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Boris Sidis, M. A., Ph.D.,
Mental Dissociation in Depressive Delusional States
BORIS SIDIS and GEORGE M. PARKER
THE following experimental notes are selected from a mass of material collected during studies of the case in the laboratory. They are given in the form in which they were taken, with many details omitted, but without any attempt to make them more connected and readable. The interesting feature of these notes is that they show the condition of the patient at various periods in the progress of his disease. The unmodified character of these notes puts the reader in closer touch with the actual manifestations as they were directly observed in the laboratory, manifestations on which the preceding paper is based:
J. F., aged twenty-six, clerk. Family history is negative; there are six children in the family, the patient is the third. He had been temperate, and denied syphilis; never had rheumatism, or scarlet fever, or diphtheria, typhoid; had been working very hard up to the time of his illness. There were no special causes of worry, no excesses.
In February, 1900, the patient began to lose appetite, to have headaches, there was loss of attention, memory became unreliable, there was a desire to seclude himself, great emotional depression, bowels became costive, and bodily condition generally poor. There was a probable history of malaria persisting for some time previous to the disease, but this could not be well verified.
At his first attack, there was considerable nausea, abdominal pain, depression passing into intense anxiety, etc. He was seen by the local doctor, who told him that he had "lumps." The suggestion of lumps formed a nucleus of a highly systematized delusion. The patient actually felt them for the first time, and described them as being beneath the mucous membrane of his stomach. Since this time the delusion of the lumps has persisted and developed. The lumps spread to other parts of the body, to the arms, to the legs, with sudden changes of location. He believed he had worms that ate the lumps, and the soul and specially the spleen were the chief scavengers. The soul and the spleen communicated by signals.
Five days before he became sick, the soul began working, rubbing the lumps out and getting them out of the way. At that time the lumps went in the same hole at which they now enter. The spleen would grunt when the soul worked right, but not like a "man's grunt." The worms meantime were working against the soul. He could feel the soul come out and open the mucous membrane and clean out the worms. The worms were very angry. Then they became still; they had been eating the lumps, but did not like them; the lumps apparently anteceded the worms; the lumps and worms did not agree. The soul also cleaned all the lumps out of the head into the veins, and the veins brought them to the stomach; when the patient became inattentive, however, and too weak to notice these lumps, the soul did not work so well. The spleen told the soul at this time, by signs, to stop; the soul never answered, but understood.
At this time he went to the hot baths. Here the veins began to "draw," and then the spleen began to work in order to get out the lumps. His bowels were especially costive at this time, there was considerable abdominal pain, and he was sleepless. He said, "I looked out of my eyes and I could not see." The lumps in the body began to feel alternately hot and cold about September, 1900.
Since this time, the localization of the lumps has become more definite. The heat and the cold are less shifting; his veins continue to "draw." Patient has no definite idea as to causation. No external or objective references. No history of anything further than noted. Especially has there been no intestinal disease.
[Friday] November 30, 1900: Patient examined as to his sensations, no changes were evident. There was no hypnosis at this time.
[Wednesday] December 5, 1900: Hypnotized; patient becomes completely changed; melancholia is gone; he is jovial, merry, and keeps on laughing and roaring without any provocation. Says, "I feel well." Delusion of lumps persists. Suggestion made as to heat and cold; as to anæsthesia, entirely successful. During pricking of the hand some exhibition of subconscious phenomena as evidenced by shaking and shivering, but the patient makes no reference to this sensation. Later, suggestion as to diffuse warmth, which was successful. Post-hypnotic suggestion as to localization of the spots, of the heat and cold to be limited to one area, the right forearm and hand. Condition apparently improved after hypnosis.
[Friday] December 7, 1900: He states that his right hand is cold, that his left and the rest of his body, except the right foot are warm; no amnesia as to the suggestion.
He dreams of frightful characters, never about being hurt or damaged. During early part of his sickness, dreamed that his spleen was jumping around and removing the lumps. Denies ever having read of this. One night he cried out that he was afraid his spleen would jump out through his chest. No somnambulism. One time, after rubbing turpentine over the body, with some consequent pain, shortly after he felt the same pain over diffuse and separate areas of his body, as if some one had thrown the turpentine upon him. During this period, in reading he could not follow the type, he became mixed up and would not know what he was reading about. If he attempted to carry it on he would have an increase of pain until he had to cease. At times very melancholic.
Thermic tests showed that his sensations as to heat and cold, were normal at this time. No kinæsthetic abnormalities. It was suggested that there would be absence of pain, absence of heat and cold except in the middle finger of the right hand.
