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VIII

        In the cases of hallucinations investigated by me I have found pathological processes which gave rise to secondary sensations crystallized into hallucinations. Thus one of my cases suffered from auditory hallucinations. The patient heard voices telling her all kinds of disagreeable things. She complained that the voices came not through the ear, but through a spot located over the Fallopian tubes. An examination of the ear showed nothing abnormal. Physical examination revealed nothing abnormal in any of' the other sense organs. The Fallopian tubes, however, were very tender and painful to pressure. The patient suffered from an old chronic salpingitis. The hallucinations, which were of a sexual character, became more severe at regular intervals coinciding with monthly periodicities.

        One case of mine suffered from visual hallucinations. He saw spirits, ghosts and visions of saints. When he travelled in a car, he could see little men with benevolent faces and for some religious reason he regarded them as saints who came to his help. He could see them splitting the rocks and disappearing there, or sometimes the rocks split open and the saintly little men came to the surface. Occasionally apparitions of the dead visited him. The visions were never quiet, but always in motion, they did not stay long and rapidly disappeared, giving rise to new visions. An examination of his special sense-organs showed nothing abnormal. The sense of touch, pressure and kinæsthetic sensibility manifested peculiar abnormalities. The skin of the body was very sensitive and that of the scalp was extremely tender to touch. The patient could not bear any pressure of the scalp and was mostly bareheaded, though he was very sensitive to draught and to changes of temperature. Occasionally he experienced a sense of formication all over the body, especially in the scalp and in the region of the neck, the muscles of which were extremely sensitive to pressure. Now when the head was inclined to one side or, pressed hard or kept in tense state for a couple of minutes at a stretch, he could see spirits floating in the air, he could see the little men with their saintly faces coming out of the ground and disappearing into it again.

        One case of functional psychosis, with epileptiform attacks resenting phenomena of dissociated states with distinct tendencies toward, the formation of multiple personality, suffered a good deal from auditory hallucinations. It will take too much pace to give all account of the details of the different seizures and of the various dissociated states manifested by the patient. For our present purpose it is enough to refer to the hallucinations. The patient complained that she could hear voices talking to her, her mother and brothers communicating wit her from a distance. An examination of the auditory apparatus proved it to be in excellent condition. Now in this case the phenomena of unconscious phonation were quite well developed, the patient was observed to move her lips and whisper―the whisper becoming sometimes quite loud so that many words which the patient referred to the voices of the mother and brothers were really uttered by the patient. An examination of the eye revealed the presence of an astigmatic condition and a imitation of the field of vision. When the patient was made to count or to read aloud or when absorbed in a conversation, the auditory hallucinations ceased. The auditory hallucinations considerably diminished, both in frequency and intensity, when the astigmatism was corrected by eye glasses.

     Similarly in another case the patient suffered from auditory hallucinations. Here the patient was observed talking to himself. This was so pronounced that now and then he himself became conscious of the fact that he was talking to himself. He describes this experience of automatic talk which seems to be uncontrollable and of which he is often unconscious by the term of 'autovocalization.' In this case the patient now and then can catch himself telling things to himself which he takes for the voices of other people as he is then conscious of the hearing, but not of the utterance of the words and phrases. This, however, is not always the case; in fact in a good many cases where unconscious phonation is present, as, for instance, in the case of the patient with the epileptiform seizures described above, the patient is entirely unconscious of the fact of 'whispering.' When attention was drawn to the phenomenon, the whisper and the hallucination disappeared.

        One of my cases, a lady of about sixty, suffered for about fourteen years from auditory and visual hallucinations. She complained that she was surrounded by ghosts of departed family members who did not leave her alone. The spirits talk to her; they give her advice which is often against her interests. Her departed husband and his brother are the chief leaders, the ‘guides' so to say. They talk to her on all important occasions and try to guide her in life. The patient resents such interferences. There is no need to go here into the details of the case. When the voices became insistent she also had visions of the spirits and could hear them talk to her, a proceeding which she always attempted to discourage, but she admitted that the voices and the spirits had the best of her and she was forced to follow their instructions. Now an examination of the patient revealed the fact that the hearing on the left side was rather defective, the tympanic membrane was thickened and there was present a chronic pathological process due to a former condition of middle ear disease. Any continuous and prolonged irritation of the diseased ear started the voices, increased their intensity and caused the manifestations of the visions.

