 
 
 passing from one state to the other the deep sleep must 
 be present. This is the hypnoleptic state. 
 
 I must add that the hypnoleptic state is, as a rule, not 
 found in artificially produced hypnoidic states. No gap, 
 no state of unconsciousness separates hypnoidic or co- 
 existent personalities cultivated by a long series of ex- 
 perimental suggestion. We may say that hypnolepsy is 
 pathognomonic of actual, spontaneous hypnoidic states. 
 
 The hypnoleptic state is a true attack. It sets in with 
 a state of irresistible drowsiness, the patient still having 
 consciousness of his environment. Stimuli which must 
 become more and more intense as the state of drowsi- 
 ness deepens, reach the subsiding, disintegrating person- 
 ality and revive it, bringing it again into momentary 
 activity. The patient can be aroused for a brief space 
 of time, for a second or a fraction of It, and soon falls 
 back into a drowsy condition. As the drowsiness deep- 
 ens the patient's reactions to external stimulations be- 
 come gradually weaker. Finally a point is reached be- 
 yond which no stimuli, however Intense, can possibly 
 arouse the patient — he is in an unconscious state. The 
 hypnoleptic state can therefore be divided into two 
 stages. One may be characterized as the first stage or 
 the stage of drowsiness. The state that follows is the 
 second stage, the stage of unconsciousness. 
 
 The state of drowsiness or the first of the hypnoleptic 
 state is of the utmost importance for theoretical, experi- 
 mental as well as for practical therapeutic purposes. It 
 is in this stage that the true crisis of alternation begins. 
 One personality Is slowly subsiding while another per- 
 sonality is being formed and Is slowly rising to its dom- 
 inant position in consciousness. 
 
 The hypnoleptic state was well manifested, in the 
 
90 Diagnosis of Psychopathic Diseases 
 
 Hanna, case, a true case of multiple personality, not 
 brought about by suggestion or by hypnosis. To quote 
 from the account : 
 
 "Mr. Hanna was now overcome by an uncontrolla- 
 ble desire to sleep. His eyelids began to close. He 
 was urged to keep them open, but each time they began 
 to drop in spite of his efforts. Attempts were made to 
 arouse him by various stimulations. His limbs were 
 moved violently, cold water was dashed in his face; 
 he was pinched and otherwise stimulated. The onset 
 of the somnolent state was irresistible. The lids finally 
 closed; he could not open them. He fell into a state 
 of unconsciouness. 
 
 Every effort to keep him awake was futile. Even 
 the mechanical opening of his lids did not bring any re- 
 sponse; he remained immovable. This is the hypnolep- 
 tic State. In this hypnoleptic state Mr. Hanna was 
 physically prostrated. He was like one dazed by a 
 hard blow, who lapsed intc^ unconsciousness. His mus- 
 cular system was passive. The conjunctival reflex was 
 absent. There was general anaesthesia to all forms of 
 sensations." 
 
 The hypnoleptic state is an attack of sudden onset. 
 It may be divided, as we have pointed out, into two 
 periods. The first is that of a rapidly increasing 
 condition of extreme fatigue and an overwhelming 
 feeling of drowsiness, culminating in a second period, 
 that of unconsciousness. The state of hypnolepsy is 
 observed in all true cases of double and multiple per- 
 sonality. The law of monocyclical or polycyclical 
 bimorphosis and polymorphosis is : All mental alterna- 
 tions have an intermediate state of drowsiness and un- 
 consciousness, a state of hypnolepsy. 
 
Hypnolepsy 9 1 
 
 The state of hypnolepsy occurs in the transition 
 from the primary to the secondary, or newly formed 
 personality. The transition from the secondary to 
 the primary personality occurs in ordinary sleep. The 
 order of the cycle is: primary state, hypnolepsy, sec- 
 ondary state, sleep; primary, hypnolepsy, secondary 
 state, sleep, -'primary, and so on. In other words the 
 passage from the secondary to the primary is through 
 the ordinary sleep-state, no unconsciousness being 
 present, while the transition from the primary to the 
 secondary is through drowsiness and unconsciousness, 
 through the state of hypnolepsy. 
 
 The transition from the primary to the secondary 
 comes on like a sudden attack. The patient may be 
 lively, in excellent spirits, he suddenly becomes drowsy 
 and lapses rapidly into a state of unconsciousness. When 
 he comes to he is in the secondary state. Nothing of 
 the kind is observed in the transition from the second- 
 ary to the primary state. If the patient could be kept 
 from going to sleep, he could be kept indefinitely in 
 the secondary state. This, however, is not the case 
 with the primary state. The primary state is more un- 
 stable, after a few hours the hypnoleptic attack comes 
 on with a consequent transformation of personality. 
 
 Why is it that while the transition from the second- 
 ary to the primary state is through the condition of 
 ordinary sleep, taking place usually at night, the con- 
 trary is the case in the transition from the primary to 
 the secondary? In other words, why should the tran- 
 sition between the primary and the secondary state take 
 place through an "attack," through a hypnoleptic state? 
 The answer is, because the sleeping state represents the 
 absence of any dominant moment of self-consciousness, 
 
92 Diagnosis of Psychopathic Diseases 
 
 the absence of any personality. That is just what takes 
 place in the interval of alternating states. But what is 
 the hypnoleptic state? The hypnoleptic state is the re- 
 production of the original attack which brought about 
 the state of double or multiple personality. 
 
 This was clearly revealed in the Hanna case. What 
 happened in that case was that the patient met with an 
 accident, lost his consciousness, his personality became 
 disintegrated and could not be reinstated; a new per- 
 sonality with new content entered into being; a second- 
 ary state, a secondary personality became gradually 
 formed and trained. The original order then was : 
 (I) the primary state, representing the patient's whole 
 previous life; (II) the state of unconsciousness due to 
 the accident; (III) the formed and trained secondary 
 state or secondary personality. The succession of the 
 states formed a cycle of the original series, a cycle that 
 went on repeating itself by association of contiguity in 
 the same order. It is the law of recurrence which dom- 
 inates all life. 
 
 We can now understand why the hypnoleptic 
 state is of the nature of an attack. Hypnolepsy is c 
 reproduced attack. We can also understand why the 
 order invariably follows a uniform course : primary 
 state, hypnolepsy , secondary state, never the reverse. 
 Such is the original order of events which recurs like 
 the rising and setting of the sun. 
 
 The phenomena of double and multiple personality 
 have a definite course of their own. Newly formed 
 personalities pass through well defined cycles, and like 
 new worlds formed by some external or internal catas- 
 trophe, they keep on revolving within the same orbits, 
 they follow the same order as the phases of the moon. 
 
Hypnolepsy 93 
 
 The order is persistent, reflex, automatic, and recurrent. 
 Further on in reviewing psychopathic states we shall 
 bring out this important recurrent aspect of all subcon- 
 scious states. 
 
PART II 
 PSYCHOPATHIC DISEASES 
 
CHAPTER XI 
 
 THE CLASSIFICATION OF NERVOUS AND MENTAL 
 DISEASES 
 
 IN reviewing the different forms of nervous and 
 mental diseases we may classify them into organic 
 and functional. By organic affections we mean 
 pathological modifications of the nerve-cell and its 
 processes taking place in the very structure of the cell. 
 The modifications are of a degenerative character, end- 
 ing in the death of the neuron. Under this category 
 come such diseases as general paresis, dementia prsecox, 
 and mental affections of a degenerative structural char- 
 acter. Such diseases may be termed organopathies or 
 necropathies. The functional affections may in turn be 
 divided into neuropathies and psychopathies. 
 
 There are mental maladies in which the neuron' un- 
 dergoes degenerative changes which at first bring about 
 an apparent increase and then a suspension of function 
 not necessarily terminating In the destruction of the 
 neuron. The neuron recovers either temporarily or per- 
 manently. Such affections are produced by poisons, al- 
 cohol, morphine, chloral hydrate, cannabis indica, and 
 other toxic agencies. To this category also belong all 
 mental affections caused by toxic products formed in the 
 organism and slowly and Imperfectly eliminated from 
 the body. Here belong all the temporary maniacal, mel- 
 ancholic, and delusional states, such as puerperal mania, 
 epileptic insanity, the insanity of the adolescent and cli- 
 macteric periods, as well as that of folic circulaire, 
 
 97 
 
98 Diagnosis of Psychopathic Diseases 
 
 periodic insanity, alternating insanity, and, in general, 
 all the mental states known at present under the descrip- 
 tion of manic-depressive insanity. All such neuron 
 affections may be termed neuropathies. 
 
 Where the affection depends not so much on the neu- 
 ron itself, but on the association of neurons, the disease 
 may be described as a psychopathy. In this form of 
 mental affection the neuron itself may remain healthy, 
 the trouble being due to associations with systems of 
 neurons which are usually not called into action by the 
 function of that particular neuron or system of 'neurons. 
 Such conditions are well known in physiology. Thus in 
 the experiments of Pavlow and his school the flow of 
 saliva in the dog could be brought about by association 
 with a blue light or with a whistle or with the ring 
 of a bell. 
 
 What holds true in the case of saliva holds true, 
 for instance, in the case of nausea and vomiting. 
 StimuH which are ordinarily indifferent may, by asso- 
 ciation, bring about such conditions. The fault does not 
 lie here in the stimulus, or in the sensation, or in percep- 
 tion, but in the association with reactions of neuron sys- 
 tems with wliich that stimulus and its percept have be- 
 come associated. In other words, the fault is of a purely 
 associative character. 
 
 Ordinarily only food or gustatory sensations and per- 
 ceptions of food can call out the flow of saliva or in- 
 duce nausea and vomiting. Colored light cannot do it. 
 Under special condition of association, however, color- 
 ed light may call forth the reactions of flow of saliva 
 or of nausea and vomiting, instance the experiments 
 carried on by Pavlow and his pupils. 
 
 Emotions are specially subject to such associations of 
 
Classification of Nervous and Mental Diseases 99 
 
 what may be regarded as morbid or pathological in 
 character. Emotions with their physiological effects may 
 be linked by the process of association with any ideas, 
 percepts, and sensations. Sometimes the physiological 
 effects of emotions, or in fact any physiological effects, 
 may be linked by special associative processes with ideas, 
 percepts, and sensations which ordinarily are either in- 
 different in character to give rise to reactions and physi- 
 ological effects of a different and even opposite type. 
 Milk may excite nausea, a rose induce disgust, while the 
 croak of a frog or the cawing of a crow may bring about 
 ecstasy; Limburger cheese and overripened game may 
 be enjoyed with intense delight. What association of 
 sense and reaction made the Greeks regard the grass- 
 hopper as highly musical ? The reactions of muscle and 
 gland are like so many bells which by various connec- 
 tions and combinations may be made to ring from any 
 sensory button. 
 
 An object, however harmless, may awaken intense 
 fear while a dangerous object may be passed by with 
 indifference. A man may be afraid of pointed sticks 
 for instance and handle carelessly a revolver. The emo- 
 tion of fear is associated with the one object, but is dis- 
 sociated from the other. It is such associations and dis- 
 sociations that give rise to the mental diseases of a 
 psychopathic character. 
 
 This holds true not only of man, but also of the 
 psychic life of the lower animals. My horse is not afraid 
 of automobiles, regards with suspicion camels, and is 
 somewhat startled at the sight of an elephant, yet passes 
 them by; but he gets scared at a piece of paper. Psy- 
 chopathies, then, may be regarded as essentially patho- 
 logical affections of associative life. Mental diseases 
 
100 Diagnosis of Psychopathic Diseases 
 
 may thus provisionally and roughly be classified into 
 organopat^ies, neuropathies, and psychopathies. 
 
 If the psychomotor manifestations of the pathological 
 process of neuron disaggregation and neuron degener- 
 ation be formed into a series, then the first stages of 
 that series of that process constitute the phenomena of 
 functional psychosis or of psychopathy. The stages are 
 concomitant with the pathological conditions In which 
 only the associations, the interrelations of neuron sys- 
 tems, are affected by dissociations; — the neurons, the dis- 
 sociated aggregates, themselves remain unaffected. 
 
 The whole domain of the subconscious belongs to 
 these stages of disaggregation in the course of the pa- 
 thological process, e. g., the phenomena of hypnosis, 
 of somnambulism, of motor and sensory automatism, 
 of the so-called hysterical sensori-motor disturbances of 
 various organs, over the functions of which the personal 
 consciousness is found on examination to have lost con- 
 trol by reason of neuron disaggregation and dissocia- 
 tion. Here belong the phenomena of double and mul- 
 tiple personality, the various phenomena of amnesia, 
 the lost content of which can be revealed in the strata 
 of subconscious life. 
 
 The domain of functional psychosis or of psychop- 
 athy also includes the phenomena of the different forms 
 of so-called "psychic epilepsy." Here also belongs the 
 great class of psychomotor derangements, such as 
 phobias, impulsions, obsessions, fixed Ideas, and allied 
 states. ' • • n-f^^ 
 
 The phenomena of functional psychosis are coexten- 
 sive with the whole domain of the subconscious. Func- 
 tional psychic disturbances, or psychopathies are cor- 
 related not with organic, structural neuron degenera- 
 
Classification of Nervous and Mental Diseases loi 
 
 tlon, but with disaggregation of functioning systems or 
 of neuron aggregates. The physiological cause is the 
 rise of thresholds of the intercommunicating neuron sys- 
 tems. 
 
 In psychopathic affections the function apparently 
 lost and destroyed is found to be present in the subcon- 
 scious, — the loss of function is only for the direct per- 
 sonal consciousness. The affection is only of a dissoci- 
 ative character. The activity of the affected system is 
 Itself sound; in fact, is often found to be exaggerated, 
 — the system is only dissociated from other functioning 
 systems. 
 
 The total energy of the neuron may be classified into 
 dynamic energy, reserve energy, static energy, and or- 
 ganic energy. 
 
 KEDRON ENEBGT AND ITS PSTCHOUOTOB MANIFESTATIONS 
 
 peatruetlon of 
 
 Neuron. 
 
 DiBlmeBratlon ot 
 
 Cytoreuculum. 
 
 Lower Levels ot S»tlo Dneivy, 
 
 Nouron BegeneratloD and Regen- 
 eretloD. FrocesseB of Cjrtolympli 
 Integration and Disintegration. 
 
 Upper Levele 
 )f Statlo 
 BnerB7. 
 
 ••■R-B-»T-i-T-H-r-I- 
 
 ■•■•A-6-S-H-H a a-o • 
 
 Lower Levola ol 
 
 Drnamlo Bnernr 
 
 or ot Roierro 
 
 Energy. 
 
 ot Syatemlo Cellular 
 and DlHggregatloo. 
 
 ,i..a.,ff...I..II.... 
 
 T 
 
 HfBualo Bnerff. 
 
 T 
 
 T A L 
 
 E N E R G 
 
 N B U 
 
 RON 
 
 '.■■ft".a--4-v— iL- 
 
 «■•*•■■*-•»-*■- 
 
 Pathol 
 
 -L-S-B-P"!- 
 Patrol 
 
 o O I A 
 
 K-6 'S- 
 
 *-A-*-»-8~ 
 
 O Q I A 
 
 DEBTRTJCnVB KEO- NSUBbl»ATHIBB. PKCHOfATHDlB. NOSKALPBTWOLOO. 
 
 aoPATHrtB, Psychotnotor phenomena of Neuron Phenomena ot AasoelatloB spfl lOAL PBBtOKIIIA. 
 
 Death of Neuron or ot Degeneration and Regeneration. Dlaaoclatlon ot Fsychin Syatemi or 
 Syatenu of Neurone. 
 
 Moments of Consolausneaai 
 
 OKUANIC. 
 
 FUNCTIONAL. 
 
I02 Diagnosis of Psychopathic Diseases 
 
 The psychopathies, neuropathies, and organopathies 
 or necropathies may be correlated with the flow and 
 ebb ot neuron energy, with the physiological and path- 
 ological processes that take place in the neuron in the 
 course of its activity. This may be represented by the 
 diagram on page loi. 
 
 By dynamic energy of the neuron is meant that part 
 of energy which the neuron as an individual organism 
 can dispose of in its relations to other neurons forming 
 complex functioning organizations. 
 
 The dynamic energy is represented by the upper por- 
 tion of the parallelogram A M L K. 
 
 By reserve energy is meant that surplus amount of 
 dynamic energy which is kept in reserve and drawn 
 upon by the organism under special conditions and 
 emergencies. 
 
 Reserve energy is indicated by the diagram K N W A 
 
 By static energy is designated that portion of energy 
 that is used only for the life maintenance of the neu- 
 ron, both in relation to other neurons and to its own 
 inner molecular constitution. Static energy cannot be 
 drawn upon by the neuron in its functioning activity 
 with other neurons whhout bringing about a state of 
 disintegration. 
 
 Static energy is indicated by the diagram N W F I. 
 
 By organic energy is meant that energy contained in 
 the very structure of the tissues of the neuron, not as 
 yet decomposed into their inorganic constituents. This 
 is indicated by diagram I F G H. 
 
 These phases of neuron energy are not different 
 kinds of energy, in the sense of being distinct entities; 
 they merely represent progressive phases or stages of 
 the same process of neuron activity. 
 
Classification of Nervous and Mental Diseases 103 
 
 Liberation of neuron energy is correlative with ac- 
 tive psychic and physical manifestations. Hence states 
 of the nervous system corresponding to liberations of 
 energy are designated as waking states. Restitution 
 of expended energy or arrest of liberation of neuron 
 energy goes hand in hand with passive conditions of 
 the nervous system; hence states of restitution or ar- 
 rest of energy are termed collectively sleeping states. 
 
 In the diagram this correlation is followed out in 
 the direction of the arrows. The arrow, indicating suc- 
 cessive levels of liberation of energy, corresponds to a 
 similar arrow which indicates the course and progress 
 of the waking states running parallel to the process of 
 liberation of energy. The arrows at the top of the dia- 
 gram illustrate the physiological and pathological pro- 
 cesses at work in the cycles of expenditure and restitu- 
 tion of energy, while the bottom of the diagram indi- 
 cates by its arrows the concomitant psychomotor mani- 
 festations — the waking and sleeping states. 
 
 The ascending arrow, indicating the process of res- 
 titution of energy, corresponds to the ascending arrow 
 indicating the parallel psychomotor sleeping states. The 
 descending arrows indicate physiological and patholog- 
 ical processes of liberation of energy, and also their 
 concomitant psychomotor waking states. 
 
 "Ascending" and "descending" mean the rise and 
 fall of the amount of neuron energy, taking the upper 
 level of dynamic energy as the starting point. Briefly 
 stated, descent means liberation of energy with its con- 
 comitant psychomotor waking states. Ascent means 
 restitution of energy with its parallel sleeping states. 
 
 The cycles in dynamic energy correspond to the phy- 
 siological manifestations of the nervous system in the 
 
I04 Diagnosis of Psychopathic Diseases 
 
 activity and rest of the individual in normal daily life. 
 Concomitant with the expenditure of dynamic energy 
 of the neurons, the individual passes through the active 
 normal waking state, and, hand in hand with the resti- 
 tution of this expended dynamic energy, he passes 
 through the sleeping state of normal daily life. 
 
 When, however, in the expenditure of energy, the 
 border line or margin, A K or N W, is crossed, dy- 
 namic and reserve energies are used up, and reserve 
 and static energy are drawn upon. In crossing A K or 
 N W the border line that separates the normal physio- 
 logical from the abnormal or pathological psychomo- 
 tor manifestations is stepped over. 
 
 "The thresholds of our psychological systems are 
 usually raised, mental activity working in the course of 
 its development and growth of associative processes 
 under ever-increasing inhibitions with ever higher 
 thresholds. . . . On account of the high thresholds 
 and inhibitions, not the whole amount of the psycho- 
 physiological energy possessed by the system is mani- 
 fested; in fact, but a very small portion is displayed 
 in response to stimuli coming from the habitual envi- 
 ronment. What becomes of the rest of the unused en- 
 ergy? It is stored, reserve energy. 
 
 "Biologically regarded, we can well see the import- 
 ance of such stored or reserve energy. In the struggle 
 for existence the organism whose energies are econom- 
 ically used and well guarded against waste will meet 
 with better success in the process of survival of the fit- 
 test or will have better chances in the process of natural 
 selection. The high thresholds and inhibitions will pre- 
 vent hasty and harmful reactions, useless waste of en- 
 ergy, unnecessary fatigue, and states of helpless ex- 
 
Classification of Nervous and Mental Diseases 105 
 
 haustion. Moreover, natural selection will favor or- 
 ganisms with greater stores of reserve energy, which 
 could be put forth under critical conditions of life. In 
 fact, the higher the organization of the individual, the 
 moire varied and complex the external environment, 
 the more valuable and even indispensable will such a 
 store of reserve energy prove to be." 
 
 Static energy may be divided into two phases accord- 
 ing to the nature of the process of liberation of neuron 
 energy. As long as the process of liberation of energy 
 effects only a dissociation of systems of neurons the 
 correlative psychomotor manifestations fall under the 
 category of psychopathies. If, however, the process 
 of liberation affects the neuron itself, bringing about a 
 disintegration of its constituent parts compatible with 
 restitution, the correlative psychomotor manifestations 
 fall under the category of neuropathies. This process 
 of disintegration, equivalent to cell degeneration may 
 end in death, in the dissolution of the neuron itself. 
 
 By psychopathies, then, is designated the patholog- 
 ical phenomena of psychic disaggregation correlative 
 with the state or processes of dissociation within clus- 
 ters or constellations of neurons, the neuron itself re- 
 maining undamaged. 
 
 By neuropathies is indicated a group of psychophy- 
 sical manifestations running parallel to fluctuations of 
 static energy and accompanied by functional and or- 
 ganic changes in the neuron. 
 
 By organopathies or necropathies is indicated a 
 group of psychophysical manifestations running paral- 
 lel with fluctuations of organic energies and accompan- 
 ied by structural changes or by necrotic modifications 
 resulting in the ultimate death of the neuron system. 
 
io6 Diagnosis of Psychopathic Diseases 
 
 The usual classification of mental functions is into : 
 intellect, feeling, and will. By intellect is under- 
 stood such functions as perception, conception, mem- 
 ory, abstraction, imagination and judgment. Under 
 feeling are ranged sensations, pleasures, pains, moods, 
 affective states and emotions. By will is meant all 
 the functions leading towards action, our conations, 
 desires, strivings, tendencies, and decisions. If we ac- 
 cept this psychological classification, we may accord- 
 ingly classify mental diseases. ^ 
 
 From our standpoint we need not go into the details 
 of psychological classification. What we wish is to 
 classify the nervous and mental derangements that fall 
 into the domain of psychopathology. 
 
 We may take the physiological reflex arc as bur basis 
 of classification, namely the passage of a nerve current 
 from a sense-organ through a sensory nerve to an inter- 
 mediary central neuron or ganglion, and thence through 
 a motor nerve to muscle ; we can conveniently classify all 
 psycho-physiological functions into sensory, intermedi- 
 ary or ideational, and motor. Biologically this classifi- 
 cation is well justified inasmuch as by means of the sen- 
 sory function the animal receives impressions from 
 the external environment, elaborates them in the centre, 
 and then reacts by motor adjustments and adaptations. 
 
 Psychopathic states are classified into sensory disturb- 
 ances of sense organs and viscera, the various forms 
 of anaesthesia ; motor disturbances, and finally derange- 
 ments of ideas, memory, will, and emotion. We give 
 here a brief clinical description of various forms of psy- 
 chopathic states in the ascending scale of their develop- 
 ment, complexity, and organization, beginning with 
 sense-disturbances known as the anaesthesias. 
 
Classification of Nervous and Mental Diseases 107 
 
 According to the symptoms we may divide psy- 
 chopathic maladies into : 
 
 (I) Peripheral. 
 
 (II) Periphero-central. 
 
 (III) Central. 
 
 Under the peripheral may be classed the following : 
 
 ( 1 ) Sensory disturbances, the anaesthesias. 
 
 (2) Motor disturbances, derangements of motor ad- 
 justments and epileptoid attacks. 
 
 (3) Visceral disturbances, glandural affections, sec- 
 retory, respiratory, cardiac, intestinal and sexual de- 
 rangements. 
 
 Under periphero-central we may class : 
 
 ( 1 ) Illusions. 
 
 (2) Hallucinations, pseudo-hallucinations, the dream- 
 hallucination, hypnotic hallucination, the aphasias. 
 
 Under central disturbances we may class : 
 
 ( I ) Delusions, the various forms of amnesia, abou- 
 
 lia, fixed ideas, morbid impulses, emotions, and morbid 
 
 propensities. 
 
 We shall follow this order in our account of the 
 
 various psychopathic maladies. 
 
CHAPTER XII 
 
 SENSORY DISTURBANCES 
 
 BY anaesthesia is generally understood a loss of 
 sensation in the epidermic layers of any of the 
 sense organs, and specially a loss of sensation 
 in the skin. 
 The anaesthesias may, with Janet, be classified as 
 follows : 
 
 Anaesthesia : 
 
 Local, 
 
 Disseminated, 
 
 Special, 
 
 General, 
 
 Total, 
 
 Systematized. 
 Paraesthesia : 
 
 Hypoaesthesia, 
 
 Hyperaesthesia. 
 
 By local anaesthesia is meant a loss of sensitivity in 
 some one part of the body. The usual stimuli applied 
 to the affected part do not give rise to their appreciation 
 in consciousness. One or more of the qualities of sensi- 
 bility may be lost. The anaesthesia is frequently on the 
 left side. It is sometimes confined to limited spots, 
 sometimes to a part or to an entire extremity, or sym- 
 metrical portions of two extremities may be involved as 
 in "glove and stocking" anaesthesia; it may again ex- 
 tend to one half of the entire body constituting hemi- 
 anaesthesia. 
 
 io8 
 
Sensory Disturbances 109 
 
 The face may be involved, often on one side and 
 along with it the eyes may be affected. Anaesthesia of 
 one side of the face and appropriate side of the body 
 may occur. When the eye is involved, not only the 
 retina, but also the lids are anaesthetic. The eye mus- 
 cles may also be affected. 
 
 Of all forms of sensation, pain and the tactile sense 
 are most frequently lost. Muscular sense and articular 
 sensibility are rarely affected. In severe cases the loss 
 of sensibility includes the deeper parts and is more or 
 less complete to all, even to intense stimuli, while in mild 
 cases, strong continuous stimuli are felt. The anaesthe- 
 sia may include parts of the mucous membranes. The 
 abdominal viscera may be analgesic, strong compres- 
 sion giving rise to no pain. 
 
 Disseminated anaesthesia is like the local form, ex- 
 cept that it is distributed over the body in patches. It 
 may be in geometrical patches or in segments. The 
 anaesthetic areas sometimes take the form of bands. 
 
 Special anaesthesia is a form in which the special 
 senses are involved. Special anaesthesia may be either 
 visual, auditory, gustatory, olfactory, or thermal. The 
 most frequent form of special anaesthesia is that of 
 limitation of the field of vision, usually of a concent<:ic 
 form. The loss of vision may be total, but this is a rare 
 form. Visual acuity usually remains unaffected. There 
 are not infrequently color disturbances, achromatopsia 
 in which all colors are seen as grey. 
 
 Another far more common variety is that in which 
 the revef'sal of the color field is present. In the normal 
 eye the largest field is for white light, — ^blue, red and 
 green come next in order, violet having the smallest 
 field. The most frequent reversal in psychopathic vis- 
 
no Diagnosis of Psychopathic Diseases 
 
 ual anaesthesia is between red and blue, the red preced- 
 ing the blue, and showing a larger iield. 
 
 Psychopathic deafness is less common than the other 
 forms of special sense anaesthesia. In most of the 
 cases there is also anaesthesia of the external auditory 
 meatus and of the outer surface of the drum. The 
 deafness is rather for notes of high pitch. The ten- 
 dency to involvement of the various special senses is 
 according to the law of adaptation, reproduction or re- 
 currence. The senses involved in the trauma show the 
 recurrence of anaesthesia. The auditory is more es- 
 sential than the visual in carrying on social rela- 
 tions, and is therefore less frequently affected. Taste, 
 smell, and muscular sensibility, which are still more 
 important in carrying on life activity are more rarely 
 involved. In the form of special anaesthesia one or 
 both sides may be involved. 
 
 In general anaesthesia all forms of sensibility of 
 skin and mucous membrane are involved. This gen- 
 eral anaesthesia may be localized, in patches, or in 
 bands ; it may cover the entire body or half of it. When 
 the anaesthesia appears in the form of patches or as 
 hemianaesthesia, touching or pricking two symmetri- 
 cal parts, the one normal the other anaesthetic, presents 
 interesting phenomena. The normal side may become 
 red from the stimulus, while the anaesthetic part re- 
 mains relatively unaffected. 
 
 Occasionally anomalies of sweat secretion, such as in- 
 crease or decrease of perspiration, are present. There is 
 no difference in temperature or circulation or general nu- 
 trition of the two sides. The anaesthetic part usually 
 retains its reflexes. When the lower leg is involved 
 the patellar reflex may be increased, but often it re- 
 
Sensory Disturbances ili 
 
 mains unchanged. 
 
 The anaesthesia may be total, it may affect the en- 
 tire body, involving also the mucous membranes. The 
 anaesthesia may be for all qualities of skin sensation, 
 such as touch, pressure, pain, heat and cold and may 
 also involve completely or partially the special sense- 
 organs. This formi of anaesthesia is rare. In total 
 anaesthesia the more frequent form is the loss of sen- 
 sibility of skin and mucous membrane. The muscular 
 sense is usually preserved, though in some cases it may 
 be slightly diminished. In total anaesthesia the patel- 
 lar reflex, the abdominal reflex, the secretory and vaso- 
 motor reflexes are present. 
 
 Systematized anaesthesia consists in the loss of sen- 
 sibility in relation to definite systems of impressions, 
 coming from certain external objects. That is, while 
 the patient is anaesthetic to certain objects, he is not 
 anaesthetic to other objects, though of the same na- 
 ture. This form of anaesthesia may effect any of the 
 senses, and is specially characteristic of the psycho- 
 pathic state. 
 
 The tendency to dissociation or anaesthesia is in in- 
 verse ratio of its biological and social adaptations. Sys- 
 tematized anaesthesia becomes greater with emotional 
 excitement and with increase of the intensity of atten- 
 tion. The pathological process here as in other psy- 
 chopathies consists in a disaggregation of mental sys- 
 tems; it has its parallel in those forms of aphasia in 
 which certain kinds of words only are forgotten, while 
 others are retained. 
 
 Along with the anaesthetic or hypoaesthetic disturb- 
 ances we sometimes find hyperaesthetic spots in which 
 the sensitivity is abnormally great. On account of the 
 
112 Diagnosis of Psychopathic Diseases 
 
 general process of disaggregation the touching, or 
 pricking of certain spots gives rise only to indefinite 
 feelings, the patient indistinctly or vaguely feels the 
 stimulus. 
 
 In some patients with psychopathic disturbances, 
 touching, pricking, or sending even a strong elec- 
 tric current through a limb, a hand for example, is only 
 vaguely felt and localized. This phenomenon is 
 known as allochiria. If the hypersensitiveness is very 
 acute, the patient may localize the impression in a sym- 
 metrical place on the opposite extremity. This may be 
 termed complex allochiria. 
 
 In psychopathic hyperalgesia, while the slightest 
 touch may give rise to pain, often a firm pressure is 
 not painful. The mucous membranes may be the seat 
 of the hypersensibility giving rise to pain during swal- 
 lowing, urination, defecation, etc. 
 
 Hyperaesthesia of the special sense-organs may occa- 
 sion disturbances of vision, smell, hearing, or taste. A 
 common form of psychopathic paraesthesia is that of a 
 boring pain at the vertex of the skull, as though a dull 
 instrument were being driven into the head. This form 
 of pain is sometimes termed clavus hystericus. There 
 may be hyperaesthesia or more commonly anaesthesia 
 of the genital organs. The breasts may often be the 
 seat of paraesthesia. In some cases the paraesthetic 
 member feels to the patients, as if amputated or belong- 
 ing to some other individual. 
 
 There may also be anaesthesia relating to hunger, 
 thirst, and micturition. When thete is anaesthesia re- 
 lating to hunger and thirst, the patient may go on for 
 some time without food, or tdke but little nourishmeflt 
 as the desire for food is diminished. When there 
 
Sensory Disturbances 113 
 
 is anaesthesia of the bladder and urethra and also 
 of the skin and muscles there may be incontinence of 
 urine. The anaesthesia of the bladder may give rise 
 to retention of the urine. Sensations of crawling, numb- 
 ness, feeling as though snakes crawled beneath the skin 
 are among the other forms of anaesthesia. 
 
 Disseminated or small islands of hyperaesthetic or 
 paraesthetic spots are often found in psychopathic cases 
 and may occur alongside of the anaesthetic ones. In 
 psychopathic cases in which anaesthesia is present, there 
 is almost invariably present some form of motor dis- 
 turbance or paroxysm, occurring at irregular intervals. 
 The anaesthesia always becomes more pronounced af- 
 ter the attack which may be considered as a form of 
 hypnoleptic state. 
 
 There are often pains In different parts of the body, 
 especially about the breast, ovaries, and spine. Pres- 
 sure upon these spots may provoke a so-called hysterical 
 attack or sometimes stop it. Such zones are termed 
 hysterogenetic. Pains of psychopathic nature in the 
 vagina or in the breast have sometimes led to diag- 
 nosis of organic disease and consequent operations. // 
 must always be remembered that psychopathic sensory 
 disturbances are psychic in character, they are disturb- 
 ances of the patient's subconscious life activity. 
 
CHAPTER XIII 
 
 MOTOR, VISCERAL, AND CIRCULATORY DISTURBANCES 
 
 IN this form of psychomotor disturbances a long- 
 er time is required to execute voluntary move- 
 ments. This is shown by the fact that the reac- 
 tion time is greater for the affected than the 
 unaffected extremity, the difference may amount to one- 
 fifth of a second. In the simple reaction time of the 
 affected extremity it may rise to two seconds and some- 
 times, though rarely, to twenty seconds. Usually the 
 affected extremity is hypoaesthetic or anaesthetic and the 
 reaction time is more or less in proportion to the anaes- 
 thesia, or to the depth of the process of disaggrega- 
 tion. When voluntary movements are executed, they 
 are carried out hesitatingly. This may be character- 
 ized as a kind of psychopathic ataxia. 
 
 The kinaesthetic memory of processes is present, 
 while the kinaesthetic sensations are lost; that is, the 
 central process of kinaesthesia is preserved, while the 
 peripheral is lost. Hence we often find the following 
 phenomenon, the patient with his eyes closed is told to 
 raise his hand, he tries to do so. If now the hand is 
 seized and held down, the patient still exerting force 
 and endeavoring to raise it, finally believes that the 
 hand is fully raised. 
 
 The voluntary movements become simplified or rath- 
 er weakened in their range. Only simple movements 
 can be executed, while the more complex are affected, 
 the latter are carried out with effort, in a slow, uncer- 
 tain way; simultaneous movements interfere with 
 
 114 
 
Motor, Visceral, and Circulatory Disturbances 115 
 
 each other. If, for example, the patient is asked 
 to close his hand, and at the same time to perform an- 
 other movement, such for instance as raising the eye- 
 brows, the one movement stops the other, they can- 
 not be performed simultaneously. 
 
 The voluntary movements become weakened in in- 
 tensity. The movements and muscular power are less 
 than one would expect from the general health and ap- 
 pearance of the patient. This condition is sometimes 
 characterized as amyosthenia. Thus, for instance, it 
 is sometimes surprising to find in one or both of the up- 
 per extremities affected, that the dynamometric force 
 is unduly diminished. In some cases it may fall to 
 nine or even five units. In such cases the muscular 
 weakness is both for active and passive movement; 
 the patient is deficient not only in pressing or squeez- 
 ing or in the performance of similar acts, but he like- 
 wise lacks the power of active resistance. 
 
 Amyosthenia, is as a rule, greater when the attention 
 of the patient is diverted. Sometimes when the patient 
 is asked to press the dynamometer with eyes closed, he 
 does not press at all ; it may register zero. The pres- 
 sure increases when the patient is directed to concen- 
 trate his power of attention and will upon the effort. 
 During all this time while the patient is unable to press 
 upon the dynamometer, he may still in some other liab- 
 itual exertions show great muscular power. We may 
 call this form Systematized amyosthenia. The gen- 
 eral law of amyosthenia is that the disturbance pro- 
 ceeds from the complex to the simple and from the less 
 useful to the more useful, and the more habitual func- 
 tions, from the functions more associated with trau- 
 matic disturbances to functions with fewer traumatic 
 
ii6 Diagnosis of Psychopathic Diseases ^ 
 
 associations. 
 
 The weakening of voluntary movements in psy- 
 chopathies is especially pronounced in rapid repetition 
 of the same movements, so that sometimes the patient 
 may after a few endeavors be quite incapable of per- 
 forming the movement. Tested, however, by other 
 psychopathic methods, it is found that although the 
 patient cannot perform these movements, he is still 
 able, to carry them out in a subconscious state. 
 
 Psychopathic motor disturbances, like sensory 
 troubles, are essentially morbid modifications of the 
 subconscious. 
 
 The general symptoms of psycho-motor disturb- 
 ances in psychopathic diseases have been formulated as 
 follows : 
 
 (I) The patient's movements on the anaesthetic 
 side are largely guided by the sense of sight. If the pa- 
 tient does not see the anaesthetic member, the movement 
 is performed subconsciously. 
 
 (II) In some cases when movements are apparently 
 impossible without the sense of sight, if the eyes are 
 closed in the middle of the movemnt, the process of 
 movement may be continued. 
 
 (III) In some cases, when without the knowledge 
 of the patient, the anaesthetic member is raised, it be- 
 comes cataleptic. 
 
 (IV) Movements can be induced in the patient 
 without the help of sight, if the movements are brought 
 about subconsciously. 
 
 Among other phenomena observed in psychopathic 
 motor disturbances are synkinesia, allokinesia, and het- 
 erokinesia. 
 
 Synkinesia is the performance of associated move- 
 
Motor, Visceral, and Circulatory Disturbances 117 
 
 ments. If the patient's limb is anaesthetic in the left 
 upper extremity, for instance, he is able to raise either 
 the right or left hand with his eyes open, and the right 
 hand even with closed eyes. If, however, he is asked 
 to raise the left hand alone, the eyes being closed, he 
 raises both hands. When the patient is told to execute 
 certain movements with the left anaesthetic hand, he 
 makes synchronic, symmetrical movements with the right 
 hand. The patient is able to move his right hand alone, 
 but cannot move the left alone, without synchronous 
 symmetrical movement of the right hand. 
 
 The phenomena of allokinesia are parallel to those of 
 allochiria. In allokinesia the patient is unable to local- 
 ize well his peripheral kinaesthetic sensations. If for 
 instance, the patient is asked to raise the right hand, 
 he raises the left instead and is not aware of the dif- 
 ference. In this way the patient's anaesthesia or any 
 form of motor disturbance may be transferred from one 
 side to the other. The phenomenon of transfer is often 
 due to this form of experiment. 
 
 The phenomenon of heterokinesia is rare. It con- 
 sists in the performance of opposite movements. When 
 the patient, for instance, is told to close his hand, he 
 opens it, or when he wants to bend the arm, he straight- 
 ens it. 
 
 Psychopathic tremor is usually hemiplegic or mono- 
 plegic that is, the tremor may occur on one side of the 
 body, or it may be confined to one limb. The tremor, 
 as in that of epilepsy, is usually present in the intervals 
 between paroxysmal states. If, for example, the tremor 
 is in the upper limb, and the patient is asked to extend 
 the limb and keep it in a certain position a tremor of 
 rather slight range, of about eight or ten oscillations per 
 
1 1 8 Diagnosis of Psychopathic Diseases 
 
 second is observed. 
 
 There are two types of psychopathic tremor. The 
 one form is present during repose and is only shghtly 
 affected by voluntary movement, while the other form 
 may not be present during repose, but is greatly in- 
 creased by voluntary movement. The tremor of the 
 first type resembles that of exophthalmic goitre, while 
 the second form' is more like that of disseminated 
 sclerosis. Emotional excitement increases both forms. 
 The nature of psychopathic tremor like that of other 
 psychopathic conditions, is some subconscious state. The 
 duration of the tremors varies from a period of a few 
 weeks to that of months or years. 
 
 The tremor ceases during a psychopathic crisis, or 
 so called "hysterical attack," but becomes exaggerated 
 shortly after, and may also become marked when 
 pressure is exerted over the so called hysterogenetic 
 zones. The tremor may occur in many parts of the 
 body, head, neck or extremities, and is increased by fix- 
 ation of attention. 
 
 Local and general clonic spasms of small range may 
 occur. The movements in such spasms may assume a 
 form which may be termed psychopathic chorea. Some- 
 times the movements are sudden and shock-like in 
 character, suggesting electrical chorea. This form is 
 easily acquired by imitation, and in the middle ages 
 has at times become epidemic. 
 
 Rhythmical movements of more extensive range 
 may occur ; this condition may be termed psychopathic 
 rhythmical chorea, or psychopathic chorea major. The 
 movements are of wide range, deliberate, and complex. 
 They are of regular sequence and consist of more or 
 less alternate contractions of the muscles, especially 
 
Motor, Visceral, and Circulatory Disturbances 119 
 
 the flexors and extensors of the trunk and extremities. 
 The movements are oscillatory, of regukr rhythm and 
 may last for weeks or months; they invariably cease 
 during sleep. 
 
 Different parts of the body may be involved; the 
 tongue, the eyes or the jaw-muscles may be affected. 
 The rhythmical movement may extend to various mem- 
 bers, sometimes involving the whole trunk. The 
 tremor may be of such a character as to suggest a 
 neuropathic condition. The movements are sometimes 
 arrested by a strong emotion or by an anaesthetic, such 
 as ether, or by a hypnotic, such as morphine. The 
 temporary arrest is succeeded by psychopathic paralysis 
 or contracture. 
 
 The convulsive attacks of psychopathic origin may 
 be divided into minor and major seizures. 
 
 The minor psychopathic convulsive attacks usually 
 follow some deep emotional disturbance. During the 
 attack the patient may make wild and purposeless ges- 
 tures, or aimless movements, utter incoherent cries, go 
 into uncontrollable fits of laughter or weeping, some- 
 times of an alternating character. The onset of the at- 
 tack is usually preceded by a premonition consisting of 
 spasmodic movements of the muscles of the throat, giv- 
 ing rise to a sensation of constriction or to a feeling as 
 though a foreign body were in the throat. This phe- 
 nomena is known as globus hystericus, so named be- 
 cause it was believed that the cause lay in the ascent of 
 the uterus into the pharynx. Some muscular rigidity 
 may be present. Rigidity or contraction of certain mus- 
 cles may be premonitory of the attack. 
 
 The movements in these convulsive attacks, unlike 
 those of epilepsy, appear to be not altogether without 
 
120 Diagnosis of Psychopathic Diseases 
 
 purpose. The patient may make an effort to seize a per- 
 son or object, or to kick at something or destroy it. Ef- 
 forts to restrain the patient forcibly meet with opposi- 
 tion and increase the violence of the attack. Frequently 
 a characteristic tremor or quiver of the eyelids is ob- 
 served when the patient closes the eyes. Pulse and res- 
 piration usually remain unaffected, although the breath- 
 ing may become shallow. After a time, varying from a 
 few minutes to several hours, the patient becomes calm, 
 passive, and then depressed. 
 
 Major motor attacks, sometimes characterized by the 
 Inappropriate term of hystero-epilepsy, consist of con- 
 vulsive seizures of a violent and extensive nature of defi- 
 nite types and stages. Attacks passing through definite 
 stages are of rare occurrence, and when present are found 
 in cases that show during the interparoxysmal period, 
 some form of disaggregation, such as anaesthesia, 
 aboulia or some motor disturbance. 
 
 The major motor attacks are hypnoidic in character 
 being reproductions of conditions that have induced the 
 psychopathic state. The major attacks have prodromal 
 symptoms, which appear several days before the par- 
 oxysm. These may consist of anaesthesia, aboulia, 
 aphasia, general nervousness, etc. 
 
 During the paroxysm, the sensibility of the 
 patient is changed. There may be hyperaesthesia, or 
 anaesthesia, clavus, epigastric pains or uneasiness, etc. 
 This prodromal stage suggests the aura of epi- 
 lepsy, but is altogether different in its nature. In epi- 
 lepsy, the symptoms are due to neuropathic derange- 
 ments, the neuron itself being affected, while in the 
 psychopathic attacks the symptoms are due to dissocia- 
 tion of neuron-systems. Epileptic states are due to 
 
Motor, Visceral, and Circulatory Disturbances 1 2 1 
 
 organic or neuropathic disturbances, while psychopa- 
 thies are subconscious affections. 
 
 The prodromal period is followed by the epileptoid 
 stage, which may come on either suddenly or gradually. 
 The face becomes pallid, the expression vacant, the eyes 
 staring and the patient falls to the ground. The fall 
 is not so violent and precipitate as it is in epilepsy, the 
 patient rarely sustaining injury. The reason of this 
 is that consciousness is really not lost. The subcon- 
 scious self remains active and controls the movements 
 and acts of the patient. In the beginning or during 
 the epileptoid stage a sound is emitted, or word, or 
 phrase is pronounced. At the height of this stage the 
 muscles become rigid and finally the entire body is 
 affected by tonic muscular contraction. 
 
 This condition may be succeeded by relaxation of 
 the muscles. The patient is motionless and only a per- 
 ceptible movement of the eyelids is evident. In some 
 cases the relaxation does not occur. The next stage 
 in the epileptoid condition may be followed by clonism, 
 or the rare phenomenon of opisthotonos may be en- 
 counterdd,-^the body is arched and rests upon the 
 back of the head and foot-soles, the abdominal mus- 
 cles become exceedingly rigid. Soon opisthotonos 
 gives place to bounding movements of great violence. 
 
 The patient then passes through various emo- 
 tions characteristic of the subconscious state. Vari- 
 ous attitudes and expressions are assumed corres- 
 ponding to the prevailing emotion. Th« patient talks 
 incoherently. The riiovements ai-e generally of such 
 nature as to form more oi- less- coordinated systems, 
 they are usually of a struggling, defending nature. 
 
 The eyelids, are usually clostd, th« conjunctival r^^i 
 
122 Diagnosis of Psychopathic Diseases 
 
 flex is diminished and general bodily sensibility is de- 
 creased. A pin stuck far into the flesh does not give 
 rise to any manifestations or reactions of pain. A 
 spasmodic laryngeal convulsion may be present giving 
 rise to dyspnoea. The patient may be unable to swal- 
 low for hours or even days. There may be severe 
 gastric disturbance, pain and vomiting. Anorexia may 
 be so persistent, owing to fear of vomiting, that pa- 
 tients may absolutely refuse food for some time. The 
 attacks may occur at long intervals and sometimes in 
 such a rapid succession as to give rise to a psychopathic 
 status epilepticus. 
 
 The various stages of the major attacks should be 
 regarded as the emergence of a hypnoidic state, as the 
 growth and development of an abortive subconscious 
 personality. A hypnoidic state consists of emotional 
 disturbances with a change of sensibility accompanied 
 by motor disturbances. The emotion forming the nu- 
 cleus of the hypnoidic state is generally the manifesta- 
 tion of some event that had occurred Jn the patient's 
 life, but which afterward subsided within the subcon- 
 scious, in a form more or less disaggregated from the 
 patient's upper consciousness, and now recurring at 
 each favorable opportunity. The hypnoidic state is the 
 hallucination of an actual past event. 
 
 The reason why the attacks recur, is that the 
 emotional state with its train of psychomotor man- 
 ifestations, is easily brought to the surface by the 
 influence of certain stimuli, events and circumstances 
 recalling the original trauma with all its consequences. 
 These stimuli, acting on the patient, may modify his 
 general sensibility. This modification of sensibility 
 when associated with the hypnoidic state brings 
 
Motor, Visceral, and Circulatory Disturbances 123 
 
 about a recurrence of that very state. If the 
 patient is disposed to this hypnoidic state, that is, if 
 there is a tendency to the arousal of those subconscious 
 mental systems, the least stimulus that suggests any of 
 the component associations that go to form the total 
 complex system will bring about that particular synthe- 
 sis of systems of sensibility that go with that particular 
 hypnoidic state. 
 
 The general law of psychology and especially of 
 psychopathology is that a sensory state has motor and 
 glandular accompaniments or reactions. As Pavlow 
 and his pupils have shown, modifications of sensory 
 impressions are associated with glandular secretions. 
 The same holds true of ideas, every idea has relations 
 to motor reactions and glandular changes. A change 
 therefore of sensibility with its accompanying changes 
 in ideas and images will bring about a motor disturb- 
 ance. This motor disturbance is of a nature character- 
 istic of that hypnoidic state with which that particular 
 modified sensibility is associated. 
 
 If two states have been asisociated, the presence of 
 the one will recall the other. Thus epileptoid states 
 arise with their sensori-motor disturbances and glandu- 
 lar changes. Sensori-motor, visceral, and glandular 
 disturbances give rise in their turn to a change 
 in the emotions, because different emotions are 
 made up of various peripheral and organic sen- 
 sations, coming from different parts of the body. A 
 change, therefore, in sensori-motor activity gives rise 
 to a profound modification of emotional life. It is 
 clear that a profound disturbance of sensori-motor, 
 ideo-motor life and glandular activities must be fol- 
 lowed by emotions with their concomitant motor ex- 
 
124 Diagnosis of Psychopathic Diseases 
 
 pressions. 
 
 The emotions develop a fully systematized hyp- 
 noidic state, recalling and reviving in a perceptual 
 form all the circumstances that occurred at that time; 
 the patient, being in a delusional state having hallucina- 
 tions and illusions, considers himself in quite an- 
 other environment. Thus in the psychopathic convul- 
 sive attacks the hypnoidic state is apparently passing 
 in an inverse form through the various stages of its 
 original occurrence. In reality all the manifestations 
 and symptoms are guided and controlled by the awak- 
 ening of the submerged, subconscious, emotional, hyp- 
 noidic state. 
 
 Contracture is common in the psychopathies, but it is 
 less frequent than anaesthesia. Contracture may be 
 caused by various stimuli, such as a blow, electric cur- 
 rent, massage, etc., and often follows a convulsive seiz- 
 ure, or an intense overwhelming emotion. As a rule, 
 contracture occurs suddenly, and when of gradual onset 
 follows amyosthenia, paralysis, or convulsive attacks. 
 The contracture may affect a bundle of muscle giving 
 rise to a kind of tumor or it may affect a number of mus- 
 cles. i\3 a rule the voluntary muscles are affected, but 
 the involuntary muscles, such as those of the bowels may 
 
 be involved. 
 
 Psychopathic motor disturbances may be of the 
 monoplegic, the paraplegic, the hemiplegic, the cross- 
 ed, the general, the periarticular, or the irregular 
 type. In contracture of the upper extremity the fin- 
 gers are strongly closed upon the palm, the wrist and 
 forearm flexed in the position of pronation or supina- 
 tion. When the lower limb is affected, the thigh and leg 
 are strongly extended and the foot is in the equfiiovarus 
 
Motor, Visceral, and Circulatory Disturbances 125 
 
 position. The thigh is in a position of adduction, the 
 entire limb is held in strong muscle contraction. Occa- 
 sionally flexion instead of extension occurs. In the hem- 
 iplegic form the arm is usually flexed and the leg ex- 
 tended. 
 
 The left side is often more involved than the right. 
 Both extremities may be involved or the contracture 
 may pass from one to the other. In the paraplegic 
 type both legs are extended and adducted. All four 
 extremities may be involved. In the so-called periarti- 
 cular variety, in which the muscles about the joint arc 
 involved the several forms of talipes are simulated. Con- 
 tractures of the muscles of the face may also occur. 
 
 Generally the contracture is uniform while it 
 continues, but sometimes it varies at irregular periods. 
 It is as a rule greater when an attempt is made to over- 
 come it, and the increase of resistance of the muscle in 
 proportion to the effort made to overcome it is of great 
 value in the determination of the psychopathic nature 
 of the contracture. The contracture, unless of a mild 
 degree, may persist during sleep, but disappears in hyp- 
 nosis and deep anaesthesia, induced by such drugs as al- 
 cohol, chloroform, and ether. In rare cases of very 
 long standing structural changes may occur. 
 
 So-called hysterical trismus is due to contracture of 
 the muscles of mastication. In this condition the jaws 
 resist all efforts to operate the mouth. When the tris- 
 mus follows a motor paroxysm it generally persists un- 
 til another paroxysm occurs. Contractures in the jaw 
 depressors leading to opening of the mouth are very 
 rare. Contraction of the abdominal muscles and intes- 
 tines may give rise to the so-called phantom tumor. 
 Pressure may sometimes change the form of the tumor. 
 
126 Diagnosis of Psychopathic Diseases 
 
 Psychopathic paralysis consists of a loss of control 
 in certain muscles, and is a frequent sjmiptom in psy- 
 chopathic diseases. The paralysis may vary in inten- 
 sity, and is usually of very rapid or sudden onset. 
 
 The most familiar form of paralysis is the hemipleg- 
 ic type and usually follows a paroxysm. When only one 
 limb is affected, all of its muscles are involved, and the 
 member is simply dragged along and not swung in a 
 semi-circle as is the case in familiar forms of hemi- 
 plegia of organic nature. The loss of power is not 
 complete. Certain forms of psychopathic ataxia are 
 also observed. Resistance to passive motion is reg- 
 ularly sustained, but varies from time to time or mo- 
 ment to moment. An effort by the patient to set in 
 motion a certain group of muscles, such as the flexors 
 of the foot, may throw into activity the opposite group, 
 the extensors, thus bringing about the inhibition of the 
 intended movements. A tremor is often present in 
 the partially paralyzed muscles. There may be slight 
 atrophy present due to disuse. 
 
 The electrical reactions remain normal. Pain in the 
 spine is not uncommon, and may intensify the paralysis. 
 Complete loss of power is rare, the patient is able to 
 move the limb slowly, but falls to the ground, when 
 attempting to stand. The myotactic irritability is of- 
 ten increased. A pseudo or spurious foot clonus, how- 
 ever, is sometimes elicited due to a subconscious con- 
 traction in the calf muscles. The contractures in psy- 
 chopathic states are often persistent remnants of hyp- 
 noidic states, after the states themselves have subsided 
 into the subconscious regions. 
 
 The origin of psychopathic contractures, as indeed 
 of all motor disturbances, may be well demonstrated 
 
Motor, Visceral, and Circulatory Disturbances 127 
 
 by experiments which may be made in hypnosis. If, 
 for instance, during the hypnotic state the patient is 
 directed to do something, to take an imaginary bird, 
 for example, and keep it tightly in the hand, the sub- 
 ject upon coming out of the hypnotic state, will keep 
 the hand closed and will be unable to open it, though 
 he does not know why it remains in that position. Such 
 states are termed by me "hypnonergic." 
 
 These contractures, like all other allied conditions in 
 psychopathic states, are of the same nature as those in- 
 duced during hypnosis and persisting in the post-hyp- 
 notic state. In the psychopathic disturbances the hyp- 
 nonergic states are more persistent, although they may 
 pass away again as easily and suddenly as in those of 
 hypnosis They are due to present and past mental and 
 emotional disturbances. 
 
 Astasia-abasia is a form of psychopathic incoordina- 
 tion observed most frequently in children, the principal 
 psychomotor manifestation being the inability to main- 
 tain the upright attitude. Tremors and movements of 
 a choreic nature are sometimes present. In reclining 
 postures the legs have normal power, but on attempt- 
 ing to stand or walk the patient falls or moves in a 
 most awkward manner. There are no objective signs 
 to indicate organic change in the motor apparatus. The 
 onset is sudden and is generally due to subconscious 
 emotions, to dissociated mental states. Other psy- 
 chopathic symptoms may be present. The psychomo- 
 tor manifestations of astasia-abasia are as sudden in 
 their disappearance as in their onset. 
 
 Psychopathic mutism, or aphonia is often of sudden 
 onset and usually disappears suddenly. The difference 
 between psychopathic aponia and psychopathic mutism 
 
128 Diagnosis of Psychopathic Diseases 
 
 is that while in the former the patient can still speak in a 
 whisper, in the latter he cannot speak at all. 
 
 Sometimes in mutism words and phrases can still be 
 produced, and are usually those that were uttered dur- 
 ing the accident or fright that caused the functional dis- 
 turbance. Such phrases are hypnoid in character. In 
 sleep the subject of psychopathic mutism shows the abil- 
 ity to talk during dreams. Such dreams are really hyp- 
 noidic states. 
 
 Psychopathic aphonia may have its origin in the local 
 affection of the larynx, but in some instances it appears 
 spontaneously, specially after an intense emotion with 
 subconscious mental dissociation. The laryngoscope 
 may show paralysis of the adductor muscles of the vo- 
 cal cords. The voice may often be brought out during 
 coughing, and is then found to be possessed of its usual 
 character. Frequently the patient, though not able to 
 speak aloud, is still able to use his voice in singing. In 
 rare cases of psychopathic aphonia the tongue may also 
 be affected in the paralysis. 
 
 Stammering is often present in psychopathic persons. 
 It is very much like the aphonia in character and is 
 often the result of intense dissociative emotional states, 
 occuring mostly in children. In cases of aphonia under 
 my care the patients talked in dreams or in the deep 
 conditions of induced subconscious states. 
 
 The phenomena of stammering may be explained best 
 by a brief reference to the factors operating in the pro- 
 duction of speech. 
 
 In the production of speech we have two sets of 
 mechanisms: the laryngeal and the oral; the former 
 produces the vocal elements of speech and the latter, 
 the oral, modifies the sounds of the larynx as to tone or 
 
Motor, Visceral, and Circulatory Disturbances 129 
 
 timbre and helps in the production of new sounds. 
 
 In stammering the common defect is due to delayed 
 activity of the laryngeal mechanism; occasionally the 
 oral mechanism may be at fault. When the patient 
 tries to speak he throws the increased force into the lips. 
 The centre of the oral mechanism thus becomes sur- 
 charged with energy and spasmodic movements even of 
 great extent may occur. The nerve-centres of the 
 speech-mechanism become so surcharged with energy 
 that its liberation may give rise to irritation of other 
 centres and extensive movements in various parts of the 
 body may result. 
 
 Stammerers find it especially difficult to pronounce 
 the first syllables of words. No matter how dif- 
 ficult it may be for the patient to speak he can 
 always sing with ease, because the vocal elements which 
 form a part of speech and by which song is produced 
 are formed in the larynx, and the laryngeal mechanism 
 in itself is not effected, but only itis cooperation, or as- 
 sociation-activity with the oral is interfered with. Stam- 
 merers in ^ordinary conversations may be excellent 
 preachers, and in rapid conversation or speech, experi- 
 ence but little difficulty. 
 
 Partial catalepsy is a psychopathic motor disturb- 
 ance in which the extremities of the patient tend to 
 maintain any position impressed upon them, and is due 
 to a local disaggregation of the systems of neurons 
 innervating the particular limb. The pathology of this 
 state may be well represented as follows. Let 
 C represent the muscles of the limb, B the motor cen- 
 tre which innervates them, A the centre for the kinaes- 
 thetic sensation of the limb, D and E the fibres going 
 from the centre to the limb and from the limb to the 
 
130 Diagnosis of Psychopathic Diseases 
 
 centre. Assume now that the centres A and B are 
 dissociated from the other brain centres, thus 
 forming a closed system. Any impulse brought 
 to the centre B, will provoke a discharge, which 
 propagated through D will excite movement in C. The 
 contraction of C gives rise to a discharge which is prop- 
 agated through the sensory nerve to the kinaesthetic 
 centre, A, awakening a kinaesthetic sensation. The 
 energy from A is then propagated to B and there is 
 once more a discharge of energy in B which again gives 
 rise to a contraction of C. This goes on until the cen- 
 tres are exhausted, the limb being maintained in the 
 same position. This form of catalepsy is known as a 
 recurrent state or as circular reaction. 
 
 Partial catalepsy usually occurs in limbs which are 
 anaesthetic. A very slight stimfulus may change the 
 position of the limb leaving it in the same state of rig- 
 idity and catalepsy. The cataleptic condition is char- 
 acterized by its persistency and duration, the affected 
 limb retaijiing for a long time positions impossible in 
 the normal state. So rigid and steadfast is the cata- 
 leptic limb that tracings taken of it on a smoked drum 
 show a straight line, while the normal member held in 
 the same position shows a quite irregular tracing, due to 
 tremor. The rigid limb can often maintain its position for 
 a half an hour, and the interest lies in the fact that no 
 fatigue is felt by the patient, although sometimes he 
 may complain of severe pain in the limb. 
 
 During the cataleptic state the patient does not know 
 the position of the limb, and may have an erroneous 
 impression as to its position when his attention is dis- 
 tracted. If the patient is asked to change the atti- 
 tude of the limb, he is unable to do it, not knowing its 
 
Motor, Visceral; and Circulatory Disturbances 131 
 
 position. 
 
 In the cataleptic state the phenomena of rapport 
 may be present. If the arm, for instance, is placed in 
 a certain position, that position can be changed only by 
 the experimenter who induced it, and by no one else. 
 If a definite movement is imparted to the cataleptic 
 limb, the member will continue to move with regular 
 rhythm, the patient being unconscious of the move- 
 ments. If however, the patient's attention is drawn to 
 the movements, they cease at once, to be resumed when 
 the attention is withdrawn. If the arm is placed in a 
 cataleptic state, adaptation to certain objects placed 
 in the hand, occurs. For instance, if a pencil is put in 
 the hand, the fingers grasp it, and sometimes begin to 
 write. 
 
 Catalepsy is said to be general, when it involves the 
 whole body. General catalepsy is common In the third 
 stage, that of emotional attitudes, of the major at- 
 tacks of the psychopathic paroxysm. At the beginning 
 of the attack there may be some rigidity and' then a 
 condition of wax-like flexibility (cerea flexibilltas) fol- 
 lows. Such a condition occurs also in insanities as in 
 katatonia. General catalepsy may also be produced in 
 hypnosis. It occurs also in melancholia, and is some- 
 times present in epileptics. 
 
 In complete catalepsy the entire body becomes more 
 or less rigid, the limbs remaining in the position they 
 have originally assumed. At first the muscular rigidity 
 is considerable and an attempt at passive movement is 
 resisted. Soon however, the limbs become flexible and 
 remain in any position in which they are placed. The 
 rigidity finally yields when the energy from the inner- 
 vating centers becomes exhausted. The state of sen- 
 
132 Diagnosis of Psychopathic Diseases 
 
 sibility varies. In deep cataleptic states sensibility to 
 touch, pain, and electricity is lost. The reflexes includ- 
 ing the conjunctival are lost. In rare cases the re- 
 flexes and the general sensibility remain unaffected. 
 Cataleptic attacks are sometimes preceded by hiccough, 
 headache, and dizziness. 
 
 It is not uncommon to find a periodicity in the re- 
 currence of the cataleptic attacks. This periodicity, 
 however, is readily understood, since the cataleptic state 
 is hypnoidic in character. Catalepsy is a hypnoidic state. 
 
 The physiological tendency of systems of cells in 
 their functional activity is to form habits in which the 
 energy discharges or runs down in some regular clock- 
 like form. The hypnoidic state in catalepsy may be 
 called up by stimuli which may happen to come at reg- 
 ular or irregular intervals. More often, of course, they 
 will come at irregular intervals, and the hypnoidic cata- 
 leptic state will then occur irregularly. Some stimuli, 
 however, may happen to come a few times at regular 
 intervals, the disaggregated systems thus form a habit 
 to appear at regular intervals; hence the periodicity of 
 the attacks. 
 
 Lethargy is a psychopathic disturbance in which the 
 patient is In a sleep-like state, with slowness of muscu- 
 lar movement, due to exhaustion of neuron energy. The 
 patient Is aroused with difficulty. Etiologically heredi- 
 tary or neurotic predispositions play important roles. 
 Excessive mental work, exhausting fevers, such as 
 typhoid, etc., influenza and trauma, especially when as- 
 sociated with strong emotion are among the proximate 
 causes. Intense emotions alone in those predisposed 
 may be an exciting cause. 
 
 Lethargy is generally sudden in its onset, the state 
 
Motor, Visceral, and Circulatory Disturbances 133 
 
 lasting from a few days to several weeks. During the 
 attack the limbs are limp and the face is pallid. The 
 closed eyelids cannot be opened, the subject apparently 
 resisting the attempt. The eyeballs are turned upward ; 
 the pupils remain normal in size and in their reaction. 
 There is occasionally a change in reflex activity, the 
 nasal and conjunctival reflexes sometimes being absent. 
 The upper consciousness is in abeyance and the special 
 senses may be unusually keen, although motor manifes- 
 tations are inhibited, owing to a disaggregation within 
 the psychomotor areas. 
 
 The pulse, as in sleeping states generally, is often 
 small and the respiration may become shallow and 
 scarcely perceptible. The temperature is normal. The 
 urine may be retained or may be passed involuntarily. 
 The vital functions may be so depressed that the patient 
 may be seemingly dead. This state is sometimes charac- 
 terized as morbus hypnoticus. If the trance-state is 
 long in duration, the patient may awaken partially and 
 partake of nourishment. The end of the state is often 
 indicated by sighing or ileep breathing. 
 
 Vaso-motor changes, such as extravasations, may oc- 
 cur. The deep lethargic state sometimes closely simu- 
 lates real death, the fundus of the eyeball, however, is 
 normal, the muscles react to electricity, and there are no 
 signs of degeneration. 
 
 The lethargic state, like the cataleptic, is doubtless 
 of a hypnoidic nature, subconscious activity being oc- 
 casionally made manifest by movements and exclama- 
 tions. In some cases it is possible to come into direct 
 communication with the disaggregate subconscious, and 
 to induce illusions, hallucinations, various movements 
 and reactions and adaptations to the illusory and hal- 
 
134 Diagnosis of Psychopathic Diseases 
 
 lucinatory environment. 
 
 In visceral disturbances of psychopathic character, 
 gastric paraesthesia is common, giving rise to sensation 
 of fullness or distention, sinking, emptiness, etc. So 
 called nervous dyspepsia with its attendant feeling of 
 distress may be present. There may be spasmodic con- 
 tracture of the oesophageal or pharyngeal muscles pro- 
 duced by taking food in solid form. The spasm may 
 last for a short period, or may persist for months. 
 When there is vomiting, it may or may not be accom- 
 panied by nausea; the vomiting sometimes seems to be 
 provoked by food, irritating the gastric mucous mem- 
 brane. There may be slight haematemesis, the blood 
 being of a bright color. 
 
 Psychopathic anorexia or anorexia nervosa is not 
 uncommon. Th6 patient in this condition has a dis- 
 gust for food and rejects it. A perverted taste for odd 
 or indigestible material is occasionally present. The 
 patient's nutrition may suffer severely, and he may 
 lose greatly in weight. 
 
 Intestinal derangements are not unusual, nervous 
 diarrhoea or obstinate constipation is sometimes ob- 
 served. Accumulation of gas in the bowels giving rise 
 to borborygmus is common, often causing cardiac pal- 
 pitation and respiratory difficulty. The heart-beat Is 
 rapid and weak; there is paleness, general muscular 
 weakness and dizziness which may end in syncope. 
 Polyuria, either permanent or temporary, is not uncom- 
 mon, the patient sometimes passing a large quantity of 
 pale urine; haematuria is rare. Ischuria occasionally 
 occurs. Perspiration may be profuse. There may also 
 be severe vomiting. 
 
 In psychopathic states patients, especially women, 
 
Motor, Visceral, and Circulatory Disturbances 135 
 
 often locate the trouble in some part of the genital ap- 
 paratus. This gave rise to identification of psycho- 
 pathies in general with those associated with uterine 
 disturbances, under the name of hysteria, or sometimes 
 hystero-neurosis, which really bear no relation to sexual 
 organs in general and to the uterus in particular. 
 
 The sexual organs, like any other organs, may give 
 rise reflexly to psychopathic disturbances, but psychopa- 
 thic states, can be as little identified with sexual troubles 
 as with gastric disturbances. Women are prone to refer 
 their ills to sexual derangements, because by education, 
 training, and persisten^t suggestion the sexual functions 
 are given undue prominence in the patient's mind. Fre- 
 quently, especially in former years, all sorts of opera- 
 tions, hysterectomy, ovariotomy, etc., have been re- 
 sorted to for the alleviation of psychopathic affections. 
 
 The recent psychoanalytic theories of hysteria and 
 hystero-neurosis, implying the relation of psychopathic 
 states to sexual life are scientifically fallacious and prac- 
 tically extremely harmful to the patient and pernicious 
 to the community. A good deal of the sexual matter 
 claimed to be revealed by psychoanalysis is due to sug- 
 gestions given by the patient's surroundings and educa- 
 tion, and then specially enforced by the physician's psy- 
 choanalytic, preconceived prejudices. 
 
 Among the psychopathic visceral disturbances involv- 
 mg the mechanism of respiration we find psychopathic 
 asthma. There may be cough and profuse expectora- 
 tion, occasionally followed by convulsive or spasmodic 
 attack of dyspnoea. There is often a reflex so called 
 "nervous cough," of psychopathic nature. It is of a 
 hard, dry, paroxysmal character; it may occur many 
 times during the day, and be of short or of long dura- 
 
136 Diagnosis of Psychopathic Diseases 
 
 tion. The cough ceases during the night when the pa- 
 tient sleeps. Psychopathic coughs are sometimes pro- 
 duced in imitation of the cry of an animal, such as the 
 barking of a dog or mewing of a cat. These peculiar 
 noises sometimes occur in epidemic form. Hiccoughs, 
 yawning, sobbing, etc., may occur in paroxysms. 
 
