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SYMPTOMATOLOGY, PSYCHOGNOSIS, AND DIAGNOSIS OF PSYCHOPATHIC DISEASES
Boris Sidis, Ph.D., M.D.
Boston: R. Badger, 1914
PSYCHOGNOSIS BY HYPNOSIS
THE following case of psychopathic, recurrent epileptoid attacks was studied by me in cooperation with Dr. Prince and Dr. Linenthal:
Mr. M., aged twenty-one years, was born in Russia, and came to this country four years ago. His family history, as far as can be ascertained, is good. There is no nervous trouble of any sort in the immediate or remote members of his family.
The patient himself has always enjoyed good health. He is an intelligent young man of good habits. He does not use alcohol or tobacco, and gives no venereal history.
He was referred to me for epileptiform attacks and anaesthesia of the right half of his body. The attack is preceded by an aura consisting of headache and a general feeling of malaise. The aura lasts a few days and terminates in the attack which always sets in about midnight, when the patient is fully awake. The attack consists of a series of spasms, rhythmic in character, and lasting about one or two minutes. After an interval of not more than thirty seconds the spasms set in again.
This condition continues uninterruptedly for a period of five or six days (a sort of status epilepticus), persisting during the time the patient is awake, and ceasing only during the short intervals or rather moments of sleep. Throughout the whole period of the attacks the patient is troubled with insomnia. He sleeps restlessly for only ten or fifteen minutes at a time. On one occasion he was observed to be in a state of delirium as found in post-epileptic insanity and the so-called “Dämmerzustände” of epilepsy. This delirium was observed but once in the course of five years.
The regular attack is not accompanied by any delirious states or “Dämmerzustände.” On the contrary, during the whole course of the attack the patient’s mind remains perfectly clear. During the period of the attack the whole right side becomes anaesthetic to all forms of sensations, kinaesthesis included, so that he is not even aware of the spasms unless he actually observes the affected limbs.
The affected limbs, previously normal, also become paretic. After the attack has subsided, the paresis and anaesthesia persist (as sometimes happens in true idiopathic epilepsy) for a few days, after which the patient’s condition remains normal until the next attack. After his last attack, however, the anaesthesia and paresis continued for about three weeks.
He has had every year one attack which, very curiously, sets in about the same time, namely, about the month of January or February. The attacks have of late increased in frequency, so that the patient has had four, at intervals of about three or four months. On two different occasions he was in the Boston City Hospital for the attacks.
Examination of the patient, made three weeks after the last attack, showed the following; Pupils were equal and reacted promptly to light and accommodation. Knee jerks were slightly exaggerated. No ankle clonus was present. No Babinsky was observed. There was a profound right hemianaesthesia including the right half of the tongue, with a marked hypoaesthesia of the right side of the pharynx. All the senses of the right side were involved. The field of vision of the right eye was much limited. The ticking of a watch could not be heard more than three inches away from the right ear. Hearing in left ear was normal. Taste and smell were likewise involved on the right side. The muscular and kinaesthetic sensations on the right side were much impaired.
The patient’s mental condition was good. He was well balanced, and did not give evidence of any emotional disturbances. He states that he has few dreams and these are insignificant, concerned as they are with the ordinary matters of his daily life. Occasionally he dreams that he is falling, but there is no definite content to the dream.
These findings were indicative of functional rather than organic disease. The previous history of the case was significant. The first attack came on after peculiar circumstances, when the patient was sixteen years of age and living in Russia. After returning from a ball one night, he was sent back to look for a ring which the lady, whom he escorted, had lost on the way. It was after midnight, and his way lay on a lonely road which led by a cemetery. When near the cemetery he was suddenly overcome by a great fright, thinking that somebody was running after him. He fell, struck his right side, and lost consciousness.