        I may also refer to a patient under my care who suffered from auditory hallucinations and thought herself possessed by demons. From her ninth year she suffered at various intervals from those voices which sometimes told her quite unpleasant things. Along with the hallucinations she also had attacks of automatic speech. Now and then she simply heard voices and was not conscious of any involuntary speech, but occasionally the involuntary utterance took such possession of her that she could not control it. She felt as if some other being got possession of her organs of speech. This frightened her even more than the hallucinations. She kept away from her friends fearing sudden attacks of involuntary speech. It appeared to the patient, as if some other beings made her talk against her will. She shunned society, because the other beings forced her to tell aloud what she thought of the people in whose company she was present. When she was not conscious of the forced speech, she often heard voices which she ascribed to the same demons. There was nothing of the delusion of paranoia in it as she could not account for the involuntary speech and auditory hallucinations. The patient was of Irish descent and uneducated though very intelligent, and the explanation of demoniacal possession was given and maintained by her family in Ireland. She was glad to take my view of the phenomena which I tried to make plain to her, as much as it was possible under the circumstances. A quotation from her written account may be of interest: "When I was nine years old, one day I remember I sat down on a stone and suddenly I heard a voice: 'If you live four or five years more you will wish you had never grown up.' I thought it was strange, but soon forgot it and went to play again. I had no trouble until I was fourteen, when the voice changed and forced me to talk with my own voice. The voices would make me speak of things that in my own self I had no idea of doing and would not do for anything. About eight years ago I had a terrible fright after which I thought I talked with saints and angels and saw unusual things, I really saw them." We find here the presence of automatic speech, unconscious phonation with subconscious states resulting in dissociations of secondary from primary sensory elements with the consequent formation of various forms of hallucinations.

IX

        I should have liked very much to bring in here some of the work on hallucinations carried out by Dr. William A. White, space requirements forbid. The cases studied by Dr. White are extremely interesting and go to substantiate the theory of hallucinations advanced by me. By a close study of a series of cases he sustains the validity of the present theory of hallucinations. Dr. White's studies are of great importance to normal and abnormal psychology, and the reader who is interested in the subject I refer to his original contribution.⁴

       Observations and experiments incontestably prove that hallucinations are synthetized compounds of secondary sensory elements, dissociated completely or incompletely from their primary elements.⁵ Normal and abnormal perception do not differ psychologically as to their make-up, except in the relation of their primary and secondary sensory elements. Hallucinations are not central; they are essentially of peripheral origin; they are induced by peripheral excitations giving rise to peripheral physiological processes awakening primary sensory elements which are subconscious or fall out entirely of the patient's consciousness leaving the groups of secondary sensory elements to stand out as fully developed hallucinations. The hallucinatory secondary sensory elements may be tinged with the qualitative aspect of the dissociated primary sensory elements, thus pathological processes in the auditory sense organ may give rise to voices; or morbid processes of the visual apparatus may give rise to visions. Quite often, however, the dissociation is so deep and extensive that the synthetized system of secondary sensory elements does not bear the least trace of the qualitative aspect of the primary sensory elements; thus a morbid condition of the pharynx, for example, may give rise to an auditory and even to a visual hallucination. Whatever may be the qualitative character of the sensory compounds one thing stands out clear and distinct, and that is the fact that the percept, whether normal or abnormal, does not consist of images, but of sensations, primary and secondary.

