Table of Contents
AMNESIA, ABOULIA, AND APROSEXIA
A MENTAL state that refers to an event which has taken place in the past, or at a certain date within the same personal experience is regarded as memory. Memory requires the retention or conservation of the past experience, reproduction as an idea or mental image, localization in time, and the reference to the same experiencing personality, or self. As James tersely puts it: “A general feeling of the past direction in the time, then, a particular date conceived as lying along that direction, and defined by its name or phenomenal contents, an event imagined as located therein, and owned as part of my experience,—such are the elements of every act of memory.”
Memory depends on what Professor James terms “setting” that is the concomitant date, self present, warmth and intimacy, and so on. It is this setting which makes us conscious of the past as past. According to James “The only hypothesis to which the facts of inward experience give countenance is that the brain tracts excited by the event proper, and those excited by its recall, are in part different from each other. If we could revive the past event without any associates, we should exclude the possibility of memory, and simply dream that we were undergoing the experiences as if for the first time.” In other words, we would have what I describe as a hypnoidic state.
Forgetfulness in itself should not be regarded as an abnormal phenomenon as some are apt to think and even develop a fanciful psychopathology of every day life which claims that forgetfulness depends on some hidden wish and desire, as if forgetfulness is a voluntary affair or something that depends on wishes and desires of the subconscious, getting rid and suppressing or forgetting the disagreeable. Nothing can be further from the truth. They who claim it show not only lack of psychological insight into human nature, but in order to retain the Procrustean bed of their fanciful speculation, they cripple and ignore the facts of ordinary life.
Nothing so much impresses itself on the mind and is remembered so lastingly as some extremely painful experience. The very attempt at trying to forget a painful experience stamps it all the more strongly on the mind. We remember best what we eagerly wish to suppress and forget. The human race, and in fact all animal life, would have long ago disappeared from the face of the earth, if painful experience tended to be forgotten.
We may also add that experiments performed on the oblivescence of the painful tend to prove that it is the painful that remains for a long time specially vivid in consciousness.
The characteristic of consciousness is purposive selection for the need of the present moment of consciousness. What is not requisite for the present moment has to be forgotten in order that mental activity should be carried on at all. “If we remembered every thing” says James, “we should on most occasions be as ill off as if we remembered nothing. It would take as long for us to recall a space of time as it took the original time to elapse, and we should never get ahead with our thinking. All recollected times undergo, accordingly, what M. Ribot calls foreshortening; and this foreshortening is due to the omission of an enormous number of facts which filled them.”
Ribot insists on the fact that “one condition of remembering is that we should forget. Without totally forgetting a prodigious number of states of consciousness, and momentarily forgetting a large number, we could not remember at all. Oblivion, except in certain cases, is thus no malady of memory, but a condition of its health and its life.” Remembering is a continuous forgetting.
The greater the number of associations, or the more numerous the experiences of the settings, associated with the event, the easier it is to remember, especially so if the event and its setting have been gone over repeatedly in recollection.
The principle of substitution is of importance in the phenomenon of forgetfulness. The possibility of substitution of other ideas or words serving the same purpose makes it harder to remember. Hence in proportion as the possibility of such substitution becomes more increased, forgetfulness increases.
“One of the most striking symptoms of failing memory,” says Wundt “in both normal and pathological cases, is the weakening of verbal memory. There is a lack of ability to remember, first proper names, then names of concrete objects in the ordinary environment, still later abstract words, and finally particles that are entirely abstract in character. The succession corresponds exactly to the possibility of substituting in consciousness for single classes of words other ideas that are regularly connected with them through complication. This possibility is obviously greater for proper names, and least for abstract particles which can be retained only through their verbal signs.”
Kussmaul puts the matter in a still clearer light: “The more concrete a conception is, the sooner is it forgotten. This is because our ideas of persons and things are less strongly bound up with their names than with such abstractions as their business, their circumstances, their qualities. We easily can imagine persons and things without their names, the sensorial image of them being more important than that other symbollic image, their name. Abstract conceptions, on the other hand, are only acquired by means of the words which alone serve to cover stability, and still more adverbs, prepositions, and conjunctions are more intimately connected with our thinking than are substantives.”
We may add that the factor of repetition must also be taken into consideration, inasmuch as proper names are not so often repeated in experience as verbs, adjectives, and pronouns.
Forgetfulness in short is not as some superficial writers explain a matter of wish and will, whether conscious or subconscious, it is a highly complex phenomenon depending on a number of physiological and psychological factors.
The same holds true in the case of amnesia. A subconscious state with a vague or weak attention as in dreams or narcosis, or a change from one state of consciousness into another, as from somnambulism into the waking state is sufficient to give rise to amnesia.
