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"Studies in Psychopathology" (1907)
Journal of Philosophy, Psychology, and Scientific Methods, 1907, 4, 633-639.
See also Sidis's reply.
Studies in Psychopathology. Boris Sidis. Reprint from the Boston Medical and Surgical Journal, Vol. 156, Nos. 11-15, 1907.
The contentions of the paper are briefly as follows: What are described as phobias, as obsessions, as impulsions, as psychic epilepsy are best designated as recurrent psychomotor states, and these states are due to the existence of dissociated memories of past events, which, owing to their dissociation, accumulate energy insufficiently balanced or inhibited. The principle of accumulated nerve energy is a very general principle which promises to be of great importance.
The cases which Dr. Sidis adduces for his views are very interesting and deserve a brief recapitulation.
The first case, a young man with many obsessions, a dreamer in his boyhood, under the strain of examinations had to urinate every five minutes, at the risk of distressing bewilderment, unless he was especially absorbed by some interest. An insistent idea of an oozing out of his vitality leads to continual examinations of urine. Under fatigue, in close conversation with a male person, he gets, he does not know why, an "idiotically stupid" and disgusting idea of homosexual relations. He has a folie du doute about addressing letters, about putting put the gas, locking the door, without any general weakening of the sense of reality. A mysophobic fear of consumption, occasionally a feeling as if his will or his arm is paralyzed, and lately an idea of tearing out his eyes. And having them crushed under his chair or a car, torture him, usually in flashes, at intervals. The urinary trouble and the "oozing" away of vitality and hesitancy of grasping a glass and the repeated trying of the doors were all traced to painful observations of such difficulties in the grandfather, when the patient was five years old; the abulia and feeling of palsy were traced to the sight of a paralyzed child at six, and the remembrance of his having feigned and felt the paralysis of his right hand when a man with a paralyzed hand entered the schoolroom; on that occasion the feeling of paralysis was so real that he fainted and was sick for a few days (at the age of six or seven). The homosexual tendencies were traced to an attempt at seduction by boys of sixteen when he was a little over eight years old. "This experience lapsed from his conscious memory, giving rise to the apparently unaccountable sexual ideas at which he felt so much disgust." A green petticoat, the smell of a heated iron, the sight and feel of starched clothes excited him sexually, also certain features of a woman―traced to a nurse he had up to his fifth year; his ideal of feminine beauty was traced to a child he knew at the age of seven. The mysophobia, the fear of infection, of death, of palpitation of the heart, were all traced to "dissociated subconscious experiences." The inflamed eyes of his great-grandmother and the treatment of his own inflamed eyes with his great-grandmother's eyewashes on one occasion, and stories of people with glassy eyes who can take the eyes out and have them "crushed and cracked by passing objects," were found in a deep hypnoidal state to be at the bottom of the eye notion. "The dissociated subconscious experiences [having their origin far back in the dim regions of the patient's child-life], like the moment-consciousness of low types, kept on recurring with the same or similar mental content and psychomotor reactions, giving rise to apparently unaccountable, irrational, insistent ideas and emotions, deeply affecting the patient's self-consciousness."
