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MULTIPLE PERSONALITY AND THE HYPNOLEPTIC STATE
OUR analysis of the cases of double or multiple consciousness, together with the experimental study of the Hanna case, reveals to us the law that governs the different forms of psychophysiological segmentation.
A close examination of the cases reveals the fact that in some of them, though not in all, we find a psychopathic or neuropathic disposition. The patient's mental life is in a state of unstable equilibrium. The higher constellations and clusters of neurons with their concomitant mental systems are not firmly organized in the principal constellation correlative with the synthetic moment of self-consciousness. Thus the very cerebral organization has an inherent tendency to segmentation, or even disintegration, under conditions that would in no way affect more stable organizations. A strong stimulus, or even one of medium intensity, may set up a process of disorganization. A fall, a blow, a concussion, a strong emotion, any of them may produce “commotion cerebri,” disintegration of the unstable neuron systems. Such cases we have already brought to the notice of the reader in our former chapters, and there is, therefore, no need to have them repeated here.
The hurtful stimulus, however, may not be of a violent character, acting suddenly, but of a mild nature, acting for a long time on the neural constellations and finally inducing the phenomena of dissociation and disintegration. In cases of confirmed alcoholism or in epilepsy we frequently find such disorders. The accumulation of toxic matter may bring about a rise of thresholds with a consequent disintegration of the constellation of neuron systems, and the elimination of this poisonous material may effect a restitution.
It must, however, be pointed out that though cases of double consciousness may occur in epilepsy, epilepsy is not the only cause of all such cases. Double or multiple consciousness may be induced by many different causes, and epilepsy is but one of them. Epilepsy and the phenomena of multiple consciousness must by no means be identified. When we find a case of amnesia and double consciousness without any typical epileptic attacks, we are not justified to ascribe it to epilepsy, simply because such phenomena are also manifested in this disease. The moon is one of the causes of light, but it does not follow that wherever there is light the moon must necessarily be present. Moreover, the secondary states, or the moments consciousness found in the epileptic “Dämmerzustände,” are of a very low type, because the disintegration is deeper and more extensive. Epilepsy and multiple consciousness should not be confounded; one can exist without the other. There is epilepsy with no organized double or multiple consciousness, and there is organized double consciousness with no epilepsy. In our sleep, which no one will deny as being a perfectly healthy and normal state, nearly every one of us, some time or other, presents phenomena of mental segmentation. Some isolated area of the brain or rather a constellation of clusters of neurons continues or begins to function and we get some type of hypnoidic states in the form of very vivid dreams. We find this especially to occur in children, who often cry, play and act out their dreams, living over in these states the more striking events of their life. A child, for instance, is frightened by a dog that ran over it. In its dream the child lives over again the occurrence of the day, and it cries out with fear. Children are known to sing in their dreams, remarking then, “That is enough; I cannot sing any more.” Every father and mother, who have paid attention to their children, will tell you of such vivid dreams. If now the phenomena of multiple consciousness were nothing but a form of epilepsy, a “masked epilepsy,” or, as some term it, a “psychic epilepsy,” then we are all of us confirmed epileptics. One thing, however, is perfectly clear from the study and analysis of the cases of multiple consciousness, and that is the preliminary condition of such states. The prerequisite of multiple consciousness is either a highly complex organization or, what is more frequent, an unstable neural equilibrium.
To effect an overthrow of this neural equilibrium some agents are required. This, as we have just pointed out, may be of any kind, only they must either be of an intensity stronger than the usual stimuli, or of a low intensity, but durable in their hurtful activity. In short, the intensity of a normal stimulus or the duration of hurtful irritation may produce the same effect. Once such an effect is induced and the principal constellation is broken up, or disintegrated, an attack of unconsciousness sets in, an attack which may be of any duration, sometimes occupying a few minutes only, and sometimes covering a period of many hours, and even days. The disintegration is a form of cerebral shock akin to one induced by direct excision of the frontal lobes or of other areas of the brain in the psychophysiological experiments on localization.
The principal organization of the leading constellations of systems is disintegrated, and on account of the shock no other moment is yet organized to take the lead and become the focus of the disturbed stream of mental life. Systems with accompanying moments consciousness may arise and attempt to form a focus, but not being well organized, and not being able to concentrate enough psychic content so as to maintain their own existence, they fall back into the same obscurity from which they come, and other moments take their place, until at last a moment comes to the surface, a moment fit to survive and able to maintain itself above the threshold of self-consciousness. The whole process is a struggle for existence among the many systems, among the many moments constituting man's mental life. Only the fittest survive.
