PART III

CHAPTER XXIV

SECONDARY INFANT PERSONALITIES

THE cases we have analyzed thus far present formation of independently functioning constellations with concomitant moments that possess more or less common content. Though the change is great in the character of the moment, still the fundamental psychic material remains unchanged; instincts, acquirements and many of the habits are present to both or to all the independently functioning moments. Not so is it in the cases we have to consider now. The content of the moment that ceases to function is submerged, and is not present in the newly functioning moment. The patient in coming out from the “attack” is invariably characterized by the observers as “one newly born, one just ushered into life.” The newly rising or developing moment must acquire new content, although the dissociated moment with its submerged content greatly aids in the speedy development of the newly functioning moment consciousness.

            In these phenomena the dissociation reaches its maximum. We must, however, point out that even such pathological manifestations present dissociation of different degrees of extensity. Some shreds of the old experience and acquirements are more or less present in the newly rising moment. The only case which is altogether free from such remnants and presents the phenomena of dissociation in their purest aspect is the case of Hanna, and that is why it is so extremely valuable for the purposes of investigation.

            Cases of total dissociation, phenomena where the psychic content itself is lost with the disaggregation of the old moment consciousness, though even some odd remnants of former riches may have been transmitted to the young heir, are extremely rare, but for that very reason they are so highly valuable. We may begin with the interesting case described by Dr. Mortimer Granville, in Brain, for 1879.

            In 1858 (20 years before) Dr. Mortimer Granville was requested to see daily a governess and teacher of music, who had been attacked with what was called acute mania. “Found a spare, somewhat angular, eccentric-looking woman, age 26, in state of great excitement, hysterical and choreic. Within a few hours after paroxysm of considerable violence, during which she talked and sang mildly, and was with difficulty restrained by those around her; she fell into a state verging on suspended animation, which lasted a week. Skin was cold, presented dark, mottled appearance; pulse scarcely perceptible at wrist. Breathing slow and seldom deep; seemed to be complete loss of consciousness and scarcely any trace of sensibility. Muscles cataleptic and extremities dropped slowly when raised. Was barely possible to feed patient by mouth; by holding forward the larynx and placing the fluid far back in pharynx with spoon, where it seemed to flow down the oesophagus as through a flaccid tube. This condition, which was treated with interrupted current from occiput to hypogastrium, etc., subsided very gradually. Then came the state I am chiefly interested to note. There had clearly been an exciting cause for the attack in religious excitement acting on a nervous system exhausted by protracted toil as teacher.

            “When consciousness began to return the latest sane ideas formed previous to the illness mingled curiously with the new impressions received, as in case of a person awakening slowly from a dream. When propped up with pillows near the bed, so that passers in the street could be seen, the patient described the moving objects as ‘trees walking,’ and when asked where she saw these things she immediately replied, ‘In the other gospel.’ In short, her mental state was one in which the real and the ideal were not separable. Her recollections on recovery and for some time after were indistinct, and, in regard to a large class of common topics, which must have formed the staple material of her thought up to the period of attack, memory was blank. For example, although this young woman supported herself as governess, she had no recollection of so simple a matter as the use of a writing implement. When a pen or pencil was placed in her hand, as it might be thrust between the fingers of a child, the reflex act of grasping it was not excited. This state lasted some weeks, and the ‘recollection’ of what had been ‘forgotten’ was slow and painful, needing or seeming to require a process of re-education. In the end recovery was mentally and physically satisfactory.”

            Another case of still greater interest and far richer in details and in the course of its manifestations is described by William Sharpey, F.R.S., Professor of Anatomy and Physiology, the University of London, in Brain, for 1879.

            “Mrs. H., patient, about twenty-four years old (this was written in 1824), pale complexion and slender make. Married in July, 1823, and with exception of occasional headache, to which she, in common with some of the rest of her family, was subject, previously enjoyed good health of body and mind.

            “After her marriage she resided in England till the end of April, 1824, when, in consequence of ill-health, she was brought here by her husband. From husband’s account it, appeared that for about three months after their marriage she enjoyed perfect health and spirits, but that after that she complained a good deal of pain in stomach and bowels; appetite bad, bad spirits, imagining herself unequal to concerns of house, though only herself and husband, and it was also observed she slept more than usual.