By the time he was brought home he had regained consciousness, but there existed a spasmodic shaking of the right side, involving the arm, leg, and head. The spasm persisted for one week. During this time he could not voluntarily move his right arm or leg, and the right half of his body felt numb. There was also apparently a loss of muscular sense, for he stated that he was unaware of the shaking of his arm or leg, unless he looked and saw the movements. In other words, there was right hemiplegia, anaesthesia, and spasms.
For one week after the cessation of the spasms his right arm and leg remained weak, but he was soon able to resume his work, and he felt as well as ever. Since then every year, as already stated, about the same month the patient has an attack similar in every respect to the original attack, with the only exception that there is no loss of consciousness. Otherwise the subsequent yearly attacks are photographic pictures, close repetitions, recurrences of the original attack.
A series of experiments accordingly was undertaken. First, as to the anaesthesia. If the anaesthesia was functional, sensory impressions ought to be felt, even though the patient was unconscious of them, and we ought to be able to get sensory reactions.
The experiments which were made to determine the nature of the anaesthesia produced interesting results. These experiments show that the anaesthesia is not a true one, but that impressions from the anaesthetic parts which seem not to be felt are really perceived subconsciously.
The method made use of consisted in producing a visual hallucination whenever
the anaesthetic hand was touched. That is to say, although the subject does not
consciously perceive the tactile impressions, he claims to see the image of a
number which corresponds with the number of times the hand is pricked or
touched. This was found to be the result in this case. Whenever the hand was
pricked a certain number of times successively, he claimed to see that number, a
sort of pseudo-hallucination. The number was always correct, and showed that
subconsciously the pricks must have been felt.
The details of the experiment were as follows:
The anaesthetic hand was placed behind a screen and the patient was told to look in a glass of water and tell what he saw there. Impressions made on the anaesthetic hand gave rise to visual pseudo-hallucinations representing the sensory stimuli. Thus, for example, when his hand was touched, very lightly, five times, he saw the figure five very vividly and described it in detail. He saw the number written; it looked very large; and he saw it written on the back of a hand.
The vividness of the claimed pseudo-hallucination was well brought out when, projecting the hallucinatory hand on a screen instead of in the water, the patient outlined it with a pencil. When one of us placed his hand on the screen by the side of the hallucinatory hand, and the patient was asked to tell which hand looked more real, he insisted that both hands looked equally real, except that the hallucinatory hand looked farther away.
Different tests also showed that the subconscious reactions to impressions from the anaesthetic hand were more delicately plastic and responsive than the conscious reactions to impressions from the normal hand. We have the so-called “psychopathic paradox” that functional anaesthesia is a hyperaesthesia.
It is evident then that there could be no inhibition of the sensory centers, or suppression of their activity, or whatever else it may be called. In spite of the apparent profound anaesthesia, the pin pricks were felt and perceived. The perception of them gave rise to perception, cognition, to a sort of pseudo-hallucinations that showed the pin pricks were counted and localized in the hand. The results of these tests demonstrate that in psychopathic patients all sensory impressions received from anaesthetic parts, while they do not reach the personal consciousness are perceived subconsciously.
Inasmuch as the sensations are perceived, the failure of the subject to be conscious of them must be due to a failure in association. The perception of the sensation is dissociated from the personal consciousness. More than this, these dissociated sensations are capable of a certain amount of independent functioning; hence the pseudo-hallucinations, and hence the failure of psychopathic patients to be incommoded by their anaesthesia. This condition of dissociation underlies psychopathic states.
For the purpose of studying the attacks themselves, the patient was hypnotized. He went into a deep somnambulic condition, in which, however, the anaesthesia still persisted. This showed that the dissociation of the sensory impressions was unchanged.
In hypnosis he related again the history of the onset of the trouble. His memory became broader, and he was able to give the additional information, which he could not do in his waking state, that at the time he was frightened he fell on his right side. Moreover, he recalled what he did not remember when awake, that throughout the period of his attacks when he fell asleep, he had vivid dreams of an intense hallucinatory character, all relating to the fright and fall.
