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THE THRESHOLD IN ABNORMAL MENTAL LIFE
IN the interrelation of moment aggregates the moment threshold plays an important role, since its oscillations, its height and fall are at the basis of their associations and dissociations. Consciousness, consisting of complex aggregates of moments, passes in the course of degeneration through stages in the inverse order in which it has been built up. The complex aggregates of the higher type become dissolved, dissociated into less complex aggregates of moments of lower types. Constellations become disaggregated into clusters, clusters into communities, communities into systems, systems into groups, and groups may become decomposed into their constituent elements. The process of disaggregation may be slow or rapid, but its course is the same, it is from constellations to groups, from higher to lower types of moments.
With the process of dissolution going on in a mental aggregate we find modifications and redistributions of thresholds of all those moments with which the dissolving aggregate is directly or indirectly connected. A variation produced in one moment threshold tends to modify all the rest. An aggregate consists of many subordinate aggregates, and with its dissolution many moment thresholds become modified, affecting other thresholds of moments with which the constituents of the given aggregate are interrelated.
The slow heightening of the thresholds going hand in hand with the process of disaggregation may result in a permanent rise of thresholds or may end in a paradoxical fall of thresholds. The components of the dissolving or already dissolved aggregate fall into the subconscious, the moment thresholds become lowered. While the thresholds of the moments, when stimulated through the components of the dissolving aggregate, become insurmountable, the components of the moments become more easily accessible through the lowering thresholds, if the attempt is made through the subconscious. We are thus met with the paradoxical state in which anesthesias are also hyperaesthesias, and amnesias are at the same time hypermnesias. In fact we may assert that all psychopathic functional disturbances, that is, disturbances in which great rise of moment thresholds with consequent functional dissociation of moment aggregates have taken place, present this seemingly contradictory double aspect of loss and presence, of a hyperasthetic anesthesia and a hypermnesic amnesia. Redistribution with rise and fall of thresholds gives us a clew to the phenomena of functional psychosis.
The dissolution of a moment aggregate sets the components free, which become through subconscious intercommunication more easily accessible. In other words, the, process of disaggregation, while raising the conscious moment thresholds, reveals by it the low subconscious thresholds, in the same way as distraction of the attention reveals the presence of an exaggerated reflex knee-jerk or as the removal of the cerebrum in a frog reveals the low thresholds of the spinal nervous aggregates. The subconscious is in fact a reflex consciousness, and its activity becomes fully revealed with the removal or dissolution of the upper strata of consciousness. As long as a group, system, community, cluster, forms a part of an aggregate it is more difficult to have it aroused to function than when it is dissociated, isolated from its other constituents. This relation may be formulated in the statement that the rise of threshold is directly proportional to the complexity of the aggregate and inversely proportional to the simplicity of its constitution.
The simpler an aggregate is the lower are the moment thresholds. This truth is clearly manifested in the case of children. The child is easily aroused to action, slight stimuli divert its attention in different directions, and any idea and image crossing its mind has its motor manifestations. In savages, too, we meet with a similar condition of mind. Mental life is simple, and any passing mood and emotion have immediate motor manifestations. In the mentally defective, such as the imbecile, the cretin, the idiot, the systems that are more or less intact are easily aroused by slight stimuli; in other words, the aggregates have low thresholds. In psychopathic cases and in the insane we meet once more with similar conditions of mental aggregates, the moment thresholds fall and become lower with the process of degeneration.
