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Boris Sidis, M. A., Ph.D.,
Mental Dissociation in Depressive Delusional States
BORIS SIDIS and GEORGE M. PARKER
THE following experimental notes are selected from a mass of material collected during studies of the case in the laboratory. They are given in the form in which they were taken, with many details omitted, but without any attempt to make them more connected and readable. The interesting feature of these notes is that they show the condition of the patient at various periods in the progress of his disease. The unmodified character of these notes puts the reader in closer touch with the actual manifestations as they were directly observed in the laboratory, manifestations on which the preceding paper is based:
J. F., aged twenty-six, clerk. Family history is negative; there are six children in the family, the patient is the third. He had been temperate, and denied syphilis; never had rheumatism, or scarlet fever, or diphtheria, typhoid; had been working very hard up to the time of his illness. There were no special causes of worry, no excesses.
In February, 1900, the patient began to lose appetite, to have headaches, there was loss of attention, memory became unreliable, there was a desire to seclude himself, great emotional depression, bowels became costive, and bodily condition generally poor. There was a probable history of malaria persisting for some time previous to the disease, but this could not be well verified.
At his first attack, there was considerable nausea, abdominal pain, depression passing into intense anxiety, etc. He was seen by the local doctor, who told him that he had "lumps." The suggestion of lumps formed a nucleus of a highly systematized delusion. The patient actually felt them for the first time, and described them as being beneath the mucous membrane of his stomach. Since this time the delusion of the lumps has persisted and developed. The lumps spread to other parts of the body, to the arms, to the legs, with sudden changes of location. He believed he had worms that ate the lumps, and the soul and specially the spleen were the chief scavengers. The soul and the spleen communicated by signals.
Five days before he became sick, the soul began working, rubbing the lumps out and getting them out of the way. At that time the lumps went in the same hole at which they now enter. The spleen would grunt when the soul worked right, but not like a "man's grunt." The worms meantime were working against the soul. He could feel the soul come out and open the mucous membrane and clean out the worms. The worms were very angry. Then they became still; they had been eating the lumps, but did not like them; the lumps apparently anteceded the worms; the lumps and worms did not agree. The soul also cleaned all the lumps out of the head into the veins, and the veins brought them to the stomach; when the patient became inattentive, however, and too weak to notice these lumps, the soul did not work so well. The spleen told the soul at this time, by signs, to stop; the soul never answered, but understood.
At this time he went to the hot baths. Here the veins began to "draw," and then the spleen began to work in order to get out the lumps. His bowels were especially costive at this time, there was considerable abdominal pain, and he was sleepless. He said, "I looked out of my eyes and I could not see." The lumps in the body began to feel alternately hot and cold about September, 1900.
Since this time, the localization of the lumps has become more definite. The heat and the cold are less shifting; his veins continue to "draw." Patient has no definite idea as to causation. No external or objective references. No history of anything further than noted. Especially has there been no intestinal disease.
November 30, 1900: Patient examined as to his sensations, no changes were evident. There was no hypnosis at this time.
December 5, 1900: Hypnotized; patient becomes completely changed; melancholia is gone; he is jovial, merry, and keeps on laughing and roaring without any provocation. Says, "I feel well." Delusion of lumps persists. Suggestion made as to heat and cold; as to anęsthesia, entirely successful. During pricking of the hand some exhibition of subconscious phenomena as evidenced by shaking and shivering, but the patient makes no reference to this sensation. Later, suggestion as to diffuse warmth, which was successful. Post-hypnotic suggestion as to localization of the spots, of the heat and cold to be limited to one area, the right forearm and hand. Condition apparently improved after hypnosis.
December 7, 1900: He states that his right hand is cold, that his left and the rest of his body, except the right foot are warm; no amnesia as to the suggestion.