 Irregularities in cardiac rhythm are common and 
 these are provoked by the least emotional excitement. 
 Tachycardia is frequent. The attacks may be of sev- 
 eral hours' duration. Angina pectoris of psychopathic 
 origin is sometimes observed. Bradycardia is rare. 
 
 Vasomotor changes are found in some cases. Sud- 
 den flushing or pallor of the face, or of the upper 
 part of the body accompanied by heat and cold sensa- 
 tions are observed. At times constriction of the blood- 
 vessels may cause local cyanosis. 
 
 Various skin eruptions are occasionally observed in 
 psychopathic cases. These have been regarded and 
 described as hysterical or psychopathic. They are, how- 
 ever, neuropathic in their nature, though they may be 
 often associated with psychopathic states. 
 
 We cannot impress too much on the physician's mind 
 that all psychopathic disturbances, whether sensory, 
 motor, visceral, and glandular, are essentially morbid 
 affections of the patient's subconscious life. 
 
 One important law holds true of all psychopathic 
 maladies and that is all conscious losses are subconscious 
 gains. Whatever function is lost to the upper con- 
 sciousness is present to the subconscious. This can be 
 tested by the various methods for reaching the subcon- 
 scious. 
 
CHAPTER XIV 
 
 ILLUSIONS 
 
 THE brain receives impressions from the ex- 
 ternal world. These impressions stimulate 
 the activity of groups and systems of neu- 
 rons and give rise to complex physiological 
 processes having sensations as their concomitants. 
 These processes stimulate activity of still more com- 
 plex systems, groups of systems giving rise to 
 physiological processes, having percepts as their accom- 
 paniment, and finally with the awakening of the activity 
 of the highest constellations of neurons with their con- 
 comitant moments the highest form of consciousness, 
 conceptual thought and judgment, is formed. There 
 may be a disturbance in any of the several levels 
 of psycho-physiological activity. Where the disturb- 
 ance is chiefly of a perceptual character it gives rise to 
 illusions and hallucinations. 
 
 An illusion is a wrong perception of stimuli com- 
 ing from an external source, a false perception of an ex- 
 ternal object. If an object, such for instance as a chair, 
 is regarded as a man, the percept is illusory, and the 
 perception is an illusion. 
 
 Illusions may often appear in healthy individuals in 
 waking states and more specially in dream states, in 
 fact, art, such as painting, scenic effect produced in the 
 dramatic world, etc., is based upon illusion. Illusions are 
 common in psychopathic diseases, they may be induced 
 in hypnosis and in other forms of subconscious states. 
 Illusions occur most frequently in the insane. 
 
 137 
 
138 Diagnosis of Psychopathic Diseases 
 
 An hallucination differs from an illusion in the fact 
 that the projection of the precept is more subjective in 
 its nature. There may be nothing in the external world 
 and yet the subject or patient perceives a person 
 or hears a voice, for instance, wheSn no sound is 
 present. An illusion seems to be more peripheral in its 
 nature while an hallucination seems to be more central 
 in its character. There can be as many illusions or hal- 
 lucinations as there are special senses. Hence they may 
 be classified as visual, olfactory, gustatory, auditory, 
 tactile. 
 
 The physiological processes which operate in an il- 
 lusion are as follows : In general the perception of an 
 object consists in a synthesis of a present sensation 
 with emerged subconscious, secondary sensations. 
 Take for instance an apple, the perception of the apple 
 may be by simple vision; we may see the outside gen- 
 eral form, or perhaps only the general outline of the 
 form and color, the one due to muscular eye move- 
 ments and the other due to processes within the optic 
 nerve. 
 
 These sensations are peripheral Incoming impres- 
 sions, they would not in themselves constitute the per- 
 ception of the apple. Along with them Is aroused the 
 spherical form of the apple, which could not be per- 
 ceived by the visual sense alone, but depends also on 
 muscular eye movements, and depends also on previ- 
 ous tactile and muscular sensations In the handling of 
 the apple. The solidity and hardness of the apple, 
 which depend on sensations given by the resistance and 
 the weight of the apple, are due to muscular and tactile 
 sensations. Then the peculiar taste and smell of the ap- 
 ple depend on previous gustatory and olfactory sensa- 
 
Illusions 139 
 
 tions. The average temperature of the apple is also an 
 aid. All these psychic processes are awakened as soon 
 as the eye perceives the apple. 
 
 The eye itself cannot smell, or touch or weigh 
 the apple; it cannot feel the solidity of the ap- 
 ple, and yet all these are present in the vision of 
 the object. It is evident therefore that in seeing an ap- 
 ple the visual sensation awakens, by association, many 
 subconscious psychic processes which form a synthesis 
 in the percept, apple. This can be accomplished not 
 only by vision, but also by the olfactory or tactile sen- 
 sations, or even by auditory sensation, such as the pecu- 
 liar sound which the paring of the apple produces. 
 
 If A, B, C, D, E, F, etc., represent the associated 
 physiological processes, and if A is peripherally awak- 
 ened, then the others become synthetized and form the 
 percept. The same occurs if B first appears, the rest of 
 the processes may become synthetized, etc. In short, 
 all these processes form a system, and if one is awak- 
 ened all the rest may appear and become synthetized. 
 
 Suppose now another synthesis, that is, one resulting 
 in the percept of another object, is formed in which 
 on€, two or more of the elements of another system, ele- 
 ments which are common to both, are present. The 
 two synthetized systems may become interchangeable 
 by the principle of association by contiguity or resem- 
 blance. Thus it is possible that under certain circum- 
 stances, such as change of intensity of one or of some of 
 the sensory components, or of lack of critical discrimi- 
 nation of the differences and details of the presented 
 content instead of the one system exactly corresponding 
 to the object being awakened, another one, which does 
 not exactly correspond to the object is brought out in- 
 
140 Diagnosis of Psychopathic Diseases 
 
 stead. This will constitute an illusion. In art we find 
 common examples when for instance artificial objects 
 are made so as to represent as nearly as possible' the 
 real object. 
 
 Living in a more or less constant environment, cer- 
 tain sensations naturally give rise to the most familiar 
 systems, but when the environment is changed we 
 often fall into illusions. Our environment, how- 
 ever, does not go on changing so rapidly as to 
 give rise to illusions, and, therefore, our familiar 
 percepts are correct, corresponding to external objects. 
 These familiar percepts are adaptations between exter- 
 nal objects and internal relations. 
 
 Instead, however, of there being a disturbance in the 
 external relations, in the environment, there may be de- 
 rangement of the internal psychic processes. A stim- 
 ulus therefore may give rise to sensations and in- 
 stead of calling out the most familiar synthesis 
 corresponding to this aggregation of external stim- 
 uli, calls out some other system, having some- 
 thing in common with the most familiar sys- 
 tem. This gives rise to illusions. As a rule in or- 
 dinary illusions of common life, there is some similarity 
 between the object and the illusory system awakened, but 
 in insanity and under the influence of some toxic agents, 
 the disturbance may be so great that but slight, inessen- 
 tial similarity is present. 
 
 In illusions the peripheral sense organ may be in no 
 way at fault, as a rule it is not, but rather the subcon- 
 scious psychic systems which are excited and go to form 
 the percept are at fault. In short, the fault is not in the 
 sensation, but in the association. 
 
 An aggregation of stimuli giving rise to peripheral 
 
Illusions 141 
 
 sensory impressions and awakening sensations excite 
 also subconscious psychic processes which in themselves 
 are not of the nature of direct sensation, but rather of 
 the nature of indirect sensation belonging to the most 
 familiar systems of synthetized psychic processes form- 
 ing familiar percepts. 
 
 There are, however, cases, though rare and unusual 
 in common life, in which an impression, giving rise to 
 a special sensation, directly revives another impression 
 also of a sensory character, giving rise to what we may 
 call a secondary sensation. There is no external stimu- 
 lus present to awaken this sensation, but it is awakened 
 by the excitement of another special sense organ. 
 
 It seems that in such persons there must be an 
 association formed between two or more of the 
 lower sensory centers. Thus for example there are per- 
 sons who seeing a certain color, for instance, red, will at 
 once hear a certain sound. This is not in the nature of 
 a memory merely, the patient seems really to hear the 
 sound. 
 
 A sensation of smell may give rise to a sensa- 
 tion of light, etc. Sometimes the sensations may 
 be related. For instance, a certain form, say that 
 of a certain letter, may awaken the sensation of a 
 certain color. In this way all kinds of combinations 
 may be formed. 
 
 There may be variou-s combinations of primary with 
 secondary sensations. We may have the following 
 photisms and phonisms or synaesthesia : 
 
142 Diagnosis of Psychopathic Diseases 
 
 Sound photism, Light phonism, 
 
 Taste photism, Taste phonism, 
 
 Pressure photism. Pressure phonism, 
 
 Movement photism. Movement phonism, 
 
 Smell photism. Smell phonism. 
 
 Touch photism, Touch phonism, 
 
 Temperature photism, Temperature phonism, 
 
 In fact any combination of primary with secondary 
 sensation may be present. 
 
 These secondary sensations are due to the formation 
 probably of certain special, subcortical associations be- 
 tween die respective sensory centers. 
 
 The following laws have been formulated : 
 
 1 . Photisms bright in color are produced by sounds 
 of high quality, by intense pain, sharply defined sensa- 
 tions of touch. Dark photisms form opposite condi- 
 tions. 
 
 2. High phonisms are produced by bright light, well 
 defined outlines, small objects, pointed forms. Low 
 phonisms form opposite conditions. 
 
 3. Photisms are associated with well defined forms, 
 small, pointed; photisms are often produced by sounds 
 of high pitch. 
 
 4. Red, yellow, and brown are frequent photism col- 
 ors; violet and green are rare, while blue stands be- 
 tween these extremes. 
 
 Secondary sensations in their pure form, although 
 found in normal persons, usually appear in those of 
 neurotic tendency and in psychopathic states. 
 
CHAPTER XV 
 
 HALLUCINATION AND PERCEPTION 
 
 HALLUCINATIONS consist in the percep- 
 tion of objects which as far as it is possible 
 to determine have no existence in the exter- 
 nal environment at the time perceived, or 
 may have no existence whatever. If a man sees, for in- 
 stance, the stump of a tree and takes it for an animal, 
 we would say he has an illusion. If, however, there is 
 no object at all, but still the man perceives a moving 
 animal or object, he is the subject of an hallucination. 
 In the same way hallucinations may be of a gustatory, 
 olfactory, tactile or auditory character. 
 
 Putting together hallucinations and illusions, we 
 may arrange them in the following order of frequency, 
 hearing, sight, common sensibility, smell, and taste. 
 Various theories have been advanced to explain the 
 mechanism of hallucinations, but none seem satisfac- 
 tory. In my works I ventured to advance the following 
 theory: Hallucinations are of the nature of secondary 
 sensations. When a certain stimulus makes an impres- 
 sion on a peripheral sense organ and gives rise to second- 
 ary sensations we really have an hallucination, but in its 
 simplest form. The one who on perceiving the letter A 
 sees at the same time a yellow or red color, or hears a 
 sound or feels a touch, really has a hallucination. He 
 has a sensation which has no corresponding external 
 stimulus. Thus far it is quite clear that hallucinations 
 at least in their simplest form may be nothing else than 
 
 143 
 
144 Diagnosis of Psychopathic Diseases 
 
 secondary sensations. 
 
 We have seen previously that sensations form 
 the cue, awakening subconscious psychic processes 
 which become synthetized into a percept. If the 
 secondary sensation is of such a nature as to enter into 
 a subconscious synthetized system, it will awaken a per- 
 cept, and we shall have the hallucination of objects. 
 The corresponding physiological process is the dissocia- 
 tion of the sensory centers or of some groups of neurons 
 within the sensory centers from the corresponding per- 
 ceptive center, and associations of these groups with 
 those of another sensory center. 
 
 This process gives rise to secondary sensations, 
 which in their turn may give rise to a complex physio- 
 logical activity, awakening subconscious processes, 
 with the psychic correlate, the percept, the hallucina- 
 tory percept. The least stimulus may give rise to such 
 dissociations of groups of neurons within the higher 
 perceptive centres, and to the formation of new sub- 
 cortical associations of the disaggregated groups, re- 
 sulting in the formation of hallucinations. The stimu- 
 lus, will in fact, be disregarded by the patient and the 
 hallucination will absorb his entire attention. The 
 hallucination in such a case is regarded of purely cen- 
 tral origin. In this way voices, visions, and similar 
 hallucinations are generated. 
 
 Hallucination plays an important role in the domain 
 of psychopathology, it Is therefore advisable to enter 
 into a more detailed study of the subject. The subject 
 of hallucinations forms the stumbling block both of 
 psychologists and psychopathologlsts. The deeper we 
 penetrate into the subject the greater confusion we en- 
 counter. Some regard hallucinations as being of peri- 
 
Hallucination and Perception 145 
 
 pheral origin, others regard them as central in charac- 
 ter, while still others go to the extent of claiming that 
 the most central hallucinations are of supernatural ori- 
 gin, being communications and messages from a trans- 
 cendental world. In view of the importance of the 
 subject it may be well to make an attempt to throw 
 some additional ray of light on this obscure matter 
 from the standpoint of psychological and psychopatho- 
 logical analysis. 
 
 The usual definition of illusion and hallucination is 
 with regard to the external object. Illusion is defined 
 as fallacious perception of some actually existing ob- 
 ject, while hallucination is perception of a non-existing 
 object. This definition is good for practical purposes 
 of the clinician, but it is not psychological. From a 
 strictly psychological standpoint illusions and halluci- 
 nations cannot possibly be differentiated from other 
 psychic states by the presence or absence of external 
 objects. External objects can hardly be regarded as 
 constituents or necessary ingredients of psychic states. 
 Illusions and hallucinations should be defined in terms 
 of psychic processes. In order to get a clearer insight 
 into the nature of illusions and hallucinations it may 
 be well to begin with a brief analysis of the process of 
 perception. 
 
 If we take a cross-section of a moment of conscious- 
 ness and try to fixate it with our mental eye, we find a 
 central psychic experience, or psychic element round 
 which other psychic experiences or psychic elements are 
 crystallized and organized. This psychic experience, 
 or central element, is prominent, vivid, and constitutes 
 the vital point of all the other organized states, giving 
 the tone to the rest, to a whole, to one organized ex- 
 
146 Diagnosis of Psychopathic Diseases 
 
 perience. 
 
 The psychic matter that surrounds the luminous 
 central point does not stand in a free more or less 
 disconnected relation to the latter, it is intinHately re- 
 lated to the center, and cannot be separated without de- 
 stroying the moment as a whole and even the life ex- 
 istence of each particular constituent. The whole mo- 
 ment seems to form an organic network in which the 
 other elements take their place according to a plan. 
 
 The structure of the moment may in this respect be 
 compared with that of the cell. In the cell we discern 
 a nucleus round which cytoplasm is grouped. The 
 protoplasm is connected with the nucleus by a network 
 imbedded in the cytoplasm. The destruction of the 
 nucleus affects the cytoplasm and the destruction of the 
 cytoplasm affects the nucleus. The two are intimately, or- 
 ganically interrelated by the common network, the gen- 
 eral plan of their organization. 
 
 If we closely examine the percept, we find in it 
 a central, sensory element, surrounded by other ele- 
 ments. This central element stands out prominently in 
 the given psychic state, while the other elements are 
 subordinate. Not that those elements are unimportant 
 for the percept, on the contrary they are of the highest 
 consequence and moment, they only lie outside the 
 focus of the mental state. Along with the focus those 
 elements form one organized whole. All the elements 
 of the percept form one texture, having the central 
 sensory element as its nucleus. 
 
 Integrated, however, as all these elements are they 
 are not of equal value and importance to the life eX' 
 istence of the whole. The central sensory element is 
 of the utmost consequence, it is the vital point of the 
 
Hallucination and Perception I47 
 
 total experience. While the change, or destruction of 
 one or of some of the subordinate elements may still 
 leave the total percept unchanged, or but slightly modi- 
 fied, a change of the central sensory element or of the 
 nucleus will profoundly modify all the other elements 
 and their interrelation. 
 
 The elements of the percept may be regarded as 
 bound up in a 'chemical' compound, so to say, together 
 giving rise to the qualitative aspect of the total com- 
 bination, the difference being that in the psychic com- 
 pound there is a central element that gives the keynote 
 to the combination; in the chemical compound the ele- 
 ments are all equal in value and importance. To form 
 water for instance, an atom of oxygen to two of hydro- 
 gen is required; the oxygen and the hydrogen are both 
 equally Requisite to the formation of the compound; 
 one is not more important than the other. Not so is 
 it in the psychic cooipound; there the elements are of 
 unequal value. The mtost important of them is the nu- 
 cleus; it determines the interrelation of the psychic ele- 
 ments and also the outcome of the whole combination. 
 
 From a biological standpoint we can well see why 
 this should be so. A psychic compound is biological, 
 not purely physical or chemical. In the physical com- 
 ponents there is no higher and no lower, all are of 
 equal value ; in the psychic, as in all life existence, there 
 is a higher and a lower structure. In other words, 
 the biological compound is peculiar and different from 
 the chemical, inasmuch as the former is really not a 
 compound, but an organization. The characteristic of 
 organization is just this systemic combination of parts 
 related in different grades and orders of importance 
 for the total life existence of the whole. 
 
148 Diagnosis of Psychopathic Diseases 
 
 Looked at from another standpoint we can further 
 see the necessity of such a central element. We have 
 pointed out in another place that one aspect of the bio- 
 logical process is that of purpose, and if that be 
 granted, then psychic processes regarded as highly de- 
 veloped biological processes should present this general 
 characteristic of purposiveness in its fully developed 
 form. Now, where purpose is involved the end alone 
 is the important thing, all the other elements are for 
 that end, subordinate and~ determined by it. 
 
 Not that the other elements are unimportant; they 
 may be intimately related, but they, after all, are only 
 means to accomplish the end. The elements that have 
 for the time being the organizing power to aggregate 
 round themselves the proper elements and lead towards 
 the required end are predominant. For every psychic 
 state is essentially for some reaction and that sensory ele- 
 ment which gives the cue for the formation of the psy- 
 chomotor elements, leading to some given reaction is 
 for the time being the center, the nucleus of the total 
 state. 
 
 The flower before me attracts my attention. I see 
 its color of a light violet tint, its rounded bell shape 
 and its velvet-like softness ; I stretch out my hand, car- 
 rying the flower to my nose, to enjoy its fragrance. 
 What I really see is the violet tint; the rest of 
 the elements are not given directly, they are largely in- 
 ferred. The shape is largely an inference from prev- 
 ious muscular eye-movements and its softness is de- 
 rived from previous tactual experiences. They are all 
 however, perceived by the eye, the cue being given by 
 the prominent visual sensation. 
 
 Although the flower as percept appears as an organ- 
 
Hallucination and Perception 149 
 
 ized whole, still the sensation of sight forms the nucleus 
 round which the others cluster; the perceptual tone is 
 given and determined by the particular sensations of 
 sight. The softness, though perceived, is still alto- 
 gether different from the sensation softness as directly 
 experienced through the organ of touch; it is a sensory 
 sight softness. The same is true of all the other sen- 
 sory elements; they are all essentially determined in 
 their quality by the central sensation. 
 
 In seeing a lump of ice we perceive its white- 
 ness, its transparency, its hardness,. its smoothness, etc. 
 The hardness and smoothness are essential elements of 
 the percept ice. These elements seem to be given di- 
 rectly in sensory experience. They seem to be direct- 
 ly perceived and still are qualitatively different from 
 the hardness, smoothness, and coldness as given direct- 
 ly by the experience, when the hand gets hold of a 
 smooth lump of ice. The sensory elements are de- 
 termined and colored by the central, visual, sensory ele- 
 ments. The sensory elements of coldness, hardness, 
 smoothness are of a visual character. 
 
 It is usually claimed that such additional elements 
 that are not given directly by the stimulated organ are 
 elements representative in character, derived from 
 memory. This statement is not quite correct. In see- 
 ing the piece of ice the hardness, smoothness are not 
 represented, they are presented to the eye; we really 
 seem to see, to experience these sensations going to make 
 up the percept ice. It is not true that on catching sight 
 of a whitish, transparent, glittering lump we remember 
 that it is also hard, smooth, and cold. 
 
 The whole percept with all its sensory elements ap- 
 pears at once in the synthesis of the percept Ice — we 
 
150 Diagnosis of Psychopathic Diseases 
 
 see, we perceive the hard, smooth, cold ice. The hard- 
 ness simply remembered is altogether different from 
 the hardness perceived in the seeing of the lump of ice. 
 The hardness, smoothness as they appear in the ice are 
 different to the eye, and as different psychologically 
 from the corresponding representations as the latter 
 differ from the corresponding sensations directly exper- 
 ienced by the appropriate sense organs. 
 
 Pathological cases seem to confirm the same point of 
 view. There are certain mental diseases, when the pa- 
 tient can perceive the object correctly, though he can- 
 not represent it to himself. The patient can perceive all 
 the elements on being confronted with the object, but by 
 no means can he remember them. On the other hand, 
 there are cases when the patient can easily represent to 
 himself objects, but cannot recognize the object when 
 directly confronted with it. 
 
 The subordinate elements in their turn play an im- 
 portant role in the total unity of psychic experience, in 
 the percept, inasmuch as they give the content of the to- 
 tal moment, fermented, so to say, by the predominant 
 nuclear element. The visual elements, the perception of 
 play of light and shade would have been nothing but 
 mere play of light and shade, if not for the subordinate 
 tactual and motor elements that give rise to the percep- 
 tion of distance, dimension, size, body. The leading 
 element gives the character to the content by having it 
 appear under its own special sensory aspect, while the 
 other elements give the content to the whole moment. 
 Thus where space is perceived through the organ of 
 sight mainly, the space is visual in character, though the 
 content that gives rise to the perception of space itself 
 is filled in by other psychic elements. 
 
Hallucination and Perception 15 1 
 
 The central element with its content may be regarded 
 as the nucleus of the cell, surrounded by its cytoplasm, 
 and the total organic whole may be termed psychic com- 
 pound. Now in the psychic compound the constituent 
 elements of the content can no longer be directly dis- 
 criminated. In the lower forms of mental life the ele- 
 ments are firmly bound as we find it to be in the psychic 
 compound — the percept. 
 
 In the forms where the elements are more com- 
 plex the synthesis results in fusion in which the 
 elements can be more or less easily discriminated. 
 Thus if one listens to the beats of a metronome 
 and to the rhythmical vibrations of a pendulum, the sen- 
 sations blend and fuse, the sounds seem to proceed from 
 the vibrating pendulum. The same case is well illus- 
 trated in the well-known amusement of having one hid- 
 den behind a screen and making a speech, while another 
 one is watched who is gesticulating in accordance with 
 the modulations of the Speaker's voice. The two ser- 
 ies of sensations blend and the voice seems to proceed 
 from the gesticulating person. The synthetized ele- 
 ments here are fused or more or less "mechanically" 
 joined instead of being firmly combined in a sort of 
 "mental chemistry." 
 
 In the higher and more complex mental states the con- 
 stituents of the synthesis are neither "chemically," nor 
 "mechanically" fused. The constituents stand out free 
 and distinct. While I am writing this page I see on my 
 table at one glance the light, the lamp, the paper, the 
 pen writing words and lines, and hear and feel the pen 
 move on the surface of the paper; at the same time I 
 see the table, the chair in the room and hear the ticking 
 of the clock. The multiplicity of all these experiences 
 
152 Diagnosis of Psychopathic Diseases 
 
 is simultaneously synthetized, and at the same time dis- 
 criminated in the unity of the total experience. 
 
 In the processes of succession of complexes of psychic 
 elements, in the trains of ideas, the constituent elements 
 attain their greatest freedom and independence. In the 
 states of perceptual synthesis, on the contrary, the di- 
 rectly experienced sensory elements, constituting the nu- 
 cleus of the percept call out immediately their appropriate 
 associated, perceptual elements, and the compound, the 
 percept, appears, as a whole that can be analyzed only 
 under highly artificial conditions. Fixity is the essential 
 characteristic of lower mental stages as -well as of the 
 percept. 
 
 The constituent psychic elements are so intimately 
 united in the percept that they resist efforts at decompo- 
 sition. If a percept A is composed of elements a, b, c, d, 
 and if'fl be the nucleus, the stimulation of the nucleus 
 brings out the rest — b, c, d. The central, or nuclear 
 element is purely sensory, but the rest of the psychic 
 elements b, c, d, are not sensory in the same sense as a 
 is, since they are not derived from direct stimulations of 
 the appropriated sense organs. Their character is not 
 primarily, but only secondarily sensory. 
 
 The retina gives only light sensations. The most dif- 
 ferentiated and highly organized retinal structure of 
 the highest vertebrates, such as that of the higher mam- 
 mals, can only give rise to local signs, to highly differ- 
 entiated light sensations varying with each retinal point 
 or element, or cellular termination. The stimulated 
 retinal elements with the neuron terminations of the 
 optic nerve can give nothing else but light sensations, 
 and the image formed on the retina is in fact nothing 
 else but a series of light sensations. If this be so, how 
 
Hallucination and Perception 153 
 
 then do we come to see that tangible, heavy, solid body 
 yonder at a more or less definite distance? Solidity, 
 bulk are not given in light sensations as such, how then 
 are those spatial and physical characters perceived so 
 distinctly as to assume a direct sensory character? 
 
 It cannot be ascribed to the principle of association 
 of ideas. For the object and its distance appear 
 at once, in one single glance, before any idea comes 
 to the mind. Furthermore, an idea from its very 
 nature stands out distinct and definite; it is essen- 
 tially free, but the psychic elements of object and dis- 
 tance are not discriminated. Again, phylogenetically and 
 ontogenetically sensation and perception precede idea- 
 tion. The infant, the animal perceives objects and dis- 
 tance, and certainly with little or no ideation present. 
 
 In the visual perception of distance the subordinate 
 psychic elements derived from other senses are not of an 
 ideational character, they are of a sensory character. 
 The eyes sees the distance. The eye sees distance or 
 volume directly, because of other elements involved in 
 the process of perception, such as the kinaesthetic sensa- 
 tions coming from the movements of the eyes in their 
 adjustment to the stimulations from the external en- 
 vironment, also tactual, muscular and kinaesthetic sensa- 
 tions derived from skin, muscles, joints and articular 
 surfaces, all synthetized in the given percept. 
 
 The subordinate psychic elements are neither of the 
 character of pure sensations nor are they of the nature 
 of pure ideas. What are they? They seem to be 
 intermediary in character, intermediary between the na- 
 ture of sensation and that of idea. Perception appears 
 to be an intermediary process. 
 
 We may regard the same process from a hypothetical 
 
154 Diagnosis of Psychopathic Diseases 
 
 physiological standpoint which may possibly help us in 
 picturing the mechanism. A specific physical stimulus 
 produces in the peripheral sense organ a definite physio- 
 logical process which is transmitted to groups of neuron 
 systems, stimulating them to activity and giving rise to 
 specific physiological processes. Whenever these spe- 
 cific physiological processes are peripherally induced, the 
 special, sensory elements arise. 
 
 If groups and systems of such psycho-physiological 
 elements become associated and organized round a cen- 
 tral nucleus, the result of the functioning activity of the 
 total organic complex is a psychic compound, a percept. 
 Whenever one of the groups is peripherally stimulated 
 and is awakened to activity, the other elements become 
 stimulated, and the result is the organized activity of 
 function of all the elements, thus giving rise to the 
 synthesis of all the psychic elements, namely the percept. 
 
 Now we should postulate some difference in the psy- 
 chic state as to whether psycho-physiological elements 
 are stimulated directly through their own appropriate 
 sense organ or whether they are awakened to activity 
 indirectly through other sense organs. The direct peri- 
 pheral stimulation gives rise to psychic elements char- 
 acteristic of the particular sense organ and its nervous 
 tracts and central systems of neurons, whilst the indirect 
 peripheral stimulation gives rise to psychic elements 
 v/hose pure and real sensory character is not clearly re- 
 vealed in the total psychic state or moment. 
 
 These indirectly induced sensory elements are so 
 much colored and infused with the sensory qualities 
 of the nuclear, sensory elements that their character 
 and origin are transformed, and they appear not 
 to differ in their nature from the nuclear elements. 
 
Hallucination and Perception 155 
 
 A closer inspection however fully reveals their real 
 nature as sensory elements, extraneous to the nuclear 
 elements and derived from different sensory sources. 
 The nuclear elements are primarily derived, in so far as 
 they are directly initiated by the incoming peripheral 
 stimulations, while the extra-nuclear sensory elements 
 may be regarded as secondarily initiated by peripheral 
 stimuli. 
 
 Let F be the sensory visual system, T and M tactual 
 and sensory motor systems, A sensory auditory systems. 
 Let Fi be the visual sensations peripherally stimulated, 
 Tt, Mi, Ai, the tactual motor and auditory sensations of 
 the corresponding sensory systems. Let, further, F^, 
 Ti, M2, A' be the psychic elements indirectly or second- 
 arily initiated ; then the percept when Ft \i the nucleus 
 may be represented by FtfTiM'Ai. 
 
 Psychic elements primarily or secondarily peripher- 
 ally initiated are not identical with ideational states. An 
 idea or image differs qualitatively from a percept and 
 its elements — an image lacks sensory character. An 
 image is more generic, while a percept is more specific. 
 I see that lamp-post yonder; it is a particular object 
 rigidly limited in a particular space ; not so is the image, 
 the image of the lamp-post refers to lamp-posts in gen- 
 eral. When I perceive an object and then try to repre- 
 sent it to myself, the object is not presented to con- 
 sciousness in its sensory perceptual form — it is present 
 to consciousness rather as a symbol, ideally representing 
 perceptual experience peripherally initiated. 
 
 From an anatomical and physiological standpoint it 
 is quite probable that ideo-motor systems are neuron 
 organizations different from those of the sensori-motor 
 systems. Psychtjpathology with its rich store of facts 
 
156 Diagnosis of Psychopathic Diseases 
 
 seems to favor this view. As we have already pointed 
 out there are pathological cases where the patient does 
 not know the object on perceiving it, although he can 
 represent it to himself, and again there are other cases 
 where the patient cannot represent to himself the 
 object, but he knows the object on perceiving it. 
 
 Flechsig's embryological studies go further to show 
 that the sensory centers are different from the associa- 
 tive centers which do not stand in direct relation with 
 the external environment and appear rather late in the 
 course of ontogenetic development. The view often 
 maintained that the same sensory structures underlie 
 both sensory and ideational processes does not seem to 
 be probable in the light of recent research. 
 
 The activity of the sensori-motor neuron systems does 
 not give rise to ideas, but to psychic states essentially 
 sensory in character. In the case of the percept the sub- 
 ordinate psychic elements entering into the synthesis of 
 perceptual psychic compounds are of a sensbry nature; 
 they only differ from pure sensations in so far as they 
 are not directly peripherally initiated, but centrally, or 
 truer to say, indirectly peripherally initiated, and as 
 such occupy an intermediary state between sensation and 
 ideation. In other words, the subordinate perceptual 
 elements may be regarded as reflex in character, as be- 
 ing of the nature of secondary sensations. 
 
 The nature of illusions and hallucinations is more or 
 less cleared up from this standpoint, and the latter in its 
 turn may be still further illustrated and confirmed by the 
 facts coming from the domain of abnormal mental life. 
 Let us take a series of cases of abnormal or fallacious 
 perception. In looking through the stereoscope the two 
 plane dissimilar views are combined and give the illu- 
 
Hallucination and Perception 157 
 
 sion of a solid object. Here the illusion is due to imita- 
 tion of external conditions; the external stimulations 
 that give rise to the perception of a solid object are here 
 closely reproduced. The visual sensory elements are 
 stimulated and the rest of the groups are reproduced, 
 associated sensory elements or secondary sensations 
 emerge, and perceptual synthesis arises. 
 
 The illusions to which in my student days I attracted 
 Professor Miinsterberg's attention are of a similar char- 
 acter. If each eye looks through a separate tube, and 
 if the other ends of the tubes are brought together, the 
 openings of the tubes coincide, appearing as one, and 
 the eye appears to look through one tube only. If now 
 only one tube is looked through, and the other eye glides 
 along the surface of the tube, the opening of the tube 
 appears outside, removed and raised higher than the 
 real opening; the opening appearing to be directly seen 
 not by the eye which looks through the tube, but by the 
 other eye that does not look through. The illusion can 
 be made more striking by putting the hand where the 
 illusory opening appears and the hand appears to be 
 pierced by a round hole. 
 
 The conditions are such that the convergence of the 
 eyes displaces the lighted-up opening towards the field 
 of vision of the open eye not inclosed in the dark tube. 
 Similarly when closing one eye and having the other 
 wide open we press th^ closed eye sideways towards the 
 nasal side, the round phosphene seems to be projected 
 into the field of vision of the other eye, and the phos- 
 phene really appearing in the field of the closed eye as 
 one can convince oneself by closing the open eye, ap- 
 pears to be directly seen by the open eye. 
 
 In all these experiments the arrangement is such as 
 
158 Diagnosis of Psychopathic Diseases 
 
 to imitate conditions under which other percepts nor- 
 mally arise, and the result is the reproduction of those 
 specific states of perception. To take another example, 
 in a fog or in the darkness we may take a tree for a 
 man or mistake a rope for a snake. Similarly, in the 
 shape of clouds and blots we can often see different fig- 
 ures. The illusion here is rather due to the vagueness 
 of the cue or of the sensory nucleus, the character of 
 which may vary with distance or with the intensity of 
 light. 
 
 In mental derangements, such as in the different forms 
 of insanity or of psychopathic functional diseases, in 
 hypnotic, post-hypnotic and hypnoidic states the object 
 is perceived as different, independent of external condi- 
 tions, such, for instance, as convergence, divergence, 
 light, distance. A chair may be perceived as a tiger no 
 matter how the visual axis is placed or what the distance 
 be, or how intense the light Is. Certain definite visual 
 sensations may be correctly perceived, but on account of 
 dissociation in psychopathic states, sensations different 
 from the customary, associated secondary sensations are 
 aroused which In turn awaken different secondary sensa- 
 tions in other sensorl-motor systems of neurons, and the 
 result is a different psychic compound, an illusion or a 
 hallucination. 
 
 In the preceding cases the nuclear elements obscured 
 In different ways by the subordinate elements are never- 
 theless present in consciousness and still form the nucleus 
 of the percept into which other subordinate elements en- 
 ter as constituents, and give rise to fallacious per- 
 ception. Should now the nuclear elements themselves, 
 on account of inattention or of their minimal sen- 
 sory Intensity, or what Is still more often the case, on 
 
Hallucination and Perception 159 
 
 account of states of dissociation, should such nuclear ele- 
 ments be left out of consciousness or remain in the sub- 
 consciousness, as in dissociative states, then the fallacious 
 percept stands out clear and distinct in the light of con- 
 sciousness, and a fully developed hallucination results. 
 
 Sensory elements which themselves may remain unper- 
 ceived stimulate other sensory elements that give rise to 
 a perceptual compound which is entirely of a secondary 
 sensory character. The hallucinatory percept does not 
 contain the primary sensations aroused by the stimulus ; 
 it consists of secondary sensory elements and as such a 
 hallucination may be regarded as a secondary percept. 
 Hallucinations are of the nature of secondary sensations. 
 
 The simplest state of hallucination is found in 
 the phenomena of synaesthesia or in the phenomena of 
 secondary sensations, such as light-phonisms, sound-pho- 
 tisms, etc., when one sensation, instead of giving rise to 
 a subsequent idea, awakens instead a qualitatively differ- 
 ent sensation derived from another sense organ — a color 
 or letter arousing a certain sound, definite sounds arous- 
 ing certain colors, and so on. When a certain stimulus 
 makes an impression on a peripheral sense organ and 
 gives rise to secondary sensations, we really have a hallu- 
 cination, but in its simplest form. He who on seeing tTie 
 letter A, for instance, also hears a sound or feels a prick, 
 or a touch may be regarded as having a hallucination. 
 
 In this simple form we can possibly more clearly dis- 
 criminate the character of hallucination. When on see- 
 ing letter A, we hear a sound, the indirectly aroused aud- 
 itory, sensory elements do not contain the primary sen- 
 sory visual elements. In the secondary sensation or in 
 the more complex state of perception of secondary char- 
 acter the primary elements are left out. A stimulus may 
 
i6o Diagnosis of Psychopathic Diseases 
 
 arouse sensory elements in one sensory center, which in 
 its turn may stimulate systems of sensory elements in 
 other sensory centers, thus giving rise to a group of 
 secondary sensations synthetized into a percept, while 
 the original sensation with its nuclear sensory elements 
 may remain in the background. Such a physiological 
 stimulus may often be not an external physical stimulus, 
 but a pathological process going on either in the peri- 
 pheral sense organ from which the nuclear sensory ele- 
 ments arise or in the sense organs from which the sec- 
 ondary sensory elements originate. 
 
 Let S be the stimulus and F^ the visual sensory ele- 
 ments and A2TiM2 the secondary sensory elements, then 
 Vx may be dissociated, while the secondary sensory ele- 
 ments J2T2M2 stand out alone in consciousness as a 
 secondary percept or hallucination. 
 
 It may again be that not only the primary but also 
 the appropriate system of secondary elements may be 
 left out of consciousness, while associated systems of 
 secondary elements may be awakened and stand out 
 fully in the light of consciousness, thus giving rise to a 
 hallucination removed in its character from the original 
 primary elements with their organized secondary ele- 
 ments. 
 
 The preparedness of remote secondary groups may 
 often be determined by the type of mental structure. 
 Hallucinations of visions, or of voices, or of movements 
 will predominate, according as the type of mental struc- 
 ture is visual, audile, or motile. The mental type plays 
 no doubt, a very important part in the formation of il- 
 lusions and hallucinations. In the insane, auditory illu- 
 sions and hallucinations predominate in the audiles ; and 
 while, on the one hand, paranoiacs are often audiles, on 
 
Hallucination and Perception i6i 
 
 the other hand, audiles are inclined to paranoia. In 
 hypnosis hallucinations become more easily realized, if 
 they are adapted to the mental type of the subject. 
 
 Preparedness and subexcitement of ideo-motor groups 
 with which the secondary sensory groups are associated 
 also form an important factor in the final determination 
 of the character of the illusion or hallucination. This 
 is rather of an Indirect character. It is not that the ideo- 
 motor groups themselves directly enter into the struc- 
 ture of fallacious perception, but they often may determ- 
 ine which of the remote secondary sensory groups should 
 be stimulated to activity. Groups of elements are more 
 easily brought into active functioning, the greater the 
 activity of the elements with which they are associated, 
 the course of group excitation being, so to say, in the 
 direction of least resistance. 
 
 Pathological processes going on in one sense organ 
 may sometimes give rise to secondary sensory elements 
 belonging to other sense organs especially when favored 
 by general states of dissociation ; in fact, we may say that 
 from our point of view a state of dissociation is an indis- 
 pensable condition to the formation of hallucination. 
 
 The following cases may be taken as clear typical in- 
 stances. In one of the cases the patient saw spirits and 
 regarded them as ghosts of her deceased daughters. On 
 examination her eyes were found to be normal in all re- 
 spects. The patient saw the spirits even when her eyes 
 were shut, and furthermore the hallucinations were not 
 in the least affected even when her eyes were injected 
 with atropine. 
 
 When, however, the ears were examined a patho- 
 logical process of old standing was discovered. Now 
 when auditory stimuli were applied to the ear, the hallu- 
 
1 62 Diagnosis of Psychopathic Diseases 
 
 cinations were at once strongly affected, the spirits multi- 
 plied in number. This increase of spirits ceased as soon 
 as the auditory stimuli were removed. A closer exami- 
 nation revealed the fact that the patient was greatly af- 
 fected by the loss of a daughter. The pathological pro- 
 cess served as the stimulus, while the excitability of the 
 ideo-motor systems along with the general state of dis- 
 sociation determined the nervous processes, initiated in 
 the ear in the direction of the sensory visual systems and 
 gave rise to secondary sensory elements, formed in the 
 hallucinatory percept of ghosts and spirits resembling 
 the patient's daughter. The aural pathological process it- 
 self remained in the background of consciousness and 
 was unknown to the patient. 
 
 A similar case is that of a paranoiac who had 
 visual hallucinations of spirits, hobgoblins, and saints. 
 The organs of sight and hearing were found nor- 
 mal, but a pathological state was found in his scalp, es- 
 pecially in the sensibility of the muscles of the neck. An 
 inclination of his head in any direction caused him to see 
 the spirits and hear their voices. 
 
 In another case of mine, definite auditory stimuli, 
 such as the singing of birds brought about hyp- 
 noidic states which are really complex states of halluci- 
 nations. In another case, in a female paranoiac with 
 clearly defined auditory hallucinations, a similar state 
 was revealed. The patient heard voices not through 
 the ear, but through a spot located just over the region 
 of the Fallopian tubes. Examination of the spot re- 
 vealed tenderness and pain fulness to pressure. The hal- 
 lucinations, which were of a sexual character, became ex- 
 acerbated during the menstrual period. 
 
 Similarly in another case under investigation the au- 
 
Hallucination and Perception 163 
 
 ditory hallucinations were shown to be intimately con- 
 nected with phenomena of unconscious phonation and 
 with frequent earaches, with a limitation of the field of 
 vision due to an error of refraction which, when cor- 
 rected by eye glasses, modified the auditory hallucina- 
 tions, the latter finally becoming dissolved. More cases 
 of similar nature could be adduced, but the ones refer- 
 red to are sufficient, and extreme as they are, they bring 
 out clearly the secondary reflex character of hallucina- 
 tions. Hallucinations are essentially secondary percepts. 
 
 Hallucinations are frequently due to peripheral pro- 
 cesses, pathological or otherwise, occurring under condi- 
 tions of dissociation, within the same sense organ, but 
 the reflex hallucinations originating in other sense or- 
 gans bring more clearly to light the secondary nature of 
 hallucinations. The contention generally maintained 
 that there are hallucinations independent of peripheral 
 sources, or hallucinations of 'purely central origin' 
 which some even regard as supernormal experiences is 
 highly dubious. As far as directly observed facts go, 
 whether they be normal or abnormal, there is little to 
 justify the central point of view. 
 
 Like percepts, hallucinations are peripheral in char- 
 acter, and are only in so far central as peripherally 
 initiated secondary sensations are concerned. Halluci- 
 nations are of peripheral origin, and may be regarded 
 as complex cases of secondary sensations with the origi- 
 nal primary sensation dissociated from or left in the 
 background of consciousness. 
 
 If, however, hallucination is abnormal perception, 
 perception is normal hallucination. If a hallucination 
 is a secondary compound with the primary sensations 
 ABSENT, a percept, in so far as it consists of secondary 
 
164 Diagnosis of Psychopathic Diseases 
 
 sensory elements, is a hallucination with the primary 
 sensations present. Normal perception, illusion and 
 hallucination have the same underlying process and as 
 such may be arranged in a continuous series, according 
 to presence or absence of the primary sensory elements. 
 
CHAPTER XVI 
 
 HALLUCINATION, DISSOCIATION, AND DREAMS 
 
 A PERIPHERAL process often of a patho- 
 logical nature, a state of dissociation and a 
 subexcitement of secondary sensory and 
 ideo-motor elements constitute the main con- 
 ditions of hallucinations. The peripheral pathological 
 process and the state of dissociation are requisite to 
 the formation of the hallucinatory percept, while the 
 content of such percepts is given by the systems of 
 sensori-motor and ideo-motor elements. A peripheral 
 process alone, even if it be pathological in character, 
 does not give rise to hallucinations. 
 
 Similarly a state of dissociation by itself or a state 
 of subexcitement of secondary and representative ele- 
 ments cannot give rise to hallucinations. It is only when 
 these conditions cooperate, it is only then that hallucina- 
 tions arise. The state of dissociation and that of sub- 
 excitement of 'central' systems may be regarded as the 
 'central' conditions of hallucinations, while the periph- 
 eral process is the factor that supplies to the systems 
 the primary, sensory, nuclear elements round which the 
 secondary elements crystallize and form a hallucination. 
 States of dissociation, provided the other conditions 
 are present, are preeminently favorable to the forma- 
 tion of hallucinatory percepts. In sleep, when the 
 mind is immersed in darkness, isolated isles of systems 
 may stand out of this general night of consciousness 
 and give rise to dreams of various degrees of intensity. 
 
 165 
 
1 66 Diagnosis of Psychopathic Diseases 
 
 Dreams are sleep hallucinations, while hallucinations 
 are waking dreams. Both hallucinations and dreams 
 develop under the same conditions of dissociation. 
 
 The nature of dreams and hallucinations is essentially 
 the same. An isolated dissociated system of secondary 
 sensory and representative elements predisposed to 
 function becomes awakened by a special peripheral stim- 
 ulus or by a summation of series of stimulations, and 
 gives rise to hallucinations or dreams, according to the 
 general state of consciousness, waking or sleeping. This 
 process can be clearly traced in all hypnagogic and hyp- 
 napagogic dream hallucinations. 
 
 The hallucination of the comparatively waking state 
 stands out alone, it remains more or less isolated and 
 becomes obliterated by the general inrushing flood of 
 peripheral sensations and perceptions of the waking con- 
 sciousness. The dream is made up of a series of halluc- 
 inations going sometimes to form a complicated hal- 
 lucination, expanded into a whole life history. From 
 this standpoint we may say that a hallucination is an ab- 
 breviated dream, while a dream is an expanded hal- 
 lucination. 
 
 In sleep the primary sensory nucleus of the dream 
 hallucination is supplied by the peripheral processes 
 coming either from external stimuli or from internal 
 stimulations, from changes taking place in the organ- 
 ism. The psychophysiological threshold is raised in 
 sleep, the resistance to the entrance of sense impres- 
 sions is increased, the rise being proportionate to the 
 depth of the sleep state. The peripheral sensory chan- 
 nels are closed to external stimulations. 
 
 External stimuli, however, assail the peripheral sense 
 organs from all sides and now and then, whether on ac- 
 
Hallucination, Dissociation, and Dreams 167 
 
 count of the intensity of the stimulus or of the summa- 
 tion of a series of stimulations or of the temporary rise 
 of the sleep level and consequent fall of the threshold 
 and decrease of resistance to the influence of external 
 stimuli, sense impressions force an entrance and awak- 
 en to activity some slightly slun;bering systems thus 
 giving rise to the dream hallucination. Under such 
 conditions the sense impressions have but small chance 
 to awaken their appropriate systems, and hence they be- 
 come incorporated into systems with the lowest psycho- 
 physiological threshold, thus giving rise to the phantas- 
 tic combinations characteristic of dream life.* 
 
 Sense impressions form the nucleus around which 
 cluster systems of secondary sensations and repre- 
 sentations, all tinged with the sensory color derived 
 from the original primary, nuclear sensory elements. 
 The systems of secondary sensory and representative 
 elements once awakened may go on expanding and de- 
 veloping, awakening other groups and systems, assimi- 
 lating them or being assimilated by them as much as the 
 nature of their content permits and being further rein- 
 forced by incoming stimulations. 
 
 During the whole course of its expansion the 
 aroused groups and systems maintain their sensory or 
 rather their perceptual character. For, if a system 
 is once awakened to activity, the threshold, the resist- 
 ance to incoming stimulations is lowered, and many 
 more sense impressions gain access to the functioning 
 system's and become incorporated and assimilated. This 
 assimilation of chance systems and sense-impressions 
 
 ♦Recent speculations about the "interpretation'' and "meaning" of 
 dreams are unscientific, arbitrary, and meaningless. The "Traum- 
 deutjMjg" is nothing but a play on words, an ingenious play of 
 Talmudic^ cabalistic puerility jnd childish s^^asticism. 
 
1 68 Diagnosis of Psychopathic Diseases 
 
 often gives birth to highly elaborated phantastic dreams 
 and visions. 
 
 Systems awakened by stimuli must have some re- 
 lation of familiarity to the nuclear sense impressions. 
 If perception is to take place, there must be some con- 
 gruence between the sense impressions and the stimu- 
 lated systems. Only on such conditions can assimila- 
 tion take place. Similarly the awakened systems in 
 sleep assimilate congruent sense impressions, the lat- 
 ter becoming so transformed as to fit the system, and 
 the system is modified by the incoming impressions. 
 
 This congruence in the dream state is often strained 
 and remote and consequently often of a phantastic and 
 irrelevant character. Thus the taking off a plaster 
 may give rise to a dream of being skinned alive, or of 
 being scalped by an Indian. A change to an easier 
 position and a freer respiration may generate a dream 
 of flying. In one of my experiments of dream hallucina- 
 tion the uncovering of the feet in a cold room gave rise 
 to the dream of walking on the frozen surface of a riv- 
 er, the impeded respiration awakening the feeling of 
 fear of falling into the water. In a great number of 
 experiments and dreams carried on by me for years, I 
 have been enabled to trace dreams to sensory changes 
 and stimulations. 
 
 The internal sensations such as arise from the dif- 
 ferent functions of the bodily organs are import- 
 ant factors in the generation of dream hallucinations. 
 Every one knows the fact that indigestion often gives 
 rise to nightmares and unpleasant dreams, but not 
 many realize the fact that coenassthetic sensations, sen- 
 sations that come from our internal organs play an 
 important role in the production of dream hallucina- 
 
Hallucination, Dissociation, and Dreams 169 
 
 tions. The circulation of the blood, the secretion of 
 the various glands, the peristaltic movement of the 
 small intestines, the atction of the stomach, the changes 
 in the muscles, the metabolism going on in the various 
 organs of the body, in the cells of the organism, all 
 these give rise to sensations which, though obscure and 
 confused, go to makeup the general sense of organic 
 life activity.* 
 
 This sense of coenassthesis may, in fact, be re- 
 garded as the basis of our physical being or of 
 our physical personality. A change of this sense is fre- 
 quently an important factor in the formation of delu- 
 sions, when mental life becomes dissociated and disag- 
 gregated. Hypoaesthesia or anssthesia of the leg, for 
 instance, may form the nucleus for the formation of 
 the delusion that the leg is made of glass or of putty 
 or is totally gone. Anaesthesia of the body or of the 
 internal organs may develop the delusion of being 
 dead, the patient asking to be buried. 
 
 Similar conditions are also present in dream life. 
 Toxic and antitoxic material, accumulation of waste 
 products, various drugs, gases and injections of various 
 poisons have in my experiments given rise to hallucin- 
 atory dream states. Affection of special organs have 
 given rise to nightmares. Changes of coenaesthesis play 
 no doubt an important role in the activity of the dream 
 consciousness. Changes in the various component ele- 
 ments that go to make up the obscure but highly com- 
 
 *In another work I shall take up the study of the dream con- 
 sciousness more in detail, meanwhile I must strongly protest against 
 the flood of psychoanalytic literature about the supposed psychology 
 of dreams. Psychoanalysis in general and psychoanalysis^ofjdtssinis. 
 in particular display not only arrogance of" the ignorant parvenu 
 ift psychology, but also nvacif est _a total, inca|iacity of comjjrehea- 
 sion of psychological problem?. 
 
170 Diagnosis of Psychopathic Diseases 
 
 pies, life of organic sensibility affect profoundly the rich 
 exuberant play of the dream consciousness. 
 
 Since the channels to external stimulations are 
 closed, the coenassthetic sensations that form the 
 obscure basis of waking consciousness become the 
 sole possessors and guides of whatever mental activity 
 is present in sleep. These internal sensations are wov- 
 en by the dream consciousness into phantastic images 
 of all shapes and forms. 
 
 The dream consciousness presents many characteris- 
 tics found in states of mental dissociation and disintegra- 
 tion. Moral tone is lowered, attention is greatly re- 
 duced, logical thought is enfeebled and the sensori-mo- 
 tor and ideo-motor elements are thrown out of gear, of- 
 ten resulting in the formation of illusions, hallucina- 
 tions, and delusions. In the dream state there is present 
 the mental degradation of dementia, the sordid delu 
 sions of hypochondria and melancholia, the delirious 
 states of mania, the delusions of grandeur of general 
 paralysis, and even the persistent systematized delu- 
 sions of paranoia. 
 
 The dream consciousness is extremely unstable, 
 it forms no definite type of mental disintegration and 
 has no determinate course, it Is extremely fluctuating in 
 Its states, and Its background Is usually shifting ceaseless- 
 ly. From this standpoint It may be said that the dream 
 consciousness Is a normal form of mental alienation and 
 that mental alienation Is an abnormal form of dream 
 consciousness. 
 
 A very characteristic diary brought to my notice 
 in which a retrospective and Introspective account 
 Is given by a patient in the normal condition of 
 the experiences lived through in the state of mental 
 
Hallucination, Dissociation, and Dreams 171 
 
 aberration opens with the suggestive title: Memories 
 of my Dream Life and with the following interesting in- 
 troductory remarks : 
 
 "Where shall I commence? How shall I begin to 
 recall and record this to me mysterious life I have been 
 living? So beautiful, so strange, and in some way so 
 terrible. Yet I would not forget, for it seems as though 
 I must have been in communication with intelligences 
 above — ^spirits of the air, if it were possible. 
 
 "When did it commence? How long has it been with 
 me? are questions I cannot solve. For weeks before 
 coming to the hospital I must have been living this 'ideal 
 life' as in an 'ideal world.' I have jotted down what I 
 have thought, though they are not one hundredth part 
 of the thoughts which passed through my mind during 
 this strange time of dreaming." 
 
 Tn my cases of katatonia the frightful dreams of 
 the year preceding the disease became hallucinations 
 of the maniacal stages, and appeared again as dreams 
 during convalescence. The dreamer dreams with his 
 eyes closed, the insane dream with their eyes open. 
 
 In both the dreamers and the insane the disaggre- 
 gated states under the influence of external and especial- 
 ly of internal stimuli give rise to illusions, hallucinations 
 and delusions. Dissociated states grouped round nuclei 
 of primary sensations form the internal organizations of 
 hallucinations and delusions so often characteristic of 
 dream life and insanity. 
 
 Coenaesthetic sensations are important agents in 
 the formation of insane delusions and hallucina- 
 tions, they are so many fermentation nuclei among 
 masses of dissociated states. Irritation of the genitalia 
 may in the insane awaken hallucinations and de- 
 
172 Diagnosis of Psychopathic Diseases 
 
 lusions of a sexual character ; constipation and heaviness 
 in the intestinal tract may generate delusions and hal- 
 lucinations of rats and pigs in the stomach; rumbling 
 in- the stomach and the intestines may give rise to the 
 delusions and hallucinations of devils in the body or of 
 electric discharges of powerful batteries, placed in the 
 abdomen. 
 
 The difference between the waking life of the insane 
 and that of dream consciousness is the mode of activity, 
 the dream consciousness works in images, in secondary 
 sensory percepts, while in the insane mind the activity is 
 largely representative. This difference is due to great- 
 er dissociation present in dream consciousness. The 
 dwakened dissociated systems in dream life become 
 tinged with a perceptual sensory color by the process of 
 absorption and assimilation of all the incoming sense 
 impressions. 
 
 Pathological states of rapid mental dissociation, such 
 as the acute states of maniacal excitement or in states 
 of psychopathic functional dissociation, such as the 
 "Ddmmerzustdnde" of psychic epilepsy and other states 
 of functional psychosis, closely approximate to the con- 
 dition of dream consciousness, though the former are 
 more stable and far more consistent, being narrowed 
 to the active functioning of definite mental systems, con- 
 ditions rarely to be met with in dream states. 
 
 The dream consciousness lacks unity of logical 
 thought, certainly fails in critical judgment, and is some- 
 times indifferent to immoral situations and acts. 
 The credulity of dream consciousness is well known to 
 every active dreamer. Changes of time, place, and of 
 objects are often instantaneous, and the most incongru- 
 ent situations as well as transformations of personality 
 
Hallucination, Dissociation, and Dreams 173 
 
 are placidly and credulously accepted. The dream con- 
 sciousness is entirely at the mercy of incoming sense im- 
 pressions which spin the dream experience regardless of 
 truth and reality and steadiness of logical purpose and 
 moral ideals of the race. From this standpoint it may 
 be claimed that the dream consciousness is to some ex- 
 tent a reversion to the earliest forms of mental life, 
 when the race was as yet undisciplined by the accumu- 
 lated experience of ages of social life. 
 
 The teleological aspect of the dream consciousness 
 may possibly lie in the fact suggested by some that the 
 many trains of thought started in the activity of waking 
 consciousness and arrested by the selective thought and 
 logic of things and events of waking life find their vent 
 and completion in the activity of dream conscious- 
 ness. This vent relieves us from the high pressure of 
 suppressed thought and makes it easier to sustain the 
 rigid selection of sequences of mental states required by 
 the struggle of existence and social life in our adjust- 
 ments to the conditions of external environment. 
 
 This view, however, is not correct. For the 
 dream consciousness follows not only along the lines of 
 thoughts started in waking life, but more often forms 
 new lines of associations giving rise to highly dramatic 
 situations bearing no relation whatever to the interests 
 of waking life, and far from relieving waking thought 
 impedes and depresses it, since the mind feels unre- 
 freshed by the sleep and in many cases serious mental 
 troubles arise, due to the disturbing influence of active 
 dreams on the course of waking thought. 
 
 It is more likely that there is little teleology to dream 
 life, and if any teleology there be, it may consist in the 
 freedom and ease in which the mind finds itself in the 
 
174 Diagnosis of Psychopathic Diseases 
 
 dream state, fettered as the mind is by the rigid rela- 
 tions of the external environment. In dream life the 
 routine of waking life is interrupted and new associa- 
 tions are formed. 
 
 This possibility of forming new associations and thus 
 breaking through the routine of life, a possibility main- 
 tained and fostered by the dream consciousness, might 
 ^have possibly proved of some consequence to the 
 human race. The dream consciousness may thus be re- 
 garded as an important factor in the progress of hu- 
 man thought, as an agent in the breaking up of habits 
 of thought, due to the routine of life, calling the at- 
 tention of man, absorbed as he is with the interests and 
 requirements of the needs of his physical world, to an- 
 other life existence and strange universe of reality. It 
 is out of the activity of dream consciousness that the 
 concept of an independent spiritual life has developed. 
 In sleep and dreams man breaks away from the bond- 
 age of the interests of this world. 
 
CHAPTER XVII 
 
 HALLUCINATION, DREAMS, AND REALITY 
 
 THE sense of reality and the belief in the ex- 
 ternal existence of the hallucinatory objects 
 are quite strong in hallucinations and in some 
 of the more vivid and intense dream states. 
 In order to explain this seemingly anomalous sense of 
 reality, it may be well to revert to our general principle 
 of subsuming both the normal and the abnormal under 
 the same general laws and processes. 
 
 Although the abnormal is of the highest importance 
 in revealing new relations which the customary and 
 habitual normal seems to hide, as found, for in- 
 stance, in the growth and development of physiology, 
 largely due to pathological research, still we must clear- 
 ly remember that from a strictly scientific standpoint 
 the normal and abnormal are but teleological concepts 
 which are of importance for the practical purposes of 
 our habitual life activity and possibly for classification 
 of various types of phenomena, but which science is to 
 reduce to the same laws and processes. The abnormal 
 is the normal out of place. 
 
 In mental life as in the phenomena of life in general 
 the atypical, or the variation, helps to explain the typi- 
 cal, the normal, and the latter in its turn explains the 
 atypical, the abnormal. We may therefore turn to the 
 criterion of the normal sense of reality and validity of 
 experience as explaining the same relations in abnormal 
 mental life and the latter in its turn may throw light on 
 
 175 
 
176 Diagnosis of Psychopathic Diseases 
 
 the "reality and validity" of "normal" experience. A brief 
 review will suffice for our purpose. It may look as if 
 we attempt to make an excursion into a domain not be- 
 longing to normal or abnormal psychology proper, but 
 to epistemology. This may be so, but the nature of 
 our subject brings us so closely to this problem that 
 a brief discussion may help us to see the facts in a clear- 
 er light. 
 
 Abnormal psychology with its various forms of men- 
 tal aberration, such as are to be found in the phenomena 
 of insanity, functional psychosis, hallucination, delusion, 
 somnambulic states, hypnoidic states, is so intimately 
 connected with aberrations of the 'sense of reality and 
 validity' of experience that not only the abnormal psy- 
 chologist, but also the clinician must take it into account 
 from a purely practical standpoint. We shall view the 
 problem only in so far as it directly concerns and illus- 
 trates the general subject of our discussion, namely hal- 
 lucination and illusion, or fallacious perception. 
 
 The objective reality of the physical world is some- 
 times defined, and apparently with best of reasons, as 
 social experience, as experience common to ourselves and 
 our fellow men, as experience which men share in com- 
 mon. This view, however, of 'external reality' seems in 
 contradistinction to the psychic experience which is 
 essentially of an individual character. The tree 
 yonder can be seen by everyone who possesses 
 eyes, but my perception of the tree, or my idea of it, 
 can only be experienced by myself. It may be said that 
 this difference between the physical object and psychic 
 state is a valid and valuable one. It is, however, neith- 
 er general enough, nor specific enough. 
 
 For on the one hand it may be claimed that from a 
 
Hallucination, Dreams, and Reality 177 
 
 more general philosophical standpoint even the physical 
 object belongs ultimately to the individual only, and on 
 the other hand, it may be claimed that psychic experi- 
 ence is communicated to our fellow men not only in 
 terms of the physical object, but far more often in terms 
 drawn dfrectly from our mental life. , Neither the 
 physicist nor the psychologist will be quite satisfied with 
 this point of view as both physical objects and psychic 
 objects are entirely emptied of their specific contents 
 and must remain at best in the dubious regions of epis- 
 temology. 
 
 Still this social aspect of the physical object 
 is significant and valid and is even used by the psy- 
 chiatric clinician as a practical standard In the valua- 
 tion of abnormal mental life in general and of insanity 
 in particular. It may, therefore, be of value even 
 if we do not agree with the extreme way In which 
 this view Is sometimes put. 
 
 It Is true that at the first glance we cannot help be- 
 ing struck by the import of the comjnon or social as- 
 pect of external reality. We are well assured of the 
 existence and presence of an external object, if we have 
 the assurance of our fellow-beings, and what is ac- 
 cepted by our fellow men assumes the dignity and au- 
 thority of actuality. A fact is regarded as existing be- 
 yond the shadow of any dispute, if every one can verify 
 It in his own experience. The categorical necessity of 
 our modern science rests entirely on this principle of 
 validity: The social object is the valid object. 
 
 This criterion of validity of the external object stands 
 out specially clear and distinct In our standard of ab- 
 normal mental life. A belief is regarded as Insane and 
 delusional. If It Is in opposition to social beliefs and ex- 
 
178 Diagnosis of Psychopathic Diseases 
 
 perience, and is emphatically rejected by all other men. 
 An object is regarded as illusory or hallucinatory, if it 
 is treated as non-existent by other people ; a desire, an 
 action is considered immoral, if it is spurned by our 
 neighbors. The real object is the social object, the 
 valid belief is the social belief, and the social will is the 
 moral will. The individual object, the individual be- 
 lief, the individual will are treated as insane. 
 
 One can not help noticing the semblance of truth in 
 the assertions of those pathological anthropologists who 
 put genius in the same category with insanity. What is 
 social is alone true, valid and real, the individual is 
 false, non-existent. The individual can buy the reality 
 and truth of his being on condition of becoming social. 
 Sociality is verity. 
 
 Let us now, however, try to break through, if for 
 a moment only, the traditions of social regime with 
 its criteria of social reality and validity. When being 
 pricked or getting a blow, or when cut or scratched, 
 along with the experience of the sensation, the experi- 
 ence of the external stimulus is also given. In looking 
 out of the window and seeing the tree with its green 
 leaves moving in the wind, along with the perception 
 of sensory elements, primary and secondary, the 
 external existence of the object tree is also given. Sim- 
 ilarly in listening to the sounds of a familiar and dear 
 voice and listening to the words as they form into phrases 
 and sentences is not the sense of reality of the external 
 object given along with the series of sound sensations? 
 Sensation carries along with it the sense, the reality of its 
 stimulus. It is not that the sense of reality is different 
 from the sensation, it is given in the sensation itself. 
 
 Similarly the percept and the sense of reality of the 
 
Hallucination, Dreams, and Reality 179 
 
 external object are not two different things; they are 
 given together in the same process of perception and are 
 identical. The percept tree is the perception of the 
 reality of the objective tree yonder. The sensory pro- 
 cess is also the process of the sense of reality. As 
 Spinoza puts it in his Ethics: "If the human body is 
 affected in a manner which involves the nature of any 
 external body, the human mind will regard the said 
 external body as actually existing." In seeing or per- 
 ceiving the chair yonder we do not perceive it as real, 
 because of its social or common aspect — the reality of 
 its existence is given directly in the sensory processes 
 of the percept itself. Sensory elements involve the re- 
 xlity and existence of their stimuli; the percept in- 
 volves the existence of the perceived objective content. 
 The sense of reality of the external stimulus or ob- 
 ject is strengthened by association of the original sen- 
 sory systems with other sensory systems, and the in- 
 tensity rises in proportion to the number of systems of 
 sensory elements, brought into relation with the func- 
 tioning sensory system. If on perceiving an object, we 
 wish still further to assure ourselves of its reality, we 
 verify it by mieans of other sense organs. If one sees 
 an apple and wishes still further to assure himself of 
 the real presence of the object, he goes to it and ex- 
 amines it with his other sense organs, he touches it, 
 presses it, bites it, tastes It. 
 
 Kinaesthetic elements, being the most important in 
 adaptations and reactions to the stimuli coming from 
 the external environment, are possibly of all sensory 
 elements the ones that give the keenest and most in- 
 tense form of sense reality. Facts warrant us to assert 
 with some show of probability that the sense of reality 
 
i8o Diagnosis of Psychopathic Diseases 
 
 is chiefly centered in the sensori-motor or kinaesthetic 
 elements which serve as nuclei for other sensory ele- 
 ments. 
 
 Whether this be correct or not, it remains true that 
 the sense of reality is given directly by sensory elements 
 and their combinations and organizations. The more 
 systems of sensory elements are pressed into service, 
 the stronger is the sense of reality and the more assured 
 is the reaction to the stimuli of the external environ- 
 ment. 
 
 In the evolutionary process of man's adaptation to 
 his environment he becomes extended in being and 
 grows more developed, because of his social relations 
 with other men. Man presses into active service the 
 systems of sensory elements of his fellow beings. Adap- 
 tations and hence successful reactions to the external 
 environment are now more assured, and the sense of 
 reality is still further emphasized and intensified. 
 
 Throughout the course of intensification of the sense 
 of reality the principle remains unchanged in nature. 
 The sense of reality is given by and consists in nothing 
 else but the sensory elements. 
 
 Social experience may be regarded as more real or 
 as giving a more intense sense of reality, because of the 
 greater number of sensory systems involved, but an 
 object is not felt as external and real, because of its 
 social aspect merely, the sensory aspect is by far the 
 more fundamental. If one's perception of the house 
 yonder is of a purely "individual" character, not shared 
 by his fellow men and even emphatically denied by 
 them, the visual perception, as such, still directly per- 
 ceives it as real, external, and physical. 
 
 Should furthermore this experience be intensified or 
 
Hallucination, Dreams, and Reality 1 8 1 
 
 confirmed by all the other senses — should he be able to 
 touch it, to press it and feel its resistance, knock against 
 it and feel concussion and pain, and have a series of 
 tactual and muscular sensations by walking into the 
 perceived house and around it, and should he further 
 have this purely 'individual' experience of all the senses 
 each time he comes to the same spot, the perceived ob- 
 ject would then be a real, external, physical object, and 
 no amount of social contradiction and lack of the ear 
 marks of community could make it less real, objective, 
 and physical. 
 
 Epistemologically regarded, community may be 
 sufficient for the purpose of reality; psychologically 
 regarded, the real, existent physical object is essentially 
 the perceived sensory object given by the 'community' 
 of sfensory elements. Sensory elements give the objec- 
 tive "reals." 
 
 From this digression we may turn again to the 
 question : "What is it that makes hallucinations in gen- 
 eral and dream hallucinations in particular appear real, 
 objective?" The solution is given in the question itself. 
 We have shown in our analysis that hallucinations are 
 essentially peripheral and sensory in character and do 
 not differ in their make-up from sensation and percep- 
 tion in general which furnish the very foundations of 
 our sense of reality. Hence hallucinations are real and 
 objective, because of the constituent sensory elements. 
 
 Strictly psychologically considered, percepts do not 
 differ from hallucinations as far as process is concerned. 
 Normal percepts differ from hallucinations mainly by 
 the fact that the former are the habitual, the customary, 
 confirmed by other systems of sensory elements, and 
 that in the struggle for life, they proved the fittest to 
 
1 82 Diagnosis of Psychopathic Diseases 
 
 call forth the best adapted reaction. 
 