The same thing is manifested in the state of belief induced in persons whose mental life is narrow and limited. Belief is the beginning of action. Now in children, savages, and mentally defective, belief is easily induced. This is clearly manifested in the case of suggestibility, which in fact is closely connected with the state of belief. It is notorious how children are extremely suggestible, so are savages, so are mentally defective persons of narrow thought and low education, and also the mentally unbalanced and insane. Anything, no matter how absurd, that falls in with their expectations is greedily accepted and immediately acted upon. Insane delusions in the different forms of melancholia and paranoia seem to present an exception to our statement, but as a matter of fact they, too, fall in line, considering the fact that any suggestion is readily accepted by the insane, if it only goes to strengthen the central delusion. Whatever can be assimilated by the functioning mental aggregate gains easy access, clearly demonstrating the fact that even where the mental disease is of such a nature as to have moment thresholds raised, conditions found in the various forms of melancholias, still the chief organized functioning systems are set into activity by the slightest stimulations showing a low threshold of the dissociated active moments. All other conditions remaining the same, it may be asserted that the simpler in structure a moment becomes the lower falls its threshold. An aggregate in the state of disaggregation will have the thresholds of its constituent moments progressively lowered, the fall being directly proportional to the depth of the disaggregative process.
The continuous functioning of an aggregate brings about a process of disaggregation, the moment threshold of the given aggregate slowly rising until the reverse process of aggregation sets in, more or less restoring the previous state of the moment threshold. This is partly to be seen in the phenomena of fluctuation of the attention. If the attention is fixed on an object, say on a blot of ink, at first the interest flags, then there is a persistent tendency to look away from the blot, transfer the gaze to something else, and finally the whole blot vanishes from the field of attention and vision. New, persistent, though fluctuating efforts of attention are requisite to keep the object, the image, the idea before the focus of mental vision. The functioning of the particular mental aggregate is slowly bringing about a. process of disaggregation, thereby raising the moment threshold, making further functioning more difficult, and finally having it arrested through the maximum rise of the moment threshold. This rise of threshold through function makes it possible for other aggregates to be aroused in the order of the heights of their thresholds; the lower the threshold the earlier is the aggregate stimulated, the higher the threshold the later is the aggregate set into activity.
Fluctuations of moment thresholds and formation of combinations of moment aggregates are of special importance in pathological states. Maniacal states of different forms of mental alienation present a similar distribution of thresholds. Maniacal states, wherever they occur, present a disintegration of the total interrelation of aggregates of moments as synthetized in the principal constellation, with a consequent lowering of the disintegrated constituent aggregates. Once such disorganization is induced, any stimulus may call forth an aggregate, which, through its radiating stimulations, may awaken all kinds of combinations and constellations in the aggregates the thresholds of which have been lowered. These aggregates, liberated from the control of the principal constellation, when stimulated, naturally give rise to chaotic, meaningless kaleidoscopic play of moments. The maniac is full of activity, his muscles are in constant play, and when the attack is at its height, he is continually gesticulating, running, dancing, shouting, singing and screaming. Reactions are intensified, reflexes are lively, verbal associations are greatly facilitated.
Disintegration of moment aggregates, redistribution and fall of thresholds are the cardinal traits that characterize maniacal states, wherever they are found, whether in the general somatic diseases, or in the conditions of mental alienation. Now in all states of such a nature, once a moment is started to activity, it goes on developing by ever forming new phantastic combinations. This process is very much similar in character to the activity of the moments in dream states. The difference between the two being that while the combinations in the dream states are largely due to a rise of moment thresholds, in the maniacal states the different combinations and connection of moments are mainly due to a fall of the moment thresholds.
Maniacal states, on account of the general fall of moment thresholds, are very much similar to the waking states. In both the waking and maniacal states the same condition of reduction of the moment thresholds is to be found. Maniacal states are waking states with the only difference that they are abnormal, psychopathic waking states. The maniac is too much awake, responding with all his being to every slight and passing stimulus. He is in a state of intoxication, his mind and body are shaky and unstable, as if he were under the influence of strong liquors. The maniac seems to be possessed by powerful, active and malicious demons of the world of spirits.
