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Originally published in:
Collected Papers on Analytical Psychology
(1916)
In that wide field of psychopathic deficiency where Science has demarcated the
diseases of epilepsy, hysteria and neurasthenia, we meet scattered
observations concerning certain rare states of consciousness as to whose
meaning authors are not yet agreed. These observations spring up sporadically
in the literature on narcolepsy, lethargy, automatisme ambulatoire, periodic
amnesia, double consciousness, somnambulism, pathological dreamy states,
pathological lying, etc.
These states are sometimes attributed to epilepsy, sometimes to hysteria,
sometimes to exhaustion of the nervous system, or neurasthenia, sometimes
they are allowed all the dignity of a disease sui generis. Patients occasionally
work through a whole graduated scale of diagnoses, from epilepsy, through
hysteria, up to simulation. In practice, on the one hand, these conditions can
only be separated with great difficulty from the so-called neuroses, sometimes
even are indistinguishable from them; on the other, certain features in the
region of pathological deficiency present more than a mere analogical
relationship not only with phenomena of normal psychology, but also with the
psychology of the supernormal, of genius. Various as are the individual
phenomena in this region, there is certainly no case that cannot be connected
by some intermediate example with the other typical cases. This relationship in
the pictures presented by hysteria and epilepsy is very close. Recently the view
has even been maintained that there is no clean-cut frontier between epilepsy
and hysteria, and that a difference is only to be noted in extreme cases.
Steffens says, for example "We are forced to the conclusion that in essence
hysteria and epilepsy are not fundamentally different, but that the cause of the
disease is the same but is manifest in a diverse form, in different intensity and
permanence."
The demarcation of hysteria and certain borderline cases of epilepsy, from
congenital and acquired psychopathic mental deficiency, likewise presents the
greatest difficulties. The symptoms of one or other disease everywhere invade
the neighbouring realm, so violence is done to the facts when they are split off
and considered as belonging to one or other realm. The demarcation of
psychopathic mental deficiency from the normal is an absolutely impossible
task, the difference is everywhere only " more or less." The classification in the
region of mental deficiency itself is confronted by the same difficulty. At the
most, certain classes can be separated off which crystallise round some well-
marked nucleus through having peculiarly typical features. Turning away from
the two large groups of intellectual and emotional deficiency, there remain
those deficiencies coloured pre-eminently by hysteria or epilepsy (epileptoid)
or neurasthenia, which are not notably deficiency of the intellect or of feeling.
It is pre-eminently in this region, insusceptible of any absolute classification,
that the above-named conditions play their part. As is well known, they can
appear as part manifestations of a typical epilepsy or hysteria, or can exist
separately in the realm of psychopathic mental deficiency, where their
qualifications of epileptic or hysterical are often due to the non-essential
accessory features. It is thus the rule to count somnambulism among
hysterical diseases, because it is occasionally a phenomenon of severe
hysteria, or because mild so-called hysterical symptoms may accompany it.
Binet says: " Il n'y a pas une somnambulisme, etat nerveux toujours identique
a lui-meme, il y a des somnambulismes." As one of the manifestations of a
severe hysteria, somnambulism is not an unknown phenomenon, but as a
pathological entity, as a disease sui generis, it must be somewhat rare, to
judge by its infrequency in German literature on the subject. So-called
spontaneous somnambulism, resting upon a foundation of hysterically-tinged
psychopathic deficiency, is not a very common occurrence and it is worth while
to devote closer study to these cases, for they occasionally present a mass of
interesting observations.