 Dream hallucinations, like hallucinations in general, 
 are initiated by peripheral stimulations; even the so- 
 called "central" hallucinations are really peripheral in 
 origin, the dream hallucinations naturally falling under 
 the same category. The entrance of external peripheral 
 stimulations being difficult in proportion to the depth of 
 sleep and extent of hallucinatory dissociation, the inter- 
 nal sensations predominate in the functioning systems of 
 dream life. For in sleep the activity of the internal or- 
 gans, though depressed, still goes on uninterruptedly; 
 the glands continue their function of secretion and excre- 
 tion, the heart continues to contract and dilate, the blood 
 goes on circulating through arteries and veins ; the liver, 
 the spleen, the stomach, the intestines, the lungs and oth- 
 er organs carry on their functions without a moment's 
 arrest; the whole sympathetic nervous system, the vaso- 
 motor, the spinal cord, the medulla and other basal 
 ganglia, all, contributing to the vast mass of internal 
 sensations, can hardly be regarded as being asleep. 
 
 All these peripheral internal sensations go to form 
 nuclei of primary sensations around which secondary 
 sensory elements become crystallized and organized, and 
 give rise to hallucinatory percepts — to dreams. To these 
 must be added the external peripheral sensations coming 
 from touch and pressure of bed clothes, from changes in 
 the muscles, joints, ligaments, and synovial surfaces, 
 from changes In the superficial temperature of the ex- 
 tremities, from chemical changes in the olfactory and 
 gustatory organs, from summation of minimal acoustic 
 stimulations, and above all from changes In the visual 
 apparatus, and especially from the masses of light in the 
 retina and macula lutea. 
 
Hallucination, Dreams, and Reality 183 
 
 With the obscuration and dissociation of the mind the 
 internal sensations along with the external peripheral 
 minimal sensations come to the foreground of mental 
 life. The dreaming consciousness stands in closer rela- 
 tion to the bodily functions than the waking conscious- 
 ness, absorbed as the latter is with the intense stimula- 
 tions coming from the external environment. The in- 
 tense, external, peripheral sensations of waking con- 
 sciousness obscures the weaker, but more constant inter- 
 nal sensations, as Hobbes puts it, much "as the light of 
 the sun obscureth the light of the stars." 
 
 This intimate relation between internal sensations 
 and dreams was clearly seen and pointed out by 
 Aristotle : "For the movements which occur in the day- 
 time (within the body) are, unless very great and vio- 
 lent, lost sight of in contrast with the waking move- 
 ments, which are more impressive. In sleep the oppo- 
 site takes place, for then even trifling movements seem 
 considerable." Similarly Hobbes says : "and because 
 the brain and nerves which are the necessary organs of 
 sense, are so benumbed in sleep as not easily to be moved 
 by the action of external objects, there can happen in 
 sleep no imagination and therefore no dream, but what 
 proceeds from the agitation of the inward parts of 
 man's body ; which inward parts for the connection they 
 have with the brain and other organs, when they be dis- 
 tempered, do keep the same in motion." 
 
 Dreams sometimes reveal in phantastic and grotesque 
 images the conditions of bodily function, conditions 
 which the waking consciousness cannot detect, because 
 they lie in the subconsciousness and cannot overstep the 
 threshold of waking consciousness. It is here in the 
 deeper regions of coenassthesis, that we have to look for 
 
184 Diagnosis of Psychopathic Diseases 
 
 those "prophetic" dreams which seem to foretell some 
 future event, some future state of the organism. 
 
 An incipient irritation of the nerve endings in the 
 teeth, an irritation not yet felt in the waking conscious- 
 ness, may become the nucleus of a dream and give rise 
 to a dramatic vision of sitting in a dentist's chair and 
 being operated upon, a prevision that may actually be- 
 come fulfilled soon after. Incipient organic affections, 
 not yet felt in the waking consciousness, may become 
 the starting point of a highly dramatic prophetic dream. 
 Dreams of such a "veridical" character often appear 
 highly mysterious and their fulfilled prophecy seems 
 nothing short of the miraculous and supernatural. There 
 are many such cases on record, but the following may 
 be regarded as typical : 
 
 A lady, a relative of mine, had a vivid vision 
 which proved "veridical," and seemingly could only be 
 accounted for on supernatural grounds. One evening, 
 on being left in a room all alone, she suddenly saw the 
 apparitions of her deceased parents. The lady became 
 much frightened, but the parents quieted her and 
 told her not to be afraid as they came to bring her good 
 tidings. "You will give birth to twins, a girl and boy, 
 name them after us, they will be strong and healthy." 
 With this the apparitions vanished. 
 
 The lady became greatly agitated and, although 
 she did not suspect to become a mother, still, being 
 religious and a firm believer in spirits, she had implicit 
 faith in the actual presence of her parents, who appear- 
 ed to her in order to bring her glad tidings from 
 another world, and naturally she even began to 
 prepare clothes for the promised twins. As this 
 happened in a remote country place the news of this 
 
Hallucination, Dreams, and Reality 185 
 
 vision soon circulated among all the neighbors, and 
 expectations were aroused as to the fulfillment of 
 the prophecy. It soon became apparent that at least 
 a portion of the prophecy was being fulfilled. The lady 
 soon discovered that she was going to become a mother 
 — the sceptics were somewhat confused, still they main- 
 tained their front, but they were completely silenced, 
 when after a few months the lady gave birth to twins 
 and that a boy and girl. The vision then did prove to 
 be of supernatural origin. 
 
 If, however, we analyze the vision somewhat more 
 closely, we find that it can easily be resolved into ele- 
 ments which admit of a perfectly natural explanation. 
 The vision first of all occurred during the state of repose 
 and was really a dream hallucination. Still this does not 
 explain the fact that the hallucination appeared in such 
 a dramatic form which turned out to be so strikingly 
 prophetic. 
 
 On further examination of the lady's history it 
 was found that she lost both her parents but a few 
 months before the occurrence of the hallucination and 
 that this loss deeply affected her. This mental system 
 was an important factor in shaping the course and devel- 
 opment of the hallucination. At the same time there 
 was another factor at work in the elaboration of the dra- 
 matically effective dream hallucination. The lady be- 
 fore she gave birth to the twins was already a mother 
 of fourteen children. It is quite possible that, although 
 in her waking state she did not suspect of being preg- 
 nant, still in her dream state, being cut dff from the in- 
 tense external stimulations, she Could more easily realize 
 her condition from symptoms and changes in the inter- 
 nal organic sensations which now alone reigned supreme 
 
1 86 Diagnosis of Psychopathic Diseases 
 
 in the dream consciousness. 
 
 These symptoms and changes in the organic sensa- 
 tions during the incipient stages of pregnancy could all 
 the more be easily appreciated by the lady as she had 
 ample experience of them before. Some special changes 
 in the organic sensations such as the arrest of the men- 
 ses, changes in the circulation, in the metabolism of the 
 generative organs, and other changes of similar nature 
 served as so many peripheral stimulations which, in 
 states of dissociation, such as occur in the light states 
 of sleep, favored the occurrence of a dream hallucina- 
 tion that took the form of apparitions of the deceased 
 parents, because of the subexcitement of this particular 
 system, and because for the time being, the system played 
 a dominant role in consciousness. 
 
 Moreover, the organic changes differed greatly 
 from the previous experiences of similar kind, and 
 it was therefore quite natural that the dreaming 
 consciousness should suspect the coming of twins, a cir- 
 cumstance which connected Itself all the more closely 
 with the formation of the dream and was no doubt a 
 factor in the determination of the appearance of the ap- 
 paritions of the parents, which in turn, helped her 
 further to confirm the intuition that she was to be a 
 mother of twins. All this was represented in that vivid 
 way characteristic of dissociated states in general.* 
 
 ♦Another theory, based on subconscious wishes, symbolism, and 
 on a fancifully elaborate mechanism of condensation, displacement 
 dramatization, and secondary elaboration, finally reduces dreams 
 to the sexual wish, dating as far back as the sexual or "bisexual" 
 life, as the school terms it, of early childhood and infancy. Of 
 course, this theory is not psychological, but rather teleolo^cal and 
 metaphysical, inasmuch as the whole of psychic life activity is re- 
 duced to wish and desire of which the sexual instinct is supposed to 
 play the sole role. 
 
 There is the manifest content of the dream which is directly given 
 
Hallucination, Dreams, and Reality 187 
 
 by the dream and the latent content which underlines the dream 
 activity. The four factors of the dream activity distort the dream 
 so that the latent content cannot be recognized in the manifest con- 
 tent. This distortion is done by the "censor" who for the protection 
 or self-defense of the person does not permit the subconscious 
 latent content to come forward in dream. 
 
 As I shall discuss dreams more in detail in my forthcoming vol- 
 ume on the causation of mental diseases I limit myself here with a 
 few remarks on the subject. The 'psychoanalytic' theory is unpsy- 
 chological and arbitrary as it introduces a process of symbolism 
 which by sufficient distortion and suggestion leads the whole investi- 
 gation astray and puts it on the same basis with the Oneirology of 
 ancient times and the middle ages. 
 
 Professor William James, whose introspective powers no one can 
 call in question, in speaking to me about this theory told me that 
 he could not find anything of this kind claimed by the theory in his 
 own dream experience. I myself have dealt with dream experiences 
 in my own case as well as in the case of subjects and most of my 
 patients for about fifteen years at least and I could not find any- 
 thing that should in the least substantiate this fanciful theory of 
 what may be termed symbolic psychology. 
 
 There is no doubt that with sufficient distortion, twisting and sug- 
 gestion one can get anything out of a dream. By a series of asso- 
 ciations and suggestions long continued, aided by ingenious symbolic 
 interpretation there is no difficulty in arriving at "sexual com- 
 plexes," and then fix the subject's or patient's attention on them. 
 It is the easiest thing to do with suggestible people. 
 
 I may add that the view of "dream symbolism" is a psychological 
 fallacy. The fallacy is the confusion of what is understood by 
 symbolism with the associative activity of the dream consciousness. 
 Thus one writer tell us there is no doubt of the presence of symbol- 
 ism in dreams. When we hear in our sleep the singing of birds we 
 may dream of hearing an orchestra. Now an orchestra is not at all 
 a symbol of birds. A symbol is the use of a certain definite image 
 indicating the essence and meaning of a complicated psychic activity 
 coming from another sphere of mental life. Even the psycho-analytic 
 enthusiasts would hardly r.-^^ard the above example as one of sym- 
 bolism. Still fundamentally there is the same fallacy present in all 
 the works on psycho-analysis and, that is, the ideiitification and con- 
 fusion of the associative image activity characteristic of the dream 
 consciousness with the widely different mental £^ctivity of sjonbol- 
 iza,tion which is essentially universal and abstract, and utilizes the 
 object or the percept as the embodiment of its highly abstract mean- 
 ing. 
 
CHAPTER XVIII 
 
 THE VIVIDNESS OF HALLUCINATIONS AND DREAMS 
 
 STATES of dissociation, light sleep, and especial- 
 ly the intermediary states occurring in the course 
 of falling into deep sleep or coming out of it are 
 favorable to the formation of hallucinations. 
 Such conditions occur in abnormal mental states, in 
 hypnosis, in somnambulism, in hypnoidal and hyp- 
 noidic states, in the so-called psychic equivalents of 
 epilepsy, in pure psychic epilepsy, and, generally, in 
 states of functional psychosis. In the intermediary states 
 between waking and sleeping, dissociated systems awake 
 and become accessible to the influence of external stim- 
 uli. 
 
 This is clearly shown in the hypnagogic hallucina- 
 tions, as well as in the frequent dreams often taking 
 place in the lighter sleep states usually before waking. 
 I have often observed in myself, when being fatigued 
 and becoming drowsy and closing my eyes, how fast 
 phantoms and scenes flit before the mental gaze, most 
 of them being formed by the flitting masses of light in 
 the field of vision. Often in closing my eyes and keep- 
 ing quiet, so as to become somewhat drowsy, and watch- 
 ing the field of vision, not directly, but, so to say, from 
 the comer of the eye, animals, figures, faces, can be 
 seen forming and dissolving into mist. These have an 
 important influence in the guidance of the mental con- 
 tent of the dream consciousness. 
 
 These dream phantoms can be directly traced to 
 
 i88 ' 
 
The Vividness of Hallucinations and Dreams 189 
 
 specks of light and masses of color, coming from the re- 
 tina and especially from the macula lutea. In many psy- 
 chopathic cases, not only vision, but also sounds and 
 voices are experienced as in some of my cases that have 
 hypnagogic hallucinations of voices. The dimly lighted 
 up regions that lie on the borderland of sleep and wak- 
 ing states are peopled with phantoms, ghosts, and ap- 
 paritions. 
 
 Statistics seem to confirm this point of view, since 
 about 50 per cent, of cases of hallucinations may be 
 classed as 'borderland hallucinations.' Some recent crit- 
 ics in this field of inquiry strongly favor the view that 
 hallucinations occur in dream states, hallucinations be- 
 ing but vivid dreams, the percipient not being conscious 
 of having fallen asleep. This view is not new, it is 
 favored by Hobbes. 'The most difficult discerning,' 
 Hobbes tells us, "of a man's dream from his waking 
 thoughts is then when by some accident we observe not 
 that we have slept." 
 
 Many cases no doubt admit of such an explana- 
 tion. I myself had an experience of such a char- 
 acter. While sitting and studying one evening, I 
 felt myself suddenly transported into my father's 
 house and looking out of the window, seeing the 
 scenery characteristic of the locality and hearing the 
 voices of my parents in the next room, but I could nv..t 
 discriminate the words. The vision was so real that I 
 was surprised to find myself again at my book and in a 
 place hundreds of miles away from home whither my 
 hallucinatory state had so suddenly transported me. The 
 hallucination was so strong and real that had I not criti- 
 cally analyzed the conditions of its occurrence I should 
 have been fully certain that the hallucination appeared 
 
190 Diagnosis of Psychopathic Diseases 
 
 in the waking state. 
 
 As a matter of fact, I was fatigued from my studies 
 and 'dropped off. The actual surroundings, the room, 
 the table, the book, the voices of my friends present, 
 all disappeared from my view during the intermediary 
 state, and when I came out of it I gave a start in realiz- 
 ing once more the actual situation. 
 
 According to records, hallucinations take place 
 when the percipient is in bed, just after retiring, or 
 about to wake up, or after waking. The percipient is 
 really asleep, only he is not aware of it, so brief is the 
 state and so intense and vivid is the hallucination. It 
 may, therefore, be maintained with some show of truth 
 that hallucinations are dreams and take place in sleep 
 states. 
 
 We must guard, however, against carrying a gener- 
 alization too far. This contention that hallucinations 
 occur in dissociated dream states is somewhat over- 
 stated. It is true that hallucinations require states of 
 dissociation, but this does not necessarily mean sleep 
 states. Not all states of dissociation are dream states 
 taking place in sleep, although it may be safely assert- 
 ed that all dissociative states have many traits in com- 
 mon and are at bottom of the same nature. Halluci- 
 nations and dreams mlay be analogous, may be of the 
 same structure requiring the same general conditions, 
 but it does not for that reason follow that they occur 
 in the same states, in sleep states. 
 
 Dissociation with consequent hallucinations may also 
 take place in waking states. Those who have studied 
 hallucinations in different forms of mental diseases 
 know that most of the hallucinations occur under wide- 
 ly different conditions, and they further know that it is 
 
The Vividness of Hallucinations and Dreams 191 
 
 precisely in the waking states that hallucinations are 
 most commonly present, while in the sleeping states they 
 are more frequently absent. Insanity may be compared 
 with dream states, but they are by no means identical. 
 The important condition requisite for the occurrence of 
 hallucination is dissociation, and this condition often oc- 
 curs in waking states, such as the hallucinations found in 
 many forms of insanity, as for instance paranoia, hebe- 
 phrenia, katatonia, general paralysis and other states 
 of mental aberration. 
 
 Even hypnotic and post-hypnotic hallucinations 
 can hardly be claimed to have been really induced 
 in dream states. They who have devoted time and 
 labor to hypnosis know that the hypnotic state can 
 by no means be identified with sleep, and that in 
 the very deepest stages of hypnosis the subject 
 is to all intents and purposes fully awake ; he is full of 
 activity, his eyes are open, his senses are on the alert 
 — he is far more awake to' external stimuli than even 
 in his normal state. The rrlind is active and the 
 subject carries on long trains of reasoning, argumenta- 
 tions and discussions with the people around him; in 
 short, the subject in the deep somnambulic state is in 
 a condition the very opposite from that of the sleeping 
 state. Hallucinations occur both in the waking and 
 sleeping states and require dissociation as an indispen- 
 sable condition. 
 
 If we inspect more closely the relation of the stim- 
 ulus to the hallucination, especially to the dream hal- 
 lucination, we find that the intensity of the content is 
 disproportionate to the intensity of the initiating stim- 
 ulus, to the peripheral sense impression. A compara- 
 tively slight stimulation often gives rise to a dream 
 
192 Diagnosis of Psychopathid Diseases 
 
 of a highly dramatic character. This exaggerated 
 character of the dream hallucination is well known. 
 Thus a prick of a pin may give rise to a dream of be- 
 ing attacked by robbers, and finally being run through 
 by a thrust of a dagger. The application of a warm 
 bottle to the feet may develop a dream of ascending 
 a volcano and walking on molten lava, while a cold 
 stimulus may give rise to a dream of participating in a 
 dangerous expedition to the North Pole. Pain in the 
 head, impeded respiration and pressure in the region 
 of the neck may develop, as in the case of a friend of 
 mine, the horrible dream of being dragged into a nar- 
 row dungeon and then beheaded. 
 
 To explain this dream exaggeration a theory is ad- 
 vanced based on dissociation. It is claimed by James 
 that dissociation tends to convert the physiological 
 "ideational currents" into sensory "currents" and thus 
 intensify and exaggerate the psychic states. 
 
 Before "discussing the theory it may not be amiss to 
 examine the facts which the theory is called to explain. 
 It is questionable whether the general relation of dream 
 stimulus is quite correctly stated. It appears that the 
 generalization is stated somewhat in the form of the 
 well-known question: Why do great rivers flow by 
 great cities? It is by no means generally true that the 
 characteristic of dream consciousness is to exaggerate 
 stimuli received and work them up to a pitch so as to 
 convert "ideational into sensory currents." The rela- 
 tion is far simpler. 
 
 The dreani does not necessarily exaggerate in- 
 coming stimuli and make of them exciting and 
 sensational dream hallucinations. What happens is 
 this: the commonplace, non-exaggerated, unaffectivc 
 
The Vividness of Hallucinations and Dreams 193 
 
 dreams tend to fade away almost immediately on wak- 
 ing, while the impressive dreams are usually remem- 
 bered. I have observed a number of dreams in my 
 own case as well as in others and have found that the 
 number of ordinary commonplace dreams far predom- 
 inates over the striking and extraordinary dreams. 
 
 Even in psychopathic cases in which subconscious 
 dream life is often well developed,"even in such states I 
 have found in the cases which have been under my ob- 
 servation and experimentation that the commonplace 
 dreams far predominate over the dramatic and extraor- 
 dinary ones. The only way to convince oneself of it is to 
 try to write down the dream immediately on waking. I 
 find that the ordinary dream is hard to hold in 
 memory, it is elusive and is constantly slipping away 
 from us, a special effort of attention Is requisite to hold 
 on to it; It is usually hazy, vague, and confused. 
 
 On the whole, the indiferent dreams really pre- 
 dominate, but it is only the impressive ones that re- 
 main in memory. Even the freshness and recency of 
 the dreami do not save it from falling into oblivion. 
 Now while commonplace and indifferent dreams are 
 forgotten, older dreams, but more impressive, more 
 awakening our emotions, especially emotions of fear, 
 will be clearly and vividly remembered. 
 
 Still the fact that exaggeration and intensification of 
 the sense Impressions received by awakening a greater 
 volume of secondary sensory elements and represen- 
 tations more often than In the waking state requires 
 an explanation. This Intensification is partly due 
 to the fact that In sleep sensory impressions often enter 
 consciousness suddenly. This brings about a shock, 
 
194 Diagnosis of Psychopathic Diseases 
 
 awakening emotions which are conducive to a 
 stimulation of a greater volume of secondary sensory 
 elements and their accompanying representations. 
 Even in the normal waking state sense impressions 
 suddenly introduced into consciousness may cause a 
 shock and give rise to an illusion, the object appearing 
 as something strange and formidable. 
 
 We can often observe it in ourselves, when falling in- 
 to a drowsy condition, a slight stimulus which we other- 
 wise ignore will give us a sudden start. I often ob- 
 served in myself when in a drowsy state and "dropping 
 off" how an ordinary stimulus, such as a cough, for in- 
 stance, will produce a shock, affecting the visceral or- 
 gans, the feeling being somewhat similar to the condi- 
 tion commonly described as a "sinking sensation In the 
 pit of the stomach;" the shock seems to reverberate all 
 through the organism. 
 
 To this must be added another important factor, 
 namely, the emotion aroused. When an object Is per- 
 ceived under conditions that do not permit its recogni- 
 tion or its assimilation and consequently Its customary 
 reaction, an emotion of fear. Is produced. Such Is the 
 case, for Instance, when some objects Impress us in the 
 dark or when we get hold In the dark of some slimy, 
 slippery, and especially of moving objects. 
 
 These two factors often work together, Inasmuch 
 as an object suddenly Introduced Into consciousness 
 is also not speedily assimilated so that the shock 
 and emotion due to non-rdcognition or non-assimilation 
 go together. Now In sleep stimuli entering Into con- 
 sciousness effect it In a sudden way, and from the very 
 nature of the sleeping consciousness the external stim- 
 ulation is but imperfectly assimilated; both factors, 
 
The Vividness of Hallucinations and Dreams 195 
 
 shock and emotion, due to non-assimilation are present 
 and sometimes give rise to a highly wrought up emo- 
 tional state which is so apt to transform objects by 
 arousing different systems of elements and at the same 
 time to impress the memory powerfully. 
 
 It is claimed that the very fact of dissociation brings 
 about an intensification of ideational states converting 
 them into sensory states. Physiologically, the assump- 
 tion is made by James that the sensory nerve cells can be 
 set into activity not only by peripheral stimuli, but also 
 by central "currents" going from center to periphery. 
 The sensory centres are like a bucket with water, the up- 
 setting of the bucket being likened to the upsetting of 
 the sensory centers, giving rise to sensations. This up- 
 setting can be affected by peripheral "currents." Small 
 intracellular, ideational currents flow freely through the 
 centers without upsetting them. 
 
 Now when an obstruction occurs in the sensory cen- 
 ters the ideational currents which otherwise flow out 
 and disperse may accumulate, and aided by a chance ac- 
 tivity of central character niay upset the nerve cell in 
 the same way as our bucket may be upset by the accumu- 
 lation of water from the small incoming currents (like 
 the ideational currents), when the holes and interstices 
 through which they usually flow out are stopped up. 
 The hypothesis, as far as explanation goes, is good 
 enough, the drawback is that it explains too much. For 
 it is hard to understand why intense dreams of this char- 
 acter do not occur more often. 
 
 Besides it is hard to realize how an idea can give rise 
 to a sensation of any intensity by the mere agency of 
 ideas, the sensation and its intensity being entirely a 
 function of peripheral stimulation and consequent sense 
 
196 Diagnosis of Psychopathic Diseases 
 
 impressions. An idea, a representation, may be very 
 vivid, but does not become a presentation or sensation. 
 A sensation is not an "intense" idea, nor is an idea a weak 
 sensation. 
 
 A series of sensations arranged in ascending or 
 descending gradation of intensity may be likened to 
 the continuous series of the spectrum in which there is a 
 qualitative difference from line to line, a difference that 
 admits of no substitution. A sensation the intensity of 
 which is changed is a fallacious percept, an illusion. 
 A thunder clap perceived as a whisper, a whisper per- 
 ceived as a thunder clap may be equally regarded as 
 fallacious perception as any other change in the content 
 of the percept. The rustling of leaves perceived as an 
 explosion is as much of a fallacious perception as when 
 the paranoiac, for instance, hears in it curses and threats 
 of his enemies. Sensations and percepts cannot change 
 in content or intensity without giving rise to illusions or 
 hallucinations. 
 
 The changes that may occur in regard to sen- 
 sations and percepts, without their being qualita- 
 tively changed and becoming fallacious, can only be in 
 vividness belonging to the representative elements which 
 cluster round the primary and secondary sensory ele- 
 ments. A less intense sensation may be more vividly 
 represented than one of greater intensity. A weak 
 sound, a pale color, a light pain may be more vividly 
 represented than the ones the intensity of which is far 
 greater. This vividness, however, is not at all a charac- 
 teristic attribute of the sensory elements, it is rather an 
 attribute belonging to the functioning system of repre- 
 sentative elements into which the given sensory elements 
 
The Vividness of Hallucinations and Dreams 197 
 
 enter as constituent nuclei. Taking all this into con- 
 sideration we inevitably arrive at the conclusion that 
 James' view of dreams is not psychologically valid. 
 
CHAPTER XIX 
 
 VIVIDNESS, FUNCTIONAL PSYCHOSIS, AND HALLUCINA- 
 TIONS 
 
 KEEPING to facts as closely as possible we 
 may venture without much risk on the fol- 
 lowing generalization which may be regarded 
 in the light of a working hypothesis. Just as 
 sensory primary or secondary sensory elements vary in 
 intensity and can be arranged in a continuous series of 
 gradations of intensities, so do the representative ele- 
 ments vary in vividness and may be arranged in a con- 
 tinuous gradated series of vividness. Sensory elements 
 have intensity, but no vividness, while representative ele- 
 ments have vividness, but no intensity. 
 
 Representative elements may refer to the same pre- 
 sentative content with different degrees of vividness. 
 Vividness of representative elements, like intensity of 
 sensory elements, may pass through all degrees of varia- 
 tion from maximum to minimum, and finally reach a 
 vanishing point. In this respect vividness is like sense 
 intensity, and as a matter of fact the two are usually in- 
 terrelated. 
 
 Under ordinary conditions of psychic activity sen- 
 sory intensity and representative vividness vary togeth- 
 er. An intense sensation is vividly represented and a 
 weak sensation less so, the vividness varying directly 
 with increase or decrease of sensory intensity. This di- 
 rect variation, however, is not always constant ; there are 
 conditions under which the two may part company, such, 
 
 198 
 
Functional Psychosis and Hallucinations 199 
 
 for instance, as are found in states of distraction or in 
 states of dissociation. Under such conditions a strong 
 stimulation giving rise to sensory elements of great in- 
 tensity may awaken representative elements of but slight 
 vividness. 
 
 In states of distraction, as well as in various states 
 of mental dissociation, sensations of great intensity may 
 meet with so little vividness in the representative ele- 
 ments as to fall below the threshold of consciousness, 
 they may be submerged into the twilight region of the 
 subconscious and "not be preceived at all." From this 
 standpoint we may say that the depth of dissociation 
 varies inversely as the degree of vividness. When vivid- 
 ness is at its minimum, dissociation is at its maximum, 
 and inversely. Briefly stated, dissociation and vivid- 
 ness are inversely interrelated variables. 
 
 Functional psychosis, the basis of which is dissocia- 
 tion, may also psychologically be regarded, according to 
 the gravity of the psychopathic affection, as a decrease 
 or even loss of vividness of representative elements. The 
 diminution or total loss of vividness may be of different 
 systems of representative elements, and will thus give 
 rise to various forms of psychopathic amnesias, which 
 play such an important role in functional psychosis, 
 which in the main is a disease of representative life, con- 
 sisting in a decrease of functional activity of represent- 
 ative elements, and which from the present point of view 
 may be regarded as the tendency towards a minimum of 
 the most important attribute of ideational elements, 
 namely, vividness. 
 
 From this standpoint, the degree of vividness of idea- 
 tional elements can no more confer on them sensory in- 
 tensity than the idea of riches, however vivid, can con- 
 
20O Diagnosis of Psychopathic Diseases 
 
 fer upon one the power of wealth. Dream hallucifta- 
 tions, like hallucinations in general, are sensory in char- 
 acter, not because of the intensive nature of the central 
 elements or ideas, but because of the primary and sec- 
 ondary sensory elements present, directly and indirectly 
 peripherally initiated, as it is in the case of all sensory 
 and perceptive processes. Hallucinations are induced 
 peripherally, and are started either in the same sense or- 
 gan, or indirectly in some other sense organ, the second- 
 ary sensory elements form, so to say, the hypertrophied 
 portion of the hallucinatory percept, but they are always 
 sensory in character and peripherally initiated. 
 
 The more closely one investigates hallucinations, the 
 more one learns to trace cases of supposed mysterious 
 hallucinations to external peripheral sources. A pure 
 central hallucination is as rare as the fabulous phoenix. 
 A central hallucination means an unanalyzed psychic 
 state. Whenever an analysis of such hallucinations is 
 made, the peripheral sensory character, primary and 
 secondary, stands out distinctly in the foreground. 
 
 In the so-called "purely central hallucination" the 
 nuclear primary sensory elements remaining in the back- 
 ground of consciousness cannot easily be traced to their 
 appropriate peripheral sense organs and their external 
 stimuli, and they are on that account regarded as "cen- 
 trally initiated." Dream hallucinations, hypnotic, hyp- 
 nagogic and pseudo-hallucinations, if closely analyzed, 
 can be clearly traced to peripheral origjn, — to periph- 
 eral stimuli that give rise to primary sensory elements 
 that form nuclei round which secondary sensory ele- 
 ments become organized as cytoplasm. 
 
 These so-called central hallucinations form the stum- 
 bling block of the psychologist and the psychopatholo- 
 
Functional Psychosis and Hallucinations 201 
 
 gist. To account for them, the theory is commonly ad- 
 vanced that the irritability of the ideational centers may 
 reach such a pitch as to give rise to intense ideational 
 states amounting to a full-fledged sensation or per- 
 ception, thus bringing abput a pure central hallucination. 
 
 It is strange that such a theory should be main- 
 tained at all, and that it should gain currency. The 
 theory does not accord with experience, its very prin- 
 ciple disregards facts. For no matter what strength an 
 image may attain it is still far from becoming a sensa- 
 tion. An image of a bell does not sound and an image 
 of a blow does not strike. The fact is, as we have 
 pointed out before, images or representations are quali- 
 tatively different from sensations; an image can as little 
 be converted into a sensation as the sour taste of vinegar 
 can be turned into the violet color of the spectrum. 
 
 Images and sensations differ fundamentally, they dif- 
 fer in kind and no amount of ideational activity can 
 ever be made to become sensory in nature. A higher 
 pitch of ideational activity will make an image more 
 vivid, but can nowise confer upon it sensory qualities, 
 just as all the immensity of space and infinity or eternity 
 of time can not make them weigh as much as a grain. 
 
 A further modification of the same theory is given by 
 those who maintain that central hallucinations are due 
 to the irritability of the higher ideational centers from 
 which "ideational" currents are propagated to the lower 
 sensory centers. In other words, it is not the image that 
 becomes by its intensity or by its vividness directly trans- 
 formed into a sensation, but an intense or vivid image 
 may give rise to a corresponding sensation without the 
 presence of an external stimulus, or of a peripheral sen- 
 sory process, 
 
202 Diagnosis of Psychopathic Diseases 
 
 Psychologically as well as biologically regarded, 
 the theory is untenable. For it is not in accordance with 
 observed facts that an image, however vivid, should give 
 rise to a corresponding sensation or percept. Were that 
 the case the course of internal and external worlds 
 would have become confused and confounded, man 
 would have become the dupe of his own ideas, the world 
 a gigantic madhouse, and the process of ideational ac- 
 tivity would have long ago become eliminated in the 
 struggle for existence. 
 
 From a physiological standpoint, the theory can 
 hardly be considered, inasmuch as it is in direct oppo- 
 sition to the known physiological laws. Sensory excita- 
 tion, ideational processes and motor reaction form, so 
 to say, a sensori-ideo-motor arc, — the excitation going 
 from peripheral sense organs to central systems, and 
 thence to the muscles and glands. Now the conditions 
 postulated by the central theory are such as to have the 
 processes reversed. Sensory processes work upward, 
 from periphery to center, while motor processes work 
 downward, from center to periphery. 
 
 On the modified central theory, the sensory pro- 
 cess in hallucinations is reversed, it goes downward 
 instead of upward. There is not a particle of evi- 
 dence for such reversal, the assumption being in 
 contradiction to the principles of physiology. The 
 claim of special structures for effecting such a re- 
 versal is unfounded. As far as can be ascertained, 
 the neuron works "cellulipetally," in the direction 
 of the sensory ganglia and central neuron systems, while 
 the neuro-axon works "cellulifugally," that is from sen- 
 sory ganglia and central neuron systems to the peri- 
 phery to the muscular apparatus. There is on the other 
 
Functional Psychosis and Hallucinations 203 
 
 hand not the least bit of evidence that the functions of 
 neuron systems can be reversed in their course. 
 
 The central theory then cannot stand the test of crit- 
 ical examination as it is neither in accord with the 
 facts it is called to explain, nor does it fall in line with 
 the facts and principles of physiology. We are there- 
 fore forced to fall back on the peripheral origin of hal- 
 lucinations under the condition of central dissociation. 
 According to our theory, the origin and structure of 
 hallucinations, of dream hallucinations as well as of 
 pseudo-hallucinations do not differ in the least from 
 those of normal perception, a difference unwarrantly 
 claimed by the theories of central origin of hallucina- 
 tions. Hallucinations are peripherally initiated, hallu- 
 cinations are abnormal percepts, occurring under the 
 conditions of central dissociation^ with primary and sec- 
 ondary elements as their central nuclei. 
 
CHAPTER XX 
 
 DOUBLE THINKING 
 
 THE phenomena of so-called "double think- 
 ing" are extremely interesting from' our point 
 of view. The patient hears his own thoughts 
 uttered aloud. He has the hallucination of 
 his thoughts uttered when engaged in writing or in read- 
 ing, though loud reading may check the hallucinatory 
 voices. These hallucinatory voices may be of an imi- 
 tative character and simply repeat what is spoken or 
 read by the patient ; or they may be of an anticipatory 
 character and utter the patient's thoughts before he 
 himself utters them. 
 
 The usual explanation of such cases is found in 
 the theory of the so-called "overcharged centers." 
 Where the voices follow and repeat the patient's 
 words and phrases, it is assumed that the auditory 
 centers are highly irritable and overcharged so that 
 stimulations from other centers bring about a dls- 
 c|iarge into the "ideational" auditory centers and 
 auditory hallucinations result. In the case of read- 
 ing, for instance, the visual image of the word 
 awakens also an auditory image, but when the audi- 
 tory centers are overcharged the visual images awaken 
 directly an auditory image before the spoken words take 
 place. Now this auditory image is so intense, on ac- 
 count of overcharge, that it becomes an auditory hal- 
 lucination and the patient hears his own thoughts ut- 
 tered aloud. This reflex action from one "ideational" 
 
 204 
 
Double Thinking 205 
 
 center into another occurs while the patient reads or 
 writes, and that is why he has the experience, the hal- 
 lucination that there is a voice often regarded as "in- 
 ner" which repeats his own words and phrases. 
 
 Cases where the voice utters the words and phrases 
 before they are written are explained on the hypothesis 
 that the central discharge into the overwrought, audi- 
 tory centers occurs before the words are written down 
 or before the motor discharge takes place. When, how- 
 ever, the patient hears the voice repeat the phrases 
 soon after he has utterd them, the phenomena are ex- 
 plained on the supposition that the centripetal currents 
 from the speech centers into the auditory centers give 
 rise to the voices, the patient hearing his own words 
 shortly after he has uttered them; the efferent dis- 
 charge from the graphic centers into the auditory cen- 
 ters will give rise to an auditory hallucinarion of hear- 
 ing the words and phrases he has just written. 
 
 In the phenomena of "double hearing" the patient 
 hears his own voice while talking or reading aloud, and 
 then hears another voice due to the discharge from the 
 speech centers to the overcharged auditory centers. Thus 
 in some patients these hallucinations of hearing are 
 brought about by the voluntary suppression of speech, 
 the patient then hears a voice uttering his own thoughts. 
 This is claimed as confirming central initiation — the cur- 
 rents from the word images in the speech centers not 
 having a free outlet run into the overcharged "ideational 
 auditory centers," and give rise to inner speech heard 
 by the patient. 
 
 In opposition to this central theory of double think- 
 ing or of "inner speech" held in various forms by 
 psychologists and psychopathologists, there are some 
 
2o6 Diagnosis of Psychopathic Diseases 
 
 who maintain the view that these "double thoughts" 
 hallucinations are not of central, but of peripheral ori- 
 gin, being due to hyperssthesia of the centripetal 
 paths. The apparatus employed in speech carries out 
 not only the requisite delicate movements, but also 
 forms the sensitive apparatus for information of the 
 movements executed. 
 
 The sense of movement may be regarded as 
 originating in the .muscles, especially in the joints 
 and articular surfaces. Sensory stimulations coming 
 from these structures to their appropriate central 
 systems give rise to kinaesthetic sensations and mo- 
 tor ideas. Now if the peripheral sensory tracts of the 
 muscle sense or of kinesthetic sensations become hyper- 
 aesthetic, kinaesthetic sensations and motor ideas are 
 aroused automatically and may give rise to halluci- 
 nations of positions, movements and acts; movements 
 which have not been performed are thus experienced. 
 
 If now the centripetal sensory tracts of the speech 
 centers are hyperaesthetic, then kinaesthetic sensations 
 and ideas arise which go to form the hallucinations 
 known as "double thought." The patient experiences 
 "inner" speech, a voice repeats after him his own 
 thoughts, his own words and phrases. 
 
 When the speech centers are overcharged and give 
 rise to automatic, centrifugal discharges, then the hyper- 
 ffisthetic centripetal paths bring it back in the form of 
 spoken words, and the patient experiences his own 
 thoughts uttered by an inner voice which is foreign to 
 him. In speaking the Inner voice comesi after the speech 
 and reverberates like an echo, it persists as an "after 
 image" of the spoken word or phrase. When the pa- 
 tient is engaged in writing, the voic6 usually precedes 
 
Double Thinking icyj 
 
 the written phrase, because the spoken word image pre- 
 cedes the written word image, the inner voice thus antic- 
 ipates the patient's writing by uttering his thoughts. 
 
 This theory seems further to be confirmed by cases in 
 which such hallucinations take place. If one observes 
 closely cases of "double thinking" or of "inner speech," 
 he often finds "involuntary whispering" present — the 
 patient whispers to himself. These whispers come 
 back to him; on account of the hypersesthesia of the 
 peripheral paths, he hears it as speech of some inner 
 voice. 
 
 A close examination of the two theories, of the cen- 
 tral and of the peripheral, reveals their inadequacy. 
 The central theory, as it is generally put forth and 
 commonly accepted, may possibly be regarded as the 
 more inadequate of the two. For the central theory rests 
 on the psychological fallacy, so prevalent in psychopath- 
 ology that it may be regarded as the psychopathologist's 
 fallacy, namely, that an image may reach such a high 
 pitch of intensity as to become sensory in nature and give 
 rise to a percept. The percepts, formed by the visual 
 perception of reading, awaken, according to this theory, 
 also accompanying ideas of sound intimately related to 
 and associated with visual word reading, and it is these 
 ideas that reach such a high intensity as to give rise 
 to hallucinations of hearing, the words are read aloud, 
 as if by a strange voice. 
 
 This explanation, as we have already pointed 
 out, is psychologically incorrect and rests on the fallacy 
 that ideas or images have intensity, and that an in- 
 tense idea becomes a sensation, or that a sensation 
 is but an intense idea, and an idea is a weak, a faint 
 sensation. To modify this view and assume that an 
 
2o8 Diagnosis of Psychopathic Diseases 
 
 intense idea stimulates and gives rise to the formation 
 of a percept is to assume a supposition not warranted 
 by facts that an idea is equivalent to the action of ex- 
 ternal stimuli or objects with their requisite physical 
 structures and processes. In either case, the central 
 theory as it stands is not in accord with psychological 
 and physiological data, and, as such, cannot possibly 
 be accepted, at least in the shape as it is usually put 
 forth. 
 
 Furthermore, there is an inherent difficulty in the 
 central theory itself. For if it be correct, as the theory 
 claims, that the visual image calls forth an intense au- 
 ditory imiage amounting to a hallucination, the halluci- 
 natory voice should precede and not follow the patient's 
 reading. In order to explain the hallucinations of 
 double thinking or of double hearing in the case when 
 the voice follows the reading, it would have to be as- 
 sumed first that the visual image of the written or 
 printed word stimulates the speech centers, which, in- 
 nervating the muscular apparatus of speech, give rise 
 to reading, which in turn stimulates the peripheral au- 
 ditory apparatus, awakening activity in the auditory 
 centers, giving rise to the hearing of the read words, 
 and that then only do the indirect stimulations of the 
 visual image, coming from the visual centers, awaken 
 once more the same central connections, thus bringing 
 about a repetition of the self-same words heard. 
 
 We have to assume that the action of the visual cen- 
 ters in stimulating the motor speech centers with the re- 
 sulting acoustic stimulations and functioning activity of 
 the auditory centers are enacted before the direct central 
 stimulations from visual center to auditory center take 
 place ; in other words we must assume central retarda- 
 
Double Thinking 40$ 
 
 tion. Now what does this central retardation mean ? 
 It means that the phenomena of double thinking or of 
 double hearing are brought about by some form of cen- 
 tral inhibition, of central blocking of pathways as it is 
 usually put: In other words, the requisite condition of 
 double thinking is reduced to the psychopathologlcal 
 state of central dissociation. 
 
 The inadequate side of the central theory as it is 
 commonly advanced lies In the supposition of re- 
 ferring auditory hallucinations in the phenomena of 
 double thinking or hearing to the Intensification of the 
 auditory image or Idea, but no straining of an audi- 
 tory image can get a sound out of it. 
 
 Moreover, were the central theory correct it would 
 really involve a double auditory hallucination, one pre- 
 ceding and the other succeeding the reading. For In 
 the process of reading the visual image of the word 
 awakens the auditory image along with its kinaesthetic 
 image, stimulating the centrifugal motor apparatus and 
 giving rise to the spoken word. Now this awakened 
 auditory image preceding the spoken word, on account 
 of the assumed Irritability of the auditory centers and 
 the consequent "intensification" of the stimulated au- 
 ditory Images, should necessarily give rise to a full- 
 fledged hallucination. When the voice also follows the 
 reading, a sudden dissociation of the visual from the 
 auditory centers is assumed, a momentary dissociation 
 that gives rise to a secondary succeeding hallucination 
 of the words and phrases read and spoken. 
 
 The fact that the central theory requires the 
 presence in all phenomena of double thinking, that 
 when the voice follows the reading, another halluci- 
 natory voice must have also preceded, and that there is 
 
2IO Diagnosis of Psychopathic Diseases 
 
 also a double stimulation from the visual into the au- 
 ditory centers; that the hallucination first appears un- 
 der conditions of association of visual and auditory 
 centers, while the succeeding hallucination occurs im- 
 mediately under the opposite conditions, namely dis- 
 sociation, — all these assumptions make the central 
 theory wholly unsatisfactory and unacceptable. 
 
 The peripheral theory of double thinking is on 
 general grounds more acceptable as it falls in line 
 with psychological and physiological principles and 
 facts. Unfortunately the special facts which the theory 
 is called for to explain do not exactly tally with it and 
 may even be said to contradict the hypothesis. For if 
 the hallucinations of double thought are due to hyper- 
 esthesia of the centripetal sensory-motor 'racts then 
 reading aloud should intensify the hallucination, but the 
 case is quite the Reverse, — reading aloud makes the hal- 
 lucinatory voice to disappear altogether. 
 
 On this theory again, the voice should follow and not 
 precede the reading. We are thus confronted with the 
 opposite difficulty met with in the central theory. On the 
 central theory the hallucination should precede, while on 
 the peripheral theory the hallucination should follow 
 the reading. The central theory cannot account well 
 for succeeding hallucinations, while the peripheral the- 
 ory does not account well for preceding hallucinations. 
 
 On the central theory there should be double hal- 
 lucinations in cases where the voice follows reading, 
 while on the peripheral theory there should be double 
 hallucinations, when the voice precedes the reading. Be- 
 sides, "hyperesthesia" should rob the perception of its 
 hallucinatory character, the patient should be all the 
 more conscious of his own utterance. 
 
Double Thinking 211 
 
 A closer examination of the peripheral theory dis- 
 closes a fundamental fallacy which it primarily involves, 
 a kind of ignoratio elenchi. The theory is probably cor- 
 rect in principle, but it misses the essential point of the 
 whole problem; it may be an adequate explanation for 
 motor, but not for auditory hallucinations. Hyperaes- 
 thesia of the central motor speech tracts would at most 
 give rise to pure kinaesthetic hallucinations. The pa- 
 tient may have hallucinations of actions, tension, or of 
 movements in his peripheral speech organs, but he will 
 have no hallucinations of hearing. 
 
 To have an auditory hallucination, as to have an au- 
 ditory perception in general, the auditory peripheral 
 and central apparatus should be stimulated. No other 
 organ but the acoustic apparatus can possibly supply 
 sensations and percepts of an auditory quality, unless 
 the hallucination be of a reflex, secondary character, but 
 then it may be induced through any other peripheral 
 source than that of kinassthesis of the speech organs. 
 
 Although each theory taken by itself proves to be in- 
 adequate and leads to contradictions to facts, still the 
 two may be regarded in a certain sense as supplementing 
 each other. Now the central theory emphasizes the 
 aspect of the central character of the phenomena, while 
 the peripheral theory lays stress on centripetal factors. 
 
 Both theories can be brought in line with facts, 
 if assuming centripetal factors of kinaesthesia and 
 auditory hyperaethesia, we also refer to the central 
 conditions of dissociation. The patient in double think- 
 ing is subject to subconscious states, to states of disso- 
 ciation. This dissociation is of a central character and 
 specially affects the visual and kinaesthetic systems. Im- 
 pressions, on account of dissociation and peripheral 
 
212 Diagnosis of Psychopathic Diseases 
 
 hyperassthesia, are subconsciously received and subcon- 
 sciously reacted upon. The visual impressions of the 
 written and printed characters are subconsciously per- 
 ceived and subconsciously uttered in a whisper and some- 
 times quite loud, as I had occasion to observe in my 
 cases. This subconscious utterance, unperceived by the 
 patient, comes back to him as a strange, external voice 
 proclaiming the patient's thoughts or repeating his 
 words and phrases. 
 
 The phenomenon of "double hearing" is due to 
 subconscious whispering which comes back to the pa- 
 tient as an auditory hallucination. I had the occasion 
 to verify this phenomenon of subconscious whispering 
 in cases in which functional dissociation was quite 
 marked, and in which auditory hallucinations and dou- 
 ble thought were quite persistent. 
 
 In cases where the auditory hallucinations precede the 
 reading or writing it is the subconscious whispering 
 along with kinassthetic and auditory hyperaesthesia that 
 give rise to the phenomena of "double thought," 
 or of "double hearing." The dissociation being in the 
 kinaesthetic systems the patient does not experience con- 
 sciously the peripheral incoming sensations due to his 
 subconscious whispering. 
 
 More often the patient continues to whisper subcon- 
 sciously what he has just read consciously. Such a 
 habit is common with many people in the normal state 
 and is due to the persistence of the peripheral sensory 
 impression, to a kind of verbal after-image. The ab- 
 sence, however, in the normal condition of dissociative 
 states prevents the formation of subconscious whispering 
 with its consequent auditory hallucinations partly due to 
 hyperaesthesia of the auditory tracts. 
 
Douhie Thinking ii^ 
 
 If cases of "double thinking" are closely examined, 
 one finds in them the presence of subconscious states with 
 their psychomotor reactions; the patient in walking on 
 the street, for instance, may hear a voice telling him 
 words and phrases that can be traced to signs and ad- 
 vertisements which he has read subconsciously, though 
 he himself has not been aware of it. What happens in 
 such cases is this, the patient whispers or even utters 
 aloud the words he subconsciously sees on the signs. 
 
 It is this subconscious whispering that comes back to 
 him as an auditory hallucination of a voice. In my 
 cases in which the patients suffered from auditory hallu- 
 cinations I found on close examination the phenomenon 
 of unconscious or subconscious whispering, which be- 
 came aggravated in proportion to the state of dis- 
 traction in which the patient was, ranging from an 
 almost inaudible whisper to a loud talk, the patient be- 
 ing entirely ignorant of it, so that he could not be made 
 aware of it, even when his attention was called to his 
 talking. One of my patients suffering from pronounced 
 auditory hallucinations, but in whom the dissociation is 
 not deep, aptly describes his experiences as "autovocali- 
 zation." 
 
 Similar conditions can be induced in hypnosis, thus 
 confirming our point of view by experiment on other- 
 wise normal people. If a post-hypnotic suggestion of 
 subconscious whispering is given, the subject experiences 
 an hallucination analogous to that of "double thought," 
 — the subject hears a voice telling him the words and 
 phrases which he himself whispers, but of which he 
 personally is entirely ignorant. The peripheral char- 
 acter of the "double thought" under condition of cen- 
 tral dissociation may thus be regarded as an efficient 
 
214 Diagnosis of Psychopathic Diseases 
 
 working theory in accord with facts. 
 
 From the whole course of our review of facts and 
 theories it appears that we remain more closely in touch 
 with facts, if we accept the view that hallucinations re- 
 quire states of dissociation as a central condition, and 
 that they are primarily peripherally initiated, having 
 secondary sensory elements as their main content; in 
 other words, hallucinations are dissociated secondary 
 percepts. 
 
CHAPTER XXI 
 
 HALLUCINATIONS AND PSEUDO-HALLUCINATIONS 
 
 WE must emphasize the fact that persons 
 who happen to have occasional hallucina- 
 tions may not be subjects of secondary sen- 
 sations. They may happen to have been 
 under conditions which produced in them a sensory dis- 
 aggregation and the formation of new and tem- 
 porary sensory association, giving rise to hallucinations. 
 But this condition of the nervous system vanishes 
 with the disappearance of the conditions themselves. 
 Such states are produced by toxic agents, such as has- 
 chish, opium, morphine, and other hypnotics. As soon 
 as the operating causes are removed the nervous system 
 returns to its previous condition. 
 
 In the case of sane individuals who happen to have 
 illusions or hallucinations there are two criteria used 
 for a verification of the correspondence of internal 
 percepts formed in response to external objects. One is 
 (a) sensory, and the other (b) social. 
 
 If a man perceives an object and wishes to satisfy him- 
 self that it is really there, he verifies it by means of other 
 sense organs. Thus if one sees an apple or hears a 
 sound and wishes to determine whether the object is 
 really there, he goes to the object, examines it with 
 his other senses. If he hears a bell or organ, he goes 
 and verifies its presence by the sense of sight and touch. 
 This, however, is not the only criterion, for man in 
 
 215.. 
 
2i6 Diagnosis of Psychopathic Diseases 
 
 psychopathic states or under the influence of certain 
 toxic or autotoxic agents may have hallucinations of 
 any or all of his sense organs. In fact, hallucinations 
 of all the organs sometimes occur. Man, therefore, 
 has often recourse to the other criterion, the social 
 one. He seeks verification of the existence of an 
 external object from his fellow beingsr When one 
 hears a voice or a sound, he turns to his companion to 
 learn if he too heard it, and if others present do not 
 confirm his perception of sound or sight, the sane 
 man will consider it as an hallucination. 
 
 It is shown by statistics that at least one in ten nor- 
 mal individuals has had an hallucination once in his 
 life. However, as in the case of illusions, hallu- 
 cinations are much more often found in insanity 
 when there is present a more permanent and more ex- 
 tensive disturbance of psycho-physiological processes. 
 Xhe hallucinations, therefore, are not only more fre- 
 quent, but more persistent than in sane persons. 
 
 While sane persons have more often visual halluci- 
 nations, in the insane auditory hallucinations predom- 
 inate. This does not mean that sane persons 
 miay not have auditory hallucinations, but the latter are 
 not so persistent. In fact, I have good reasons for be- 
 lieving that many young children have auditory halluci- 
 nations and illusions. 
 
 It may be that those with auditory hallucinations 
 more often form delusions than those having the 
 visual, since speech is more impressive. Speech is 
 the medium of social intercourse, which lies at the 
 base of growth and intelligence in man, and hence 
 the social criterion is an important factor in the forma- 
 tion, by persistent suggestion, of our belief in the exist- 
 
Hallucinations and Pseudo-Hallucinations 217 
 
 ence of an external object. The patient therefore who 
 persistently hears external voices lives in a social en- 
 vironment of his own that gives him the suggestion and 
 assurance of the real existence of the hallucination, and 
 thus a delusion is developed. In short, it is quite con- 
 ceivable that one should form a delusion by experienc- 
 ing persistent auditory hallucinations. 
 
 Even in normal persons hallucinations and illusions 
 are not uncommon when sleep comes or goes. These 
 are known as hypnagogic or hypnapagogic hallucina- 
 tions. They always appear in the intermediary state 
 between the waking and sleeping states. At this time 
 also occur the "nightmares" which really consist of 
 hypnagogic hallucinations and illusions. 
 
 Hallucinations may occur while the person is passing 
 from the waking to the sleeping state or vice versa. 
 Such hallucinations and illusions, hypnagogic and hyp- 
 napagogic, are due to the fact that when man wakens 
 or goes to sleep any of the senses may be awakened, and 
 these senses give rise to percepts or to secondary sensa- 
 tions with their accompanying percepts. Very vivid 
 dreams are of the same nature. 
 
 Pseudo-hallucinations are forms of hallucinations in 
 which the sensory element is not strong and the sub- 
 ject is not sure of its existence; he does not project it 
 into the external world, and still In some vague man- 
 ner he refers it to some agency in the external world. 
 Those persons who hear internal voices have pseudo- 
 hallucinations. This condition is probably the begin- 
 ning of the more pronounced form of hallucination in- 
 to which the pseudo-form may sooner or later develop. 
 The manifestation of pseudo-hallucinations is the be- 
 ginning of the process of disaggregation and of th? 
 
2i8 Diagnosis of Psychopathic Diseases 
 
 formation of new sensory associations. 
 
 Pseudo-hallucinations may be temporary, oc- 
 curring only once, or they may become persistent. It 
 must not however be understood that pseudo-halluci- 
 nations must necessarily precede fixed hallucinations. 
 It depends simply upon the process of disaggregation 
 and the formation of new sensory associations. 
 The process may be a slow one, beginning with 
 pseudo-hallucinations, or may be intense, having at 
 once full fledged hallucinations. This in its turn is de- 
 pendent on the intensity of the stimulus causing the 
 condition* and on the predisposition of the patient to 
 such a disaggregation and formation of new sensory 
 associations. 
 
CHAPTER XXII 
 
 HYPNOTIC HALLUCINATIONS 
 
 WHEN we first formed our acquaintance 
 with hypnotic phenomena, we had many 
 reports of the wonderful feats possible in 
 the hypnotic state. Among the many mar- 
 vels hypnotic and post-hypnotic hallucinations, induced 
 by suggestion, occupied a prominent place. A good 
 many of such hypnotic studies have been the result of 
 amusement and at best of wonder. If it be true as 
 Plato and Aristotle tell us that the origin of science is 
 in wonder, all this is well and good as a beginning. 
 When however we find that the beginning persists, 
 when we find that the apparently precocious baby does 
 not reach its adolescence and manhood, we begin to 
 wonder what the trouble may possibly be, and wheth- 
 er it is not a case of mental defectiveness. 
 
 When we find that as the literature of the subject 
 grows, the same state of blank wonder still persists; 
 when we find that hallucinations induced by suggestion 
 are described in all their minutiae, without the least criti- 
 cal psychological analysis of the phenomena, it is time 
 to ask whether the preliminary stage of hypnotic mar- 
 vels and mysteries has not lasted too long. It is well 
 to pause and ask the question: "Are there any hal- 
 lucinations hypnotically suggested? Does the subject 
 really experience the hallucinations?" 
 
 We rarely find in the whole literature of the 
 subject that any of the writers should even as much 
 
 219 
 
220 Diagnosis of Psychopathic Diseases 
 
 as refer to the question of the validity of hyp- 
 notic hallucinations. The hypnotic subject accepts the 
 experimenter's suggestion and the experimenter takes 
 the subject's honest word on faith. The trust is 
 mutual. He, however, who has devoted time and 
 reflection to the matter realizes that the introspec- 
 tive account of the hypnotic subject must be taken 
 cum grano salts. First, because one rarely finds 
 a subject who is able and trustworthy to give an in- 
 trospective account; and second, one must always re- 
 member the training and extreme suggestibility of the 
 subject, a suggestibility which makes the subject in- 
 sist on what the experimenter suggests to him, no mat- 
 ter whether he really experiences it or not. This is 
 the dangerous pitfall of hypnosis into which many 
 an investigator in this field has fallen. 
 
 We cannot possibly base our scientific generalizations 
 on the insight and "psychologizing" of one hypnotic 
 case, nor can we accept universally the statements of the 
 subject on the ground that the latter is of an exemplary 
 conscientious character. One must be constantly on his 
 guard, must have many cases, and keep on constantly 
 sifting his material, and that with a good deal of skep- 
 ticism. One must watch his subjects or patients closely, 
 always have his suspidons, compare their statements 
 with one another, and especially those of the same pa- 
 tient in various states. 
 
 In my experience of many years with hypnotic sub- 
 jects, some of whom went into a deep somnambulistic 
 state, a doubt gradually began to arise in my mind as 
 to the validity of the hypnotic hallucination. When 
 I came to devote my time to studies of cases afflicted 
 with hallucinations, the doubt grew stronger and al- 
 
Hypnotic Hallucinations 221 
 
 most became a certainty. I could not help reaching 
 the conclusion that hallucinations hypnotically sug- 
 gested are not genuine. In other words, facts lead me 
 to think that there is no hypnotic hallucination in the 
 strict sense of that word. 
 
 Before we proceed with our discussion it may be well 
 to review in brief our analysis of percept and hallucina- 
 tion, and then compare the latter with experiments of 
 hypnotic and post-hypnotic hallucinations. 
 
 We may begin with the percept and its elements. In 
 looking at the vase before me I see its beautiful tints, 
 its rounded shape, its heavy pedestal with its rough 
 curves, its solidity, weight, brittleness and other ex- 
 periences which go to make up the perception of the 
 vase. Now, the visual elements are given directly by 
 the visual perceptive experience ; but whence come the 
 seemingly direct experiences of weight, heaviness, 
 roughness, smoothness, and others of the like kind? 
 They are evidently derived from other senses. 
 
 The whole perceptive experience is of a visual char- 
 acter. We take in the whole with our eye. In the organic 
 structure of the percept then, besides the experiences 
 directly given by the stimulated sense-organ, there are 
 other experiences, sensory in character, indirectly given, 
 and which come from other sense organs not di- 
 rectly stimulated. 
 
 The percept is a complicated dynamic product, and 
 its elementary processes are never derived from one 
 isolated domain of sensory experience. The activity 
 of all the sensory domains cooperates in the total re- 
 sult of an apparently simple percept. Along with sen- 
 sory processes directly stimulated, a mass of other sen- 
 sory processes become organized and help to contribute 
 
222 Diagnosis of Psychopathic Diseases 
 
 to the total result. The direct sensory elements are 
 termed by me primary sensory elements; the indirect- 
 ly given experiences are termed secondary sensory ele- 
 ments. The secondary sensory elements may be figu- 
 ratively said to cluster round the primary sensory ele- 
 ments as their nucleus. 
 
 The whole perceptual experience is tinged by the 
 character of the primary elements which constitute the 
 guiding nucleus, so to say. Thus, where the primary 
 sensory elements are visual, the whole mass, no mat- 
 ter from what domain the sensory experiences are de- 
 rived, appears under the form of the visual sense, and 
 the percept is a visual percept. 
 
 While the primary sensory elements form, so to say, 
 the dynamic center of the total perceptual experience, 
 the secondary sensory elements mainly constitute its con- 
 tent. Both primary and secondary elements are sensory 
 and are induced peripherally; the primary directly, the 
 secondary indirectly. The percept then is sensory, and 
 is constituted by primary sensory elements, or primary 
 sensations, and by secondary sensory elements, or second- 
 ary sensations. 
 
 The character of the secondary sensory elements 
 stands out clear and independent in the phenomena of 
 synaesthesia, or of secondary sensations. In synesthesia 
 we have a sensation of one sense organ followed, with- 
 out an intermediary direct stimulation, by a sensation 
 coming fronj another sense organ. Thus, when a sen- 
 sation of light instead of giving rise to a subsequent 
 Idea gives rise to a sensation of sound, for instance, we 
 have the phenomenon of secondary sensation. Here 
 the secondary sensations stand out free and distinct, 
 but they are really always present in our ordinary per- 
 
Hypnotic Hallucinations 223 
 
 ceptive experiences as bound-up secondary sensory ele- 
 ments, as secondary sensations grouped around pri- 
 mary sensations. 
 
 When the phenomena of synaesthesia were first 
 brought to the notice of the scientific world, they were 
 regarded as abnormal and exceptional, and only pres- 
 ent in special pathological cases. Soon however their 
 field became widened, and they were found not only in 
 the insane and "degenerate, but in many persons other- 
 wise perfectly normal. We find now that we must 
 further widen the field of secondary sensory elements 
 and, instead of regarding them as a freak of nature 
 existing under highly artificial conditions, we must put 
 them at the very foundation of the process of per- 
 ception. 
 
 Secondary sensations are at the basis of perception. 
 We have become so accustomed to them that we simply 
 disregard them. When, however, the conditions 
 change, when the secondary sensations stand out by 
 themselves, isolated from the primary, nuclear ele- 
 ments with which they are usually organically syn- 
 thetized into a whole, into a percept, when they become 
 dissociated, it is only then that we become conscious 
 of them directly and declare them as abnormal. 
 
 Secondary sensations are always present in every act 
 of perception ; in fact, they form the main content of our 
 perceptual activity, only we are not conscious of them 
 and it requires a special analysis to reveal them. Sec- 
 ondary sensations per se are not something abnormal 
 — just as hydrogen present in the water we drink or the 
 oxygen present in the air we breathe are not newly cre- 
 ated elements, — it only requires an analysis to dis- 
 cover them. If there be any abnormality about sec- 
 
224 Diagnosis of Psychopathic Diseases 
 
 ondary sensations, it is not in die elements themselves, 
 but rather in the fact of their dissociation from the 
 primary nuclear elements. 
 
 Now when the secondary sensory elements come to 
 the foreground and stand out clearly in consciousness, 
 a full-fledged hallucination arises. In the phenomena 
 of synaesthesia we have hallucinations in the simplest 
 form, inasmuch as only isolated, secondary, sensory 
 elements, dissociated from their active, primary, central 
 elements stand out in the foreground of consciousness. 
 
 This very simplification, however, of hallucinations 
 reveals their inner character. The most complex hal- 
 lucinations are only compounds, so to say, of sec- 
 ondary sensory elements. Hallucinations are not 
 mysterious, are not different from what we find in 
 the normal ordinary processes of perception; they are 
 of the same character and have the same elements in 
 their constitution as processes of perception. 
 
 Both hallucinations and percepts have the same sec- 
 ondary as well as primary elements. The difference be- 
 tween hallucinations and percepts is only one of rela- 
 tionship, of rearrangement of elements, primary and 
 secondary. When secondary sensory elements become, 
 under conditions of dissociation, dynamically active i^ 
 the focus of consciousness, we have hallucinations. 
 
 From this standpoint we can well understand why a 
 hallucination, like a percept, has all the attributes of 
 external reality. A hallucination Is no more mys- 
 terious and wonderful than a percept. We do not 
 recognize the humdrum percept, when it appears in 
 the guise of a hallucination, and we regard it as some 
 strange visitant, coming from a central world, from a 
 supersensory universe. Halli)cin^tion?, like percepts, 
 
Hypnotic Hallucinations 225 
 
 are constituted of primary and especially of secondary 
 sensory elements, and like percepts, hallucinations too 
 are induced peripherally. 
 
 Now how is it with suggested or hypnotic hallucina- 
 tions? Do we find in hypnotic or suggested halluci- 
 nations, as in the case of hallucinations in general, the 
 requisite primary and secondary sensory elements di- 
 rectly and indirectly induced ? Binet makes an attempt 
 to establish a peripheral stimulus in the case of hyp- 
 notic hallucinations, claiming that there is a point de 
 repere, a kind of a peg, on which the hypnotic hallu- 
 cination is hung. This position is hardly tenable when 
 confronted with facts. 
 
 Hypnotic hallucinations may develop without any 
 peg and prop. Furthermore, granted even that now 
 and then such a peg could be discovered, and that 
 the alleged hypnotic hallucination develops more 
 easily when such a peg is furnished, still the fact re- 
 mains that even in such cases the peg is altogether in- 
 significant, that it is altogether out of proportion and 
 relation to the suggested hallucination ; and that on the 
 same peg all kinds of hallucinations can be hung; and 
 that finally it can be fully dispensed with. All this 
 would go to show that the peg, as such, is of no con- 
 sequence, and is really more of the nature of an em- 
 phatic suggestion for the development of the alleged 
 hypnotic or post-hypnotic hallucinations. 
 
 The arbitrariness of hypnotic hallucinations, show- 
 ing that the whole thing is simply a matter of rep- 
 resentation, or of what the patient happens to think 
 at that particular moment, is well brought out in the 
 following experiments : 
 
 Mr. F. is put into a hypnotic state, and a post-hyp- 
 
226 Diagnosis of Psychopathic Diseases 
 
 notic suggestion is given to him that he shall see a 
 watch. On awakening he claims he sees a watch. 
 The eyeball is then displaced, the watch is also 
 displaced; when the eyeball returns to its normal 
 condition, we should expect that the hallucinatory 
 watch would return to its former^ place; but no, 
 the watch is not perceived in its previous place, — it ap- 
 pears in a displaced position. The hallucinatory watch 
 could thus be displaced any distance from its original 
 position. The patient evidently did not see anything, 
 but simply supplied from his stock of knowledge as to 
 how a seen watch would appear under such conditions, 
 and he omitted to notice the fact that with the normal 
 position of the eye the watch should once more return 
 to its former position. 
 
 Such inconsistencies are often found in hypnosis. 
 More intelligent and better informed patients would 
 reason out the matter differently, and would give dif- 
 ferent results. 
 
 If the subject knows of contrast colors, and if 
 a color is suggested to him, he will without fail 
 see such contrast colors. If his eyes have been fixed on 
 some hallucinatory color, such as red, for instance, he 
 will even give you a detailed account of the green he 
 sees, but if he does not know anything of the effects 
 of contrast colors no amount of fixation on hallucinatory 
 colors will bring out the least contrast effects. The rea- 
 son is, — the patient does not know anything about it and 
 cannot think of it. 
 
 I tried to mix by suggestion different hallucinatory 
 colors, and as long as the subject knew nothing of the 
 real results, his replies were uniformly wrong; no soon- 
 er did he find out what the right mixture should be than 
 
Hypnotic Hallucinations 227 
 
 he gave correct results. The hypnotic subject really 
 does not perceive anything; he simply tells to the best 
 of his abilites what he believes he ought to see under 
 the given conditions. 
 
 It is extremely interesting to make one experiment 
 which gives an insight into the alleged suggested hal- 
 lucination, and shows its fictitious character. The ex- 
 periment succeeds best when the subject is unprepared 
 and is taken oiiF his guard. I have tried it in various 
 cases and have had uniform results. A suggestion is 
 given to the subject to see a watch, say, on awakening. 
 When he awakens, the watch of course is claimed to 
 be seen in a kind of perfunctory manner. 
 
 If now another watch is put near the hallucinatory 
 watch, the real watch is not taken notice of; it is abso- 
 lutely ignored, as if it did not exist. If his attention is 
 drawn to the real watch, the subject still continues to 
 treat the real watch as unreal, and the suggested hal- 
 lucinatory watch as the only real one. It is evident that 
 in his honest zeal to carry out the suggestion he over- 
 does the matter, and thus clearly reveals the fictitious 
 character of his alleged hallucination, which he, in fact, 
 does not experience. 
 
 If now we give him the benefit of the doubt 
 and tell the subject, when in the hypnotic con- 
 dition, that when he wakes he will see two watches, 
 thus calling his attention by suggestion equally to both 
 watches, one as much as the other, on awakening he 
 still ignores the real watch and his whole attention is 
 occupied with the hallucinatory watch. The subject 
 simply overacts. He is too anxious to carry out your^ 
 suggestion and oblige you. 
 
 If we now try to test the matter by choice, and 
 
228 Diagnosis of Psychopathic Diseases 
 
 ask him which of the two watches he prefers to 
 have, he unhesitatingly points to the hallucinatory 
 watch. When asked the reason, he replies almost 
 anything that may at that moment occur to him; 
 such, for instance, that the hallucinatory watch is 
 newer or bigger, or any old thing he may happen to 
 think of, no matter how absurd the reason is. In his 
 eagerness to carry out the suggestion and to show the 
 reality of the hallucinatory object, he chooses the hallu- 
 cinatory in preference to the real watch. 
 
 The subject, in short, does everything in his power to 
 convince us of the reality of his alleged hallucination, 
 and in his eagerness he overdoes things, thus clearly re- 
 vealing the fact that he really does not perceive the 
 hallucinatory object. The so-called hypnotic or post- 
 hypnotic hallucination is really not a hallucination and 
 should not be taken as such. The suggested hallucina- 
 tion is more of the character of a delusion. 
 
