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Boris Sidis, M. A., Ph.D.,
Mental Dissociation in Depressive Delusional States
THE HISTORY AND THE FORMED DELUSION
FROM the standpoint of abnormal as well as normal psychology the following observations and experiments on what may be regarded as a typical case of melancholia present many points of interest to the student of psychology and psychopathology.
The patient is a Russian Jew; he is twenty-six years of age, and by occupation a clerk. He is quite intelligent and is temperate in his habits. His physical constitution up to the time of his illness was strong and healthy, except that he seemed to have had a severe attack of malaria. He had no mental anxiety, suffered from no worry; and from his temperament and race one could be tolerably sure that he never indulged in any excesses.
The family history could not be well ascertained, but- from the patient's account it appeared that he was of good stock, his parents as well as his nearest relatives being all of a good healthy constitution.
About February, 1900, the patient began to suffer from headaches, insomnia, and loss of appetite. The patient found he could not fix attention on anything, his mind wandering aimlessly; he could not retain anything in his memory. He began to feel gloomy, depressed, and dejected in spirits; he avoided company, having a desire to be left alone; his physical health became greatly deteriorated; his appetite was getting poorer; his bowels were costive, and he suffered from great pain in the abdomen.
The patient called on one of the local physicians, who, on examination, referred the whole trouble to the stomach and to the intestinal tract and indigestion. To bring the matter home to the patient the physician told him he had" lumps." From this time dates the definite manifestation of the disorder. The incautious statement was, so to say, the last straw that broke the camel's back. These "lumps" proved the nqc1eus of a complicated, highly organized systematized delusion. The patient formed the fixed delusion that a vast amount of waste materials in the form of lumps had become accumulated in his intestines. This delusion developed further and became minutely worked out. The mass of lumps was regarded by the patient not as being stationary, but as spreading to other organs of the body, continually shifting position and taking many courses in different directions. These courses were minutely described and localized by the patient. The lumps seemed to have kept a course of their own; in the form of minute spots, they streamed to the head and came out in a definite hole in the thigh. These were the main streams; minor currents circulated through various other organs, finally coming to the same holes. This formed the basis of the delusion.
On this delusional basis was superimposed a highly complicated delusional superstructure. The patient believed he had worms in the intestines; it was these worms working on the great amount of lumps that broke the big hard lumps and ate them; at the same time being stupid and careless, they sprinkled tiny lumps all about them. It was this sprinkling that gave rise to the different currents in various directions. The worms were regarded by the patient as not unfriendly agents; in fact, they were useful in breaking up the stuff of the lumps and eating away his waste materials as much as they could. The only objection to the worms was the process of sprinkling which sent tiny lumps circulating through the body. In this process of sprinkling, due to the careless mode of "feasting," the worms themselves became besprinkled with tiny lumps and were very uncomfortable, but they could not free themselves from the lumps which stuck fast to their slimy, sticky bodies. The more the greedy worms ate, the more did they become besprinkled with tiny lumps in a most disgusting fashion, and the more uncomfortable they felt. Were he dependent on the agency of these stupid worms alone the patient believed' he would have been in a very bad fix indeed; he would have simply become chock-full of these tiny lumps, and there would have been an end of him. Fortunately for himself as well as for the worms, three agencies came to the rescue of this intolerable state of affairs,―the spleen, the soul, and the veins. The veins took a passive part, but the soul was specially active in removing the, lumps as fast as possible as well as taking directions from its more intelligent companion, the spleen. The worms were now taken in hand by the soul and cleansed of their fast accumulating lumps, which were taken up by the veins and driven in definite currents to the two main holes of the body. The spleen and the soul were the two active agents in this purifying process. The soul was the scavenger and the spleen the director. This was rather an unusual function for the soul, but the patient did not find it degrading, and was rather glad that the soul had undertaken this highly useful function. Although the situation was sad and deplorable, still, under the circumstances, the patient considered that nothing better could have happened.
With the soul as scavenger-in-chief and the spleen as superintendent the state of things was by no means cheerful. Things dragged on; the worms at first were very angry at being handled, but then they felt comfortable as they were cleaned quite carefully by the soul under the constant watchful direction of the spleen; the patient, however, felt as uncomfortable as ever. A whole system of signs was established between the two scavengers, the soul and the spleen, signs which the patient could hear distinctly. He could hear the spleen grunt in reply to the signals given to it in a sort of deaf and mute fashion by the ever-waking, never-tiring soul. The spleen would grunt when the soul worked well, but its grunt did not resemble that of "man."
The worms in their stupid way were piling up work for the poor soul. The patient believed that he could distinctly feel the soul come and go and open the mucous membrane and clean up the worms, which at first quite resented such an operation, appreciating it, however, in the end and acquiescing in the process of this unceremonious handling.
The good, efficient work of the soul depended a great deal on the intensity of the attention. When there was nothing to distract the attention, the patient believed that he could feel the soul going round in its silent way and cleaning away all his lumps from the head into the veins and then to the stomach. When, however, his attention became distracted, the soul did not work well; the spleen then by signs commanded the soul to stop; the soul did not and could not answer, but it understood and ceased its activity. When the patient was asleep the cleaning activity of the soul came to a complete standstill.
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