Of course, there is no need to point out the well known fact that the time element has a strong influence in the weakening of retention, reproduction and recognition of our past experiences. Ebbinghaus and afterwards Wolfe discovered by a long series of experiments the following law: “The quotients of retention and forgetfulness (of the time saved for memorization and the time requisite for relearning) are inversely proportional to the logarithms of the times passed since the first learning.”
We have pointed out that while sensory elements have intensity, representative elements possess vividness. Representative elements representing as they do presentative or sensory elements may refer with various degrees of vividness to the same sensory experience. Thus we may have different vivid representations in regard to the same event which we have lived through some time before. Such vividness may pass through all degrees, from the highest to the lowest and finally reach the barely representable, almost bordering on the threshold of vividness.
Sensory intensity and representative vividness are closely interrelated. Intense sensory processes usually go with vivid representations. There are however conditions when the two do not go together. A sensory process, however strong, instead of giving rise to an intense representation, may awaken a representation of low or of marginal vividness. In many subconscious states intense sensory experience may give rise to representative processes of such low marginal vividness that the latter fall below margin or the threshold of consciousness or awareness, and are not perceived by the person. The experiences cannot be reproduced, cannot be recognized, and hence are not remembered. The experiences become dissociated. We may therefore say that where vividness is very low there we have dissociation. In other words, as we have pointed out before dissociation and vividness are in inverse ratio to each other. The lower the vividness the greater the amount of dissociation.
The same holds true in the case of amnesia, the lower the vividness of the mental states the greater and deeper the amnesia. In dream states as well as in other states in which the vividness of the representative elements is low and vague there is a corresponding degree of amnesia. The amnesia is all the greater and deeper where not only the representative elements are devoid of vividness, but where the sensory elements of the experience are lacking in intensity. Many psychopathic states, hypnosis and somnambulism, pre-epileptic and post-epileptic states as well as states of narcosis, and many dream states answer such conditions. Amnesia may be regarded as a function of representative vividness and sensory intensity.
Amnesia may be considered as anaesthesia of memory. The underlying pathological process of amnesia is a functional disaggregation of neuron systems in the cortical association areas. Instead of having relation to sensations, the anaesthesia is related to recollection of events, percepts, and concepts, or to their reproduction and recognition.
Memory, as we have pointed out, requires retention, reproduction, recognition, and localization in the person’s time; that is, an experience must be retained, must be capable of being reproduced or recalled, and when reproduced the experience has to be recognized as having taken place within the past personal life. In many cases the experience is retained, but can only be reproduced and recognized in subconscious states.
Regarded from this standpoint the process of memory disaggregation the following forms of amnesia:
I Amnesia of reproduction.
II Amnesia of recognition.
III Amnesia of the waking state, or amnesia.
IV Amnesia of retention, or absolute amnesia.
By amnesia of reproduction is understood that type of amnesia in which the reproduction of the experience is lost. Of course, it is clear that when reproduction is lost the recognition is also gone, for it is impossible to recognize the memories which are not reproduced. Still the fact that reproduction is lost does not mean that the element of recognition is completely gone. For while the patient is unable to reproduce the experience, he can recognize it fully and even localize it correctly in time, when the experience is presented to him in connection with some sensory impressions. We find such cases in the aphasias, the patient cannot write spontaneously, he cannot reproduce the letters, but he can read them when he sees them.
By amnesia of recognition is understood that form of loss of memory in which the recognition alone is gone. For memory requires retention, reproduction, and recognition. An experience must not only be reproduced, but must also be recognized as belonging to one’s own past.
The patient is able to reproduce the old content of memory, the event, percept, or concepts and their combination, but he is unable to recognize them as belonging to his past. They simply come into his mind, but seem to him strange and unfamiliar. These forgotten memories usually can be brought out by distracting the patient’s attention, or by placing him in a state of mental rest and comparative inactivity, or they may appear in the form of hypnoidic states. In many subconscious states, such as the hypnoid, hypnoidic and hypnoidal states, in the different forms of double and multiple personality experiences are reproduced, but they are not recognized.
In the psychopathic forms of amnesia of a motor character in which large zones of memories are engulfed into the subconscious we sometimes find that memories are gone, memories which can neither be recognized nor reproduced, still we are not justified in thinking that the memories are completely lost. For we can find them present on tapping the patient’s subconsciousness. In deep and extensive forms of amnesia the patient can neither recognize nor reproduce what has been forgotten. The process of disaggregation of conscious and subconscious is complete.