            “On her arrival here, in April, physically appeared well; all her external senses were sound, but memory was impaired, and she was very inattentive to surrounding objects. The sleepiness had been gradually increasing, and was now at such a height that unless when conversing with another person, or engaged in manual occupation, she fell asleep at all times and in whatever position. When in this state her eyes were nearly closed; she breathed softly and, in short, very much resembled a person in natural sleep, except that when she happened to fall asleep in a position in which the body naturally requires to be supported; as, for instance, on a chair, she did not lean forward or backward, as is commonly the case, but sat with her body quite erect and her head gently inclined to one side. While in this state she was subject to frequent startings, during which she raised herself up, talked as if frightened, drew herself back, as if to avoid something disagreeable, and then lay quietly down again as if without having awoke. What she said on these occasions, though quite incoherent, was yet always nearly of the same nature and for most part consisted even of same expressions, which were those of great aversion or horror; of this she had no recollection when awake, nor of anything connected with it; and she herself remarked as something extraordinary that now she did not dream, although she used formerly to be subject to dreaming. From this sleep she never awoke of her own accord, except to obey the calls of nature; and there was no other way of rousing her up upon other occasions but by placing her on her feet and endeavoring to make her walk.

            “When thus forcibly awakened, she was fretful and cried for some time after. She took food in sufficient amount and often with evident relish, but it took entreaty to make her take the first mouthfuls.

            “The pulse varied a little, but on the whole natural; during sleep was 56 to 70, and somewhat more when awake. Urine charge normal; catamenia hitherto regular, but small amount. She complained of no pain or other uneasiness except a peculiar feeling on top of head which she called ‘funny.’

            “For five weeks after arrival the torpid state and indifference to surrounding objects gradually became worse, and difficulty of awakening her increased daily, till about the 8th or 10th of June it was found impossible to rouse her up at all by any means, and thenceforth, except a few short intervals, she remained in a state of constant sleep till beginning of August. Her condition was now singular. She still made an attempt to get out of bed to stool; when food was presented to her lips with a spoon she readily took it into her mouth and swallowed it, and thus she was fed; when she had taken what appeared to be enough she closed her teeth as a sign she was satisfied; she appeared able to distinguish different tastes. She gave evident preference to some sorts of food, and ostensibly refused others. She sometimes even judged of nature of food or medicine offered by sense of smell.

            “By this time the startings in her sleep had left her; although expressions uttered in that state were nearly same as formerly, yet her manner of speaking was now of satisfaction and not fright. She often even sang to a simple but cheerful air nearly the same words which she used formerly to cry out in terror.

            “The torpor continued in same degree till end of July, with occasional intervals of awakening which happened at uncertain periods, but usually at distance of a few days from each other and occasioned by pain experienced in some part of her body. First of these took place after she had been ten days in continued torpor ; caused by griping medicine, she awakened in great pain, crying out, ‘Pain, pain, die, die,’ placing her hands on abdomen. She was relieved by fomentations, but nevertheless kept awake for some hours, during which she answered no questions and recognized nobody except one old acquaintance whom had not seen for more than twelve months. She looked steadfastly into this person’s face for a few moments, apparently occupied in trying to remember his name, which she at length found out and repeated again and again, and at the same time taking him by the hand as if overjoyed to see him; but when questioned regarding him she answered only by calling out his name, which she continued to repeat for some time after she had fallen asleep in addition to what she usually said. In the course of the next eight days she was twice roused from her sleep by similar cause, but not so completely; same individual was the only person she knew; among others she did not recognize even her own husband.

            “The next interval of waking took place three or four days after; it appeared occasioned by pain in the head; she cried for some time, then awoke complaining of pain with her hand on her forehead; she placed hand of person nearby also on her forehead. The same thing happened on next three or four succeeding evenings, nearly at the same time. Other circumstances this time showed she was suffering from uneasiness in the head. She was very impatient in erect posture, and when placed on ground drew up her legs as if to force lying down again. This was not the case when she needed to be taken up for evacuation. She generally also preferred to lie on her face and with head low, both hands clasped firmly over it, exactly on part to which she had referred as peculiar feeling. After this torpor continued for some time without being interrupted.