Meanwhile, during the whole course of this process the patient remains in a “deep sleep,” in a state of unconsciousness. A deep sleep, or a state which we may practically term unconsciousness, since the higher moments or systems are disaggregated and “inhibited,” and only the lower ones remain and continue their function, is a necessary preparatory stage of the phenomena of double or multiple consciousness. All the cases analyzed and studied by us present this stage. Where it is absent, where the patient, without falling into an unconscious condition, directly before our eyes begins to manifest a different personality with loss of memory, we should have our eyes wide open and be strongly suspicious of the genuineness of the ease. A state of unconsciousness or of low moment consciousness precedes the first manifestations of double or multiple personality.
It does not require a close scrutiny to discover that 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, however short it may be. One synthetic moment does not directly touch the other in time. The point of the end of one moment does not form the starting-point of another. The two alternately functioning systems are separated by an interval of unconsciousness, however short. At first the interval is long, extending over a period of many minutes, or even hours, but gradually, with the repetition of the alternation, this interval becomes shorter and shorter, and is finally reduced to but a few seconds.
In the first cycles of multiple consciousness none of the moments are well organized, each of the leading functioning moments can maintain itself above the threshold of personality only for a short time. With the disintegration of the latter another constellation with its correlative moment begins to rise, reaches the threshold of self-consciousness, steps it over and begins to function; the moment not being well organized, the process takes a considerable time. As the cycles of alternation are more and more repeated, the alternating moments become well organized and the time of the submergence of one and the emergence of the other becomes considerably reduced, but still the process must occupy some fraction of time, how-ever short; hence the intermediary stage of “deep sleep,” the state of unconsciousness. In passing from one state to the other the deep sleep must invariably be present. This is the hypnoleptic state.
The hypnoleptic state is a true attack. It sets in with a state of irresistible drowsiness, the patient still having consciousness of his environment, and stimuli, which must become more and more intense as the state of drowsiness deepens, reach the subsiding synthetic moment consciousness and bring it into momentary activity again. The patient can be aroused, but only for a brief space of time, for a second or a fraction of it, and soon falls back into the drowsy condition. As the drowsiness deepens the patient’s reaction to external stimuli becomes less and less, and finally a point is reached beyond 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 may be characterized as the second or the stage of unconsciousness.
The stage of drowsiness or the first stage of the hypnoleptic state is of the utmost importance for theoretical, experimental, as well as for practical therapeutic purposes. It is in this stage that the true crisis of alternation begins. One functioning moment is slowly subsiding, while another moment is being formed and is slowly rising to its dominant position in consciousness.
Now, basing myself on this theoretical knowledge of the hypnoleptic state, I was enabled to bring about a synthesis in the Hanna case of the two dissociated systems or moments. The hypnoidic and the hypnoidal states clearly revealed the formation of independent centres, of independent constellations in the subconscious regions of the patient’s mind. There were many centres, many systems of neurons of the disaggregated constellation with its concomitant synthetic moment of self-consciousness. They were in a state of formation. The incessant bringing up of the hypnoidal states by means of experimentation, the methods of psychic and physiological stimulation employed by me, of which an account was given in a previous chapter, stimulated those independent constellations to a more active function, which was bound to result in their synthesis.
The treatment was the first experiment of the kind in the effectiveness of synthesis, since, as we have seen, in no case of multiple personality was a synthesis brought about. So much so, that Ribot, in his book, “Diseases of Memory,” tells us that “observation does not show that its chasm is ever bridged over by direct recollection.” The cases were of long standing, the alternations of personalities continuing for years, and sometimes the whole lifetime; the only one who attempted to effect a synthesis was Professor James, but he unfortunately failed, as he employed a wrong method, not basing his attempt on the insight into the mechanism of this form of mental malady. The fact that such a synthesis, or, as Ribot terms it, a bridge, was until now not effected in any of the cases, made the great French psychologist stop short in his conclusions and say that “two suppositions are possible, either the registration of anterior states is effaced, or the conservation of anterior states persisting their power of revivication by association with the present is destroyed. It is impossible to decide arbitrarily between these two hypotheses.” In the case of Hanna the chasm was bridged over by direct recollection, thus demonstrating the correctness of the second hypothesis.
The methods for bringing about a synthesis were worked on my theory of the moment consciousness. Each step was controlled by this theory, and each phenomena as it came along was foreseen beforehand. I think, therefore, that this was an experimentum crucis of the truth of my position. Once the disaggregated moments became synthetized they formed one synthetic moment embracing the whole content of experience up to the time of the accident. Their stimulation and the memory of the functioning constellation of mental systems brought the old, now reintegrated moment, to the surface of the waking consciousness. This always took place at night, in sleep, when the constellation of the secondary state was in abeyance and the primary could come forth and assume supremacy.