[Tuesday] December 11, 1900: Condition much improved; the heat and cold sensations have not limited themselves to the area circumscribed as in last suggestion, but are noticeable, especially in the legs and lower part of the body. With this increase in somatic sensation the synthesis is apparently increased. He can read and not forget; he walks without being frightened; sleeps better, and has had no further dreams, until last night when he felt the spleen pull for the first time. He always remembers his troubles better when he is feeling well. He felt distinctively better after leaving here; very happy and joyful. He is constantly recounting his delusions and likes to dilate on them. Suggested constant insistence upon the disappearance of the spots. Of not remembering the chill or the cold experienced in his first hypnosis, but rather of constantly feeling warm.
December 12th-14th: Pain again in his leg. He calls it a "separation of the mucous membrane." He can read more intelligently and remembers more. Under hypnosis, it was suggested that the pain disappear. He seems to be hypnotized more readily.
The second hypnosis far deeper. Change very great. Looks quiet and grave though contented. Contrast to the melancholic waking state and merry hypnotic state is very striking. Remembers well. No memory on awaking. Attempt towards raising general affective tone. Instead of directing the measures toward changing of sensation it is rather an attack on the affective state.
December 15th-21st: Feeling happier, memory is better, reads more and more rapidly; he sleeps better, and has no dreams. Feels pain in right leg only, then it is rather a feeling of "grain over the skin."
He brought a sample of grain to show this. He limped from the pain in his leg; this limp was removed by suggestion. The subconscious phenomena of heat and cold, which appeared during the first hypnosis, are still present. Suggestion is still directed toward affective states. Constantly improving.
December 22d-29th: He looks brighter, is more attentive, reads continuously with a distinct memory of what he has read. Does not think as much as usual about himself. Pain only in the right foot with a feeling of heat and cold, as per suggestion. Nowhere else is this found. Electricity was begun at this time.
He feels happy in the evening; the change is immediate after hypnosis; is no more afraid; he has seen the effect of the lumps in the black underneath the nails; as he feels them drop off, he smiles. In all attempts at diffusion of the feeling, there is an insistence upon a warm feeling in the region of the epigastrium. All attempts at amnesia of the suggestions given when patient is in the "gay" state are unsuccessful. Feels that he will be well within two weeks.
[Wednesday] January 2, 1901: Suggested that he should, after waking up, hand a "lump" to S. Amnesia enforced; at first he could not remember; gradually the memory came back when asked if P. had not told him something, and then the specific recollections emerged. The second time hypnotized, the same orders enforced, and post-hypnotic suggestions made more specific. Patient woke up but did not remember; still the suggestion developed partially. Hypnotized again, with post-hypnotic suggestion still more strenuously enforced; still not successful. Put into hypnosis; when partially awakened, patient looked out of the window, thought he was in his own home, looked about with amazement, but recognized no one; thought some one had been speaking to him in his own home. Said nothing for a moment, and soon completely awakened and recognized those about him; he remembered about his shoe being off. Post-hypnotic suggestion was not efficient. He goes back into the state of hypnosis readily. Patient was put into a deeper hypnosis. Sudden marked emotional transformation; from boisterous, gay, and light-hearted became quiet, sedate, and grave. He awakens in a startled manner; could not remember taking his shoes off. Complete amnesia; post-hypnotic suggestions are not followed out.
After awaking, he says he does not remember having seen Dr. S., but remembers P. When asked what time he would come, he could not remember, but said he remembered what P. said. Does not remember that S. has told him something.
[Saturday] January 19th: Has said that at some time he saw and heard things without understanding them; feels the lumps now only between the toes; dropping out now every day; knows that they will disappear at this rate in two weeks; extremely sensitive over extremities; feeling of cold and warmth reproduced as in first experiments. Movements of his arms and toes produced as though bathing. This is in hypnosis and afterwards.
[Monday] January 21st: He feels better, the lumps are getting better; he knows they are dropping out; cannot catch them because they run away; idea of lumps is very indefinite; lumps also run up the bowels and run down the bowels and emerge with the movements; he feels them in the passages of the bowels.
The succession of the two contrasting affective personalities is still very striking; the gay is of very brief duration.
[Saturday] January 26th: Feels worse; notices the spots upon the mucous membrane for the past two days. His attitude and expression are again depressed; in taking a tremor tracing of the right hand, he felt the spot run off his left leg. The same as to the spots in his head; he has a pain in the right side of his head when his left hand is engaged. On awaking from hypnosis, there is a reverse procession of the affective states; the superficial states, which are now very brief, being characterized by gaiety, the deeper states by quietness. Hypnotic suggestion that he must light a match after awaking; on awaking and hearing the signal, he began to laugh and stretched out his hand for a match; asked "whose are they?"; then said, "Maybe I will light one"; said he would pay for it, and insisted upon lighting it in spite of our efforts to the contrary; said he liked to smoke, then later said he wished to warm the room. After lighting the match, he said: "I dreamed about lighting a match, that I would have to see fire; some one wanted to take away my memory." During his hypnosis he was pricked in his hand; he remembers this also as in his dream.