The content of memory may be reproduced, but cannot be recognized as such. Memories can be easily reproduced, but they cannot be recognized as belonging to the moment's past experiences. This form of amnesia is characterized as amnesia of recognition, since one of the elements of memory, namely, that of recognition is wanting. There is a whole class of amnesias in which the patient is able to tell events from his former life, but he is unable to recognize them as belonging to his own past.
The hypnoidal states have just this characteristic that when they first come to the surface, the memory content brought up is regarded by the patient as new experience, and only later on, with the synthesis of the hypnoidal states into the functioning moment, can recognition possibly become effected. Thus in the M. and F. cases the lost memories reproduced in hypnoidal states were not immediately recognized, they were taken as chance ideas, or mere fancies, and only some time later were they acknowledged and owned by the patient. Similarly in W. and other cases of like character the lost memories welling up from the subconscious in the form of spontaneous hypnoidal states often lack the element of recognition, and acquire it with the process of effected synthesis which, however, is not always forthcoming, as it depends on the depth or extent of disaggregation.
We must emphasize the fact which has been but too often overlooked, namely, the fundamental difference between reproductive amnesia and that of the purely recognitive character. In reproductive amnesia the very contents of memory are lost, whether the loss be functional or organic, whether relative and temporal or absolute; in recognitive amnesia or amnesia of recognition, the content of memory, on examination, can be shown to be present and reproduced, but it is not recognized as belonging to one's past life.
Amnesia of recognition is no doubt due to a narrowing down of associative connections brought about by the process of functional dissociation, affecting the particular content. For recognition, as we have shown is a function of associative systems, recognition becoming more localized in time and more specific in proportion to the number of associative interconnections.
Recognitive amnesia depends on a limited field of associative activity, or rather to say on a great extent of dissociation, while reproductive amnesia, or amnesia of reproduction is the outcome of complete functional dissociation. In both cases the psychic content is retained, only in one case it is reproduced, but not recognized, in the other it is neither recognized nor reproduced.
In the phenomena of bimorphosis and polymorphosis of personality, whether coexistent or successive, the same important distinction between amnesia of recognition and amnesia of reproduction should be maintained. This distinction gives us a wider, deeper and clearer view of the phenomena and their interrelation.
In amnesia of the waking state or in complete amnesia the process of disaggregation has proceeded far deeper than in that of the previous forms. The moment has not only lost the power of recognition, but also that of reproduction. Hypnoidal states can sometimes be induced, but with extreme difficulty. When the lost content is indirectly presented to the patient by outsiders, such as his family, he cannot believe that he has lived through it, he cannot identify his past experience.
Similarly when the lost content wells up directly into consciousness through hypnoidal states occurring spontaneously, or induced experimentally, or coming in an indirect mode by way of dreams, the patient is still unable to recognize it as his own past. In this form of amnesia one has to look for hypnoidic states which occur during sleep in which the lost content is reproduced and recognized by the outlived and now fully resurrected moment.
Cases of complete amnesia are found in normal, healthy life, in abnormal mental states, in nervous diseases, in sanity and insanity. In the normal state we find it in relation to dream life. A third of our life we pass in sleep, a large part of which is filled with dreams, often exciting, but frequently leaving no trace behind. On awakening we can by no effort of will retrace the forgotten dream experience. It is apparently gone and lost forever, so it seems, but this is not so. Inhibit the principal synthetic moment of self-consciousness, descend to the lower subconscious regions of moments-consciousness, and there we may find the dreams. The dream becomes dissociated from the principal functioning constellations, the synthesis of which is the given waking personality.
In the abnormal states of alcoholic intoxication, for instance, we find that experiences of one state, especially that of the state of intoxication, are frequently not known to the sober state; the memories may recur with the return of the toxic conditions. In psychopathic sleeping states due to ill nutrition, or worry, or overwork and overexertion, or to all of them combined, we find that experiences lived through and acted out are immediately forgotten on awakening. We meet with cases of amnesia in many forms of psychopathic and neuropathic waking states.
In complete amnesia the system that has withdrawn is perfectly sound, only it possesses groups of a less complex nature, and the former connections can be again reinstated under favorable circumstances. Should, however, the hurtful stimulus be of such a nature as to destroy a whole system, then the amnesia effected is absolute. The connections can not any more be reinstated, because the system itself is destroyed.
The process of disaggregation setting in under the action of strong and hurtful stimuli is not something new and different in kind from the usual; it is a continuation of the process of association and dissociation normally going on in the higher constellations of mental systems. The one process gradually passes into the other with the increase of the intensity or duration of the hurtful stimulus.