X

        Contrary to the general view maintained by most psychologists we have laid special stress on the fact of the fundamental qualitative difference between image and sensation. We shall not venture far from our facts if we arrange images and sensations in two qualitatively different psychic series. Sensations can be ranged in a graduated series of intensities, while images or representations can be ranged in a graduated series of clearness and distinctness, or of vividness as it is sometimes described by some psychologists. I use the term vividness in the sense of clearness and distinctness and not in the sense of intensity as it is often used; even those psychologists who do not use intensity and vividness indiscriminately ascribe both of them equally to sensation and image. Now vividness and intensity are understood by me to be two fundamentally qualitatively different aspects, or attributes. Sensations have intensity, but no vividness; images or representations have vividness, but no intensity. Sensory elements may vary from minimum to maximum intensity. This variation in intensity holds true both of primary and secondary sensory elements. Similarly, images or representations may pass through all degrees of vividness minimum to maximum. The image represents the sensation. In this respect we may somewhat modify the well-known dictum of the sensationalists into: 'Nihil est in imagine quod non antefuerit in sensu.' The sensory element is symbolized by its respective representative element. Now the representative elements may refer with different degrees of vividness to the same sensory elements. An image with one degree of vividness can be substituted for another with a different degree of vividness and still refer to the same sensory elements. The degree of vividness does not change the qualitative character of representation. Not so is it with the qualitative attribute of sensation. The slightest change in the intensity of the sensation changes its qualitative character. A sensation with one degree of intensity cannot be substituted for another. A sound or a color of a definite intensity cannot be substituted for a sound or color of a different intensity. The two are different sensations and no sensation can substitute another. Sensations falling in the same series of intensity are really independent of one another, but each sensation of the intensive series can be represented by a whole series of representations of different vividness, from to maximum. Different series of representative elements may also be regarded as independent, since they [missing line of text].

        If we symbolize a series of sensory elements by the letters: A₁, A₂, A₃, A4, A₅, . . , A_n; and if we symbolize the corresponding series of representative elements by a₁, a₂, a₃, a₄, a₅, . . . a_n, then the series of both sensory and representative elements may be symbolized by the following formula:

        The characteristic of the image, or of the representative element is just its extraordinary plasticity and possibility of substitution; This function of substitution was described by Taine with all the power of his lucid style. The great modifiability of the representation plays an important rôle in psychic life―adaptability to various conditions of life increases, reactions cease to be rigid and uniform, but change easily in response to a changing environment. Variations of sense-organs with their physiological processes are rather slow and tardy, often requiring generations for an effective change, while the representative element can be modified and adapted within the life-existence of the individual and often in a very short time. In brief, the function of substitution possessed by the representative element in the process of mental selection is the substitute for natural selection in the highest representatives of animal life.

        Now under ordinary conditions of life the gradated series representative vividness runs parallel to the gradated series of sensory intensities. Usually a more intense sensation is represented with greater vividness. The increase or decrease of intensity of the sensory series has a corresponding change in the vividness of the elements of the representative series. Intensity and vividness vary directly. Such direct variation, however, is not always the rule. There are cases, when the two part company. In states of distraction in subwaking states, in states of dissociation and generally in the conditions of functional psychosis, intensity and vividness do not vary directly. Strong stimulations may give rise to sensations of great intensity, but the vividness of the representative elements may fall so low as almost to reach the minimum. When the vividness is so low as to reach the minimum, the representative elements cannot be used as substitutes and, since reproduction belongs to representative elements which symbolically reproduce the sensations by the process of substitution, reproduction or memory of the original experience is absent and there is a break, a gap in mental continuity, dissociation results. The depth and extent of dissociated mental systems may be regarded as variables of vividness. Dissociation varies inversely as vividness. When vividness is at its minimum, dissociation is at its maximum. The phenomena of functional psychosis having their origin in states of dissociation may thus be regarded psychologically as functions of vividness, the most characteristic attribute of representative elements. Functional psychosis with all its protean manifestations, the great variety of dissociated and subconscious states may thus be reduced to variations of one fundamental attribute―vividness.

XI

        We must not omit to point out another fundamental difference between sensory and representative elements. Sensations have significance, or possess the attribute of external reality, images, ideas or representations entirely lack it. Put in Professor Baldwin's excellent terminology―sensations have the coefficient of external reality, the sensory coefficient of reality. No matter whether the sensation was produced by an external stimulus, or by a pathological process going on in the sense­organ, or brought about indirectly through the action of another organ by means of indirect association-paths of neuron collaterals, no matter whether the sensation is primary or secondary, as long as it is a sensation at all, it possesses the sensory coefficient of reality. A sensation whether ‘true or false' possesses rightfully the coefficient of reality as its necessary attribute. The percept, true or hallucinatory, consisting of sensory elements has therefore the sensory coefficient of reality.