He goes now rapidly into the deeper hypnosis; the "gay" stage is extremely brief; the emotional change is very marked; he is no longer gay and laughing, but quiet and grave, still very cheerful and contented. After awaking from hypnosis, he looked in the chair; asking to see "the black cat," which it had been suggested he should see after awaking. He took up a weight which had been placed purposely in the chair, and said "This is not the cat." It was suggested that it was a dead black cat. He looked around for it, then said he wanted to see the cat, that he would find the cat, that he had dreamed about it, and wanted to take it and pet it. Then he took up the weight and laughed, and said it has the color of the cat, and took it in his hands, and passed his hand over it. When asked why he rubbed it, he said, "There is no question about it." He asked how much it was worth. When asked why he wanted it, he said it was the color of a black cat, and he wanted to buy it. He then took it and pushed it back and forth, as in the fatigue experiments. Again when asked why he rubbed it, he said that he would go into the next room and rub it.
He said, "It is the first time I have seen it"; he reiterates this. When insistence is made upon the reproduction of the sensory suggestion, the motor associations of the fatigue experiments only are realized. He rubs the weight on his leg, then incorporating these motor associations into his delusional system, says that in so rubbing it the spots come off. Complete amnesia after awaking.
Before awaking, the weight had been put in his pocket, where he found it. He asked who put it there, and if some one were not in the room. He thought that the matches and weight were in the chair―that they must have been in the chair. He does not care for either the matches or the weight. Absolute amnesia afterward. He thinks somebody has told him that he could have the weight. When asked if he remembered anything about the hypnosis, he remembered nothing, not even of any dream, but he thought the weight was good for exercising, and for ironing,―both of which are memories from the states intervening between the hypnoses.
[Wednesday] January 30, 1901: He feels the lumps still. They are still coming up to his body. Hypnosis, very readily effected, but less of the emotional disturbance which characterized it at first. Post-hypnotic suggestion that he will see the picture of P. Picture was represented by a circular outline of head and shoulders. Complete amnesia on awaking. He looks at the picture, and laughs and says that it is not right, but that he could identify it among others; he says it has no nose, nor eyes, but that it must be his picture, because "it is on the paper used here when I came." Later, says it is only some marks; that it is nothing else; and that the paper is the only thing which helps him. No illusory phenomena; sensory element recognized exactly. Patient put in deep hypnosis; suggestion that he is to see on paper a man in a suit about whom he is to dream; he is awaked; said that the man is not swell, that he has no good clothes on, that he is not well dressed; the man has black clothes; he sees the picture plainly with a double-breasted coat. The picture is simply a few lines, but he works out all the details. He evidently has blended the two suggestions,―the general about the man and the particular about P. Said he had dreamed of an iron burning him; this was due to the weight with which he played in the hypnotic state at a previous time, and under previous suggestion, that he would feel- better with this weight.
P. hypnotized patient, suggested sensory hallucination of a figure (fly); when a signal (knock) was given, suggestion realized, saw the fly and caught it, let it go, then looked for it everywhere; he picked up P.'s picture, the one suggested previously, and said it was P.'s picture, and wanted to take it; pointed out all the details.
Hypnosis, suggestion to see father, and speak to him; wakes up, took P. to be his father, and spoke English, although his father speaks only Russian. When asked where Dr. P. was, said he had him in his pocket. When insisted that he see P., said that he did not care to see him, that P. was very busy; rehypnotized and suggested that he see sister open the door and come in, while it was further suggested that his father was going to help him in his trouble and take his spots away; awaked and said, "May I go to the door?" He did not see his sister until D. came in, and then he took him for his sister. Finally, when we attracted his attention to the difference between D. and his sister, said we were mixing him up, and finally told D. to go away, that everybody laughs at him, and said, "I shall not take you up here any more." When we insisted that he open his eyes and see D., he still insisted that D. was his sister, and that he was not out of his mind.
[Friday] February 1st: Still feels lumps; said he had a bad dream, that two men were trying to kill him, and that he had called the firemen for help; the men in the dream resembled no one; he felt mixed up after awaking. He remembered this in the night, directly after waking up, but not on the next morning. Did not dream about his father or sister; does not remember having his sister or father here last time. Remembers that the picture was one of P., but now it does not look like him; he knows it is not one of P., he only dreamed of it. As soon as he wakes up, he knows that the spleen works between his toes, where during hypnosis the electricity is applied. The spleen takes everything away and pushes it down the bowels; he heard a few days ago a signal from the soul to the spleen; the soul is working and rubbing away the spots. The delusional system is, still complete, and its integrity is but little affected.
He is hypnotized; post-hypnotic suggestion that the lumps will jump at a signal to the hole near the spleen, then through the bowels and out of sight; he lies down upon his left side in order to have these spots go in the hole; he feels the flesh dry; feels the spots jump to the arm, and then to the head, and then to both holes, both behind and in the side; he cannot tell how many minutes longer it takes. When the toes flex, the lumps come up on the anterior surface of the leg; when they extend, they come up the under surface of the leg.