He dreams of frightful characters, never about being hurt or damaged. During early part of his sickness, dreamed that his spleen was jumping around and removing the lumps. Denies ever having read of this. One night he cried out that he was afraid his spleen would jump out through his chest. No somnambulism. One time, after rubbing turpentine over the body, with some consequent pain, shortly after he felt the same pain over diffuse and separate areas of his body, as if some one had thrown the turpentine upon him. During this period, in reading he could not follow the type, he became mixed up and would not know what he was reading about. If he attempted to carry it on he would have an increase of pain until he had to cease. At times very melancholic.
Thermic tests showed that his sensations as to heat and cold, were normal at this time. No kinęsthetic abnormalities. It was suggested that there would be absence of pain, absence of heat and cold except in the middle finger of the right hand.
December 11, 1900: Condition much improved; the heat and cold sensations have not limited themselves to the area circumscribed as in last suggestion, but are noticeable, especially in the legs and lower part of the body. With this increase in somatic sensation the synthesis is apparently increased. He can read and not forget; he walks without being frightened; sleeps better, and has had no further dreams, until last night when he felt the spleen pull for the first time. He always remembers his troubles better when he is feeling well. He felt distinctively better after leaving here; very happy and joyful. He is constantly recounting his delusions and likes to dilate on them. Suggested constant insistence upon the disappearance of the spots. Of not remembering the chill or the cold experienced in his first hypnosis, but rather of constantly feeling warm.
December 12th-14th: Pain again in his leg. He calls it a "separation of the mucous membrane." He can read more intelligently and remembers more. Under hypnosis, it was suggested that the pain disappear. He seems to be hypnotized more readily.
The second hypnosis far deeper. Change very great. Looks quiet and grave though contented. Contrast to the melancholic waking state and merry hypnotic state is very striking. Remembers well. No memory on awaking. Attempt towards raising general affective tone. Instead of directing the measures toward changing of sensation it is rather an attack on the affective state.
December 15th-21st: Feeling happier, memory is better, reads more and more rapidly; he sleeps better, and has no dreams. Feels pain in right leg only, then it is rather a feeling of "grain over the skin."
He brought a sample of grain to show this. He limped from the pain in his leg; this limp was removed by suggestion. The subconscious phenomena of heat and cold, which appeared during the first hypnosis, are still present. Suggestion is still directed toward affective states. Constantly improving.
December 22d-29th: He looks brighter, is more attentive, reads continuously with a distinct memory of what he has read. Does not think as much as usual about himself. Pain only in the right foot with a feeling of heat and cold, as per suggestion. Nowhere else is this found. Electricity was begun at this time.
He feels happy in the evening; the change is immediate after hypnosis; is no more afraid; he has seen the effect of the lumps in the black underneath the nails; as he feels them drop off, he smiles. In all attempts at diffusion of the feeling, there is an insistence upon a warm feeling in the region of the epigastrium. All attempts at amnesia of the suggestions given when patient is in the "gay" state are unsuccessful. Feels that he will be well within two weeks.
January 2, 1901: Suggested that he should, after waking up, hand a "lump" to S. Amnesia enforced; at first he could not remember; gradually the memory came back when asked if P. had not told him something, and then the specific recollections emerged. The second time hypnotized, the same orders enforced, and post-hypnotic suggestions made more specific. Patient woke up but did not remember; still the suggestion developed partially. Hypnotized again, with post-hypnotic suggestion still more strenuously enforced; still not successful. Put into hypnosis; when partially awakened, patient looked out of the window, thought he was in his own home, looked about with amazement, but recognized no one; thought some one had been speaking to him in his own home. Said nothing for a moment, and soon completely awakened and recognized those about him; he remembered about his shoe being off. Post-hypnotic suggestion was not efficient. He goes back into the state of hypnosis readily. Patient was put into a deeper hypnosis. Sudden marked emotional transformation; from boisterous, gay, and light-hearted became quiet, sedate, and grave. He awakens in a startled manner; could not remember taking his shoes off. Complete amnesia; post-hypnotic suggestions are not followed out.
After awaking, he says he does not remember having seen Dr. S., but remembers P. When asked what time he would come, he could not remember, but said he remembered what P. said. Does not remember that S. has told him something.