        Psychologically regarded, the 'true' percept and the hallu­cination have the same sensory constitution with the same attributes. The difference between the true and false percept may be regarded from a biological standpoint as a matter of adjustment. The percepts with successful adjustments are true, while those with unsuccessful motor reactions are false and hallucinatory. Psychologically, the difference between the ‘true' percept and hallucination is in the shifting of the primary and secondary sensory elements. Where the secondary sensory elements can be shifted and become primary, the percept is regarded as true; where the secondary sensory elements do not admit of being shifted and become primary, the percept is regarded as hallucinatory.

        If we turn now to the representative elements, we find that they lack the sensory coefficient .of reality. This lack of sensory coefficient is only the negative side of the image. There is also a positive side to it, The image is not felt as image simply because it is not sensation or lacks the sensory coefficient, but because it possesses a qualitative, character of its own. A sensation is not felt as such simply because it lacks the character of another sensation. Thus sensation green is not experienced as the particular color sensation, because it has not the quale of sound or of pressure, but because the sensation green has a positive experience of its awn. The same holds good of the representation―it possesses its own characteristic quale. As an experience sui generis we claim far the representation a special psychic mark, an 'ideational or representative' coefficient. The image has its own qualitative character just as the sensation possesses its own. In contrast to the sensation which possesses the coefficient of external reality, the image or representation has the coefficient of internal reality. Both sensation and image have reality, each one has its own kind of reality―the sensation has external objective reality, the image has intern subjective reality. It is on account of the ideational or representative coefficient that every image is placed unhesitatingly into its awn world of reality, into its own series of images with which it easily associates and fuses.

        Writers on psychology in trying to define further the coefficient of reality refer it to the will. Some maintain that the coefficient of reality is the 'independence of the will,' while others claim that the coefficient of reality is ‘subjection to the will.' Professor Baldwin in his paper, 'The Perception of External Reality,' offers an extremely interesting solution which reconciles both views. He points out that there is a difference between the 'memory coefficient' of reality and 'sensational coefficient' of reality. The two coefficients are opposite as far as control of will is concerned. The sensational coefficient is independence of the will, while the memory coefficient is control by the will. A sensation, in short, is not under the control of the will, while an image is subject to the will. He makes a further distinction between a simple image or 'memory image' and a 'memory image of external reality.' The memory image can be brought up voluntarily by its proper associates, but it has no sensational coefficient as a result, while the memory image of external reality can be followed by sensational coefficients, that is, sensations can be brought about in the train of such an image. To quote Professor Baldwin: "Certainly a present sensible reality is not under the control of my will; it is independent, and if my coefficient is to be discovered in the relation of the presentation to my voluntary life, this must be its expression and I go over to the class of writers who find the psychological basis of external reality in sensations of resistance. But when we come to inquire into the 'memory' coefficient―asking the question what character is in a memory-image which testifies to its being a memory of reality?―the tables seemed to be turned. Without stopping to examine other views, I hold that that image is a true memory which we are able to get again as a sensation (Professor Baldwin's italics) by voluntarily repeating the series of muscular sensations which were associated with it its first experience. The memory coefficient therefore is subjection to the will in the sense indicated. . . . A true memory in short is an image which I can get at will by a train of memory associates, and which, when got, is further subject to my will; a memory of external reality, on the contrary, is an image which I can get at will by a train of sensational associates and which, when got, is not subject to my will."

        Now if I understand Professor Baldwin aright, a sensation does not fall under the control of the will, while a simple ‘memory image' and a 'memory image of external reality' are both under the control of the will, the difference being that the former does not terminate in a sensation, whereas the latter does. This I take to mean that a sensation does not depend on the subject (will), but on the external object; in other words, a sensation cannot be produced from center to periphery (not internally initiated by the will), but is initiated by an external excitation peripherally stimulating the sense-organ and giving rise to sensation. An image, on the other hand, does not depend for its initiation on the external object or excitation, but is essentially an internal event which can be brought about from within by the process of associative activity so highly characteristic of the image. Thus far my analysis seems to me to be in full accord with Professor Baldwin's view. Similarly, Professor Baldwin's views in regard to 'memory images' and 'memory images of external reality,' the former not ending in sensory experience, the latter terminating in experience with sensory coefficient, seem to me to be closely related to the views expressed by me in this paper and in my other works on the subject.