In these dreams he lived over and over again the experience which was the beginning of his trouble. He again finds himself in his little native town, on a lonely road; he thinks some one is running after him; he becomes frightened, calls for help, falls, and then wakes up with a start, and the whole dream is forgotten. After he wakes he knows nothing of all this; there is no more fear or any emotional disturbance; he is then simply distressed by the spasms.
While testing the anaesthesia during hypnosis, an attack developed; his right arm and leg began to shake, first mildly and then with increasing intensity and frequency. His head also spasmodically turned to the right side. The movements soon became rhythmic.
Arm and leg were abducted and adducted in a slow rhythmic way at the rate of about thirty-six times per minute. With the same rate and rhythm, the head turned to the right side, with chin pointing upward. The right side of the face was distorted by spasm, as if in great pain. The left side of the face was unaffected. Pressure over his right side (where he struck when he fell) elicited evidences of great pain. Respiration became deep and labored, and was synchronous with each spasm. The whole symptom-complex simulated Jacksonian epilepsy.
It is noteworthy that the kneejerk on the right side was exaggerated by comparison with the left during the attack. Consciousness persisted unimpaired, but showed a curious and unexpected alteration. When asked what was the matter, he replied in his native dialect, “I do not understand what you say.” It was found that he had lost all understanding of English, so that it was necessary to speak to him in his native dialect. His answers to our questions made it apparent that during the attack, as in his dreams, he was living through the experience which had originally excited his trouble.
The attack was hypnoidic in character. He said that he was sixteen years old, that he was in Rovno (Russia), that he had just fallen, because he was frightened, that he was lying on the roadside near the cemetery, and that he wanted somebody to pick him up.
The hypnoidic state developed further, the patient living through, as in a dream, the whole experience that had taken place at that period. He was in a carriage, though he did not know who put him there. Then in a few moments he was again home, in his house, with his parents attending on him as in the onset of his first epileptiform seizures.
The attack terminated at this point, and thereupon he became perfectly passive, and when spoken to answered again in English. Now he was again twenty-one years old, was conscious of where he was, and was in absolute ignorance of what had just taken place.
It was found that an attack could regularly and artificially be induced, if the patient in hypnosis was taken back by suggestion to the period when the accident happened.
The experiment was now tried of taking him back to a period antedating the first attack. He was told that he was fifteen years old, that is, a year before the accident occurred. He could no longer speak or understand English, he was again in Rovno, engaged as a salesman in a little store, had never been in America, and did not know who we were. Testing sensation, it was found that it had spontaneously returned to the hand. There was not a trace of the anaesthesia left. The hand which did not feel deep pin pricks before now reacted to the slightest stimulation. Spontaneous synthesis of the dissociated sensory impressions had occurred. Just as formerly before the accident, sensation was in normal association with the rest of his mental processes, so now this association was reestablished with the memories of that period to which the patient was artificially reduced.
The patient was now (while still believing himself to be fifteen years old) taken a year forward to the day on which the accident happened. He says he is going to the ball to-night. He is now at the ball; he returns home; he is sent back to look for a ring. Like a magic formula, it calls forth an attack in which again he lives through the accident,—the fright, and the spasms. With the onset of the spasm, dissociation again occurs, the hand becomes anaesthetic, and remains anaesthetic after the subject is awakened.
It was thus possible to reproduce an attack at any time with clock-like precision by taking him back to the period of the accident, and reproducing all its details in a hypnoidic state. Each time the fright and the physical manifestations of the attack (spasms, paresis, and anaesthesia) developed. These induced attacks were identical with the spontaneous attacks, one of which we had occasion to observe later. This psychognosis enables us to understand to a large extent the psychogenesis of the attacks. At the time of the accident the intense emotional disturbance, the fright, acted as a dissociating agent, and dissociated the sensory and motor reactions of one half of the body involved in the accident so that they were no longer under the control of the personal consciousness. These dissociated elements were not, however, inhibited, or incapable of functioning, as was shown by the hypnoidic states and other phenomena brought out in the test experiments.