            “Toward end of July torpid state which had suffered no intermissions had become on the whole not quite so deep, at least, patient gave signs of more consciousness of anything done to her. She smiled and seemed pleased on receiving particular sorts of food, and when eye opened and face touched, whole countenance was suffused with flush. Some time after it was possible to awake her by opening her eyes and holding anything before them likely to catch her attention, such as a glass of water.

            “When thus awakened she laughed a good deal, and seemed delighted, and always bestowed her whole attention vessel containing her food and the person holding it; she did not speak, however, or pay any attention to questions put to her. She began to take great liking to the attendant, and would hardly allow her out of sight. Now, also, she would creep cautiously onto the floor from her bed and creep to fireside and would lie down on the hearth-rug as if warming herself. At length, after gradually improving, she was by third week in August almost free from torpor and slept little more than healthy persons. Temperature was normal. Pupil normal. Had lost flesh.

            “On her recovery from torpor she appeared to have forgotten all her previous knowledge; everything seemed new to her, and she did not recognize a single person, not even her nearest relatives. In behavior she was restless and inattentive, but very lively and cheerful. She was delighted with everything she saw or heard and, altogether, resembled a child more than a grown person.

            “In short, she became rather more sedate and her attention could be longer fixed on one object. Her memory, too, so entirely lost as far as regards previous knowledge, was soon found to be most acute and retentive with respect to everything she saw or heard subsequent to her disorder, and she has by this time recovered many of her former acquirements, some with greater, some with less facility. With regard to these it is remarkable that though the process followed in regaining many of them consisted in recalling them to mind with assistance of neighbors rather than in studying them anew, yet even now she does not appear to be in the smallest degree conscious of having possessed them before.

            “At first it was scarcely possible to engage her in conversation; in place of answering questions, she repeated them aloud in same words put, and even long after she came to answer questions she constantly repeated them over once before replying. At first she had very few words, but soon acquired many and often strangely misapplied them. She did this, however, mostly in particular ways; often, for instance, made one word answer for all others which were in any way allied to it; thus, in place of tea, she asked for juice, and this word she long used for liquids. For a long time, in expressing qualities of objects, she invariably used very opposite words; thus, ‘white’ in place of ‘black,’ ‘hot’ for ‘cold,’ etc.

            “She now uses words with propriety.

            “Has as yet recognized no person; that is, has no recollection of seeing them previous to her illness; knows them only as new acquaintances, but with no idea of what relation they bear to her.

            “Has acquired reading, but had to begin with alphabet. Afterward learned to form syllables and small words.

            “Reacquisition of her reading facilitated by singing words of familiar songs. In learning to write began with elements.

            “In singing she at first generally required to be helped for first two or three words, and made out the rest apparently from memory.

            “Friends think she now plays as well, if not better, than before illness.

            “When asked how she learned to play notes from book, replied she couldn’t tell, and wondered why questioner could not do the same.

            “Once or twice had dreams which she often related to friends, and seemed quite aware of difference between dreams and reality.

            “Indeed, from casual remarks, it appears she has many complex ideas which she had no opportunity of acquiring since recovery.

            “Postscript, 1879:

            “After a time patient returned home and passed rest of life happily and gave birth to a daughter, who survives her.”

            The patient was of psychopathic disposition. She proved unequal to the cares of housewife duties, cares that would in no way affect any average healthy individual. Her mental system was in unstable equilibrium, and it broke down under the strain of ordinary stimuli. She had a prolonged coma-like attack from which she woke up with all her previous knowledge entirely gone. She had to learn to speak, read and write. At first she hardly ever realized the meaning of speech, and like a child simply repeated by instinct the questions put to her. A similar state was also observed in the Hanna case. Whether her natural instincts were lost, such, for instance, as eating, drinking, or the way to take and handle utensils in connection with food, or whether she could dress herself, walk, etc., we do not know from the report of the ease. It seems, however, as far as one can judge from the account, that much of it was lost, and whatever was retained was in a rather imperfect form. The instincts of the submerged moment were largely lost.

            Memory in the newly formed or secondary moment proved extraordinarily retentive, a fact we also found in the Hanna case. Whatever was learned or mentioned once was fully retained.