Second hypnosis was easier; suggested that all the spots on the right and left foot would disappear within one minute, and he would feel much happier after awaking.
Awaked, he said, "Some one in my dream told me to count the spots; I can't do it, for they are all there; I would like to have them all go; they would all go through the holes." After two minutes he thinks they are all gone except a few; when asked to guess how many are left, he holds himself in an attitude of attention, and counts to twenty on the right side, and to ten on the left. Said "I dreamed that my spots will go right away, and when I count them they go quicker."
[Saturday] February 2d: No dreams; diminution of spots; believes that the spots are worse when the weather is wet; thinks it will take a long time. It was suggested in hypnosis that after awaking he would see writing upon the paper and read it, the writing being that "the spots are going fast." When reading this the spots will begin to go much faster. After awaking, he says "I cannot count them"; this is a revival of a former hypnotic state; he said, "I have been asleep, and I heard some one say for me to read upon the paper and to count the spots, but I can't read." Rehypnotized with post-hypnotic suggestion that his father would speak to him and tell him that he would get well, and after awaking he would speak of it to P.
He awaked and said: "I saw my father in a dream, and he told me that my feet would get well and dry, whether in wet weather or dry; that even in damp weather I would be well; my father, he tells the truth"; he has not responded to the latter part of the suggestion, as to telling P. about his increased strength; only that which interests the delusional system in question is adopted. The amnesia is complete.
He said, "If my memory for those spots would only go then I would be well." Also said during hypnosis, "When my feet get dry then the spots go away." The upper current of the spots to the body has possibly been suggested by the feeling of the electrical current up the legs to the arms and hands. The positive tendency towards extension of the systematization is not so marked, but the negative tendency as to the exclusion of any ideas which cannot be fused is still strong.
The merry hypnotic state is now markedly dwindling away and the patient rapidly passes into the grave state, now greatly moderated. Patient begins to smile in his grave hypnotic state. There seems to be a blending of the two contrasting hypnotic states, with predominance of the main features of the second state.
[Friday] February 8th: Says his father has told him the truth, that his fingers and toes are getting drier; that his father has told him they would gradually get drier. But they are not yet completely dry. This is from a dream, but he does not remember at what period. In hypnosis, anæsthesia of the left hand was suggested, with warmth of the right hand, and a negative auditory hallucination. None of these was successful; apparently they were too numerous for assimilation by his delusional system.
In second hypnosis it was suggested that when a pencil would be put in his right hand, he would answer the question by writing. A negative auditory hallucination involving S. was given that he would answer S's question by writing without remembering how or why. He was distracted by P. while S. spoke in his ear. Patient says that P. has asked him about his sister. It was really S. He further says, "I can't write for my arm hurts me." When S. speaks he jumps and discontinues any conversation with P. In third hypnosis there was insistence on writing and the negative hallucination of S. As before, he says that P. is speaking to him about his sister, about matches; each time after S. speaks to him he lapses again into a slight hypnosis. There is a fixed objection to writing. Evident lack of initiative. When he once begins he finishes completely; he said he wrote because in his dream he was told to write. He said he heard only P. Says he does not hear S., but answers S., explaining that it is P. who is talking to him. He insists that he does not hear S., but only P. Says some one bothers him, meaning S. Patient looks at S. and then turns away for he only hears P.; whenever he answers S. he shuts his eyes and says he is talking to P. He takes the paper and says "that when he writes upon it with a pencil the spots will emerge through the pencil and be dropped upon the paper; he refers to the spots upon the paper made by him as the spots which have emerged.
He tries to keep this paper; it is snatched away, whereupon he gets up and looks for it; he talks to S., yet says he is talking to P. Says he does not know how the spots get away with the paper, but thinks that the spots have carried it away. When shown some spots by S., he sees them, but says they are not the ones. It was further suggested in hypnosis that when writing he will see the spots come off, and each day more will come, and each day he will forget more about the spots which are left. Also insistence upon the paternal authority, with verbal repetition; upon awakening, he asked who was talking to him in a dream.
[Tuesday] February 12th: He has not attempted to "write out the lumps," because he has not felt like writing; says his father has not told a lie, because his feet are becoming a little drier, but not entirely so. Hypnotized, and suggested that he see upon awaking a black cat with a white tail; that he pet the cat, and pull her tail. On awaking, he said he dreamed of a cat once, but "this (the weight) is no cat"; he says it is simply something for exercise; he insisted, however, that he wished to put it in his pocket, but did not wish to steal it. This is from the previous hypnosis of two weeks past.
Second time hypnotized; suggested he would see a dog; on awaking, said "it is no dog, no face of a dog, does not look like a dog"; exercises with the weight.