 To take a couple more of my experiments with cases 
 of hypnotic subjects: H. R. goes into a deep som- 
 nambulistic state. I carried out on H. R. a series of 
 experiments in color hallucinations. The results were 
 far from being uniform. To take an example: He 
 was given a suggestion to see red ; he saw it, of course. 
 He was then told to look at it and tell me what he 
 saw. At first he answered at random; he saw the 
 chair, the table, the books, and so on. When he found 
 out that color was wanted, he obliged me with that. 
 All kinds of contrast colors, white, blue, yellow, or- 
 ange and brown were given. No sooner did he find 
 out the approved color than he saw it and stuck to it 
 afterwards. 
 
 I had similar results in the case of mixture of hal- 
 
Hypnotic Hallucinations 229 
 
 luclnatory colors. Red and green, for instance, gave 
 all kinds of results but the right one. No sooner was 
 the right color hit and the subject felt that the ex- 
 perimenter approved of the guess, than he kept on "see- 
 ing" it without any further modification. 
 
 All through these experiments a good deal of fishing 
 was done by the subject, and this fishing was probably 
 the most instructive part of the experiment. On the 
 whole, I must say that the statements of the hypnotic 
 subject should be treated with extreme circumspection. 
 / often wondered which of the two is the greater dupe, 
 the subject or the hypnotizer. 
 
 On one occasion I suggested to H. R. to see a hal- 
 lucinatory pencil ; he saw it, of course. He was given 
 the suggestion to insert the pencil in water; he did so. 
 "What happened to the pencil ?" I asked. "It turned 
 red," he replied. When, however, he found out that 
 the experimenter had in mind the refraction of the 
 pencil, then his pencil behaved accordingly. The sub- 
 ject, especially the good one, the one who is capable 
 of good training, is eagerly on the lookout for the 
 slightest wish and caprice of his manager, and is al- 
 ways fishing for the best way of doing it, of carrying 
 out those wishes to the delight of the hypnotizer. 
 
 In cases of primary dementia or dementia praecox 
 and katatonia under my observation and experimenta- 
 tion, I found hallucinatory states strikingly like those of 
 hypnosis. Thus in one of my cases of katatonia, Q. 
 M., the patient could readily be made to see all kinds 
 of hallucinations, no matter how incongruent. The pa- 
 tient could see a "four-horned chicken with toes on its 
 tail;" "a cat with two legs and wings;" "a tree with 
 feet, eyes, and wings," and other visions of like kind. 
 
230 Diagnosis of Psychopathic Diseases 
 
 To demonstrate their reality the patient actually drew 
 these visions. Similar experiments were carried out 
 by me on hypnotic subjects. The patient could be 
 made to see lions, wolves, elephants and tigers, and 
 was no more afraid of them than the hypnotic subjects 
 are in similar conditions. The fact is that neither 
 the demented nor the hypnotic subjects actually exper- 
 ience the suggested hallucinations. 
 
 Experiments, therefore, point to the fact that sug- 
 gested hallucinations, hypnotic and post-hypnotic, are 
 purely ideational and closely conform to the course of 
 associative, ideational, or representative activity. In 
 other words, the subject does not really perceive the 
 suggested hallucinatory object. He simply thinks of it. 
 
 The subject to whom I gave the suggestion of seeing 
 the watch no more saw the hallucinatory watch than I 
 saw it. He thought of the watch, and he claimed he 
 saw it and acted as if he did see it. Furthermore, he 
 was anxious to carry out fully my suggestion to the best 
 of his abilites, and persuade me that he really did see 
 an actual watch, more real than a real watch. The 
 alleged hypnotic or post-hypnotic hallucination is not 
 at all of the nature of a hallucination, it is a delusion. 
 
 All we do by such a suggestion is to act on the sub- 
 ject's belief. The subject believes that he perceives, 
 and he, in his turn, as one under a delusion, tries to 
 convince us of the reality of his belief; and I must 
 say that he is quite successful in imparting this delu- 
 sional belief to the experimenter himself, thus uncon- 
 sciously, but ironically none the less, repaying his de- 
 luder in the same coin. 
 
 One of the special characteristics of hallucinations, 
 as of percepts in general, is that of reality or of ex- 
 
Hypnotic Hallucinations 23 1 
 
 ternality. The hallucination, like the percept, during 
 the time it is experienced, is clothed in the full garb of 
 external reality. The hallucination is regarded by the 
 percipient as an external object of perception. Hence 
 he who suffers from hallucinations experiences them 
 as he does any normal sensory percept, and, unless he 
 Jearns in other ways the hallucinatory character of his 
 perception, he reacts to it as he would to any of his 
 normal percepts of external reality. 
 
 Now if we closely watch the subject possessed by the 
 alleged hypnotic or post-hypnotic hallucination, we 
 find that the inmost character of externality is sadly 
 lacking. The sensori-motor reaction is by no means 
 the one produced by the corresponding sensory percept. 
 
 After all, the best criterion of an experienced percept, 
 especially if it be that of another organic living being, 
 is the total motor reaction. The proof of the pudding 
 is in the eating. The subject does not react to the "sug- 
 gested" pudding as if it were worth the eating. The 
 reaction is by no means the one called out by the per- 
 ception of an external object, regarded for the time be- 
 ing by the percipient as actually present, no matter 
 whether that presence be right or wrong, whether it be 
 hallucinatory or npt. 
 
 The suggested hallucination calls forth a reac- 
 tion, if there is any at all, of a very weak character 
 totally disproportionate to the supposed stimulating 
 presence of the hallucinatory object. The motor reaction 
 is such a one as is called out by a representation, by a 
 thought of the object, but not by an actual perceptive 
 experience of an external object, as it is in the case of 
 an actual hallucination. 
 
 In hallucinations of ghosts or of tigers, for in- 
 
i^i Diagnosis of Psychopathic Diseases 
 
 stance, the patient actually perceives, sees the. ghosts, 
 the tigers, the serpents; but in suggested hallucinations 
 the subject sees the suggested objects no more than we 
 do when we talk, about ghosts, tigers and serpents, or 
 when we suggest them to the subject. The subject 
 thinks of the suggested hallucinations and acts as if he 
 perceived them. In fact, the most we can do is to create 
 in him a belief in the supposed presence of the suggest- 
 ed hallucinatory object. The subject is not in the psy- 
 chic condition characteristic of hallucination, but he is 
 in the mental state characteristic of delusion. 
 
 The most we can say of hypnotic, post-hypnotic, or 
 suggested hallucinations is that they are saturated, so 
 to say, with the belief in the supposed presence or ex- 
 istence of the object suggested, somewhat in the same 
 way as the child believes in Santa Claus, or as the 
 school boy believes in Washington, or as we believe 
 in the existence of Julius Caesar. The belief, how- 
 ever, is not of the vital over-bubbling, stimulating ef- 
 fect given by a direct perception of an external ob- 
 ject, t^e or hallucinatory, but is one essentially rep- 
 resentative in character. And that is all that we can 
 claim for the potency of the hypnotic state and efficacy 
 of suggestion. 
 
 Hypnosis with its allied states can modify, under' 
 mine, create belief, and important modifications can be 
 induced in the total mass of representative life activity. 
 Associations and dissociations can be brought about 
 in the dynamic processes of representations or ideas, 
 but we cannot create objective sensory miracles. If 
 faith and ideas move the world, as they most certainly 
 do, we have in our hands a powerful instrument, which, 
 if intelligently used, may prove of the greatest benefit 
 
Hypnotic Hallucinations 233 
 
 to civilization and humanity. 
 
 We should not, however, delude ourselves and as- 
 cribe to hypnosis mysterious magic virtues. The hyp- 
 notic state with its abnormally increased suggestibility 
 can give rise to belief, to new associations and dissocia- 
 tions of ideas, but by no legerdemain can it produce, 
 without the intermediacy of peripheral physiological 
 processes, the faintest sensory element. Faith may move 
 mountains, but it cannot create the minutest particle of 
 dust, nor can suggestion create the most insignificant 
 sensation. 
 
 We should not delude ourselves as to the power of 
 suggestion, even if it be in the hypnotic state. A sug- 
 gestion even in a hypnotic state, however deep, can do 
 no more than a very vivid persistent idea can do in the 
 waking state. An ideational process can give rise to 
 motor and possibly to some glandular changes, but no 
 mental magic will ever make of it an external stimulus 
 capable of giving rise to peripheral physiological proc- 
 esses resulting in a sensation with the cumulative effects 
 ending in perception. 
 
 Suggestion cannot cause an amputated leg to 
 grow, nor is suggestion a reliable antitoxin in in- 
 fectious diseases, nor is it regarded as an effica- 
 cious antiseptic; it can hardly be credited with the 
 power of destruction of the minutest bacterium, 
 nor is suggestion regarded as possessing the medicinal 
 virtues of regenerating a single destroyed neuron. Why 
 then should we be so credulous as to endow suggestion 
 with the wonderful and mysterious qualities of produc- 
 ing sensations and percepts without their adequate, com- 
 plex, peripheral, physiological processes? 
 
 As far as our present knowledge of facts goes we 
 
234 Diagnosis of Psychopathic Diseases 
 
 are not only justified in saying that the efEcacy of the 
 hypnotic state with its greatly increased suggestibility is 
 limited entirely to ideational processes, to their inte- 
 gration and disintegration, and that it can do no more 
 than can be effected by a very vivid idea under the 
 most favorable conditions. But are we justified in 
 claiming that ideas however vivid can become sensa- 
 tions and perceptions? No more than our ideas of 
 vapor can become the power of steam. 
 
 We may as well claim that our idea, say of red, pro- 
 vided it is "strong" enough, may give rise not only to 
 the peripheral, physiological, sensory processes, but also 
 to the requisite physical processes, to ether vibrations of 
 color red, and thus to influence by a backward "reverse 
 current," so to say, the sense organs and minds of other 
 persons. 
 
 We may arrive at that "scientific" speculation about 
 telepathic power possessed by our minds of impressing 
 the "Universal Ether," and of imprinting on it our 
 thoughts, wishes, and sensations, so that it simply re- 
 mains for other men or "sensitive mediums" to breathe 
 in or take in the impressions that flood the ethereal uni- 
 verse. 
 
 There is not a particle of evidence that ideas, how- 
 ever vivid, may become "centrally" transformed into 
 sensations. The idea of musk does not smell ; the idea 
 of white does not shine, and the idea of sound does 
 not Ting. The suggested hypnotic and post-hypnotic 
 hallucinations, along with the alleged central hallucina- 
 tions and other notions of like kind belong to the gen- 
 eral category of psychological and psychopathological 
 fallacies. 
 
 It savors somewhat of the mediaeval alchem- 
 ists' belief that gold could be refiped out of any 61^ 
 
Hypnotic Hallucinations 235 
 
 rubbish. Suggestion reminds one of the magic powers 
 of the philosopher's stone, — its touch can convert the 
 base metal of fictitious ideas into the pure gold of sen- 
 sory experience. The wonder is that the world is not 
 one large asylum for ideas to play gambols in, 
 raise havoc with all our sensory experience, and make 
 us suffer from all kinds and forms of hallucinations, 
 inasmuch as a high-pitched ideational activity would 
 give rise to the same sensory elements and consequent 
 perceptions as do peripheral stimuli and physiological 
 processes. Our ideas would be regarded as realities 
 and our great expectations as actualities. 
 
 It is agreed on all hands that no sensation can be 
 transformed into another even if they both belong to 
 the same domain — ^the sensation of yellow cannot be- 
 come orange much less that of sound, for Instance, be- 
 cause they are qualitatively different. How then can 
 we maintain the untenable position that ideas, no matter 
 how intense and vivid, can ever become sensations or 
 percepts, can ever form sensory, perceptive experiences, 
 even If they be nalluclnatory In character? 
 
 The validity of hypnotic hallucinations has passed 
 unchallenged, because of the dubious assumption of the 
 central origin of hallucinations, an assumption still cur- 
 rent among psychologists and especially among psychi- 
 atrists who still pin their faith to "Images and Idols" 
 and accept uncritically the introspective lucubrations of 
 insane and dements. Although the introspective ac- 
 count of the hypnotic subject Is far more trustworthy 
 and valid than that of the Insane and dements, it should 
 nevertheless be taken with the utmost caution and 
 should not be too credulously accepted on its face value. 
 
236 Diagnosis of Psychopathic Diseases 
 
 If we eliminate then the psychopathological fallacy 
 of central transformation of ideas into sensations and 
 percepts, we clearly realize the flimsiness, the spurious 
 character of suggested, hypnotic hallucinations. We 
 have first of all to prove that the subject actually ex- 
 periences the suggested hallucinations. 
 
 We should not be blinded by a too devout worship of 
 "central images," but should pay more attention to 
 facts, to the actual mental condition of the hypnotic 
 subject. The fact that the introspective account given 
 by the subject confirms most emphatically the presence 
 of an actual hallucination does not count in this case. 
 The introspective account is just the one that is the least 
 reliable in such cases, because of the untrustworthy, sug- 
 gestible nature of the whole state, and as such should 
 if possible be avoided, especially in cases of long stand- 
 ing in which suggestibility has been trained to its ut- 
 most. 
 
 We must always keep in mind the highly sug- 
 gestible character of the hypnotic subject, and that 
 from the very nature of his state of suggestibility, he 
 sticks to the apparently objective description of a 
 purely ideational experience. We must remember that 
 the suggested hallucination is given in terms of objec- 
 tive perceptual experience, and that the more effective 
 the suggestion is, the more suggestible the patient is, 
 the more will he insist in his introspective account on 
 objective description of his experience, given to him 
 in the suggestion by the experimenter. The so-called 
 hypnotic hallucination is an artifact elaborated by both 
 parties in the experiment, — it is a kind of an uncon- 
 scious collusion, formed between the experimenter and 
 the subject. 
 
Hypnotic Hallucinations 237 
 
 In order to find out the delusional nature of the sug- 
 gested hallucination, it is well to begin with an intelli- 
 gent, trustworthy subject who has no knowledge of the 
 marvels and mysteries of the hypnotic state, and no 
 training has yet been permitted to effect by means of 
 the cumulative effect of suggestion the highly artificial 
 results which destroy the value of many a valuable 
 case. 
 
 Now if we take a fresh case with no mystical 
 humbug about it, we meet with results far different 
 from those which are usually described and reported. 
 Of the various cases under my observation and experi- 
 mentation I may take the case of one patient who went 
 into a deep hypnotic state. To quote from my notes : 
 
 "Mr. N. goes into a deep trance. While Mr. N. is in 
 the hypnotic trance I suggest to him that as soon as he 
 wakes he shall go to a jar full of water and look into 
 it and see a series of scenes from his former life. On 
 awakening and hearing the signal he goes to the jar, 
 looks into it, and begins to recite the scenes or the 
 events of his former life. I suddenly stopped him and 
 asked him: Do you see all that in the jar? No, he 
 replied, I see it in my mind ; I have it all in my mind." 
 The subject did not really see it; he simply thought of 
 it. 
 
 The subject is hypnotized again; the suggestion of 
 hallucination is enforced. On being awakened, when 
 the signal is given he goes to the jar, looks into it, and 
 begins once more to recite his supposed visions. "Do 
 you see them in the jar?" I ask again. "I do not know," 
 he answers, "whether I see them in the jar or in my 
 mind; it is hard to tell." Evidently my succeeding sug- 
 gestion has brought about some hesitation in his belief 
 
238 Diagnosis of Psychopathic Diseases 
 
 or attitude as to the pure ideational ciiaracter of his 
 supposed visions. He would not have hesitated in his 
 statement as to the whereabouts of the alleged hallu- 
 cinatory objects had he perceived the actual, external 
 objects as is the case in actual hallucinations. 
 
 The hesitation is also instructive from another stand- 
 point, namely, the training which the subject gets by the 
 form and insistence of the suggestions given to him. The 
 patient was just on the point of giving way to the sug- 
 gestion of objectivity of pure ideational experiences; 
 a few more experiments and suggestions and he would 
 have given a full description of a suggested hallucina- 
 tion in its full perceptual objective glory, so delightful 
 to the heart of most experimenters. 
 
 The simple truth of the whole matter was that the pa- 
 tient had not the least perceptual experience of the ob- 
 jects suggested by the alleged hallucination; he did not 
 see anything, he did not see the scenes anywhere, he only 
 thought of them, he simply remembered them, possibly 
 very vividly, but still they were only thoughts, mem- 
 ories, and not perceptions, not actual visions. 
 
 I could similarly bring from records a number of 
 other cases under my observation, cases in which the 
 suggested hallucinations were at first regarded as un- 
 successful, and only after some repetition did the hal- 
 lucinations apparently become fully developed. Thus 
 in some of the cases put into hypnosis for the first time 
 the subjects declared on awakening that they did not 
 see anything, but that the thought of the suggested ob- 
 ject came to their minds. 
 
 What really happened was that the subjects not as 
 yet trained by a whole course of "suggestive treatment" 
 gave me at first a real account of what was actually tak- 
 
Hypnotic Hallucinations 239 
 
 ing place in their minds. Such results are usually re- 
 garded as unsuccessful suggestions. As a matter of fact, 
 it is such failures that are really successful and that give 
 the actual state of mind, while the successful, suggested 
 hallucinations are artifacts. 
 
 Dr. I. C, on whom I have carried out a series of ex- 
 periments, goes into a deep somnambulistic state. 
 He is an excellent visualizer and takes readily visual 
 hallucinations. Being a physician and psychiatrist the 
 subject's account is all the more valuable. Dr. I. C. de- 
 scribes his hallucinations as "mental pictures," as "audi- 
 tory memories," which "lack exteriority, are not located 
 in space." He aptly characterizes his hallucinations 
 visual, auditory, and others, as "fixed ideas." 
 
 Mr. M. goes into deep hypnosis. When in one of 
 the deep trance-states a suggestion is given to him 
 that on awakening he shall see a watch. When awake 
 he claimed he saw a watch. He was asked: "Do you 
 really see it?" He replied "Yes." The interesting 
 point here was the fact that the subject did not even 
 look in the direction where the suggested hallucinatory 
 watch was supposed to be placed, and where he him- 
 self claimed that the watch was located. When tested 
 by automatic writing the hand wrote : "Yes, I see the 
 watch." The subconscious then was also under the 
 influence of the suggested hallucination. This point 
 is well to bear in mind. 
 
 Rehypnotized, and suggested that on awakening he 
 would see two watches. One was a real silver watch 
 and the . ther was hallucinatory. The subject claimed 
 he saw both, but he handled the hallucinatory one, and 
 when asked which of the two he would prefer, he point- 
 ed to the hallucinatory watch. Wjien asked why, he 
 
240 Diagnosis of Psychopathic Diseases 
 
 replied that the suggested watch was bigger. He was 
 really indifferent to the chosen watch and paid no 
 further attention to it, as if it did not exist for him. 
 
 He was again put into the hypnotic state and was 
 suggested to see a flower. On awakening he claimed 
 he saw a flower and smelled it in an indifferent, per- 
 functory fashion. The subconscious was then tested 
 by automatic writing and the writing was to the effect 
 that he saw it: "I see a flower." The subconscious 
 then had also the same hallucination. A series of sim- 
 ilar experiments was carried out with the same results. 
 The subconscious claimed in automatic writing that the 
 suggested hallucination was real. 
 
 The subject was again put into hypnosis and was giv- 
 en the suggestion that he would see a watch on awaken- 
 ing, but here I made some modification. "When you 
 wake up you will be sure to see a watch," I said em- 
 phatically. "Look here ; I want you to write what you 
 really see and not what you do not see." When 
 awake he saw a watch, but he immediately wrote: "I 
 do not see anything." Here the subconscious dis- 
 claimed the suggested hallucinations which it had claim- 
 ed and insisted on before. 
 
 Rehypnotized, he was given the suggestion that on 
 awakening he would see three watches. He was 
 awakened and a real silver watch was put before him ; 
 the other two were hallucinatory. He claimed he saw 
 all three. Meanwhile, in automatic writing he wrote : 
 "One silver watch, real, the others golden, not real; 
 nothing there." A series of similar experiments was 
 made and with the same results. The automatic writ- 
 ing disclaimed the hallucinations, although before, un- 
 der the same conditions, it most emphatically insisted 
 
Hypnotic Hallucinations l\t 
 
 on their reality. 
 
 The subject was put into hypnosis and a post-hyp- 
 notic suggestion was given to him that he would see his 
 wife and child. When awake he began to smile, and 
 when asked why he smiled" he said: "I see my wife 
 and child;" but he wrote: "I see nobody." When 
 put again in hypnosis he still continued to smile and 
 said: "I see my wife and child;" but he wrote (in 
 hypnotic state) : "I do not see them really; I see noth- 
 ing; I see my child, but I really see nothing." "What 
 do you mean," I asked, "by 'I see my child, but I really 
 see nothing?' " To which he replied: "I mean that 
 I see my child in my mind only, but 'honest I don't 
 see anj^hing." 
 
 I then gave him a post-hypnotic suggestion to see a 
 snake. He claimed on awaking that he saw a snake. 
 He manifested no fear. He certainly did not behave 
 as if he really saw a snake, and wrote "I see a 
 snake. I see it in my mind." A great number of sim- 
 ilar experiments were carried out by me varying the 
 suggestions, and all with the same results. I shall not 
 burden the reader with a detailed account as they all 
 gave identical results. 
 
 At first the automatic writing claimed emphatically 
 the presence of the hallucinatory object, but when the 
 truth of the automatic writing was insisted on, the 
 writing disclaimed fully the perception of the halluci- 
 natory object. Finally we came on the real character 
 of the suggested hallucination; "I see my child but 
 honestly, I do not see anything; I see my child in my 
 mind only; I don't see anything." In other words, if 
 we take the facts plainly and do not play hide and seek 
 with the subconscious, we come to the conclusion that 
 
24i Diagnosis of Psychopathic Diseases 
 
 in suggested hallucinarions the subject does not per- 
 ceive anything as is the case in an actual hallucination, 
 but that he simply represents, vividly perhaps, what is 
 suggested to him; in short he does not perceive, but 
 he simply thinks of the suggested hallucinatory object. 
 
 Another interesting point may be brought out here. 
 The automatic writing, as is usually the case, is not 
 taken cognizance of by the patient, and, although this 
 same writing at first claimed the actuality and genuine- 
 ness of the suggested hallucinations, it gave in the sec- 
 ond series of experiments the real insight into the 
 whole matter: "I see the child; I see nothing; I see it 
 in my mind." 
 
 When the subject was made conscious of his 
 automatic writing, and became fully aware that he 
 was being entrapped, he once more began to claim 
 in ^automatic writing the actuality of the suggested 
 hallucination. As long then as the automatic writing 
 was regarded by the subject as independent of him, for 
 which he was not responsible, and as long as the sugges- 
 tion of the hallucination was not taken as directly ad- 
 dressed to it, the subject himself frankly acknowledged 
 the fact that he did not see anything. 
 
 No sooner, however, was this truth of the automatic 
 writing brought home to the subject so that he should be 
 confronted with it directly and squarely, than he was 
 bound by the fact of the given suggestion to claim that 
 he actually saw the suggested hallucinatory object, al- 
 though he really did not see anything at all. This is 
 most instructive. For it shows clearly that the hypnotic 
 consciousness, from the very nature of its heightened 
 suggestibility, clings most anxiously to the given sugges- 
 tion and insists on the reality of its fulfillment. 
 
Hypnotic Hallucinations 243 
 
 We must, therefore, be on our guard and not trust 
 the subject's introspective account, unless it is corrobo- 
 rated by good circumstantial evidence. It is because such 
 precautions have not been taken in the close interroga- 
 tion of the subject's actual state of mind, and because of 
 the deep-rooted psychological fallacy as to the relation 
 of ideational and perceptual activities that the prevalent 
 belief in the validity of suggested hallucinations has 
 passed unchallenged. If not for those fallacies, it seems 
 to me, it would have been quite evident that hypnotic 
 and post-hypnotic suggested hallucinations are not gen- 
 uine, hut are essentially spurious; that hypnotic hallucin- 
 ations, unlike actual hallucinations, are not really ex- 
 perienced; that hypnotically suggested hallucinations 
 are only forms of delusions. 
 
CHAPTER XXIII 
 
 THE APHASIAS 
 
 THE aphasias are on the border of the do- 
 main of psychopathic states and a knowledge 
 of them is instructive to the student of psy- 
 chopathology. To comprehend the aphasias 
 we must again make a brief review of the process of per- 
 ception. In perceiving an object, in having impres- 
 sions come from a particular object, these impres- 
 sions give rise to sensations, and the sensations bring 
 into operation subconscious processes, the results of as- 
 sociative, synthetic activity of other sense organs. These 
 enter once more into association and give rise again to 
 the synthesis of a percept. 
 
 In the formation of a percept subconscious associa- 
 tive groups and systems are awakened by the impression 
 produced by the stimuli of the particular object. The 
 impressions or their accompanying psychic elements, the 
 sensations, form the cue and also the centre of the awak- 
 ened, subconscious groups. 
 
 The sensations produced by the object form the liv- 
 ing elements of the percept. To give an example : In 
 seeing an orange, the orange impresses the eye, peri- 
 pheral physiological processes are induced in the optic 
 nerve; these processes go to the centre, the occipital 
 lobes, where sensation of sight is awakened. At the 
 same time, movements are induced in the eye. The 
 eye explores, so to say, the outside of the orange; 
 some sensations of form may be excited, the orange may 
 
 244 
 
The Aphasias 445 
 
 appear somewhat round. These sensations form the 
 cue to the percept. 
 
 Really what is directly experienced is only a group 
 of sensations of light and form. But this does not 
 yet constitute the percept of orange. As soon as such 
 particular sensations of form and light are experienced 
 the entire percept of orange emerges, that is, pre- 
 viously experienced states of consciousness emerge, be- 
 come associated with the given sensation, and the per- 
 cept orange arises. In other words, as soon as we see 
 the orange and experience the particular sensations of 
 its color and form, we see that it is an orange ; that it 
 is juicy, has a certain taste and weight, is globular 
 in form, that if touched it will give a certain sensation 
 of hardness or resistance, or when taken in the mouth it 
 will give a certain taste sensation; all that is directly 
 seen by the eye as soon as the peripheral stimulus is 
 given by the external object, the orange. 
 
 We say we see the orange. The eye, however, cannot 
 feel taste, cannot feel pressure, cannot feel coolness; 
 what the eye can specifically see is only color and perhaps 
 some form due to kinesthetic sensations, arising from 
 movements of the muscles of the eye ball. We are not 
 conscious of all this mechanism. As soon as we get the 
 visual sensation from the orange, at once all other states 
 are brought into synthesis in consciousness. 
 
 To show that such is really the case, let us see what 
 happens, if an artificial orange is substituted. We take 
 it for the real orange, we try to smell it, we try to feel 
 it, and then we find out that it is not the real object, and 
 we then often say we are surprised to have been de- 
 ceived. 
 
 The fact is in seeing an object we never directly ex- 
 
246 Diagnosis of Psychopathic Diseases 
 
 pcrience all the other sensations which arise from the 
 particular object and which go to constitute the partic- 
 ular percept. In other words, in perception, far more 
 is indirectly than directly experienced. The sensations 
 directly experienced form the nucleus of the percept. 
 In the particular example given, the orange as seen, 
 the nucleus, is the sensations of light and form. The 
 other elements come indirectly, they are reproductions 
 of previously experienced subconscious processes. 
 
 What do we mean by subconscious processes pre- 
 viously experienced? How do they happen to rome 
 to us ? The orange has been experienced many times, 
 we have handled the orange, we have smelled it, 
 pressed it, tasted it. The external object, the orange, 
 acted on our tactual organs, giving rise to sensations of 
 touch ; it acted on our muscles and gave rise to kinaes- 
 thetic sensations; it acted on the olfactory organ, giv- 
 ing rise to sensations of smell; it acted on our gusta- 
 tory organs and awakened sensations of taste. These 
 sensations have been repeatedly associated in our 
 lives; we cannot possibly eat the orange without 
 handling, seeing, and tasting it. Now when men- 
 tal or sensory states become associated, the excite- 
 ment of one of them awakens all the others, and all the 
 states emerge in the same synthesis as before, in the 
 percept. That is why when we see an artificial orange 
 or when we see another fruit which looks like an or- 
 ange or would give rise to altogether different sets of 
 sensations and other experiences than the orange, we 
 still in seeing it, perceive the orange. 
 
 It is possible so to arrange light and shade as to give 
 the eye sensations similar to the ones that come from 
 the real object, the orange. The sensations being similar, 
 
The Aphasias %^ 
 
 the percept emerges to the surface and once more we 
 see an orange. Every one is familiar with this effect in 
 art, in pictures. In experiencing a certain sensation, we 
 also have the immediate knowledge of the object that 
 gives rise to the sensation, in other words, simultaneous- 
 ly with the sensation, many other experiences emerge 
 which have been assjociated with this particular sen- 
 sation and which correspond to the sensations that this 
 particular object may excite, if it were applied to other 
 sense-organs. 
 
 It is usually said that the other sensations are re- 
 vived memory-images. Thus in hearing a ring and 
 having immediately the presentation of a bell, we say 
 that the bell has in the course of our life given rise to 
 many different sensations, and that each sensation was 
 preserved in memory, it has, so to say, left a memory 
 image in the particular area that regulates this partic- 
 ular sense. The areas have become associated, on ac- 
 count of the associated stimuli of the particular object, 
 the bell, and now when one sensation arises, such for 
 instance, as the auditory sensation, the rest of the sen- 
 sations are also revived in memory. 
 
 This account is not exactly true; we must remember 
 that a revived sensation is a sensation itself, but the 
 memory image is certainly not a sensation. In hearing 
 a sound and thinking of a bell we do not actually have 
 the sensation of seeing the bell, but we only represent 
 to ourselves the bell. A memory image is not a revived 
 sensation. Had the sensation of sight been actually re- 
 vived we would have had a perceptual experience, per- 
 haps a secondary sensation, but not a representation. 
 Memory-images are not of the nature of revived sensa- 
 tions, they are peculiar ideational processes, different in 
 
448 Diagnosis of Psychopathic Diseases 
 
 nature from sensations. Physiological processes of rep- 
 resentation differ fundamentally from sensory processes. 
 
 It is wrong to assert, as some are apt to do, that sen- 
 sations leave a kind of after-sensation, a memory im- 
 age, which can at any time be revived. The most we 
 can say is, that the physiological process that goes on 
 within the respective sensory centers gives rise to other 
 physiological processes within some other neighboring 
 centers, processes different in character, but analogous 
 as to content. Thus, for instance, the vibration of the air 
 acting on the drum of the ear induces a peripheral phy- 
 siological process within the auditory nerve. This physio- 
 logical process reaches the sensory area, a physiolog- 
 ical process takes place then which gives rise to par- 
 ticular sound sensations. At the same time the sound 
 is here directly presented in consciousness. 
 
 We may now close our ears, we no longer hear the 
 sound. The sensation is no longer present in conscious- 
 ness, but we can represent to ourselves the same sound; 
 the sound is now represented in consciousness. The 
 representation of the sound is not the same as the sensa- 
 tion of sound, nor is it another sensation of sound; in 
 fact it is not a sensation at all ; it is rather an idea or im- 
 age that corresponds to that sensation. 
 
 We cannot say that the representation of the sound 
 is the same as the sensation of sound but less in degree. 
 For if that were so, we should experience not the same 
 sensation as the original one, but rather a sound of less 
 intensity, and hence really a different sound. In short, 
 we must conclude that every presentation has its cor- 
 responding representation which is different in Its psy- 
 chic nature from the original sensation. 
 
 A representation or image therefore is not a revived 
 
The Aphasias 249 
 
 sensation, it is a psychic process sui generis. What we can 
 say is that every sensation gives rise to a psychic pro- 
 cess which we call "a memory-image" or representa- 
 tion, and which has the same functional relation to sen- 
 sation as the sensation to the external stimulus. 
 
 Every percept consists of a synthesis of a central 
 presentation in one sensory area associated with sen- 
 sory elements coming from other sensory areas. Thus 
 let O be an object in the external world; let a, h, c, d, 
 be the respective sensations which this object gives, if 
 applied to different sense organs. Let a, b', c, d', be 
 the respective reproduced sensory elements which may 
 be termed secondary sensory elements of the sensa- 
 tions given to the object O, a corresponding to a, h' to 
 b, c to c and d' to d. Now a, b, c, d, will become 
 associated, in the course of the individual's life, 
 with their respective secondary sensory elements 
 and corresponding representations, so that when 
 a occurs, the secondary sensory elements and cor- 
 responding representations of the others that were 
 not directly excited in this particular expe- 
 rience also recur so that a brings up a' b' c d' ; b 
 brings up a b' c d' and so on. The percept recurs each 
 time as one of the constituent sensations is excited. 
 
 Physiologically regarded, a percept, therefore, con- 
 sists of many processes taking place in various sensory 
 and associative areas. On seeing an orange, there is 
 a sensory process going on in the visual areas sup- 
 posed to be in the occipital lobe, in the areas that sub- 
 serve gustatory sensations supposed to be located in 
 the lower part of the fourth temporal convolution, 
 and those of touch and muscular sense in the post 
 parietal precuneus and gyrus fornicatus CQnVQlutions, 
 
250 Diagnosis of Psychopathic Diseases 
 
 associated with these there may be also sensations of 
 sound going in the auditory area, the first and second 
 temporal convolutions. Along with the perception there 
 are also present motor adjustments due to physiological 
 processes in the motor areas grouped about 
 the Rolandic fissure. Moreover, the percept is lo- 
 calized in space and time and is associated with respec- 
 tive representations, and with the consciousness of per- 
 sonality. We may, therefore, say that such a simple func- 
 tion as perception involves the activity of the whole 
 cortex. 
 
 As soon as the object, orange, produces the impres- 
 sion and gives rise to a physiological process in the 
 sensory area of the occipital lobes, all the other cortical 
 areas associated with it, become sub-excited, sys- 
 tems of neurons in the different areas begin to func- 
 tion, and give rise to the psychic concomitant, the per- 
 cept, orange. These different associated areas and the 
 physiological processes of systems of neurons, corres- 
 ponding to the representations, each one near its sen- 
 sory area, form all kinds of combinations, adjusted to 
 external objects, responsive to particular stimuli, and 
 go to constitute what we term the associative areas. 
 
 What happens if dissociation or a lesion occurs 
 between the sensory area of the occipital lobe, thus cut- 
 ting off the occipital area from the other centres? The 
 patient experiences the particular sensation awakened 
 in the occipital lobe. He will see the shades and 
 colors of an object, for example, the orange, and if 
 the muscular sensations of the eyes are still associated 
 with the occipital lobe, the person may even see the 
 form, and may even be able to represent to himself 
 the particular sensations experienced, but no percept 
 
The Aphasias 251 
 
 will come to consciousness, the sensation will have for 
 him no meaning, that is, there are no associative, sen- 
 sory and ideational interrelations with other cortical 
 j.nd subcortical systems with their consequent motor ad- 
 justments and glandular reactions. The patient suffers 
 from what is termed visual apraxia. 
 
 The same may happen for example with gustatory 
 sensations. You may ask a man to close his eyes and 
 you place a bit of orange in his mouth; he may imme- 
 diately recognize the taste as belonging to the par- 
 ticular fruit. Should there be, however, a lesion 
 in the temporo-sphenoidal lobe, affecting the gustatory 
 area, so as to separate it from the other areas of sen- 
 sation, the patient will experience the sensation of 
 taste, possibly, also that of pressure, if this area is not 
 dissociated by the lesion; he will be able to represent 
 the sensation afterward, i. e. he will have a memory of 
 the sensation, but he will not know the character of the 
 object, he will not know it is an orange, for instance. 
 This may be called gustatory apraxia. 
 
 In hearing a bell, the image of the particular object 
 rises to our consciousness with all its accompanying as- 
 sociated secondary sensory elements and corresponding 
 representations. Should, however, a lesion occur in the 
 third temporo-sphenoidal convolution, thus shutting 
 off the auditory area from the rest of the areas, the 
 other areas will not be stimulated, the secondary 
 sensory elements and corresponding representations 
 will be absent and the patient will not know the 
 character of the object, the bell. As soon as the 
 sound ceases the subject will be able to represent 
 again to himself the sound, but he cannot form an idea 
 as to the character of the ori^nal object, no image of 
 
252 Diagnosis of Psychopathic Diseases 
 
 bell arising in his consciousness. This may be charac- 
 terized as auditory apraxia. 
 
 Systems of tactual presentations may similarly be- 
 come disaggregated. External stimulations may give 
 rise to sensory processes, but no representations are 
 awakened ; the memories relating to this particular class 
 of sensations are gone, and no appreciation of tactual 
 stimulations is aroused. The patient does not know 
 of the stimulations, he is not directly conscious of 
 them, since the stimuli fall below the threshold of 
 representative consciousness, although they may be 
 subconsciously present to simpler moments of lower 
 types. 
 
 If the clustering memory representations of the oth- 
 er senses become disaggregated from the psychic ele- 
 ments of the tactual sense, then the functioning of those 
 elements does not give rise to the associative activity 
 of unlike representations entering into synthesis with 
 tactual elements to form particular systems of moments. 
 The patient on being stimulated through tactual sense 
 realizes and knows the nature of the stimulus, he feels 
 and knows the touch, the pain, the pressure, the prick, 
 the burn, but no particular object or system of objects 
 is called up in his mind. 
 
 In the individuals in which the visual sense is pres- 
 ent and forms the focus of most of the lower presen- 
 tation moments the sensory elements of the tactual sense 
 rarely, if ever, become the integrating nuclei of mo- 
 ments-consciousness. Their combination with other un- 
 like elements is rather of the nature of representative 
 association, than that of integrating synthesis. If I 
 happen to touch an object in the dark, the visual rep- 
 resentation of the object, or rather the associated mem- 
 
The Aphasias 253 
 
 ories with visual representations as nuclei arise in my 
 mind, the elements of the tactual sense are felt in a 
 synthesis with the revived associates. 
 
 This, of course, varies with individuals of different 
 types, such as the auditory, the motile, and others. 
 In the motile type the tactual sensory elements are 
 no doubt of far more integrating value than is that of 
 the visual type. Still it remains true that in man the 
 visual sense predominates and forms the nuclear ele- 
 ments of psychic synthesis. This is especially seen in 
 perceptual activity where synthesis is at its height. 
 
 In the blind, tactual as well as kinacsthetic and 
 auditory psychic elements are of importance in the life 
 of the individual as they form the nuclei of moment- 
 consciousness. A disaggregation of these nuclei gives 
 rise to forms of amnesia of much interest. It goes with- 
 out saying that a disaggregation of the tactual memories 
 affects the blind far more profoundly than a similar dis- 
 aggregation in normal individuals. 
 
 The patient may become quite helpless, especially 
 is this the case, if the loss involves representations of 
 tactual and pressure sensations, coming from the more 
 deeply situated tissues, such as the muscles, joints, and 
 tendons, thus also involving kinaesthetic representations. 
 If the process of disaggregation affects the interre- 
 lation between the tactual, sensory presentations and 
 representations, the result will be that the patient 
 on touching one object, say a bell, or a liquid, as water, 
 will be unable to know the object, but he will immedi- 
 ately know it when sensory stimulations will awaken 
 presentations In other senses. 
 
 This will become still more evident In the edu- 
 cated blind. The blind who have learned to read by 
 
254 Diagnosis of Psychopathic Diseases 
 
 passing their fingers over raised symbols, have ac- 
 quired a special system of representations correspond- 
 ing in complexity to our visual system of representa- 
 tions in reading written and printed characters. Should 
 this system become disaggregated, the patient loses 
 his knowledge of reading with his hands, although he 
 may be able to write, that is, to make the raised signs 
 of objects, qualities, actions, and relations. This will 
 correspond to alexia, only in this case it is not visual, but 
 tactual alexia. The patient is able to write, but he can- 
 not read his own writing. 
 
 If the auditory representations are disaggregated, 
 the patient will not be able to understand spoken words, 
 will be unable to write to dictation, but he will be able 
 to speak spontaneously, write, and read, although he 
 will be unable to understand his own reading. In this 
 respect there is no difference in the psychomotor man- 
 ifestations or symptoms from what is ordinarily ob- 
 served in similar cases of otherwise normal individ- 
 uals. 
 
 In the same way apraxias of other sensations may 
 occur. There may be apraxia of two or more sensa- 
 tions. In fact any combination may occur. It is 
 clear that in visual apraxia, for example, although the 
 patient in looking, say at the orange, will be unable to 
 tell the character of the object, he will, however, be 
 enabled to tell its nature, if the object is acting upon 
 some other sense organ, not dissociated from the system 
 of sense areas. Thus he will be able by smell or taste 
 or even by touch to know that it is an orange, although 
 he will be unable to perceive it in visual terms. He will 
 be much as the blind man who has never seen an orange, 
 and hence has his representations in terms of other 
 
The Aphasias 255 
 
 senses, yet appreciates the character and use of the 
 orange. 
 
 ^The percept formed will lack the representation of 
 the particular dissociated sense area. For instance in case 
 of gustatory apraxia the patient in seeing the orange 
 will have the representation of every sensation of the 
 orange except as to its taste. Or- in auditory apraxia 
 the patient in seeing a bell will lack the representation 
 of sound. 
 
 If now there is a lesion of such extefit as to prevent 
 the associative activity of all the special sense areas, 
 Ave have a condition termed mental blindness or total 
 apraxia. The patient will be unable to know the 
 character of objects no matter which sense is im- 
 pressed. The sensations are correctly perceived, and 
 each may even be represented In consciousness, but 
 their representative association in synthesis will be ab- 
 sent. 
 
 Man's mental life, however, is not so simple as we 
 have described It^ Man Is a social being. Living in 
 a social environment he communicates his experiences 
 to his fellow beings. This communication is expressed 
 either by gesture, such for instance, as we find among 
 deaf mutes and among different Indian tribes, or what 
 is more common, by sound or by different combinations 
 of sound. Sound being more variable than are gestures, 
 it is better adapted to express the variety of experiences. 
 
 In the synthesis of the percept, therefore, there 
 must be associated also sound representations and 
 kinaesthetic memories of production of sounds. These 
 sounds, their representations and the kinaesthetic 
 memories of their productions, do not directly come 
 from the object Itself, they are symbolical, call- 
 
256 Diagnosis of Psychopathic Diseases 
 
 ing up the synthesis of the percept, or the percept 
 calls «p its particular symbol. To give an ex- 
 ample : On seeing the orange not only all the constit- 
 uent representations of the percept orange arise in con- 
 sciousness, but also the sounds that constitute the sym- 
 bol of the orange, or its name, likewise arise, and not 
 only the name of the object, but also the kinaesthetic 
 representations of the name. 
 
 On seeing the object the name occurs to us, and 
 vice versa on hearing or pronouncing the name of 
 the object its representation appears in conscious- 
 ness; the percept itself, the characteristic of which 
 is that in normal life it must have as a center a particu- 
 lar sensation awakened by peripheral stimuli only, is not 
 present. The percept gives rise to representation of the 
 word or name, and the hearing of the name or word 
 gives rise to the representation of the percept. 
 
 In other words, on perceiving the object the name 
 occurs to us, and vice versa on hearing or pronouncing 
 the name the representation of the taste of the orange 
 or of the sound of the bell calls up the rest of the asso- 
 ciated representations of the object. The same is true 
 in more complex mental life, the representation of a 
 word will call out other associated representations, that 
 is, the meaning of the word or the representation of the 
 object of which that word is a symbol. 
 
 Should however the auditory area, or those systems of 
 neurons the function of which are concomitant with 
 the sensations and representations of words, become 
 affected, be dissociated, the hearing of the word or 
 of the name no longer calls up its associated representa- 
 tions of which it is a symbol. The patient hears a word, 
 pan represent th^ soqnds tP himself, can repeat 
 
The Aphasias 257 
 
 it, if the motor area of speech is not dissociated, but he 
 no longer knows the meaning of the words he hears. 
 This condition is called sensory aphasia. 
 
 Should, however, the kinaesthetic sensations, or the 
 motor area of speech alone be affected, hearing of the 
 word will call out its associated representations of which 
 it is a symbol, but not the kinaesthetic representations. 
 The patient, on hearing the word, will know its mean- 
 ing, but will be unable to pronounce it. This condition 
 is termed motor aphasia. 
 
 In reviewing the disturbances of speech we have 
 endeavored to simplify matters. The mental mechan- 
 ism we are now examining is rather of a more complex 
 nature. Not only has man in his social life, in his in- 
 tercommunication with his fellow beings, developed 
 sound symbols, expressed in speech, but in the course 
 of social development there was also worked out a 
 whole system of signs symbolizing the auditory sym- 
 bols. The word is represented by a written sign. A 
 child learns first to speak, to call different objects by 
 their names which are symbols of objects, and after- 
 wards, as he grows up, he learns to write, that is, to 
 express these sound symbols by visual symbols. 
 
 The association of mental states, called up by an ob- 
 ject, becomes still more complicated. In the first place 
 a sensation produced by an object acting on the sense or- 
 gans calls up conscious and subconscious representative 
 states corresponding to this object and synthetized in 
 the percept; then the representations of the name with 
 the kinaesthetic representation of its production are 
 awakened, and besides there may also be awakened vis- 
 ual representations of the sound representations and 
 also kinaesthetic sensations by which these visual rep- 
 
258 Diagnosis of Psychopathic Diseases 
 
 resentations are manifested, that is, expressed in motor 
 terms. In the second place, one may see these visual 
 signs of auditory symbols, and all the complexities of 
 representations, corresponding to the name and to the 
 object will be awakened. 
 
 To illustrate our point, on seeing a man the visual 
 sensation will give rise to a complexity of presenta- 
 tions and representations synthetized in the percept, 
 'man.' Furthermore, the name 'man' may come into 
 consciousness, and this may give rise to the kinaesthetic 
 representations manifesting themselves in the sound 
 'man.' This will further give rise to the visual sym- 
 bolization of the auditory symbols, and if the kinaes- 
 thetic sensations are also awakened, we may write the 
 word 'man.' 
 
 We started here directly from the object. The pro- 
 cess may, however, be started in the reverse order, in- 
 stead of going from the percept to the symbol, we may 
 go from the symbol to the percept. We open a book 
 and see there certain signs man. These visual sensa- 
 tions awaken their corresponding visual representations 
 of memories, associated with their related auditory and 
 kinaesthetic representations which may be manifested in 
 the word 'man,' and along with it all the synthetized 
 representations, corresponding to the percept, are awak- 
 ened, and we know that the word means 'man,' a cer- 
 tain object. This is especially clear in observing children 
 learning to read and write and in the study of foreign 
 languages. On seeing the word homo the first attempt 
 is to pronounce it, then to associate it with-some system 
 of representations. 
 
 What will happen if in the occipital lobe the sys- 
 tems of neurons whose functional activity is conco- 
 
The Aphasias 259 
 
 mitant with the psychic processes of visual representa- 
 tions of auditory sjmibols, i. e. reading or writing, is 
 dissociated or destroyed? The patient will be unable 
 to read. There will be a condition known as alexia. The 
 patient will be able to see the letters, may even be able 
 to imitate, to reproduce them but will not know their 
 meaning. 
 
 Similarly in the case of writing, if the systems of 
 neurons, the functions of which consist in the repre- 
 sensations of the kinaesthetic sensations of writing, 
 be destroyed or dissociated, the patient will be able to 
 see the word, to read it, will know its meaning, 
 but will be unable to write it. This will constitute the 
 state of agraphia. 
 
 There may be a complicated pathological process 
 where the lesion occurs in the conducting fibers be- 
 tween the visual sensory word system of neurons and 
 that of their associated representations. The result will 
 be that the patient, on seeing written or printed letters 
 or words, will be unable to read them. He will be, how- 
 ever, able to write, although he will be unable to read 
 his own writing. The only way for him to grasp writ- 
 ten symbols is by kinaesthetic sensations. He may pass 
 his hand over the printed or written letters and may 
 thus be able to know their meaning. Of course, this will 
 require some education. This will constitute one of 
 the forms of visual aphasia. If all the representations 
 are gone then the patient will be unable by any means 
 to grasp the meaning of the word or letters. The 
 former may be termed relative visual aphasia, the lat- 
 ter absolute visual aphasia. 
 
 The same thing may happen in the case of writing. 
 If the area of the graphic, sensory, neuron systems 
 
260 Diagnosis of Psychopathic Diseases 
 
 is injured or the fibres going to their associative 
 representations are interrupted by a lesion, the pa- 
 tient will still be able to write correctly, but upon 
 closing his eyes or attempting to write with his 
 eyes closed, he will be unable to know whether he has 
 written correctly or not. That is, the kinaesthetic sen- 
 sations being absent or dissociated, the patient will not 
 know what his hand has written. He will however be 
 able to know what he has written by looking at the 
 words. This may be termed relative agraphia. 
 
 Should, however, the kinaesthetic representations of 
 writing also be injured he will be unable to write at all. 
 This may be termed absolute agraphia. In the same 
 way there may be absolute and relative apraxia. 
 
 We can realize now that there may be various forms 
 of aphasia and apraxia, according to the number and 
 function of the systems of neurons involved. Thus 
 systems in the sensory area may become affected, or sys- 
 tems in the association areas may become dissociated, or 
 different combinations of systems in the sensory and as- 
 sociation areas may become involved. 
 
 In addition to these forms there' may also be dif- 
 ferent forms of apraxia and aphasia due to lesions 
 or pathological processes within the conducting fibers, 
 either from the sense organ to the sensory area or in 
 the fibres between the sensory area and association 
 areas, or in the conducting fibers within the associa- 
 tion areas. That is, the lesion may be subcortical, or 
 cortical, when within the body cells themselves, and 
 transcortical when within the fibers in the associa- 
 tive areas. These will give rise to various forms of 
 aphasia. We may therefore classify the aphasias and 
 apraxias physiologically, according to the location of 
 
The Aphasias 261 
 
 the lesion as subcortical aphasia and apraxia, cortical 
 aphasia and apraxia, and transcortical aphasia and 
 apraxia. 
 
 There are some special forms of aphasia and 
 apraxia that are of interest. Amusia is a name applied 
 to a condition in which the patient, a musician, is un- 
 able to understand muisc when he hears it; or it may 
 be of the visual form in which case he will be unable 
 to read notes ; or of the motor form, when the patient 
 cannot sing or play; or it may be of the graphic form 
 when the patient formerly familiar with musical com- 
 position lost the skill of writing notes. 
 
 As a rule amusia is associated with some other form 
 of aphasia or apraxia. Frequently we find that aphasic 
 patients more or less retain their musical knowledge, 
 since music, the language of emotions. Is more organ- 
 ized, more primitive than speech and writing. 
 
 Amimias are forms in which the patient has lost the 
 power of expressing himself in gestures commonly used 
 in life. Amimias may be either of the motor or sen- 
 sory type. Expression by gestures is simple, acquired 
 early in life and Is associated with the emotions. Ges- 
 tures are more stably organized than the rest of mental 
 life and are therefore the last to succumb to patholog- 
 ical processes. 
 
 The process of disintegration in different systems of 
 neurons may be of various degrees and intensities thus 
 distorting the process of association. This may give 
 rise to occasional wrong associations. Thus we may 
 have paraphasia, if for instance, the patient Inserts a 
 wrong syllable In a word or a wrong word In a phrase, 
 etc.; or in reading the patient may read incorrectly; or 
 in seeing an object he may occasionally regard It as 
 
262 Diagnosis of Psychopathic Diseases 
 
 another object. For example, he may use a knife as 
 a spoon, or try to cut with a fork. These various forms 
 of paralexia, parpraxia, etc., may in their turn he cor- 
 tical, subcortical, and transcortical. 
 
 The forms of reviewed aphasias may be of an or- 
 ganic nature, or of a functional psychopathic character 
 which may closely simulate organic conditions. 
 
CHAPTER XXIV 
 
 DELUSIONS 
 
 DELUSIONS do not belong to the domain 
 of functional psychology, but deserve our 
 consideration, because they fall on the bor- 
 derland of psychopathic states. A delusion 
 is conceptual in its nature. One may have an illusion 
 or hallucination and still be perfectly sane. He may 
 attempt to verify it by one of the two or both criteria 
 and, finding it false, refuse to give assent to its external 
 reality or objectification. It is only when one gives assent 
 to his illusion or hallucination, that is, when he believes 
 that it really exists externally, it is only then that it be- 
 comes a delusion. To give an example, — There may be 
 paraesthesia in one's hand. The member may feel like 
 putty or glass. This in itself may be considered an illu- 
 sion. The patient attempts to verify it with his other 
 senses, tries to show it to other people, his physician 
 for instance, and failing to confirm it, then simply re- 
 gards the feeling as subjective. But if the patient, in 
 spite of all verification with negative results, and social 
 objections and assurances and arguments by his fel- 
 low-men, should give assent or still confirm the objec- 
 tification of his illusion or hallucination, then it would 
 constitute a delusion characteristic of insanity. 
 
 To give another example, if a man has an hallucina- 
 tion or illusion that he has seen something like a mer- 
 maid, it is a delusion when he gives his assent to it and 
 affirms that it really exists. In short, the man who has 
 
 263 
 
264 Diagnosis of Psychopathic Diseases 
 
 an illusion or hallucination is correct subjectively. He 
 is only wrong when he objectifies it, and then it be- 
 comes a delusion. The patient may have the hallucina- 
 tion of hearing a voice; it becomes a delusion, if he ob- 
 jectifies the voice and thinks some one is addressing him. 
 
 Delusion can be defined only in social terms. Man 
 is essentially social in nature and living in a certain 
 social environment, he may maintain certain ideas and 
 do certain things, which under other social conditions 
 would be considered as non-adaptations. Thus for 
 instance, a man performing an Australian dance in a 
 public thoroughfare of some civilized city would be 
 promptly examined as to his mental state, while an 
 Australian savage performing the same feat in his 
 own country would not be regarded as abnormal, be- 
 cause the actions are adapted to his social environment. 
 
 The same holds true with regard to ideas and beliefs. 
 A delusion, therefore, may be defined as a false belief 
 which may lead to actions, out of accord with the 
 social environment. This, however, does not entirely 
 constitute the insane delusion. Another factor of the in- 
 sane delusion is the impossibility of changing or correct- 
 ing the erroneous beliefs, even though the lack of adap' 
 tation is pointed out and made perfectly obvious. An in- 
 sane delusion, therefore, may be defined as a persistent, 
 incorrigible, unsocial, erroneous belief. 
 
 Although an assent given to an hallucination or il- 
 lusion constitutes a delusion, not all delusions are neces- 
 sarily accompanied by illusions or hallucinations. All 
 of the perceptions may be quite correct and the patient 
 may still have a false belief in his formation of judg- 
 ment about the perceptions. Thus for example, a man 
 may in reality hear whispering or conversation, but the 
 
Delusions 265 
 
 interpretation of the whispering and talking may be 
 incorrect, that is he may believe that all of them relate 
 to himsdf, such as conspiracies to injure him, in spite of 
 the general assurance and evidence by his friends that 
 nothing of the sort exists. Here then the sensory cri- 
 terion cannot be used since the man is quite correct in 
 his impressions. It is only when the social criterion is 
 applied that he is found to be insane. 
 
 The general definition of delusion, therefore, may be 
 expressed as a persistent, incorrigible, individualized, 
 false belief, either in regard to self or environment, or 
 their interrelation. An insane delusion differs from 
 the sane delusion which may be maintained by the 
 members of a whole society. Thus, for instance, in 
 the middle ages, people who became ill, explained their 
 illness as the result of witchery, were perfectly normal 
 persons, because this was the general belief, although 
 false, of the age. But if to-day a civilized man should 
 make any such claim and persist in his belief, he would 
 be suffering from an insane delusion. Since delusions 
 are false beliefs in regard to adjustments of external to 
 internal relations, they may be classified, with Mercier, 
 as due to : 
 
 1. Delusion in regard to change in environment. 
 
 2. Delusion in regard to change of self. 
 
 3. Delusion in regard to change of adjustment of 
 self to environment. 
 
 Delusion in regard to environment may be of 
 illusory or hallucinatory character, or incorrect belief 
 as to the external environment. For example, a 
 man may regard a clock in his room as an animal 
 and constantly treat it as such. Or he may have an 
 hallucination of angels or devils and then believe that 
 
266 Diagnosis of Psychopathic Diseases 
 
 he is having conversations with them. 
 
 The incorrect interpretation of the external environ- 
 ment is illustrated by those who have the delusion 
 that they are in some strange country surrounded by 
 a foreign people and will make attempts to speak the 
 foreign language. 
 
 Delusion in regard to change of self may be either 
 partial when for example, the patient believes a part of 
 his body is made of some material, such as wood or 
 glass, or it may be complete, when, for instance, the pa- 
 tient believes that the entire body is changed. 
 
 Delusion in regard to change of adjustment of self to 
 environment is well illustrated in delusions of grandeur, 
 persecution, megalomania, or micromania, etc. In delu- 
 sions of grandeur the subject considers himself better 
 or richer than he is, or may think himself some great 
 personage, the Saviour, or God Almighty, etc. 
 
 Delusions may again be divided into ( i ) svstema- 
 tized; and (2) unsystematized. 
 
 I. A systematized delusion is an organized system 
 of mental states of which an erroneous belief or delu- 
 sion forms the center. The patient brings the different 
 impressions coming from the external world in logical 
 relation to some one erroneous belief that has com- 
 plete possession of him. The belief seems to form a 
 mental eddy in which all external impressions are 
 caught; the whole mental life of the patient becomes 
 crystallized about this false idea. He may, for in- 
 stance, consider himself a messiah; he will behave in 
 accordance with this belief, live up to it, dress accord- 
 ingly, and no matter what he sees or hears he will in 
 some way relate it to his messianic mission. 
 
 2- An unsystematized delusion is one in which a false 
 
Delusions 267 
 
 belief is entertained, but there are at the same time 
 maintained other beliefs and other impressions, which 
 are in direct opposition to the delusion. The patient 
 makes no attempt to bring his various sensations and 
 perceptions in accord with his delusion. Such delusions 
 we find for example in dementia paralytica, dementia 
 praecox, and other cognate conditions. The patient, for 
 instance, may consider himself a thousand miles in 
 height. It may be pointed out to him that his neighbor 
 is only six feet tall. He will agree that his neighbor is 
 tall and that he himself is shorter. But when at once 
 asked how tall he is, he will again reply that he is a 
 thousand miles high. In short, he fails to harmonize 
 the rest of his perceptions and ideas with his delusion. 
 
CHAPTER XXV 
 
 AMNESIA, ABOULIA, AND APROSEXIA 
 
 A MENTAL state that refers to an event 
 which has taken place in the past, or at a cer- 
 tain date within the same personal experi- 
 ence is regarded as memory. Memory re- 
 quires the retention or conservation of the past experi- 
 ence, reproduction as an idea or mental image, local- 
 ization in time, and the reference to the same ex- 
 periencing personality, or self. As James tersely puts 
 it: "A general feeling of the past direction in the 
 time, then, a particular date conceived as lying along 
 that direction, and defined by its name or phenomenal 
 contents, an event imagined as located therein, and 
 owned as part of my experience, — such are the ele- 
 ments of every act of memory." 
 
 Memory depends on what Professor James terms 
 "setting" that is the concomitant date, self present, 
 warmth and intimacy, and so on. It is this setting 
 which makes us conscious of the past as past. Ac- 
 cording to James "The only hypothesis to which the 
 facts of inward experience give countenance is that the 
 brain tracts excited by the event proper, and those ex- 
 cited by its recall, are in part different from each oth- 
 er. If we could revive the past event without any associ- 
 ates, we should exclude the possibility of memory, and 
 simply dream that we were undergoing the experiences 
 as if for the first time." In other words, we would 
 have what I describe as a hypnoidic state. 
 
 268 
 
Amnesia, Aboulia, and Aprosexia 269 
 
 Forgetfulness in itself should not be regarded as an 
 abnormal phenomenon as some are apt to think and 
 even develop a fanciful psychopathology of every day 
 life which claims that forgetfulness depends on some 
 hidden wish and desire, as if forgetfulness is a volun- 
 tary affair or something that depends on wisheis and 
 desires of the subconscious, getting rid and suppress- 
 ing or forgetting the disagreeable. Nothing can be 
 further from the truth. They who claim it show not 
 only lack of psychological insight into human nature, 
 but in order to retain the Procrustean bed of their fanci- 
 ful speculation, they cripple and ignore the facts of or- 
 dinary life. 
 
 Nothing so much impresses itself on the mind 
 and is remembered so lastingly as some extremely 
 painful experience. The very attempt at trying to for- 
 get a painful experience stamps it all the more strongly 
 on the mind. We remember best what we eagerly wish 
 to suppress and forget. The human race, and in fact 
 all animal life, would have long ago disappeared from 
 the face of the earth, if painful experience tended to be 
 forgotten. 
 
 We may also add that experiments performed on 
 the oblivescence of the painful tend to prove that it is 
 the painful that remains for a long time specially vivid 
 in consciousness. 
 
 The characteristic of consciousness is purposive 
 selection for the need of the present moment of 
 consciousness. What is not requisite for the present 
 moment has to be forgotten in order that mental 
 activity should be carried on at all. "If we remem- 
 bered every thing" says James, "we should on most oc- 
 casions be as ill off as if we remembered nothing. It 
 
270 Diagnosis of Psychopathic Diseases 
 
 would take as long for us to recall a space of time as it 
 took the original time to elapse, and we should never 
 get ahead with our thinking. All recollected times un- 
 dergo, accordingly, what M. Ribot calls foreshorten- 
 ing; and this foreshortening is due to the omission 
 of an enormous number of facts which filled them." 
 
 Ribot insists on the fact that "one condition of 
 remembering is that we should forget. Without 
 tbtally forgetting a prodigious number of states of 
 consciousness, and momentarily forgetting a large 
 number, we could not remember at all. Oblivion, ex- 
 cept in certain cases, is thus no malady of memory, 
 but a condition of its health and its life." Remember- 
 ing is a continuous forgetting. 
 
 The greater the number of associations, or the more 
 numerous the experiences of the settings, associated 
 with the event, the easier it is to remember, especially 
 so if the event and its setting have been gone over re- 
 peatedly in recollection. 
 
 The principle of substitution is of importance 
 in the phenomenon of forgetfulness. The possibil- 
 ity of substitution of other ideas or words serving 
 the same purpose makes it harder to rememben 
 'Hence in proportion as the possibility of such sub- 
 stitution becomes more increased, forgetfulness in- 
 creases. 
 
 "One of the most striking symptoms of fail- 
 ihg memory," says Wundt "in both normal andpath- 
 olldgical cases, is the weakening of verbal memory. 
 There is a lack of ability to remember, first proper 
 names, then names of concrete objects in the ordinary 
 envirdnriifent, Still later abstract words, and finally par- 
 ticles' thdt are entirely abstract in character. The sue- 
 
Amnesia, Aboulia, and Aprosexia 271 
 
 cession corresponds exactly to the possibility of substi- 
 tuting in consciousness for single classes of words oth- 
 er ideas that are regularly connected with them 
 through complication. This possibility is obviously 
 greater for proper names, and least for abstract par- 
 ticles which can be retained only through their verbal 
 signs." 
 
 Kussmaul puts the matter in a still clearer light: 
 "The more concrete a conception is, the sooner 
 is it forgotten. This is because our ideas of persons 
 and things are less strongly bound up with their names 
 than with such abstractions as their business, their cir- 
 cumstances, their qualities. We easily can imagine per- 
 sons and things without their names, the sensorial 
 image of them being more important than that other 
 symboUic image, their name. Abstract conceptions, 
 on the other hand, are only acquired by means of the 
 words which alone serve to cover stability, and still 
 more adverbs, prepositions, and conjunctions are more 
 intimately connected with our thinking than are sub- 
 stantives." 
 
 We may add that the factor of repetition must also 
 be taken into consideration, inasmuch as proper names 
 are not so often repeated in experience as verbs, adjec- 
 tives, and pronouns. 
 
 Forgetfulness in short is not as some superficial wri- 
 ters explain a matter of wish and will, whether con- 
 scious or subconscious, it is a highly complex phenom- 
 enon depending on a number of physiological and psy- 
 chological factors. 
 
 The same holds true in the case of amnesia. A 
 subconscious state with a vague or weak attention as in 
 dreams or narcosis, or a change from one state 
 
272 Diagnosis of Psychopathic Diseases 
 
 of consciousness into another, as from somnambulism 
 into the waking state is sufficient to give rise to amnesia. 
 
 Of course, there is no need to point out the well 
 known fact that the time element has a strong influ- 
 ence in the weakening of retention, reproduction and 
 recognition of our past experiences. Ebbinghaus and 
 afterwards Wolfe discovered by a long series of ex- 
 periments the following law : "The quotients of reten- 
 tion and forgetfulness (of the time saved for mem- 
 orization and the time requisite for relearning) are 
 inversely proportional to the logarithms of the times 
 passed since the first learning." 
 
 We have pointed out that while sensory elements 
 have intensity, representative elements possess vivid- 
 ness. Representative elements representing as they do 
 presentative or sensory elements may refer with vari- 
 ous degrees of vividness to the same sensory experi- 
 ence. Thus we may have different vivid representations 
 in regard to the same event which we have lived 
 through some time before. Such vividness may pass 
 through all degrees, from the highest to the lowest and 
 finally reach the barely representable, almost border- 
 ing on the threshold of vividness. 
 
 Sensory intensity and representative vividness are 
 closely interrelated. Intense sensory processes usually 
 go with vivid representations. There are however con- 
 ditions when the two do not go together. A sensory 
 process, however strong, instead of giving rise to an in- 
 tense representation, may awaken a representation of 
 low or of marginal vividness. In many subconscious 
 states intense sensory experience may give rise to rep- 
 resentative processes of such low marginal vividness 
 that the latter fall below margin or the threshold of 
 
Amnesia, Aboulia, and Aprosexia 273 
 
 consciousness or awareness, and are not perceived by 
 the person. The experiences cannot be reproduced, can- 
 not be recognized, and hence are not remembered. The 
 experiences become dissociated. We may therefore say 
 that where vividness is very low there we have dissocia- 
 tion. In other words, as we have pointed out before dis- 
 sociation and vividness are in inverse ratio to each other. 
 The lower the vividness the greater the amount of dis- 
 sociation. 
 
 The same holds true in the case of amnesia, 
 the lower the vividness of the mental states the greater 
 and deeper the amnesia. In dream states as well as in 
 other states in which the vividness of the representa- 
 tive elements is low and vague there is a corresponding 
 degree of amnesia. The amnesia is all the greater and 
 deeper where not only the representative elements are de- 
 void of vividness, but where the sensory elements of the 
 experience are lacking in intensity. Many psychopathic 
 states, hypnosis and somnambulism, pre-epileptic and 
 post-epileptic states as well as states of narcosis, and 
 many dream states answer such conditions. Amnesia 
 may he regarded as a function of representative vivid- 
 ness and sensory intensity. 
 
 Amnesia may be considered as anaesthesia of mem- 
 ory. The underlying pathological process of amnesia 
 is a functional disaggregation of neuron systems in the 
 cortical association areas. Instead of having relation 
 to sensations, the anaesthesia is related to recollection of 
 events, percepts, and concepts, or to their reproduction 
 and recognition. 
 
 Memory, as we have pointed out, requires retention, 
 reproduction, recognition, and localization in the per- 
 son's time ; that is, an experience must be retained, must 
 
274 Diagnosis of Psychopathic Diseases 
 
 be capable of being reproduced or recalled, and when re- 
 produced the experience has to be recognized as having 
 taken place within the past personal life. In many cases 
 the experience is retained, but can only be reproduced 
 and recognized in subconscious states. 
 
 Regarded from this standpoint the pathological 
 process of memory disaggregation may give rise to 
 the following forms of amnesia : 
 
 I Amnesia of reproduction. 
 
 II Amnesia of recognition. 
 
 III Amnesia of the waking state, or complete am- 
 nesia. 
 
 IV Amnesia of retention, or absolute amnesia. 
 
 By amnesia of reproduction is understood that type 
 of amnesia in which the reproduction of the experience 
 is lost. Of course, it is clear that when reproduction is 
 lost the recognition is also gone, for it is impossible to 
 recognize the memories which are not reproduced. 
 Still the fact that reproduction is lost does not mean 
 that the element of recognition is completely gone. 
 For while the patient is unable to reproduce the 
 experience, he can recognize it fully and even localize it 
 correctly in time, when the experience is presented to 
 him in connection with some sensory impressions. We 
 find such cases in the aphasias, the patient cannot write 
 spontaneously, he cannot reproduce the letters, but he 
 can read them when he sees them. 
 
 By amnesia of recognition is understood that form 
 of loss of memory in which the recognition alone is 
 gone. For memory requires retention, reproduction, and 
 recognition. An experience must not only be repro- 
 duced, but must also be recognized as belonging to one's 
 own past. 
 
Amnesia, Aboulia, and Aprosexia 275 
 
 The patient is able to reproduce the old content of 
 memory, the event, percept, or concepts and their com- 
 bination, but he is unable to recognize them as belong- 
 ing to his past. They simply come into his mind, but 
 seem to him strange and unfamiliar. These forgotten 
 memories usually can be brought out by distracting the 
 patient's attention, or by placing him in a state of 
 mental rest and comparative inactivity, or they may 
 appear in the form of hypnoidic states. In many sub- 
 conscious states, such as the hypnoid, hypnoidic and 
 hypnoidal states, in the, different forms of double and 
 multiple personality experiences are reproduced, but 
 they are not recognized. 
 
