Table of Contents
RECURRENT MENTAL SYSTEMS
We can pass now to a consideration of functional nervous and mental diseases which I have described by the term “recurrent mental states.” Under recurrent psycho-motor states I include 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 these various states are found in many a symptom-complex of the insanities, but they are still more often met with in the functional mental and nervous diseases,—in functional psychosis. In fact, in many forms of hysteria, in many types of neurasthenia, or of the more fashionable “psychoasthenia,” recurrent psychomotor states constitute the main and often the only symptoms of the malady.
The recurrent psychomotor states, with their great wealth of symptoms, appear almost mysterious in their onset and origin; they flash lightning-like on the patient’s mind, get possession of it, then disappear, only to reappear on some other favorable occasion. Others persist in consciousness, with but slight remissions, and keep the patient in a continuous agony. The patients are aware of the absurdity of the ideas and impulses, but they are powerless to resist them. They regard such onsets somewhat in the same way as the epileptics regard their attacks, which set in against will and consciousness, and which are not subject to control. I do not mean by it to indicate that all those psychic attacks are of an epileptic origin, but I wish only to point out the fact that there is some analogy between recurrent psychomotor states and epilepsy, inasmuch as both of them come on as sudden, uncontrollable attacks.
It is true that in some cases we can drive the analogy more closely, because in some of the forms of recurrent psychomotor states we observe somewhat similar symptoms. We find the presence of a distinct aura, sensory in character, a sense of oppression, and sometimes a profound disturbance of consciousness during the attack, the patient occasionally being insensible to external stimuli. In some cases we even find a dazed state of consciousness, headache, and a condition of extreme fatigue after the attack is over.
This resemblance, however, is but a superficial one. Recurrent psychomotor states differ widely from epilepsy. Many writers are deceived by this superficial resemblance and regard such attacks as “larval epilepsy,” as “psychic equivalent of epilepsy.” Such a view is entirely unjustified on a close scientific analysis of the facts. The most that can be done is to draw an analogy between the attacks of insistent states and the attacks of epilepsy, but we must bear in mind that analogy is not a safe method, as one may find himself reasoning on the same lines with the Esquimaux who regards glass as a kind of ice.
It can be shown by a rigid study of the cases of recurrent psychomotor states reveals the presence of subconscious activities which become manifested as insistent ideas, uncontrollable emotions, irresistible impulses and various psychomotor states closely simulating epileptic attacks. It is from this standpoint that we may designate such simulating attacks as psychic epilepsy, not because they are psychic attacks, “equivalents” of real epilepsy, but they are pseudo-epileptic attacks of a purely psychic origin,—they are manifestations of subconscious activities.
One general characteristic of these psychomotor states is their recurrence with the same or similar content of consciousness and with the same or similar motor reactions. The patient thinks, feels, wills and acts the same way. Subconscious dissociated states belong to the type of recurrent moment consciousness, a type characteristic of the lower forms of animal life, responding to external environment with the same adjustments, with the same psychomotor reactions. This biological type of mental activity is described by me in “The Foundations.” From this standpoint, we may regard recurrent psychomotor states as a reversion to the lower forms of mental life.
The suddenness of the attack, the uniformity of the manifestations of the symptom-complex, the uncontrollable, overpowering effect on the patient’s personal consciousness are all due to the same underlying factor of dissociation of the patient’s subconsciousness. A disaggregated, subconscious life gives rise to recurrent psychomotor states,—to insistent ideas, imperative concepts, uncontrollable emotions, irresistible impulses, and to states of “psychic” epilepsy.
There are many cases of insistent ideas and irresistible impulses which seem to contradict this law of uniformity and recurrence of psychomotor states which are seemingly of an evanescent character,—they are like stray comets coming out of the depths of space only to disappear again and never to recur. A close investigation will reveal the fact that the contradiction is but an apparent one. The various insistent ideas and impulses can in reality be referred to some few fundamental states persistently present in the subconscious, and only appearing under different forms in the personal consciousness; they are like so many leaves and fruits of a single plant whose roots are planted firmly in the subsoil of mental life. We may then say that all insistent mental states take their origin in a disaggregated subconsciousness and are periodic or recurrent in character, and as such may well be designated as recurrent, psychomotor states.
We may possibly get better oriented in the vast domain of insistent mental states, if we make some provisional classification. We may classify insistent mental states according to content and form. Classified according to content, we may divide insistent mental states into:
1. Conceptual or ideational.
According to form they may be classified as:
In the conceptual forms it is the general, abstract idea that keeps on troubling the patient, such as the nature of God, of Christ, or the nature of the Trinity, and so on. The insistent ideas are here more or less of a metaphysical character. The patient does not feel satisfied with any answer. In many different ways the patient tries to raise difficulties to all kinds of possible answers. He tries to find loop-holes to escape from any solution, so as to have the question remain in full force.
Were it not for the intense anxiety which is sometimes associated with such states, one would say that the patient delights in the mere process of questioning. He wants the problem, but refuses obstinately to accept the solution. In reality, however, it is not a matter of delight to the patient to persist in a state of problematic consciousness, so to say. Logical as the solution may appear to the patient, the problem is ever forced on the patient's personal consciousness, for it is the work of dissociated states, having their origin in recurrent systems or settings of a disaggregated subconsciousness.