Patient's memory of the motor elements, as before, is the best; he begins to exercise with the weight as before, although he says he has never seen it before. Rehypnotized, and suggested that he would perceive a snake; the snake being a pneumographic belt. He looks at it and says "it is no snake, it must be dead; my worms are alive, but this is not alive, nor is it my vein"; he looks at it very frequently, and with questioning and uncertainty; he keeps looking at it; says: "I don't know what it is, but I am scared at it, for when my vein came I was scared at that; that thing must have come from somebody and was once alive, and so I am scared at it now, and I shall throw it away." There is here a complete systematization. He puts it away, then takes it out and again looks at it, saying each time, "I am scared at it"; then he says, "Maybe it is mine; I will keep it any way; it can't be a snake, for I have no snakes."
When shown the chain connected with the belt, he said, "In my body I have such a piece as that. Those dry pieces the vein would take by signs from the soul and the spleen." He did not appreciate what the flat pieces were,―he said, he "didn't have anything like that; the vein had a mouth something like this, but not just quite"; a look of recognition passed over him as he gazed at the plate; and he said, "I can't exactly remember what the vein had here," pointing to the plate, "but it was some kind of a mouth."
In the fourth hypnosis, amnesia for all this was complete.
After awaking he sees no use in the weight; does not regard the rubber belt as the vein; he looks very happy; there is evidently complete amnesia.
[Saturday] February 16th: Yesterday the spots were upon the arm and the head, and my sleep was poor, because my brains are mixed up, and because of my memory of the bad feeling, which comes back when I sleep; after I wake up I can't remember anything except the memory of the bad feelings." He has slept poorly; his appearance is more depressed. Application of electricity, without hypnosis, suggesting indirectly a limitation of the area of the spots. After the application, he was happy and laughing. There is a constant reversion to the manifestations described earlier in the course of the disease. The patient passes now directly into the deeper grave state. The first light, "gay" hypnotic state seems to have completely dropped out.
The idea of getting advice of Dr. N. has become fixed in the mind. He reiterates constantly, "Will Dr. P. see Dr. N.; it is in my head and I must see him, for it is always in my mind and bothers me." In hypnosis it was suggested that he forget Dr. N., that he have no desire to see him or anyone else except P.; that he will want to be hypnotized, that he will feel better; that all the spots will be on the right foot, and that on awaking he will feel easy and happy. After awaking he says, "I do not care to see Dr. N., I have no desire at all to see him." He still thinks that his sleep is bad for him, because while he is sleeping the lumps stay still and do not move, but he sleeps better, because his" brains are not mixed."
[Thursday] February 21st: "Two days after I left here the spots begin to come up through my veins and to the head, and then I feel mixed up in my brain and unhappy." Lightly hypnotized, with suggestion of limitation of spots as before. After this hypnosis he began to feel better, saying the spots begin to move more to the hole; "When I walk, the spots go somewhere else and not to the hole, but when I lie still they go to the hole"; there was no mention of Dr. N.; "when the spots go away they stay away." He says that whenever he tells anyone about the trouble in the past he feels mixed up and feels that his "chest wants to cry." "The dreams I have here, I have again at night; my memory of the past is worse, and I feel very unhappy; when I walk the spots keep still and when I sit still then they move." He makes a line of demarkation of the veins which separate the small toes from the great toe; he also says that as the spots run off the right foot they also run off the left.
He was now hypnotized, and for the first time amnesia of the delusion was attempted; it was suggested that the delusion would be rather indistinct arid be felt as a past experience; that the memories would seem so long ago that they would be faint and amusing, that they would seem to make him laugh without knowing why; that he will never dream of them, except as having been long ago. Special emphasis laid on the destruction of the delusional spleen and soul; that after awaking he would feel only small wet spots over the feet; that there would be nothing else, no feeling of the soul or the spleen, nothing but the spots; that these spots would make him happy, because they go so fast.
Upon awaking he was laughing and happy; said "I had a good sleep"; "this is the first time my spots are going out when I sleep; since I had my trouble of last year, this is my best sleep"; this is due apparently to the suggestion, now successful, of partial amnesia of the delusional systems.
Patient asked to be allowed to go to sleep again; he was rehypnotized; suggestion of small wet spots instead of lumps; that they are so small that he can hardly notice them; that they are amusing him. This is an attempt to remove them from the active malevolent ideas given in his own system and transfer them to pleasanter groups. Upon awaking he again was happy and laughing and said: "They run off very quickly; I don't feel mixed up; I like such a treatment for I slept good; my toes are going to be dry; the spots don't stay thick but thin; I am soon going to be well and happy; I wish the spots would move at night like they do now; I feel light on my feet; I feel bright and strong"; he was brighter than ever before.
The" gay" emotional personality no longer emerges. Attempt at disaggregation; amnesia as to the past; transfer or metamorphosis by means of association with pleasant emotional states. It was suggested the spots be absolutely limited to the foot; that they are simply small wet spots which get dry as they go to the hole; attempt to make these sensations less and less focal.