 In the psychopathic forms of amnesia of a motor 
 character in which large zones of memories are 
 engulfed into the subconscious we sometimes find 
 that memories are gone, memories which can neither 
 be recognized nor reproduced, still we are not justified 
 in thinking that the memories are completely lost. For 
 we can find them present on tapping the patient's subcon- 
 sciousness. In deep and extensive forms of amnesia the 
 ipatient can neither recognize nor reproduce what has 
 been forgotten. The process of disaggregation of con- 
 scious and subconscious is complete. 
 
 The content of memory may be reproduced, but can- 
 not be recognized as such. Memories can be easily 
 reproduced, but' they cannot be recognized as belong- 
 ing to the moment's past experiences. This form, of 
 amnesia is characterized as amnesia of recognition, 
 since one of the elements of memory, namely, that of 
 recognition is wanting. There is a whole class of 
 amnesias in which the patient is able to tell events from 
 his former life, but he is unable to recognize them as 
 
276 Diagnosis of Psychupdiku Diseaidi 
 
 belonging to his own past. 
 
 The hypnoidal states have just this characteris- 
 tic that when they first come to the surface, the 
 memory content brought up is regarded by the 
 patient as new experience, and only later on, with 
 the synthesis of the hypnoidal states into the function- 
 ing moment, can recognition possibly become ef- 
 fected. Thus in the M. and F. cases the lost mem- 
 ories reproduced in hypnoidal states were not im- 
 mediately recognized, they were taken as chance ideas, 
 or mere fancies, and only some time later were they ac- 
 knowledged and owned by the patient. Similarly in 
 W. and other cases of like character the lost memories 
 welling up from the subconscious in the form of spon- 
 taneous hypnoidal states often lack the element of rec- 
 ognition, and acquire it with the process of effected syn- 
 thesis which, however, is not always forthcoming, as it 
 depends on the depth or extent of disaggregation. 
 
 We must emphasize the fact which has been but too 
 often overlooked, namely, the fundamental difference 
 between reproductive amnesia and that of the purely 
 recognitive character. In reproductive amnesia the very 
 contents of memory are lost, whether the loss be func- 
 tional or organic, whether relative and temporal or 
 absolute ; in recognitive amnesia or amnesia of recogni- 
 tion, the content of memory, on examination, can be 
 shown to be present and reproduced, but it is not rec- 
 ognized'as belonging to one's past life. 
 
 Amnesia of recognition is no doubt due to a narrow- 
 ing down of associative connections brought about by 
 the process of functional dissociation, affecting the par- 
 ticular content. For recognition, as we have shown is 
 a function of associative systems, recognition becoming 
 
Amnesia, AbouUa, and Aprosexia 477 
 
 more localized in time and more specific in proportion 
 to the number of associative interconnections. 
 
 Recognitive amnesia depends On a limited field of as- 
 sociative activity, or rather to say on a great extent of 
 dissociation, while reproductive amnesia, or amnesia of 
 reproduction is the outcome of complete functional dis- 
 sociation. In both cases the psychic content is retained, 
 only in one case it is reproduced, but not recognized, in 
 the other it is neither recognized nor reproduced. 
 
 In the phenomena of bimorphosis and polymorphosis 
 of personality, whether coexistent or successive, the 
 same important distinction between amnesia of rec- 
 ognition and amnesia of reproduction should be main- 
 tained. This distinction gives us a wider, deeper and 
 clearer view of the phenomena and their interrelation. 
 
 In amnesia of the waking state or in complete amnesia 
 the process of disaggregation has proceeded far deeper 
 than in that of the previous forms. The moment has 
 not only lost the power of recognition, but also that of 
 reproduction. Hypnoidal states can sometimes be in- 
 duced, but with extreme difficulty. When the lost con- 
 tent is indirectly presented to the patient by outsiders, 
 such as his family, he cannot believe that he has lived 
 through it, he cannot identify his past experience. 
 
 Similarly when the lost content wells up directly into 
 consciousness through hypnoidal states occurring spon- 
 taneously, or induced experimentally, or coming in an 
 indirect mode by way of dreams, the patient is still un- 
 able to recognize it as his own past. In this form of 
 amnesia one has to look for hypnoidic states which oc- 
 cur during sleep in which the lost content is re- 
 produced and recognized by the outlived and now fully 
 resurrected moment. 
 
278 Diagnosis of Psychopathic Diseases 
 
 Cases of complete amnesia are found in normal, 
 healthy life, in abnormal mental states, in nervous dis- 
 eases, in sanity and insanity. In the normal state we 
 find it in relation to dream life. A third of our life 
 we pass in sleep, a large part of which is filled with 
 dreams, often exciting, but frequently leaving no trace 
 behind. On awakening we can by no effort of 
 will retrace the forgotten dream experience. It is 
 apparently gone and lost forever, so it seems, but this is 
 not so. Inhibit the principal synthetic mpment of self- 
 consciousness, descend to the lower subconscious 
 regions of moments-consciousness, and there we may 
 find the dreams. The dream becomes dissociated 
 from the principal functioning constellations, the syn- 
 thesis of which is the given waking personality. 
 
 In the abnormal states of alcoholic intoxication, for 
 instance, we find that experiences of one state, espe- 
 cially that of the state of intoxication, are frequently not 
 known to the sober state ; the memories may recur with 
 the return of the toxic conditions. In psychopathic 
 sleeping states due to ill nutrition, or worry, or over- 
 work and overexertion, or to all of them combined, we 
 find that experiences lived through and acted out are 
 immediately forgotten on awakening. We meet with 
 cases of amnesia in many forms of psychopathic and 
 neuropathic waking states. 
 
 In complete amnesia the system that has withdrawn 
 is perfectly sound, only it possesses groups of a less 
 complex nature, and the former connections can be 
 again reinstated under favorable circumstances. Should, 
 however, the hurtful stimulus be of such a nature as to 
 destroy a whole system, then the amnesia effected is 
 absolute. The connections can not any more be rein- 
 
Amnesia, Aboulta, and Aprosexia 279 
 
 stated, because the system itself isdestroyed* 
 
 The process of disaggregation setting in under the 
 action of strong and hurtful stimuli is not something 
 new and different in kind from the usual; it is a con- 
 tinuation of the process of association and dissocia- 
 tion normally going on in the higher constellations of 
 mental systems. The one process gradually passes into 
 the other with the increase of the intensity or duration 
 of the hurtful stimulus. 
 
 In amnesia of retention or absolute amnesia the 
 process of disaggregation has gone still farther and 
 has brought about distintegration within the content 
 itself. Recognition and reproduction are impossible, 
 from the very nature of this type of amnesia, since the 
 very content is affected. Hypnoidal and hypnoidic 
 states cannot possibly be induced, because the disag- 
 gregated moment-consciousness has lost through de- 
 generation all its psychic content. In the different 
 forms of brain lesions, involving loss of cellular nerve 
 tissue of the higher spheres, we meet with this form 
 of amnesia, such, for instance, as the different forms 
 of organic aphasias, or apraxias. 
 
 The results of the one continuous process of disag- 
 gregation through absolute amnesia differ fundament- 
 ally from reproductive, recognitive, and complete am- 
 nesia. In the former, in absolute amnesia, the disaggre- 
 gated states are irretrievably lost; in the latter, forms 
 of amnesia the seemingly lost memories are really pres- 
 ent within the patient's mind in a subconscious condi- 
 tion. They can become manifest and finally even be- 
 come synthetized within the functioning moment-con- 
 sciousness. 
 
 Psychopathic amnesia differs radically from that of 
 
28o Diagnosis of Psychopathic Tfiseaies 
 
 organic nature. In the latter the affected content is 
 irretrievably lost, in the former the seemingly lost 
 memories are really present in a subconscious form, and 
 can be brought out in hypnotic, hypnoidic, and hypnoid- 
 lal states by proper psychopathological methods. 
 
 Regarded clinically from the standpoint of lost con- 
 tent, amnesia may be divided into the following types : 
 I General. 
 II Special. 
 
 III Localized. 
 
 IV Systematized. 
 V l&nsory : 
 
 a. local, 
 
 b. total, 
 VI Motor : 
 
 a. local, 
 
 b. total, 
 VII Periodic. 
 
 VIII Alternating. 
 IX Progressive. 
 
 In general amnesia the whole content of the patient's 
 memory is lost. In such cases the amnesia is so pro- 
 found as to make of the patient almost an infant. The 
 patient does not know how to eat, to talk, to walk, 
 nor does he know anything of space or time. In short, 
 he must learn everything over again. In such cases 
 the retentiveness of memory in general for acquiring 
 new things may be quite acute or even better than in 
 the preamnesic state. Such a state is shown in the classic 
 case of the Rev. J. C. Hanna. The general amnesia 
 in this case is, one of recognition, the reproduction oc- 
 curring in hypnoidic states ; the element of recognition, 
 however, is absent. 
 
Amnesia, Aboulia, and Aprosexia 281 
 
 In general amnesia memory is affected as a whole. 
 No definite systems of the functioning moment become 
 submerged and subconscious, but the functioning mo- 
 ment as a whole with all its acquisitions and riches sinks 
 into the subconscious depths from which it cannot 
 emerge, unless put under special conditions. The man- 
 ifested psychic activity is at its minimum. The func- 
 tioning moment-consciousness being submerged, there 
 is apparently no manifested mental activity and a deep 
 coma seems to be present. 
 
 External and internal stimuli finally awaken some 
 new moment which begins to function with a min- 
 imum of content characteristic of early infancy. The 
 amnesia is so profound that the patient becomes 
 very much infant-like. The patient does not know any- 
 thing about space and time, does not know how to eat, 
 how to walk, how to dress, how to talk. Everything 
 must be learned over again. It is true that the patient 
 in such cases shows great, even extraordinary proficiency, 
 learning things in a very short time, but he must learn 
 every thing all over again. The general retentive- 
 ness of memory is often extremely good, even better 
 than in the normal state. The Hanna case described in 
 "Multiple Personality," may serve as a good illustra- 
 tion. In general amnesia hypnoidal states are not in- 
 frequent, and one has to be on the lookout for them. 
 Hypnoidic states may occur. 
 
 The lost content may be of a special character, the 
 amnesia referring to the special senses, such as sound 
 or light. The memory associated with visual stimuli 
 for instance, may become affected and the patient may 
 lose all ability to interpret visual impressions and 
 sensations coming from external stimyli, The pa- 
 
282 Diagnosis of Psychopathic Diseases 
 
 tient on seeing objects may be able to appreciate the 
 different stimulations and impressions, and can even 
 describe them, but he cannot know the object, or the 
 particular visual stimuli which call forth visual im- 
 pressions. The complex memory that is normally awak- 
 ened by the visual impression is absent, the patient does 
 not know the meaning of the impression, in other words, 
 he does not know the object. 
 
 In this respect the patient may be regarded as blind ; 
 only it is not a sensory blindness, as the senses may, in 
 fact, be in excellent condition, it is associated mem- 
 ory representations by which the sensation is per- 
 ceptually interpreted as being this or that particular ob- 
 ject that is wanting. It is not the sense that is deficient, 
 but it is the mind that is blind. This is sometimes called 
 mental blindness, more correctly visual apraxia, since 
 it is only the memories awakened at visual sensory cues, 
 it is only these memories that are really affected. 
 
 More frequently the amnesia is even more special, re- 
 ferring to a highly specialized content; the memories 
 relating, for instance, to the interpretation of visual 
 signs oFsymbols, such as written words may become af- 
 fected. The patient is unable to read or even know his 
 letters, although he may be able to trace them with 
 his finger and even reproduce their shape and outlines 
 from memory. In such highly specialized cases of am- 
 nesia it is not the visual memory which is deficient, but 
 rather the systems of auditory representations. 
 
 We must guard against the confusion between 
 visual memory proper and that "visual memory" 
 which has little or nothing to do with visualiza- 
 tion. The visual memory may be well preserved, be 
 even in excellent state and still the patient may be to- 
 
Amnesia, Aboulia, and Aprosexia 283 
 
 tally unable to read, may suffer from alexia. Thus 
 in the case of C. an extremely interesting case of apha- 
 sia this state was present. 
 
 The patient could trace with her finger letters, 
 numerals, both printed and written, could represent 
 them in her mind with her eyes closed, but still 
 could not read them. In other words, the patient for- 
 got their names, that is the auditory representations 
 and the modes of their auditory combinations. Visual 
 memory then was present, but the auditory memory 
 representations associated with and awakened by vis- 
 ual presentations was absent. 
 
 There are, however, cases where the pure visual mem- 
 ory Is lost, when the patient is unable to represent to 
 himself visually, he does not know, he forgets how 
 things look as soon as they are removed from his direct 
 visual presentation. 
 
 The amnesia again may be in relation to sound, tac- 
 tual, kinaesthetic, and other stimuli. The specific im- 
 pressions do not awaken the associated memories syn- 
 thetized within the moment and giving rise to the per- 
 ception of external objects. Once more we have to 
 point out the fact that one must guard against the 
 confusion of amnesia of the particular special sense 
 representations and amnesia of associated representa- 
 tions coming from other senses. The two amnesias 
 are different as to their nature of content, in the one 
 case it is representations of the same sense that are 
 lost, in the other case it is representations of other senses 
 that are affected. This distinction is not only of psy- 
 chological value, but also of clinical importance. 
 
 When memories having auditory sensations as their 
 nucleus are affected, the patient can hear words 
 
284 Diagnosis of Psychopathic Diseases 
 
 and voices, he reacts to external sound stimulations, 
 has auditory sense impressions and sensations, but he 
 does not understand them, he cannot interpret them, he 
 has forgotten their meaning as relating to other systems 
 of memory-representations. The special auditory pre- 
 sensations, excited by special sound stimuli, do not 
 awakea their associated representations, synthetized 
 within the same system of moments. 
 
 At the same time when the patient is examined as to 
 his auditory memory proper it may be found that he 
 can imitate sounds, words, phrases, repeat them some- 
 time after they are pronounced before him, only he does 
 not realize their meaning, just as we can learn to imitate 
 and repeat words and phrases of a foreign tongue, the 
 meaning of which is entirely unknown to us. This 
 shows that auditory memory proper, or memory of au- 
 ditory "images," as some neurologists would say, is ac- 
 tually present. 
 
 If the auditory memory is also affected, then the 
 patient is unable even to imitate sounds, words and 
 phrases, still less is he able to repeat them some time af- 
 ter he has heard them, since he has no auditory rep- 
 resentations. Should, however, the auditory memory 
 alone be lost, then the patient loses all auditory repre- 
 sentations and, of course, all power of verbal concep- 
 tions. The patient may be able to speak, may even be 
 able to imitate and repeat sounds, but will be unable to 
 understand when spoken to. 
 
 Similar forms and varieties of amnesia may occur in 
 other kind of memory representations, where the 
 nucleus of the moment consists of presentations, coming 
 from other senses. fVe should in all of them discrimin- 
 ate between the memories of the same sense proper and 
 
Amnesia, Ahoulia, and Aprosexia 285 
 
 those of the associated memories. The memory repre- 
 sentations that are of the same nature with the nucleus 
 of the moment, namely, the sensory presentations are 
 different in kind from the associated memory repre- 
 sentations, unlike in nature of their sensory origin. 
 
 In case of amnesia of kinaesthetic representations, 
 the moment is unable to carry out its motor reactions 
 and adaptations. If the disaggregation is not of the 
 absolute type, but rather of the psychopathic, functional 
 type, whether reproductive or complete, the patient 
 is in a condition that looks very much like paralysis, 
 although the patient is actually not paralyzed; in other 
 words, the state is one of aboulia. 
 
 The amnesia may be in relation to special move- 
 ments, or to special organs of the body, then the 
 motor memory is affected. In all these forms of am- 
 nesia a part of life-experience is gone, — the patient's 
 hfe experience relating to a special sense is lost. 
 
 It must, however, be emphasized that if the amnesia 
 is of a psychopathic nature, the lost content is present 
 in a dissociated form in the subconscious, and can be 
 brought to the surface, if the patient is put in subcon- 
 scious states and subjected to psychopathic methods of 
 investigation. The pathological process in special am- 
 nesia is concomitant with functional dissociation in the 
 sensory or motor areas. 
 
 In the different forms of special amnesia we must 
 differentiate between the form of dissociation of repre- 
 sentations of a given quality from other representations, 
 unlike in quality, and the form of dissociation of rep- 
 resentations from their own sensory presentations. 
 The first form of disaggregation may be termed con- 
 veniently representative disaggregation, the second 
 
286 Diagnosis of Psychopathic Diseases 
 
 form presentative-representative disaggregation. 
 
 In the representative forms of disaggregation other 
 qualitatively unlike representations are absent and the 
 presentations with their qualitatively appropriated rep- 
 resentations lose their meaning. Sensations can be men- 
 tally reproduced, or what is the same represented, but 
 they do not awaken in the patient's mind any associ- 
 ated representations, coming from other sense organs, 
 and hence there is no knowledge of the mean- 
 ing of the external stimuli. Objects, affecting this par- 
 ticular disaggregated region of mental life, are not 
 recognized, and the patient in this direction may be 
 regarded as psychically blind or mentally anaesthetic. 
 
 In the presentative-representative form there can- 
 not be even a reproduction of the sensory stimulation, 
 the sensation cannot be reproduced, it is gone and lost 
 as soon as the sensory process ceases. In this respect 
 the form of consciousness reverts to the lowest type, 
 that of desultory consciousness. The patient falls in 
 a condition in which his mental life becomes inacces- 
 sible to stimuli, coming through this particular affected 
 mental system. Although sensory elements are awak- 
 ened each time as stimulations occur, no accumulative 
 process takes place, and the patient's psychic activity 
 in this particular direction loses all plasticity. The type 
 of moment-consciousness reverts to the extreme rigidity, 
 characteristic of the reflex type of moment-conscious- 
 ness. 
 
 Localized amnesia may be characterized also as 
 temporal amnesia. It is forgetfulness of a certain con- 
 tent in time past. The patient, for instance, may for- 
 get the experience of a day, of a month, or of a num- 
 ber of years. The memory for experiences before and 
 
Amnesia, Aboulia, and Aprosexia 287 
 
 after that time remains intact. The lapses can be 
 exactly located In time. 
 
 Usually such a localized amnesia occurs after some 
 Intense shock of a disaggregative character. This form 
 of amnesia is characteristic of psychopathic states. Psy- 
 chopathic amnesia is of the type of localized amnesia 
 and involves the memories of events that have occur- 
 red just before, during or some time shortly following 
 the trauma. 
 
 More often the lapse is for the time just preceding 
 and during the attack. The reason given by Ribot is that 
 the experiences preceding or during the attack had no 
 time to become organized, because the nutrition of the 
 cells was disturbed by the attack. This explanation, 
 however, is hardly tenable, as the cases of psychopathic 
 amnesia really show that the experiences are present 
 within the subconscious. It is more probable that re- 
 cently acquired memories having few associations can 
 be easily disaggregated and fall into the subconscious. 
 
 Systematized amnesia is somewhat like systematized 
 anaesthesia In that the forgetfulness Is in relation to 
 certain events only. Events of certain character are 
 forgotten. 
 
 In periodic amnesia the lapse of memory occurs pe- 
 riodically at regular or irregular intervals. The am- 
 nesia may each time be of the same content; again there 
 may be periodic amnesia where the forgotten content 
 varies. A definite experience may be forgotten at cer- 
 tain intervals: thus for Instance a woman may forget 
 at certain intervals that she is married, that she has 
 given birth to a child, etc., or the attack of amnesia 
 may each time involve a different set of experience. 
 The first form may be termed persistent periodic am- 
 
288 Diagnosis of Psychopathic Diseases 
 
 nesia, while the second form may be termed variable 
 periodic amnesia. In cases of variable periodic am- 
 nesia, the lost content is usually of a localized nature. 
 Experiences of certain times are forgotten, conscious- 
 ness is connecting and synthetizing its experience, leav- 
 ing out definite links. 
 
 Alternating amnesia is of an oscillating nature, the 
 lost content is oscillating sometimes coming up to the 
 surface of consciousness and sometimes lapsing, fall- 
 ing back into the subconscious. Alternating amnesia 
 may be of a systematized or of a localized nature. In 
 either case the content is always oscillating and vary- 
 ing. In the forms of alternating amnesia the 
 memory synthetizes certain links of experiences, while 
 others are altogether omitted from the synthesis, con- 
 sciousness bridges the missing links just as if they never 
 existed for the patient. 
 
 After a hypnoleptic attack these synthetized mem- 
 ories subside or lapse into the subconscious while 
 the omitted memories emerge also in a synthetized 
 form. Here the former memories constitute the 
 omitted links. It may, however, be that after an attack 
 the whole chain of experiences becomes complete. In 
 such cases, however, the patient though regaining the 
 lost experiences, does not recognize them as belonging 
 to himself, he regards them as experiences of the life 
 of another person. 
 
 The oscillations of forgotten content in alternating 
 amnesia may be represented by the following case : At 
 the end of 1890 a crisis or disturbing event occurred in 
 the life of the patient and during 1891 the experiences 
 of 1890 were forgotten, while in 1892 the experiences 
 of 1890 revived while those of 1891 were forgotten. 
 
Amnesia, Aboulia, and Aprosexia 289 
 
 In 1893 the experiences of 1891 were revived while 
 those of 1890 and 1892 were lost. In 1894 the experi- 
 ences of 1890 and 1892 were once more revived, while 
 those of 1 89 1 and 1893 were forgotten. In 1895 the 
 events of 1890, 1892 and 1894 were forgotten while 
 those of 1 89 1 and 1893 w^^e revived. In 1896 the ex- 
 periences of 1890, 1892 and 1894 were remembered 
 while those of 1891, 1893 and 1895 were forgotten or 
 rather, had subsided into the subconscious. The experi- 
 ences of 1890, 1892, 1894 and 1896 were bridged over 
 in synthesis and were made contiguous, as if the omitted 
 links of 1 89 1, 1893 ^nd 1895 did not exist. In the 
 same way the experiences of 1891, 1893, and 1895 
 were synthetized, while the lapse of 1890, 1892, 1894 
 and 1896 was not appreciated as a gap by conscious- 
 ness. When subconscious experiences recur they 
 form a synthesis, are bridged over and are contigu- 
 ous, while the ones that have subsided become the 
 omitted links and are in their turn regarded as 
 if not existing. If they do come to memory, they are 
 of a purely reproductive nature, without any element 
 of recognition. 
 
 The form of progressive amnesia consists in a pro- 
 gressive loss of the content of memory. This form of 
 amnesia probably seldom, if ever, occurs in the psy- 
 chopathic state. It is, however, common in certain 
 forms of organic disease, such as general paresis, senile 
 dementia and all forms of secondary dementia. 
 
 Etiologically considered, amnesia may be classified 
 into four types: 
 
 I. Traumatic Amnesia. 
 II. Toxic Amnesia. 
 
 III. Autotoxic Amnesia. 
 
2<)0 Diagnosis of Psychopathic Diseases 
 
 IV. Emotional Amnesia. 
 
 Traumatic amnesia is due to some intense mechan- 
 ical stimulus affecting the brain. The character of the 
 amnesia is determined by the seat of trauma, the dis- 
 turbance being of a psychopathic nature, namely, a dis- 
 aggregation in the interrelation of the moments, the con- 
 tent falling into the subconscious and is present in a low- 
 er type of moment-consciousness which can be revealed 
 by different psychopathological methods. 
 
 In psychopathic amnesia the character is not determ- 
 ined by the trauma alone, but also by the nature of the 
 circumstances and conditions surrounding the patient 
 during the time of the trauma. 
 
 Toxic amnesia is due to some toxic agent taken into 
 the system. Thus in alcoholism the patient may for- 
 get events occurring during the state of intoxication. 
 In my experiments with chloroform or ether gaps, lapses 
 appeared in memory. These memory gaps are of a 
 systematized or of a localized nature. In toxic amnesia 
 the patient on emerging from the state of intoxication 
 often forgets his conscious experiences during that state. 
 The lost memories, however, may sometimes be revived 
 in subconscious states. 
 
 Amnesia is autotoxic when the toxic agent is devel- 
 oped periodically, regularly or irregularly, by the organ- 
 ism itself, and may be due to defective elimination of 
 waste products. Attacks of this kind may be some- 
 times seen in the psychic equivalent attacks of epilepsy, 
 found interspersed in a number of typical epileptic at- 
 tacks. The various forms of periodical and circular 
 insanities are due to such conditions. To autotoxic 
 amnesia also belong the amnesias or lapses of memory 
 observed during severe headaches. 
 
Amnesia, Aboulia, and Aprosexia 291 
 
 Amnesia may be caused by some strong emotion, and 
 is termed emotional. The character of this form of 
 amnesia is determined largely by the nature of the event 
 and also by the character of the emotional disturbance. 
 
 The general law of amnesia is disaggregation from 
 the higher to the lower, from the complex to the simple, 
 from the less familiar to the more familiar; the loss of 
 psycho-motor activities is in the order of their complex- 
 ity and familiarity. Thus, for instance, habitual move- 
 ments or movements required in carrying on daily life 
 existence are last effected by the process of disaggrega- 
 tion. The very lowest forms of activity, such as reflex 
 action, remain unchanged. 
 
 The order of disappearance again depends also on 
 stability, on time element, on recency and on repetition 
 of the activity of the organized functioning systems. 
 The ones first organized and more often brought into 
 activity will be the more stable and will longer resist the 
 process of disaggregation. 
 
 Aboulia consists in a deficiency of will power. The 
 patient is unable to determine upon any definite move- 
 ment or action, especially when the mind is concentrated 
 upon it. From the very nature of the aboulias it is evi- 
 dent that they relate to motor phenomena. The lack of 
 resolution of the patient is due to general mental de- 
 pression brought about by subconscious experiences. 
 
 Anaesthesia and motor disturbances are associated 
 with aboulia. In aboulia a certain action becomes diffi- 
 cult to execute when the patient desires to perform it, 
 the patient cannot resolve or decide to perform a certain 
 act, no matter how strong his desire be. 
 
 There is in aboulia a disaggregation in the mental 
 systems forming the personality, the given wish or de- 
 
i^2 Diagnosis of Psychopathic Diseases 
 
 sire cannot be fulfilled; no impulse can apparently be 
 transmitted from the higher ideational to the motor 
 centres. If, for instance, the patient is told to perform 
 a certain act, he finds it difficult or impossible to execute 
 it. If the subconscious self, however, is appealed to, 
 the action or movement can be performed with ease. 
 This differentiates aboulia which is of a psychopathic 
 character from organic motor disturbances, since in 
 aboulia the patient can really perform the act when his 
 attention is diverted, while in organic disturbances there 
 is a permanent inability to execute movements or acts. 
 
 The aboulias may, like the anaesthesias, be divided 
 into: 
 
 I. Systematized. 
 II. Localized. 
 
 III. General. 
 
 IV. Special. 
 
 In systematized aboulia certain forms of ac- 
 tivity cannot be voluntarily performed. Certain actions 
 which the patient can perform in relation to all other 
 objects cannot be executed by him when these actions 
 relate to a definite class of objects. 
 
 Specialized aboulia is present when the patient cannot 
 say or write a certain word or do a definite act under 
 special circumstances. The power of forming the reso- 
 lution seems lost. The performance of the certain spec- 
 ialized act is associated with some past inhibitory experi- 
 ence, producing a disaggregation of a certain mental 
 system from the voluntary, controlling centres. 
 
 The inability may relate to the pronounciation of a 
 certain word or phrase or to the writing of a certain word 
 under certain circumstances, such as the presence of cer- 
 tain persons. The patient may be, for instance, una- 
 
Amnesia, Aboulia, and Aprosexia 293 
 
 ble to greet or bid adieu to certain persons, but finds 
 no difficulty in expressing this to other persons. Again 
 the patient may be unable to do a certain action under 
 some special conditions only, thus he may be unable to 
 write upon a particular table or when seated in a par- 
 ticular chair. 
 
 Localized aboulia has relation only to a particular 
 member of the body. This is not due to local disturb- 
 ances, but there is general apathy in relation to move- 
 ment of this particular member. The member affect- 
 ed seems to be entirely disregarded by the patient. As 
 long as the patient's attention is diverted from the 
 affected limb, its use is carried on normally, but when 
 the patient's attention is directed toward the member, 
 its voluntary control is almost entirely suspended. In 
 short, the patient cannot move a certain limb at will. 
 The deficiency is more marked when the patient is di- 
 rected to move the affected limb. 
 
 In general aboulia, there is a general paralysis of the 
 will, or of voluntary activity in general. In this as in 
 other forms of aboulia, the patient performs acts sub- 
 consciously, but cannot do so voluntarily, when his 
 attention is fixed upon them, or when directed to by 
 others. Under emotional excitement the aboulic state 
 is, so to speak, broken through, and the patient per- 
 forms all acts normally. The aboulia may at times 
 go so far as to make it impossible for the patient to 
 make up his mind to fall asleep or to arouse himself. 
 
 We have pointed out that the aboulia may be gen- 
 eral, special, or localized. It may involve all kinaes- 
 thetic memories or only some systems of them relating 
 to the activity of a particular member, or to certain 
 definite activities. The patient is unable to execute 
 
294 Diagnosis of Psychopathic Diseases 
 
 movements or particular sets of motor reactions. The 
 patient cannot vividly realize the motor representations 
 requisite for carrying out motor responses to the exter- 
 nal environment, he does not remember how to act; in 
 other words he forgets all about these actions, and when 
 attention is drawn to the action, the consciousness of 
 lack of execution may become an additional fac- 
 tor in bringing about a further disaggregation, the pa- 
 tient thus becoming even more helpless than before. 
 
 By different psychopathic methods, however, it can 
 be easily shown that the kinaesthetic memories are not 
 really lost, but can become manifested under favorable 
 opportunities ; in other words, they are still present sub- 
 consciously. 
 
 More often, however, the amnesia as to kinaes- 
 thetic memories is in relation to special, organized sys- 
 tems, such, for instance, as writing. The patient loses all 
 ability to write, although he may be able to read written 
 characters; he has all the memories associated with the 
 visual presentations of the letters, but the represen- 
 tations of kinaesthetic sensations are absent. The kin- 
 aesthetic sensations themselves, however, may be pres- 
 ent and can be brought about by proper external stim- 
 uli, but they do not awaken kinaesthetic representations. 
 
 Once more we must point out the fact that the phe- 
 nomena manifested depend on the depth of the disag- 
 gregation process. If the process distintegrates the 
 kinaesthetic memories themselves and brings about 
 their total effacement, then there is an absolute and 
 often an irretraceable loss of content and function, 
 unless other moments closely related, unaffected by the 
 process of degeneration, take up the function of the ef- 
 faced moments. 
 
Amnesia, Ahoulia, and Aprosexia 295 
 
 Should, however, only a disaggregation or dis- 
 sociation of the systems take place, then the dissociated 
 aggregates sink into the background of consciousness 
 or into subconsciousness, often giving rise to subcon- 
 scious manifestations. The patient has all the kinaes- 
 thetic representations, seemingly lost, but as a matter of 
 fact he is really able to carry out the movements, as it 
 can be shown by different psychopathological methods, 
 only the patient has no power to bring the movements 
 into function. The content is present, the function is 
 absent. 
 
 The patient has forgotten how to associate and uti- 
 lize these systems of kinaesthetic representations. We 
 may say that the patient has not the will to remember 
 them. This fact of not having the will is the characteris- 
 tic trait of psychopathic maladies, having as their back- 
 ground disaggregation of constellations of mental sys- 
 tems with preservation of content in simpler systems, 
 subconsciously present. From this standpoint we may 
 say that all psychopathic diseases are at bottom amnesias, 
 and that all psychopathic amnesias are in a certain sense 
 aboulias. 
 
 Aprosexia is a condition in which the patient is un- 
 able to concentrate his attention. The patient appears 
 to be in a state of indifference to all forms of activity. 
 He cannot fix his attention steadily upon anything, he 
 is in a state of apathy. The patient's attention may be 
 suddenly awakened, but he soon again lapses into his 
 indifferent state. The events of life do not interest or 
 move him. If a book is given to the patient or if some- 
 thing is read to him, he appears not to understand its 
 meaning, simply because the attention is not fixed upon 
 it 
 
296 Diagnosis of Psychopathic Diseases 
 
 The psychomotor disturbances, such as anaesthesia, 
 convulsive movements, etc., usually associated with 
 aprosexia are disregarded by the patient, as if the de- 
 rangements related to a different person. The atten- 
 tion can sometimes be temporarily fastened on some in- 
 teresting object or on some amusement in which the pa- 
 tient is ordinarily specially interested. In this state, 
 however, the patient cannot take cognizance of any 
 other event or activity taking place about him, the at- 
 tention being narrow and limited. 
 
 In such states of narrowed attention the patient 
 becomes highly suggestible. The attention is of- 
 ten so narrow and the available energy appears to be so 
 low that a drawing off even of a small amount of energy 
 results in neuron disaggregation, thus giving rise to a 
 state of suggestibility. So great is the tendency to neu- 
 ron disaggregation that even the momentary use of an 
 extremity may give rise to motor or sensory paralysis, in 
 the same way asthenopia may follow an attempt at read- 
 ing. 
 
 In aprosexia the least fatigue, the least concentration 
 of attention, brings about states of disaggregation, 
 such as hypnoidal, hypnoidic, convulsive, somnambulic 
 or sensory disturbances. This occurs especially when 
 the act of concentration of attention is accompanied by 
 emotion. This is due to the fact that in emotion there 
 is a large draught on neuron energy, giving rise to a 
 more extensive disaggregation with its concomitant psy- 
 chomotor manifestations. 
 
 In aprosexia it is difficult for the patient to acquire 
 new mental material. His life seems to be arrested, it 
 does not receive additional experience. What is ac- 
 quired is easily forgotten. 
 
Amnesia, Aboulia, and Aprosexia 297 
 
 Aprosexia Is really a form of aboulia. It is a lack 
 of will-power to concentrate the attention on a thing, or 
 circumstance or definite purpose. Aprosexia is rather 
 frequent in different degrees of intensity in psychopathic 
 states, but does not by any means constitute a funda- 
 mental trait of psychopathic diseases. Indeed, in some 
 forms of psychopathies the power of concentration of 
 attention may be very great. 
 
 Aprosexia may give rise to fixed systems of ideas. 
 Ideas or emotions that have become habitual and, there- 
 fore, more stable will in the struggle of the disaggre- 
 gated systems for the possession of the narrowed atten- 
 tion recur more often and obtain possession of the pa- 
 tient's mind, finally becoming fixed, in the form of fixed 
 ideas. 
 
 The forms of psychopathic fixed ideas differ from 
 the fixed ideas in the insane. In the latter the fixed idea 
 becomes the predominant feature of the patient's at- 
 tention and around it are grouped other ideas more or 
 less dependent upon the fixed one, often giving rise to 
 the formation of a delusion; in the psychopathic form 
 the fixed idea rises up into the patient's mind more or 
 less automatically. In aboulia, in the amnesias and 
 other psychopathic states the lost experiences and activ- 
 ities are not absolutely lost, but are present in the sub- 
 conscious. 
 
 In the organic diseases these experiences and activ- 
 ities are absolutely lost and cannot be reproduced. The 
 presence of the lapsed states and acquirements can be 
 proven to exist, subconsciously, in all psychopathic 
 cases. The patient, though apparently not fixing his at- 
 tention in psychopathic aprosexia, really does so sub- 
 consciously and the experience lost to the upper con- 
 
298 Diagnosis of Psychopathic Diseases 
 
 sciousness is retained by the subconscious. The pres- 
 ence of these experiences and activities in the subcon- 
 scious may be brought out by automatic writing, hyp- 
 nosis, and other psychopathological methods. 
 
 The general law of psychopathic disaggregation is 
 what is lost to the upper consciousness is present in 
 the subconscious. 
 
CHAPTER XXVI 
 
 FIXED IDEAS, MORBID IMPULSES, AND EMOTIONS 
 
 THERE is a form of mental derangement to 
 which the term imperative concepts or in- 
 sistent ideas is applied. From some sub- 
 conscious source, unknown to the patient, an 
 idea rises into consciousness with a persistency which 
 the patient cannot overcome. Thus a number or a sen- 
 tence may repeatedly and at various times force itself 
 into the mind of the subject. The person may be en- 
 gaged in some entirely different thought when suddenly 
 this idea or concept forces itself into the mind and 
 crowds out all others. This is usually a source of great 
 discomfort and inconvenience to the patient, as it in- 
 terferes greatly with his mental activity. 
 
 These forms of mental disturbances may occur 
 in otherwise mentally normal persons, but more 
 especially in those of neurotic predisposition. The 
 pathology consists in the dissociation of a persistent 
 well organized system, present in the subconscious and 
 then coming into consciousness in the form of a state 
 more or less hypnoid or hypnoidal in character. 
 
 Morbid impulses are uncontrollable manifestations 
 of affective, ideo-motor states. An unaccountable im- 
 pulse to do a certain thing suddenly takes possession 
 of the patient's mind, an impulse which may be so over- 
 whelming that restraint is almost impossible. The im- 
 pulse as soon as it appears in consciousness may im- 
 mediately pass into action. It is a form of emotional 
 
 299 
 
30O Diagnosis of Psychopathic Diseases 
 
 automatism. Thus a patient confined in an asylum met 
 an attendant with whom he was on pleasant relations. 
 The patient at once and without reason or warning sud- 
 denly struck the attendant a blow, felling him to the 
 ground. The patient immediately after expressed great 
 regret and sorrow at his deed. The impulse to strike 
 was simply irresistible. 
 
 Morbid impulses are of the nature of hypnonergic 
 states, or of post-hypnotic suggestion. Like the lat- 
 ter, they consist in a dissociation of ideo-motor systems 
 from the upper consciousness, but present to the sub- 
 conscious. They may emerge at regular or irregular 
 intervals and work themselves out automatically. Mor- 
 bid impulses differ from hypnonergic or post-hyp- 
 notic states, manifested in the hypnotic subject and 
 in different forms of psychopathies, in that they are bet- 
 ter organized, more persistent, and usually of a charac- 
 ter harmful to the patient or his social environment. 
 
 To this class also belong the phenomena of auto- 
 matism sometimes termed imperative movements. 
 The movements are often automatic, the consciousness 
 accompanying them is disconnected from the general 
 stream of consciousness. The patient may be conscious 
 of what he is doing, but continues the same movement 
 over and over. Thus some will move in a certain direc- 
 tion, as in a circle or in a certain figure; others will re- 
 peatedly walk to and fro, others move their lips, etc. 
 Similar movements are sometimes found in idiots and 
 imbeciles. Imperative, automatic, subconscious move- 
 ments occur in hypnonergic states and also in the dif- 
 ferent forms of psychopathic states. 
 
 Under morbid emotional states may be classed all 
 those states in which an apparently unaccountable emo- 
 
Fixed Ideas, Morbid Impulses, and Emotions 301 
 
 tion appears, not adapted to the particular, external en. 
 vironment. Some of these states may be revivals of 
 primitive emotions, adapted to a former environment. 
 Most of such morbid emotional states, however, 
 are due to experiences, often traced to early child- 
 hood, experiences which have become dissociated from 
 the upper consciousness and formed into a stable, well 
 organized system, emerging from the subconscious un- 
 der certain conditions. Such states usually occur in those 
 of neurotic predisposition and under circumstances 
 which favor such a dissociation. 
 
 In agoraphobia there is an intense and apparently un- 
 accountable anxiety when remaining in an open space, 
 or in an open square. The anxiety may become so great 
 that the patient becomes almost paralyzed and unable to 
 move. This state some consider as an atavistic, racial, 
 subconscious manifestation, dating to the time when an- 
 thropoid ape was living in a forest and for safety 
 avoiding open places. A similar condition we find in 
 wild animals and even iii the domesticated cat. The 
 cat always avoids open spaces, seeks to remain near 
 a hedge or fence when she goes about. It can, how- 
 ever, be shown that the phobia is due to some associa- 
 tion formed in early childhood. 
 
 Claustrophobia consists In a morbid anxiety of re- 
 maining in closed places, such as a small room or closed 
 vehicle. This state some consider as being atavistic in its 
 nature, and going back to the time when primitive man 
 or animals lived in caves having many exits for their 
 escape. It can, however, be proven that claustrophobia, 
 like agoraphobia, is due to subconscious experiences of 
 early childhood. 
 
 We not infrequently find in the lower classes 
 
302 Diagnosis of Psychopathic Diseases 
 
 of European or Asiatic populations a fear of en- 
 tering into dark, deserted places, or uninhabited houses 
 or passing through a graveyard at night, on account of 
 associations formed in childhood about ghosts and 
 spirits. This is true not only of superstitious persons, 
 but also of the highly educated who in daylight ridicule 
 the superstition, but when in darkness are unable to 
 overcome their intense emotion. 
 
 Various terms have been applied to these morbid 
 fears, and the number of phobias may be endless, per- 
 taining to all sorts of ideas. Among the most common 
 beside those above mentioned, are phobia or fear of 
 heights, monophobia, fear of solitude, misophobia or 
 fear of contamination, or defilement, aichmophobia or 
 fear of sharp objects, crystallophobia or fear of glass, 
 metallophobia or fear of metals, anthropophobia or fear 
 of men, and so on. 
 
 Morbid propensities are morbid impulses, associated 
 with intense morbid emotional states. The patient has 
 an impulse to do a certain act, but the act is not auto- 
 matic; he is fully conscious of the impulse and has in- 
 tense satisfaction and sometimes great pleasure in the 
 fulfillment of it. Morbid propensites may be of great 
 variety, relating almost to any acts or objects. They 
 may be of a harmless nature, or they may be dangerous 
 to life and property. 
 
 Desires and emotions play an important part in life, 
 and may give rise to morbid propensities. An example 
 of the harmless variety may be the desire to collect all 
 forms of newspapers, or old shoes, clothes, etc. Morbid 
 propensities may take the form of desire to set fire to 
 buildings (pyromania), or to steal (kleptomania), or 
 to kill (homicidal mania), morphomania, alcoholism. 
 
Fixed Ideas, Morbid Impuhes, and Emotions 303 
 
 onanism and many other forms. 
 
 The sexual propensities, on account of their sensa- 
 tional character, have of late attracted undue at- 
 tention. Freud and his school have made an un- 
 successful attempt to identify all psychopathic states 
 with sexual propensities. The Freudian school forces 
 the facts by means of a mediaeval or Chaldean symbol- 
 ism, by means of a revival of the superstitious 
 symbolism characteristic of astrology, alchemy, chiro- 
 manthy, or palmistry, and onieromancy. Oneiromancy 
 is specially the stronghold of this school of occultism. 
 
 All those various states, impulses, emotional condi- 
 tions and morbid propensities can be traced by psycho ff- 
 nosis to subconscious experiences, originated in early 
 child life. 
 
PART III 
 PSYCHOGNOSIS AND DIAGNOSIS 
 
CHAPTER XXVII 
 
 RECURRENT MENTAL SYSTEMS 
 
 WE can pass now to a consideration of func- 
 tional nervous and mental diseases which 
 I have described by the term "recurrent 
 mental states." Under recurrent psycho- 
 motor states I include insistent ideas, imperative con- 
 cepts, persistent or periodically appearing emotional 
 states, irresistible impulses, as well as the psychomotor 
 attacks of an apparently epileptic character which may 
 be designated as "psychic epilepsy." All these vari- 
 ous states are found in many a symptom-complex of 
 the insanities, but they are still more often met with in 
 the functional mental and nervous diseases, — in func- 
 tional psychosis. In fact, in many forms of hysteria, 
 in many types of neurasthenia, or of the more fash- 
 ionable "psychoasthenia," recurrent psychomotor states 
 constitute the main and often the only symptoms of the 
 malady. 
 
 The recurrent psychomotor states, with their great 
 wealth of symptoms, appear almost mysterious in their 
 onset and origin; they flash lightning-like on the pa- 
 tient's mind, get possession of it. then disappear, only 
 to reappear on some other favorable occasion. Others 
 persist in consciousness, with but slight remissions, 
 and keep the patient in a continuous agony. The pa- 
 tients are aware of the absurdity of the ideas and im- 
 pulses, but they are powerless to resist them. They re- 
 gard such onsets somewhat in the same way as the epi- 
 leptics regard their attacks, which set in against will 
 
 307 
 
3o8 Diagnosis of Psychopathic Diseases 
 
 and consciousness, and which are not subject to control. 
 I do not mean by it to indicate that all those psychic 
 attacks are of an epileptic origin, but I wish only to 
 point out the fact that there is some analogy between 
 recurrent psychomotor states and epilepsy, inasmuch 
 as both of them come on as sudden, uncontrollable at- 
 tacks. 
 
 It is true that in some cases we can drive the analogy 
 more closely, because in some of the forms of recurrent 
 psychomotor states we observe somewhat similar symp- 
 toms. We find the presence of a distinct aura, sen- 
 sory in character, a sense of oppression, and sometimes 
 a profound disturbance of consciousness during the at- 
 tack, the patient occasionally being insensible to ex- 
 ternal stimuli. In some cases we even find a dazed 
 state of consciousness, headache, and a condition of ex- 
 treme fatigue after the attack is over. 
 
 This resemblance, however, is but a superficial one. 
 Recurrent psychomotor states differ widely from epi- 
 lepsy. Many writers are deceived by this superficial 
 resemblance and regard such attacks as "larval epi- 
 lepsy," as "psychic equivalent of epilepsy." Such a 
 view is entirely unjustified on a close scientific analysis 
 of the facts. The most that can be done is to draw an 
 analogy between the attacks of insistent states and the 
 attacks of epilepsy, but we must bear in mind that an- 
 alogy is not a safe method, as one may find himself 
 reasoning on the same lines with the Esquimaux who 
 regards glass as a kind of ice. 
 
 It can be shown by a rigid study of the cases 
 of recurrent psychomotor states that they have nothing 
 to do with epilepsy, although they may be associated 
 with it. A study of the cases of recurrent psychomotor 
 
Recurrent Mental Systems 309 
 
 states reveals the presence of subconscious activities 
 which become manifested as insistent ideas, uncontrol- 
 lable emotions, irresistible impulses and various psy- 
 chomotor states closely simulating epileptic attacks. It 
 is from this standpoint that we may designate such 
 simulating attacks as psychic epilepsy, not because they 
 are psychic attacks, "equivalents" of real epilepsy, but 
 they are pseudo-epileptic attacks of a purely psychic 
 origin, — they are manifestations of subconscious ac- 
 tivities. 
 
 One general characteristic of these psychomotor states 
 is their recurrence with the same or similar content of 
 consciousness and with the same or similar motor reac- 
 tions. The patient thinks, feels, wills and acts the 
 same way. Subconscious dissociated states belong to 
 the type of recurrent moment consciousness, a type char- 
 acteristic of the lower forms of animal life, responding 
 to external environment with the same adjustments, with 
 the same psychomotor reactions. This biological type 
 of mental activity is described by me in "The Founda- 
 tions." From this standpoint, we may regard recurrent 
 psychomotor states as a reversion to the lower forms of 
 mental life. 
 
 The suddenness gf the attack, the uniformity of the 
 manifestations of the symptom-complex, the uncontrol- 
 lable, overpowering effect on the patient's personal con- 
 sciousness are all due to the same underlying factor of 
 dissociation of the patient's subconsciousness. A dis- 
 aggregated, subconscious life gives rise to recurrent psy- 
 chomotor states, — to insistent ideas, imperative con- 
 cepts, uncontrollable emotions, irresistible impulses, and 
 to states of "psychic" epilepsy. 
 
 There are many cases of insistent ideas and irresist- 
 
310 Diagnosis of Psychopathic Diseases 
 
 ible impulses which seem to contradict this law of uni- 
 formity and recurrence of psychomotor states which 
 are seemingly of an evanescent character, — they are 
 like stray comets coming out of the depths of space 
 only to disappear again and never to recur. A close 
 investigation will reveal the fact that the contradiction 
 is but an apparent one. The various insistent ideas and 
 impulses can in reality be referred to some few fun- 
 damental states persistently present in the subconscious, 
 and only appearing under different forms in the per- 
 sonal consciousness ; they are like so many leaves and 
 fruits of a single plant whose roots are planted firm- 
 ly in the subsoil of mental life. We may then 
 say that all insistent mental states take their origin in 
 a disaggregated subconsciousness and are periodic or 
 recurrent in character, and as such may well be desig- 
 nated as recurrent, psychomotor states. 
 
 We may possibly get better oriented in the vast do- 
 main of insistent mental states, if we make some pro- 
 visional classification. We may classify insistent mental 
 states according to content and form. Classified ac- 
 cording to content, we may divide insistent mental 
 states into: 
 
 1. Conceptual or ideational. 
 
 2. Ideo-motor. 
 
 3. Sensory. 
 
 4. Sensori-motor. 
 
 5. Motor. 
 
 According to form they may be classified as : 
 
 1. Desultory. 
 
 2. Systematized. 
 
 In the conceptual forms it is the general, abstract 
 idea that keeps on troubling the patient, such as the na- 
 
Recurrent Mental Systems 311 
 
 ture of God, of Christ, or the nature of the Trinity, 
 and so on. The insistent ideas arc here more or 
 less of a metaphysical character. The patient does 
 not feel satisfied with any answer. In many different 
 ways the patient tries to raise difficulties to all kinds of 
 possible answers. He tries to find loop-holes to escape 
 from any solution, so as to have the question remain 
 in full force. 
 
 Were it not for the intense anxiety which is 
 sometimes associated with such states, one would say 
 that the patient delights in the mere process of ques- 
 tioning. He wants the problem, but refuses obstinately 
 to accept the solution. In reality, however, it is not a 
 matter of delight to the patient to persist in a state of 
 problematic consciousness, so to say. Logical as the 
 solution may appear to the patient, the problem is ever 
 forced on the patient's personal consciousness, for it is 
 the work of dissociated states, having their origin in re- 
 current systems or settings of a disaggregated sub- 
 consciousness. 
 
 The insistent ideo-motor states refer to some act or 
 motor activity which the patient has to reason out so 
 as to know all the pros and cons, such as, whether it is 
 right to play cards, or read a Sunday newspaper, or to 
 visit theatre, or to travel on a Sabbath day. The pa- 
 tient gets lost in argumentations and discussions. He 
 employs the most subtle casuistry, but he always meets 
 with difficulties, never coming to any definite conclu- 
 sions. His mind is set entirely on the thought of the 
 action which is never to become a reality. The patient's 
 will is thus paralyzed, he is in a state of doubt, indeci- 
 sion and hesitancy. The patient cannot accept any deci- 
 sion, however logical, as the same problem ever surges 
 
312 Diagnosis of Psychopathic Diseases 
 
 up in his mind with renewed vigor. What avails the pa- 
 tient's reason against the blind dissociated forces of 
 systems or 'settings' as some prefer to put it, stirring in 
 the depths of a disaggregated subconsciousness? 
 
 The insistent sensory states comprise a wide domain 
 of manifestations. All the insistent emotional states 
 could be classed as sensory, since an emotion may be 
 regarded as a massive complex of sensory elements 
 coming from various parts of the organism. 
 
 Under this head we may include the functional states 
 of depression and anxiety as well as the various phobias. 
 Here also belong the various pains, headaches, hemi- 
 cranias or migraines, when forming the main or central 
 symptom of functional psychosis. The sensory symp- 
 toms of the hysterias, such as the anaesthesias and hyp- 
 eraesthesias, belong to the same category. 
 
 All those states present the typical characteristics of 
 the recurrent moment-consciousness. All of them can 
 be referred to dissociated experiences, to insulated men- 
 tal systems, 'settings,' 'complexes' persisting in a dis- 
 aggregated subconsciousness. 
 
 What is manifested as the attack with the whole 
 symptom-complex characteristic of it can be traced by 
 a rigid analysis to an original experience which has oc- 
 curred during the process of dissociation. The disso- 
 ciated subconscious experience, system, 'setting,' 'com- 
 plex' keeps on recurring as an attack. What goes under 
 the name of hysterical stigmata can in reality he traced 
 to dissociated, subconscious experiences. 
 
 During the attack the patient may preserve his per- 
 sonal consciousness fully or but partially. In such a 
 case it appears as if two centers of consciousness are 
 at work, one beside the other and one independent of 
 
Recurrent Mental Systems 313 
 
 the other. The patient may be aware of the new inde- 
 pendent forces which are foreign to him, but which 
 have apparently taken possession of him in spite of 
 himself. The self seems to be torn in two, and con- 
 sciousness is doubled. A new, incipient, parasitic per- 
 sonality is being formed in the recesses of the subcon- 
 scious, a parasitic personality having a will of its own 
 and no longer subject to the patient's personal con- 
 trol. 
 
 ^ In some cases, the dissociated systems forming the 
 parasitic personality may become fully manifested with- 
 out the patient being aware of it. We have two per- 
 sonalities in one organism working side by side, each ap- 
 parently ignoring or not taking cognizance of the ex- 
 istence of the other. 
 
 In other cases, again, the subconscious personality 
 seems to take full possession of the principal focus of 
 consciousness, the parasitic personality swamps the per- 
 sonal consciousness which sinks below the level of 
 active mental life, becomes submerged, and not 
 longer enters into active relations with the external en- 
 vironment. During such an attack the character of the 
 person is changed and the memory is not bridged over, 
 as it is in the course of the normal associative activity, 
 the functional recognitive elements are missing, con- 
 sciousness may know of those experiences, but does not 
 know them as its own. 
 
 The phenomena of recurrent or insistent mental 
 states range through various stages of dissociation; 
 they can all by analysis be referred to a condition of dis- 
 aggregated, subconscious, mental systems. 
 
 The sensori-motor and purely motor manifestations 
 are closely interrelated; sometimes the sensory and 
 
314 Diagnosis of Psychopathic Diseases 
 
 sometimes the motor symptoms predominate in the 
 total symptom-complex, when examined from a clinical 
 standpoint. Here belong the various functional or 
 hysterical, visceral disturbances, hemiplegias, paraple- 
 gias, paralyses and contractures, also the functional tre- 
 mors of psychic origin, all the states of "epilepsy" of the 
 psychic type known under the name of "psychic epilep- 
 sy" which so closely simulate typical epileptic attacks. 
 Finally, to the same category belong the various types of 
 tics. 
 
 The dissociated subconscious states may appear in 
 consciousness in a disconnected, disseminated form, — 
 they may appear as broken-up sentences, phrases and 
 sounds, or as images having no relation with one 
 another; they may come and go in great confusion, 
 often producing a chaotic condition in the patient's 
 mind. The ideas keep on chasing one another, turning 
 in circles without any rhyme and reason until the pa- 
 tient feels tired, exhausted, and dazed by the kaleido- 
 scopic whirl of the storm of ideas. Such insistent 
 states may be designated as desultory. 
 
 Quite often, however, the recurrent states are pa- 
 ranoidal in form. The ideas and feelings are well or- 
 ganized. The patient can give a clear, interconnected 
 account of his insistent states. In fact, the insistent 
 states stand out in the patient's mind so clear and defi- 
 nite that the patient can give a detailed analysis of all 
 the minutiae of the condition. It seems as If his gaze 
 is almost microscopically distinct, the least relation and 
 outline are noticed. 
 
 The Insistent mental states seem as If fixed, so that 
 the mental picture is strongly impressed on the patient's 
 consciousness, and the vaguest detail cannot escape 
 
Recurrent Mental Systems 315 
 
 scrutiny. A wealth of associations is grouped around 
 the central experience of the recurrent mental states, 
 which form nuclei of highly organized groups of mental 
 systems, arranged in an orderly array and logical rela- 
 tionship, forming an organic whole of a high degree of 
 organization, the nature of which cannot be under- 
 stood without a thorough exploration of the subcon- 
 conscious. Such recurrent mental states may be de- 
 scribed as systematized. 
 
 All those various manifestations can, by close investi- 
 gation into the patient's subconscious life, be traced to 
 active dissociated systems, having their origin in a dis- 
 aggregated subconsciousness. 
 
CHAPTER XXVIII 
 
 TRAITS AND THRESHOLDS OF DISSOCIATED SYSTEMS 
 
 ONE point is worth while emphasizing, and 
 that is the fact of recurrence, so highly char- 
 acteristic of the activity of dissociated sub- 
 conscious states or moments-consciousness. 
 The dissociated moment rises from the depths of the 
 subconscious regions, oversteps the threshold of con- 
 sciousness, manifests itself with an irresistible energy, 
 throws the normal psychomotor reactions, for the time 
 being, into a state of disorganization, and then lapses 
 from consciousness, only to be resurrected under con- 
 ditions favorable to its activity. Such dissociated, sub- 
 conscious activities I describe under the term of recur- 
 rent moment-consciousness. 
 
 This characteristic of recurrence is of great impor- 
 tance in psychopathology, as it brings the subconscious 
 activities under one perspective view, gives an insight 
 into their nature and mode of manifestation; and from 
 a biological standpoint brings them in line with the 
 mode of action of the lower mental types, which re- 
 spond to special stimuli of the external environment 
 with the same amount and quality of sensori-motor reac- 
 tions. 
 
 The sense of reality is usually described, by writers 
 on the subject, as not being affected. This is not the 
 case. A close study of the facts shows that the in- 
 sistent mental states come with an intensity of the sense 
 of their reality almost directly proportional to the in- 
 
 316 
 
Thresholds of Dissociated Systems 317 
 
 sistence of the mental state, a reality which is truly delu- 
 sional, or even hallucinatory, in character. This is es- 
 pecially true of the systematized, recurrent states of the 
 sensory type. The dissociated subconscious states refer 
 to a past reality, now subconsciously real. In the idea- 
 tional or conceptual forms the sense of reality appears 
 to be weakened, because of the weaker insistence of the 
 ideational elements as contrasted with the sensori-motor 
 elements. 
 
 Another important and striking trait of the dissoci- 
 ated states is the violence, I would almost say the 
 vehemence, with which they become manifested; they 
 reveal an amount of energy which similar states do not 
 possess in the normal condition, when the personal 
 consciousness is in active relation with the external en- 
 vironment. The energy displayed is more than the in- 
 dividual is capable of putting forth under ordinary con- 
 ditions of life. 
 
 The sudden, mysterious onset of subconscious states, 
 foreign to the whole character of the individual, 
 as well as the sudden display of energies, until now 
 unsuspected in the person, make those states ap- 
 pear as mystical in the eyes of the populace and the 
 superstitious. No wonder that the church has regard- 
 ed subconscious activities as supernormal and miracu- 
 lous, and either ascribed them to divine powers, or to 
 Satanic agencies, demoniacal possessions and obses- 
 sions. In our own time we have men devoting time and 
 energy to the investigation of the supernormal na- 
 ture of subconscious phenomena. 
 
 In my previous works on the subject I have dis- 
 cussed the energy and violence of the eruption of sub- 
 conscious forces as due to lack of inhibitions. This 
 
3 1 8 Diagnosis of Psychopathic Diseases 
 
 follows from the very nature of dissociation. Dis- 
 sociated subconscious systems being released from all 
 relations with other systems and groups of mental ele- 
 ments, being let loose, so to say, from all associative 
 bonds, will naturally display an amount of energy, un- 
 usual for similar systems under the normal conditions 
 of mental association. 
 
 Still the phenomena of dissociation point to facts of 
 a very important character. They point to an extremely 
 important principle which I term 'the principle of po- 
 tential subconscious energy,' a principle which is of im- 
 portance from a theoretical as well as from a practical 
 therapeutic standpoint. Meanwhile, we should keep in 
 mind two characteristic traits of subconscious phe- 
 nomena as manifested by dissociated states, — recurrence 
 and latent energy. 
 
 It may also be well to bring out another point of 
 interest which holds true of the various types of in- 
 sistent mental states, — they cannot be understood in 
 the light of conditions under which they occur, or truer 
 to say recur, since they bear no relation to their imme- 
 diate environment, but to that under which the states 
 have originally taken place. Unlike mental states of 
 the personal consciousness characterized by direct ad- 
 justments to the present conditions, the insistent sub- 
 conscious states are adjustments to past conditions. 
 They have no meaning in the present. May we not de- 
 scribe recurrent states as resurrected moments? 
 
 The theory of thresholds advanced by me in my 
 former works accounts for the phenomena of dissocia- 
 tion with their manifestations, the recurrent mental states. 
 The concept of threshold is not new, — it is at the 
 foundation of physiology and psychology. The phy- 
 
Thresholds of Dissociated Systems 319 
 
 siologist is familiar with the concept of threshold in his 
 experimental work, and the same holds true in the case 
 of the experimental psychologist. The theory of thres- 
 holds as advanced in my work is simply an extension of 
 the work of the physiologist and of the psychologist to 
 the domain of abnormal mental life. 
 
 It may be well to call attention to the recent tendency 
 of introducing metaphysical considerations of teleology 
 and of meaning into the phenomena of abnormal mental 
 life. Meaning is forced on abnormal mental life wheth- 
 er it is there or not. 'There is a reason' it is claimed 
 and a reason must be found and expressed in teleologi- 
 cal terms of purpose, wish, desire, and meaning. I 
 must say once for all that they who try their ingenuity 
 and fanciful symbolization and mental conflicts in order 
 to squeeze out some important meaning out of psycho- 
 pathic symptoms in the present life adjustments of the 
 patient miss the essential point of psychopathic states. 
 Psychopathic symptoms are essentially meaningless. 
 
 Psychopathic symptoms are like the actions and reac- 
 tions of a hypnotized subject or of a somnambulist 
 whose adaptations are to an unreality, to a world fanci- 
 ful and certainly widely different from the actual sur- 
 roundings. To search for a present meaning and for 
 an adaptive purpose in the symptom-complex of psycho- 
 pathic states is to misconceive their nature. 
 
 Psychopathic states in the individual closely corres- 
 pond to outlived, social customs and meaningless relig- 
 ious rites and traditions which society keeps on practic- 
 ing in reverence and which some thinkers attempt to 
 rationalize, pointing out that the meaningless customs 
 are fraught with a hidden, symbolic meaning. As Dr. 
 Frazer puts it well: "The history of religion is a long 
 
320 Diagnosis of Psychopathic Diseases 
 
 attempt to reconcile old custom with new reason, 
 to find a sound theory for absurd practice." The 
 same holds true in the case of the phenomena 
 of abnormal mental life. There is no symbolic or 
 hidden meaning in the symptoms of psychopathic states 
 for the simple fact that they have no meaning at all. 
 
 The symptoms of psychopathic states can only be un- 
 derstood in the light of the patient's past life experience, 
 but they have no meaning in the present. Psychopathic 
 symptoms are recurrent reversions to a former life period 
 in the patient's life, a period which has gone, which has 
 no further existence, but to which psychomotor reactions 
 keep on taking place. The psychomotor reactions of 
 the pathological symptoms-complex have no meaning in 
 the present life, because the conditions, circumstances 
 and relations are no longer in existence. 
 
 We find the same states in animals of low intelligence, 
 when the conditions of their existence are suddenly 
 changed, the animals keep on making adaptations which 
 are now useless, meaningless, and even harmful, 
 they make adjustments to conditions of a former 
 environment which is no longer in existence. The 
 duckling goes through swimming motions in a dry 
 pan; the squirrel keeps on hiding nuts in the cage, 
 dining room or the parlor; the beaver builds a 
 dam with books in the library. Psychopathic affections 
 are like the heliotropism of the moth attracted by light, 
 burning its wings and perishing in the flame. The psy- 
 chopathic symptom-complex is a survival from an an- 
 cient, long past period of the patient's life, a period still 
 subjectively surviving in the patient's subconscious life, 
 giving rise to psychomotor manifestations which are 
 meaningless, useless, harmful, and therefore pathologi- 
 
Thresholds of Dissociated Systems 321 
 
 cal. Psychomotor reactions are psychopathic, not be- 
 cause they have a hidden meaning, the mystical symbol- 
 ism of which the physician is to read by the aid of a 
 deep, cabalistic 'interpretation of dreams and psycho- 
 analysis,' but the symptom-complex and its reac- 
 tions are useless, meaningless, and even absurd. 
 
 It cannot be too much insisted on the fact that absence 
 of meaning and lack of adaptation are essential charac- 
 teristics of psychopathic states. Psychopathic states are 
 disease states, not because they have meaning, but just 
 because they are devoid of all meaning. Like tumors, 
 cancers, infections, and poisons of the body all the sig- 
 nificance psychopathic states possess is disease, degener- 
 ation, dissociation, disintegration with consequent suf- 
 fering and mental decay. 
 
 The concept of threshold is of importance to a right 
 understanding of psychopathic states. The concept of 
 threshold appears difficult and complicated. As a mat- 
 ter of fact it is simple and easy to comprehend. We 
 know that a certain amount of friction is necessary to 
 ignite a match, or a definite amount of pressure is requi- 
 site to press on the electric button to light an electric 
 lamp or ring a bell. That amount of energy which is 
 just sufficient to produce the efect may be termed the 
 stimulus threshold, the energy requisite to overcome the 
 resistance or the release of a certain amount of energy 
 is termed threshold. 
 
 It is clear that, if the energy falls below the threshold, 
 the effect cannot be called forth. A rise of threshold 
 would mean that more energy is requisite to bring about 
 the desired effect. The match is harder to light, and 
 the button is harder to press. 
 
 One of the main characteristics of living protopllasm 
 
^^2 Diagnosis of Psychopathic Diseases 
 
 is its adaptability to the conditions of the external en- 
 vironment. External stimuli give rise to reactions of 
 adjustment on the part of living substance. This prop- 
 erty, known in physiology as irritability, is characteris- 
 tic of ail living matter, or of what Huxley so aptly de- 
 scribes as "the physical basis of life." 
 
 Verwom defines the irritability of living substance 
 "as its capacity of reacting to changes in its environment 
 by changes in the equilibrium of its matter and its en- 
 ergy." In other words, living tissue responds to ex- 
 ternal stimulation with some discharge of energy. The 
 form of the discharge depends on the peculiar pro- 
 toplasmic structure, according as it is muscle, gland, 
 nerve cell, or but slightly differentiated protoplasm, 
 such as amoeba, or bacterium. The character of the 
 reaction to stimuli depends on the state of organiza- 
 tion of the living tissue. 
 
 The delicacy of response of living matter to external 
 stimuli has its limit. Very weak stimulations do not 
 call forth any reactions. Living tissue can only be set 
 into activity by stimuli of certain intensity. If the stim- 
 ulus falls below that intensity, the protoplasm does not 
 react. This holds true of all cells, from the simplest 
 bacterium and infusorium to the most highly differ- 
 entiated muscle-cell or neuron. 
 
 The minimal intensity below which the stimulus re- 
 mains ineffective is regarded as the threshold of stimula- 
 tion. "Exceedingly feeble stimuli" says Landois "are 
 without effect. The degree of intensity of stimulation 
 that originates the first trace of sensation is called the 
 threshold of sensation or the threshold-value." 
 
 The same is more clearly put by Verwom : 
 
 "Let us imagine an organism, e. g., a muscle, under 
 
Thresholds of Dissociated Systems 323 
 
 conditions in wiiich no stimulus aiffects it, and let us 
 bring to bear upon it a stimulus, e. g., the galvanic cur- 
 rent, which varies in intensity from zero upward and 
 can be graded easily and delicately. Then wc should 
 expect the muscle to exhibit phenomena of stimulation, 
 i. e., to perform a contraction, as soon as the intensity 
 is increased above O. But this docs not happen. The 
 intensity can be increased considerably before the mus- 
 cle performs even the slightest twitch. Only when the 
 intensity has reached a certain degree does the muscle 
 respond with a contraction. From here on the con- 
 traction is never wanting and up to a certain degree be- 
 comes more energetic the more the intensity is increas- 
 ed. The stimulus, therefore, begins to operate only at a 
 certain intensity, and this point is termed the threshold 
 of stimulation. Below the threshold the stimulus is 
 ineffective; above it the effect increases with the in- 
 creasing intensity of the stimulus. For the different 
 forms of living substance the value of the threshold is 
 very different. Thus nerve-fibres are put into activity 
 by extremely feeble galvanic stimuli while amoeba 
 demands very strong currents. The same is true of 
 all other varieties of stimuli in relation to the various 
 forms of living substance." 
 
 Psychologically, we may agree with Stout that "the 
 point at which it (the stimulus) is just indistinguisha- 
 ble, — so that the least increase would make it distin- 
 guishable is called stimulus-threshold." 
 
 Kiilpe's definition is short; "the just noticeable stim- 
 ulus is technically termed the stimulus-threshold." 
 
 With the increase of stimulation the irritability 
 of living substance diminishes, — ^the threshold rises. 
 The same stimulus no longer brings about a reaction, 
 
324 Diagnosis of Psychopathic Diseases 
 
 the stimulus must be increased in intensity before any 
 effect can take place. 
 
 An excellent account of it is given by Verworn in 
 his "General Physiology:" 
 
 "If a living object be stimulated by long continued, 
 oft repeated, or very strong stimuli, after some time it 
 passes into the condition of fatigue. The general char- 
 acteristic of fatigue is a gradual decrease of the irrita- 
 bility of the living substance. This is expressed espe- 
 cially in the fact that with increasing fatigue, the inten- 
 sity of the stimulus remaining the same, the result of 
 stimulation becomes constantly less. 
 