In cases of this kind, dissociated sensory and motor reactions become subconscious and capable of automatic activity. Sensory impressions are subconsciously perceived and motor reactions subconsciously excited. The dissociation (through the influence of the emotion) of these sensory and motor reactions and their automatic subconscious excitation is the attack. The original emotion of fear remains (unknown to the subject) dissociated in the subconsciousness as a fixed state. Here from time to time it acquires a separate and independent activity.
At periodic intervals, as under the stress of some emotion, or by association of ideas, the dormant activity is awakened and, though still unknown to the patient, gives rise to the same sensori-motor disturbances which characterized the original experience. These subconscious dissociated states are so much more intense in their manifestations by the very fact of their dissociation from the inhibitory influences of the normal mental life.
The psychognosis of such cases then, reveal on the one hand a dissociation of
mental processes, and on the other hand an independent and automatic activity of
the disaggregated psychic states. Dissociation and automatism are the two
fundamental conditions of psychopathic states.
The following case of recurrent tremor is of interest. The psychognosis was made by me with the assistance of Dr. Linenthal.
M. R., fifty years of age; widower; salesman.
Patient complains of general nervousness. What troubles him most is a tremor of his hands. The tremor becomes especially marked when he does something, such as writing, or carrying food to his mouth. The tremor gets much worse when he is excited or when he is fatigued, and predominates in his right hand. This disturbs him so much that he is ashamed to appear in company. He had the tremor for some years, but he noticed that it had become worse in the last few years.
About six months ago while he was sitting in company both legs began to shake. The shaking kept up for about ten minutes. He had had some wine then, but not enough to produce intoxication. This is the only time that his legs shook. He has not had it since then.
The patient’s digestion is very poor, the slightest indiscretion in diet upsets him, and produces headache. He has attacks of headache only when there is digestive disturbances; the headaches are more frequently on the right side of the head. He does not get dizzy and has no specks before the eyes. For the last few weeks he has had ringing in the right ear. He attributes it to a cold.
When young he used alcohol considerably, though never to intoxication. Now he is quite moderate in the use of alcohol, drinks neither tea nor coffee, smokes a cigar every other day.
The patient has always been of a nervous temperament. About 23 years ago was sick for a few weeks with some stomach trouble. Seven years ago had rheumatism and was confined to bed for about six weeks. Ever since he has had a slight stiffness in his legs. Some years ago he used to get occasional attacks of epistaxis. Many members of his family are subject to nose bleeds.
Patient's father died at 76 of a “paralytic stroke.” Mother died at so; cause is unknown to the patient. One brother died of diabetes. Two brothers are living and well. Patient had three children, two died in infancy. The remaining child, a daughter, is living and well.
Patient is a well built, healthy looking man; does not impress one as being of a neurotic temperament; tends to make light of his troubles, and is in no way hypochondriacal. Knee jerks were present, though difficult to get, on account of a slight rigidity in his legs. Pupils react promptly to accommodation and to light. The ocular muscles are all right. No sensory disturbances are present. Touch discrimination is good, though it is slightly more acute on the left side than on the right. Discrimination of the temperature sense is good. Field of vision is normal.
A fine tremor was observed in both hands, more marked in the right hand. The tremor was increased when patient was told to do something. When he took a pencil to write his name the tremor was exaggerated, the writing was irregular and jerky. Tremor also became more pronounced when the patient carried a glass of water to his mouth.
When he was asked, if he had any dreams, he said that he used to have bad dreams formerly, though he could not tell what they were about. It was insisted that he try to remind himself of the nature of his dreams, but it was of no avail. His dreams now are not bad; they are on the contrary of a pleasant nature. He dreams of winning lots of money in the lottery, of meeting some of his friends, and has other dreams of an indifferent nature. During the conversation with the patient the question of dreams was referred to over and over again, but nothing could be obtained.