        In spite of the agreement on so many points there are other points which do not appear to me acceptable. We may agree that kinæsthetic and muscular sensations or sensations of resistance are at the core of things, but are they the be-all of external reality? Have not sensations of pain, of hearing, of color, or of smell as much reality as our sensations coming from muscle, joint, synovial membrane and articular surfaces? The acute, shooting, twinging pains of rheumatism, gout, tabes-dorsalis, the burning pains of meningitis, the excruciating throbs of megrim, the fine stabbing pains of toothache, the agony of angina, the sharp tormenting pains of facial neuralgia and many other pains coming from different organs and tissues, are not they real and external? In fact do they not bear on them more the mark of grim, pitiless, external necessity than any of the sensations coming from active muscle and joint? What about light, color, sound, smell, are not they sensations of external reality, even if sensations of resistance do not enter into their make-up? Muscular and kinæsthetic sensations may be granted to play a very important rôle in our knowledge of things, but psychologically regarded, all sensations bear on them unmistakably the mark of external reality. It is not the particular form or kind of sensation, but it is the sensory quale as such that gives the coefficient of reality. As far as resistance is concerned Professor Baldwin is right, if it be applied to each and every sensation. For each and every sensation possesses this mark of stubbornness about it; it shows opposition, resistance and floods the mind. We may say that the stimulus forces open the gates of the sense-organs and invades the mind with an overwhelming power. Still, on the whole, Professor Baldwin is right in laying special stress on sensations of activity (?) and resistance since, biologically regarded, they are the ones that give the smack of life and the kernel of things and help to bring out adjustments to the external environment.

        Thus far the difference between Professor Baldwin and myself seems to be rather insignificant.⁷ When, however, we reach what Professor Baldwin terms the 'memory image of external reality' the difference stands out somewhat more strongly. He contrasts the two, image and sensation, on the basis of dependence or independence of the will. The sensation is independent of the will, while the memory image of external reality is subject to the will which can bring about the sensation originally experienced. Now it seems to me that we are just as sure of the external reality of a sensation referred to by the memory image, even if we cannot bring about the original experience. We may perceive sensations which cannot possibly be repeated and still they are regarded in memory as events that have taken place in the world of external reality. We may have the perception of a comet which may never again come into our experience, and even if it should come its coming is not due to our voluntary control; it is not we that can make the comet-experience come into our perceptual or sensory world with its sensory coefficient of external reality. We may be in the position of Plato's cave-dwellers and have no control over the reality, the reflection of which is displayed before us, and still we may agree with Plato that for the cave-dwellers the memory images of external reality, the recurrence of which is not under control, will still be discriminated from a general memory image, from an image of fancy. The sensation or percept may be unique, its reproduction may not be possible and still its memory image will be that of external reality.

        On the other hand we meet in psychopathology with a vast domain of phenomena, such as recurrent mental states, insistent ideas which force themselves on the patient's mind against his will. The recurrent mental states or the insistent ideas are far more stubborn and uncontrollable than any resistant sensory object. The ideas may come like attacks which overcome that patient more than any sensory reality, or the idea may be  a persistent gnawing at the very vitals of his mental life. No external object is so stubbornly, so painfully resistant as just such an idea; and still the insistent idea is not regarded as a sensory reality. The insistent idea possesses the coefficient of external reality, independence of the will, painfully so, and still it is not regarded by the patient as external reality; in spite of its being independent of the will, it is still regarded as an idea.⁸ It seems to me that we cannot express the sensational and ideational coefficients in terms of will of control or non-control. It is not resistance to the will that makes experience sensory, nor is it subjection to the will that makes experience ideational or representative. Why not state the fact as it is, external reality is the quale of sensory experience, while internal reality is the quale of the image or representation? A sensation is experienced as sensation, no matter whether or no it depends on the will, the independence is a secondary matter; the same is in the case of the image, it is experienced as image, independent of the fact of its subjection to the will.

