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Boris Sidis, M. A., Ph.D.,
DISSOCIATION AND SYNTHESIS
To return then to our case: what remains to be considered is the further development of these complex series of dissociation, based upon the established genetic point. By reason of the dissociation which has evidently occurred in this case, a certain system became subconscious; its very intensity served to accentuate and make it dominant.
With a system of such freshness and intensity, the tendency was rather towards extension than even relative fixity. The application of the straps to the foot, a necessary measure, was here another of the causative factors. The resultant prevention of movement produced a deeper lapse of kinęsthetic sensations and memories relative to the particular affected member. The growth and development of the dissociated system progressed, aided by the very failures of attempts at its disintegration. It will be recalled that, three weeks after the accident, patient removed straps and unsuccessfully attempted to walk. That success, which would have disintegrated the previously constructed system, here was wanting. This plainly signified that thus early was the systematization compact and strong. Crutches now were ordered. During all this time, the sympathy shown by the family, appreciably aided the result. After six months, the patient was taken to several surgeons. Unwisely, also, series of suggestive questions, were offered to the now sensitive mind of the patient. Following one of these consultations there began to develop a rather novel extension of this system. Over all bony surfaces hyperęsthesia soon prevailed. Its source was readily traced to the marked attention directed by the surgeon to these identical points. So marked was this development that one year later it presented itself as one of the prominent aspects of the case. The dependence of the dema upon the systematization was evident. The dema did not appreciably develop until six months after accident. At this time, it appeared in a slight degree, as a consequence of the continuous application of straps and suspension of leg. Its appearance was duly noted by consultants, and the dissociated system thereby correspondingly nourished. At least, we know that about this time an increase became apparent, accompanied by pain, later by discoloration. That aberrations of vasomotor control form prominent features of so-called "hysterical" syndromes countless citations would confirm. In the present case, a grasping powerful subconscious system undoubtedly aided in the result. The slight pain, primarily produced by stasis, further increased the assimilating power of the dissociated system.
At the hospital was enacted the last act in the production of an absolutely functionless joint. The application of a plaster cast, the marked elevation of the foot, were the finishing details. Repeated examinations, with and without anęsthesia, availed nothing. The examination, however, confirmed the surgical opinion, that further care in the hospital was useless. The obstinacy of the family, however, delayed the patient's discharge, until six months later. The description of the joint, at this time, has previously been given.
In the study of the case, much was left undone that should have been done. The reluctance of the family towards the use of psychopathic methods prevented a clear analysis of the genesis. The failure to utilize these measures undoubtedly extended the time limits of the subsequent treatment. What was necessary here was the recovery of the normal functions, by synthetising the dissociated systems into the patient's personal consciousness.
The groups which had most probably lapsed in the functioning of the joint were the kinęsthetic sensations and memories. Towards their recovery our efforts were first directed, as it was evident that the function was especially affected and formed the nucleus of the dissociated system.
With both feet before her, the patient was told to close her eyes, then to flex and extend both ankles. The normal only responded. Then she was told to especially note and intently think how the ankle felt when moved. During this time my position was directly behind patient. When the normal joint was fully flexed, she was suddenly commanded to flex the (left) invalided joint. There was an increased response.
Taking, then, a small dry-cell battery of weak potentiality, an application was, made to the left ankle, with insistence, upon reproduction of sensation of flexion. At first only the toes moved, but with increased and unremitting insistence there suddenly occurred a more or less complete normal flexion. 'The patient saw it, but insisted she did not feel it, attributing it to the battery, which at that particular moment was not applied. As illustrative of the strength, compactness, and resistance of the system, it need only be added that not for three months did so complete a flexion again occur. The utmost endeavors,-under the limited conditions set by the family were insufficient to reproduce this almost initial result. Had other methods been employed at this time, the termination of the case might have been greatly hastened. That which did date from this period was the gradual restoration of the psychomotor function. A certain degree of flexion was soon induced; later, in three weeks, freer locomotion. The dema was similarly handled. The removal of the supports, the immediate lowering of the foot coincident with the tepid douche of the spine, of itself non-remedial, but in conjunction with suggestion speedily removed the dema. The maintenance of a normal vasomotor control was further conditioned by the recovery of the lost kinęsthetic elements.
In order satisfactorily to accomplish a complete functional restitution, a maintenance of definite conditions is a distinct necessity. Intelligent directions must be given so that the patient may not undo all that has been done. To the interference with such directions may partially be ascribed the duration of the case for six months, rather than for six weeks. That the recovery or synthesis of dissociated elements has not been completed has been demonstrated by the occurrence of contractures in other joints for short periods of time. Until the synthesis is complete, such recurrences must be foreseen.
Association in this case has not been fully effected. The dema disappeared. The joint has attained a fair degree of function. The angle of motion is somewhat less than normal. Locomotion is easy, free, though not entirely perfect.
Cases as the one described here are by no means rare. What is specially interesting from the psychopathological standpoint is the common typical traits presented by all of them, namely, kinęsthetic anęsthesia and loss of motor memories. As pointed out by Dr. Sidis in a previous paper, sensori-motor and ideo-motor groups, though normally more persistent. on account of the wealth of associations which they readily form, are for that very reason also more subject to derangements, to dissociations. In the process of mental dissolution, motor memories are the first to become affected.1
1. See pp. 197, 198,199.
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