The second case was that of a shop boy of nineteen with enuresis and peculiar ague-like attacks. The spells were traced to his being forced to sleep a few nights in a dark, damp and cold cellar, and were even elicited by the mere mention of the words dark, damp, and cold―"Those magic words had the power to release the pent-up subconscious forces and throw the patient into convulsions of shakings and shiverings, with feeling of cold and chattering of the teeth. Thus the apparent epileptiform seizures, the insistent psychomotor states of seemingly unaccountable origin, were traced to dissociated systems of a disaggregated subconsciousness." The third patient, with "recurrent states with trophic disturbances and epileptic attacks," was a woman of sixty, with fear of becoming insane, attacks of functional amblyopia, severe headaches, swellings and rashes of the skin, coughing spells, attacks of helplessness and paralysis, occasional visual hallucinations and tinnitus, and an epileptiform convulsion when her throat was touched in a hypnoidal state; all these reactions could be traced to experiences of early childhood (seeing an insane woman at five, followed by frequent dreams and fears of hell and ghosts, effects of early overwork in teaching, then loss of a daughter through consumption, etc.) The fourth patient was a young Pole, unusually timid, with severe headaches and peculiar attacks of hyperæsthesia and chilliness of extremities, fear of murderers and of funerals, and threatening dreams, traced to a scare by fire on a cold winter night (at four), and to a more pathological reaction at fire at eight, long rehearsed in dreams. "The experiences lapsed from his consciousness, but persisted in his subconsciousness, and found expression in his dream hallucinations, which appeared as real experiences to his subconsciousness. The content of the dreams is varied, largely depending on the sensory content of the total moment-consciousness, but it refers to the same dissociated systems of the patient's child-life." He had heard much of ghosts and ghouls, and to check a certain growth on his chest the cold hand of a dead woman had been put on his chest when he was about nine; he fainted. Shortly afterward, his parents were beaten by drunken soldiers and his little brother...[line of text illegible]…after that the headaches came in full severity. The next case was one of a woman of thirty-eight, with continuous fears of mysterious powers in childhood (which later lapsed into subconsciousness), and later a recurrent feeling of sexual excitement in presence of strange men, based on an episode of similar excitement while sitting opposite a strange young man in a car at eighteen, an excitement which made her "all broke up and prostrated for several days. After a few days she recovered, and then the whole incident faded from her memory." But "it only lapsed from personal consciousness; it became dissociated and subconscious, to come once more to the surface of consciousness on subsequent favorable occasions."
The sixth case is also very interesting: A woman of thirty-five, of neurotic family, married three years, with attacks of paresthesia and paresis of the whole body, and with a profound abhorrence of women, who to her are impurity and filth (an exaggeration of early teaching in a convent brought out again by jealousy of her husband). This "gynophobia" led to many absurd protective reactions and demands on her husband, partly based on sexual symbolism. A search showed frightful dreams of the devil in childhood (once the" devil" actually threw her out of bed and the mattress after her). The paresthesias were picked up from a fall on the spine at twelve. A sexual assault at eighteen led to hysterical attacks; "she really never got fully over it, and the incident, though apparently but faintly present in her conscious memory, has remained active in her subconscious life."
The last case, a Russian of nervous stock, thirty-one years old, developed after a childhood of misery and oppression, and as a revolt over the contrast between the teaching of an ideal Providence and his own real misery. Hence "a struggle full of anguish and agony between a shattered personality and a newly forming self out of a chaotic disaggregated subconsciousness"; from the age of eighteen contrary and blasphemous thoughts in regard to God and filthy words and curses in his prayers, struggle with the evil ideas, which also appear as hypnagogic voices and in nightmares; several periods of hysterical paralysis, later replaced by episodes of sexual thoughts. Evil and "nonsense" thoughts give him no rest. In the street "dreams come to him," then he seems to wake up and does not remember anything; voices talk to him; he can not remember what they say, etc. He asks for help "without weakening my love for my people and my religion." "The patient's condition is the agony of a mortally wounded self struggling against the merciless onslaughts of a pitiless, nihilistic secondary self forming out of chaotic states of a disaggregated subconsciousness."
This is a brief summary of the cases in which Sidis arrived at an elucidation of the "otherwise unintelligible and strange symptoms" by reviving, with his method of hypnoidization, memories floating in the subconscious. In a number of the cases ventilation and reintegration of their memories led to recovery.