M. R. ascribes his trouble to a great deal of worry. He had been a well to do man, he was the owner of a large mercantile establishment. But due to some business reverses he lost all he had. Besides, his wife had been an invalid for twenty years, and her illness consumed a large part of his possessions. Now he has to work for some one else and he is worrying all the time. He is also grieved by the change of the attitude of people towards him. People for whom he had done a good deal formerly now refuse to recognize him. All this worries him, and he thinks that this constant worry is the cause of his trouble.
The history was once more gone over and was found to be consistent with the previous account. About nine years ago M. R. had to give up his business and was under considerable worry and excitement. His wife died nine years ago and had been an invalid for twenty years. When M. R. held out both hands there was a marked tremor, more marked in the right hand. After a while the tremor disappeared from the left hand and was much diminished in the right hand.
M. R. was put in the hypnotic condition. While being hypnotized he was a little excited, he wanted to know what would be done to him. He was assured that every thing was all right and that he need not worry. His eyes gradually began to close. He resisted for a time, but finally he was no longer able to open them. He was in a state of complete relaxation. He could not open his eyes when challenged to do so. There was a marked degree of catalepsy. The tremor had completely disappeared while in the hypnotic condition. He held up his hands with the fingers spread out, there was no perceptible tremor.
M. R. was now asked to give an account of the conditions under which he first observed the tremor. He did not answer at first. The question had to be repeated. When the patient did answer, he spoke in a very low voice, somewhat hesitatingly. He said that he first noticed the tremor when he was told that his wife died. He was away from home when she died and when he returned he was told that she had just breathed her last.
He was asked if he had any dreams. “I dream frequently about my wife” was the reply.
“Tell us some of the dreams.”
“Last February I dreamt that my wife was brought to life by a physician. I was in the next room and the nurse came in to tell me that she was dead. I was much excited and trembled all over.”
“Have you had any other dreams?”
“What were they?”
“I dreamt that my wife who had been wretched for many years asked me to take her to Europe so that she might get well. I promised to take her the following spring. She died before spring came. I thought that had I taken her over she might have recovered.” (Patient could not give the time when he had the dream.)
“Can you remember any other dream you had?”
“I dreamt that my wife came to me and told me that she felt sorry that I was left all alone, that she could not come to me.”
In answer to a question as to what she looked like, M. R. said she was dressed in white. While relating this dream patient became excited; his face expressed the most extreme suffering, he began to sob and tears ran down his face.
“A few weeks ago I dreamt that my wife came to me dressed in white, and told me that she was very sorry that our daughter was ill.”
Patient was asked to give the earliest dream he could remember that he had after the death of his wife.
“Six years ago (his wife died nine years ago.) I dreamt that I took my wife to
Europe and she had completely recovered. I was very happy to see her.”
In answer to a question patient said that his wife looked very well and that she wore a new black dress.
When asked if he had any dreams about his wife before six years ago, he answered in the negative. It was then insisted that he should recall some dream he had before that time. M. R. said he could not remember. Some of the dreams he remembered when he woke up, but he had forgotten them since, but now they came back to him.
“Four years ago I dreamt that I came back with my wife from Europe, but in some way or other I lost her. I became very much excited I fell out of bed, cried out, and woke up. I was shivering all over. I went back to sleep and then dreamt that I looked for her everywhere, but could not find her. I cried much.”
While relating this dream M. R. became excited. He sobbed and tears rolled from under his eyelids. It seemed as if he was living that experience over again.
The dreams came up in rapid succession, all that was necessary was to say “What other dream did you have?” when the patient in a low trembling voice, full of anguish, began to relate his sad dream experiences.
“I dreamt that my father and mother were standing by my bedside and crying over me. I complained to them about my condition. I told them how lonely I was in this world, that my wife was dead, and that I had nothing to live for.