In amnesia of retention or absolute amnesia the process of disaggregation has gone still farther and has brought about distintegration within the content itself. Recognition and reproduction are impossible, from the very nature of this type of amnesia, since the very content is affected. Hypnoidal and hypnoidic states cannot possibly be induced, because the disaggregated moment-consciousness has lost through degeneration all its psychic content. In the different forms of brain lesions, involving loss of cellular nerve tissue of the higher spheres, we meet with this form of amnesia, such, for instance, as the different forms of organic aphasias, or apraxias.
The results of the one continuous process of disaggregation through absolute amnesia differ fundamentally from reproductive, recognitive, and complete amnesia. In the former, in absolute amnesia, the disaggregated states are irretrievably lost; in the latter, forms of amnesia the seemingly lost memories are really present within the patient’s mind in a subconscious condition. They can become manifest and finally even become synthetized within the functioning moment-consciousness.
Psychopathic amnesia differs radically from that of organic nature. In the latter the affected content is irretrievably lost, in the former the seemingly lost memories are really present in a subconscious form, and can be brought out in hypnotic, hypnoidic, and hypnoidial states by proper psychopathological methods.
Regarded clinically from the standpoint of lost content, amnesia may be divided into the following types:
In general amnesia the whole content of the patient’s memory is lost. In such cases the amnesia is so profound as to make of the patient almost an infant. The patient does not know how to eat, to talk, to walk, nor does he know anything of space or time. In short, he must learn everything over again. In such cases the retentiveness of memory in general for acquiring new things may be quite acute or even better than in the pre-amnesic state. Such a state is shown in the classic case of the Rev. J. C. Hanna. The general amnesia in this case is one of recognition, the reproduction occurring in hypnoidic states; the element of recognition, however, is absent.
In general amnesia memory is affected as a whole. No definite systems of the functioning moment become submerged and subconscious, but the functioning moment as a whole with all its acquisitions and riches sinks into the subconscious depths from which it cannot emerge, unless put under special conditions. The manifested psychic activity is at its minimum. The functioning moment-consciousness being submerged, there is apparently no manifested mental activity and a deep coma seems to be present.
External and internal stimuli finally awaken some new moment which begins to function with a minimum of content characteristic of early infancy. The amnesia is so profound that the patient becomes very much infant-like. The patient does not know anything about space and time, does not know how to eat, how to walk, how to dress, how to talk. Everything must be learned over again. It is true that the patient in such cases shows great, even extraordinary proficiency, learning things in a very short time, but he must learn every thing all over again. The general retentiveness of memory is often extremely good, even better than in the normal state. The Hanna case described in “Multiple Personality,” may serve as a good illustration. In general amnesia hypnoidal states are not infrequent, and one has to be on the lookout for them. Hypnoidic states may occur.
The lost content may be of a special character, the amnesia referring to the special senses, such as sound or light. The memory associated with visual stimuli for instance, may become affected and the patient may lose all ability to interpret visual impressions and sensations coming from external stimuli. The patient on seeing objects may be able to appreciate the different stimulations and impressions, and can even describe them, but he cannot know the object, or the particular visual stimuli which call forth visual impressions. The complex memory that is normally awakened by the visual impression is absent, the patient does not know the meaning of the impression, in other words, he does not know the object.
In this respect the patient may be regarded as blind; only it is not a sensory blindness, as the senses may, in fact, be in excellent condition, it is associated memory representations by which the sensation is perceptually interpreted as being this or that particular object that is wanting. It is not the sense that is deficient, but it is the mind that is blind. This is sometimes called mental blindness, more correctly visual apraxia, since it is only the memories awakened at visual sensory cues, it is only these memories that are really affected.
More frequently the amnesia is even more special, referring to a highly specialized content; the memories relating, for instance, to the interpretation of visual signs or symbols, such as written words may become affected. The patient is unable to read or even know his letters, although he may be able to trace them with his finger and even reproduce their shape and outlines from memory. In such highly specialized cases of amnesia it is not the visual memory which is deficient, but rather the systems of auditory representations.
We must guard against the confusion between visual memory proper and that “visual memory” which has little or nothing to do with visualization. The visual memory may be well preserved, be even in excellent state and still the patient may be totally unable to read, may suffer from alexia. Thus in the case of C. an extremely interesting case of aphasia this state was present.
The patient could trace with her finger letters, numerals, both printed and written, could represent them in her mind with her eyes closed, but still could not read them. In other words, the patient forgot their names, that is the auditory representations and the modes of their auditory combinations. Visual memory then was present, but the auditory memory representations associated with and awakened by visual presentations was absent.
There are, however, cases where the pure visual memory is lost, when the patient is unable to represent to himself visually, he does not know, he forgets how things look as soon as they are removed from his direct visual presentation.