January 19th: Has said that at some time he saw and heard things without understanding them; feels the lumps now only between the toes; dropping out now every day; knows that they will disappear at this rate in two weeks; extremely sensitive over extremities; feeling- of cold and warmth reproduced as in first experiments. Movements of his arms and toes produced as though bathing. This is in hypnosis and afterwards.
January 21st: He feels better, the lumps are getting better; he knows they are dropping out; cannot catch them because they run away; idea of lumps is very indefinite; lumps also run up the bowels and run down the bowels and emerge with the movements; he feels them in the passages of the bowels.
The succession of the two contrasting affective personalities is still very striking; the gay is of very brief duration.
January 26th: Feels worse; notices the spots upon the mucous membrane for the past two days. His attitude and expression are again depressed; in taking a tremor tracing of the right hand, he felt the spot run off his left leg. The same as to the spots in his head; he has a pain in the right side of his head when his left hand is engaged. On awaking from hypnosis, there is a reverse procession of the affective states; the superficial states, which are now very brief, being characterized by gaiety, the deeper states by quietness. Hypnotic suggestion that he must light a match after awaking; on awaking and hearing the signal, he began to laugh and stretched out his hand for a match; asked "whose are they?"; then said, "Maybe I will light one"; said he would pay for it, and insisted upon lighting it in spite of our efforts to the contrary; said he liked to smoke, then later said he wished to warm the room. After lighting the match, he said: "I dreamed about lighting a match, that I would have to see fire; some one wanted to take away my memory." During his hypnosis he was pricked in his hand; he remembers this also as in his dream.
He goes now rapidly into the deeper hypnosis; the "gay" stage is extremely brief; the emotional change is very marked; he is no longer gay and laughing, but quiet and grave, still very cheerful and contented. After awaking from hypnosis, he looked in the chair; asking to see "the black cat," which it had been suggested he should see after awaking. He took up a weight which had been placed purposely in the chair, and said "This is not the cat." It was suggested that it was a dead black cat. He looked around for it, then said he wanted to see the cat, that he would find the cat, that he had dreamed about it, and wanted to take it and pet it. Then he took up the weight and laughed, and said it has the color of the cat, and took it in his hands, and passed his hand over it. When asked why he rubbed it, he said, "There is no question about it." He asked how much it was worth. When asked why he wanted it, he said it was the color of a black cat, and he wanted to buy it. He then took it and pushed it back and forth, as in the fatigue experiments. Again when asked why he rubbed it, he said that he would go into the next room and rub it.
He said, "It is the first time I have seen it"; he reiterates this. When insistence is made upon the reproduction of the sensory suggestion, the motor associations of the fatigue experiments only are realized. He rubs the weight on his leg, then incorporating these motor associations into his delusional system, says that in so rubbing it the spots come off. Complete amnesia after awaking.
Before awaking, the weight had been put in his pocket, where he found it. He asked who put it there, and if some one were not in the room. He thought that the matches and weight were in the chair―that they must have been in the chair. He does not care for either the matches or the weight. Absolute amnesia afterward. He thinks somebody has told him that he could have the weight. When asked if he remembered anything about the hypnosis, he remembered nothing, not even of any dream, but he thought the weight was good for exercising, and for ironing,―both of which are memories from the states intervening between the hypnoses.
January 30, 1901: He feels the lumps still. They are still coming up to his body. Hypnosis, very readily effected, but less of the emotional disturbance which characterized it at first. Post-hypnotic suggestion that he will see the picture of P. Picture was represented by a circular outline of head and shoulders. Complete amnesia on awaking. He looks at the picture, and laughs and says that it is not right, but that he could identify it among others; he says it has no nose, nor eyes, but that it must be his picture, because "it is on the paper used here when I came." Later, says it is only some marks; that it is nothing else; and that the paper is the only thing which helps him. No illusory phenomena; sensory element recognized exactly. Patient put in deep hypnosis; suggestion that he is to see on paper a man in a suit about whom he is to dream; he is awaked; said that the man is not swell, that he has no good clothes on, that he is not well dressed; the man has black clothes; he sees the picture plainly with a double-breasted coat. The picture is simply a few lines, but he works out all the details. He evidently has blended the two suggestions,―the general about the man and the particular about P. Said he had dreamed of an iron burning him; this was due to the weight with which he played in the hypnotic state at a previous time, and under previous suggestion, that he would feel- better with this weight.