The theoretical portion of the paper is in part a reiteration of conceptions developed in former publications of the writer (freely quoted as "I do not think that I shall be accused of plagiarism if I take the liberty of quoting, etc."). He insists that his method of hypnoidization is radically different from that of Breuer and Freud, and from Janet's method of distraction. It is the method of monotony; a condition of enforced quiet, in: which the subject is asked to attend to some monotonous stimulus, such as reading or singing or the monotonous beats of a metronome. When the reading is over the patient, with his eyes shut, is asked to repeat what has been read and tell what conies into his mind during the reading or during the repetition or immediately after it, or simply the nature of ideas and images that have entered his mind. Or when the metronome is used and his respiration and pulse are found somewhat lowered, and he declares that he thinks of nothing in particular, he is asked to concentrate his attention on a subject closely relating to the symptoms of the malady or to the submerged subconscious states. Or he looks into a glass of water on a white background with a light shining through the contents of the glass; the metronome is set going and after a while the subject is asked to tell or write the stray ideas about a topic relating to his symptoms. The principle is the production of a subwaking state which may deepen into sleep or into hypnosis if pushed further. The data come up in bits and scraps, often under a constant struggle to maintain the highly unstable hypnoidal state. "The hypnoidal state may sometimes reproduce the original experience which, at first struggling up in a broken, distorted form and finally becoming synthetized, gives rise to a full attack. The symptoms of the malady turn out to be portions, bits and chips, of past experiences which have become dissociated, subconscious, giving rise to a disaggregated subconsciousness. The method of hypnoidization and the hypnoidal states induced by it enable us to trace the history and etiology of the symptoms and also to effect a synthesis and a cure by means of methods which will be described further on."
To understand Sidis we must follow his rather over-systematized conception concerning dissociated states. We meet, a certain desire to keep in line his conception of neurone energy evolved in the days when the neurone-retraction theory furnished a pleasing figure of speech equally adapted to neurology and to psychology. From the view-point of general classification he calls the disorders described "recurrent psychomotor states," including insistent ideas, imperative concepts, persistent or periodically appearing emotional states, irresistible impulses, as well as the psychomotor attacks of an apparently epileptic character which may be designated as psychic epilepsy―all are seen in the insanities and still more often in the functional psychoses (when will it be possible to eradicate the artificial contrast between "insanity," "psychoses," and "neuroses"?); also irresistible, uncontrollable attacks appreciated as abnormal and all referable to some few fundamental states persistently present in the subconscious. He classifies them, according to content, into (1) conceptual or ideational (insistent metaphysical and religious...[line of text illegible]…examples about doing things on Sunday, or other doubts about actions); (3) sensory (including all the insistent emotional states, depression, anxiety, phobias, pains, headaches, the anesthesias and hyperesthesias of hysteria―all original experience which has occurred during the process of dissociation, dissociated and recurring as an attack, with a tendency to form a new parasitic personality); (4) sensori-motor; and (5) "motor (visceral and motor disorders, palsies, tremors, and states of psychic epilepsy and tics). According to form the insistent states may be disjointed or desultory (chaotic, without rhyme or reason, unintelligible, or reasoned out and systematized). The latter he refers to as frequently paranoidal.
The common feature, then, is the recurrence "so highly characteristic, of the activity of dissociated subconscious states" or moments-consciousness. This fact of recurrence brings the subconscious activities under one perspective view, and biologically in line with the (reflex-like) lower, mental states which respond to various stimuli of the external environment with the same amount and quality, of sensori-motor reactions. Another feature, the vehemence of the dissociated states, is due to the lack of inhibition, and this leads him to see a special latent energy in these detached "moments" or psychophysical systems, which is further discussed in the last two divisions of the paper―"The Moment Threshold and Dynamogenesis" and "The Principle of Reserve Energy."
The first one of these divisions is a recapitulation of the theories of Sidis. The final chapter, "The Principle of Reserve Energy," is difficult to summarize owing to the not very clearly connected accumulation of many suggestive ideas: It should be read, in toto by anyone wishing to be fair to the author. I merely single out a few passages.
"All the remedial work and all the great work depend on the capacity of the nervous system to accumulate energy. In many cases, the inhibitions become too heavy and the thresholds too high. We must loosen the grip of some of the inhibitions and lower the thresholds, thus utilizing a fresh supply of reserve energy."
Medicine must learn to do for the individua1 what wars and revolutions have done for nations. "By means of special qualitative stimuli and by the reduction of the inhibitions and of the moment-thresholds we are able to utilize energy out of the patient's reserve energy for the reestablishment of disturbed inner relations and dissociations."
This, is an idea which has been developed in a different way by James, and also, with far less reference to the extraordinary, by Forel, in his instances of psychotherapeutics, with the help of opening new channels of occupations and interest. A comparison between Forel's cases1 and the cases and theories of Sidis shows one how numerous are the ways of achieving restoration in disorders so ingeniously reduced to an apparently scientific principle by Sidis.