The amnesia again may be in relation to sound, tactual, kinaesthetic, and other stimuli. The specific impressions do not awaken the associated memories synthetized within the moment and giving rise to the perception of external objects. Once more we have to point out the fact that one must guard against the confusion of amnesia of the particular special sense representations and amnesia of associated representations coming from other senses. The two amnesias are different as to their nature of content, in the one case it is representations of the same sense that are lost, in the other case it is representations of other senses that are affected. This distinction is not only of psychological value, but also of clinical importance.
When memories having auditory sensations as their nucleus are affected, the patient can hear words and voices, he reacts to external sound stimulations, has auditory sense impressions and sensations, but he does not understand them, he cannot interpret them, he has forgotten their meaning as relating to other systems of memory-representations. The special auditory pre-sensations, excited by special sound stimuli, do not awaken their associated representations, synthetized within the same system of moments.
At the same time when the patient is examined as to his auditory memory proper it may be found that he can imitate sounds, words, phrases, repeat them sometime after they are pronounced before him, only he does not realize their meaning, just as we can learn to imitate and repeat words and phrases of a foreign tongue, the meaning of which is entirely unknown to us. This shows that auditory memory proper, or memory of auditory “images,” as some neurologists would say, is actually present.
If the auditory memory is also affected, then the patient is unable even to imitate sounds, words and phrases, still less is he able to repeat them some time after he has heard them, since he has no auditory representations. Should, however, the auditory memory alone be lost, then the patient loses all auditory representations and, of course, all power of verbal conceptions. The patient may be able to speak, may even be able to imitate and repeat sounds, but will be unable to understand when spoken to.
Similar forms and varieties of amnesia may occur in other kind of memory representations, where the nucleus of the moment consists of presentations, coming from other senses. We should in all of them discriminate between the memories of the same sense proper and those of the associated memories. The memory representations that are of the same nature with the nucleus of the moment, namely, the sensory presentations are different in kind from the associated memory representations, unlike in nature of their sensory origin.
In case of amnesia of kinaesthetic representations, the moment is unable to carry out its motor reactions and adaptations. If the disaggregation is not of the absolute type, but rather of the psychopathic, functional type, whether reproductive or complete, the patient is in a condition that looks very much like paralysis, although the patient is actually not paralyzed; in other words, the state is one of aboulia.
The amnesia may be in relation to special movements, or to special organs of the body, then the motor memory is affected. In all these forms of amnesia a part of life-experience is gone,—the patient’s life experience relating to a special sense is lost.
It must, however, be emphasized that if the amnesia is of a psychopathic nature, the lost content is present in a dissociated form in the subconscious, and can be brought to the surface, if the patient is put in subconscious states and subjected to psychopathic methods of investigation. The pathological process in special amnesia is concomitant with functional dissociation in the sensory or motor areas.
In the different forms of special amnesia we must differentiate between the form of dissociation of representations of a given quality from other representations, unlike in quality, and the form of dissociation of representations from their own sensory presentations. The first form of disaggregation may be termed conveniently representative disaggregation, the second form presentative-representative disaggregation.
In the representative forms of disaggregation other qualitatively unlike representations are absent and the presentations with their qualitatively appropriated representations lose their meaning. Sensations can be mentally reproduced, or what is the same represented, but they do not awaken in the patient's mind any associated representations, coming from other sense organs, and hence there is no knowledge of the meaning of the external stimuli. Objects, affecting this particular disaggregated region of mental life, are not recognized, and the patient in this direction may be regarded as psychically blind or mentally anaesthetic.
In the presentative-representative form there cannot be even a reproduction of the sensory stimulation, the sensation cannot be reproduced, it is gone and lost as soon as the sensory process ceases. In this respect the form of consciousness reverts to the lowest type, that of desultory consciousness. The patient falls in a condition in which his mental life becomes inaccessible to stimuli, coming through this particular affected mental system. Although sensory elements are awakened each time as stimulations occur, no accumulative process takes place, and the patient's psychic activity in this particular direction loses all plasticity. The type of moment-consciousness reverts to the extreme rigidity, characteristic of the reflex type of moment-consciousness.
Localized amnesia may be characterized also as temporal amnesia. It is forgetfulness of a certain content in time past. The patient, for instance, may forget the experience of a day, of a month, or of a number of years. The memory for experiences before and after that time remains intact. The lapses can be exactly located in time.
Usually such a localized amnesia occurs after some intense shock of a disaggregative character. This form of amnesia is characteristic of psychopathic states. Psychopathic amnesia is of the type of localized amnesia and involves the memories of events that have occurred just before, during or some time shortly following the trauma.