 "We have already become acquainted with some ex- 
 amples of this fact in considering galvanic stimulation. 
 If a constant current of average strength be passed 
 through an Actinosphoerium, at the moment of making 
 there begin to appear at the anode marked phenomena 
 of contraction. The protoplasm of the pseudopodia 
 flows centripetally until the latter are drawn in. Then 
 the vacuoles break; and a granular disintegration of 
 the protoplasm results, which proceeds constantly farth- 
 er from the kathode during the passage of the current. 
 This disintegration, beginning with great energy, be- 
 comes slower and less extensive the longer the current 
 flows, and after some time is at a complete standstill. 
 This means that the living substance of the Actinos- 
 phoerium becomes fatigued in the course of continual 
 stimulation, and decreases in irritability; hence the 
 stimulus, which at first induced pronounced phenomena 
 of disintegration, later produces no reaction at all. 
 Pelomyxa is fatigued still more rapidly than Actinos- 
 phoerium. Stimulation for a few seconds is sufficient 
 to make individuals of this genus wholly non-irritable 
 
Thresholds of Dissociated Systems 325 
 
 to currents of equal intensity; a much greater intensity 
 is then required to call out the same reaction." 
 
 The principle of variability of stimulation is of im- 
 portance in the reaction of nerve-tissue. When the 
 stimulus remains invariable, both in intensity and qual- 
 ity, no reaction follows. 
 
 This is clearly brought out in experiments on 
 nerve tissue. "The electrical current," says Landois, 
 "produces its strongest irritant effect upon a nerve at the 
 time of its entrance into the nerve and at the time of 
 its disappearance. In like manner any rapid increase 
 or decrease of the current passing through a nerve has 
 a strong irritant effect. If on the other hand, the cur- 
 rent be allowed to pass gradually into the nerve trunk 
 or to disappear, or the current passing through the 
 nerve be gradually increased or diminished, the visible 
 signs of nerve irritation are much less marked. In 
 general, the stimulation is more pronounced the more 
 rapid the current variation within the nerve, that is, 
 the more suddenly the strength of the current passing 
 through the nerve is increased or diminished." This 
 holds true in the case of the nerve in which, as Bow- 
 ditch has shown, there is little or no fatigue. 
 
 Where fatigue is present the principle of vari- 
 ability becomes a factor of the utmost consequence. 
 The principle of variability of stimulation plays an 
 important role in cells in general and in nerve cells in 
 particular where fatigue easily sets in and the threshold 
 is raised with the continuation of the stimulation and 
 with the successive discharges of cell energy. Variabil- 
 ity of stimulation and fatigue influence the fluctuations 
 of thresholds. 
 
 What is true in regard to unicellular organisms, such 
 
326 Diagnosis of Psychopathic Diseases 
 
 as the amoeba and cells and nerves in general, holds 
 also true of nerve-cells in their various combinations, 
 complex groups and systems, such as constitute the 
 highly complex organization of the central nervous 
 system. Each psycho-physiological system has its usual 
 threshold of stimulation just sufiEcient to set it into 
 activity. If under the influence of external and internal 
 conditions, the thresholds rise so that the ordinary stim- 
 uli of the environment cannot arouse the system into 
 activity, then that system is practically isolated from 
 the rest of the functioning mental aggregate, consti- 
 tuting the moving equilibrium of the living organism. 
 The system with the raised threshold is dissociated. 
 
 An illustration may bring the matter home to the 
 student. Let us imagine a telephone system of bells so 
 arranged that the pressure on a knob or the taking of a 
 receiver sends an electric current of a definite inten- 
 sity through a series of systems of bells, causing them 
 to ring. Suppose now that in one system the wires 
 have become so changed in their diameter or constitu- 
 tion that a current of a different intensity is now 
 requisite to set that system of bells into activity. The 
 former current is no longer sufficient. The particular 
 system can no longer ring by the action of the liberated 
 current. That system is dissociated. 
 
 By changing the intensity of the current or by tap- 
 ping the system from a different direction we may be 
 able to set ringing the disabled dissociated system of 
 bells. This would indicate that the system of bells it- 
 self is in good condition, and that only its interrelation 
 with other systems of bells has changed. Something 
 similar takes place in mental life. When the threshold 
 of a particular system has risen, that system has become 
 
Thresholds of Dissociated Systems 327 
 
 dissociated, communication with the rest of the psycho- 
 physiological or mental systems becomes difficult. 
 
 All the phenomena of dissociation are due to such a 
 change or rise of thresholds. In that particular direc- 
 tion communication has become difficult. As some psy- 
 chologists put it the paths have become blocked. This 
 condition gives rise to functional anaesthesias, aboulias, 
 amnesias, to all the manifestations characteristic of func- 
 tional psychosis, or of functional nervous diseases. 
 
 There is another aspect to functional psychosis which 
 appears to be paradoxical. While the usual thresh- 
 old of personal consciousness is raised, the subconscious 
 thresholds may, on examination, be found lowered. In 
 fact, we may even lay it down as the law of functional 
 psychosis that all anaesthesias, aboulias, amnesias are 
 also hyperaesthesias, hyper amnesias, — all losses are also 
 gains. 
 
 When the usual direct tracts are blocked, the 
 indirect may do good service. To revert to the illus- 
 tration of our disconnected or dissociated system of 
 bells. When the wires ordinarily in use have become 
 difficult to utilize, we may look for connections which 
 have not been in use. It may be found that if such indi- 
 rect, unused wires are properly tapped, the system may 
 begin to ring louder, longer, and with a rather un- 
 welcome noise and recurrence. The particular dissoci- 
 ated line once started cannot be arrested by other inter- 
 fering lines, it is no longer inhibited by other asso- 
 ciated lines, and hence, on a proper occasion, when 
 called from a particular direction, the system of bells 
 will respond with full vigor and without check. 
 
 This illustration brings out clearly the character of 
 recurrent mental states. Recurrence is the result of dis- 
 
328 Diagnosis of Psychopathic Diseases 
 
 sociation. The system keeps on ringing until the energy 
 of the current is either exhausted or inhibited. The 
 blocking of paths, due to rise of thresholds, constitutes 
 the mechanism of functional nervous diseases. 
 
 The state of dissociation furnishes the general rule 
 for diagnosis of functional nervous and mental dis- 
 eases. // a disabled system can function subconsciously, 
 the malady is functional. This can be found by differ- 
 ent methods and by the induction of such states as hyp- 
 nosis, the hypnoidal, and by the occurrence of the hyp- 
 noidic state. 
 
CHAPTER XXIX 
 
 PSYCHOGNOSIS BY HYPNOSIS 
 
 THE following case of psychopathic, recurrent 
 epileptoid attacks was studied by me in co- 
 operation with Dr. Prince and Dr. Linen- 
 thai: 
 
 Mr. M., aged twenty-one years, was born in Rus- 
 sia, and came to this country four years ago. His fam- 
 ily history, as far as can be ascertained, is good. There 
 is no nervous trouble of any sort in the immediate or 
 remote members of his family. 
 
 The patient himself has always enjoyed good health. 
 He is an intelligent young man of good habits. He 
 docs not use alcohol or tobacco, and gives no venereal 
 history. 
 
 He was referred to me for epileptiform at- 
 tacks and anaesthesia of the right half of his body. 
 The attack is preceded by an aura consisting of head- 
 ache and a general feeling of malaise. The aura lasts 
 a few days and terminates in the attack which always 
 sets in about midnight, when the patient is fully 
 awake. The attack consists of a series of spasms, 
 rhythmic in character, and lasting about one or two 
 minutes. After an interval of not more than thirty 
 seconds the spasms set in again. 
 
 This condition continues uninterruptedly for a 
 period of five or six days (a sort of status epilep- 
 ticus), persisting during the time the patient is awake, 
 and ceasing only during the short intervals or rather 
 moments of sleep. Throughout the whole period of 
 the attacks the patient is troubled with insomnia. He 
 
 329 ' 
 
330 Diagnosis of Psychopathic Diseases 
 
 sleeps restlessly for only ten or fifteen minutes at a time. 
 On one occasion he was observed to be in a state of 
 delirium as found in post-epileptic insanity and the so- 
 called "Ddmmerzustdnde" of epilepsy. This delirium 
 was observed but once in the course of five years. 
 
 The regular attack is not accompanied by any de- 
 lirious states or "Ddmmerzustdnde." On the contrary, 
 during the whole course of the attack the patient's 
 mind remains perfectly clear. During the period of the 
 attack the whole right side becomes anaesthetic to all 
 forms of sensations, kinaesthesis included, so that he is 
 not even aware of the spasms unless he actually observes 
 the affected limbs. 
 
 The affected limbs, previously normal, also become 
 paretic. After the attack has subsided, the paresis 
 and anaesthesia persist (as sometimes happens in true 
 idiopathic epilepsy) for a few days, after which the 
 patient's condition remains normal until the next at- 
 tack. After his last attack, however, the anaesthesia 
 and paresis continued for about three weeks. 
 
 He has had every year one attack which, very curi- 
 ously, sets in about the same time, namely, about the 
 month of January or February. The attacks have of 
 late increased in frequency, so that the patient has had 
 four, at intervals of about three or four months. On 
 two different occasions he was in the Boston City Hos- 
 pital for the attacks. 
 
 Examination of the patient, made three weeks after 
 the last attack, showed the following: Pupils were equal 
 and reacted promptly to light and accommodation. 
 Knee jerks were slightly exaggerated. No ankle 
 clonus was present. No Babinsky was observed. 
 There was a profound right hemianaesthesia includ- 
 
Psychognosis by Hypnosis 331 
 
 ing the right half of the tongue, with a marked 
 hypoaesthesia of the right side of the pharynx. All the 
 senses of the right side were involved. The field of 
 vision of the right eye was much limited. The tick- 
 ing of a watch could not be heard more than three 
 inches away from the right ear. Hearing in left ear 
 was normal. Taste and smell were likewise involved 
 on the right side. The muscular and kinaesthetic sensa- 
 tions on the right side were much impaired. 
 
 The patient's mental condition was good. He was 
 well balanced, and did not give evidence of any emo- 
 tional disturbances. He states that he has few dreams 
 and these are insignificant, concerned as they are with 
 the ordinary matters of his daily life. Occasionally he 
 dreams that he is falling, but there is no definite con- 
 tent to the dream. 
 
 These findings were indicative of functional rather 
 than organic disease. The previous history of the case 
 was significant. The first attack came on after pecu- 
 liar circumstances, when the patient was sixteen years 
 of age and living in Russia. After returning from 
 a ball one night, he was sent back to look for 
 a ring which the lady, whom he escorted, had 
 lost on the way. It was after midnight, and his way 
 lay on a lonely road which led by a cemetery. When 
 near the cemetery he was suddenly overcome by a 
 great fright, thinking that somebody was running after 
 him. He fell, struck his right side, and lost conscious- 
 ness. 
 
 By the time he was brought home he had regained 
 consciousness, but there existed a spasmodic shaking of 
 the right side, involving the arm, leg, and head. The 
 spasm persisted for one week. During this time he 
 
332 Diagnosis of Psychopathic Diseases 
 
 could not voluntarily move his right arm or leg, and 
 the right half of his body felt numb. There was also 
 apparently a loss of muscular sense, for he stated that 
 he was unaware of the shaking of his arm or leg, unless 
 he looked and saw the movements. In other words, 
 there was right hemiplegia, anaesthesia, and spasms. 
 
 For one week after the cessation of the spasms his 
 right arm and leg remained weak, but he was soon able 
 to resume his work, and he felt as well as ever. Since 
 then every year, as already stated, about the same 
 month the patient has an attack similar in every respect 
 to the original attack, with the only exception that 
 there is no loss of consciousness. Otherwise the sub- 
 sequent yearly attacks are photographic pictures, close 
 repetitions, recurrences of the original attack. 
 
 A series of experiments accordingly was undertaken. 
 First, as to the anaesthesia. If the anaesthesia was func- 
 tional, sensory impressions ought to be felt, even though 
 the patient was unconscious of them, and we ought to be 
 able to get sensory reactions. 
 
 The experiments which were made to determine the 
 nature of the anaesthesia produced interesting results. 
 These experiments show that the anaesthesia is not a 
 true one, but that impressions from the anaesthetic parts 
 which seem not to be felt are really perceived subcon- 
 sciously. 
 
 The method made use of consisted in producing a vis- 
 ual hallucination whenever the anaesthetic hand was 
 touched. That is to say, although the subject does 
 not consciously perceive the tactile impressions, he 
 claims to see the image of a number which cor- 
 responds with the number of times the hand is 
 pricked or touched. This was found to be the re- 
 
Psyckognosis by Hypnosis 333 
 
 suit in this case. Wiienever the hand was pricked 
 a certain number of times successively, he claimed to see 
 that number, a sort of pseudo-hallucination. The num- 
 ber was always correct, and showed that subconsciously 
 the pricks must have been felt. 
 
 The details of the experiment were as follows : The 
 anaesthetic hand was placed behind a screen and the pa- 
 tient was told to look in a glass of water and tell what 
 he saw there. Impressions made on the anaesthetic hand 
 gave rise to visual pseudo-hallucinations representing 
 the sensory stimuli. Thus, for example, when his hand 
 was touched, very lightly, five times, he saw the figure 
 five very vividly and described it in detail. He saw the 
 number written; it looked very large; and he saw it 
 written on the back of a hand. 
 
 The vividness of the claimed pseudo-hallucination 
 was well brought out when, projecting the hallucinatory 
 hand on a screen instead of in the water, the patient out- 
 lined it with a pencil. When one of us placed his hand on 
 the screen by the side of the hallucinatory hand, and the 
 patient was asked to tell which hand looked more real, 
 he insisted that both hands looked equally real, except 
 that the hallucinatory hand looked farther away. 
 
 Different tests also showed that the subconscious reac- 
 tions to impressions from the anaesthetic hand were 
 more delicately plastic and responsive than the conscious 
 reactions to impressions from the normal hand. We 
 have the so-called "psychopathic paradox" that func- 
 tional anaesthesia is a hypaeresthesia. 
 
 It is evident then that there could be no inhibition 
 of the sensory centers, or suppression of their activity, 
 or whatever else it may be called. In spite of the ap- 
 parent profound anaesthesia, the pin pricks were felt 
 
334 Diagnosis of Psychopathic Diseases 
 
 and perceived. The perception of them gave rise to 
 perception, cognition, to a sort of pseudo-hallucinations 
 that showed the pin pricks were counted and localized 
 in the hand. The results of these tests demonstrate that 
 in psychopathic patients all sensory impressions received 
 from anaesthetic parts, while they do not reach the per- 
 sonal consciousness are perceived subconsciously. 
 
 Inasmuch as the sensations are perceived, the failure 
 of the subject to be conscious of them must be due to a 
 failure in association. The perception of the sensation 
 is dissociated from the personal consciousness. More 
 than this, these dissociated sensations are capable of a 
 certain amount of independent functioning; hence the 
 pseudo-hallucinations, and hence the failure of psycho- 
 pathic patients to be incommoded by their anaesthesia. 
 This condition of dissociation underlies psychopathic 
 states. 
 
 For the purpose of studying the attacks themselves, 
 the patient was hypnotized. He went into a deep som- 
 nambulic condition, in which, however, the anaesthesia 
 still persisted. This showed that the dissociation of the 
 sensory impressions was unchanged. 
 
 In hypnosis he related again the history of the onset 
 of the trouble. His memory became broader, 
 and he was able to give the additional information, 
 which he could not do in his waking state, that at the 
 time he was frightened he fell on his right side. More- 
 over, he recalled what he did not remember when 
 awake, that throughout the period of his attacks when 
 he fell asleep, he had vivid dreams of an intense hal- 
 lucinatory character, all relating to the fright and fall. 
 
 In these dreams he lived over and over again the ex- 
 perience which was the beginning of his trouble. He 
 
Psychognosis by Hypnosis 335 
 
 again finds himself in his little native town, on a lonely 
 road; he thinks some one is running after him; he be- 
 comes frightened, calls for help, falls, and then wakes 
 up with a start, and the whole dream is forgotten. 
 After he wakes he knows nothing of all this; there is 
 no more fear or any emotional disturbance; he is then 
 simply distressed by the spasms. 
 
 While testing the anaesthesia during hypnosis, an at- 
 tack developed; his right arm and leg began to shake, 
 first mildly and then with increasing intensity and fre- 
 quency. His head also spasmodically turned to the 
 right side. The movements soon became rhythmic. 
 Arm and leg were abducted and adducted in a slow 
 rhythmic way at the rate of about thirty-six times per 
 minute. With the same rate and rhythm, the head 
 turned to the right side, with chin pointing upward. 
 The right side of the face was distorted by spasm, as if 
 in great pain. The left side of the face was unaffected. 
 Pressure over his right side (where he struck when he 
 fell) elicited evidences of great pain. Respiration be- 
 came deep and labored, and was sjmchronous with each 
 spasm. The whole symptom-complex simulated Jack' 
 sonian epilepsy. 
 
 It is noteworthy that the knee jerk on the right side 
 was exaggerated by comparison with the left during 
 the attack. Consciousness persisted unimpaired, but 
 showed a curious and unexpected alteration. When 
 asked what was the matter, he replied in his na- 
 tive dialect, "I do not understand what you say." 
 It was found that he had lost all understanding 
 of English, so that it was necessary to speak to him in 
 his native dialect. His answers to our questions 
 made It apparent that during the attack, as in his 
 
336 Diagnosis of Psychopathic Diseases 
 
 dreams, he was living through the experience which had 
 originally excited his trouble. 
 
 The attack was hypnoidic in character. He said 
 that he was sixteen years old, that he was in Rovno 
 (Russia), that he had just fallen, because he was fright- 
 ened, that he was lying on the roadside near the ceme- 
 tery, and that he wanted somebody to pick him up. 
 
 The hypnoidic state developed further, the pa- 
 tient living through, as in a dream, the whole ex- 
 perience that had taken place at that period. He 
 was in a carriage, though he did not know who put him 
 there. Then in a few moments he was again home, in 
 his house, with his parents attending on him as in the 
 onset of his first epileptiform seizures. 
 
 The attack terminated at this point, and thereupon 
 he became perfectly passive, and when spoken to an- 
 swered again in English. Now he was again twenty- 
 one years old, was conscious of where he was, and was 
 in absolute ignorance of what had just taken place. 
 
 It was found that an attack could regularly and arti- 
 ficially be induced, if the patient in hypnosis was taken 
 back by suggestion to the period when the accident hap- 
 pened. 
 
 The experiment was now tried of taking him back to 
 a period antedating the first attack. He was told that 
 he was fifteen years old, that is, a year before the acci- 
 dent occurred. He could no longer speak or 
 understand English, he was again In Rovno, engaged 
 as a salesman In a little store, had never been in Ameri- 
 ca, and did not know who we were. Testing sensation, 
 it was found that It had spontaneously returned to the 
 hand. There was not a trace of the anaesthesia left. The 
 hand which did not feel deep pin pricks before now re- 
 
Psychognosis by Hypnosis , 337 
 
 acted to the slightest stimulation. Spontaneous syn- 
 thesis of the dissociated sensory impressions had oc- 
 curred. Just as formerly before the accident, sensation 
 was in normal association with the rest of his mental 
 processes, so now this association was re-established 
 with the memories of that period to which the patient 
 was artificially reduced. 
 
 The patient was now (while still believing himself 
 to be fifteen years old) taken a year forward to the day 
 on which the accident happened. He says he Is going 
 to the ball to-night. He is now at the ball; he returns 
 home ; he is sent back to look for a ring. Like a magk 
 formula, It calls forth an attack in which again he 
 lives through the accident,— f/?^ fright, and the spasms. 
 With the onset of the spasm, dissociation again occurs, 
 the hand becomes anaesthetic, and remains anaesthetic 
 after the subject Is awakened. 
 
 It was thus possible to reproduce an attack at any 
 time with clock-like precision by taking him back to the 
 period of the accident, and reproducing all its details in 
 a hypnoidic state. Each time the fright and the physi- 
 cal manifestations of the attack (spasms, paresis, and 
 anaesthesia) developed. These Induced attacks were 
 Identical with the spontaneous attacks, one of which we 
 had occasion to observe later. 
 
 This psychognosis enables us to understand to a large 
 extent the psychogenesis of the attacks. At the time of 
 the accident the intense emotional disturbance, the 
 fright, acted as a dissociating agent, and dissociated the 
 sensory and motor reactions of one half of the body In- 
 volved In the accident so that they were no longer under 
 the control of the personal consciousness. These disso- 
 ciated elements were not, however, inhibited, or Incap- 
 
338 Diagnosis of Psychopathic Diseases 
 
 ^blc of functioning, as was shown by the hypnoidic 
 states and other phenomena brought out in the test ex- 
 periments. 
 
 In cases of this kind, dissociated sensory and motor 
 reactions become subconscious and capable of automatic 
 activity. Sensory impressions are subconsciously per- 
 ceived and motor reactions subconsciously excited. 
 The dissociation (through the influence of the emo- 
 tion) of these sensory and motor reactions and their 
 automatic subconscious excitation is the attack. The 
 original emotion of fear remains (unknown to the sub- 
 ject) dissociated in the subconsciousness as a fixed state. 
 Here from time to time it acquires a separate and inde- 
 pendent activity. 
 
 At periodic intervals, as under the stress of some emo- 
 tion, or by association of ideas, the dormant activity is 
 awakened and, though still unknown to the patient, gives 
 rise to the same sensori-motor disturbances which char- 
 acterized the original experience. These subconscious 
 dissociated states are so much more intense in their man- 
 ifestations by the very fact of their dissociation from 
 the inhibitory influences of the normal mental life. 
 
 The psychognosis of such cases then, reveal on the 
 one hand a dissociation of mental processes, and on the 
 other hand an independent and automatic activity of the 
 disaggregated psychic states. Dissociation and auto- 
 matism are the two fundamental conditions of psycho- 
 pathic states. 
 
 The following case of recurrent tremor is of interest. 
 The psychognosis was made by me with the assistance 
 of Dr. Linenthal. 
 
 M. R., fifty years of age; widower; salesman. 
 
 Patient complains of general nervousness. What 
 
Psycho gnosis by Hypnosis 339 
 
 troubles him most is a tremor of his hands. The 
 tremor becomes especially marked when he does some- 
 thing, such as writing, or carrying food to his mouth. 
 The tremor gets much worse when he is excited or when 
 he is fatigued, and predominates in his right hand. This 
 disturbs him so much that he is ashamed to appear in 
 company. He had the tremor for some years, but he 
 noticed that it had become worse in the last few years. 
 
 About six months ago while he was sitting in company 
 both legs began to shake. The shaking kept up for 
 about ten minutes. He had had some wine then, but 
 not enough to produce intoxication. This is the only 
 time that his legs shook. He has not had it since then. 
 
 The patient's digestion is very poor, the slightest in- 
 discretion In diet upsets him, and produces headache. 
 He has attacks of headache only when there is digestive 
 disturbances; the headaches are more frequently on the 
 right side of the head. He does not get dizzy and has 
 no specks before the eyes. For the last few weeks he 
 has had ringing in the right ear. He attributes it to a 
 cold. 
 
 When young he used alcohol considerably, though 
 never to intoxication. Now he is quite moderate in the 
 use of alcohol, drinks neither tea nor coffee, smokes a 
 cigar every other day. 
 
 The patient has always been of a nervous tempera- 
 ment. About 23 years ago was sick for a few weeks 
 with some stomach trouble. Seven years ago had rheuma- 
 tism and was confined to bed for about six weeks. Ever 
 since he has had a slight stiffness in his legs. Some 
 years ago he used to get occasional attacks of epistaxis. 
 Many members of his family are subject to nose bleeds. 
 
 Patient's father died at 76 of a "paralytic stroke." 
 
34^ Ibiagnosis of Psychopathic Diseases 
 
 Mother died at 50; cause is unknown to the patient. 
 One brother died of diabetes. Two brothers are living 
 and well. Patient had three children, two died in in- 
 fancy. The remaining child, a daughter, is living and 
 well. 
 
 Patient is a well built, healthy looking man ; does not 
 impress one as being of a neurotic temperament; tends 
 to make light of his troubles, and is in no way hypochon- 
 driacal. Knee jerks were present, though difficult to 
 get, on account of a slight rigidity in his legs. Pu- 
 pils react promptly to accommodation and to light. 
 The ocular muscles are all right. No sensory disturb- 
 ances are present. Touch discrimination is good, 
 though it is slightly more acute on the left side than on 
 the right. Discrimination of the temperature sense is 
 good. Field of vision is normal. 
 
 A fine tremor was observed in both hands, more 
 marked in the right hand. The tremor was increased 
 when patient was told to do something. When he took 
 a pencil to write his name the tremor was exaggerated, 
 the writing was irregular and jerky. Tremor also be- 
 came more pronounced when the patient carried a glass 
 of water to his mouth. 
 
 When he was asked, if he had any dreams, he said 
 that he used to have bad dreams formerly, though he 
 could not tell what they were about. It was insisted 
 that he try to remind himself of the nature of his 
 dreams, but it was of no avail. His dreams now are 
 not bad ; they are on the contrary of a pleasant nature. 
 He dreams of winning lots of money in the lottery, of 
 meeting some of his friends, and has other dreams of 
 an indifferent nature. During the conversation with the 
 patient the question of dreams was referred to over and 
 
Psychognosis by Hypnosis 341 
 
 ovet again, but nothing could be obtained. 
 
 M. R. ascribes his trouble to a great deal of worry. 
 He had been a well to do man, he was the owner of a 
 large mercantile establishment. But due to some busi- 
 ness reverses he lost all he had. Besides, his wife had 
 been an invalid for twenty years, and her illness con- 
 sumed a large part of his possessions. Now he has to 
 work for some one else and he is worrying all the time. 
 He is also grieved by the change of the attitude of peo- 
 ple towards him. People for whom he had done a 
 good deal formerly now refuse to recognize him. All 
 this worries him, and he thinks that this constant worry 
 is the cause of his trouble. 
 
 The history was once more gone over and was found 
 to be consistent with the previous account. About nine 
 years ago M. R. had to give up his business and was 
 under considerable worry and excitement. His wife 
 died nine years ago and had been an invalid for twenty 
 years. When M. R. held out both hands there was a 
 marked tremor, more marked in the right hand. After 
 a while the tremor disappeared from the left hand and 
 was much diminished in the right hand. 
 
 M. R. was put in the hypnotic condition. While 
 being hypnotized he was a little excited, he wanted to 
 know what would be done to him. He was assured that 
 every thing was all right and that he need not worry. 
 His eyes gradually began to close. He resisted for a 
 time, but finally he was no longer able to open them. He 
 was in a state of complete relaxation. He could not 
 open his eyes when challenged to do so. There was a 
 marked degree of catalepsy. The tremor had complete- 
 ly disappeared while in the hypnotic condition. He 
 held up his hands with the fingers spread out, there was 
 
342 Diagnosis of Psychopathic Diseases 
 
 no perceptible tremor. 
 
 M. R. was now asked to give an account of the con- 
 ditions under which he first observed the tremor. He 
 did not answer at first. The question had to be re- 
 peated. When the patient did answer, he spoke in a 
 very low voice, somewhat hesitatingly. He said that 
 he first noticed the tremor when he was told that his 
 wife died. He was away from home when she died 
 and when he returned he was told that she had just 
 breathed her last. 
 
 He was asked if he had any dreams. "I dream fre- 
 quently about my wife" was the reply. 
 
 "Tell us some of the dreams." 
 
 "Last February I dreamt that my wife was brought 
 to life by a physician. I was in the next room and 
 the nurse came in to tell me that she was dead. I 
 was much excited and trembled all over." 
 
 "Have you had any other dreams?" 
 
 "Yes." "What were they?" 
 
 "I dreamt that my wife who had been wretched for 
 many years asked me to take her to Europe so that she 
 might get well. I promised to take her the following 
 spring. She died before spring came. I thought that 
 had I taken her over she might have recovered." (Pa- 
 tient could not give the time when he had the dream.) 
 
 "Can you remember any other dream you had?" 
 
 "I dreamt that my wife came to me and told me that 
 she felt sorry that I was left all alone, that she could 
 not come to me." 
 
 In answer to a question as to what she looked like, 
 M. R. said she was dressed in white. While relating 
 this dream patient became excited; his face expressed 
 the most extreme suffering, he began to sob and tears 
 
Psychognosis by Hypnosis 343 
 
 ran down his face. 
 
 "A few weeks ago I dreamt that my wife came to 
 me dressed in white, and told me that she was very 
 sorry that our daughter was ill." 
 
 Patient was asked to give the earliest dream he could 
 remember that he had after the death of his wife. 
 
 "Six years ago (his wife died nine years ago.) 
 I dreamt that I took my wife to Europe and she had 
 completely recovered. I was very happy to see her." 
 
 In answer to a question patient said that his wife 
 looked very well and that she wore a new black dress. 
 
 When asked if he had any dreams about his wife be- 
 fore six years ago, he answered in the negative. It was 
 then insisted that he should recall some dream he had 
 before that time. M. R. said he could not remember. 
 Some of the dreams he remembered when he woke up, 
 but he had forgotten them since, but now they came 
 back to him. 
 
 "Four years ago I dreamt that I came back with my 
 wife from Europe, but in some way or other I lost her. 
 I became very much excited I fell out of bed, cried out, 
 and woke up. I was shivering all over. I went back 
 to sleep and then dreamt that I looked for her every- 
 where, but could not find her. I cried much.^' 
 
 While relating this dream M. R. became excited. 
 He sobbed and tears rolled from under his eyelids. // 
 seemed as if he was living that experience over again. 
 
 The dreams came up in rapid succession, all that was 
 necessary was to say "What other dream did you have?" 
 when the patient in a low trembling Voice, full of an- 
 guish, began to relate his sad dream experiences. 
 
 "I dreamt that my father and mother were standing 
 by my bedside and crying over me. I complained to 
 
344 Diagnosis of Psychopathic Diseases 
 
 them about my condition. I told them how lonely I 
 was in this world, that my wife was dead, and that I 
 had nothing to live for. 
 
 "I dreamt that I was told that my father and mother 
 were also dead. I cried bitterly as I had no one in the 
 world. 
 
 "Last Christmas I dreamt that I saw my dead father 
 standing by my bed side. He told me that he was going 
 to pray for me. I was very much excited and shook all 
 over." (Patient moved restlessly and looked as if in 
 agony.) 
 
 "Can you tell any other dreams?" 
 
 "I had many dreams in which I saw my wife standing 
 over me and crying. She told me that I was always so 
 kind to her, and she was very sorry that I was so lonely 
 and wretched now. 
 
 "Last night I dreamt that I fell and sprained my an- 
 kle. My legs pained me much and they were rather 
 stiff." 
 
 The tremor in his hands disappeared. When pa- 
 tient's hand was held up it was steady. No tremor 
 could be perceived. 
 
 When asked, if he remembered any more dreams, he 
 said: "I dreamt that my mother came to me and cried. 
 She told me that she would see that I had a better life 
 henceforth. I cried and trembled all over." In an- 
 swer to a question he said that when he awoke he did not 
 remember that he had the dream. 
 
 The account of the various dreams seemed to have 
 exhausted the patient, and it was not considered wise to 
 question him any further. Suggestion of well-being was 
 given. Patient was awakened. There was complete 
 amnesia of what took place during hypnosis. 
 
Psychognvsis by Hypnosis 345 
 
 When he came again M. R. said that he slept sound- 
 ly. He was immediately questioned about his dreams, 
 he said that it occurred to him, that he occasionally 
 dreamt about his wife. He said that he could not think 
 of it before when we took his history, he could not 
 however give the contents of any dream that he had 
 about his wife. 
 
 M. R. says he feels much better and that the tremor 
 has diminished considerably, but that he is worrying a 
 good deal. Dreamt the last few nights about business 
 matters. This morning he dreamt that he had lost his 
 position. 
 
 The following additional facts in the patient's history 
 were obtained. M. R. came to this country thirty-one 
 years ago. Shortly after he came over he was attacked 
 by thieves one night while carrying a bundle of mer- 
 chandise, and the bundle was taken away from him. 
 About two years later while on a country road, he was 
 accosted by two men who demanded money from him. 
 Both these incidents upset him much. 
 
 When a boy of ten he was in the habit of visiting a 
 neighboring shoemaker's shop. He used to annoy the 
 shoemaker, and the latter threatened to cut off his arm. 
 Once the shoemaker caught him and while holding a 
 knife in his hand he unintentionally made a deep cut on 
 the patient's right arm in which the tremor specially pre- 
 dominates. The patient was greatly frightened over 
 it. He showed us the scar on his right arm. 
 
 M. R. told us that his life had been a very hard one. 
 He met with many business reverses which constituted 
 the chief cause of his worry. Besides he worried a 
 good deal when his wife was ill. Her illness cost him a 
 
346 Diagnosis of Psychopathic Diseases 
 
 good deal of money. He used to spend many sleepless 
 nights which completely exhausted him at times. He 
 was married for twenty-seven years. 
 
 He was then given to copy some lines from a news- 
 paper. The writing was irregular and jerky. 
 
 M. R. was put in hypnotic condition. Could not 
 open his eyes, when challenged. Catalepsy was easily 
 induced. 
 
 "When did you first notice the tremor?" 
 
 "I first noticed it a couple of months before my wife 
 died. I was writing a letter and my daughter noticed 
 that my hand was shaking." 
 
 "What caused the tremor?" 
 
 "I had lots of trouble at that time. I had a good 
 deal of business troubles, my wife's illness, and I had 
 at that time a very severe nose bleed which weakened 
 me. 
 
 On further questioning he told us that the next time 
 he noticed the tremor was when he was told that his 
 wife died. He said he was very much excited then. He 
 felt that he had lost his only friend in the world. 
 
 When asked, if anything happened during his wife's 
 illness that especially excited him. He said that he was 
 present at several operations that were performed on 
 his wife. He saw her cut open, and he was affected 
 with intense anxiety and fear. 
 
 "When did you have the first dream about your 
 wife?" "About three or four years ago." "Any 
 dreams before this?" "Yes, aboijt one year after the 
 death of my wife I had the first dream." "Any dreams 
 about her before that time?" "I can not remember 
 any." "What was the first dream you had?" "My 
 wife dressed in white came to me. She was crying over 
 
Psychognosis by Hypnosis 347 
 
 me, she felt sorry that I was left all alone in the world." 
 At another time he dreamt that she came to him. She 
 looked worried. Both cried very much. He fell out of 
 bed. The fall woke him up. He looked around for 
 his wife, but he could not find her; she was gone. 
 
 M. R. was asked to relate some more of his dreams. 
 He became restless, and drew up his legs, as if he had a 
 cramp. When asked what the matter was, he said that 
 he had a severe pain in both legs. When asked the 
 cause of the pain, he said he did not know; he has 
 the pains very often when he sleeps; he thinks it is 
 due to his falling out of bed, that he never has the 
 pains during day time. It was suggested that the pain 
 will go away, and that he will feel comfortable. Pa- 
 tient was relieved and said that the pain was gone. 
 
 M. R. was now asked to give some more of his 
 dreams. He gave a number of dreams all of the 
 same content, that his wife was coming to him dressed 
 in white and cried over him, and kept telling him that 
 she felt sorry for him. 
 
 The patient apparently did not remember many of 
 the dreams that he told us the last time. We tried to 
 help his memory by telling him part of the content of 
 some of his dreams, but even then they were imperfect- 
 ly remembered. 
 
 In contrast to the last time he did not show any agita- 
 tion while relating his dreams. He was calm and did 
 not display the emotional excitement when he was first 
 put into the hypnotic state. 
 
 M. R. also told of a number of dreams which he had 
 about business matters. He dreams of making money 
 and then again of losing it. He also dreams about a 
 brother who is dead now. This brother had been sick 
 
348 Diagnosis of Psychopathic Diseases 
 
 for a long time and the patient took care of him during 
 his illness. Patient frequently dreams of the brother 
 coming to him saying : "You are the best friend I had 
 in the world." Occasionally he dreams about his father 
 and mother. 
 
 We now tried to see whether M. R. could in this state 
 give the reasons for some of his motor manifestation. 
 
 "You said that about six months ago while you 
 were in the company of friends talking about business 
 your legs began to shake. What was it that passed 
 through your mind at that time?" 
 "I thought about my wife at that time." 
 "What caused you to think of your wife then?" 
 "Somebody asked me how long she had been dead." 
 When asked if he attributed the shaking to the 
 thought about his wife, he said that he did not know, 
 but he added that it was very likely that this thought 
 caused the shaking. 
 
 When asked why his right hand shook more than his 
 left, he said that he did not know, but he thought it 
 might be due to the fact that he worked harder with 
 his right hand than he did with his left, and also that 
 when "I fall out of bed I often fall on my right side." 
 The right side has been the nucleus of his psychopathic 
 state since the trauma with the shoemaker. He could 
 not remember having had any distressing dreams be- 
 fore his wife died except once when he dreamt about 
 his mother. 
 
 M. R. was told to open his eyes and sit up, but still to 
 remain in the hypnotic condition. He was given a paper 
 to write his name on, and a few lines were dictated to 
 him. The writing was more steady and regular than 
 in his waking state. Towards the end the tremor 
 
Psychognosis by Hypnosis 349 
 
 became more manifest. The patient seemed to have 
 fully emerged from his hypnotic condition. 
 
 There was complete amnesia as to what took place 
 in the hypnotic state. 
 
 Thus we find that a study, or psychognosis of psy- 
 chopathic cases clearly reveals the presence of a set of 
 subconscious systems which forms the cause or substra- 
 tum of the symptoms of the psychopathic states. 
 The main characteristic of this set of systems is its per- 
 sistence in the subconscious and its continuous recurrence 
 in the upper consciousness. The sensory, the emotional, 
 and the conceptual aspect of the set of systems remains 
 in the subconscious, but the reactions, characteristic 
 of the set of subconscious systems, come to the 
 full light of consciousness, and become manifested 
 as the symptoms of the malady. The psychognosis re- 
 veals this subconscious side of the symptom complex, 
 hidden from the direct consciousness of the patient. 
 The motor manifestations are usually the ones that 
 form the predominant symptoms of a dissociated com- 
 plex, or what I prefer to term the "dissociated set of 
 systems." The subconscious processes are the sensory, 
 emotional, and ideational elements of the dis- 
 sociated set of systems, while the motor elements asso- 
 ciated with them are the ones that come to the sur- 
 face. 
 
 Of course, this law is not rigid as quite often sensory 
 elements belonging to the system come forward in 
 the form of sensory and emotional disturbances, and 
 give rise to what we term psychopathic sensory symp- 
 toms, the motor elements, however, usually predomi- 
 nate. 
 
 Dissociated sets of systems have to use the same 
 
350 Diagnosis of Psychopathic Diseases 
 
 motor apparatus, the same motor arrangements and re- 
 actions as the ones used by the normal personality. The 
 patient does not understand the reason of the motor 
 manifestations, since the whole set of systems is buried 
 deep in his subconscious, but he can from time to time 
 witness the motor convulsions when the systems heave 
 up from the depth of the subconscious regions. Thus 
 the psychognosis in the one case showed us the systems 
 or set of dissociated systems which have given rise to 
 motor symptoms of a psychopathic Jacksonian epilepsy 
 with hemi anaesthesia, while in the other case a similar 
 psychognostic investigation by means of hypnosis has 
 revealed to us the set of subconscious systems which 
 have given rise to the motor symptoms of an uncon- 
 trollable tremor. 
 
CHAPTER XXX 
 
 PSYCHOGNOSIS BY HYPNOIDAL STATES 
 
 AS an illustration of the nature of recurrent, 
 active, subconscious sets of systems, giving 
 rise to psychopathic affections I may take the 
 following psychognostic study, carried out 
 by means of the hypnoidal state. 
 
 Mr. C, a young man of twenty-five, a college student 
 of good standing, is very able, conscientious in his work, 
 and is scrupulously moral in his daily life. 
 
 Except for an aunt who has apparently died of tuber- 
 culosis, family history is negative. Parents are living 
 and healthy, sisters and brothers are all well. Both ma- 
 ternal and paternal branches of the family are of good 
 healthy stock, with no neuropathic or psychopathic taint. 
 The family is well to do, and the members are intelli- 
 gent, educated, and able, so that the patient's childhood 
 and early youth have passed amidst relatively healthy 
 surroundings. 
 
 As a child the patient passed through children's dis- 
 eases, but did not suffer from any nervous troubles As 
 a boy he has been of robust health, taking great delight 
 In physical exercises and pranks characteristic of boy- 
 hood. Although he is now of a rather serious, scientific 
 turn of mind, devoting most of his time to mathematics, 
 mechanics, and to the various branches of physical 
 science, he has been in his childhood and boyhood 
 impressionable and imaginative. He was a great lover 
 of fairy tales, an omnivorous reader of all sorts of ex- 
 
 351 
 
352 Diagnosis of Psychopathic Diseases 
 
 travagant stories and of voluminous novels. 
 
 Dreaming was his delight. Many a time he went off 
 into a dark nook and kept on dreaming about princes 
 and princesses; sailing In airships, ascending inacces- 
 sible mountains, scaling high peaks and then descending 
 into mysterious caves and chasms. He lived in his im- 
 agination the world over, and in all ages. Time and 
 place were no barrier to him. He lived "the universe 
 over and through eternity." He lived with fairies, 
 spirits, and genii, who built for him enchanted palaces. 
 He was "at the creation of the universe and saw the 
 formation of the world." Stories were to him histories, 
 real histories in which he was the central figure, the 
 real hero. When very young, he had auditory hal- 
 lucinations, — "angels called him by name and he lis- 
 tened in dreams to the music of the spheres." He 
 ceased to have those hallucinations about the age of ten. 
 
 On examination, patient is found well nourished. Re- 
 flexes are not exaggerated; field of vision is normal; no 
 sensory disturbances, no motor troubles are present. 
 Memory for disconnected impressions is good, while his 
 recollection of past events and memory for present 
 events are excellent. There are no disturbances of recog- 
 nition. Sense of localization is good, so also is his sense 
 of orientation. He is rather a good visuallzer. A few 
 times in his later years he experienced illusions of rever- 
 sion of locality, and also hallucinations of recognition, of 
 having seen the same place before. Voluntary attention 
 is in excellent condition. His conception of abstract ideas, 
 his logical acuteness for points and distinctions, for com- 
 prehension of complicated trains of reasoning and for 
 disputation by logical processes are truly remarkable. 
 His sleep is very good and he has no bad dreams, 
 
Psychognosis by Hypnoidal States 353 
 
 though he is quite an active dreamer. The color field, 
 on closure of eyes, is "brilliant," and his hypnagogic and 
 hypnapagogic* hallucinations are often rich and bril- 
 liant in color. 
 
 Of late, the patient has been hard at work, studying 
 for his examinations; he has been worrying over some 
 family troubles as well as over his future career. He is 
 somewhat nervous and restless, and occasionally a fit of 
 irritability seems to take possession of him, an irrita- 
 bility which he sometimes has great difficulty to con- 
 trol. The patient complains of irritation of the blad- 
 der, — he cannot retain his urine for more than five min- 
 utes at a time and sometimes less than that. When he 
 makes an effort to control his urgent desire to urinate, 
 he begins to feel hot, his eyes begin to hurt and feel 
 queer and bulging, and he has a distressing feeling of 
 tension in his forehead, almost amounting to a head- 
 ache. 
 
 During that time he feels confused, his attention is 
 wandering, his apprehension of complicated trains of 
 thoughts becomes defective, his desultory memory be- 
 comes extremely poor, he cannot repeat any series of 
 disconnected syllables, while his logical memory for 
 phrases and connected events becomes vague. All 
 these distressing symptoms are instantly relieved as 
 soon as the pressing need for urination is satisfied. 
 
 This insistent, troublesome desire of urination dis- 
 turbs the patient's studies, interferes with his regular 
 work, makes him undergo tortures in the lecture-room, 
 or in church during services, or when visiting some 
 
 ♦This term has been used by me for dream hallucinations of the 
 intermediary state in passing from sleep to waking, in contradistinc- 
 tion to hypnagogic hallucinations of the state of falling asleep. 
 
354 Diagnosis of Psychopathic Diseases 
 
 friend. When, however, he gets interested and ab- 
 sorbed In his work, or in some conversation, the insis- 
 tent, distressing desire disappears for hours together. 
 As soon as the interest lapses the desire reappears. 
 
 In addition to this insistent desire there is also pres- 
 ent the insistent idea that along with the continuous out- 
 pour of the urine there is also an oozing out of his "vi- 
 tality." This fear of loss of vitality gives rise to an al- 
 most continuous examination of the urine to discover 
 any abnormal changes. The color, the dribbling, the 
 feel of the urine, — all are noticed and watched with a 
 feeling of anxiety. The patient is conscious of the ab- 
 surdity of the insistent idea, but he cannot help it. The 
 idea gets the better of his reason. 
 
 Occasionally, when he gets specially fatigued, an idea 
 of which he feels extreme disgust enters his mind. When 
 entering into close conversation with a male person, the 
 idea of homosexual relations gets possession of his mind. 
 He does not have the least desire, in fact, he feels dis- 
 gust at the very thought of it. He cannot account to 
 himself for the reason of it, whether or no it is the hor- 
 ror of the idea which suggests it by association of con- 
 trast; he cannot understand it; the idea to his extreme 
 disgust flashes on his mind; there is absolutely no desire 
 accompanied with it, but deep disgust. The idea comes 
 suddenly and as suddenly disappears. When the idea 
 is gone, he afterwards wonders how it could have possi- 
 bly entered his mind at all. It appears to him so "idioti- 
 cally stupid." "Why should such a disgusting, stupid 
 thought come to one's mind?" 
 
 The patient is also troubled by a form of folie du 
 doute. He is not sure that the addresses on his letters 
 are correctly writtei; and no matter how many times 
 
Psychognosis by Hypnoidal States 355 
 
 he may read them over, he cannot feel assured that the 
 addresses are correct. Some one else must read them 
 and assure him that the addresses are right. In 
 the absence of others he has devised the plan of 
 copying the address from the envelope. This is some- 
 what more satisfactory, but then sometimes he is seized 
 with the idea that may be the copying is wrong. Now 
 and then he can help himself out by reading the address 
 aloud. The seeing, reading aloud, the hearing of the 
 words read, and the feeling of pronouncing the words, 
 along with the movements of copying — all those sen- 
 sory stimuli seem to help to intensify the sense of reality 
 and increase the feeling of assurance in the "real cor- 
 rectness" of the address. 
 
 When he has to write many letters sometimes a sud- 
 den fear gets possession of him that he had interchanged 
 the letters and had put them into the wrong envelopes. 
 He has then to tear open the envelopes and look the let- 
 ters over and over again to assure himself that the let- 
 ters have been put by him into the right envelopes. He 
 becomes satisfied when assured by some one else. Be- 
 fore he drops the letters into the letter box he must re- 
 peatedly read over the addresses to be fully sure that he 
 has the addresses all right. This condition is not a 
 permanent one, as this whole trpubjp disappears for 
 week§, and reappears wheij he is greatly worried or 
 fatigued. 
 
 Similarly, iij turning out the gas jet he must peeds try 
 it over and over again, and is often forced to get up 
 from bed to try again whether the gas is "really" shut 
 off. He lights the gas, then puts it out, then tries to 
 test the gas jet with a lighted match to see whether the 
 gas leaks and is "really" completely shut off. 
 
35 6 Diagnosis of Psychopathic Diseases 
 
 Similarly, in closing the door of his room, he must 
 try the lock over and over again ; he locks the door and 
 then unlocks it again, then locks it once more, still he is 
 not sure ; he then must shake it violently so as to get the 
 full assurance that the door has been actually and "real- 
 ly" locked. 
 
 One is almost tempted to generalize that the sense of 
 reality is weakened in the patient. But is it not strange 
 that this weakness of the sense of reality should only be 
 in relation to particular ideas and acts, while it is in ex- 
 cellent condition as far as all other ideas and acts are 
 concerned ? // is not the sense of reality that is at fault, 
 — it is the special insistent idea. 
 
 At one time he suffered from palpitation of the heart, 
 he thought he had some heart trouble, for which he 
 visited many physicians who kept on palpating, auscul- 
 tating and percussing his heart, giving him all kinds of 
 directions and precautions, putting him on a "strict diet, 
 regulating his exercises, prescribing bromides, digitalis 
 and strychnine. But the more physicians regulated and 
 prescribed, the more the refractory heart kept on thump- 
 ing. Finally, losing patience, he gave up treatment and 
 felt much better. 
 
 Another trouble which has possession of him, though 
 it is not insistent, is the fear of getting consumptioli, 
 or of being infected. Sometimes the fear becomes quite 
 troublesome, it becomes a regular mysophobia, a 
 delire du toucher; he may then keep on washing him- 
 self incessantly, rubbing his skin until it gets sore. Al- 
 though the patient feels quite troubled, when the fear 
 is on him, still it is not persistent; it seems to come in 
 flashes, and he is quite free from it for long intervals of 
 time. Still he has the feeding that the fear i« there and 
 
Psychognosis by ttypnoidal States 3^7 
 
 it requires only special conditions to have it awakened. 
 The mere sight of a supposed case of an infectious dis- 
 ease, or the contact with a tubercular patient, is suf- 
 ficient to revive the state of mysophobia. 
 
 There are again times when he feels as if his will is 
 paralyzed. This condition comes on him at great in- 
 tervals, when he happens to be very tired, and he is 
 in a state of abstraction and reverie. He feels as if he 
 has no power of movement, he has hardly the strength 
 to ask for a glass of water. When the water is brought 
 to him he cannot reach out for it. He cannot account 
 for this peculiar feeling that sweeps over him so sudden- 
 ly. He knows well he is not paralyzed, and still he can- 
 not move. It is an attack of abulia, it is his will that is 
 paralyzed. After making one effort the spell is broken. 
 
 Occasionally an insistent idea gets a hold of the pa- 
 tient, an idea which is distressing to him and 
 which makes him miserable. He thinks of tearing out 
 his eyes and put them under some weight and ha^ e them 
 crushed. If the patient sits in a chair, he thinks of put- 
 ting the eyes under the chair and have them crushed. If 
 he goes in a car, he thinks of having his eyes crushed 
 under the wheels of the car. He tells me that the insist- 
 ent idea is sometimes so vivid and real that he can al- 
 most feel the cars passing over the eyes, and that he can 
 almost hear the eyeballs crush and crack. The patient 
 fully realizes the absurdity of the idea, but it keeps on 
 coming against his will. The idea comes in flashes, 
 leaves for some time, and then comes again when he ex- 
 pects it least. 
 
 By means of the method of hypnoidization, or by in- 
 duction of hypnoidal states the following data were ob- 
 tained : 
 
358 Diagnosis of Psychopathic Diseases 
 
 When a young child the patient lived with an old 
 grandfather of his who suffered from bladder irritation 
 with incontinence of urine, obliging the old man to go to 
 the toilet room almost every five minutes. He was 
 much attached to the poor old grandfather, whose suf- 
 ferings evidently made a deep impression on the child. 
 
 The grandfather was also absent-minded and he had 
 to try to qIosc the door or turn the key in the closet 
 many times before he could fully be assured that the 
 closet door was locked. The grandfather had also diffi- 
 culty and hesitancy to handle the various things given 
 him. When he asked for water, the glass given him 
 was sometimes left on the tray for several minutes be- 
 fore he was reminded to take it. All this the child 
 watched with great sympathy and distress. Being a 
 highly impressionable, sensitive, and imaginative child, 
 can we wonder that his mind has been deeply impressed 
 with what had taken place before him every moment of 
 his young life ? 
 
 It was also in relation to his grandfather that he over- 
 heard people say that "the vitality is oozing away." In 
 his childish mind he connected the oozing of vitality 
 with the act of urination. This was still further em- 
 phasized by his reading of quack literature about "the 
 fearful results of oozing vitality" during puberty and 
 manhood. All this was manifested in a state of anxiety 
 and trepidation for the "oozing vitality," and, though 
 those sad experiences have all gone from the patient's 
 conscious memory, they have not, on that account, ceased 
 their life existence, — they have simply lapsed from 
 his personal consciousness, but only to become sub- 
 merged into his subconscious life ; and from the depth of 
 his subconsciousness these dissociated, disaggregated ex- 
 
Psychognosis by HypnoUal States 359 
 
 periences of child-life kept on recurring as insistent psy- 
 chomotor states with all the intensity of anguish of the 
 original experiences. 
 
 Instead, however, of the symptoms being associated 
 with his grandfather, they have, by a very natural pro- 
 cess of confluence and fore-shortening, become grouped 
 around the emotions which the patient has actually 
 gone through at that time of his life, and have 
 hence become associated with himself. The patient 
 was living over again in his own subconscious life 
 the life experiences of his deceased grandfather, ex- 
 periencing all those various distressing symptoms for 
 which the patient could consciously give no account. 
 May we not in a certain sense say that the grandfather's 
 sufferings have been transmitted to the grandson ? May 
 we not say, be it in a figurative sense, that the grand- 
 father's life has become resurrected in the subconscious 
 self of the grandson? 
 
 The abulia manifested by the patient no doubt took 
 its origin in what may be termed the subconscious 
 "grandfather cycle" of experiences. Other experiences 
 belonging to different cycles have also co-operated sub- 
 consciously and have helped to give rise to the state of 
 will-defect. In one of the hypnoidal states it has come 
 to light that, when the patient was quite young, prob- 
 ably not more than six, he was taken to the bedside of a 
 child of twelve who was stricken down with some form 
 of paralysis. Once the experience struggled up in the 
 hypnoidal state it stood out clear and distinct. The pa- 
 tient could in his mind's eye see the courtyard, the house, 
 the people and the paralytic child lying helpless in his 
 little bed, a kind of a crib. Even now when the sub- 
 conscious experiences have become identified not as his 
 
3^0 Diagnosis of Psychopathic Diseases 
 
 own, he still feels a sinking sensation "in the pit of the 
 stomach," and feels the helplessness of the paralytic 
 child. We can hardly realize what a deep and lasting 
 impression such an experience may have on the tender 
 mind of an extremely sensitive and highly imaginative 
 child. 
 
 The great sensitivity and impressionability of the 
 child can be gathered from another fact that also be- 
 came revealed in one of the hypnoidal states. At about 
 the same age of six or seven, the period to which the 
 cycles of dissociated experiences belong, and which have 
 later on given rise to most of the distressing symptoms 
 from which the patient has been suffering, when the child 
 was in school, a man with a paralyzed right hand hap- 
 pened to come into the schoolroom. The child represent- 
 ed to himself vividly this same condition of paralysis in 
 his own hand ; he felt his hand and fingers growing pow- 
 erless and his arm hanging limp by his side. Finally the 
 feeling of helplessness and mental anguish became so 
 intense, the paralysis so real that, overcome by his emo- 
 tion, he fainted away. He felt sick for a few days. 
 There is little doubt that such experiences have largely 
 contributed to the patient's abulic state in which his 
 will to move his limbs and especially his hand is para- 
 lyzed. 
 
 Now as to the homosexual ideas, what was the cause 
 of ideas of sexual inversion, unaccompanied by any de- 
 sire, foreign to the patient's nature and associated with 
 a feeling of almost "nauseating disgust" ? 
 
 In one of the hypnoidal states subconscious experi- 
 ences emerged which, after a little tapping and close fol- 
 lowing of the course of the warped train of subconscious 
 associations, finally assumed the shape of the following 
 
Psychognosis by Hypnoidal States 361 
 
 connected account : When about the age of eight and a 
 half he entered a private school in which there were also 
 boys of the age of sixteen. Two of those boys gained 
 his friendship and one day took him out for a walk into 
 the woods. There they told him of a secret club they 
 had formed arid asked him to join it. The little boy was 
 much pleased by an invitation to join a club of big boys. 
 They then took him farther away into the woods into 
 some lonely corner where they proceeded to enter into 
 homosexual relations and urged him to imitate them, 
 ending their urgings by forcible seizure. The little fel- 
 low got frightened and ran; the big boys gave chase, 
 but they soon gave it up, as he hid himself in some thick 
 bushes. He told his parents about it and was taken out 
 of the school. This experience lapsed from his con- 
 scious memory, but remained firmly imprinted on his 
 subconscious memory, giving rise to the apparently un- 
 accountable homosexual ideas at which he felt so much 
 disgust. The homosexual ideas were really foreign to 
 his character and no wonder his whole nature felt re- 
 volting disgust toward them. 
 
 There are other ideas, some of an insistent, some of 
 a pleasing character, some of an apparently persisting 
 aesthetic type, ideas and ideals, unaccountable on any 
 other view, but on the theory of dissociated states and 
 disaggregated subconsciousness. We cannot possibly de- 
 scribe here all of them, but we can bring a couple, typi- 
 cal of the rest. Why should the patient be pleased and 
 even become sexually excited at the sight of a green pet- 
 ticoat? Why should the smell of heated iron, the sight 
 and feel of starched clothes be so agreeable and even 
 sexually exciting? Why should a prominent abdomen, 
 large hips, long, pendulous breasts, a few small black 
 
362 Diagnosis of Psychopathic Diseases 
 
 patches, interspersed with some little red pimples on the 
 face have a sexual attraction and possess the significance 
 of sexual stimulations? Why, again, should his idea of 
 feminine beauty be jet black, curly hair; large, black, lus- 
 trous eyes; a pale, somewhat dark, skin; a pouting 
 mouth; a low forehead and a slightly protruding chin? 
 The method of hypnoidization, or the induction of hyp- 
 noidal states gives an insight into these apparently un- 
 accountable and whimsical mental states revealing their 
 origin In subconscious sets of mental systems of his early 
 boyhood and childhood. 
 
 Now in the hypnoidal states the Image of a female 
 figure emerged, a figure which the patient recognized 
 as a nurse of his whom he had up to his fifth year. She 
 was a young woman of not more than thirty, of tall stat- 
 ure, with big hips and pendulous breasts, her face bear- 
 ing the markings of small black plaster patches and red 
 pimples. He sees her Ironing some white goods while 
 he tucks and pulls at her dress, at her green petticoat. 
 She used to fondle him, kiss him, embrace him and 
 press him to her breasts with which she often let him 
 play. 
 
 All those subconscious experiences of the patient's 
 childhood have helped to endow definite sensations and 
 peculiar physical characteristics with an otherwise un- 
 accountable attraction and sexual significance. 
 
 Likes and dislikes. If they belong to the fundamental 
 Instincts, can be traced, if one is sufficiently persistent 
 with the hypnoidal state and the method of hypnoidiza- 
 tion, to definite, dissociated, subconscious system, mean- 
 ingless in the patient's present life adaptations. 
 
 Similarly, in the case of the patient's peculiar ideal 
 of feminine beauty, the hypnoidal states brought 
 
Psychognosis by Hypnoidal States 363 
 
 out the underlying subconscious systems. When the 
 patient was of the age of seven he lived in the 
 same house with his maternal aunt who had a 
 little girl who was his companion in his plays 
 and games, whom he worshiped and adored. It 
 was that little cousin of his that possessed all those 
 physical characteristics, — black, curly hair ; large, black, 
 lustrous eyes ; a low forehead ; a pouting mouth ; a pale, 
 dark skin; a slightly protruding chin, — characteristics 
 which have formed the foundation of his psychopathic 
 ideal of feminine beauty. These subconscious states 
 gathered all the more latent force from the circum- 
 stance that the little girl fell a victim to an infectious 
 disease, scarlet fever, and the little fellow stood at the 
 deathbed of his little cousin. 
 
 All those experiences may be regarded as belonging 
 to the patient's "sexual cycle" of subconscious life activ- 
 ity. 
 
 We may turn now to other subconscious systems 
 which may be designated as the "infectious cycle." 
 What is the origin of the patient's mysophobia? Why 
 and whence his fear of death and palpitation of the 
 heart ? As a very young child and at a very tender age 
 he had a rather rich experience in witnessing death 
 agonies. He was present at the deathbed of his great- 
 grandmother just at the moment when she gave up the 
 ghost in the arms of his grandfather; he also watched 
 the death agonies of his aunt who died of tuberculosis. 
 When af the age of seven and a half an epidemic of 
 scarlet fever broke out in the house ; his sister, his young- 
 er brother and his cousin, fell victims to the contagious 
 disease, and he was present at their death-bed. 
 
 During the hypnoidal states an image of a figure 
 
364 Diagnosis of Psychopathic Diseases 
 
 suddenly appeared before the patient's mind, held the 
 hand over the heart, then fell, blood gushing from 
 its mouth. The patient could not identify the figure, but 
 he felt it was some real experience. It is quite probable 
 that this related to some actual event of his early child- 
 hood. The fear of infection and of death, as well as 
 the palpitation of the heart consequent on such fears, 
 were, by means of the induced hypnoidal states, traced, 
 as have been the rest of the recurrent psychomotor 
 states, to dissociated subconscious experiences. 
 
 But why those insistent ideas about the eyes? For 
 some time this could not be answered. One time, how- 
 ever, the patient happened to go into a deep hypnoidal 
 condition, he fell into one of those intermediary states 
 closely bordering on hypnosis. In this intermediary, sub- 
 conscious state new episodes from the patient's child-life 
 emerged. We may characterize this cycle of subcon- 
 scious experiences as "the great-grandmother episode." 
 An ancient great-grandmother of his lingered in the 
 same house with the patient. While in his deep hyp- 
 noidal state the patient could clearly see the tall figure 
 of his great-grandmother. She was greatly emaciated, 
 skin and bone, and he stood in awe of her. 
 
 Now this great-grandmother of his suffered from 
 inflammation of the eyes. In the hypnoidal state the pa- 
 tient could recollect the many different liquids she used 
 as washes for the eyes. She lived in a dark room and 
 complained she could not see, the eyes pained her so 
 much. 
 
 And now a new experience emerged. Once the pa- 
 tient happened to get an inflammation of the eyes. How 
 he dreaded those great-grandmother's bottles I He had 
 to undergo the ordeal of having his eyes bathed by his 
 
Psychognosis by Hypnoidal States 365 
 
 great-grandmother's various washes. He also remem- 
 bers some horrible stories told of people who have pains 
 in the eyes, how the eyes "swell and bulge and then crack 
 and burst." He also recollects stories of people with 
 "glassy eyes," who can take the eyes out and have them 
 "crushed and cracked by passing objects." We can well 
 imagine what a deep and lasting, though subconscious, 
 influence such gruesome tales may exert on the sensitive 
 mind of a highly imaginative child. 
 
 Thus by means of the method of hypnoidization, or 
 by the induction of hypnoidal or intermediary states, 
 the various threads of the complex web of insistent or 
 recurrent psychomotor states with their concomitant 
 symptoms have been traced to dissociated, subcon- 
 scious systems, having their origin far back In the dim 
 regions of the patient's child life. 
 
 The dissociated subconscious experiences, like the 
 moment consciousness of low types, kept on recur- 
 ring with the same or similar mental content and psy- 
 chomotor reactions, giving rise to apparently unaccount- 
 able, irrational, insistent ideas and emotions, deeply af- 
 fecting the patient's self-consciousness. 
 
 All those experiences have no meaning in the pa- 
 tient's present life activities. They are pathological, 
 just because they are meaningless, not adaptable to the 
 present environment. Biologically they have as much 
 meaning in the economy of the individual as the appen- 
 dix and a host of other rudimentary organs, functions 
 and processes. Psychopathic states are cases of atav- 
 ism within the life history of the individual. 
 
 The following case may serve as a good example of 
 hypnoidal psychognosis, revealing sets of subconscious 
 systems as the basis of psychopathic symptoms. 
 
366 Diagnosis of Psychopathic Diseases 
 
 M. L. nineteen years of age. Family history is neg- 
 ative, his parents died when the patient was young, and 
 he was left without kith and kin, so that no data could 
 possibly be obtained. 
 
 Physical examination is negative. Field of vision is 
 normal. There are no sensory disturbances. The pro- 
 cess of perception is normal, and so also is recognition. 
 Memory for past and present events is good. His pow- 
 er of reasoning is quite limited, and the whole of his 
 mental life is undeveloped, embryonic. His sleep is 
 sound ;'he dreams little, wets his bed since childhood. 
 Digestion is excellent; he can digest anything in the way 
 of eatables. ^ He is of an easy-going, gay disposition, a 
 New York "street Arab." 
 
 The patient complains of "shaking spells." The at- 
 tack sets on with tremor of all the extremities, and then 
 spreads to the whole body. The tremor becomes gen- 
 eral, and the patient is seized by a convulsion of shiver- 
 ing, tremblings, and chattering of teeth. Sometimes 
 he falls down, shivering, trembling and shaking all over. 
 The seizure seems to be epileptiform, only it lasts 
 sometimes for more than three hours. The attack may 
 come any time during the day, but it is more frequent at 
 night. 
 
 During the attack the patient does not lose conscious- 
 ness, he knows everything that is taking place around 
 him, he can feel everything pretty well ; his teeth violent- 
 ly chatter, he trembles and shivers all over, and is help- 
 less to do anything. There is also a feeling of chilliness, 
 as if he is possessed by an attack of "ague." The seiz- 
 ure does not start with any numbness of the extremities, 
 nor is there any anaesthesia or paraesthesia during the 
 whole course of the attack. With the exception of the 
 
Psychognosis by Hypnoidal States 367 
 
 shivers and chills the patient claims he feels "all right." 
 
 Patient was put into a deep hypnoidal condition. 
 There was some catalepsy of a transient character, but 
 no suggestibility of the hypnotic type. In this hyp- 
 noidal state it came to light that the patient "many years 
 ago" was forced to sleep in a dark, damp cellar where 
 it was bitter cold. \The few nights passed in that cold 
 cellar he had to leave his bed, and shaking, trembling, 
 shivering and chattering with cold he had to go to uri- 
 nate, fearing to wet his bed, in expectation of a severe 
 punishment.^^ 
 
 The patient, while in that intermediary, subwaking, 
 hypnoidal state, was told to think of that dark, damp, 
 cold cellar. Suddenly the attack set on, — the patient 
 began to shake, shiver and tremble all over, his teeth 
 chattering, as if he was suffering from great cold. The 
 attack was thus reproduced in the hypnoidal state. 
 "This is the way I have them," he said. 
 
 During this attack no numbness, no sensory distur- 
 bances, were present. The patient was quieted, and after 
 a little while the attack of shivering and cold disap- 
 peared. The room in which the patient was put into 
 the hypnoidal state was dark, and accidentally the 
 remark was made that the room was too dark to see 
 anything; immediately the attack reappeared in all its 
 violence. 
 
 It was found later that it was sufficient to mention the 
 words "dark, damp, cold" to bring on an attack even 
 in the fully waking state. We could thus reproduce the 
 attacks at will, — those magic words had the power to 
 release the pent-up subconscious forces, and throw the 
 patient into convulsions of shakings' and shiverings, with 
 feeling of cold and chattering of the teeth. 
 
368- Diaghosis of Psychopathic Diseases 
 
 Thus the apparent epileptiform seizures, the insistent 
 psychomotor states of seemingly unaccountable origin, 
 were traced to dissociated, subconscious systems, How 
 lapsed and meaningless in the patient's present environ- 
 ment and life reactions. They are recurrent rever- 
 sions, atavistic manifestations of lapsed, noiv mean- 
 ingless groups of psychomotor reactions. 
 
 Mrs. L., sixty years of age ; married. Family history 
 is good. Parents died of old age ; brother died of apo- 
 plexy. Patient had one daughter who died some fifteen 
 years ago. 
 
 The patient complains of sensitiveness of the stom- 
 ach, of kidney trouble, and of nervousness. During the 
 attacks of nervousness she is restless, sleepless, and is un- 
 dergoing "death agonies." The suffering is so intense 
 that, in spite of her religious scruples, the thought of 
 suicide forces itself on her niind. She has an insistent 
 fear of getting insane; the fear is so intense that she 
 paces the floor night after night, like an animal in a cage. 
 
 She is unable to eat and hardly drinks anything when 
 the attack is on. If she attempts to eat, she rejects it 
 immediately. "While my brain is perfectly clear 
 to take up any intellectual pursuit, if I attempt, 
 for instance, to purchase anything in the way of 
 apparel, my brain gets on fire and I walk the 
 floor in a frenzy of excitement, not having the least 
 idea as to the choice I should make. I am not able to 
 sleep or eat, and what little food I eat does not digest. 
 Although so disabled in judgment as to myself, my 
 friends often come to me to aid them in their decisions 
 in matters of apparel, because they value my judgment, 
 which is perfectly cool, when I am deciding for them." 
 
 Though the oculists do not find anything special the 
 
Psychofftiosis by Hypnoidal States 3^9 
 
 rpatter with her eyes, she complains of weakness and oc- 
 casionally of complete darkness settling on the eyes, at 
 first In the form of a mist, and then, becoming denser, 
 ends in total darkness, a form of functional amblyopia. 
 She also complains of severe headaches, — ^the head feels 
 at first dizzy, sore, painful, throbbing, and hot, 
 as if it were on fire. Patient also complains of trophic 
 disturbances, of a dry skin, of swellings and rashes on 
 the body. For years she has been suffering from those 
 trophic disturbances which she terms "erysipelas." 
 
 When the attack sets on, the patient becomes greatly 
 depressed, — the hands and the feet are cold ; the bowels 
 are constipated; there is irritation pf the bladder; tinni- 
 tus aurium is present; there is a feeling of pressure in 
 the head with dreams of a distressing character; then 
 the headache grows in severity and becomes throbbing. 
 After a time trpphic disturbances appear, such as rashes 
 in the form pf "pimples and swellings," with oedema 
 of the legs, of hands and eyes. 
 
