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THE ARTEFACTS OF PSYCHOPATHOLOGY
THE investigator becomes specially puzzled when he comes in contact with the initial stages of what we may call functional psychosis, what may be more correctly termed as psychic dissociation, and what is commonly known under the name of "hysteria." In functional psychosis, one finds himself on shifting sands, so to say. The nature of those psychophysiological phenomena presents such an extreme instability,―the symptoms or manifestations are so unstable, so ephemeral, so ill defined in character and form,―coming, vanishing, ceaselessly playing like combinations of color in a kaleidoscope, ever changing and shifting their position like the ever-restless waves on the ocean, no wonder that many an investigator feels at sea, turns dizzy, and finally becomes nauseated at the whole affair and gives it up in disgust. This disheartening state of things becomes to many minds all the more intolerable, because a good many of the phenomena, being of a psychic character, necessarily depend on the patient's introspective account, and one has to take such accounts not only cum grano salis, but often almost the whole of them have to be entirely distrusted. Shamming, simulation, gross lying, and courses of deliberate deception frustrate all attempts of the earnest scientist, who finally gives up the whole matter, not being able to find his way in this tangle of deceit and conceit, and is glad to leave this labyrinth of lies, sham, and fraud for something more real and truthful to spend his time upon. The story is told of a physician who had devoted a good deal of his time to an interesting case of a young lady suffering from "hysteria" and had scrupulously taken detailed notes on the subject. One day the young lady, in a confidential mood before she left the physician's office, told him she had one thing more to add, and that was that the whole thing was not true. One can imagine the physician's just indignation. He never after took an interest in any sort of that" sham and fraud."
It is no wonder that some go to the extreme and declare that all phenomena of psychic character are nothing but fraud, or as some have termed them "innate cussedness." Granted that there is a good deal of "innate cussedness" in some cases of functional psychosis, still one can not make this sweeping statement in all cases. In throwing away the husks one should be careful not to throwaway the kernel; gold comes with a good deal of sand, and diamonds are rarely found without a quantity of gravel. To abandon metaphors, in all sciences the initial stages of natural processes are uncertain and ill defined. This uncertainty increases with the complexity of the phenomena, and in organic life where the complexity reaches a very high degree the uncertainty is proportionately greater. They who work in minute microscopic anatomy know how disheartening and disappointing are artefacts, and artefacts in microscopical anatomy correspond closely to the illusory "facts" of the "shams and frauds" of functional psychosis. In fact, we may regard the fraud phenomena of psychosis as the artefacts of psychopathology. In cytology, we know how uncertain, almost deceitful, the microscopic presentations are, as, for instance, in the neurofibrils coursing through the neuron, or the intraconnections of the terminal arborizations, or the varicosities found under certain conditions in the dendrons and neuraxons with their collaterals. Similarly uncertain is the whole extent of biological discussions and works clustering round the function and rôle of the centrosome and microsomes, and so on. One could multiply, ad infinitum, instances of this kind taken from various branches of science. No one, however, will claim that it is nothing but a waste of energy to spend time and labor on such investigations and that the whole domain of cytology and biology is nothing but a snare and a delusion.
In the early stages of science, the uncertainty of the phenomena is extreme,―myth and fraud form a good portion of the web and woof of early science, which even at its best is inevitably saturated with metaphysics. Physics has its magic, chemistry is bound up in alchemy, astronomy is mingled with astrology, biology and medicine are organically interwoven with spiritualism and incantations, and even mathematics has its early stages of magic symbolism, as one can witness it yet in the magic squares now forming amusement and play in leisure hours. Even in Greek civilization, in which philosophy and science have made considerable progress, the greatest thinker of the age, Socrates, was so disappointed with the state of uncertainty of physics and astronomy that he turned away in disgust to the more practical and more certain knowledge, that of man, and so was Hobbes in modern times in his relations to the scientific investigations of the English Royal Society.
Patience and perseverance are the great virtues of the scientist. In spite of all disappointments and failures, physicists and astronomers went on working on their material and now they fall but short of the exact mathematical sciences. We must not, therefore, be disheartened at the obstacles in psychopathology, but take courage and work at them with all the more patience and ardor in proportion as the difficulties are greater.
