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ALTERNATING DOUBLE PERSONALITY
THUS far we have dealt with cases presenting only one attack of double consciousness. We turn now to cases where such attacks are periodical. We begin with a brief account of the well-known case of Felida X., reported by M. Azam:
The patient is of psychopathic disposition. She suffers from various nervous troubles, from uncertain pain and hemorrhage from the lungs. Under the influence of some strong stimulus, such as a violent emotion, the patient has a tendency to pass into a secondary state. This is preceded by some sort of aura, a feeling of throbbing pain in the temples. The patient then falls into a short but deep sleep, from which no stimuli, however strong or painful, can possibly rouse her. This is the hypnoleptic state, the intermediate condition that separates the primary from the secondary state. The hypnoleptic state lasted at first about ten minutes, but afterward became shorter, until it was reduced to but a few seconds.
The primary and secondary states differ widely. In the primary state the patient suffers from various illnesses of functional nature; she is depressed, morose, not communicative, has a decided eagerness for work and has no memory whatever of what has occurred in the secondary state. In the secondary state, on the contrary, she is gay, lively, haughty, confident, free from functional troubles, and has memory for both secondary and primary states. Her natural instincts, her acquirements and many of her habits remained unchanged in both states. The only changes were in character, in disposition, in memory and in the general organic sensibility.
In this case we meet the phenomena of mental alternation, a condition not found in the previous cases. This alternation covers a period of many years. At first the secondary state was but rare and of short duration, but in the course of time became more frequent, of longer duration, and at last became the patient's natural state. Thus the second condition, according to the account, at first occupied about a tenth part of her life; then it became equal to her normal life; then it filled almost her whole existence, the primary state appearing only at very short intervals. When the secondary state came to occupy most of the patient’s life, it gradually changed as to mood and disposition, not presenting such a marked contrast to the primary state.
It is interesting to observe the fact that the patient also presented a third state. She fell asleep in the usual way and woke up, not in any of the two states, but in some peculiar state, the leading trait of which was great fright. In this state she knew no one but her husband. This psychic condition must have been some sort of hypnoidic state. That the patient did have hypnoidic states we can judge from the fact that “her slumber is often troubled by dreams and nightmares.” It is a pity that M. Azam did not make a thorough investigation of the patient’s dreams in her primary state, when all memory of the secondary state was absent. An investigation of such a nature would no doubt have revealed the presence of hypnoidic states, reproduction in the primary state of moments belonging to the secondary state.
Had M. Azam not permitted the hypnoleptic state to become shorter; had he, on the contrary, directed his endeavors to the prolongation of the hypnoleptic state and had he tried by means of psychological as well as physiological stimuli to bring about a more frequent alternation of the primary and secondary states, the poor woman would have been saved from the affliction of mental alternation. This was precisely the method followed in the Hanna case. From the therapeutic stand-point alone the Hanna case will remain one of the most important cases in psychopathology. It was the first case in which the importance of the hypnoleptic state for therapeutic purposes was pointed out, and the possibility of scientific treatment and control in cases which until now were considered as outside the domain of therapeutics was clearly demonstrated.
To return, however, to our case in hand. We must draw the reader’s attention to the highly significant fact that the primary state, though appearing sometimes after a strong, violent emotion or trouble, still invariably appeared during sleep. Not so is it with the change from the primary to the secondary state. In this latter change, the patient passed through the intermediary hypnoleptic state.
The interesting point here is the relation of the two states. While the secondary state could remember the experiences of the primary state, the latter had no memory of the secondary state. The case is somewhat complicated. For while there is dissociation in one state there is no such dissociation in the other state. The secondary seems to synthetize the primary, but not the reverse. If, however, we look at the case somewhat more closely, we find that the states are really dissociated. For although the patient in the secondary state knew of the events of the primary state, still she regarded that primary state as “the other,” as “the attack,” as “the crisis.” She had always maintained that the state, whichever one she happened to be in when one spoke to her, was the normal one, which she called the rational state, in opposition to the other one, which she called “the crisis.” In whichever state she was, she considered the remaining one the abnormal, the opposite, “the other” one. The difference only is that while in the secondary state she subjectively could recall “the other,” in the primary state the subjective knowledge, the recollection of that “other” was totally lacking.
The secondary state represents here a complex moment of consciousness with rich content, so that while the memory-experiences of the primary state representing another moment consciousness with a narrower circle of psychic life are partly synthetized by the primary moment. The secondary moment, while synthetizing the content of the primary one, regards at the same time the primary moment as another, as distinct and separate from itself. The functioning constellations of neurons, having the secondary state as their concomitant, are able also to awaken in the constellations of neurons, having as concomitant the primary state, those neural conditions the correlatives of which are memory-experiences, and are transmitted as such by association-paths to the secondary constellation. The secondary moment then remembers that the experiences happened not within its own past of the other, of the primary moment.1
1 Dr. Prince maintains that a patient put into trance really manifests her full healthy normal self in which all the experiences are synthetized. This is true in some cases, while in others, such as Ansel Bourne and many similar cases, hypnosis brings out different persons with partial content. But even with fully synthetized content, there is still double personality, since the trance personality regards the life experience of the waking person as not belonging to its own life.