Suggested first that the past memories are funny; that the spots are amusing him; that they are not unpleasant. The task is to limit the wide systematization which has taken place, pleasant groups of systems are continually to be assimilated to the old systems, substituting themselves for portions of the old.
[Tuesday] February 26th: He says" the spots do not go to the hole when I walk, only when I lie down; the spots are hardly felt, they are now only slightly wet or dry; but on the head there are sometimes spots when they come up, that is, when the wet comes up, it dries out and makes the spot." This statement is elicited upon a question as to how there could be spots on the head, when there are no spots on the feet, but only wetness. It is simply a question of development of existing systems in the patient. He proceeds to say, "When I sit still then these dry spots go to the hole; if I walk they go to the head and from there to the hole; I don't think over my troubles any more, I have pretty near forgotten them; it is no use to me; I don't get nervous any more." In hypnosis the same suggestion of the pastness of the delusion was given to him, associated with a pleasant affective state as to the present sensations; also suggestion of indistinctness of the wet area over the feet; also for the first time associated this wetness with the idea of sweating. Suggested that the wet must be sweat; that it is so slight that it is rather amusing; that it is so slight that it cannot go above the feet, to the head or to the body or to the arms; that it runs off waking or lying still; that the spots must have been wet like sweat; that all the wetness he has had must have been wet sweat. His sleep is deep. Upon awaking he says that "the feet are only wet with wet sweat, that it can’t go anywhere else; that when they get warm they will be cured; that it runs off so fast to its hole that I can feel it." The attempt to limit the spots to the feet and to create a new system for the dispersal of the sweat did not work; the old systems are still strong and cannot at present be disturbed.
After hypnosis he further said he did not feel so much running off because not much was left to run off; he was getting better.
[Saturday] March 2d: "Am getting better; for two days after leaving here everything was all dry, then when the weather changed, a little sweat came under the nails and a little on the face, just like sweat; it seems to be different than before, it is more like sweat; it still feels like an inside wet"―he cannot just tell; he does not feel it as he did before because it does not collect; he cannot tell where it comes from; feels more happy, and wants to get up and go to work; says he dreams about business, but cannot remember what it is; says he feels differently; says he can read now, and that it does not bother him so much; that he can talk more to people; he does not remember about the "past sickness,” and when he tries to remember, he feels he cannot. The wet does not trouble him―says he can stand it. In hypnosis, suggestions as before; that the delusion is an experience of the past; that the wetness is on the outside just like wet sweat, that the inside wet seems" long ago"; is nearly forgotten; that the outside wet is on the toes, none on the body, that it runs off like sweat; that he will think of business; that he will feel happy and strong.
[Tuesday] March 5th: "I am getting better; all my trouble is now in the toes and feet; simply the toes, not the feet any more, just underneath the nails"; he feels "no more wet, just little spots of dryness. Now it moves up to the body dry, it does not go up wet. I cannot feel the wet places any more for something dry comes up from the toes." The dry feeling is like sweating, but still "inside sweating"; the dry spots come up the body and get warm and then pass away; his hole is closing up, and when that closes up then things will be over: he thinks it will be shut in a week's time; "things are going out rapidly" and he is getting fleshy; "the hole has no chance to close up until the spots stop coming out."
He says that when he wakes up in the morning "there is nothing on the body, it stays only on the toes; they are just dry spots, not wet"; that when he wakes up his face is bright and he feels good; that when he comes into a warm room" something goes to his head." In talking he combats the idea of sweat being the same as the wetness, that his wetness cannot come outside, as his sweat does: that "it must go out through the inside"; this apparently explains the inability to fuse by suggestion "inside" and "outside" sweat; it is necessary to follow as yet along the lines of least resistance; patient says the "spots will get less and less, and then the wet and the warm of the body will go, and my hole will close; whatever comes up in the body gets wet and warm and then goes out through the hole."
Patient says that "the holes are so very little the spots must go in now more rapidly, because they have to be soft and warm to get in"; asked what side the spots go in, says "they go inside to the front; then sometimes in the back side; but now all go in one hole in front upon the left side."
In hypnosis the suggestions as before were directed toward making the delusion a past experience; the spots to be limited to two toes only, that they are to be so small that they can only go to the one hole, taking the course back of the knee to the thigh, and thence to the hole. This route he had described while in his waking state. Further suggested that the hole is closing; that in two days only one toe will be left "dry"; that he is fast getting well; amnesia as to the other hole; continuous thinking of the route of the spots while in hypnosis; that after awaking he will feel it; that the dry spots will go every day; that then the wet and the warm of the body will diminish, and he will feel the hole close. Feels fine and strong on awaking.