We can not possibly close our eyes to the reality of the phenomena of psychic nature in general and those of psychopathic character in particular, lest we be like the baby who hides himself by shutting his eyes, or like the bird that puts its head under its wing to escape from imminent danger. One can not shut out the world by ignoring it. The wisdom of science is to look with eyes wide open. Because a number of cases are snares and artefacts, we are not in the least justified in ignoring the whole subject. We do not throwaway pearls and diamonds because of imitations.
What is requisite is the sharpening and training of if' that power of discernment which discriminates between the false and the genuine. We may claim that this power of discernment in regard, to psychic facts is not yet fully developed or is possibly lacking altogether, although this is not strictly true, but it will t not do to brush the whole subject aside by a vague objection of "innate cussedness." First of all, "innate cussedness" in itself may make a psychic trouble worth while studying; and secondly, all types and forms of psychic troubles are subject to the same taunting criticism.
The multiform types of aphasias and apraxias are liable to similar doubts and criticisms. How do we know that all those different aphasias and apraxias are not sham and simulation? What assures us of the fact that the aphasiac is not an impostor and fraud? The patient suffers from auditory aphasia; we speak to him and he seemingly does not understand us; he can not write from dictation, but he can write spontaneously; may it not be all mere fraud and deception? The patient suffers from visual apraxia; we show him a shoe and he tells us it is a cat or a horse; what if the patient simply lies systematically and persistently? The patient suffers from alexia; he is shown words which he claims he can not read, but he can write from dictation as well as spontaneously; what if it is only so much simulation, "innate cussedness"? Are not all the forms of aphasias and apraxias subject to similar criticisms?
Delusions, illusions, hallucinations, in the different forms of mental alienation, can not be directly known, and the investigator depends for a knowledge of them on the patient's introspection. One can not directly perceive fallacious perceptions and false systems of ideas occurring in other people's minds. We can not see other people's visions, nor can we feel their joys and pains, nor can we directly know and think other people's ideas and thoughts. Not even the mystical agency of telepathy can accomplish such a miracle. The phenomena of mental diseases are essentially subjective, and can be communicated only by the individual's own introspective account, and as such they are uncertain, dubious, and for all we know may be only sham and deception. The systematized delusion of paranoia may be only deceit and fraud; the actions, hallucinations, illusions, and delusions of the maniac, melancholiac, general paretic, paranoiac, may be nothing but tissues of falsehood and perverse "innate cussedness." In fact, all types and forms of insanity may be so many variations of the one fundamental trait of perverse "innate cussedness." What we have to do is to open wide the gates of the asylums and hospitals and turn loose the insane.
It is clear that no one will for a moment entertain such an extreme and untenable position. If, then, such a position can not possibly be maintained, where shall we draw the line? Where do the real forms of mental aberration begin, and where lies the province of the unreal, of sham, simulation, and "innate cussedness"? What we must agree to is the indisputable fact that all mental ailments, that all psychic processes, whether they be normal or abnormal, are all essentially "innate" in their nature, and to discard them by terming them "cussed" will neither explain nor help matters. The phenomena, whether they be "innate cussedness" or not, are there and can not be ignored theoretically or practically. The only way out of the difficulties, and they are most certainly great and grave, is to accept them with scientific impartiality of judgment and study them with great caution and circumspection in such order as the processes appear, in a series from the early to the later stages, the early stages requiring our special attention, since they are the most valuable for scientific research, though the pitfalls are more numerous and more dangerous.
The practical aspect of the study of the early stages of abnormal mental life must not be overlooked, for it is in the early stages that the physician is enabled to arrest the disease process which, when permitted to reach the advanced stages, may often be of a grave or fatal character. In this respect the study of functional psychosis is invaluable. The scientific men of the medical profession should be specially interested in the investigation of the problems presented by functional psychosis, because the manifestations of functional psychosis lend themselves to so much abuse by all kinds and forms of "fakes," "miracle cures," abject superstitions and prejudices which mar and disgrace civilized humanity.