XII

        There is another view which finds the fundamental difference between percept and image in what is and what is not common to all selves. Perceptual experience is common, while ideational experience is not common to all fellow-beings. I see the sun and other people can share it with me, while my image of the sun is experienced by myself. Thus one writer I tells us: "I perceive lowering heavens, pouring rain, bare trees and drenched sparrows, but I imagine wide horizons, brilliant sky, blossoming apple-trees and nestling orioles. The main difference is this: in the one case I assume that my experience is shared by other people and that everybody who looks out sees the same dreary landscape; but my imagination of the sunny orchard I regard as my private and unshared experience."⁹ Now the mark of being common is not the essential coefficient of external reality given by the percept. The percept is not experienced as external, because it is common to other people. We do not see the tree yonder, because other people can see it too; we would see it there, even, if, like Robinson Crusoe, we had no fellow-being to compare notes with. A hallucination is as fully a percept and is perceived in the full garb of external reality, although it may have no currency with my fellow-men. The percept possesses the coefficient of external reality, no matter whether or no others can share in it.

        Moreover, psychologically regarded, the percept is as much of a private experience as the image is; in fact every psychic state has the privacy ascribed to the image and as such is unshared by other selves.' It is simply the old psychological fallacy of confusing the physical with the psychic object or with true psychic state cognizant of the physical object.¹⁰ The flower as psychical object, as stimulus is shared by all who perceive it, but the perception of the flower varies with each individual. My perception of the flower cannot be experienced by any one else; like the image, the percept is entirely individual, unshared by other selves. I perceive the flower as having external reality not because my perceptual experience is the same as that of other people, nor because it is shared with others―as a matter of fact, it is not the same and from its very nature cannot be the same as the experience of others, as we cannot possibly share our individual psychic experience with our fellow-men. We perceive the flower as an external reality simply and solely because it is sensory. The percept consisting of sensations, primary and secondary, bears the impress of external reality; it possesses what Professor Baldwin so aptly terms ‘sensorial coefficient’ giving external reality. External reality is given directly and immediately by the sensation or by the sensory compound, by the percept.

        To quote from a former paper of mine: "Sensation carries with it 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 external reality are not two different things; they are given together in the same process of perception and are identical. . . . The sensory process is also the process of the sense of external reality. . . . In seeing or perceiving the chair yonder we do not perceive it as real because of its social or common character―the reality of its existence is given directly in the sensory processes of the percept itself. . . . The sense of reality of the external object is strengthened by association of the original sensory systems with other sensory systems, and the intensity rises in proportion to the number of systems of sensory elements, brought into relation with the functioning sensory systems. . . . The more sensory elements are pressed into service, the stronger is the sense of external reality and the more assured is the reaction to the stimuli of the external environment. 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. Man presses into active service the systems of sensory elements of his fellow-beings. Adaptations and hence successful reactions to the external environment are now more assured and the sense of external 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." From a philosophical and epistemological standpoint the social aspect may perhaps be sufficient to fix the externality of the object, but from a psychological standpoint the trade-mark of 'shares and common stock’ has no currency. The percept consisting, as we have own, of sensory elements, primary and secondary, possesses, on that account, the sensory attribute of external reality.

_________

⁵ See Journal of Nervous and Mental Disease, 1904.
6 [missing]
⁷ The difference is far less than I have originally thought. In a letter to me Professor Baldwin writes: “I am much interested in your views. You will find my later and fuller treatment of resistance and of the nature of memory images in my Thought and Things, or Genetic Logic, where I attempt explicitly to trace the genetic development of knowledge from sense objects to image objects in detail, being I think nearer to your views than my earlier article brought out.” I have since made myself acquainted with Professor Baldwin's great work on the genesis of knowledge, which I find to be of the utmost importance to psychology and epistemology. Much as I wish to discuss that masterly work in connection with my present theory, I find it impracticable on account of lack of space. I hope, however, to return to the subject in another paper.
⁸ Professor Baldwin admirably discusses this point. See Baldwin, Thought and Things, Vol. I., Ch. X, § 2.
⁹ Mary W. Calkins, An Introduction to Psychology.
¹⁰ Royce and Münsterberg define the physical object in terms of ‘sociality,' but if I understand them correctly they do not regard the definition as a psychological one.

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