More often the lapse is for the time just preceding and during the attack. The reason given by Ribot is that the experiences preceding or during the attack had no time to become organized, because the nutrition of the cells was disturbed by the attack. This explanation, however, is hardly tenable, as the cases of psychopathic amnesia really show that the experiences are present within the subconscious. It is more probable that recently acquired memories having few associations can be easily disaggregated and fall into the subconscious.
Systematized amnesia is somewhat like systematized anaesthesia in that the forgetfulness is in relation to certain events only. Events of certain character are forgotten.
In periodic amnesia the lapse of memory occurs periodically at regular or irregular intervals. The amnesia may each time be of the same content; again there may be periodic amnesia where the forgotten content varies. A definite experience may be forgotten at certain intervals: thus for instance a woman may forget at certain intervals that she is married, that she has given birth to a child, etc., or the attack of amnesia may each time involve a different set of experience. The first form may be termed persistent periodic amnesia, while the second form may be termed variable periodic amnesia. In cases of variable periodic amnesia the lost content is usually of a localized nature. Experiences of certain times are forgotten, consciousness is connecting and synthetizing its experience, leaving out definite links.
Alternating amnesia is of an oscillating nature, the lost content is oscillating sometimes coming up to the surface of consciousness and sometimes lapsing, falling back into the subconscious. Alternating amnesia may be of a systematized or of a localized nature. In either case the content is always oscillating and varying. In the forms of alternating amnesia the memory synthetizes certain links of experiences, while others are altogether omitted from the synthesis, consciousness bridges the missing links just as if they never existed for the patient.
After a hypnoleptic attack these synthetized memories subside or lapse into the subconscious while the omitted memories emerge also in a synthetized form. Here the former memories constitute the omitted links. It may, however, be that after an attack the whole chain of experiences becomes complete. In such cases, however, the patient though regaining the lost experiences, does not recognize them as belonging to himself, he regards them as experiences of the life of another person.
The oscillations of forgotten content in alternating amnesia may be represented by the following case: At the end of 1890 a crisis or disturbing event occurred in the life of the patient and during 1891 the experiences of 1890 were forgotten, while in 1892 the experiences of 1890 revived while those of 1891 were forgotten. In 1893 the experiences of 1891 were revived while those of 1890 and 1892 were lost. In 1894 the experiences of 1890 and 1892 were once more revived, while those of 1891 and 1893 were forgotten. In 1895 the events of 1890, 1892 and 1894 were forgotten while those of 1891 89I and 1893 were revived. In 1896 the experiences of 1890, 1892 and 1894 were remembered while those of 1891, 1893 and 1895 were forgotten or rather, had subsided into the subconscious. The experiences of 1890, 1892, 1894 and 1896 were bridged over in synthesis and were made contiguous, as if the omitted links of 1891, 1893 and 1895 did not exist. In the same way the experiences of 1891, 1893, and 1895 were synthetized, while the lapse of 1890, 1892, 1894 and 1896 was not appreciated as a gap by consciousness. When subconscious experiences recur they form a synthesis, are bridged over and are contiguous, while the ones that have subsided become the omitted links and are in their turn regarded as if not existing. If they do come to memory, they are of a purely reproductive nature, without any element of recognition.
The form of progressive amnesia consists in a progressive loss of the content of memory. This form of amnesia probably seldom, if ever, occurs in the psychopathic state. It is, however, common in certain forms of organic disease, such as general paresis, senile dementia and all forms of secondary dementia.
Etiologically considered, amnesia may be classified into four types:
I. Traumatic Amnesia.
II. Toxic Amnesia.
III. Autotoxic Amnesia.
IV. Emotional Amnesia.
Traumatic amnesia is due to some intense mechanical stimulus affecting the brain. The character of the amnesia is determined by the seat of trauma, the disturbance being of a psychopathic nature, namely, a disaggregation in the interrelation of the moments, the content falling into the subconscious and is present in a lower type of moment-consciousness which can be revealed by different psychopathological methods.
In psychopathic amnesia the character is not determined by the trauma alone, but also by the nature of the circumstances and conditions surrounding the patient during the time of the trauma.
Toxic amnesia is due to some toxic agent taken into the system. Thus in alcoholism the patient may forget events occurring during the state of intoxication.
In my experiments with chloroform or ether gaps, lapses appeared in memory. These memory gaps are of a systematized or of a localized nature. In toxic amnesia the patient on emerging from the state of intoxication often forgets his conscious experiences during that state. The lost memories, however, may sometimes be revived in subconscious states.