The closing chapter, with its many paradoxes, leaves one with a feeling of awe and wonder at the many things of which one might become the victim. The whole analysis does too little to inquire into the conditions under which the dissociations take place. It assumes a more or less photographic memory, persisting in "moments or systems of consciousness" in the subconscious, and threatening the person with peculiar antics, all due to the special laws of the life of "neurone-aggregates." In this respect the descriptions which Janet, Jung, and others give of the complexes and special reactions to certain experiences appear much less artificial, more life-like, and, more likely to induce those who shape the curricula of medical colleges to heed Sidis's justified criticism of medical education. The report of the cases would gain very much if, instead of the reiteration of the formula adopted in former writings, the writer would give a fuller idea of the process of inquiry and recovery in a few of the cases, with some dates giving the curve of developments a better setting, thus enabling the reader to see to what extent the mechanism of treatment, rather than incidental developments of time and adjustment or principles held by others without the dogmatic apparatus of somehow more or less anatomically segregated memories, brought the desired change. We may feel sure that the conservatism of the practical mind will cease to treat psychopathology with suspicion in the measure in which new observations are made accessible, and free not only of metaphysics of the past, but of metaneurology and premature and excessive systematization directing the attention to that which is as yet in the air and away from the events which had best be described with all the precision with which reports of experiments are written.
Sidis was one of the few who attacked the problems of mental pathology with untiring ingenuity and devotion to the broad teachings of his master William James. But they were given a premature stabilization through an overgrowth of neurological speculation. concerning neurone-retraction, neurone-aggregates, neurone-energy, and the application of psychophysical formulas to the neurological units, the moment-threshold, the law of lowering and raising the threshold; and finally we come to that remarkable claim that relative inactivity and lack of inhibition, together with a process of passive absorption of energy by the floating, disaggregated unit, lead to an explanation of one of the most difficult problems of psychopathology. Metaneurology and metaphysiology are as dangerous as metaphysics in this field, except, perhaps, in the hand and mind of their originator. Every investigator needs his own reinforcing tautology to satisfy nature's law of extravagance the worker's pleasure of creation. Janet's analyses may appear too subtle and Freud's too simple; but they move in terms of the facts of observation, and if used with sufficient breadth of view of the clinical evolution of the disorders they are bound to lead us further. Whether Sidis's contributions will do the same will depend on the capacity of the reader to throw off the incrustations of neurologizing tautology and meet the facts in terms of the happenings which seem essential and open to test and experiment.
The observations of Sidis show that, possibly, the mechanism of submersion of painful and insufficiently digested experiences plays its role in psychasthenia as well as in hysteria, and he outlines a plan of practical procedure of reaching submerged complexes which may readily compete with the psycho-analysis methods of Freud, and its modification with the association tests by Jung and the process of direct hypnoidization employed by Janet and others.
The nature and life of the "disaggregated" reactions, and the laws of their evolution and readjustment, have lately received many valuable contributions. The work of the Zurich school tends to add a great deal to a less dogmatic biology of the conditions and forms of after-effects of fairly well-defined experiences; and Sidis's own studies of the nature of posthypnotic hallucinations might tend to do away with much of the need and the burden of neurologizing subterfuges.
It is to be hoped that a fuller account of the actual experiments with the cases of "recurrent psychomotor states" will be published. It would be a valuable addition in this field of vigorous fermentation, and might easily be given so that others, with their individual working hypotheses, could receive direct stimulation and important hints through the very difference of method of attack. Whether Sidis's terminology will find acceptance remains to be seen. There is much dissatisfaction with the terms "hysteria" and "psychasthenia." A return to the in many ways harmless term "recurrent psychomotor states" might rouse the hunger for new solutions. Personally, I prefer the term "substitutive reactions" for the entire group of "psychoneurotic" reactions. But this is not the place to discuss the issue.
1. P. 249 of the decennial volume of Clark University and in his lately translated work on hypnotism.
PATHOLOGICAL INSTITUTE, WARD'S ISLAND
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