P. hypnotized patient, suggested sensory hallucination of a figure (fly); when a signal (knock) was given, suggestion realized, saw the fly and caught it, let it go, then looked for it everywhere; he picked up P's picture, the one suggested previously, and said it was P's picture, and wanted to take it; pointed out all the details.
Hypnosis, suggestion to see father, and speak to him; wakes up, took P. to be his father, and spoke English, although his father speaks only Russian. When asked where Dr. P. was, said he had him in his pocket. When insisted that he see P., said that he did not care to see him, that P. was very busy; rehypnotized and suggested that he see sister open the door and come in, while it was further suggested that his father was going to help him in his trouble and take his spots away; awaked and said, "May I go to the door?" He did not see his sister until D. came in, and then he took him for his sister. Finally, when we attracted his attention to the difference between D. and his sister, said we were mixing him up, and finally told D. to go away, that everybody laughs at him, and said, "I shall not take you up here any more." When we insisted that he open his eyes and see D., he still insisted that D. was his sister, and that he was not out of his mind.
February 1st: Still feels lumps; said he had a bad dream, that two men were trying to kill him, and that he had called the firemen for help; the men in the dream resembled no one; he felt mixed up after awaking. He remembered this in the night, directly after waking up, but not on the next morning. Did not dream about his father or sister; does not remember having his sister or father here last time. Remembers that the picture was one of P., but now it does not look like him; he knows it is not one of P., he only dreamed of it. As soon as he wakes up, he knows that the spleen works between his toes, where during hypnosis the electricity is applied. The spleen takes everything away and pushes it down the bowels; he heard a few days ago a signal from the soul to the spleen; the soul is working and rubbing away the spots. The delusional system is, still complete, and its integrity is but little affected.
He is hypnotized; post-hypnotic suggestion that the lumps will jump at a signal to the hole near the spleen, then through the bowels and out of sight; he lies down upon his left side in order to have these spots go in the hole; he feels the flesh dry; feels the spots jump to the arm, and then to the head, and then to both holes, both behind and in the side; he cannot tell how many minutes longer it takes. When the toes flex, the lumps come up on the anterior surface of the leg; when they extend, they come up the under surface of the leg.
Second hypnosis was easier; suggested that all the spots on the right and left foot would disappear within one minute, and he would feel much happier after awaking.
Awaked, he said, "Some one in my dream told me to count the spots; I can't do it, for they are all there; I would like to have them all go; they would all go through the holes." After two minutes he thinks they are all gone except a few; when asked to guess how many are left, he holds himself in an attitude of attention, and counts to twenty on the right side, and to ten on the left. Said "I dreamed that my spots will go right away, and when I count them they go quicker."
February 2d: No dreams; diminution of spots; believes that the spots are worse when the weather is wet; thinks it will take a long time. It was suggested in hypnosis that after awaking he would see writing upon the paper and read it, the writing being that "the spots are going fast." When reading this the spots will begin to go much faster. After awaking, he says "I cannot count them"; this is a revival of a former hypnotic state; he said, "I have been asleep, and I heard some one say for me to read upon the paper and to count the spots, but I can't read." Rehypnotized with post-hypnotic suggestion that his father would speak to him and tell him that he would get well, and after awaking he would speak of it to P.
He awaked and said: "I saw my father in a dream, and he told me that my feet would get well and dry, whether in wet weather or dry; that even in damp weather I would be well; my father, he tells the truth"; he has not responded to the latter part of the suggestion, as to telling P. about his increased strength; only that which interests the delusional system in question is adopted. The amnesia is complete.