Amnesia is autotoxic when the toxic agent is developed periodically, regularly or irregularly, by the organism itself, and may be due to defective elimination of waste products. Attacks of this kind may be sometimes seen in the psychic equivalent attacks of epilepsy, found interspersed in a number of typical epileptic attacks. The various forms of periodical and circular insanities are due to such conditions. To autotoxic amnesia also belong the amnesias or lapses of memory observed during severe headaches.
Amnesia may be caused by some strong emotion, and is termed emotional. The character of this form of amnesia is determined largely by the nature of the event and also by the character of the emotional disturbance.
The general law of amnesia is disaggregation from the higher to the lower, from the complex to the simple, from the less familiar to the more familiar; the loss of psycho-motor activities is in the order of their complexity and familiarity. Thus, for instance, habitual movements or movements required in carrying on daily life existence are last effected by the process of disaggregation. The very lowest forms of activity, such as reflex action, remain unchanged.
The order of disappearance again depends also on stability, on time element, on recency and on repetition of the activity of the organized functioning systems. The ones first organized and more often brought into activity will be the more stable and will longer resist the process of disaggregation.
Aboulia consists in a deficiency of will power. The patient is unable to determine upon any definite movement or action, especially when the mind is concentrated upon it. From the very nature of the aboulias it is evident that they relate to motor phenomena. The lack of resolution of the patient is due to general mental depression brought about by subconscious experiences.
Anaesthesia and motor disturbances are associated with aboulia. In aboulia a certain action becomes difficult to execute when the patient desires to perform it, the patient cannot resolve or decide to perform a certain act, no matter how strong his desire be.
There is in aboulia a disaggregation in the mental systems forming the personality, the given wish or de-sire cannot be fulfilled; no impulse can apparently be transmitted from the higher ideational to the motor centres. If, for instance, the patient is told to perform a certain act, he finds it difficult or impossible to execute it. If the subconscious self, however, is appealed to, the action or movement can be performed with ease. This differentiates aboulia which is of a psychopathic character from organic motor disturbances, since in aboulia the patient can really perform the act when his attention is diverted, while in organic disturbances there is a permanent inability to execute movements or acts.
The aboulias may, like the anaesthesias, be divided into:
In systematized aboulia certain forms of activity cannot be voluntarily performed. Certain actions which the patient can perform in relation to all other objects cannot be executed by him when these actions relate to a definite class of objects.
Specialized aboulia is present when the patient cannot say or write a certain word or do a definite act under special circumstances. The power of forming the resolution seems lost. The performance of the certain specialized act is associated with some past inhibitory experience, producing a disaggregation of a certain mental system from the voluntary, controlling centres.
The inability may relate to the pronounciation of a certain word or phrase or to the writing of a certain word under certain circumstances, such as the presence of certain persons. The patient may be, for instance, unable to greet or bid adieu to certain persons, but finds no difficulty in expressing this to other persons. Again the patient may be unable to do a certain action under some special conditions only, thus he may be unable to write upon a particular table or when seated in a particular chair.
Localized aboulia has relation only to a particular member of the body. This is not due to local disturbances, but there is general apathy in relation to movement of this particular member. The member affected seems to be entirely disregarded by the patient. As long as the patient's attention is diverted from the affected limb, its use is carried on normally, but when the patient's attention is directed toward the member, its voluntary control is almost entirely suspended. In short, the patient cannot move a certain limb at will. The deficiency is more marked when the patient is directed to move the affected limb.
In general aboulia, there is a general paralysis of the will, or of voluntary activity in general. In this as in other forms of aboulia, the patient performs acts subconsciously, but cannot do so voluntarily, when his attention is fixed upon them, or when directed to by others. Under emotional excitement the aboulic state is, so to speak, broken through, and the patient performs all acts normally. The aboulia may at times go so far as to make it impossible for the patient to make up his mind to fall asleep or to arouse himself.
We have pointed out that the aboulia may be general, special, or localized. It may involve all kinaesthetic memories or only some systems of them relating to the activity of a particular member, or to certain definite activities. The patient is unable to execute movements or particular sets of motor reactions. The patient cannot vividly realize the motor representations requisite for carrying out motor responses to the external environment, he does not remember how to act; in other words he forgets all about these actions, and when attention is drawn to the action, the consciousness of lack of execution may become an additional factor in bringing about a further disaggregation, the patient thus becoming even more helpless than before.
By different psychopathic methods, however, it can be easily shown that the kinaesthetic memories are not really lost, but can become manifested under favorable opportunities; in other words, they are still present subconsciously.