 Now and then the patient has seizures of coughing 
 spells, and has insistent fears of some impending lung 
 troubles. Occasionally she has epileptiform attacks with 
 slight tonic and clonic convulsions, accompanied with 
 unconsciousness or semi-consciousness. Some years ago 
 she used to have "attacks of helplessness," and even of 
 complete paralysis. She also suffered from tingling 
 sensations in the extremities, "numbness all pver," be- 
 coming fully anaesthetic over the whole surface of the 
 body. 
 
 An examination of the patient shows her to be greatly 
 emaciated; poorly nourished; skin is dry and crackling. 
 There are a few macules and papules, a few wheals and 
 rexnn^nts of dried-up vesicles and blebs. Near the 
 
370 Diagnosis of Psychopathic Diseases 
 
 margin of the mucous membranes some fissures and ex- 
 coriations are found in various stages of healing and 
 crusting. The tongue is coated, furred and there is a 
 heavy smell from the mouth. The lungs are in good 
 condition. The heart-beat is irregular, aortic second 
 sound is slightly accentuated. Patellar reflexes are great- 
 ly exaggerated. The eyes do not accommodate well, — 
 the left eye is somewhat defective in convergence during 
 the act of accommodation. Pupillary reaction is rather 
 sluggish. The tympanic membrane of the left ear is 
 slightly thickened, and hearing is defective on the left 
 side. She also suffers occasionally from noises, "buz- 
 zing in the head" and dizziness. 
 
 Motor activities and sensitiveness to all forms of 
 sensory stimulations are in good condition. No oedema 
 could be found, except a slight puffy condition below 
 the eyes. Several examinations of the urine showed 
 the latter free from any trace of albumin. Patient can 
 see well, but she gets easily fatigued when reading or 
 sewing, — a darkness then comes over her, and every- 
 thing seems to be enveloped in a mist which is getting 
 heavier and thicker. Field of vision is normal. No 
 reversion of the color field is present. 
 
 Memory for present and past events is excellent. 
 Attention is good, but she cannot keep her attention for 
 any length of time; she then begins to complain of 
 fatigue and sometimes gets an attack of severe head- 
 ache. Intellectual powers are well preserved, and, in 
 fact, are quite vigorous. Patient is well educated, writes 
 well and has a deep interest in philosophical, especially 
 in theological problems. 
 
 Hypnagogic and hypnapagogic hallucinations are 
 well developed; field of vision on closure of the eyes 
 
Psychognosis by Hypnoidal States 37 1 
 
 is very rich in colors. Sleep is greatly disturbed, she 
 suffers from insomnia, and when she fall? asleep she 
 has quite elaborate dreams, often of a distressing char- 
 acter. Once she had a visual hallucination of her 
 daughter, and another time she had the peculiar hal- 
 lucination of the reality of the presence of her daugh- 
 ter, who did not appear to the "bodily senses," but to 
 the "inner mental vision," a form of pseudo-hallucina- 
 tion. She has a yearning after something, she does not 
 know what, and is in constant fear of losing her mind. 
 
 The fear of insanity is occasionally so intense that 
 she suffers agony. Her general mood or affective state 
 is one of great depression and misery. 
 
 A psychognostic examination by the hypnoidal states 
 revealed the following data : 
 
 When at the age of five, the patient happened to see 
 an insane woman in a maniacal condition. The image 
 of that woman never left the patient's thought, con- 
 scious or subconscious, so deeply was her mind im- 
 pressed with that event. She was greatly frightened 
 and the thought kept recurring: "Do little girls get in- 
 sane?" Since that time she became possessed by the 
 fear of insanity. In her ardent imagination she actually 
 felt that she was getting insane. 
 
 When asked about her dreams, the patient was un- 
 able to tell anything, but in one of the deeper hypnoidal 
 states she remembered that she used to dream about 
 that insane woman standing near her bed, bending over 
 her and even touching her. Many times she was in 
 such agony of fear that she wanted to cry out, but was 
 unable to do it. When she woke up, she cried in great 
 terror. When the patient gave birth to her child, she 
 was afraid the child would get insane ; many a time she 
 
372 Diagnosis of Psychopathic Diseases 
 
 even had the feeling, as if the child was insane. 
 
 Thus the fear of insanity is traced to an experience 
 of early childhood, an experience which, having be- 
 come subconscious, is manifesting itself persistently in 
 the patient's consciousness. 
 
 The patient's parents were very religious, and the 
 child was brought up not only in the fear of God, but 
 also in the fear of hell and the devil. Being sensitive 
 and imaginative, the devils of the gospel were to her 
 stern realities. She had a firm belief in "diabolical pos- 
 sessions" and "unclean spirits." The legend of Jesus ex- 
 orcising in the country of the Gadarenes unclean spirits, 
 whose name is Legidn, was to her a tangible reality. She 
 was brought up on brimstone and pitch, with everlasting 
 fires of the "bottomless pit" for sinners and unbelievers. 
 In the hypnoidal state she clearly remembered the 
 preacher who used every Sunday to give her the horrors 
 by his picturesque descriptions of the tortures of the 
 "bottomless pit." She was in anguish over the unsolved 
 question: "Do little sinner-girls go to hell?" This fear 
 of hell made the little girl feel depressed and miserable, 
 and had poisoned many a cheerful moment of her hfe. 
 
 What a lasting effect and what a melancholy gloom 
 this fear of ghosts and of unclean spirits of the bottom- 
 less pit produced on this young life may be judged from 
 the following facts: 
 
 When the patient was about eleven years old, a 
 young girl, a friend of hers, having noticed the pa- 
 tient's fear of ghosts, played on her one of those 
 silly, practical jokes, the effects of which on sensi- 
 tive natures are often disastrous and lasting. The girl 
 disguised herself as a ghost in a white sheet and ap- 
 peared to the patient who was just on the point of fall- 
 
Psychognosis by Mypnoidal States 373 
 
 ing asleep. The child shrieked in terror and fainted. 
 Since that time the patient suffered from nightmares and 
 was mortally afraid to sleep alone; she passed many a 
 night in a state of excitement, frenzied with fear of ap- 
 paritions and ghosts. 
 
 When about the age of seventeen, she apparently 
 freed herself from the belief in ghosts and unclean pow- 
 ers, but the fear acquired in her childhood did not lapse, 
 it persisted subconsciously and manifested itself in the 
 form of uncontrollable fears. Unless specially treated, 
 fears acquired in childhood last through life.* She was 
 afraid to remain alone in a room especially in the even- 
 ing. Thus, once when she had to go upstairs alone to 
 pack her trunks; a gauzy garment called forth the ex- 
 perience of her ghost-fright, — she had the illusion of 
 seeing a ghost and she fell fainting to the floor. 
 
 When about the age of eighteen, she began to teach 
 mathematics in a school and worked hard. Being 
 ambitious to advance, she studied assiduously after she 
 was through with her school duties; she worked hard 
 and worried piuch over her prospects of advancement. 
 It was from that period that her headaches date as well 
 as her first attack of nervous prostration. 
 
 ♦"Every ugly thing," says Mosso, "told to the child, every shock, 
 every fright given him, will remain like minute splinters in the flesh, 
 to torture him all his life long. 
 
 "An old soldier whom I asked what his greatest fears had been, 
 answered me thus : 'I have only had one, but it pursues me still. I 
 am nearly seventy years old, I have looked death in the face I do 
 not know how many times; I have never lost heart in any danger, 
 but when I pass a little old church in the shades of the forest, or -j. 
 deserted chapel in the mountains, I always remember a neglected 
 oratory in my native village, and I shiver and look around, as 
 though seeking the corpse of a murdered man which I once saw 
 carried into it when a child, and with which an old servant wanted 
 to shut me up to make me good.'" Here, too, subconscious ex- 
 periences have persisted throughout lifetime. 
 
374 Diagnosis of Psychopathic Diseases 
 
 When she got married, the duties of housewife and 
 of social relations made life still more strenuous. 
 Motherhood served only to increase the nervous strain 
 and anxiety all the more so as her child was constantly 
 ailing up to the age of five. After years of devotion 
 and of motherly self-sacrifice she succeeded in bringing 
 up her daughter, who became the very soul of the pa- 
 tient's being. 
 
 What a fearful blow it must have been to this frail 
 woman when her only daughter, in the full bloom of 
 her young womanhood, at the age of twenty, began to 
 ail, to sink in health, and was declared an incurable 
 case of tuberculosis 1 Day and night did the imfor- 
 tunate mother watch in anguish over her only child^ 
 She actually lived through the distressing cough, the 
 gastric and trophic disturbances, the loss of appetite, 
 the nausea, the inability to retain food, the weakness, 
 the helplessness, and the complete prostration of her 
 daughter who did her best to cheer her poor, suffering 
 mother who, with an aching heart, eyes blinded with 
 tears and with a mind distracted by anguish and anx- 
 iety, felt her head in a whirl ; choking sensations, dark- 
 ness, fainting spells began to seize on her, spells of 
 darkness against which she struggled in throes of con- 
 vulsions. 
 
 In one of the hypnoMal states I happened to 
 press on the throat, accidentally producing choking 
 sensations, when the patient began to feel faint 
 and, losing consciousness, became convulsed with epilep- 
 tiform tonic and clonic contractions. The state of un- 
 consciousness, of semi-consciousness or of "Ddmmersus- 
 tdnde," lasted about twenty-five seconds, the patient 
 coming back with a deep sigh and with no memory of 
 
Psychognosis by Hypnoidal States 375 
 
 what had taken place during the attack. I was thus en- 
 abled to reproduce at will the original attacks. 
 
 The patient told me that with all her "faith in the 
 Lord" she rebelled against "Providence." "I have 
 blasphemed the Lord, — He is not as good as a loving 
 mother." 
 
 The daughter passed away in the arms of 
 the mother, who from that time on had been living 
 through the disease of her. child with all the symptoms 
 of trophic disturbances and death agony, but much more 
 complicated and intensified by the agony which she her- 
 self had then undergone. Dress, receptions, visits be- 
 came painful to her, because of the daughter with whom 
 all those enjoyments have been associated. The whole 
 life experience of that period of anguish has persisted 
 in her subconsciousness and has been forcing itself with 
 all its vehemence on the patient's personal self. All 
 those symptoms, however, disappeared during the treat- 
 ment. 
 
 Thus the whole symptom-complex of the disease 
 could by means of the hypnoidal states be traced to dis- 
 sociated, submerged, subconscious experiences, or to sub- 
 conscious sets of systems, coming in the form of at- 
 tacks of insistent mental states, or of recurrent psycho- 
 motor states, now meaningless, harmful, psychopathic. 
 
CHAPTER XXXI 
 
 SOMOPSYCHOSIS AND PSYCHONEUROSIS 
 
 FROM a clinical standpoint the various psycho- 
 pathic disturbances may be reduced to two 
 main types : Somopsychosis and Psychoneuro- 
 sis. 
 
 In somopsychosis the somatic symptoms predomi- 
 nate such as paralysis, contractures, convulsions, 
 or anaesthesia, hyperaesthesia of the various organs, 
 glands, and tissues. The somatic psychoses or neuroses 
 may be further divided according to the symptoms into 
 motor, sensory, or glandular. The somatic neuroses 
 would comprise the various manifestations of what 
 is at present described in literature as hysteria and neu- 
 rasthenia, aswell as themilder forms of hypochondriasis. 
 In all such diseases the physical symptoms form the 
 prominent elements of the mental malady. The patient 
 remains unaware of the underlying mental grounds. So 
 much is this the case that the patient is offended if his 
 trouble is regarded as purely mental in character. The 
 psychic elements, although of the utmost consequence in 
 the causation of the disease, remain unknown to the pa- 
 tient. The mental side of the malady is submerged 
 subconsciously. 
 
 In the other psychopathic affections, the psychoneu- 
 roses, or neuropsychoses, the physical symptoms are, on 
 the contrary, few or none at all, while the predominat- 
 ing symptoms are entirely of a mental character. The 
 patient ignores his physical condition, even if any exists, 
 and his whole mind is occupied by mental troubles. Such 
 
 376 
 
Somopsychosis and Psychoneurosis 377 
 
 conditions are to be found in all obsessions, fixed ideas, 
 imperative impulses, aild other allied mental states. 
 Thus, one patient is in agony over the unrighteousness 
 of his conduct; another suffers tortures over the unan- 
 swerable question of "What am I ?" ; anothef is obsessed 
 by a fear of some mysteridus agency, or by a fear of 
 women, or by agonies of suspicions of criminality in her 
 husband, or by religious and moral fears of not having 
 lived up to the proper duties of life. 
 
 The two forms of psychopathies are in strong con- 
 trast with each other. 
 
 In the somatic psychopathies or somopsychoses the 
 patient brings before the physician physical symptoms, 
 — stomach trouble, intestinal pains, soreness of the ab- 
 domen, contractures of limbs, headaches, anaesthetic 
 spots of various shapes, or paresis and paralysis of vari- 
 ous organs. Hence it is for the physician to discover 
 the underlying psychic states. 
 
 In the purely mental forms, the psychoneuroses, on 
 the other hand, the patient entirely omits to describe his 
 physical condition and tells little of it even when he is 
 pressed for it. He usually states that he has always 
 been physically well, and some patients even assert they 
 are sure that they will always be physically well, that 
 the whole trouble is purely mental. The patient, in 
 fact, takes special care and time to bring out this point 
 to the physician. "I have no physical trouble," he tells 
 the physician, "all my troubles are mental. If you 
 cduld cure me of my mental suffering, I would be per- 
 fectly hippy. I am as strong and tough as a bull ; my 
 physical condition is perfect. I rarely have as much as 
 a cold. I can be exposed to any conditions of life and 
 feel all the better for it, but fny mind is hell," 
 
378 Diagnosis of Psychopathic Diseases 
 
 The psychosomatic patient lays stress on his physical 
 symptoms and is offended when they are declared to 
 be mental; the psychoneurotic, on the contrary, insists 
 on his mental symptoms and becomes impatient when 
 the physician pays attention to physical symptoms or 
 bodily functions. This difference between the somopsy- 
 choses and neuropsychoses or psychoneuroses is a funda- 
 mental one, and is of the utmost clinical importance, 
 both in diagnosis and in treatment. 
 
 The somopsychoses simulate physical and organic ner- 
 vous troubles. Thus, many "hysterical" forms simulate 
 tabes, or paralysis agitans, hemiplegia, paraplegia, or 
 epilepsy, while many of the neurasthenic, hypochondria- 
 cal, and their allied states simulate tumor or cancer of 
 the stomach, intestinal obstructions and glandular de- 
 rangements, cardiac, laryngeal, pneumonic, hepatic, 
 splanchnic, ovarian, tubal, uterine, renal, and hundreds 
 of other bodily afflictions. The neuropsychoses or psy- 
 choneuroses simulate all forms of mental disease, begin- 
 ning with melancholia and mania, and ending with gen- 
 eral paresis. 
 
 The psychosomatic patient is in constant terror of be- 
 ing afflicted by some incurable physical disease, such as 
 heart trouble, tuberculosis, kidney trouble, or of becom- 
 ing a helpless invalid, or of suffering from an incurable, 
 fatal, bodily malady. The psychoneurotic, on the con- 
 trary, ignores physical diseases, but he is in terror of 
 insanity. 
 
 Thus many of my psychosomatic patients are de- 
 lighted, for a short period of course, when, after a phy- 
 sical examination, I tell them that they have no angina 
 pectoris, or no valvular trouble, or after a urinary exam- 
 ination that there is no sugar in the urine and no dia- 
 
Somopiychosis and Psychoneurosis 379 
 
 betes, or that there is no albumin in the urine and no 
 Bright's disease, which was so much dreaded. 
 
 The psychosomatic must be assured that he is not an 
 invalid. The psychoneurotic must be constantly assured 
 that he is not crazy. The psychosomatic must be as- 
 sured that he has no fatal malady. The psychoneurotic 
 must be assured that there is no fear of his becoming 
 insane, and that he need not dread that his "head will 
 give way," and that he will have to be confined the rest 
 of his life in a sanitarium or be committed to an insane 
 asylum. 
 
 Neither psychoneurotic nor psychosomatic pa- 
 tients are aware of the real character of their malady. 
 To understand their trouble the physician must investi- 
 gate their subconscious life. Both psychoneurosis and 
 somopsychosis are diseases of the subconsciousness. In 
 the one the mental, in the other the physical, symptoms 
 predominate. 
 
 Both groups of patients are completely unaware 
 of the rich subconsciousness that forms the soil 
 of their psychopathic states. Both are ignorant of the 
 underlying, subconscious psychosis. The only difference 
 between the two is that, while the psychoneurotic is at 
 least aware that he suffers from a mental malady, the 
 psychosomatic is even ignorant of that fact, — he is con- 
 vinced all along that his trouble is purely physical, and 
 is even offended when the psychic origin of his symp- 
 toms is suggested to him. 
 
 The characteristic of both forms of functional psycho- 
 sis is the presence of subconscious, pathological nuclei 
 around which clusters the symptom-complex of the dis- 
 ease. It is this nucleus of sets of subconscious systems 
 that nourishes, guides, and controls the course and man' 
 
380 Diagnosis of Psychopathic Diseases 
 
 ifestatiotts of the total symptom-complex. Unless 
 this nucleus of the set of subconscious systems is 
 reached and disintegrated, the patient cannot be 
 regarded as cured. The psychopathologist must look 
 carefully, like the operating surgeon, for the subcon- 
 scious, pathological nucleus which forms the root of the 
 malady. 
 
 In both forms of functional psychosis, somopsychosis 
 and psychoneurosis, the pathological nucleus is subcon- 
 scious, and this means that the root of the trouble es- 
 capes the patient's consciousness. The pathological fo- 
 cus is dissociated from the rest of the patient's life. In 
 somopsychosis the dissociation is so complete that the 
 patient is not only ignorant of the origin of the symp- 
 toms, but he is even unaware of the character of the 
 trouble; he may think, for instance, that he suffers from 
 cardiac trouble and go to heart specialists, when the 
 real trouble is some subconscious emotion, referring to 
 some former experience of the patient's life. 
 
 In psychoneurosis the patient may be aware that his 
 trouble is mental, but the nature and root of the trouble 
 escape him as much as they do the psychosomatic pa- 
 tient. The pathological nucleus in both types remains 
 subconscious and dissociated from the patient's con- 
 scious life activity. Dissociation is pathognomonic of 
 functional psychosis in both its varieties, somopsychosis 
 and psychoneurosis. 
 
 In the somopsychoses the line of cleavage in the dis- 
 sociation runs along the psychic and the physical, the 
 physical symptoms alone being in consciousness, the 
 psychic systems being subconscious. In psychoneuro- 
 sis the line of cldavage runs along the line of mental 
 states. Emotional states, a few fragmentary ideas persist 
 
Somopsychosis and Psychoneurosis 381 
 
 in consciousness, while the root of the whole process is 
 hidden in the soil of the subconscious. 
 
 The psychosomatic patient is not only deprived of 
 access to the subconscious elements of his malady, but 
 he does not even suspect that such subconscious systems 
 are at the root of his affliction. In fact, so sure is he 
 that everything is well known to him that at first he Is 
 surprised at the efforts made to get hold of his sub- 
 conscious activities and trace the roots of his mental af- 
 fection. The psychoneurotic patient, however, is hard- 
 er to handle than Is the psychosomatic, inasmuch as the 
 latter has no preconceived ideas about the mental na- 
 ture of his malady. 
 
 The psychosomatic patient has, psychopathologically 
 or clinically regarded, a somewhat different attitude 
 from that found in one who is actually affected with 
 a physical malady. In the first place, the character Is 
 affected; the patient becomes at times irritable and at 
 other times quite Indifferent to what Is going on around 
 him. In the second place, the symptoms become accen- 
 tuated after concentration of attention on them, and 
 tend to lapse when the attention slackens. In the third 
 place, the symptoms form a well-connected system, a 
 kind of a well-told story. 
 
 The symptoms do not follow any physiological or 
 psychological connection, but rather a connection char- 
 acteristic of the logical order of an external event. They 
 come periodically, depending In their appearance on 
 definite stimuli and a determined series of external 
 events. Finally, the psychosomatic patient has a proc- 
 livity, without understanding the real reason, for mental 
 treatment of all kinds. It is the psychosomatic patient 
 who feeds the mental scientist, the Christian Scientist 
 
382 Diagnosis of Psychopathic Diseases 
 
 and testifies to the miracles professed by these sects. 
 
 This hankering after mental treatment and faith- 
 cures should be taken to mean that, although the psy- 
 chosomatic patieht is unaware of the psychic origin of 
 his disease, he, nevertheless, subconsciously recognizes 
 the real source of his malady, testifying to it by his cred- 
 ulity in faith-cure. 
 
 It Is from the ranks of the psychosomatics that re- 
 cruits are drawn that fill the armies of the mental heal- 
 ers and "faith curists," and overflow the offices of the 
 clerical doctors. The testimony of the psychosomatic pa- 
 tient is sincere, — his symptoms are somatic, with a sub- 
 conscious psychosis. The psychosis is the important 
 factor. A patient is psychosomatic, not because he suf- 
 fers from actual physical troubles, but because physical 
 symptoms stand out mainly in his consciousness. 
 
 The psychoneurotic person, in contradistinction to the 
 psychosomatic, Is not so apt to fall a prey to quacks. 
 This is no doubt due to the fact that he himself is aware 
 of the character of his malady, and the attending physi- 
 cian is not so apt to commit a blunder in his case, and 
 has him referred in time to the neurologist, psychiatrist, 
 and psychopatholog^st. 
 
 The psychoneurotic is characterized by his in- 
 trospection, by the close analysis of mental states 
 that rise on the fringe of his consciousness. He has in 
 htm the making of a good psychologist. His introspec- 
 tion is keen. In this respect his depression widely dif- 
 fers from the depression of the melancholic, whose men- 
 tal life is laboring under strong inhibition. The mind of 
 the psychoneurotic is in a state of conflict; he is con- 
 stantly engaged in an inner, subjective battle royal with 
 his tormenting obsessions. 
 
Sotnopsychosis and Psychoneurosis 383 
 
 It is on this account that he is an excellent subject for 
 psychological, introspective accounts. 
 
 States of inner struggle are absent in the psychoso- 
 matic, whose attention is fixed on his somatic symptoms 
 without the least comprehension of his psychopathic 
 condition. The introspection of the psychosomatic is 
 entirely occupied with physical symptoms. The intro- 
 spection of the psychoneurotic is mental, moral, or re- 
 ligious, and is full of mental distress. 
 
 The psychosomatic cases should, therefore, be inves- 
 tigated through their subconscious life activities, while 
 the psychoneurotics should be studied both through 
 their upper and lower consciousness or subconscious- 
 ness. 
 
 Psychopathic affections can be differentiated from the 
 various forms of insanity by the following important 
 symptom: Readiness of the patient to get an insight 
 into his trouble. The psychosomatic and the psycho- 
 neurotic are characterized by the fact that they are anx- 
 ious to learn the nature and causation of their trouble. 
 They are eager to learn the psychogenesis of their affec- 
 tion, and will do everything in their power to help the 
 physician in his examination and study of their case. 
 Even in the cases where the idea is fixed, the obsession 
 intense, and the impulse uncontrollable, they are anx- 
 ious to listen to views different from their own, and, in 
 fact, are always on the lookout for some help to get 
 rid of the insistent, mental states. 
 
 No matter how fixed the mental state may be, it will 
 temporarily give way to suggestion and persuasion. No 
 matter how deep and intense may be the emotional state 
 of the psychoneurotic and psychosomatic, it can be dis- 
 tracted and dissipated by the personal touch of some firni 
 
384 Diagnosis of Psychopathic Diseases 
 
 and trusted friend, or by the influence of the confidential 
 physician who has an insight into the nature of the mal- 
 ady. Neither the emotions nor the ideas are immovably 
 fixed, — they are always ready to give way to other as- 
 sociations. 
 
 Moreover, the psychoneurotic is always ready to re- 
 ceive such associations, and welcomes them with all his 
 might and main. There is a great amount of optimism 
 in the psychosomatic and psychoneurotic. This is clear- 
 ly revealed in the various religious and mental cults 
 which often delight the heart of the psychopathic pa- 
 tient. 
 
 Throughput my experience and study of functional 
 psychosis, — both somopsychosis and psychoneurosis, — 
 I have noticed two important factors which help in 
 bringing about the pathological mental condition, viz., 
 emotional shocks and a predisposition to dissociative 
 states. 
 
 In so far as the shocks are concerned, they must 
 be of a character intimately related to the most import- 
 ant interests and emotions of the personality as a whole. 
 The shock must affect the center, the nucleus of per- 
 sonality. Psychopathic states cannot be produced by 
 shocks which do not afect this central nucleus of per- 
 sonal life. 
 
 The shock to be effective must threaten the very cen- 
 ter of one's individuality. The mother and father may 
 become affected in regard to the children, the wife or 
 husband with regard to each other, the lover in regard 
 to his or her love, the ambitious man in regard to the 
 object of his ambitions, the miser in regard to his treas- 
 ured-up wealth, and the religious and highly moral per- 
 son in regard to the objects of religion or moral life, 
 
Somopsychosis and Psyehoneurosis 385 
 
 The character of the shock that is capable of producing 
 psychopathic states must be such as to afect the life ex- 
 istence of the individuality. 
 
 It Is, of course, clear that this menace of the shock 
 need not be a real one in the sense of a trauma actually 
 having in itself the power of bringing about a mental 
 shock. The event itself may be insignificant, but it is 
 enough, if the person affected considers the event as suf- 
 ficiently important to produce ill effects. So insignifi- 
 cant, in fact, may the event-producing shock be that the 
 whole process may have occurred in a dream. I could 
 adduce a number of cases in which the psychopathic con- 
 dition was traceable to dreams. Such dreams, how- 
 ever, must have their origin in some actual event or in 
 a series of events, often lapsed from the patient's con- 
 scious, memory. 
 
 The psychopathologist, however, who regards such a 
 shock as the sum total of the causation of psychopathic 
 states has not yet mastered the rudiments of psychopath- 
 ology. The event that produces the shock is but the last 
 link in a whole chain of similar shocks which can be 
 traced far hack into the dim lights of subconscious re- 
 gions, leading back to early child life. 
 
 The psychopathic state is like a plant that has 
 its roots deep in the soil of subconscious life ac- 
 tivities; it has its beginning in the very germs of 
 the patient's individuality. A long series of shocks in 
 childhood must first have shattered the individuality of 
 the patient before the given particular shock can pro- 
 duce the psychopathic upheaval. Both somopsychosis 
 and psyehoneurosis have a natural history, beginning 
 in early childhood. 
 
 On the whole, in both somopsychosis and psychoneu- 
 
386 Diagnosis of Psychopathic Diseases 
 
 rosis, there must be a cumulative influence in order that 
 the psychopathic state shall be brought about. Early 
 childhood, subsequent education, and experiences in lat- 
 er life contribute to the final outburst of the psychopath- 
 ic condition, apparently produced by some one event. 
 
 Many persons may experience shocks of an intense 
 character and yet not become psychopathic. This should 
 not be taken to mean that shocks per se are not capable 
 of producing psychopathic states, or, in other words, 
 that shocks are not regarded as causes of functional psy- 
 chosis. It only means that the shock is a contributory 
 cause. The shock requires previous conditions and prep- 
 arations to bring about a functional trouble of psycho- 
 pathic character. Rain calls forth no growth from rocks, 
 stones, and pebbles, — ^secds and soil are requisite. Peo- 
 ple do not become psychopathic through the agency of 
 one shock. Subconsciously the ground and seeds are 
 prepared, and the last shock is but the proximate cause, 
 calling forth to life what has been there before. 
 
 The last event need not necessarily result immediately 
 in some functional disturbance. There may elapse some 
 time, — a period which may be one of brooding of a sub- 
 conscious character. In short, the disease may set in 
 slowly, almost imperceptibly; or, the disease may be 
 latent, so to speak, and then be brought out by some 
 slight stimulus of a common-place character, a stimulus 
 with which the patient is fully familiar, and which he 
 would otherwise ignore. Psychopathic states have a 
 long history of development, reaching in the subcou' 
 scious far back to early childhood. 
 
 The other factor in somopsychosis and psychoneuro- 
 sis is dissociation. The psychopathic individual has a 
 predisposition to dissociative states. It is true that early 
 
Somopsychosis and Psychoneurosis 387 
 
 experiences and the training of early childhood enter 
 largely into the formation of such a predisposition. Still 
 there is no doubt that heredity has its share. A sensitive 
 nervous system is required, — a sensitive brain highly 
 susceptible to special stimuli of the external environ- 
 ment. 
 
 This, of course, does not mean that the brain must 
 suffer from stigmata of degeneration. On the con- 
 trary, it is quite possible, and in many patients we ac- 
 tually find it to be so, that the psychopathic individual 
 may even be of a superior organization. It is the sensi- 
 tivity and the delicacy of nervous organization that 
 make the system susceptible to injurious stimulations, 
 to which a lower form of organization could be sub- 
 jected with impunity. An ordinary clock can be han- 
 dled roughly without disturbance of its internal work- 
 ings, but the delicate and complicated mechanism of a 
 chronometer requires careful handling and special, fa- 
 vorable conditions for its normal functioning. 
 
 Upfavorable conditions are more apt to affect a 
 highly complex mechanism than a roughly made instru- 
 ment. It is quite probable that it is the superior minds 
 and highly complex mental and nervous organizations 
 r^hat are subject to psychopathic states or to states of 
 dissociation. 
 
 , Of course, unstable minds are also subject to 
 di^oqiative states, but we must never forget the 
 fact that highly prg^r^zed brains, on account of their 
 very complexity, are apt to become unstable under un- 
 favorable conditions. A predisposition to dissociation 
 may occur either ip degenerative minds or in minds su- 
 perior to the average. Functional psychosis requires a 
 \png history of dissociated, subconscious shocks, given to 
 
388 Diagnosis of Psychopathic Diseases 
 
 a highly or lowly organized nervous system, dating back 
 to early childhood. 
 
 As Mosso puts it : "The vivid impression of a strong 
 emotion may produce the same effects as a blow on the 
 head or some physical shock." We may, however, say 
 that no functional psychosis, whether somopsychosis or 
 psychoneurosis, can ever be produced simply by physi- 
 cal shocks. In all functional psychoses there must be a 
 mental background, and it is the mental background 
 alone that produces the psychosis, and determines the 
 character of the psychopathic state. 
 
 Thus, one of my patients gives the following account : 
 "The nervous trouble (feeling of lassitude, fear of 
 vague evil, fear of shadows fading into darkness, intense 
 depression, loss of appetite and flesh, insomnia, head- 
 aches, and visceral disturbances) began in a rudimen- 
 tary way about a year and a half ago, although I had 
 already been nervous, and was gradually getting more 
 so. At first it would be just what I call 'painful thought,' 
 that is, if I read something that was a story of misfor- 
 tune or suffering of any kind, or heard of a real case of 
 a similar nature, I could feel how the person must have 
 suffered, felt it as if it were myself. What if that had 
 been me? I shuddered and was afraid. I would go 
 through the most painful of all the sorrowful things I 
 had ever read or known of. It would seem that I was 
 going through the whole experience myself, and then I 
 would hear myself tell the story of suffering, and it was 
 I who had suffered all these experiences. I would be- 
 gin to believe the story. When the end would come I 
 would go off into a shivering horror that would end in a 
 chill, which would sometimes last for three hours. When 
 the horror would come on I would go out and walk until 
 
Somopsychosis and Psychoneurosis 389 
 
 I was tired and come home and go to bed without any 
 dinner and sleep the sleep of reaction and complete ex- 
 haustion. I slept apparently a dreamless sleep, which 
 sometimes lasted about nine hours. Then I seemed 
 to get better in the daytime, but would begin to dream 
 the whole thing at night, and wake up in a blind, shiv- 
 ering terror." 
 
 The dreams terrorized the patient, who, finally, sank 
 into a deep physical and mental depression. As in many 
 other cases, the patient presents a sensitive organization 
 subject to a series of shocks dating back to early child- 
 hood. The terrorizing dreams are hallucinations form- 
 ed by the play of associations out of fragments of ac- 
 tual former experiences, lived through during the per- 
 iod of trauma.* 
 
 *I shall revert to this subject in my forthcoming work "The 
 Causation, and Treatment of Psychopathic Diseases." 
 
CHAPTER XXXII 
 
 THE DIAGNOSIS OF PSYCHOPATHIC STATES 
 
 IN the investigation of psychopathic states the 
 psychopathologist finds a strikingly character- 
 istic pathological condition in each individual 
 case. The symptoms are not isolated, they 
 are not the results merely of nervousness, as is 
 usually and superficially explained both by the lai- 
 ty and the physician. The symptoms of a psycho- 
 pathic case are intimately related and are in each case 
 due to one underlying pathological state. 
 
 The symptom-complex is grouped round a pathologi- 
 cal nucleus of sets of subconscious systems, controlling 
 and guiding the morbid manifestations. Success in the 
 treatment of a psychopathic case depends on the ability 
 to get at that pathological nucleus of the subconscious 
 systems and have it disintegrated. Unless this is done 
 the psychotherapeutic treatment is either ineffective or 
 is but a temporary makeshift; it does not really cure, 
 but only helps to cover temporarily a pathological focus. 
 We must always attempt to get at the central, path- 
 ological, subconscious system out of which all the mor- 
 bid manifestations arise. Thus in a well developed psy- 
 chopathic case the dizziness, the faintness, the nausea, 
 the indigestion, the hemicrania, anaesthesia, and hyper- 
 aesthesia, the fatigue, the abulia, insomnia, and general 
 depression bear severally definite relations to some path- 
 ological focus, which the psychopathologist must find 
 by a searching examination before an efEective psycho- 
 
 390 
 
The Diagnosis of Psychopathic States 39 1 
 
 therapeutic treatment can be undertaken. 
 
 This pathological focus underlying the total morbid 
 symptom-complex can be proven, by various methods, to 
 be detached, or as it is termed, dissociated, from the pa- 
 tient's normal mental life. In the course of time, if it 
 persists and keeps on growing and proliferating, it may 
 become organized into a parasitic cancerous growth, 
 sapping the vital energies of the normal personality. 
 
 This parasitism is well brought out in the attitude of 
 the patient, especially in psychoneurosis, towards those 
 morbid manifestations. He regards the whole symp- 
 tom-complex as foreign to his personality. "When the 
 attack is on," one patient tells me, "I am conscious of 
 everything, and still I have no control." "Something 
 has happened," says another patient, "over which I 
 have no control." "What a fool I am to be troubled 
 by such nonsense; but I cannot help it when it comes." 
 
 Another important characteristic is the periodicity of 
 remissions in the appearance of the morbid system. The 
 attacks of functioning of the dissociated morbid system 
 run in cycles. During the attack the mind works in a 
 circle. This is an important pathognomonic symptom 
 of psychopathic afiected: cyclical and circular mental 
 movements. 
 
 The attack itself is usually sharp and brief in 
 duration and is followed by a long period of de- 
 pression and worry. It is like a controlling nucleus 
 embedded in a mass of nourishing cytoplasm. Acute 
 sensory attacks with long intervals of brooding are path- 
 ognomonic of psychopathic states. This brooding, of 
 course, may be conscious or subconscious, but it is there, 
 and it is of the utmost consequence for the psychopath- 
 ologist to uncover it, if he wishes to diagnose the case 
 
392 Diagnosis of Psychopathic Diseases 
 
 scientifically, and introduce a rational therapeutic treat- 
 ment. 
 
 In most, if not in all cases of psychopathic states, 
 somopsychosis and neuropsychosis, the origin of the at- 
 tack or of the obsession is unknown to the patient. The 
 original pathological focus escapes the patient's knowl- 
 edge just as it is often beyond the grasp of the practis- 
 ing physician. There is a strong, active, pathological 
 mental focus of subconscious systems in the patient's 
 mind, a focus of which he is not directly conscious. 
 
 In order to come to that pathological focus and clean 
 it out, the patient's subconsciousness must be skillfully 
 and thoroughly tapped. This subconscious aspect is 
 one of the most important pathognomonic symptoms 
 of psychopathic diseases. It is of great importance in 
 differential diagnosis. If it can be shown that the lost 
 function or affected organ is active subconsciously, then 
 the affection is of a psychopathic character. 
 
 A further diagnostic point is the overactivity of the 
 stimulated subconscious function. Thus psychopathic 
 anaesthesia, amnesia, is also hyperaesthesia and hyperm- 
 nesia. In functional diseases all losses of functions are 
 also subconscious gains. 
 
 Another symptom well worth knowing in the diagno- 
 sis of psychopathic states is the sudden onset of the at- 
 tack. The morbid mental state flashes on the patient's 
 mind, keeps him in agony for a brief period, some- 
 times for but a few moments, like a petit-mal of epi- 
 lepsy, and then disappears to reappear on some other 
 occasion. These occasions are not accidental; they 
 have a definite causal relation to the attacks. 
 
 Other states persist in consciousness for some time, 
 but even in such cases periodicity of remissions is quite 
 
The Diagnosis of Psychopathic States 393 
 
 marked. This characteristic of periodicity of fully de- 
 veloped psychopathic states is so pronounced that some 
 writers describe such cases by the term "psycholepsy," 
 while others classify them under the misused term of 
 "psychic epilepsy." 
 
 These states do not belong to the patient's normal as- 
 sociative life, but appear to the patient himself as op- 
 posed to his usual normal life-activities. They are 
 dissociated from the rest of his interests, from the 
 rest of his associations and psychomotor adjustments. 
 He does not understand these dissociated states for 
 they have no meaning in his present life ; they are out- 
 lived experiences and reactions, resurrected in the form 
 of hypnoid and hypnoidic-like states. Under certain 
 conditions he is not even aware of them, since they either 
 appear subconsciously, or swamp his personality during 
 the whole period of their activity. The states are es- 
 sentially subconscious, dissociated states ; they come in at- 
 tacks. In seizures, and manifest themselves, like volcanic 
 upheavals, with extraordinary violence and emotional 
 disturbances. 
 
 As pointed out in a former chapter: "One general 
 characteristic of these morbid psychomotor states is 
 the fact of their recurrence with the same con- 
 tent of consciousness and with the same, almost invaria- 
 ble psychomotor reactions. The patient thinks, feels, 
 wills and acts In the same way. Subconscious dissociated 
 states belong to the type of recurrent moment-conscious- 
 ness, — a type characteristic of the lower forms of ani- 
 mal life, a type that responds to the external environ- 
 ment with the same adjustments, with the same psycho- 
 motor reactions. From this standpoint we may regard 
 the recurrent psychomotor states as a reversion to lower 
 
394 Diagnosis of Psychopathic Diseases 
 
 forms of consciousness. The suddenness of the attack, 
 the uniformity of the manifestations of the symptom- 
 complex, the uncontrollable, overpowering effect on the 
 patient's personal consciousness are all due to the same 
 underlying condition, — the dissociation of the patient's 
 subconsciousness." 
 
 During the predominance of the recurrent states, the 
 sense of reality is affected, since the subconscious or 
 dissociated mental states come with an almost uncon- 
 trollable insistency and intensity of the sense of their 
 reality. This is especially true of the highly developed 
 and fully systematized complex recurrent mental states. 
 This affection of the sense of reality is still more en- 
 hanced by the suddenness and violence of the subcon- 
 scious eruption. 
 
 The attacks can be traced to mental trauma, emo- 
 tional shocks, and especially to experiences of early 
 childhood,* to subconscious experiences now purpose- 
 less, meaningless, and harmful to the stability of the pa- 
 tient's personality, noxious to the equilibrium of his 
 psycho-physiological organization, and detrimental to 
 the integrity of his psycho-biological adaptive reactions. 
 
 *This last generalization, advanced in my various writings, will 
 be further developed in a forthcoming work. 
 
APPENDIX I 
 
 SCHEME OF EXAMINATION 
 
 Heredity : 
 
 Diseases with especial reference to specific and men- 
 tal diseases in remote and near relatives, especially 
 parents, brothers and sisters. 
 
 Habits of ancestors. Education. 
 Personal History : 
 
 Condition of parents prior to birth, and of mother 
 during gestation. 
 
 Birth, labor, whether protracted or not; instru- 
 mental delivery or not; whether there were any injuries 
 produced by delivery. Early psychomotor develop- 
 ment of patient; when he began to walk, to talk at 
 proper times, to show normal physical and mental de- 
 velopment. Character and degree of patient's educa- 
 tion. 
 
 Occupation; its nature and under what condi- 
 tions carried on; whether exposed to the influence of 
 toxic agents, impure air, absence of sun light. Overr 
 work, physical, or mental. Domestic conditions; food, 
 sleep, light, air, cleanliness. 
 
 Previous diseases, with especial reference to specific 
 and nervous disorders. Supposed cause of present dis- 
 ease. Initial symptoms. Course of disease and treat- 
 ment up to the present time. 
 Status Praeseus: 
 
 General bodily conditions. 
 
 Physical anomaly and assymmetry. 
 
 State of nutrition; color of skin and mucous mem- 
 branes; amount of fat deposit and muscular develop- 
 ment. 
 
 Respiration ; frequency, regularity, and character. 
 
 Circulation : Frequency and character of pulse and of 
 heart beat. 
 
 395 
 
396 Appendix I 
 
 Examination of the various viscera of the body, such 
 as digestion, alimentation, etc., and analysis of the urine 
 and, where deemed advisable, of the blood. 
 Trophic Condition: 
 
 Skin; dry or moist; pigmentation, atrophy, ulcera- 
 tions; condition of hair, nails, teeth, bones and joints; 
 surface temperature and vaso-motor system; secretions, 
 tears, saliva; condition and development of sexual or- 
 gans and functions. 
 
 Reflexes: Footsole, patellar, abdominal, biceps and 
 triceps, periosteal, conjunctival, pupillary (for light and 
 convergence), pharyngeal. 
 
 Sexual life, the history of its development. 
 
 Kinaesthetic sensations and ideas. Active and pas- 
 sive movements of the various groups of muscles. 
 Movements of eye balls in various directions. Move- 
 ments of lids in opening and closing the eyes ; wrinkling 
 forehead; laughing; whistling; blowing and chewing 
 movements; movements of tongue in various directions; 
 swallowing movements; movements of vocal cords in 
 speech ; movements of head in various directions ; move- 
 ments of arms and shoulders, of hands and fingers in 
 various directions. Active and passive movements of 
 trunk, legs, feet and toes. 
 
 Motor co-ordination: Equilibrium with eyes opened 
 and closed; walking, standing on one foot with eyes 
 open and closed; power in sitting posturCj^to place heel 
 of one foot upon toes of other. Ability to produce or 
 reproduce given positions of various extremities with 
 eyes open and closed; such as touching nose with tip 
 of finger, or bringing finger tips together after holding 
 hands apart; power to appreciate small differences in 
 weight in palm of hands, with the hand at rest and 
 when aided by movement. 
 
 Power to recognize and localize tactile impressions 
 of various intensity on different parts of body and 
 whether patient is in this respect normal, hyperaesthetic, 
 hypoaesthetic, anaesthetic or paraesthetic. 
 
 Recognition of heat and cold and application of dif- 
 
Appendix I 397 
 
 ferences in temperature on various parts of the body. 
 
 Appreciation of painful stimuli, normal, hyperal- 
 gesic, hypalgesic, analgesic, or paralgesic. 
 
 Examination of special senses: taste on either side 
 of tongue, to different stimuli, such as sweet, bitter, 
 sour, and salt. 
 
 Hearing, whether normal, hyperacusis, hypocusis, 
 acusis", or paracusis. 
 
 Sight: in each eye, normal or defective. Field of 
 vision ; appreciation of colors. 
 
 Olfactory sense; normal or defective. 
 
 Subjective sensations: of heat and cold; of pain; of 
 taste; of smell, etc., whether general or local (during 
 rest and during exertion) . 
 
 Examination of higher mental functions. Imagina- 
 tion: Visual, motile, audile, etc. 
 
 Recognition of concrete objects and of pictures. 
 
 Intellectual operations not habitual to the patient. 
 
 Power of conceiving abstract ideas. 
 
 Logical acuteness (a) for points and distinctions, 
 (b) for comprehension of train bf reasoning, (c) for 
 disputation by logical processes. 
 
 Voluntary and involuntary attention, strong or weak. 
 
 Memory of present and past events. 
 
 Comprehension of speech ; imitation of speech ; spon- 
 taneous speech; appreciation of music or melodies, (a) 
 early heard; (b) of such already known to patient; 
 power of patient to imitate or reproduce them, spon- 
 taneous singing or playing. Recognition of objects, of 
 letters, of written or printed words and phrases ; iniita- 
 tion of them and their reproduction. Naming at sight 
 common objects, numerals, letters, or words. Reading 
 aloud, writing from dictation, numerals, letters, words, 
 
 Ehrases. Naming objects through direct perception, 
 earing, sight, touch, or smell, through all of them or 
 through one sense. 
 
 In case of aphasia patient may be unable to recog- 
 nize an object by sight; an apple, for instance, but might 
 be able to identify it by smell or taste, or the contrary 
 
398 Appendix I 
 
 may be true. 
 
 Ability of patient to make himself understood by ges- 
 tures and to interpret the gestures of others. Ability of 
 patient to make articulate sounds, or to make inarticu- 
 late, though rational sounds. Power of patient to make 
 appropriate use of objects. Ability to walk; to interre- 
 late movements, to correlate different space volumes. 
 Ability of patient to dress; to recognize various articles 
 of dress and their use, to handle common utensils, such 
 as spoons, forks ; proper use of food. 
 
 Attention: persistency of motor processes (a) with- 
 out distraction, (b) under distraction; whether motor 
 process under these conditions is continued or intermit- 
 tent. 
 
 Amnesic states. 
 
 The presence of any of the various forms of amnesia. 
 The presence of double or multiple consciousness, or 
 personality. 
 Paramnesia : 
 
 Is the paramnesia immediate, or does it occur some 
 time after the first reproduction? 
 
 Attacks of partial or local loss of consciousness, with 
 or without motor manifestations. 
 
 Observations of different forms of automatisms; 
 emergence of subconscious states. 
 
 Perception of flow of time. 
 
 Sense of localization upon different surfaces of body. 
 
 Perception of relative size. 
 
 Secondary sensations: Sound photism, taste; odor; 
 photism or phonism ; pain phonism ; light phonism, etc. 
 
 Dynamometric power: rapidity of movements; pre- 
 cision of movements; accuracy of aim; steadiness of 
 hand; intentional and unintentional tremor; abnormal 
 impressionability; (a) starting at slight impressions; 
 (b) involuntary imitations; subconscious motor mani- 
 festations; unconscious phorjation; slow speech, scan- 
 ning or staccato speech; speech in which words are run 
 together. Echolalia; involuntary, or impulsive speech. 
 Inverted, or mirror speech; handwriting, steady or 
 
Appendix I 399 
 
 tremulous; mirror writing; handwriting with left hand; 
 observe any manifestations of mirror writing. 
 
 Appreciation of different forms, such as .letters and 
 figures inscribed on different surfaces of body. 
 
 Localization of direction of sounds; appreciation of 
 form; memory and span of prehension; memory for 
 motor processes; suggestibility of the subject. 
 
 1. Suggestion by slight stimuli. 
 
 2. Choice suggestion. 
 
 3. Suggestion of phrases and acts. 
 
 Dreams: their nature, character and frequency; vivid 
 or vague, pleasant, indifferent, distressing. Memory of 
 dreams ; relation of the dreams to the disease. 
 
 Illusions; visual, auditory, olfactory, gustatory, tac- 
 tile. 
 
 Frequency of illusions: 
 
 Hallucinations; visual, auditory, olfactory, gusta- 
 tory, tactile. 
 
 Hypnagogic, hypnapagogic hallucinations. 
 
 Pseudo-hallucinations. 
 
 Frequency of hallucinations. 
 
 Disposition — irritable — sensitive to disturbances, 
 vehement in response, persistent in response. Quar- 
 relsome, gloomy, cheerful, dissatisfied, complaining, ap- 
 athetic, fickle. (In relation to self or environment.) 
 
 Predominant emotion — sex, love, joy, hope, sus- 
 picion, fear, grief, anger, remorse. 
 
 Aesthetic feelings — power of appreciating beauty, 
 power of appreciating the incongruous, power of ap- 
 preciating the ludicrous, power of appreciating the ugly. 
 
 Moral feelings (Duties) — ^to others, to God, to 
 state, to society, to family, to self. Homicidal tenden- 
 cies, suicidal tendencies. 
 
 Self-indulgence — sex, drink. 
 
 Political views, religious views. 
 
 Fixed ideas. 
 
 Insistent emotions. 
 
 Uncontrollable motor impulses, (movements, acts, 
 speech ) — automatic, reflex. 
 
400 Appendix I 
 
 Sense of mysteriousness, — anticipation of thoughts, 
 mysterious agencies. 
 
 Symbolization. 
 
 Formation of new symbolic words and signs. 
 
 Character of delusion. 
 
 Persistency of delusion. 
 
 Change or self — total, partial. 
 
 Habitual expressions (attitude, movements, speech) 
 — conscious, unconscious, automatic, imperative, with 
 motivation. 
 
 Simple reaction time. 
 
 Cognition time. / 
 
 Discrimination time. 
 
 Choice time. 
 
 Association time. 
 
 Reaction time is the time which elapses from the mo- 
 ment a certain signal is given to the moment the sub- 
 ject reacts with some movement. A signal, auditory, 
 visual or other, is given to the subject who is supposed 
 to react with some muscular movement as soon as he 
 perceives the signal. The moment the signal is given it 
 is registered automatically on a time registering appar- 
 atus. The subject's reaction Is also registered on the 
 same apparatus automatically. The time line between 
 the two points is the simple reaction time. In simple re- 
 action time only one signal is given and only one par- 
 ticular movement Is made as a reaction to the given 
 signal known before. Of course, simple reaction time 
 Is really physiologically complex, inasmuch as It re- 
 quires at least six stages : 
 
 1. The stimulation of the peripheral sense organ. 
 
 2. Centripetal conduction! m the sensory nerve. 
 
 3. Centripetal conduction in the sensory centres. 
 
 4. Centrifugal conduction in the motor centres. 
 
 5. Centrifugal conduction In the spinal cord and mo- 
 tor nerve. 
 
 6. Stimulation of muscle to reaction. 
 
 Clinical, simple reaction time, given in hundredths of 
 a second, varies from about 0.12 sec. to 0.35, 0.68 aec. 
 
Appendix t 461 
 
 Reaction time varies with the individual, with age, 
 with state of fatigue, with concentration of atten- 
 tion, with practice and with the intensity and qual- 
 ity of signal. Sound gives a shorter reaction time 
 than sight or touch, while taste and smell give the long- 
 est reaction time. 
 
 The following may be used as a rough clinical meth- 
 od : Have the patient knock with a pencil at a moving 
 sheet of paper as fast as possible for five seconds. Di- 
 vide the five seconds by the number of points made by 
 the patient on the paper. The result is simple re- 
 action time. Thus if the patient makes 30 points then 
 the reaction time will be 5 divided by 30 or about 0.16 
 sec. 
 
 The experimenter should also find out whether the 
 subject's attention was given to the signal or to the re- 
 action. In the first case when the attention is given to 
 the sense-stimulus, and hence termed sensorial reaction, 
 the reaction time is much longer than when the attention 
 is directed to the movement made which is termed mus- 
 cular reaction. Thus Lange who first discriminated 
 between the two types of reaction finds that in his case 
 the sensorial time averaged 0.23 sec. while the muscular 
 0.12 sec. (All the values of clinical reaction time are 
 given in hundredths of a second.) 
 
 Cognition time is determined by having the subject 
 react as soon as a visual stimulus, such as color, or audi- 
 tory, such as sound or a word is identified, or any other 
 sensory stimulus is cognized. The time when the stim- 
 ulus is given and the time when the reaction comes are 
 chronographically registered. From this should be sub- 
 tracted the subject's simple reaction time which should 
 be determined separately. The cognition time varies 
 from about .03 sec.-0.05 s^^- 
 
 Discrimination time is the time of reaction which 
 takes the subject to identify one of two or many stimuli. 
 Two or more stimuli are given and the subject is to re- 
 act when he identifies a definite stimulus.' The stim- 
 uli and the reaction made by the subject are registered 
 
402 Appendix I 
 
 automatically, and the interval between the two is found 
 out. From this time should be subtracted the simple 
 reaction time and the cognition time. Discrimination 
 time varies from about 0.15 sec. to o.io sec. 
 
 Choice time is the time it takes the subject to react 
 with a definite movement, such as with the right or left 
 hand to a definite stimulus. From this must be sub- 
 tracted the simple reaction time and cognition or apper- 
 ception time. The choice time varies from 0.06 sec. to 
 0.4 sec. according to the complexity of the movements. 
 
 Association time is the time it takes for the forma- 
 tion of an association. The subject is given a word 
 and he is supposed to reply with another word as soon 
 as possible. The time of the word given and the time oi 
 the answer are registered automatically. The interval is 
 the time requested from which however should be sub 
 tracted the simple reaction and the apperception or cog- 
 nition time; the result is the association time. The as- 
 sociation time varies from 0.59 sec. to 0.34 sec. 
 
 For clinical purposes a stop watch will do. The mo- 
 ment a word is given to the patient the watch is set go- 
 ing and is stopped as soon as the patient replies with 
 some word. In fact, an ordinary watch will do as well. 
 Of course this method of taking association time is not 
 accurate, but we must remember that all we need is the 
 clinical relative estimate of the patient's condition. As 
 Wundt insists "The value of these figures is not their 
 absolute magnitude, but their utility as checks for in- 
 trospection." 
 
 Suggestibility in Waking State. 
 
 Hypnoidal state. 
 
 Hypnoid state. 
 
 Hypnoidic state. 
 
 Hypnolepsy. 
 
 Hypnotization. 
 
 State of Hypnosis — sensory suggestions, motor sug- 
 gestions, post-hypnotic suggestions, amnesia, personality 
 metamorphosis, hallucinations. 
 
Appendix I 403 
 
 EXAMINATION FOR APHASIA 
 
 I. Presence of orientation, space, time. 
 
 II. What is patient's power : 
 
 Of producing articulate sounds? 
 
 Of comprehending spoken words ? 
 
 Of imitation or reproduction of speech? 
 
 Of spontaneous speech? 
 
 Of utterance of sounds, words, and of their com- 
 bination into phrases and sentences ? 
 
 Of analysis of spoken words into sounds and their 
 reverse process of synthesis? 
 
 Test with more familiar and less familiar or even 
 unfamiliar words. 
 
 III. What is the patient's power of visual recogni- 
 tion of objects and making proper use of them? 
 
 Of pictures? 
 
 Of written and printed words ? 
 Of letters? 
 If he cannot name them, make signs such as pressing 
 the hand a number of times. 
 
 Test with more familiar and less familiar or even 
 strange objects, foreign words. 
 
 IV. What is patient's power of picturing or repre- 
 senting images, when eyes closed? 
 
 V. What is patient's power of naming objects: 
 
 a. When looking at them ? 
 
 b. When, eyes closed? 
 
 VI. What is patient's ability of naming letters? Of 
 reading words? 
 
 If he cannot name spontaneously (voluntarily), can 
 he understand when It is done for him ? can he repeat 
 the name soon after? How long can he remember, 
 when recognizing name of object, letter, word on being 
 told? 
 
 Test with the more familiar and then with the less fa- 
 miliar. 
 
 VII. What is patient's power : 
 Of writing? 
 
404 Appendix I 
 
 Of copying? 
 
 Of writing from dictation ? 
 
 VIII. What is patient's power of recognizing and 
 naming objects through direct perception of the differ- 
 ent senses, such as hearing, touch, smell, etc. ? 
 
 If patient cannot speak nor write, 
 
 IX. What is patient's power : 
 
 Of making himself understood by gestures, and of 
 interpreting gestures of others? 
 
 X. What is patient's power of counting? 
 Of working the elementary operations? 
 Of solving arithmetical problems? 
 
 XL What is patient's power : 
 
 Of memorizing (with a given time and with dif- 
 ferent intervals) ? 
 XII. What is patient's power: 
 
 Of giving a connected account of his history? 
 
APPENDIX II 
 
 THE HYtNOIDAL STATE OF SIDIS 
 
 BY 
 
 T. W. MITCHELL, M. D. 
 
 {Presidential address to the Psycho-Medical Society, 
 London, January 26, 191 1.) 
 
 With Dr. T. W. Mitchell's kind permission I take 
 the pleasure of reprinting from the English "Transac- 
 tions of the Psycho-Medical Society" his valuable presi- 
 dential address on the hypnoidal state: 
 
 "Our knowledge of the efficacy of suggestion in the 
 treatment of morbid conditions is apt to bias our judg- 
 ment in regard to the value of other psychotherapeutic 
 measures and in regard to the interpretation of the re- 
 sults obtained by the employment of such measures. 
 We know how powerful and how far reaching is its 
 action, we know how subtle and indirect may be its 
 use, we know so well the difficulty of eliminating its 
 possible influence in every form of treatment whatso- 
 ever, that we may be inclined to ascribe to its virtues 
 results that are in part at least dependent upon other 
 factors. And although it is probable that the impor- 
 tance of suggestion in the domain of psychotherapy can 
 never be gainsaid, and that the increased suggestibility 
 brought about by the induction of hypnosis cannot be 
 denied, yet we are bound to examine any mode of psy- 
 chic treatment that is put forward by responsible men, 
 and to appraise without prejudice the theoretical con- 
 siderations advanced by them in explanation of their 
 results. 
 
 "We know the efficacy of suggestion, and we know it 
 is a good rule of method not unnecessarily to multiply 
 our causes; but we also know that no scientific dictum 
 has been more productive of advance in knowledge 
 than that which tells us to examine our residues. The 
 history of Science affords us many instances in which 
 
 405 
 
4o6 Appendix II 
 
 the neglect of residual phenomena in experimental re- 
 search has led to the overlooking of important facts, 
 and prevented investigators from making discoveries 
 which, had they paid due attention to their residues, 
 they could hardly have missed. The great chemist 
 Cavendish probably missed the discovery of argon be- 
 cause In his estimate of the nitrogen of the air he neg- 
 lected a residue which his experiments showed him 
 could not be more than i-i20th part of the whole. 
 More than a hundred years afterwards this residue was 
 accounted for by the discovery of argon. 
 
 "Now in the history of psychotherapy, from Its earli- 
 est beginnings down to our own time, we find many 
 cases where the circumstances under which curative re- 
 sults have been obtained render it difficult for us to 
 range these results under the category of the therapeu- 
 tics of suggestion. The mesmeric operator, by a pro- 
 longed series of passes, induced a trance condition which 
 In Itself appears to have had a curative Influence. In 
 other instances benefit was obtained when no evidence 
 of the mesmeric state was to be found. We try to hyp- 
 notize a patient and fail, but while he lies quiescent we 
 give him curative suggestions which seem to be effec- 
 tive. We ask a patient to lie quietly with closed eyes 
 while we murmur therapeutic suggestions in a monot- 
 onous voice, and sooner or later he derives great bene- 
 fit from this process. 
 
 "Such cases as these may be regarded as the residual 
 phenomena of the therapeutics of suggestion, and just 
 as Cavendish and his successors too readily assumed 
 that all the so-called nitrogen of the air was the same 
 as the nitrogen of nitre, so we may be missing some Im- 
 portant truth if we too readily assume that all these 
 therapeutic results arc due solely to suggestion. The 
 value of suggestion during hypnosis is well attested, 
 and the possibility of effecting physiological and psy- 
 chological change by its means is supported by a large 
 amount of experimental evidence. But evidence of this 
 kind is greatly lacking in regard to suggestion without 
 
Appendix II 407 
 
 hypnosis, and' until it is forthcoming we are justified in 
 receiving with some suspicion accounts of the therapeu- 
 tic efficacy of suggestion in the waking state. We seem 
 bound to consider whether some state of consciousness 
 intermediate between waking and hypnosis may not be 
 artificially induced and utilized for the purpose of giv- 
 ing therapeutic suggestions. We should also keep open 
 minds in regard to the possible influence of agencies 
 other than suggestion in every form of psychotherapeu- 
 tic practice. 
 
 "The scientific investigation of states of consciousness 
 intermediate between waking and hypnosis is a contri- 
 bution to psychology and psychotherapy which we owe 
 practically to one man — Dr. Boris Sidis of Brookline. 
 A research into the nature of suggestibility carried out 
 by him some thirteen or fourteen years ago led him to 
 formulate certain laws and conditions of normal and ab- 
 normal suggestibility. In order to get suggestibility in 
 the waking state he found that certain conditions have 
 to be complied with. Attention must be fixed, but it 
 must be distracted from the suggestion. There must be 
 monotony of impressions, limitation of voluntary move- 
 ments, and consequently a limitation of the field of con- 
 sciousness. He regards hypnosis (abnormal suggesti- 
 bility) as "a disaggregation of consciousness, a slit, a 
 scar produced in the mind that may extend wider and 
 deeper, ending at last in a total disjunction of the wak- 
 ing, guiding, controlling consciousness from the reflex 
 consciousness." Normal suggestibility he believes to be 
 of a like nature — "it is a cleft in the mind, only here 
 the cleft is not so deep, not so lasting, as it is in hypnosis 
 or in the state of abnormal suggestibility; the split is 
 here but momentary, evanescent, fleeting, disappearing 
 at the very moment of its appearance." 
 
 "According to Sidis there is no suggestibility without 
 disaggregation of consciousness. Suggestion in the wak- 
 ing state is effective only when limitation of the field of 
 consciousness is produced by the conditions under which 
 the suggestion is given. Sugge"stibility is an attribute 
 
4o8 Appendix II 
 
 of the subconscious, and only when there is a disag- 
 gregation of consciousness as a whole is it possible to 
 appeal directly to the subconscious. Now in the treat- 
 ment of psychopathic disorders we often find it desir- 
 able to get into communication with the subconscious- 
 ness of our patients, not primarily for the purpose of 
 giving suggestions, but in order that we may discover 
 mental material which has become dissociated from the 
 waking consciousness. So far as I can discover from 
 the writings of Dr. Sidis, it was in order to determine 
 whether certain cases of amnesia were merely disag- 
 gregative, and therefore curable, or absolute and incur- 
 able, that he first made use of the conditions of normal 
 suggestibility as a means of gaining access to the sub- 
 conscious for diagnostic or therapeutic purposes. The 
 same end may be obtained by the induction of hypnosis, 
 but hypnosis cannot always be easily induced, and some- 
 times it is objected to. But "where hypnosis is not 
 practicable, and the subconscious has to be reached, 
 we can effect a disaggregation of consciousness, and 
 thus produce an allied subconscious state by putting the 
 patient under the conditions of normal suggestibility." 
 Sidis maintains that by keeping the patient for a short 
 time under the conditions of normal suggestibility we 
 induce a peculiar mental state which he has named the 
 hypnoidal state. The process by which it is induced he 
 calls hypnoidization. 
 
 "Many different methods of hypnoidization may be 
 employed, but they all fulfil the main requisites for the 
 production of normal suggestibility, namely, monotony 
 and limitation of voluntary movement. In his work, The 
 Psychology of Suggestion (1898), Sidis gives the fol- 
 lowing account of his original method : "The patient is 
 asked to close his eyes and keep as quiet as possible, 
 without, however, making any special effort to put him- 
 self in such a state. He is then asked to attend to some 
 stimulus, such as reading or singing. When the read- 
 ing is over, the patient, with his eyes still shut, is asked 
 to repeat it, and tell what came into his mind during 
 
Appendix II 409 
 
 the reading, during the repetition, or after it. Some- 
 times, 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." 
 
 "In his'Studies in Psychopatholoffy (1907) he writes: 
 "As modifications of the same method, the patient is 
 asked to fixate his attention on some object, while at the 
 same time listening to the beats of a metronome; the 
 patient's eyes are then closed; he is to keep very quiet, 
 while the metronome or some other monotonous stimu- 
 lus is kept on going. After some time, when his res- 
 pirations and pulse are found somewhat lowered, and 
 he declares that he thinks of nothing in particular, he 
 is asked to concentrate his attention on a subject closely 
 relating to the symptoms of the malady or to the sub- 
 merged subconscious state." 
 
 "Writing in 1909 on The Therapeutic Value of the 
 Hypnoidal State, he says: "The procedure of hyp- 
 noidization is quite simple and may be described as 
 follows. The patient is told to close his eyes and keep 
 very quiet. He is then asked to attend to some monot- 
 onous stimulus, such as the beats of a metronome, or 
 listen to a continuous note produced by a tuning-fork, 
 or to smell some pleasant odour, or simply to submit 
 himself to a gentle massage in which touch and pressure 
 are of uniform intensity. This should be carried out 
 in a room where it is dark and quiet. Fatigue, physical 
 and mental, especially emotional, is a favourable con- 
 dition. A prolonged warm bath with relaxation is fa- 
 vourable. A predisposition to sleep is helpful. It is 
 therefore best to make the first attempt at hypnoidiza- 
 tion late at night, when the patient is both tired and 
 sleepy. In most cases darkness, quietness, repose, fixa- 
 tion on a bright point and listening to the monotonous 
 buzzing of an inductorium are conditions favourable to 
 the induction of the hypnoidal state, even at the very 
 first attempt." 
 
 "It may be observed that the first description is spec- 
 ially applicable to the investigation of case? gf amnesia. 
 
4IO Appendix II 
 
 The second method described would apply more par- 
 ticularly to the use of hynoidization as a means of dis- 
 covering dissociated complexes of a pathogenic nature. 
 In the last description stress is laid on the induction of 
 the hypnoidal state as an end in itself. 
 
 "By the use of these or similar methods a state of con- 
 sciousness is induced which differs from full waking 
 but is not hypnosis or ordinary sleep. The patient is 
 apparently awake and in possession of all his faculties, 
 but scraps of dissociated memories, which he cannot 
 ordinarily recall, keep rising into consciousness. The 
 whole feeling-tone becomes one of acquiescence and in- 
 difference. Pulse and respiration become diminished, 
 but are liable to occasional disturbances. Fluctuations 
 of sensory acuteness, sudden apparently unaccountable 
 starts, and a slight tendency to resist any change of pos- 
 ture of limbs or body, without actual catalepsy, may be 
 observed. But the condition is essentially an unstable 
 one and constantly varies in depth. At one moment 
 the patient may be practically in the ordinary waking 
 state, at another he may be on the very brink of hyp- 
 nosis or of sleep. Yet on the whole It is a state of rest 
 and calm. Mental and physical activity are relaxed, 
 emotional excitement becomes stilled, and suggestions 
 meet with little resistance. 
 
 "The hypnoidal state Is an Intermediate territory, on 
 the border-land of waking, sleep, and hypnosis. In the 
 course of a valuable experimental study of sleep in man 
 and the lower animals, SIdis discovered that the h3T)- 
 noldal state is a phase of consciousness which Is passed 
 through In every transition from one of these states to 
 another. In passing from the waking state to ordinary 
 sleep or hypnosis, there is always a longer or shorter 
 hypnoidal stage. In the practice of hypnoldizatlon the 
 patient sometimes drops into hypnosis, or he may fall 
 asleep without touching on h5qpnosIs. And so also, in 
 awakening from sleep or from hypnosis, the hj^jnoldal 
 state has to be passed through. Sidis found that the 
 farther we descend in the scale of animal life, the more 
 
Appendix II 
 
 411 
 
 importsint does the hypnoidal state become in relation 
 to bodily rest and recuperation, and he concludes that it 
 is the primitive rest-state out of which both sleep and 
 hypnosis have been evolved. 
 
 "The relation to each other of waking, sleep, hypno- 
 sis, and the hypnoidal state may be represented in a dia- 
 gram in which the primitive hypnoidal state is regarded 
 as a nucelus from which the segments of the larger 
 circle, waking, sleep, hypnosis, have arisen. The transi- 
 tion from one of these segments to another can take 
 place through the central territory with which they each 
 have relations. 
 
 "The spontaneous occurrence of the hypnoidal state 
 in man is as a rule merely a transitory stage in the alter- 
 nation of waking and sleep. From the point of view 
 of evolution it is a -vestige derived from a long race of 
 ancestors, a rudimentary function which has been super- 
 seded by the more highly specialized rest-state, sleep. 
 But it can be artificially induced and maintained by the 
 methods which have been described, and it can be uti- 
 
412 Appendix II 
 
 lized with effect in the treatment of psychopathic dis- 
 orders. 
 
 "The therapeutic use of the hypnoidal state is a 
 somewhat complex subject, for hypnoidization may be 
 employed merely as an adjunct to other methods or as a 
 curative measure in itself. To understand the claims 
 which Sidis puts forward for li at the present time, we 
 cannot do better than to examine the types of cases in 
 which it has been used by Sidis himself at various stages 
 in the development of his practice of it. The full rec- 
 ord of his use of hypnoidization is in the account of the 
 well-known Hanna case, given in Multiple Personality 
 by Sidis and Goodhart. (See Sidis, Psychology of Sug- 
 gestion, Ch. XXII, XXIII.) This was a case of to- 
 tal amnesia, following a severe injury. The patient, 
 a cultured clergyman, was reduced to the mental 
 condition of a new-born child. All his former ac- 
 quisitions and memories seemed to have entirely 
 disappeared, and he had to start learning every- 
 thing again from the beginning. When he was put 
 into the hypnoidal state various fragmentary ex- 
 periences of his past life emerged into consciousness, 
 demonstrating to his observers that his lost memories 
 were merely dissociated and not destroyed. The same 
 method was made use of in other cases of amnesia, and 
 it was found to be of great assistance in effecting the 
 resurrection of dissociated mental material and its rein- 
 tegration in consciousness. 
 