[Saturday] March 9th: "I feel better than ever before; I feel the spots on the toes very dry, they did not run; beginning with to-day they began to move; they went direct to the hole; now the hole is beginning to close"; on the last two days, after his former hypnosis, these feelings were less indistinct, due to the apparent reappearance of the more stable systems. "Only one toe is sick now, just one; others are warm and dry, but they are made sick because of the sick one; if the sick one becomes well, then all will be well." He feels in the sick one something like squeezing and heat; feels like a nail pulling; he shows the foot. Over the toe that is sick is the last of the wet spots; "I had them on two toes last time; now it is dry, and all that is left is cold and dry"; as his toes move he says, "There, it is working; I don’t feel it move, only when I look at it I know it moves." The kinæsthetic sensations were tested at this time and found normal Though he says he feels more in the other toes than in the sick one, no hypoæsthesia can be demonstrated.
In hypnosis, suggestion as before; localization of spots to one toe; to be warm and dry; to run off by one route along the inside of the thigh to the hole, with subsequent gradual closure of this hole. That the spot on the sick toe is so little that it can only effect the toe next to it, and no farther.
[Thursday] March 21st: Patient has been ill with a genuine attack of influenza; it is significant that the decided change in the painful tone of organic sensations did not produce any reinstatement of former systems.
He says that now all his "weakness is still in the second toe"; that any sensations in the other toes originate from this one. That the coldness under the nails of the other toes is less. It runs off to the body during motion and only to the hole during rest. There is still a tendency to assimilation by the delusional system. It was suggested that he would have no more bad dreams, that his dreams would be pleasant and happy. In this hypnosis he tells of a former dream of breaking a bottle of medicine, and being told by some doctor not to take that medicine; after awaking in the morning he remembered the bottle described, and did not feel like taking that medicine, because in the dream it had been told him not to do so, "because it drew in the spots on the stomach." Here is a revival of the old systems about which amnesia had been enforced. Nothing had been said of these stomach spots for months; there was some resemblance of the doctor in the dream to the Dr. N., the idea of seeing whom had formerly been fixed and had later to be removed by hypnosis.
In this hypnosis it was again suggested that the spots go to the hole and that they must close the hole, and that as the hole needs them they can go nowhere else. Amnesia as to the doctor in the dream insisted upon; further suggested the spots will not spread from the sick toe; that they are to run off to the hole whether he be walking, riding, or sleeping, that they will run only to the hole.
[Tuesday] March 26th: One toe and between the first and second toe is still "sick." "The spots still run to the body; I think about it and it runs to the hole, and the spots must close the hole; I have this in my mind. As I think of this it runs up faster; it must run dry very soon, as the toe could not hold very many more spots; it does not get any worse in bad weather. My right arm begins to feel better, therefore the spots must be running rapidly to the hole, even though I do not feel them. If I think of anything else the idea of the spots comes in and stops my thinking; it does not make me sad any more, because when I think about it the spots move faster."
In hypnosis it is suggested that only at night will the spots be felt, not during the day, that the toe is so nearly dry the spots run only at night; that he will be free to think of business.
[Saturday] March 30th: "I am getting better, the spots run very little, mostly during the night; in the daytime it moves to the body and not to the hole." The appreciation of sensation is becoming less distinct in the toe. Says he has dreamed of hearing and seeing Dr. P., also of Dr. P. telling him that unless the spots went soon the toes must be cut off. In the morning following this he felt the spots less; there was suggested by hypnosis a dream content; that he would hear and see Dr. P. tell the spots to go only to the hole and not to the body, and only at night; and that he was 'getting well.
[Tuesday] April 2d: "Mind is getting better," feels free in the daytime; spots run during the night; dreams at night pleasant, but cannot remember them; there is no more heavy feeling, because the spots run to the hole; he does not feel them run to the hole and does not really feel the hole. Suggestions are continued as before. The patient said that he had something he wished to tell me of Dr. S. thought it possible that there might still exist a fixed nuclear idea; after hypnosis, the question proved to be not anything focal, but simply a slight development of a system involving sensory elements proceeding from the rectum, the origin of which could be traced to a question by P. ten months previous in regard to the second opening. Following this, amnesia of the previous experiences was suggested.
[Saturday] April 6th: "Since I had the cold in the throat it moves in the daytime again." Patient had had a slight pharyngitis. This additional disturbance of sensation has been sufficient to redevelop the recently limited systems. On questioning, it was found that the patient had developed this idea from his belief that" the spots in the toe came from cold," therefore with a new cold the spots will redevelop. It is necessary to limit not only the delusion as to time and place, but also under all conditions, as in a former case of wet and dry weather, which at one time constituted a large factor. Suggestions in hypnosis were made especially emphatic towards eliminating the influence of the sore throat.
[Sunday] April 21st: The spots have been moving fast, and since they have been doing so they must come from somewhere, otherwise the demand would outrun the supply; he describes their source as between the toes; he does not feel the hole any more, simply feels the running off; says he feels happy, because he knows where they come from. "Spots don't stop in the toe at all, and the only place they do stop is between the toes."