“I dreamt that I was told that my father and mother were also dead. I cried bitterly as I had no one in the world.
“Last Christmas I dreamt that I saw my dead father standing by my bed side. He told me that he was going to pray for me. I was very much excited and shook all over.” (Patient moved restlessly and looked as if in agony.)
“Can you tell any other dreams?”
“I had many dreams in which I saw my wife standing over me and crying. She told me that I was always so kind to her, and she was very sorry that I was so lonely and wretched now.
“Last night I dreamt that I fell and sprained my ankle. My legs pained me much and they were rather stiff.”
The tremor in his hands disappeared. When patient’s hand was held up it was steady. No tremor could be perceived.
When asked, if he remembered any more dreams, he said: “I dreamt that my mother came to me and cried. She told me that she would see that I had a better life henceforth. I cried and trembled all over.” In answer to a question he said that when he awoke he did not remember that he had the dream.
The account of the various dreams seemed to have exhausted the patient, and it was not considered wise to question him any further. Suggestion of well-being was given. Patient was awakened. There was complete amnesia of what took place during hypnosis.
When he came again M. R. said that he slept soundly. He was immediately questioned about his dreams, he said that it occurred to him, that he occasionally dreamt about his wife. He said that he could not think of it before when we took his history, he could not however give the contents of any dream that he had about his wife.
M. R. says he feels much better and that the tremor has diminished considerably,
but that he is worrying a good deal. Dreamt the last few nights about business
matters. This morning he dreamt that he had lost his position.
The following additional facts in the patient's history were obtained. M. R. came to this country thirty-one years ago. Shortly after he came over he was attacked by thieves one night while carrying a bundle of merchandise, and the bundle was taken away from him. About two years later while on a country road, he was accosted by two men who demanded money from him. Both these incidents upset him much.
When a boy of ten he was in the habit of visiting a neighboring shoemaker's shop. He used to annoy the shoemaker, and the latter threatened to cut off his arm. Once the shoemaker caught him and while holding a knife in his hand he unintentionally made a deep cut on the patient’s right arm in which the tremor specially predominates. The patient was greatly frightened over it. He showed us the scar on his right arm.
M. R. told us that his life had been a very hard one. He met with many business reverses which constituted the chief cause of his worry. Besides he worried a good deal when his wife was ill. Her illness cost him a good deal of money. He used to spend many sleepless nights which completely exhausted him at times. He was married for twenty-seven years.
He was then given to copy some lines from a news-paper. The writing was irregular and jerky.
M. R. was put in hypnotic condition. Could not open his eyes, when challenged. Catalepsy was easily induced.
“When did you first notice the tremor?”
“I first noticed it a couple of months before my wife died. I was writing a letter and my daughter noticed that my hand was shaking.”
“What caused the tremor?”
“I had lots of trouble at that time. I had a good deal of business troubles, my wife’s illness, and I had at that time a very severe nose bleed which weakened me.”
On further questioning he told us that the next time he noticed the tremor was when he was told that his wife died. He said he was very much excited then. He felt that he had lost his only friend in the world.
When asked, if anything happened during his wife’s illness that especially excited him. He said that he was present at several operations that were performed on his wife. He saw her cut open, and he was affected with intense anxiety and fear.
“When did you have the first dream about your wife?” “About three or four years ago.” “Any dreams before this?” “Yes, about one year after the death of my wife I had the first dream.” “Any dreams about her before that time?” “I can not remember any.” “What was the first dream you had?” “My wife dressed in white came to me. She was crying over me, she felt sorry that I was left all alone in the world.”
At another time he dreamt that she came to him. She looked worried. Both cried very much. He fell out of bed. The fall woke him up. He looked around for his wife, but he could not find her; she was gone.