The nature of maniacal states gives us also a clew to how to counteract them, and if possible, when the process of degeneration has not advanced far, to bring about a synthesis of the moment aggregates and thus re-establish the controlling synthetic life activity of the disintegrated principal constellation, constituting the personal character of the particular individual as the result of his whole life history and development. To free the maniac from the baneful action of the world of demons, the influence of those harmful spirits must be removed. The patient’s psychic life must be better defended and protected against the, demoniacal possession by surrounding him with higher battlements and stronger fortifications. In other words, mania can be reduced by raising the moment threshold. This rise of the threshold may come on by itself and the maniacal states may even pass into states of melancholy.
States of melancholy, whether found in general somatic diseases or in conditions known as insanity, are characterized by a redistribution and rise of the thresholds of the moment aggregates. The more or less general rise of the thresholds makes it difficult for the usual combinations of moment aggregates to become formed. Combinations of incongruent moment aggregates, the thresholds of which are relatively lower, are alone in a condition to function: The field of consciousness becomes narrowed, the subconscious thresholds rise higher and higher. The course of mental activity, on account of the rise of the thresholds of the moment aggregates, is limited and confined to a narrow field, in which only those moment aggregates can participate, the thresholds of which are relatively lower than the rest. The ensuing result is the formation of a delusion, which becomes the more pronounced and the more fixed the longer the general conditions of the rise of moment thresholds continue. The mind of the melancholic, especially in the chronic forms, becomes inactive, and turns in one narrow groove delved out by the delusion. The gradual growth of difficulty in effecting combinations of moment aggregates, due to the gradual rise of the moment thresholds, are accompanied by unpleasant moods and painful emotions so highly characteristic of melancholic states. In this respect of mood and emotion melancholic states differ radically and in fact are the very opposite of the maniacal states in which the moment thresholds are lowered and the formation of moment aggregates and their combinations are effected with greater ease, giving rise to agreeable moods and pleasant emotions.
Melancholic states may be said to be characterized by the cardinal traits of redistribution and rise of moment thresholds, by a narrowed activity concomitant with a painful emotional condition. The moment aggregate aroused by a stimulus will in the melancholic mind grow and develop and arouse to activity moment aggregates, the thresholds of which are low enough to be reached by the radiating stimulations coming from the primarily awakened moment aggregate. On account of the more or less general rise of moment thresholds, the process of synthesis has but a narrow selection. In the course of time, as the process of synthesis is more often repeated, definite and stable combinations of moment aggregates become formed. The longer the general states of the rise of moment thresholds last the more stable do these combinations of moment aggregates become, and finally they become so firmly organized as to form stable compounds; the melancholic states become chronic.
The rise of moment thresholds in melancholic states can be easily, demonstrated by observation, and especially by experimentation. The mind of the melancholic patient is concentrated on his miserable condition and fixed on his principal delusion. Moments relating to his general state are alone active, while others are awakened with great difficulty. Reaction time is retarded in melancholia, and so is association time. The most simple questions must often be repeated a number of times before they are fully realized. The answers come only after a considerable time, and sometimes they are not forthcoming at all. Especially is this the case when questions relate to subjects lying outside the narrow field of the patient’s delusions.
This rise of the moment thresholds and consequent narrowing of the field of consciousness is clearly seen stuporous melancholia, but it is still more clearly demonstrated by experiments, even in the mild cases and early stages of melancholia. The method of association is valuable for testing the degree of narrowness of the field of consciousness, the height of the rise of the moment threshold, the strength and extent of the organization of the moment consciousness constituting the principal delusion. If the patient, for instance, is told that when a word is given to him, he should immediately tell a series of words that come into his mind and pronounce them in quick succession as rapidly as possible, it is found, when an interval, of five or ten seconds is allowed for the experiment, that the patient cannot tell more than a word or two, and more often nothing at all, the mind being a perfect blank. The same holds true, if the patient is told that when a word will be pronounced he should tell any phrase that happens accidentally to come into his mind. The result is the same the mind is a blank. The words and phrases given by the patient, when such are given at all, are found to relate to his principal delusion. The moment aggregates are organized round the principal moment, which forms the kernel of the delusion, the whole combination forming a stable compound.