In hypnosis it was suggested that the excessive running off was due to the constant application of the battery; with the repeated suggestion that they were running into the electrode; that as the spots disappeared from the end of the toes, those farther up would follow; the spots to disappear entirely.
[Sunday] April 28th: Condition improving; same suggestions as before; spots are now very deep and very few; they have been going fast all the week to the hole; dreamed of hearing Dr. P. say, "you are well and dry." And the next morning awoke happy; since then the toes have remained dry; in hypnosis, same suggestions, with special emphasis directed to the dream life.
[Sunday] May 5th: Since suggestion as to the limitation of spots to one toe has been omitted, there has beep a consequent extension to the other toes or metatarsal spaces. Tendency for the systems to redevelop. In the remaining three outer spaces, the spots remain on the "mucous membrane, but not on the toes; there is nothing more on the flesh, but only in the mucous membrane." As he sat looking at his foot he noticed the pulsation of an artery; he immediately assimilated this into his delusional system as being "a spot which was running off." He has dreamed, but remembers only of dreaming that" the last spot in my well toe went out through my ear."
He now thinks that there is some unnatural power that removes the spots, and he consequently cannot think of anything else. This is again a novel systematization, incorporating the idea of the battery as the power. At times as the patient's toes move, he declares he cannot feel them move,―" that it is only the spots running off which move the toes." No kinæsthetic anæsthesia can be demonstrated.
[Sunday] May 12th: He feels much better; he thinks there is but little left to do; he cannot feel where the spots are; they are rather scattered, and the only time that he can localize them is when lying down; he is not so tired; he thinks they will be gone in a week, because he has promised a friend that this will be the result.
In hypnosis, the suggestion formerly given as to the scattering of the spots and their indistinctness is continued.
[Sunday] May 19th: Spots only under the nails now and they run off very rapidly, especially during warm weather. In hypnosis, as the current was applied, it was suggested that the spots were all to go, that the flesh was to feel natural; that he is not to be able to remember the spots, simply to remember that there was something there, and that it is gone. After awaking, amnesia incomplete.
[Sunday] May 26th: He comes in smiling and bright; says he feels almost well; says he can feel the spots no more, but just a little wetness: substitution here of the "wetness" for the" spots." The wetness is very little; for the past week he has kept his toes in the sunlight―thinks it helps spots to come out. This additional system involving spots coming out, as the effect of the sun, is partially the result of previous suggestion. He says "I feel the flesh on my toes like it is everywhere else, only it is slightly wet; I feel that the spots never can come back, because the power gets everything out." The "power" is still substituted for the former "spirit" and "soul." Says the wetness is but slight. He says his" toes look skinny now, because the spots are gone; when the spots were there, they were swollen." In hypnosis, the period of happiness and joy was again prolonged; says he cannot sleep because he is "so happy and so near well." The suggestions were continued as to the elimination of the wetness; as to the natural feeling of the flesh; as to the amnesia of the spots.
[Sunday] June 2d: For two clays the wetness has moved so much that he had to lie down; in only two toes is the wetness warm, and it is very slight; he says it runs occasionally to the head. The former suggestions that the spots run to the hole had been omitted, with insistence upon amnesia as to the hole.
[Tuesday] July 2d: Certain systems still persist; apparently based upon some definite sensory condition, described as coldness and numbness of the extremities; the left foot is warm, but the toes of the right foot are definitely cold to the touch. There is no reappearance of former systems.
[Friday] July 12th: Says his "toes feel natural like flesh, in every kind of weather; I feel only wetness; the wetness goes to the bowels and then away." The improvement in regard to the character of sensations is definite, as evidenced by his statement that he now "feels the flesh." In hypnosis, suggestion has proceeded on the line of the removal of the wetness to the bowels, emphasizing by means of pressure on the abdomen; absolute amnesia being enforced.
[Tuesday] October 8th: He felt better last week, toes felt warmer; he worked; felt nothing in his body; since Sunday the wetness has run to the bowels, has had a slight sore throat; says he fancies that" the cold air has pulled the wetness from the toes to the throat, just as by a magnet." The systems have not been as yet entirely demolished. There is certainly a coldness very marked in both extremities. Blood analysis shows slight anæmia. In deep hypnosis, an attempt at heightening the temperature of extremities was unsuccessful.
[Tuesday] October 15th: Patient says that "there is a little wetness only in the centre toe; can't feel it very well; does not notice it much"; that when he does not notice it "it runs away most probably." "Occasionally the spots run to the body and thence to the bowels; they are not the old spots, for I cannot remember them; if I try to tell about them, it does not come; it is now only in one of my toes, and nowhere else; I am getting better all the time, I feel stronger and heavier; the power still works in me at night, and draws the spots from the toes to the bowels; only when I am tired during the day does this happen."
The patient has been seen from time to time, the last vestiges of his delusional system have entirely disappeared. He is now in a normal mental condition; has resumed his work under his old employer; has been advanced to the position of foreman and has given entire satisfaction.
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