The insistent ideo-motor states refer to some act or motor activity which the patient has to reason out so as to know all the pros and cons, such as, whether it is right to play cards, or read a Sunday newspaper, or to visit theatre, or to travel on a Sabbath day. The patient gets lost in argumentations and discussions. He employs the most subtle casuistry, but he always meets with difficulties, never coming to any definite conclusions. His mind is set entirely on the thought of the action which is never to become a reality. The patient’s will is thus paralyzed, he is in a state of doubt, indecision and hesitancy. The patient cannot accept any decision, however logical, as the same problem ever surges intense anxiety which is up in his mind with renewed vigor. What avails the patient’s reason against the blind dissociated forces of systems or ‘settings’ as some prefer to put it, stirring in the depths of a disaggregated subconsciousness?
The insistent sensory states comprise a wide domain of manifestations. All the insistent emotional states could be classed as sensory, since an emotion may be regarded as a massive complex of sensory elements coming from various parts of the organism.
Under this head we may include the functional states of depression and anxiety as well as the various phobias. Here also belong the various pains, headaches, hemicranias or migraines, when forming the main or central symptom of functional psychosis. The sensory symptoms of the hysterias, such as the anaesthesias and hyperaesthesias, belong to the same category.
All those states present the typical characteristics of the recurrent moment-consciousness. All of them can be referred to dissociated experiences, to insulated mental systems, ‘settings,’ ‘complexes’ persisting in a disaggregated subconsciousness.
What is manifested as the attack with the whole symptom-complex characteristic of it can be traced by a rigid analysis to an original experience which has occurred during the process of dissociation. The dissociated subconscious experience, system, ‘setting,’ ‘complex’ keeps on recurring as an attack. What goes under the name of hysterical stigmata can in reality be traced to dissociated, subconscious experiences.
During the attack the patient may preserve his personal consciousness fully or but partially. In such a case it appears as if two centers of consciousness are at work, one beside the other and one independent of the other: The patient may be aware of the new independent forces which are foreign to him, but which have apparently taken possession of him in spite of himself. The self seems to be torn in two, and consciousness is doubled. A new, incipient, parasitic personality is being formed in the recesses of the subconscious, a parasitic personality having a will of its own and no longer subject to the patient's personal control.
In some cases, the dissociated systems forming the parasitic personality may become fully manifested without the patient being aware of it. We have two personalities in one organism working side by side, each apparently ignoring or not taking cognizance of the existence of the other.
In other cases, again, the subconscious personality seems to take full possession of the principal focus of consciousness, the parasitic personality swamps the personal consciousness which sinks below the level of active mental life, becomes submerged, and no longer enters into active relations with the external environment. During such an attack the character of the person is changed and the memory is not bridged over, as it is in the course of the normal associative activity, the functional recognitive elements are missing, consciousness may know of those experiences, but does not know them as its own.
The phenomena of recurrent or insistent mental states range through various stages of dissociation; they can all by analysis be referred to a condition of disaggregated, subconscious, mental systems.
The sensori-motor and purely motor manifestations are closely interrelated; sometimes the sensory and sometimes the motor symptoms predominate in the total symptom-complex, when examined from a clinical standpoint. Here belong the various functional or hysterical, visceral disturbances, hemiplegias, paraplegias, paralyses and contractures, also the functional tremors of psychic origin, all the states of “epilepsy” of the psychic type known under the name of “psychic epilepsy” which so closely simulate typical epileptic attacks. Finally, to the same category belong the various types of tics.
The dissociated subconscious states may appear in consciousness in a disconnected, disseminated form,—they may appear as broken-up sentences, phrases and sounds, or as images having no relation with one another; they may come and go in great confusion, often producing a chaotic condition in the patient’s mind. The ideas keep on chasing one another, turning in circles without any rhyme and reason until the patient feels tired, exhausted, and dazed by the kaleidoscopic whirl of the storm of ideas. Such insistent states may be designated as desultory.
Quite often, however, the recurrent states are paranoidal in form. The ideas and feelings are well organized. The patient can give a clear, interconnected account of his insistent states. In fact, the insistent states stand out in the patient's mind so clear and definite that the patient can give a detailed analysis of all the minutiae of the condition. It seems as if his gaze is almost microscopically distinct, the least relation and outline are noticed.
The insistent mental states seem as if fixed, so that the mental picture is strongly impressed on the patient’s consciousness, and the vaguest detail cannot escape scrutiny. A wealth of associations is grouped around the central experience of the recurrent mental states, which form nuclei of highly organized groups of mental systems, arranged in an orderly array and logical relationship, forming an organic whole of a high degree of organization, the nature of which cannot be understood without a thorough exploration of the subconscious. Such recurrent mental states may be described as systematized.
All those various manifestations can, by close investigation into the patient’s subconscious life, be traced to active dissociated systems, having their origin in a disaggregated subconsciousness.