More often, however, the amnesia as to kinaesthetic memories is in relation to special, organized systems, such, for instance, as writing. The patient loses all ability to write, although he may be able to read written characters; he has all the memories associated with the visual presentations of the letters, but the representations of kinaesthetic sensations are absent. The kinaesthetic sensations themselves, however, may be present and can be brought about by proper external stimuli, but they do not awaken kinaesthetic representations.
Once more we must point out the fact that the phenomena manifested depend on the depth of the disaggregation process. If the process distintegrates the kinaesthetic memories themselves and brings about their total effacement, then there is an absolute and often an irretraceable loss of content and function, unless other moments closely related, unaffected by the process of degeneration, take up the function of the effaced moments.
Should, however, only a disaggregation or dissociation of the systems take place, then the dissociated aggregates sink into the background of consciousness or into subconsciousness, often giving rise to subconscious manifestations. The patient has all the kinaesthetic representations, seemingly lost, but as a matter of fact he is really able to carry out the movements, as it can be shown by different psychopathological methods, only the patient has no power to bring the movements into function. The content is present, the function is absent.
The patient has forgotten how to associate and utilize these systems of kinaesthetic representations. We may say that the patient has not the will to remember them. This fact of not having the will is the characteristic trait of psychopathic maladies, having as their background disaggregation of constellations of mental systems with preservation of content in simpler systems, subconsciously present. From this standpoint we may say that all psychopathic diseases are at bottom amnesias, and that all psychopathic amnesias are in a certain sense aboulias.
Aprosexia is a condition in which the patient is unable to concentrate his attention. The patient appears to be in a state of indifference to all forms of activity. He cannot fix his attention steadily upon anything, he is in a state of apathy. The patient's attention may be suddenly awakened, but he soon again lapses into his indifferent state. The events of life do not interest or move him. If a book is given to the patient or if something is read to him, he appears not to understand its meaning, simply because the attention is not fixed upon it.
The psychomotor disturbances, such as anaesthesia, convulsive movements, etc., usually associated with aprosexia are disregarded by the patient, as if the derangements related to a different person. The attention can sometimes be temporarily fastened on some interesting object or on some amusement in which the patient is ordinarily specially interested. In this state, however, the patient cannot take cognizance of any other event or activity taking place about him, the attention being narrow and limited.
In such states of narrowed attention becomes highly suggestible. The attention is often so narrow and the available energy appears to be so low that a drawing off even of a small amount of energy results in neuron disaggregation, thus giving rise to a state of suggestibility. So great is the tendency to neuron disaggregation that even the momentary use of an extremity may give rise to motor or sensory paralysis, in the same way asthenopia may follow an attempt at reading.
In aprosexia the least fatigue, the least concentration of attention, brings about states of disaggregation, such as hypnoidal, hypnoidic, convulsive, somnambulic or sensory disturbances. This occurs especially when the act of concentration of attention is accompanied by emotion. This is due to the fact that in emotion there is a large draught on neuron energy, giving rise to a more extensive disaggregation with its concomitant psychomotor manifestations.
In aprosexia it is difficult for the patient to acquire new mental material. His life seems to be arrested, it does not receive additional experience. What is acquired is easily forgotten.
Aprosexia is really a form of aboulia. It is a lack of will-power to concentrate the attention on a thing, or circumstance or definite purpose. Aprosexia is rather frequent in different degrees of intensity in psychopathic states, but does not by any means constitute a fundamental trait of psychopathic diseases. Indeed, in some forms of psychopathies the power of concentration of attention may be very great.
Aprosexia may give rise to fixed systems of ideas. Ideas or emotions that have become habitual and, therefore, more stable will in the struggle of the disaggregated systems for the possession of the narrowed attention recur more often and obtain possession of the patient’s mind, finally becoming fixed, in the form of fixed ideas.
The forms of psychopathic fixed ideas differ from the fixed ideas in the insane. In the latter the fixed idea becomes the predominant feature of the patient's attention and around it are grouped other ideas more or less dependent upon the fixed one, often giving rise to the formation of a delusion; in the psychopathic form the fixed idea rises up into the patient's mind more or less automatically. In aboulia, in the amnesias and other psychopathic states the lost experiences and activities are not absolutely lost, but are present in the subconscious.
In the organic diseases these experiences and activities are absolutely lost and cannot be reproduced. The presence of the lapsed states and acquirements can be proven to exist, subconsciously, in all psychopathic cases. The patient, though apparently not fixing his attention in psychopathic aprosexia, really does so subconsciously and the experience lost to the upper consciousness is retained by the subconscious. The presence of these experiences and activities in the subconscious may be brought out by automatic writing, hypnosis, and other psychopathological methods.
The general law of psychopathic disaggregation is what is lost to the upper consciousness is present in the subconscious.