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THE DEVELOPMENT OF THE SECONDARY STATE
FROM this first attack the development of a secondary state was assured and it accordingly began to manifest itself with ever-increasing frequency. It will be instructive if we pause and study the origin of a few separate attacks and learn how this condition was brought about and what symptoms accompanied its incidence. We can do this to better advantage if we will first pause and examine the accompanying diagram (Figure 18), which is an attempt at the graphic representation of J's abnormal mental states.
If by this diagram we represent J's stream of consciousness, then p―that portion between the middle and upper line―will represent her upper or personal consciousness, and s―that portion between the middle and lower line-will represent her subconsciousness. By w is intended to indicate that abnormal element in patient's consciousness which is alternately active―m, c ; or dormant―x. This is termed "the psychopathic wave."
When the psychopathic wave is active and it culminates in the upper consciousness as at m, J. is profoundly depressed, inactive, and melancholy, and possessed by the idea of suicide. The origin of this emotional condition is, however, in the subconscious dissociated mental states which lie at the base of the wave at d―i.e., the story of the suicide told her by the old woman, and which she has long since forgotten.
When the psychopathic wave is dormant, as at x, the emotional state is, not normal as we might expect, but one of pronounced exaltation. J. is happy, laughing, and talkative, and constantly active―e.
When, however, the psychopathic wave culminates in the subconsciousness―c, J. passes into her secondary state, and her upper consciousness, as indicated by the broken line at l, is, in large part at least, inactive.
Thus we see that J. has three distinct abnormal mental states, viz.: depressed―m, exalted―e, and secondary―c. The two former have to do with her upper or personal consciousness, although the first has its origin in the subconscious; the third has to do almost wholly with the subconscious.
On one occasion she felt tired and lay down to take a nap. She was suffering from pain in her head at the time―the same sort of pain that resulted from her fall. J. has two varieties of headaches; one is frontal and due to eye strain, the other is occipital and the result of her fall. The former she speaks of as "headache," the latter as "pain in the head." It was this latter variety from which she suffered on this occasion. While sleeping she dreamt that she visited her uncle's mills (woollen mills), and that there they were at work dyeing an unusual amount of red cloth, so that there were large quantities of this red cloth all about her. She awoke, but in her secondary state.
Other attacks were preceded in the same way by occipital pain and this sensation of red without the incidence of the sleep state.
Here we see the development of what appear to be two distinct auras, both sensory, which usher in the secondary state.
If we analyze these attacks carefully, however, especially with reference to her condition before the head injury, we will, I think, have the conclusion forced upon us that the occipital pain sensation is the only true aura of the secondary state. This pain has a constant relation to the secondary state, whereas the red sensation not only often occurs without the pain, but was frequently in evidence before the head injury, and therefore before she ever had any secondary states, The red sensation is rather an indication of the activity of the dissociated subconscious systems occurring typically in connection with the mental state―m (see Figure 18), and quite consistently appearing on the scene preceding the secondary state, when these systems are about to usurp the field of consciousness.
Let us study still further how these attacks manifested themselves under other conditions.
One day while at her uncle's house, her cousin L. played on the piano to her while they sat together in the parlor downstairs. During the playing she was thinking of what she had been told she did in her secondary state and worrying about her uncle's threat to send her to a convent. After her cousin had played for a while they went upstairs to her room. As they passed through the upper hall J. noticed that the carpet was red. This immediately brought back to her mind the recollection of the suicide and produced a peculiar feeling of fear,―erythrophobia,―which was immediately followed by pain in the back of her head. They went together into L.'s room and L. read to her. J., meanwhile, was lying down, her eyes shut (condition favorable for the outcropping of subconscious states), and thinking of the party and the subsequent scolding her brother and sister gave her. It was during the reading that the secondary state asserted itself. She was thinking of her brother's anger, and opening her eyes she mistook L. for her brother and said, "Why H., what are you mad at me for?" Her uncle took her home and when she came to herself her brother was untying her necktie preparatory to putting her to bed.
Another attack was preceded by a dream of the suicide, during which dream she had both the red and pain sensations. She awoke in her secondary state.
During all this time she suffered a great deal from headache. She would often lie down complaining bitterly of her head, saying, "Oh, how my head hurts!" Then as the secondary state would assert itself she would keep right on making this remark.
From now on attacks were much more frequent. They came almost every day, and sometimes more than one a day. Their resemblance to "epilepsy of the psychic type" became even more marked. Often she would seat herself to play on the piano, would begin all right, when a secondary state would assert itself and she would commence to play one thing after another in a confused jumble. On one occasion she started to set the table for dinner, an attack came on, and she went on with the work but mixed up everything hopelessly. She then went into the sitting-room and sat down for a few moments, then returned to the dining-room and finished setting the table, but was greatly surprised to see how everything was strewn over it, and wondered how such a condition had come about.
More interesting yet are the attacks during which she held conversations with her brother. They came on often when she was seated, sometimes alone, sometimes with people about her with whom she was conversing. If she had been conversing she would suddenly become quiet for a few moments, then looking up would mistake some one in the room for her brother, and enter into conversation with them. This would last a few moments, when she would suddenly come to herself and resume her former conversation.
Even when no one was in the room with her these attacks assumed the same characteristics. She would then imagine that she saw her brother before her, address remarks to him, and hear him answer her. She would usually talk to him of suicide, and his replies to her were of a nature to dissuade her from such an act.
Here we have a condition closely bordering on that of "double consciousness"; its relation to so-called "psychic" epilepsy is shown by being in each instance preceded by the aura previously described; its real character, however, is that of mental dissociation, the presence of dissociated systems in the depths of the subconscious.
It was at this time when her attacks were recurring with such frequency―during which she was often violent, having to be held, on one occasion breaking out the window panes (subconscious angry state), threatening and attempting suicide―that she was examined and committed as insane.