            It appears from Professor Sharpey’s account that hypnoidal states were present, many experiences suddenly appeared in the consciousness of the newly formed moment, experiences that belonged to the patient’s past life, to the content of the old disaggregated moment, but which the patient did not recognize, did not welcome as her own.

            We must draw the attention of the reader to the prolonged attack or the intermediary state, the attack that separated the two moments. In this case the state is extremely interesting on account of its being of so long duration. While in this intermediary, seemingly unconscious condition the patient presented many hypnoidic states. Different moments were making attempts to rise from the depth of the subconscious and establish themselves as the principal ones in the patient's mental life. They were not, however, strong enough. They were not organized enough to maintain themselves and take the lead. The outcome was that none of them on account of their instability were fit to take the organizing part in the patient’s mental life or become the centralizing synthetic moment of self-consciousness. Hence the patient on awaking came out with extremely limited content, with mere unorganized, broken bits of former life experience. Had any of the hypnoidic states been strong enough to get organized and gather material around itself the patient would have come out with a partly rearranged, differently crystallized, but still with much of the old content, and would have presented the phenomena of many of those cases which we have analyzed on previous pages.

            It would have been interesting to know whether the two totally dissociated moments went on alternating. Professor Sharpey does not mention it. It seems they did not. It is unlikely that Professor Sharpey would not have noticed such an important trait of the case under his observation and treatment. The alternation might have set in after Professor Sharpey lost sight of the case, since it may take time before this phenomenon appears. It might as well be that such an alternation never occurred. Whether the patient has ever regained her former memories so as to recognize her past life and in what way, if it occurred at all, is not known. The case, therefore, is incomplete, and we may put it down as one of monocyclical bimorphosis with total loss of content.

            The very frequently quoted case of Mary Reynolds, republished by Dr. S. Weir Mitchell in a more complete form, was until now the only case on record that presented a complete loss of the content of memory in so far as the acquirements and habits were concerned, along with marked phenomena of periodical alternation of the two states.

            The patient, Mary Reynolds, was of a strongly marked psychopathic disposition. She had many functional disturbances, suffered from convulsions, loss of consciousness, functional loss of sight and hearing. After having been greatly weakened by such a severe attack she fell into a profound sleep from which she could not be aroused, and on awaking was found to be deprived of all her former knowledge, of all recognition of former environment, of all her friends, no matter how near and dear. The natural instincts seem to have remained. She knew how to eat and how to drink; she neither had to learn to adapt herself to space, nor had she to learn to walk. Whether she knew how to dress herself or to observe personal cleanliness the report does not state. All her acquirements, such as speech, the understanding of it, knowledge of events or persons, or all were completely gone. Some shreds of phases of her former life remained and persisted in her second state. When she woke up from her profound slumber she, like an infant, was wailing some disconnected words and sentences, the meaning of which she did not know. In character and disposition she was completely changed. From being shy, morose and melancholic, in the primary state, she became in the secondary state gay, lively and playful. From being sedate and matter-of-fact, she became imaginative and with a knack for rhyming.

            It is of importance to note the fact that the secondary state came through an attack of profound slumber, and that in passing from the primary to the secondary there was always present such an attack of various duration. In short, the hypnoleptic state is always present as the transition state. Furthermore, while the transition between the primary and secondary state took place as a rule in the night, or, as the patient said, in the condition of ordinary sleep, usually at night-time, the contrary was in the opposite direction, the transition between the primary and secondary was always through an attack of “the profound sleep,” of which the patient had some presentiment before—some sort of aura.

            In the graduated series of cases presented to the reader we are confronted with greater and greater loss of content as we advance in the degree of dissociation. As we advance from case to case we meet with more and more dissociation of systems and their concomitant moments, until we reach cases where the dissociation is so complete that the old content is absent, where all the acquirements and habits have disappeared. Finally we reach the climax where not only all the acquirements, but where even the natural instincts have been lost. This we find in the case of Hanna. All these cases present one graduated series, and, although they may be classified into more or less definite types, still they shade imperceptibly into one another. The dissociation effected may be of any degree of extensiveness and intensity. One psychophysiological process, however, underlies all of them, and that is the process of system disaggregation and new system formation due to a redistribution in the rise and fall of the moment thresholds.