M. R. was asked to relate some more of his dreams. He became restless, and drew up his legs, as if he had a cramp. When asked what the matter was, he said that he had a severe pain in both legs. When asked the cause of the pain, he said he did not know; he has the pains very often when he sleeps; he thinks it is due to his falling out of bed, that he never has the pains during day time. It was suggested that the pain will go away, and that he will feel comfortable. Patient was relieved and said that the pain was gone.
M. R. was now asked to give some more of his dreams. He gave a number of dreams all of the same content, that his wife was coming to him dressed in white and cried over him, and kept telling him that she felt sorry for him.
The patient apparently did not remember many of the dreams that he told us the last time. We tried to help his memory by telling him part of the content of some of his dreams, but even then they were imperfectly remembered.
In contrast to the last time he did not show any agitation while relating his dreams. He was calm and did not display the emotional excitement when he was first put into the hypnotic state.
M. R. also told of a number of dreams which he had about business matters. He dreams of making money and then again of losing it. He also dreams about a brother who is dead now. This brother had been sick for a long time and the patient took care of him during his illness. Patient frequently dreams of the brother coming to him saying: “You are the best friend I had in the world.” Occasionally he dreams about his father and mother.
We now tried to see whether M. R. could in this state give the reasons for some of his motor manifestation.
“You said that about six months ago while you were in the company of friends talking about business your legs began to shake. What was it that passed through your mind at that time?”
“I thought about my wife at that time.”
“What caused you to think of your wife then?”
“Somebody asked me how long she had been dead.”
When asked if he attributed the shaking to the thought about his wife, he said that he did not know, but he added that it was very likely that this thought caused the shaking.
When asked why his right hand shook more than his left, he said that he did not know, but he thought it might be due to the fact that he worked harder with his right hand than he did with his left, and also that when “I fall out of bed I often fall on my right side.” The right side has been the nucleus of his psychopathic state since the trauma with the shoemaker. He could not remember having had any distressing dreams before his wife died except once when he dreamt about his mother.
M. R. was told to open his eyes and sit up, but still to remain in the hypnotic condition. He was given a paper to write his name on, and a few lines were dictated to him. The writing was more steady and regular than in his waking state. Towards the end the tremor became more manifest. The patient seemed to have fully emerged from his hypnotic condition.
There was complete amnesia as to what took place in the hypnotic state.
Thus we find that a study, or psychognosis of psychopathic cases clearly reveals the presence of a set of subconscious systems which forms the cause or substratum of the symptoms of the psychopathic states. The main characteristic of this set of systems is its persistence in the subconscious and its continuous recurrence in the upper consciousness. The sensory, the emotional, and the conceptual aspect of the set of systems remains in the subconscious, but the reactions, characteristic of the set of subconscious systems, come to the full light of consciousness, and become manifested as the symptoms of the malady. The psychognosis reveals this subconscious side of the symptom complex, hidden from the direct consciousness of the patient. The motor manifestations are usually the ones that form the predominant symptoms of a dissociated complex, or what I prefer to term the “dissociated set of systems.” The subconscious processes are the sensory, emotional, and ideational elements of the dissociated set of systems, while the motor elements associated with them are the ones that come to the surface.
Of course, this law is not rigid as quite often sensory elements belonging to the system come forward in the form of sensory and emotional disturbances, and give rise to what we term psychopathic sensory symptoms, the motor elements, however, usually predominate.
Dissociated sets of systems have to use the same motor apparatus, the same motor
arrangements and reactions as the ones used by the normal personality. The
patient does not understand the reason of the motor manifestations, since the
whole set of systems is buried deep in his subconscious, but he can from time to
time witness the motor convulsions when the systems heave up from the depth of
the subconscious regions. Thus the psychognosis in the one case showed us the
systems or set of dissociated systems which have given rise to motor symptoms of
a psychopathic Jacksonian epilepsy with hemianaesthesia, while in the other case
a similar psychognostic investigation by means of hypnosis has revealed to us
the set of subconscious systems which have given rise to the motor symptoms of
an uncontrollable tremor.
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