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SYMPTOMATOLOGY, PSYCHOGNOSIS, AND DIAGNOSIS OF PSYCHOPATHIC DISEASES
Boris Sidis, Ph.D., M.D.
Boston: R. Badger, 1914
In cases of double and multiple personality of the alternating type a state of hypnolepsy is present. 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. The two alternating functioning systems are separated by an interval of apparent unconsciousness or of deep sleep. 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 double and multiple personality none of the personalities are well organized; each of the leading personalities can maintain itself above the threshold of self-consciousness for but a short time only. With the disintegration of the latter another personality begins to rise, reaches the threshold of self-consciousness and begins to function; the personality not being well organized the process of formation and rise requires a considerable time. As the cycles of alternation are more and more repeated the alternating personalities become well organized and the time between the submergence of one and the emergence of the other becomes considerably reduced. Still the process must occupy some fraction of time, however short. Hence the intermediary state of deep sleep, the state of unconsciousness. In passing from one state to the other the deep sleep must be present. This is the hypnoleptic state.
I must add that the hypnoleptic state is, as a rule, not found in artificially produced hypnoidic states. No gap, no state of unconsciousness separates hypnoidic or coexistent personalities cultivated by a long series of experimental suggestion. We may say that hypnolepsy is pathognomonic of actual, spontaneous hypnoidic states.
The hypnoleptic state is a true attack. It sets in with a state of irresistible drowsiness, the patient still having consciousness of his environment. Stimuli which must become more and more intense as the state of drowsiness deepens, reach the subsiding, disintegrating personality and revive it, bringing it again into momentary activity. The patient can be aroused for a brief space of time, for a second or a fraction of it, and soon falls back into a drowsy condition. As the drowsiness deepens the patient's reactions to external stimulations become gradually weaker. 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 is the second stage, the stage of unconsciousness.
The state of drowsiness or the first 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 personality is slowly subsiding while another personality is being formed and is slowly rising to its dominant position in consciousness.
The hypnoleptic state was well manifested in the Hanna, case, a true case of multiple personality, not brought about by suggestion or by hypnosis. To quote from the account:
“Mr. Hanna was now overcome by an uncontrollable desire to sleep. His eyelids began to close. He was urged to keep them open, but each time they began to drop in spite of his efforts. Attempts were made to arouse him by various stimulations. His limbs were moved violently, cold water was dashed in his face; he was pinched and otherwise stimulated. The onset of the somnolent state was irresistible. The lids finally closed; he could not open them. He fell into a state of unconsciouness.
Every effort to keep him awake was futile. Even the mechanical opening of his lids did not bring any response; he remained immovable. This is the hypnoleptic state. In this hypnoleptic state Mr. Hanna was physically prostrated. He was like one dazed by a hard blow, who lapsed into unconsciousness. His muscular system was passive. The conjunctival reflex was absent. There was general anaesthesia to all forms of sensations.”
The hypnoleptic state is an attack of sudden onset. It may be divided, as we have pointed out, into two periods. The first is that of a rapidly increasing condition of extreme fatigue and an overwhelming feeling of drowsiness, culminating in a second period, that of unconsciousness. The state of hypnolepsy is observed in all true cases of double and multiple personality. The law of monocyclical or polycyclical bimorphosis and polymorphosis is: All mental alternations have an intermediate state of drowsiness and unconsciousness, a state of hypnolepsy.
The state of hypnolepsy occurs in the transition from the primary to the secondary, or newly formed personality. The transition from the secondary to the primary personality occurs in ordinary sleep. The order of the cycle is: primary state, hypnolepsy, secondary state, sleep; primary, hypnolepsy, secondary state, sleep; primary, and so on. In other words the passage from the secondary to the primary is through the ordinary sleep-state, no unconsciousness being present, while the transition from the primary to the secondary is through drowsiness and unconsciousness, through the state of hypnolepsy.
The transition from the primary to the secondary comes on like a sudden attack. The patient may be lively, in excellent spirits, he suddenly becomes drowsy and lapses rapidly into a state of unconsciousness. When he comes to he is in the secondary state. Nothing of the kind is observed in the transition from the secondary to the primary state. If the patient could be kept from going to sleep, he could be kept indefinitely in the secondary state. This, however, is not the case with the primary state. The primary state is more unstable, after a few hours the hypnoleptic attack comes on with a consequent transformation of personality.
Why is it that while the transition from the secondary to the primary state 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 the secondary state take place through an "attack," through a hypnoleptic state? The answer is, because the sleeping state represents the absence of any dominant moment of self-consciousness, the absence of any personality. That is just what takes place in the interval of alternating states. But what is the hypnoleptic state? The hypnoleptic state is the reproduction o f the original attack which brought about the state of double or multiple personality.
This was clearly revealed in the Hanna case. What happened in that case was that the patient met with an accident, lost his consciousness, his personality became disintegrated and could not be reinstated; a new personality with new content entered into being; a secondary state, a secondary personality became gradually formed and trained. The original order then was, (I) the primary state, representing the patient's whole previous life; (II) the state of unconsciousness due to the accident; (III) the formed and trained secondary state or secondary personality. The succession of the states formed a cycle of the original series, a cycle that went on repeating itself by association of contiguity in the same order. It is the law of recurrence which dominates all life.
We can now understand why the hypnoleptic state is of the nature of an attack. Hypnolepsy is a reproduced attack. We can also understand why the order invariably follows a uniform course: primary state, hypnolepsy, secondary state, never the reverse. Such is the original order of events which recurs like the rising and setting of the sun.
The phenomena of double and multiple personality have a definite course of their own. Newly formed personalities pass through well defined cycles, and like new worlds formed by some external or internal catastrophe, they keep on revolving within the same orbits, they follow the same order as the phases of the moon. The order is persistent, reflex, automatic, and recurrent. Further on in reviewing psychopathic states we shall bring out this important recurrent aspect of all subconscious states.
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