He said, "If my memory for those spots would only go then I would be well." Also said during hypnosis, "When my feet get dry then the spots go away." The upper current of the spots to the body has possibly been suggested by the feeling of the electrical current up the legs to the arms and hands. The positive tendency towards extension of the systematization is not so marked, but the negative tendency as to the exclusion of any ideas which cannot be fused is still strong.
The merry hypnotic state is now markedly dwindling away and the patient rapidly passes into the grave state, now greatly moderated. Patient begins to smile in his grave hypnotic state. There seems to be a blending of the two contrasting hypnotic states, with predominance of the main features of the second state.
February 8th: Says his father has told him the truth, that his fingers and toes are getting drier; that his father has told him they would gradually get drier. But they are not yet completely dry. This is from a dream, but he does not remember at what period. In hypnosis, anęsthesia of the left hand was suggested, with warmth of the right hand, and a negative auditory hallucination. None of these was successful; apparently they were too numerous for assimilation by his delusional system.
In second hypnosis it was suggested that when a pencil would be put in his right hand, he would answer the question by writing. A negative auditory hallucination involving S. was given that he would answer S's question by writing without remembering how or why. He was distracted by P. while S. spoke in his ear. Patient says that P. has asked him about his sister. It was really S. He further says, "I can't write for my arm hurts me." When S. speaks he jumps and discontinues any conversation with P. In third hypnosis there was insistence on writing and the negative hallucination of S. As before, he says that P. is speaking to him about his sister, about matches; each time after S. speaks to him he lapses again into a slight hypnosis. There is a fixed objection to writing. Evident lack of initiative. When he once begins he finishes completely; he said he wrote because in his dream he was told to write. He said he heard only P. Says he does not hear S., but answers S., explaining that it is P. who is talking to him. He insists that he does not hear S., but only P. Says some one bothers him, meaning S. Patient looks at S. and then turns away for he only hears P.; whenever he answers S. he shuts his eyes and says he is talking to P. He takes the paper and says "that when he writes upon it with a pencil the spots will emerge through the pencil and be dropped upon the paper; he refers to the spots upon the paper made by him as the spots which have emerged.
He tries to keep this paper; it is snatched away, whereupon he gets up and looks for it; he talks to S., yet says he is talking to P. Says he does not know how the spots get away with the paper, but thinks that the spots have carried it away. When shown some spots by S., he sees them, but says they are not the ones. It was further suggested in hypnosis that when writing he will see the spots come off, and each day more will come, and each day he will forget more about the spots which are left. Also insistence upon the paternal authority, with verbal repetition; upon awakening, he asked who was talking to him in a dream.
February 12th: He has not attempted to "write out the lumps," because he has not felt like writing; says his father has not told a lie, because his feet are becoming a little drier, but not entirely so. Hypnotized, and suggested that he see upon awaking a black cat with a white tail; that he pet the cat, and pull her tail. On awaking, he said he dreamed of a cat once, but "this (the weight) is no cat"; he says it is simply something for exercise; he insisted, however, that he wished to put it in his pocket, but did not wish to steal it. This is from the previous hypnosis of two weeks past.
Second time hypnotized; suggested he would see a dog; on awaking, said "it is no dog, no face of a dog, does not look like a dog"; exercises with the weight.
Patient's memory of the motor elements, as before, is the best; he begins to exercise with the weight as before, although he says he has never seen it before. Rehypnotized, and suggested that he would perceive a snake; the snake being a pneumographic belt. He looks at it and says "it is no snake, it must be dead; my worms are alive, but this is not alive, nor is it my vein"; he looks at it very frequently, and with questioning and uncertainty; he keeps looking at it; says: "I don't know what it is, but I am scared at it, for when my vein came I was scared at that; that thing must have come from somebody and was once alive, and so I am scared at it now, and I shall throw it away." There is here a complete systematization. He puts it away, then takes it out and again looks at it, saying each time, "I am scared at
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