The great stability of the combination of moment aggregates is a very characteristic and also very important trait of melancholic states. In respect to stability, melancholic states contrast strongly with maniacal states, the psychic combinations of which are extremely unstable and fluctuating.
Melancholic states have a great similarity to sleeping states. The conditions in both are very much alike. The more or less general rise of the moment thresholds in melancholic states, with only a relative fall of thresholds in a more or less narrowed field of moment aggregates, brings the melancholic states very near to the dream consciousness of sleeping states; in fact, we may say that melancholia is a sleeping state, only it is an abnormal, or psychopathic sleeping state. The melancholic dreams with his eyes open. The dream of melancholia is unchangeable, fixed, oppressive; it is of the nature of a nightmare. The melancholic has on him the relentless grip of a horrible incubus. From the depressing sleeping states the melancholic may awake, he may then have lucid intervals, and with the further removal of “inhibition,” with the fall of thresholds, may even pass into states of excitement, into states of maniacal exaltation.
This view of melancholic states from the stand-point of moment threshold is not purely theoretical; it is not entirely devoid of practical application. For it suggests a way of how to alleviate the condition of these unfortunates. As our investigations have shown that melancholic states consist in a rise of the moment thresholds, with a consequent formation of extremely limited combinations of moment aggregates, the only way to counteract this state of things is to endeavor by different means, whether by stimulants or by other agencies, to demolish the great heights of those thresholds. To counteract effectively melancholic states and to bring about a dissolution of the stably organized delusional moment compounds, one must direct the battering-ram against the thresholds. In the treatment of melancholia, the psychiatrist must keep before his mind one, and only one, paramount principle: reduce the thresholds.
The following hospital notes of observations and experiments on a case carried out by Dr. A. Heger, under my direction, may be of interest to the reader:
The principal point in this method of work is the lowering of moment thresholds, no matter by what means such lowering is effected. The best way is to use various stimuli at different intervals, so that the patient should not become habituated to them, which may on this account lose their effect. The patient in the intervals should be stimulated to greater activity and exertion.
When complex moment thresholds become lowered, moments submerged into the subconscious step over the threshold and enter consciousness. Such a fall of the moment threshold is often found under the influence of intoxicating drugs. Slight stimuli of minimal intensity set into active function numerous moment aggregates endlessly varying in their combinations, intensity and vividness. Thus under the influence of opium or of hashish long-forgotten incidents arise with such intensity and vividness that one cannot help recognizing them.
The rise and fall of moment thresholds stand out clearly and definitely in cases of sensory derangement where hypoaesthesia or hyperaesthesia is present. In the case of hypoaesthesia, the threshold is raised, while in hyperaesthesia the threshold is lowered. In hypoaesthesia, to pass the threshold and reach the psychic minimum the stimulus must either be intensified or a. series of stimulations must become summated before a moment aggregate, with its psychic minimum, is aroused to activity. Thus in a case under my observation and experimentation, a case suffering from tactual anesthesia, with hypoaesthesia of pain, pressure, temperature and kinaesthetic sensations, a stimulus to reach consciousness and be felt had either to be very intense or a series of stimuli had to be given in quick succession. When a series of intense stimuli were given in quick succession and thus became summated, overstepping the raised threshold, the many stimulations were felt as one. If, for instance, a strong prick was given, the patient felt nothing at all, but if the pricks came one after another in quick succession, then the patient declared that pain was felt as if a prick was given. If asked how many pricks, the patient either answered, “I do not know,” or declared them to be “one.”