The primary state, however, could not long maintain itself, the common synthetic bond of associative activity was weak, and the whole moment gradually began to subside into the subconscious in the disaggregated form, in which it had been before. It was a matter of fatigue and rest. The patient began to feel drowsy and gradually passed into the second stage of the hypnoleptic state where no external stimuli could bring him to self-conscious life until the moment consciousness of the secondary state stepped over the threshold of self-consciousness. The patient woke up in the secondary state.
Our efforts were then directed toward a more frequent alternation of the two formed centres, of the two foci, of the two synthetic moments consciousness. This, as we know, according to the law of alternating moments, tends to shorten the hypnoleptic state. Fortunately, the hypnoleptic state in our case was a very short one, lasting only a few minutes at the start, and two or three alternations sufficed to reduce it to seconds.
Another method to reduce the total time of the hypnoleptic state was stimulation during the hypnoleptic state itself. Powerful stimuli, acting simultaneously on all the senses, were applied to the patient. This stimulation was of importance to reduce the time of the last stages of the hypnoleptic state. For, in the last stages of the hypnoleptic state, the constellation of systems with its moment consciousness representing the secondary state was almost fully formed and near the lower threshold of self-consciousness; the stimulation helped the moment to rise earlier than it would have done otherwise. The duration of the hypnoleptic state was thus greatly shortened. The interval between the two, now more or less firmly organized moments, became reduced, and the moments were then nearer to each other in time.
When the hypnoleptic state set in, the constellation with the second moment became quickly organized and rapidly rose to the threshold of consciousness. Once this was effected our efforts were directed toward retarding as long as possible the subsiding constellation with its concomitant primary state, so that the moments, the subsiding one and the rising one, should meet and catch a glimpse of each other; in short, the whole course of our treatment was bent on one purpose, namely, to make the two moments simultaneous, even though for the briefest space of time. This could not act otherwise but result in a synthesis of both. The two alternating moments separated by the hypnoleptic state, by having them appear simultaneously, came in close touch, perceived each other for the first time.
At first the two met like enemies, but soon they had to acknowledge their intimate relationship and the synthesis was effected, though in a very laborious fashion. Thus the synthesis of the two alternating dissociative moments or mental systems was brought about by the shortening of the total period of the hypnoleptic state, then by the shortening of the secondary stage, and lastly by the lengthening of the primary stage of the hypnoleptic state. In other words, to effect a synthesis we have to shorten the secondary stage and lengthen the primary stage of the hypnoleptic state.
The hypnoleptic state is not only of the highest importance for theoretical and therapeutical purposes, but it is also of the utmost consequence from a purely diagnostic purpose. Thus I know of a case of double consciousness where the patient feigned this pathological condition and duped his physician for some time. The patient wanted to be kept in the hospital so as to escape the burden of the duties of life. Now, had the physicians known of the intermediary sleeping state, they would not have been so badly duped. Besides, the fact that there were many other flagrant contradictions in the case, the fraud could even at first sight have been detected, because the patient, after having been in the hospital for a few days, passed, in the presence of the physicians, into the primary state, directly while in the full possession of his consciousness. No sleeping state intervened between the secondary and primary state. Such a case is a fraud. It must be borne in mind that the law of monocyclical or polycyclical bimorphosis is: no mental alternation without some form of an intermediary sleeping state in general and of a hypnoleptic state in particular, especially in the transition from the primary to the secondary moment.
The intermediary states, the sleeping and especially the hypnoleptic state, now require our attention. What are they? How do they originate? And why is it that we find that while the transition from the secondary to the primary is through the condition of ordinary sleep, taking place usually at night, the contrary is the case in the transition from the primary to the secondary? In other words, why should the transition between the primary and secondary state take place through an “attack,” attack," through a hypnoleptic state? The answer is because the sleeping state represents the absence of any dominant functioning moment, and that is what takes place in the interval of the alternation of the moments. But what is that hypnoleptic state? The hypnoleptic state is the reproduction of the original attack which brought about the state of double or multiple consciousness.
This is clearly revealed in the case of Hanna. What happened there was that the patient met with an accident, lost his consciousness and the synthetic moment became disaggregated and could not get reinstated; a new moment with new content entered into being, a secondary state became gradually formed and trained. The original order then was: (1) the primary state, representing the patient’s whole previous life, (2) the state of unconsciousness, (3) the formed secondary state. The succession of the states formed a cycle that went on repeating itself in the same order; hence we can see why the hypnoleptic state is of the nature of an attack and why the order is always of the following course,—primary state, hypnoleptic state, secondary state, and so on, never the reverse. The phenomena of double or multiple personality have a definite course of their own. Newly formed personalities pass through well-defined cycles of life, and like new worlds formed by some external or internal catastrophe, they keep on revolving within the same orbits.