 "With the progress of his studies in psychopathology, 
 the reintegration of consciousness became, for Sidis, the 
 aim of all therapeutic endeavour in connection with 
 maladies that are associated with, or produced by, men- 
 tal dissociation. The recurrent psycho-motor states of 
 functional psychosis, insistent ideas, imperative con- 
 cepts, persistent or periodically appearing emotional 
 states, so-called psychic epilepsy and other states of dis- 
 sociation, all lent themselves to treatment by hypnoidi- 
 zation. By its means the dissociated complexes could be 
 recovered, the psychogenesis of the malady could be 
 
Appendix II 413 
 
 traced, a synthesis of consciousness efiected, and the 
 patient thereby cured. As his confidence in his method 
 increased, Sidis gradually extended its employment, un- 
 til at the present time he seems to use it in every kind 
 of disorder in which psychotherapy is indicated. Writ- 
 ing in 1909, he says: "All cases of a psychopathic char- 
 acter admit of treatment by hypnoidization. This, how- 
 ever, is too broad a statement, as the hypnotic state is 
 far more powerful and attains its end in a shorter time 
 than the hypnoidal state. In those cases therefore where 
 hypnosis can be used, it should by all means be em- 
 ployed. There is, however, a far larger number of 
 cases where hypnosis is not quite easy to induce, either 
 on account of the patient himself or on account of un- 
 favourable external circumstances. In such cases, and 
 they form the vast majority of psychopathic cases, the 
 hypnoidal state is of the utmost importance from a 
 diagnostic, psychopathological and therapeutic stand- 
 point." It is thus as a substitute for hypnosis, when 
 the induction of the hypnotic state is for any reason 
 impossible, that Sidis recommends treatment by hyp- 
 noidization. 
 
 "Now, it might be inferred that in using the hyp- 
 noidal state as a substitute for hypnosis, we should have 
 to rely mainly upon the suggestibility of the state in 
 the one case as in the other. We might suppose that 
 suggestion during the hypnoidal state is the essential 
 part of the treatment. But surprisingly little stress is 
 laid by Sidis on this part of the technique. The most 
 that he says of it is that "the suggestibility of the state, 
 if skilfully handled, is apt to increase the therapeutic 
 efficacy."/ Nor is it in its usefulness as a means of en- 
 abling us to get into touch with dissociated mental com- 
 plexes, and thereby to assist in their reintegration in 
 consciousness, that the sole or chief therapeutic value of 
 the hypnoidal state exists. He says, "once the hyp- 
 noidal state is induced by any of the various methods 
 of hypnoidization, we can either attempt to follow up 
 the history and the development of the malady, or we 
 
414 Appendix II 
 
 may chiefly work for the therapeutic effect and treat the 
 present symptoms. It is, however, advisable from a 
 purely practical therapeutic purpose to combine the two 
 procedures, as the cure is then far more effective and far 
 more stable. In cases where the history of the origin 
 and development of the disease could not be traced on 
 account of the age or unintelligence of the patient, the 
 therapeutic effects alone of the hypnoidal state have 
 been utilized. The results are not so satisfactory so 
 far as scientific information is concerned, but they are 
 nevertheless of great benefit to the patient." 
 
 "It would appear, then, that Sidis ascribes some spe- 
 cial therapeutic virtue to the hypnoidal state, quite 
 apart from the suggestibility which characterises it, and 
 apart also from the assistance which it gives us in trac- 
 ing the pathogenesis of psychopathic disorders. On 
 what, then, does this special therapeutic virtue depend? 
 According to Sidis, it depends on the fact that through 
 the hypnoidal state access is gained "to the stores of 
 potential, subconscious, reserve energy, which by a lib- 
 eration of energy bring about a reassociation and syn- 
 thesis of the dissociated mental systems underlying the 
 symptoms of the disease. The therapeutic value of the 
 hypnoidal state consists in the liberation of reserve 
 energy requisite for the synthesis of the dissociated 
 systems." 
 
 "Before going on to consider this contention, it will 
 be well to examine the practice of hypnoidization in 
 regard to its value as a method of employing sug- 
 gestion, and as a means of facilitating the recovery of 
 lost or dissociated memories. 
 
 "If Sidis is right in supposing the hypnoidal state to 
 have curative value in itself, it will be very diflicult to 
 determine how much importance we should ascribe to 
 suggestion during the state, even when it is persistently 
 used and relied upon by the physician as the essential 
 therapeutic measure. Sidis gives practically no de- 
 tailed record of his use of therapeutic suggestion in the 
 hypnoidal state, and other observers who have reported 
 
Appendix II , 4^5 
 
 their experience of hypnoidization have done so almost 
 exclusively with reference to the recovery of dissociated 
 memories. 
 
 "Perhaps the best example of the use of suggestion 
 as an exclusive therapeutic measure in the hypnoidal 
 state is to be found in the practice of Dr. Bramwell's 
 method of treatment by suggestion. I think there can 
 be little doubt that by his method of giving sugges- 
 tions Dr. Bramwell induces in his patients a state of 
 consciousness which is identical with the hypnoidal state 
 of Sidis. But in this mode of treatment there is, be- 
 sides the suggestions, a prolongation of the hypnoidal 
 state; and if the hypnoidal state in itself has therapeutic 
 virtue, it is manifestly difficult to be sure how much of 
 Dr. Bramwell's good results is due to suggestion and 
 how much to the postulated virtue of the hypnoidal 
 state. If, however, we disregard the supposed virtues 
 of hypnoidization by itself, there is good evidence to 
 show that in some cases valuable results may be obtain- 
 ed by the use of suggestion in the hypnoidal state. 
 
 "The value of hypnoidization in the resurrection of 
 dissociated memories is that which is perhaps most firm- 
 ly established. And this applies not only to the restora- 
 tion of the forgotten experiences of ordinary amnesia, 
 but to the recovery of dissociated memories that are of 
 pathogenic significance. The most striking work that 
 has been done in this connection is to be found in the 
 publications of Freud and his school on psycho-analysis; 
 but the general principle of the reintegration of disso- 
 ciated mental complexes as a curative measure in the 
 treatment of the psycho-neuroses has been arrived at 
 independently by several workers. Sidis himself has in- 
 sistently taught that reassociation of dissociated com- 
 plexes effects a cure of psychopathic disease. 
 
 "But although Sidis uses the hypnoidal state for psy- 
 cho-analytic ( ?) purposes, in so far as by its means he 
 brings back to consciousness pathogenic experiences that 
 cannot be recalled by ordinary association, he does not 
 believe, as the Freudians do, that this process Is in Itself 
 
41 6 Appendix II 
 
 curative. He thinks that "the information of the psy- 
 chogenesis given by the patient is valuable only in so far 
 as by a systematic course of direct and indirect sugges- 
 tion, by mediate associative and immediate associative 
 suggestion, by substitution, disintegration, and synthe- 
 sis, both in the waking and hypnoidal states, we help 
 to transform the associative course and emotiohal tone 
 of the patient's mental life." 
 
 "We must remember that Sidis admits that all the 
 lost memories that can be recovered by hypnoidization 
 can be more easily recovered if hypnosis can be induced. 
 The realm of the subconscious laid bare in patches in 
 the hypnoidal state is the same as that which is laid bare 
 in its entirety during hypnosis. But those who are 
 familiar with Freud's views will remember that he de- 
 precates the use of the hypnotic state for purposes of 
 psycho-analysis, on the grounds that whilst in hypnosis 
 the resistances to the emergence of pathogenic memories 
 are lessened in some directions, they are made more in- 
 tense in others. The region of consciousness laid bare 
 by the induction of hypnosis does not always contain 
 all the pathogenic material whose recovery is necessary, 
 and the psychic force which prevents the emergence of 
 this material into the waking consciousness is at least 
 equally effective in preventing its emergence into the 
 hypnotic consciousness. In my own experience I have 
 found this resistance to be very great in the hypnotic 
 states of patients suffering from the graver forms ot 
 hysteria. 
 
 "If then, In such cases, hypnoidization be no more 
 efficacious than hypnotization, it would seem that 
 Freud's method is the best for the purpose of psycho- 
 analysis; but I think it is possible that in some cases the 
 hypnoidal state may have a superiority over hypnosis in 
 this respect which Sidis does not explicitly claim for it. 
 Indeed, it seems probable that the hypnoidal state may 
 be the best condition of consciousness in which to make 
 use of Freud's technique ( ?). Sidis has expressed the 
 opinion that some of Freud's success may be due to the 
 
Appendix II 417 
 
 unconscious use of the hypnoidal state, and the condi- 
 tions under which Freud conducts his analysis render 
 this supposition not improbable. 
 
 "But in expressing this view Sidis is not referring to 
 Freud's success in conducting the psycho-analysis. He 
 does not mean that by the unconscious use of the hyp- 
 noidal state Freud renders easier the discovery of path- 
 ogenic complexes. What he' means is that Freud by 
 his method of conducting the analysis unconsciously in- 
 duces the hypnoidal state, and that his therapeutic suc- 
 cess may be due in part to the virtues inherent in the 
 hypnoidal state rather than to the psycho-analysis. This 
 inherent virtue of the hypnoidal state is the most inter- 
 esting claim made by Sidis in regard to the practice 
 of hypnoidization. In his later writings he insistently 
 maintains that the use of hypnoidization alone, with- 
 out suggestion or psycho-analysis ( ?) , is sufficient to cure 
 certain morbid conditions. He bases this claim on the 
 fact that he has found the hypnoidal state effective to- 
 wards this end, and he interprets his results as being 
 due to a release of reserve energy which has been lock- 
 ed up in the inhibited and dissociated systems or com- 
 plexes. 
 
 "The principle of reserve energy is based upon a wide 
 generalization of facts, namely, that far less energy is 
 utilized by the individual than is actually at his disposal. 
 In the struggle for existence, those forms of life which 
 have accumulated a store of reserve energy that can be 
 drawn upon in emergencies, have the best chance of 
 survival. The more complex an organism becomes, 
 the greater is its need to avoid reaction to every passing 
 stimulus. Such unrestrained reactions must be inhibited 
 or there will be a wasteful expenditure of energy, which 
 will leave the organism unprepared for occasions of 
 stress in its struggle for life. The inhibitions Increase 
 with the growth in complexity of the nervous system, 
 and they are brought about by the multiplicity of as- 
 sociations that are formed in the course of phylogenetic 
 and ontogenetic evolution. Nothing so clearly marks 
 
41 8 Appendix II 
 
 off the higher from the lower races of mankind as the 
 amount of inhibition they show in regard to instinc- 
 tive or immediate response to external stimuli. The in- 
 hibitions exercised by civilized man are a consequence 
 of the multiplicity of associations which all his mental 
 complexes have acquired, and it is the increase of in- 
 hibitions that has led to that accumulation of reserve 
 energy, ever ready to be called upon in emergencies, 
 which has made him master of the world. 
 
 "When we weigh the considerations for and against 
 a certain line of conduct, the delay in our response to the 
 stimulus is due to the inhibitions exercised by the mani- 
 fold of associated complexes that have been aroused to 
 function. These complexes exercise an inhibitory in- 
 fluence on the complex which has been stimulated. We 
 are familiar in experimental psychology with the no- 
 tion of a stimulus-threshold, and the effect of an in- 
 crease of associations is to raise the stimulusvthreshold 
 of a complex. A complex that has many associations 
 will not be so readily aroused to function as one that 
 has few. 
 
 "Now if a complex from any cause becomes disso- 
 ciated, it drops out of the personal life and cannot be 
 set in action through its ordinary sensory or associative 
 channels. It will then appear as if its stimulus-thres- 
 hold were very high. But in fact, if we can by any 
 means tap the dissociated complex, its threshold will be 
 found to be very low. And this is what we should ex- 
 pect. Cut off from association with other complexes 
 which were wont to exercise upon it an inhibitory in- 
 fluence, it now reacts to minimal stimuli and manifests 
 itself with great intensity. Freed from the restraining 
 influence of its normal associations, its locked-up en- 
 ergy is expended in wasteful and inappropriate activity. 
 This is well illustrated in attacks of so-called psychic 
 epilepsy and in the psychomotor reactions of other dis- 
 sociated states. 
 
 "In a dissociated complex energy is held in reserve 
 which cannot be drawn upon for the requirements of 
 
Appendix II 419 
 
 the individual, and if by any means this energy comes to 
 be released, it is expended in ways that are worse than 
 useless as regards the adjustment of the organism to its 
 environment. And even when no dissociation has oc- 
 cured, the inhibitions exercised by associated complexes 
 may, under certain circumstances, be so great that a 
 complex may be practically cut off from the functional 
 life of the individual, and its reserve energy rendered 
 unavailable. Here the result is dtie, not to the dissocia- 
 tion of the complex, but to the raising of its threshold 
 so high that normal stimuli are inadequate to arouse it 
 to function. In the one case we have a complex with 
 a very low threshold, functioning only sporadically and 
 excessively because it is dissociated. In the other we 
 have a complex, still functionally related to its asso- 
 ciated complexes, but with a stimulus-threshold so high 
 that it cannot be overstepped by the ordinary stimuli 
 of life. In one case energy is stored and then waste- 
 fully expended; in the other case energy is stored, but 
 it is unavailable. In both cases, so long as the dissocia- 
 tion or the inhibitions continue, nervous energy is lost 
 to the individual and his mental and physical life is In?- 
 poverished. 
 
 "Now these are the conditions met with in functional 
 psychosis and in the psychoneuroses, and if we can re- 
 store the dissociated functions, or break down the in- 
 hibitions, we shall liberate the reserve energy of the dis- 
 sociated and inhibited complexes, re-establish normal 
 associations, and restore the patient to health. Sidls 
 maintains that this end can frequently be obtained by 
 means of the hypnoldal state. In this state there Is a 
 lowering and redistribution of thresholds. Access Is 
 gained to the reserve energy of dissociated complexes, 
 and the energy so available assists In repairing the 
 breaches of associative continuity The high thiiesholds 
 of inhibited complexes are lowered and reserve energy 
 Is liberated. "The overacting dissociated systems with 
 their automatic reflex reactions may form associations 
 with other systems and thus become inhibited as well as 
 
420 Appendix II 
 
 controlled in their function by the voluntary activity of 
 personal consciousness, while the inhibited systems with 
 their raised thresholds and accumulated reserve energy 
 are set to function." The reintegration of the disso- 
 ciated and inhibited complexes is accompanied by a 
 new feeling-tone, a fresh emotional energy, which some- 
 times amounts to a complete transformation of per- 
 sonality. 
 
 "These are the principal points which seem to claim 
 attention in regard to the hypnoidal state. It is main- 
 tained by Sidis that a definite state of consciousness, dif- 
 ferent from waking, sleep, and hypnosis, is brought 
 about by subjecting the patient to the conditions of 
 normal suggestibility, namely, monotony and limitation 
 of voluntary movement. It is a state in which there 
 is a variable and fluctuating disaggregation of con- 
 sciousness, whereby a partial and intermittent access to 
 the subconscious may be obtained. The intercourse 
 with the subconscious so established may be utilized for 
 the purpose of ^ving therapeutic suggestions, or for 
 the recovery of the submerged memories of simple 
 amnesia and for the discovery of dissociated complexes 
 of pathogenic significance. Finally, the hypnoidal state 
 may be employed as a therapeutic agency in itself, by 
 virtue of its power of lowering and redistributing the 
 thresholds of inhibiting and inhibited complexes, and 
 so releasing reserve energy which assists in the restora- 
 tion of normal associations. This, according to Sidis, Is 
 its chief therapeutic value, and it is a claim which, if 
 substantiated by the experience of other observers, will 
 entitle the method of hypnoidization to be considered 
 a discovery of the first rank, and a most noteworthy 
 contribution to psychotherapeutics. 
 
 "I do not desire on this occasion to enter into any 
 critical examination of the views put forward by Sidis 
 in explanation of his therapeutic results. For practical 
 physicians the most Important matter at the present time 
 Is the fact that such results have been obtained by the 
 use of the methods which Sidis has described in his 
 
Appendix II 421 
 
 writings on the hypnoidal state The whole subject is 
 relatively new, and I do not think we have had suffi- 
 cient experience of the method to be justified in having 
 very decided views one way or another in regard to its 
 usefulness. My own experience, so far as it goes, tends 
 to corroborate in every respect the claims put forward 
 by Sidis. I have observed the good effects of the hyp- 
 noidal state apart from any other measure, and whether 
 or not his doctrine of the lowering and redistribution 
 of thresholds and the release of reserve energy affords 
 an adequate explanation, I have little doubt that con- 
 tinued treatment by hypnoidization is sometimes of 
 marked benefit in psychopathic disorders." 
 
APPENDIX III 
 
 THE HYPOTHESIS OF PHYSIOLOGICAL TRACES AND 
 HYPNOSIS 
 
 In Folia Neuro-Biologica, Band VII, 19 13, T. 
 Brailsford Robertson advances an interesting physio- 
 logical theory as an explanation for the concomitant 
 physiological manifestations of consciousness in gen- 
 eral and of hypnosis in particular. I quote Robertson 
 at some length so that the reader should have a clear 
 idea of the hypothesis. Of course, the hypothesis is only 
 provisional and helps the reader to the conception of a 
 possibility of picturing to oneself the physiological and 
 chemical processes concomitant with the phenomena of 
 consciousness, normal and abnormal. Our data of the 
 physiological processes concomitant with mental activi- 
 ties are so scanty and vague that the best that can be 
 done is to stick to facts and describe mental phenomena 
 in terms of consciousness : 
 
 "The chief value of the experimental evidence which 
 has so far been presented lies in the fact that in every 
 detail it goes to support and confirm the theoretical rea- 
 soning which, apart from this evidence, has led us to 
 infer that the processes which underlie and determine 
 the activities of the central nervous system {and there- 
 fore the physical correlates of mental phenomena) are 
 autocatalysed chemical reactions. 
 
 "We may however, approach the question experimen- 
 tally from an entirely different point of view and in this 
 way acquire evidence of a much more general character. 
 As we shall see, the evidence thus acquired emphatically 
 supports the conclusions already arrived at or indicated 
 in the diverse ways enumerated above. 
 
 "The time-relations which are displayed by autoca- 
 talysed chemical reactions are in the highest degree 
 characteristic and have been very extensively studied. 
 
 422 
 
Appendix III 423 
 
 All ordinary reactions at constant temperature whether 
 catalysed or uncatalysed, continuously and regularly fall 
 off in velocity from the moment at which they begin. 
 Autocatalysed reactions, on the contrary start relatively 
 slowly, but, as the initial stages of the reaction liberate 
 more and more of the catalysor, they proceed more and 
 more rapidly until a point is reached at which the de- 
 crease in the active mass of the reacting substance bal- 
 ances the increase in the active mass of the catalysor and 
 the velocity of the reaction progressively decreases. The 
 only other reactions, so far as our knowledge extends at 
 present, which display positive acceleration, that is, 
 which increase in velocity as they proceed, are certain 
 catenary reactions, that is, reactions which proceed in 
 two or more stages. Autocatalysed reactions may, how- 
 ever, be distinguished from catenary reactions by their 
 symmetry. In the majority of autocatalysed reactions the 
 first half of the reaction, during which the velocity is 
 increasing, occupies the same period of time las the sec- 
 ond half, during which the velocity is decreasing. Cat- 
 enary reactions on the contrary, are not symmetrical ; the 
 period of time occupied by the first half of the reaction 
 bears no simple relation to the period of time oc- 
 cupied by the second half of the reaction. 
 
 "If, now, the chemical processes which underlie the 
 activities of the central nervous system are autocataly- 
 tic in nature, then we should expect to find, among the 
 time-relations of these activities, the highly characteris- 
 tic time-relations which distinguish an autocatalysed 
 chemical reaction and, in point of fact, as I have else- 
 where shown, the relationship which subsists between 
 the number of meaningless syllables memorised and the 
 time spent in learning them is that which is characteris- 
 tic of the progress of an autocatalysed chemical reac- 
 tion. Similar time-relations are displayed in the per- 
 formance of other forms of intellectual effort, and the 
 Weber-Fechner law of perception is directly deducible 
 from the assumption that the central processes which 
 underlie and determine the rate of perception are auto- 
 
424 Appendix III 
 
 catalytic. 
 
 "It is in the performance of the neuro-muscular re- 
 sponse to a simple volition, however, such as that in- 
 volved in drawing a straight line that these time-rela- 
 tions are exhibited in their simplest form. By means 
 of a device originally employed by Loeb and von Ko- 
 ranyi, I have measured the relationship between the 
 time (estimated from the inception of movement) and 
 the distance moved over by the hand in drawing a 
 straight line at a fair rate of speed. 
 
 "The time-relations which are displayed in this pro- 
 cess are identical with those which are displayed by an 
 autocatalysed chemical reaction. The symmetry of the 
 relations renders it very unlikely that catenary reactions 
 play any appreciable part in determining the rate of 
 the neuro-muscular response. 
 
 "Upon the threefold basis which we have thus briefly 
 reviewed of Deduction and of Direct and Indirect Ex- 
 perimental evidence we may venture, I think, with a 
 fair measure of confidence, to erect the working hy- 
 pothesis that the processes which underlie and condi- 
 tion the various activities of the central nervous system 
 are, primarily, autocatalysed chemical reactions. The 
 utility or non-utility of this hypothesis in the further 
 elucidation and correlation of the activities of the cen- 
 tral nervous system may be trusted to justify or con- 
 demn its employment. I am about to show that this 
 hypothesis enables us to correlate in a satisfactory man- 
 ner the various phenomena encountered in hypnosis and 
 in allied conditions, both with one another and with the 
 more familiar phenomena of percefjtion, memory, etc. 
 
 "Adopting the working hypothesis outlined above we 
 perceive that the canalisation hypothesis of Exner can 
 now be expressed in a much more definite and concrete 
 form. Each incoming stimulus carves out for itself or 
 deepens a pre-existing channel in the central nervous 
 system, but the channel is not a trough formed by the 
 physical displacement of particles, it is a chemical chan- 
 nel, a thread or trace of the autocatalyst of central nerv- 
 
Appendix III 425 
 
 ous activities, a thread which need not necessarily be 
 supposed to be more than a few times the diameter of 
 "the sphere of molecular influence" in width. This 
 deposit necessarily follows faithfully the path pursued 
 by the original impulse and permits succeeding impulses 
 to pass over the same path more readily by virtue of its 
 presence. It is possessed, of course, of a definite spatial 
 location, but, and this is a very important point, if by 
 any chance it should be obliterated or destroyed it is not 
 irreplaceable even if the continuity of the original path 
 be forever interrupted. For it is only one of a con- 
 ceivably enormous number of paths which might be 
 traversed by a stimulus in its passage from one extrem- 
 ity of the original path to the other. It is not lo- 
 calised in the sense that Ziehen's and Munk's hypo- 
 thetical material images are localised, irrevocably and 
 unalteraj)ly anchored to one spot. 
 
 "Furthermore, this tract is capable of being traversed 
 by other subsequent or preformed traces in as may dif- 
 ferent ways as the axons and ganglion-cells of the cen- 
 tral nervous system intercommunicate, that is, so far 
 as our knowledge extends, in a number of ways which, 
 for all practical purposes may be regarded as Infinite. 
 
 "It must always be remembered that the trace con- 
 sists of a deposit of an autocatalyst which we are ob- 
 viously compelled to assume is an autocatalyst for the 
 propagation of all impulses. It follows therefore that 
 if a faint trace runs into, that is to say traverses or 
 intersects a well-marked trace, there will be a tendency 
 for the impulse forming or following the faint trace to 
 be deflected completely or In great part Into the well- 
 marked trace. Indeed If the Intersecting trace be suf- 
 ficiently well marked and formed subsequently to the 
 faint trace we can see how impulses now arriving by 
 way of the faint trace would become so largely de- 
 flected into the new, well-marked trace as to leave the 
 parts of the faint trace remote from the point of In- 
 tersection almost untraversed by any impulses at all. 
 Instances of the mental correlates of these psycho-chem- 
 
426 Appendix III 
 
 ical phenomena abound in our daily psychic life. For 
 the sake of illustration, however, we may instance the 
 ability of certain voluntary muscular efforts such as that 
 of clenching the teeth to inhibit the otherwise involun- 
 tary motor expression of pain. In terms of our hy- 
 pothesis we may translate this phenomenon as follows : 
 The continuous stream of powerful impulses necessary 
 to maintain the muscular effort canalises a trace suf- 
 ficiently well-marked to deflect a proportion of impulses 
 which would otherwise find their way to the traces which 
 are conducting the impulses which condition the motor 
 expression of pain. Another example is afforded by 
 the fact that when the diffused activity of the central 
 nervous system is limited and impulses are confined to 
 restricted areas they tend to follow faint traces from 
 which they would otherwise become deflected were the 
 content of consciousness larger. The phenomena which 
 accompany the formation of habits and the manner in 
 which one habit may supplant and obliterate another 
 afford a multitude of examples of the effects of "deep" 
 canalisation in confining or diverting the impulses aris- 
 ing from our sensory impressions. 
 
 "Again it is evident, since memory traces unquestion- 
 ably albeit slowly fade, that traces slowly and spon- 
 taneously tend to become fainter and fainter with dis- 
 use. The autocatalyst evidently tends to dissappear 
 (diffuse?) from the region in which it has been de- 
 posited. From what has been said above it appears, 
 therefore, that two regions of the central nervous sys- 
 tem might become almost entirely isolated, blocked off 
 from one another, owing to the sheer "depth" of cer- 
 tain channels in each region deflecting all impulses into 
 well-worn pathways that would otherwise strike across 
 the intervening faintly-channelled region and establish 
 a communication between the two regions (contents of 
 consciousness.) We are here forcibly reminded of the 
 now well-known phenomena of double and multiple 
 personality and we are led to attribute the physical cor- 
 relates of these phenomena to simultaneous excessive 
 
Appendix III 427 
 
 canalisation in one or more regions of the central nerv- 
 ous system. 
 
 "Sidis ("The Psychology of Suggestion" New York 
 1 9 1 1 pp. 1 60 et seq. ) lays in instances of dual person- 
 ality considerable stress upon the fact that one of the 
 personalities usually embraces a wider content of con- 
 sciousness than the other (the "primary" personality) 
 inasmuch as the secondary personality usually contains 
 recollections belonging to the primary personality while 
 the primary personality does not contain recollections 
 belonging to the secondary personality. In such a case 
 the primary personality evidently represents the result 
 of confinement of the area of cerebral activity to certain 
 deeply canalised regions which are usually those which 
 are customarily active in the "normal" psychic life of 
 the individual in question. The secondary personality 
 would represent the result of an overflow of impulses 
 into regions not "normally" traversed. Transition 
 from the primary to the secondary personality would 
 occur whenever a stream of impulses intersects one of 
 the (possibly very few) "channels" connecting the 
 "normal" with the "abnormal" region. The stream of 
 impulses would then divide itself, until diverted into 
 some exceptionally "deep" channel in the primary re- 
 gion, into two parts both of which would be represented 
 in the psychic life. On the other hand, if the secondary 
 area becomes "deeply" channelled, it may draw off the 
 stream of impulses completely from the primary and the 
 condition of primary and secondary consciousness may 
 alternate without either personality containing recollec- 
 tions belonging to the other. An instance of this type 
 of dual personality is afforded by the Hanna case. 
 
 "The instability of "secondary" personalities is also 
 readily understood; as the trace-system connected with 
 an "abnormal" deeply canalised region grows in extent 
 and diversity it tends more and more to encroach upon 
 and traverse other deeply-canalised areas which may 
 belong to the "normal" psychic life or to other "abnor- 
 mal" areas; sooner or later effective connection will be 
 
428 Appendix III 
 
 established, impulses formerly confined to the "second- 
 ary" trace-system will be deflected wholly or partially 
 into others and the "secondary" personality loses its 
 outline and disappears. 
 
 "Again: — -Supposing that the stimuli which impinge 
 upon the central nervous system through the agency of 
 the senses, or, indeed, through the spontaneous diffused 
 activity of the central nervous system itself, be by some 
 means so limited and suppressed that for all practical 
 purposes all impulses arriving through the senses are 
 for some time discharged along one pathway only; 
 there will obviously be a tendency for that pathway to 
 •become deeply canalised, while at the same time other 
 pathways leading from the sense-organs will be becom-^ 
 ing progressively fainter and fainter. The subsequent 
 tendency will be, until new pathways are forcibly chan- 
 nelled out, for the activities of the central nervous sys- 
 tem (field of consciousness) to become limited and 
 narrowed to this single channel. We are at once re- 
 minded of idees fixes, of the insensitiveness to disturb- 
 ance of one who is deeply engaged in the elucidation of 
 some specific problem, and of the more exiaggerated 
 phenomena of sensory hallucinations, automatic and 
 uncontrollable impulses and of the phenomena of hyp- 
 notic and post-hypnotic suggestion. We are led to in- 
 quire whether the circumstances attending the forma- 
 tion of these idees fixes correspond in any way with the 
 theoretical conditions just outlined. 
 
 "According to Sidis, whose genius for experimental 
 investigation has done so much to enlarge our knowl- 
 edge of this difficult field, the conditions leading to 
 hypnosis (which he defines as a condition of abnormal 
 suggestibility) are the following: — 
 
 1. Fixation of Attention. 
 
 2. Monotony. 
 
 3. Limitation of voluntary movements. 
 
 4. Limitation of the field of consciousness. 
 
 5. Inhibition (of the diffused activity of the central 
 nervous system.) 
 
Appendix III 429 
 
 "The exact correspondence between the theoretical 
 conditions which should, ex hypothesi, lead to a condi- 
 tion of relative automatism and the experimental con- 
 ditions which are found to lead to the condition of hyp- 
 nosis is patent. 
 
 "The testimony of other observers all points in the 
 same direction, namely, that limitation of the field of 
 consciousness, confinement of impulses to as few and as 
 limited channels as possible, is the prime condition fos- 
 tering the onset of hypnosis and the conversion of the 
 otherwise unpredictably and multifariously active cen- 
 tral nervous system into the mediator of more or less 
 automatic responses to stimuli. Thus Moll states: — 
 "Those who can by no possibility fix their attention, 
 who suffer from continual absence of mind, can hardly 
 be hypnotised at all. If he sufficiently concentrates his 
 attention; if he gazes at some object with the neces- 
 sary attention, then hypnosis may be produced at the 
 first attempt, even against the wish of the persons ex- 
 perimented upon." 
 
 "Bernheim approaches the view which I have de- 
 veloped very closely in the following passage : — "We 
 also know that subjects who have been hypnotised often 
 may contract an increase of this ideo-reflex excitability 
 through habit, that is to say, through the frequent 
 repetition of the phenomena induced; the paths most 
 frequently followed present the easiest and most rapid 
 way of diffusing the nervous force, the impression fol- 
 lows these paths from preference even in the waking 
 condition ; and for this reason subjects trained and edu- 
 cated by former hypnotisations may manifest the same 
 phenomena and carry out the same acts under the in- 
 fluence of all-powerful suggestion." 
 
 "The analogy between reflex-action and induced psy- 
 chic automatism has been frequently pointed out. From 
 what has preceded it will be clear to the reader that in 
 terms of our working hypothesis reflexes are to be re- 
 garded as attributable to a canalisation between the 
 sense-organ and the organ of motor response which is 
 
430 Appendix III 
 
 so intense as to constitute complete isolation of the 
 reflex-path in so far as any possible deflection of the 
 impulse is concerned. Instincts we may regard, with 
 Fabre and Loeb, as consisting in concatenated chains 
 of reflexes, each link in the chain being evoked by the 
 previous link and affording the stimulus which calls 
 into activity the succeeding link. In some instances, 
 however, in response to the repeated assault of novel 
 environmental conditions, the canalisation at some stage 
 in the process may not be sufficiently deep to r'revent 
 some degree of deflection of the impulses, and under 
 these circumstances instincts, even in animals whose 
 life appears totally automatic, may become perverted 
 and unpredictable results may ensue. 
 
 "The various conditions of heightened suggestibility 
 accompanying hypnotic and allied states are to be re- 
 garded as intermediate stages of canalisation lying be- 
 tween the excessive degree of canalisation which con- 
 ditions reflex and instinctive automatisms and normal, 
 equably balanced and diffused activity of those portions 
 of the central nervous system which condition our vol- 
 untary acts and thoughts, I. e., our fluctuating, non- 
 predictable reactions to environmental changes. Habits 
 constitute yet another group of members of the doubt- 
 less infinite series of gradations stretching from diffused 
 unpredictable activity to the rigidly constrained reflex 
 responses of the lower animals or of our Involuntary 
 neuro-muscular apparatus. 
 
 "I have already dwelt upon the fact that the canalisa- 
 tion-hypothesis permits us to account for the physical 
 correlates of double and multiple personality, because 
 excessive canalisation In any region would tend to iso- 
 late that region from any other deeplv canalised region 
 in the central nervous system, since all Impulses would 
 tend to be drawn off andassimllated Into one or other 
 of these regions. We have now to re-examine this 
 point because it has a strong bearing upon the "dls- 
 aQ:gregating" action of hypnosis which has been so 
 clearly demonstrated by SIdls and his co-workers. I 
 
appendix III 43 1 
 
 quote from Sidis: 
 
 "Hypnosis, we may say, is the more or less effected 
 disaggregation of the controlling inhibitory centers 
 from the rest of the nervous system; along with this 
 disaggregation there goes a dissociation of the con- 
 trolling guardian consciousness from the reflex organic 
 consciousness. Dissociation is the secret of hypnosis, 
 and amnesia is the ripe fruit. 
 
 "The magnitude of this disaggregation greatly varies. 
 If it is at its minumum the hypnosis is slight, if at its 
 maximum the hypnosis is deep and is known as som- 
 nambulism. 
 
 "From our standpoint of hypnosis we may say that 
 there are only two great distinct classes of hypnotic 
 states : — 
 
 1. Incomplete dissociation of the waking, controll- 
 ing consciousness. 
 
 2. Complete dissociation of the waking, controlling 
 consciousness. Stating the same somewhat differently 
 we may say that there are two states : — 
 
 1. Incomplete hypnosis accompanied by a greater or 
 lesser degree of memory. 
 
 2. Complete hypnosis with no memory. 
 
 In other words hypnosis has two states: — 
 
 1. The Mnesic state. 
 
 2. The Amnesic state. 
 
 "Amnesia Is the boundary line that separates two dif- 
 ferent hypnotic regions." {Psychology of Suggestion, 
 pp. 70-71). 
 
 Robertson thinks that his view of bio-chemical traces 
 disagrees with my theory of neuron disaggregation. As 
 a matter of fact, as he himself admits, the two 
 theories are interchangeable. Aggregations and disag- 
 gregations of systems of traces do not in any way differ 
 from aggregations and disaggregations of neuron sys- 
 tems. They are convenient hypotheses for the 
 physiological expression of normal and abnormal phe- 
 nomena of mental life. 
 
APPENDIX IV 
 
 "unconscious intelligence' 
 
 BY 
 
 WILLIAM JAMES SIDIS 
 
 The subject we are to deal with here is the explana- 
 tion of certain psychological facts on the basis of logical 
 methods. Certain actions have been observed which 
 seem to indicate intelligence, but which are supposed 
 not to be phenomena of consciousness. In order to pass 
 a decision on such statements (in which I must assume 
 the facts claimed by both sides to be correct) we must 
 get a general idea of the methods we are going to use. 
 
 The first of these methods is the method of isomor- 
 phism. This depends on the supposition that, if in two 
 hypotheses the consequences are the same, the two hypo- 
 theses may be considered as identical for all purposes 
 of further reasoning. In other words, there is no use 
 in drawing arbitrary distinctions where none really ex- 
 ist. When we reason from a hypothesis, its conse- 
 quences come into play at every step of the reasoning; 
 and if those consequences are the same, all reasoning 
 will be the same, and therefore no difference can really 
 be drawn. Again, a question of decision between two 
 theories whose consequences are and must be the same 
 must necessarily be one where no evidence is obtainable, 
 and is therefore a question which cannot be discussed at 
 all. It is like the old question of the man and the mon- 
 key: "If a monkey is on a pole, constantly facing a 
 man who walks round the pole, has the man gone round 
 the monkey?" 
 
 We may now proceed to apply this method of iso- 
 morphism. There are two theories to explain certain 
 psychological phenomena called the phenomena of the 
 
 432 
 
Appendix IV 433 
 
 subconscious. One of these is that there is a con- 
 sciousness performing all the acts of intelligence which 
 are called subconscious; the other theory states that 
 these acts are the results of an unconscious intelligence, 
 which consists of purely physiological processes. It ap- 
 pears from the latter of the two above-mentioned theo- 
 ries that there is no essential difference between the 
 properties of the unconscious intelligence and those of 
 consciousness. Certain facts from my own personal ex- 
 perience prove that, at least in my own case, this "un- 
 conscious intelligence" can both read and remember. 
 In March, 191 1, while walking along a street, I sudden- 
 ly began thinking about Virgil's Aeneid, and my atten- 
 tion became fixed on the expression "alma Venus" that 
 I then remembered having read in that poem. In that 
 expression I thought particularly on the meaning of 
 the first word. After a few minutes (while I was still 
 on the same block) I began wondering why I thought 
 about that expression so suddenly. Looking around, I 
 discovered that, among the things in the field of vision 
 that I had not noticed was an apartment house called 
 "The Alma." I certainly had no knowledge of the 
 process which I know must have occurred, namely, the 
 reading of the word, the memory that it was Latin, and 
 the memory of the particular expression in which it 
 occurred. Since, therefore, this process had occurred, 
 and it was not within my consciousness, it was evidently 
 a subconscious process. Accordingly, the "unconscious 
 intelligence" within my brain can read and remember, 
 and furthermore, it can remember for half a year, since 
 it had been that time since I had seen that passage 
 from Virgil. 
 
 Again, in August, 19 13, I was walking through a 
 square in which there was a book-store. This book- 
 store was at some distance from where I was walking, 
 so that I could not reasonably notice what was in the 
 show-window without looking quite hard. That night 
 I dreamed of seeing a book with indistinct lettering on 
 the cover. In the morning, passing the book-store at 
 
434 Appendix IV 
 
 closer range, I found in the show-window a book with 
 exactly the same sort of cover as the dream-book. This 
 shows that I must have seen that book the preceding 
 afternoon, but I certainly did not notice it. I must have 
 seen it subconsciously, and my "unconscious intelligence" 
 remembered it at least till two o'clock in the morning, 
 when the dream occurred. The appearance of the book 
 in the dream shows moreover that the memory was not 
 only of the fact of having seen the book, but that it was 
 also of the way the book looked : even the indistinct let- 
 tering in the dream was probably due to the fact that I 
 had passed the store from a distance. 
 
 The "unconscious intelligence" can both remember 
 and reason, that is, it has the two properties most char- 
 acteristic of consciousness. The subconscious, accord- 
 ing to the facts agreed on by both theories, can also do 
 all sorts of intelligent actions and adaptations. Thus, 
 only recently, I kept repeating two stanzas of verse that 
 could not have been composed by anything but my sub- 
 conscious. 
 
 We see then that such an "unconscious intelligence" 
 differs in no way from a normal consciousness; except 
 that / only know of it through circumstantial evidence. 
 But the same can be said of the consciousness of another 
 person; it is only through circumstantial evidence that 
 / know of it. Whether the intelligence on whose na- 
 ture we are arguing be conscious or unconscious, the 
 consequences are the same in every way, and therefore 
 such an "unconscious intelligence" is, according to the 
 rule of isomorphism, practically identical with a con- 
 sciousness that does not need proof in the Supreme Psy- 
 chological Court. 
 
 Any identity, however, is reversible. The supporters 
 of the theory of unconsciousness can then easily reverse 
 this identity, and say that the theory of actual conscious- 
 ness in the phenomena under dispute must be identical 
 with their own theory. However, what is this identity? 
 Merely that, in subconsciousness, all the phenomena are 
 present that are concomitant with consciousness. The 
 
Appendix IV 435 
 
 disputed points, such as whether these phenomena are 
 or are not to be called consciousness, may be for the 
 moment set aside as quibble, for it is a question for a 
 dictionary-maker rather than for a scientific investiga- 
 tor to define the exact use of a term such as conscious- 
 ness. The dispute can now only be reduced to the ques- 
 tion whether these phenomena, the same in every way, 
 are to be assigned to the same or to different causes. 
 That is, are the phenomena of normal consciousness 
 and of subconsciousness manifestations of the same or 
 of different occurrences? To reach any conclusion here, 
 we must refer to the assumption of the uniformity of 
 nature which is at the basis of all inductive logic, as well 
 as of all science. 
 
 This assumption is that effects which are in every es- 
 sential way similar must be ascribed to the same cause. 
 Without this proposition experimental science could 
 lead to no results in the way of general laws ; a Bacon- 
 ian collection of empty facts would be the only possible 
 result, and all science would have to be merely descrip- 
 tive. We may quote the words of Newton, who first 
 expressed this principle in definite form in his Principia 
 {Liber Hi, Regulae Philosophandi, Regula ii) : "Ideo- 
 que effectuum naturalium eiusdem generis eaedem as- 
 signandae sunt causae, quatenus fieri potest. Uti res- 
 pir^itionis in homine et in bestia; descensus lapidum in 
 Europa et in America; lucis in igne culinari et in sole; 
 reflexionis lucis in terra et in planetis. (Natural effects 
 of the same kind must be assigned to the same causes, 
 whenever possible. Such as respiration in man and in 
 animals; the fall of stones in Europe and in America; 
 the light in a kitchen fire and in the sun ; the reflection 
 of light on the earth and in the planets.) 
 
 In the dispute that we are now dealing with, we have 
 a case where two phenomena are practically alike in 
 every essential respect, and have no points of difference 
 sufficient to justify a difference in explanation. Accord- 
 ingly, as in the case of the fall of stones in Europe and 
 America, the phenomena of consciousness and subcon- 
 
436 Appendix IV 
 
 sciousness must be attributed to the same cause. Since 
 it appears from what is said by the advocates of the 
 "unconscious cerebration" theory that one of these phe- 
 nomena is due to consciousness, and the other to an un- 
 conscious intelligence, it follows from the principle 
 enunciated by Newton that their unconscious intelli- 
 gence must be conscious. That is to say, the phenomena 
 of the subconscious are due to a consciousness. 
 
 We may take up the Cartesian hypothesis of physio- 
 logical processes as an explanation of subconsciousness. 
 Here again we may apply the principle of the uniform- 
 ity of nature, if the Cartesians will accede to that logical 
 canon. The phenomena of consciousness being identi- 
 cal with those of subconsciousness, we must explain all 
 mental phenomena whatever by these same processes; 
 for the Cartesians tell us that such an explanation is 
 possible. Therefore whoever explains the phenomena 
 of subconsciousness by means of physiological processes 
 must give a mechanistic explanation of all mental phe- 
 nomena. Of course, if a person wishes to regard the 
 relation of consciousness to physiological processes eith- 
 er as that between the whistle and the locomotive, or as 
 that between the forest and the trees, he may perfectly 
 well do so. However, if this mechanistic hypothesis 
 were true, there would be no difference between the phe- 
 nomena of consciousness and of subconsciousness. The 
 physiological theory therefore proves our former con- 
 clusion, namely, that the phenomena of the subcon- 
 scious are due to a consciousness, which is the same phy- 
 siologically as normal consciousness. 
 
 Besides, since the phenomena of subconsciousness are 
 of precisely the same kind as those of ordinary con- 
 sciousness, we can certainly not consistently claim uncon- 
 sciousness for the one and consciousness for the other. 
 The existence of a consciousness is not disproved by the 
 lack of direct evidence. I have no direct evidence of 
 the consciousness of the persons with whom I speak; 
 but yet they act precisely as if they were conscious, and 
 I am thus led to infer that they are so. Similarly, if I 
 
Appendix IV 437 
 
 see actions in my own body which I myself have nothing 
 to do with (at least apparently), but which are pre- 
 cisely those kinds of actions that are produced by con- 
 sciousness, I must infer that there is one more conscious- 
 ness existent in me. Calling one conscious and denying 
 that quality to the other is introducing a difference 
 where there is none; and to deny consciousness where 
 there is no direct evidence is to construct a sort of solip- 
 sism. I must conclude then with the remark that such a 
 theory as that of "unconscious intelligence" cannot logi- 
 cally be held. 
 
 One of the supporters of the theory of "unconscious 
 intelligence" has advanced an argument which is sup- 
 posed to be a proof of the existence of unconscious intel- 
 ligence. The argument, as nearly as I can understand 
 it, is as follows: A number of subconscious actions is 
 observed, and seen to manifest all the properties usually 
 found in consciousness. Similarly, in decerebrate dogs, 
 all actions usually called intelligent are found. Here, 
 then, are examples of unconscious actions which show 
 every property of intelligence. They certainly have to 
 be called intelligence, for making a difference there is a 
 mere "pragmatic question," and there is no logical 
 point in calling conscious action intelligent, and other 
 exactly similar actions unintelligent. Thus, these uncon- 
 scious actions being intelligent, unconscious intelligence 
 must exist. 
 
 In the first place, let us see what the opposing theory 
 is. The subconscious has been explained in two ways; 
 according to one of these, the phenomena of the subcon- 
 scious are manifestations of a consciousness, possessing 
 all the attributes of intelligence and other adaptations 
 that any consciousness possesses, while according to the 
 other theory there is behind these phenomena an "un- 
 conscious intelligence" which has all the properties of 
 intelligence, but which somehow or other is not con- 
 scious. 
 
 With these two opposing theories in view, we may 
 proceed to examine the argument. The two theories 
 
438 Appendix IF 
 
 agree in stating that the phenomena of the subconscious 
 are inteUigent and have all the attributes which are us- 
 ually ascribed to intelligence. The theories disagree as to 
 whether or not the processes which produce the phe- 
 nomena are conscious. Accordingly a reasoning which 
 seeks to establish the "unconscious intelligence" theory 
 by proving that these phenomena are intelligent is sim- 
 ply proving what is already agreed on; it may be in 
 every way correct, but it is not to the point; it is an 
 irrelevant conclusion. Furthermore, the reasoning says : 
 We have proved that the phenomena under observation, 
 which are unconscious, are intelligent; therefore uncon- 
 scious processes may be intelligent. Expressed as a syl- 
 logism this would read: All processes in these experi- 
 ments are intelligent; all processes in these experiments 
 are unconscious; therefore some unconscious processes 
 are intelligent. This may seem perfectly logical rea- 
 soning, and so indeed it would be if the premises were 
 both acceptable. But let us examine the second prem- 
 ise. Stating that all the processes which come under 
 observation in the experiments mentioned are uncon- 
 scious is assuming precisely the point in question, so that 
 we are merely proving what we have assumed. As far 
 as the particular opinion of conscious action in such 
 cases is concerned, the argument advanced contains not 
 only an irrelevant conclusion, but a circular proof as 
 well. The argument is guilty at least of this double fal- 
 lacy. 
 
 Furthermore, the argument, if carried out to its logi- 
 cal conclusion, would disprove its own result; and we 
 may take this argument as an excellent disproof of the 
 theory that it was intended to prove. Our advocate of 
 "unconscious intelligence" has stated that conscious pro- 
 cesses are in no way different from subconscious pro- 
 cesses or from actions of decerebrate dogs. Therefore, 
 he concludes, it is a mere "pragmatic question" whether 
 or not we should call one of these classes of actions in- 
 telligent and the other- uninteUigent, since there is no 
 real difference between the two kinds of actions. Sub- 
 
Appendix IV 439 
 
 stitute all through the argument the term "conscious" 
 for the term "intelligent." It is, then, a mere "prag- 
 matic question" whether or not we are to call one of 
 these classes conscious and the other unconscious, 
 since there is no real difference between the two 
 kinds of actions. If the argument about intelligence is. 
 valid, the argument about consciousness must also 
 hold. Accordingly, pushing this argument to its 
 logical conclusion, we deduce that not only the 
 class of actions called subconscious, but also the 
 actions of decerebrate dogs, are conscious actions. 
 We cannot say that either the subconscious pro- 
 cesses or decerebrate dogs are unconscious, accord- 
 ing to the logical outcome of the argument advanced 
 by the supporter of "unconscious intelligence"; on the 
 contrary, we must deduce that there is a consciousness 
 causing all subconscious actions, and that the conscious- 
 ness of dogs does not depend on the presence of the 
 cortex. The first of these conclusions from the argu- 
 ment we have taken up is the only one that is important 
 for our purposes: subconscious processes are conscious. 
 
INDEX 
 
 Aboulia, 268, 291, 296, 359 
 
 general, 293 
 
 localized, 293 
 
 specialized, 292 
 
 systematized, 292 
 Absolute agraphia, 260 
 
 apraxia, 260 
 
 visual aphasia, 259 
 Agoraphobia, 301 
 Agraphia, 259 
 Aichmophobia, 302 
 Alexia, 259 
 Allochiria, 112 
 
 complex, H2 
 Allokinesia, 1 1 7 
 Alternation, mental, 79 
 Amimia, 261 
 
 Amnesia, 268, 271, 272, 273, 
 275 
 
 alternating, 288 
 
 autotoxic, 290 
 
 emotional, 290 
 
 general, 280 
 
 localised, 280, 287 
 
 persistent, periodic, 287 
 
 psychopathic, 295 
 
 recognition, 273, 276 
 
 reproduction, 272 
 
 special, 285 
 
 systematized, 287 
 
 toxic, 290 
 
 traumatic, 290 
 
 types of, 280, 289 
 
 variable periodic, 288 
 
 waking state, 273, 277 
 Amusia, 261 
 Amyosthenia, 115 
 
 systematized, 115 
 
 Anaesthesia, 76 
 
 classification of, 108 
 
 disseminated, 109 
 
 general, no 
 
 local, 108 
 
 memory of, 273 
 
 special, 109 
 
 systematized, in 
 
 total, 1 1 1 
 Angina pectoris, 136 
 Anorexia, 122 
 Anorexia nervosa, 134 
 Anxiety, 301, 312 
 Aphasia, 127, 128, 244 
 Aprosexia, 268, 296, 297, 298 
 Aristotle, 183 
 Association of ideas, 153 
 
 principle of, 139 
 Association time, 404 
 Astasia abasia, 127 
 Atavism, 365 
 
 Ataxia, psychopathic, 114, 126 
 Attention, distraction of, 14 
 
 fixation of, 64 
 Attributes of ideas and elements, 
 198 
 
 sensory elements, 196 
 Auditory apraxia, 252 
 Auto-catalysis, 425 
 Auto-hypnoidization, 59 
 Automatic writing, 74, 240, 297 
 Autovocalization, 213 
 
 Belief, 178, 264, 267 
 
 Bernheim, 431 
 
 Bianchi, 12 
 
 Bimorphosis, 277 
 
 monocyclical, 80, 81 
 polycyclical, 80, 81, 90 
 
 441 
 
442 
 
 Index 
 
 Blind, the, 253, 254 
 Blindness, mental, 235 
 Borborygmus, 134 
 Bradycardia, 136 
 Bramwell, 417 
 Brooding, 392 
 
 Canalisation hypothesis, 426 
 
 Cardiac palpitation, 134 
 
 Cardiac rhythm, 136 
 
 Catalepsy, 129, 130, 131, 132 
 
 Cavendish, 408 
 
 Cell energy, 50, 51 
 
 Central hallucinations, 200 
 
 Central theory of double think- 
 ing, 205 
 
 Centres, inferior, superior, 11 
 
 Characteristics of subconscious 
 states, 86 
 
 Childhood, early, 388 
 
 Choice time, 404 
 
 Chorea, psychopathic, 1 18 
 
 Classification of aboulia, 292 
 amnesia, 280, 289 
 anaesthe^a, 108 
 delusions, 265 
 illusions, 138 
 
 insistent mental states, 310 
 psychopathic maladies, 107 
 secondary sensations, 141 
 
 Claustrophobia, 301 
 
 Clavus hystericus, 112 
 
 Coenaesthesis, 168, 169 
 
 Cognition time, 402, 403 
 
 Complexes, suppressed, 21 
 
 Conception, 271 
 
 Conditions of abnormal sugges- 
 tibility, 430 
 
 Conflict, state of, 383 
 
 Consciousness, 16, 28 
 
 characteristics of, 269 
 disturbance of, 308 
 double, 313 
 
 dream, 170, 171, 173, i74. 
 183, 185, 192 
 
 guardian, 13 
 
 hypnotic, 70 
 
 lower, 384 
 
 movements of, 145 
 
 of personality, 250 
 
 reintegration of, 414 
 
 sleeping, 195 
 
 upper, 298, 384 
 Contractures, 125 
 Cough, nervous, 136 
 Crisis, psychopathic, 118 
 Criteria of percepts, 215 
 Criterion of external objects 
 
 177 
 Crystal gazing, 74, 75 
 Crystallophobia, 302 
 Currents, nervous, 11 
 Cyanosis, 136 
 Cycles of alternation, 88 
 Cyclical movements, 392 
 
 Dammerzustande, 1 72, 330, 
 
 .374 
 Deflections, galvanometric, 21, 
 
 22 
 
 Degeneration, stigmata of, 388 
 Delusions, 170, 171, 228, 232, 
 243, 263 
 
 classification of, 265 
 
 systematized, 266 
 
 unsystematized, 266 
 Dementia praecox, 229 
 Desultory consciousness, 286 
 
 states, 314 
 Disaggregated subconsciousness, 
 
 311, 31S, 361 
 Disaggregation, 217, 218, 294 
 
 mental, 33, 69, 100 
 Discrimination time, 403 
 Diseases, classification of, 97, 
 106 
 
Index 
 
 443 
 
 Diseases, functional, 393 
 Dissociated systems, ^i6, 368, 
 
 .375 
 
 Dissociation, 52. 69, 75, 16.5, 
 182, 183 186, 188, 190, 
 199, 211, 213, 301, 312, 
 320, 327, 328, 387, 433 
 
 Dizziness, 134 
 
 Double Jihinking, 204 
 central theory, 208 
 peripheral theory, 207, 
 209, 210, 211 
 
 Dreams, 23, 25, 166, 167, 168, 
 169, 170, 171, 172, 175, 
 182, 183, 184, 185, 188, 
 192, 193, 278, 335, 342, 
 344- 347. 371, 390, 436 
 
 Dream symbolism, 187 
 
 Dynamic energy, 51 
 
 Dyspepsia, 134 
 
 Dyspnoea, 135 
 
 Ebbinghaus, 272 
 Emotional amnesia, 290 
 Emotions, 99, 124, 312, 381, 
 
 385 
 Energy, dynamic, loi, 102 
 
 nervous, 12, 102, 103 
 
 organic, loi, 102 
 
 reserve, loi, 102 
 
 static, lOi, 102 
 Epilepsy, psychic, 188, 307, 308, 
 
 309 
 Epileptic states, 121 
 Epileptoid stage, 121 
 Epistemology, 176, 18 1 
 
 Fatigue, 324 
 
 Ferrier, 12 
 
 Fibres, conducting, 260 
 
 Fixed ideas, 297, 299 
 
 Flechsig, 156 
 
 Fluctuation of thresholds, 325 
 
 Focus, pathological, 393 
 Forces, subconscious, 367 
 Forgetfulness, 269, 270, 271 
 Frazer, 319 
 Freud, 186, 187, 418 
 Functional anaesthesia, 333 
 Functional psychosis, 100, 312, 
 327, 380, 381, 388 
 
 Galvanic reaction, 22 
 Gestures, 255 
 Globus hystericus, 119 
 Groups, ideo-motor, 161 
 
 subconscious, 244, 315 
 Gustatory apraxia, 251 
 
 Haematemesis, 134 
 Haematuria, 134 
 Hallucinations, 76, 122, 138, 
 143, 144, 159, 160, i6i, 
 163, 164, 165, 166, 17s, 
 181, 182, 190, 191, 192, 
 200, 203, 204, 207, 214, 
 215,224, 230, 243, 263 
 central, 200 
 nature of, 203 
 negative, 82 
 
 suggested, 228, 230, 231, 
 232, 236, 238, 239. 240, 
 
 243 
 Hanna case, 429 
 Hearing, double, 205, 212 
 Hemianaesthesia, 108 
 Hemiplegia, 117, 125, 314, 332 
 Heterokinesia, 117 
 HirschlafI, 58 
 Hobbes, 183, 189 
 Homosexual ideas, 361 
 Huxley, 322 
 Hyperaesdiesia, 327 
 Hypermnesia, 327 
 Hypnagogic hallucinations, i88, 
 
 200 
 
444 
 
 Index 
 
 Hypnagogic state, 36, 37, 300, 
 
 353 
 Hypnapagogic hallucination, 
 
 166 
 
 Hypnoid states, 74, 75, 79, 86, 
 87, 232, 334> 433 
 
 Hypnoidal states, 31, 32, 33, 
 34, 35. 36, 40, 43, 45, 
 47, 52, 53, 54, 55, 56, 
 57, 58, 59, 61, 63, 86, 
 128, 162, 328, 351, 359, 
 360, 361, 363, 365, 407 
 411, 413, 422 
 
 Hypnoidic personality, 85 
 
 Hjrpnoidic states, 78, 79, 81, 
 82, 83, 86, 87, 120, 122, 
 123, 124, 126, 132, 158, 
 188, 336 
 
 Hypnoidization, 28, 29, 32, 
 410, 414, 416 
 
 Hypnolepsy, 88, 90, 91, 92 
 
 Hypnoleptic state, 89, 92 
 
 Hypnonergic state, 127 
 
 Hypnosis, 27, 37, 42, 43, 44, 
 49, 52, 56, 69, 70, 71, 
 78, i6r, 188, 232, 413, 
 
 431, 433 
 Hypnotic hallucinations, 219, 
 
 221, 225, 236, 243 
 Hypnotic state, 64, 66 
 Hypochondria, 1 70 
 Hysteria, 135 
 Hysterical stigmata, 312 
 Hystero-epilepsy, 120 
 Hysterogenetic zones, 118 
 Hystero^ieurosis, 135 
 
 Illusions, 137, 140, 145, 157, 
 
 158, 216, 263 
 Images, 201, 248 
 Individuality, hypnoidic, 82 
 Inhibition, 16, 44, 66, 69 
 Insane, the, 172 
 
 Insistent ideas, 309 
 Insistent mental states, classifi- 
 cation of, 310 
 Intellect, 106 
 Intensity, sensory, 272 
 Intoxication, alcoholic, 278 
 Introspection of psychoneurosis, 
 
 .384 
 Ischuria, 134 
 
 Jacksonian epilepsy, 335 
 James, 23, 187, 192, 195, 196^ 
 
 268, 269 
 Janet, 108 
 
 Katatonia, 131, 171, 229 
 Kinaesthetic elements, 179 
 Kinaesthetic elements in the 
 
 blind, 253 
 Kinaesthetic memory, 114 
 Kinaesthetic representations, 
 
 amnesia of, 285, 294 
 Kleptomania, 302 
 Kohschiitter, 38 
 Kiilpe, 323 
 Kussmaul, 271 
 
 Landois, 322, 325 
 
 Latent energy, 318 
 
 Laws of abnormal suggestibil- 
 ity, 28 
 amnesia, 291 
 dissociation, 199 
 forgetfulness, 272 
 functional psychosis, 327 
 normal suggestibility, 28 
 physiological, 202 
 psychopathic disaggrega- 
 tion, 298 
 psychopathic maladies, 136 
 secondary sensations, 142 
 vividness, 199 
 Weber-Fechner, 425 
 
Index 
 
 445 
 
 Lesions, cortical, 260, 261 
 subcortical, 260, 261 
 transcortical, 260, 261 
 
 Lethargy, 132, 133 
 
 Linenthal, 329, 339 
 
 Living substance, 322 
 
 Localization, 273 
 
 Maniacal stages, 171 
 Meaning, 319, 365, 394 
 Memories, hidden, 59 
 
 pathogenic, 418 
 
 resurrected, 61 
 
 resurrection of, 417 
 
 synthetized, 288 
 Memory, 193, 268, 273, 274, 
 288 
 
 images, 247 
 
 visual, 282, 433 
 Mental diseases, 99 
 
 shock, 386 
 Metallophobia, 302 
 Metazoa, rest state, 55 
 Method, of choice distraction, 
 
 ^8 . .. . 
 of conscious impressions, 
 
 of determinate action, 18 
 graphic, 27 
 of guesses, 18, 30 
 of hjrpnoidization, 27 
 of hypnotization, 26 
 of indeterminate action, 17 
 psychic stimulation, 25 
 psycho-physical, 24 
 psycho-physiological, 25 
 of self observation, 24 
 statistical, 24 
 of sub-conscious impres- 
 sions, 17 
 
 Michelson, 38 
 
 Migraine, 312 
 
 Mitchell, T. W., 407 
 
 Moment consciousness, 279 
 Moment, recurrent, 312, 315, 
 
 Monoideism, 27 
 Monoplegic, 117 
 Monotony, 15, 44, 48, 50, 64 
 Morbid emotional states, 3CX) 
 Morbid fears, 302 
 Morbid impulses, 299 
 Morbus hypnoticus, 133 
 Mosso, 389 
 
 Motor disturbances, psycho- 
 pathic, 124 
 Munk, 427 
 Miinsterberg, H., 157 
 Mysophobia, 302, 356, 362 
 
 Necropathies, 97, 105 
 
 Neurasthenia, 307 
 
 Neuropathies, 97, 105 
 
 Nevroz, 39 
 
 Newton, 437 
 
 Normal states, 55 
 
 Nucleus, of personality, 385 
 
 pathological, 381, 391 
 
 subconscious, 380 
 
 Object, percept of, 249, 250 
 
 physical, 177 
 
 social, 177 
 Objective reality, 176 
 Obsessions, 383 
 Oneiromancy, 303 
 Organization, nervous, 388 
 Overcharged centres, 204, 205 
 
 Paralexia, 262 
 Paranoia, 170 
 Paraphasia, 261 
 Paraplegias, 125, 314 
 Parapraxia, 262 
 Parasitism, 392 
 Pavlow, 21, 98 
 
446 
 
 Index 
 
 Percept, 244, 249, 250 
 Perception, 138, 143, I47. I49. 
 150, 152, 153, 157, 163, 
 164, 179, i8i, 196, 207, 
 221, 223 
 sensory criterion of, 216 
 social criterion of, 216 
 Personalities, co-conscious, 77 
 hypnoidic, 78 
 parasitic, 313 
 secondary, 429 
 Personality, transformation of, 
 
 91 
 Phonisms, 141, 159 
 Phosphene, 157 
 Photisms, 157 
 
 Plethysmographic records, 2i 
 Pneumographic records, 21 
 Polymorphosis, yo, 277 
 Polyuria, 134 
 Post-hypnotic states, 82, 120, 
 
 135, 136; 200, 36s 
 Presentative representative dis- 
 aggregation, 285 
 Primary sensory elements, 222 
 Prince, 329 
 
 Principle of association, 153 
 of subconscious energy, 318 
 of substitution, 270 
 Processes, subconscious, 245 
 Pseudo-hallucinations, 215,217, 
 
 218 
 Psychic compound, 147, 158 
 elements, 155 
 epilepsy, 172, 314 
 Psychic processes, subconscious, 
 
 139 
 Psychognosis, 58, 59. 329. 337. 
 
 338, 339, 349. 350, 351. 
 
 365 
 Psycholepsy, 394 
 Psychomotor attacks, 307 
 recurrent attacks, 310 
 
 Psychopathic amnesia, 295 
 anaesthesia, 76 
 chorea, 118 
 contracture, 125, 126 
 convulsive attacks, 119 
 deafness, 1 10 
 diseases, 295 
 maladies, 107 
 mutism, 127 
 paralysis, 126 
 states, 319, 321, 386, 387, 
 
 391. 392, 393 
 status epilepticus, 122 
 symptoms, 319 
 Psychopathies, 97, 99, 105, 378 
 Psychosis, functional^ 176 
 Psychotherapeutic treatment, 
 
 391 
 Pyromania, 302 
 
 Qualitative difference of sensa- 
 tions, 196 
 Quality, of intensity, 198 
 
 of reaction, 316 
 
 sensory, 201 
 
 Reactions, 338 
 
 autocatalized, 425, 426 
 Reaction time, 72, 402, 403, 
 
 404 
 Reality, sense of, 176 
 Recognition, 273 
 Recognitive amnesia, 276 
 Recurrent mental states, 307, 
 312, 315, 316, 349, 351, 
 
 395 
 Recurrent moment conscious- 
 ness, 312 
 Redistribution of thresholds, 
 
 421 
 Relative agraphia, 260 
 apraxia, 260 
 visual aphasia, 259 
 
Index 
 
 447 
 
 Representation, 248 
 Representative disaggregation, 
 
 285 
 Reproduction, 273 
 Reproductive amnesia, 276 
 Reserve energy, 104, 419, 421 
 Resistance in hypnosis, 73 
 Rest states, 47, 54 
 Resurrected moments, 318 
 Retention, 273 
 Revived sensations, 247 
 Ribot, 270 
 Robertson, T. B., 424 
 
 I 
 
 Sante de Sanctis, 39 
 
 Secondary sensations, 141, 143, 
 
 144, 152, 156, 222, 223 
 
 Secondary sensory elements, 
 
 222, 224 
 Self, secondary, 78 
 Self-consciousness, moment of, 
 91, 92 
 threshold of, 88 
 Sensations, 138, 152, 153, 168, 
 170, 178, 182, 196, 201, 
 244 
 Sense of reality, 175, 178, 179, 
 
 180, 181 
 Sensory aphasia, 257 
 Settings, 312 
 Sidis, W. J., 434 
 Simple reaction time, 402 
 Simulation of organic troubles, 
 
 379 
 Skin eruptions, 136 
 Sleep, 37> 38, 42, 45, 47, 50, 
 
 52, 53, 54, 56, 166, 174, 
 
 191,. 193, 413 
 Somnambulistic state, 46 
 Somopsychosis, 376, 378, 379, 
 
 380, 386 
 Speech, 128, 216, 
 
 inner, 205, 206, 207 
 
 Sphygmographic records, 21 
 Stammering, 128, 129 
 Statistics of hallucinations, 189 
 Stigmata, hysterical, 312 
 Stout, 323 
 
 Subconscious, the, 16, 69, 100, 
 113, 116, 136, 139, 239, 
 240, 241, 297, 298 
 conditions of, 16, 69 
 Subconscious activities, 309, 317 
 dream life, 193 
 experiences, 312 
 memories, 63 
 secondary sensations, 138 
 states, 17, 23, 93, 133, 313, 
 
 314, 317, 442 
 v\^hispering, 212 
 Subconsciousness; 13, 14, 309, 
 311, 315, 380, 434.436, 
 438, 439 
 Subnormad states, 55 
 Subwaking rest state, 57 
 Suggestibility, 14, 26, 27, 28, 
 46, 67, 68, 72, 233, 296, 
 409, 415 
 Suggestion, 71, 78 
 
 post-hypnotic, 82, 86 
 Symbolism, 303 
 Symbols, sound, 257 
 
 visual, 257 
 Synaesthesia, 141, 159, 223 
 Synkinesia, 116 
 
 Synthesis, mental, 138, 139, 
 140, 151 
 perceptual, 157 
 Systems, 312 
 
 dissociated, 315 
 subconscious, 382 
 
 Tachycardia, 136 
 
 Teleology, 319 
 
 Thinking double, 204, 206, 207 
 
448 
 
 Index 
 
 Threshold, 50, 51, 52, 72, 73, 
 loi, 104, 166, 167,273, 
 316, 319, 321, 326 
 
 Total apraxia, 225 
 
 Toxic amnesia, 290 
 
 Traces, physiological, 424 
 
 Trance-states, 56 
 
 Trauma, mental, 395 
 periods of, 390 
 
 Traumatic amnesia, 290 
 
 Treatment, psychotherapeutic, 
 
 391 
 Tremor, psychopathic, 117, 118 
 Trismus, hysterical, 125 
 Twilight, hypnoidal state, 33, 
 
 40, 41, 49 
 Types of amnesia, 280, 289 
 
 1 
 Unconscious, intelligence, 435, 
 
 436, 439 
 processes, 440 
 Unconsciousness, 88, 91 
 Uncontrollable tremor, 350 
 Unicellular organisms, 325 
 Unsystematized delusion, 266 
 Upper consciousness, 298 
 
 Variable periodic amnesia, 288 
 Variability, principle of, 325 
 
 Vasomotor changes, 136 
 
 Verworn, 322, 324 
 
 Visceral disturbances, 107, 114, 
 
 134. 135 
 Visions, 85 
 Visual aphasia, 259 
 apraxia, 251 
 memory, 282 
 Vividness of pseudo-hallucina- 
 tion, 333 
 of representative elements, 
 196, 198, 199, 272 
 
 Waking, 413 
 
 Waking consciousness, 34 
 
 Waking state, 33, 42, 55, 272 
 amnesia of, 277 
 suggestibility in, 404 
 
 Waking states, 103, 189 
 
 Whispering, subconscious, 213 
 
 Wolfe, 272 
 
 Writing, automatic, 74, 240, 
 241 
 
 Wundt, 12, 69, 270, 404 
 
 Ziehen, 11, 427 
 Zones, hysterogenetic, 118 
 of memory, 275