The same holds true in the case of the other sensory stimulations or series of quite intense pressure, pain or temperature stimuli, they are felt as one, their multiplicity not being discriminated, their total amount being just sufficient to give rise to one impression. This impression is often so vague that it is often hard, if not impossible, for the patient to localize the stimulated place or point out the direction where a series of pain, pressure or temperature spots have been excited in quick succession, forming a line having a certain direction. The patient, while experiencing the stimulation, is often even unable to tell to which hand the stimulus was applied, whether to the right or to the left hand. The same holds true in the case of the kinaesthetic sensations. When I get hold of the patient’s hand and move it slowly, the hand can be changed in position almost through an angle of 90°, and the patient, when blindfolded, is not in the least aware of the change. The patient thinks that the hand is in the same place and in thesame position. When a series of quick, sharp movements are impressed on the hand, the patient feels the movement, but does not know in which hand to localize the movement, nor is she cognizant of its direction. It is only an intense wrench of the hand, arm or forearm that can raise in the patient a full consciousness of the movement impressed both as to locality and direction. If the intensity of the stimulation is decreased, but the extensity increased, the same result follows; thus when the stimulated area is increased, the patient is able to feel a stimulus of less intensity. This holds true of all sensations with the exception of touch. In other words, the raised moment thresholds can be overstepped either by a higher intensity or a greater extensity of stimulations.
In many nervous diseases where the advanced stages are characterized by complete loss of the muscular sense and of kinaesthesis, the early stages present phenomena of rise of threshold. This can be verified in the initiatory stages of tabes. Thus in an interesting case that came under my observation, the patient for about the course of it. No years revealed no other symptoms, except severe attacks of periodic nausea and vomiting, and on an examination revealed no sensori-motor derangements indicative of any lesion as of the active progress of a pathological process. A closer examination, however, by the method of minimal impressions revealed a great rise of the threshold for kinaesthesis in the toes. The case was afterward regarded to be one of tabes. I may add, by the way, that the method of minimal impressions in relation to the rise of thresholds can be used in many forms of nervous diseases from a purely practical diagnostic standpoint, the method being all the more valuable in the initiatory stages of the malady.
In hypnosis and trance states the moment thresholds are often found reduced. The fall of the thresholds in these subconscious states gives rise to an extreme condition of hyperaesthesia. This hyperaesthesia is by no means of an organic character, but purely of a functional psychopathic nature. In other words, the hypnotic hyperaesthesia is not at all due to a modification within the peripheral sense-organs, but simply and solely to a lowering of the moment thresholds of the more complex and higher constellations of moment aggregates. Stimuli of minimal intensity, which in the waking state cannot overstep the higher thresholds of the higher constellations of moment aggregates, constituting the personal self-consciousness of the individual, are enabled to do so when the trance state is induced and the moment thresholds are lowered. The impressions are subconsciously present, but can only enter consciousness or self-consciousness through the medium of trance states. To this effect I have carried out a series of experiments, varying them in all possible ways, but with the same result,—apparently unperceived stimuli during the waking state are still present subconsciously and become manifested with the induction of subconscious states. The hypnotic subject, when in a very deep trance, is often highly hyperaesthetic, his discrimination becoming very acute. The subject's eye can perceive a difference, when no other eye can see any; his ear can detect the slightest difference in apparently similar sounds; the hand can recognize and identify objects in all their details by the slightest and most superficial touch. This fact of hyperaesthesia in trance can be verified by anyone who has carried on extensive experiments in hypnosis and has had subjects who could be submerged into the deeper subconscious regions. In other words, moment thresholds are lowered in hypnosis, minimal and subminimal stimulations give rise to psychic processes which become assimilated in the moment aggregate.
Furthermore, experiences received subconsciously come to the surface with the induction of hypnosis and of trance states. The thresholds having become lowered, subconscious experiences are enabled to overstep thorn and become assimilated in the functioning moment aggregate. This holds true not only of subconsciously received experiences, but also of such experiences that have been so deeply submerged into the subconscious as to be beyond the reach of self-consciousness. In the deepest stages of hypnosis, as well as in similar trance states induced by other means, memories are often revived that have fallen altogether out of the grasp of the individual. In short, subconscious moment aggregates manifested in hypnosis and trance states have lower thresholds.