Case of Miss Elise K
., aged 40, single ; book-keeper in a large business ; no
hereditary taint, except that it is alleged a brother became slightly nervous
after family misfortune and illness. Well educated, of a cheerful, joyous nature,
not of a saving disposition, she was always occupied with some big idea. She
was very kind-hearted and gentle, did a great deal both for her parents, who
were living in very modest circumstances, and for strangers. Nevertheless she
was not happy, because she thought she did not understand herself. She had
always enjoyed good health till a few years ago, when she is said to have been
treated for dilatation of the stomach and tapeworm. During this illness her hair
became rapidly white, later she had typhoid fever. An engagement was
terminated by the death of her fiance from paralysis. She had been very
nervous for a year and a half. In the summer of 1897 she went away for
change of air and treatment by hydropathy. She herself says that for about a
year she has had moments during work when her thoughts seem to stand still,
but she does not fall asleep. Nevertheless she makes no mistakes in the
accounts at such times. She has often been to the wrong street and then
suddenly noticed that she was not in the right place. She has had no giddiness
or attacks of fainting. Formerly menstruation occurred regularly every four
weeks, and without any pain, but since she has been nervous and overworked
it has come every fourteen days. For a long time she has suffered from
constant headache. As accountant and book-keeper in a large establishment,
the patient has had very strenuous work, which she performs well and
conscientiously. In addition to the strenuous character of her work, in the last
year she had various new worries. The brother was suddenly divorced.
In addition to her own work, she looked after his housekeeping, nursed him
and his child in a serious illness, and so on. To recuperate, she took a journey
on the 13th September to see a woman friend in South Germany. The great
joy at seeing her friend, from whom she had been long separated, and her
participation in some festivities, deprived her of her rest. On the 15th, she and
her friend drank half a bottle of claret. This was contrary to her usual habit.
They then went for a walk in a cemetery, where she began to tear up flowers
and to scratch at the graves. She remembered absolutely nothing of this
afterwards. On the 16th she remained with her friend without anything of
importance happening. On the 17th her friend brought her to Zurich. An
acquaintance came with her to the Asylum ; on the way she spoke quite
sensibly, but was very tired. Outside the Asylum they met three boys, whom
she described as the " three dead people she had dug up." She then wanted to
go to the neighbouring cemetery, but was persuaded to come to the Asylum.
She is small, delicately formed, slightly anaemic. The heart is slightly enlarged
to the left, there are no murmurs, but some reduplication of the sounds, the
mitral being markedly accentuated. The liver dulness reaches to the border of
the ribs. Patella-reflex is somewhat increased, but otherwise no tendon-
reflexes. There is neither anaesthesia, analgesia, nor paralysis. Rough
examination of the field of vision with the hands shows no contraction. The
patient's hair is a very light yellow- white colour; on the whole she looks her
years. She gives her history and tells recent events quite clearly, but has no
recollection of what took place in the cemetery at C. or outside the Asylum.
During the night of the 17th-18th she spoke to the attendant and declared she
saw the whole room full of dead people looking like skeletons. She was not at
all frightened, but was rather surprised that the attendant did not see them
too. Once she ran to the window, but was otherwise quiet. The next morning
while still in bed, she saw skeletons, but not in the afternoon. The following
night at four o'clock she awoke and heard the dead children in the
neighbouring cemetery cry out that they had been buried alive. She wanted to
go out to dig them up, but allowed herself to be restrained. Next morning at
seven o'clock she was still delirious, but recalled accurately the events in the
cemetery at C. and those on approaching the Asylum. She stated that at C.
she wanted to dig up the dead children who were calling her. She had only torn
up the flowers to free the graves and to be able to get at them. In this state
Professor Bleuler explained to her that later on, when in a normal state again,
she would remember everything. The patient slept in the morning, afterwards
was quite clear, and felt herself relatively well. She did indeed remember the
attacks, but maintained a remarkable indifference towards them. The following
nights, with the exception of those of the 22nd and the 25th September, she
again had slight attacks of delirium, when once more she had to deal with the
dead. The details of the attacks differed, however. Twice she saw the dead in
her bed, but she did not appear to be afraid of them, but she got out of bed
frequently because she did not want "to inconvenience the dead" ; several
times she wanted to leave the room.
After a few nights free from attacks, there was a slight one on the 30th Sept.,
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Originally published in:
Collected Papers on Analytical Psychology
(1916)
In that wide field of psychopathic deficiency where Science has demarcated the
diseases of epilepsy, hysteria and neurasthenia, we meet scattered
observations concerning certain rare states of consciousness as to whose
meaning authors are not yet agreed. These observations spring up sporadically
in the literature on narcolepsy, lethargy, automatisme ambulatoire, periodic
amnesia, double consciousness, somnambulism, pathological dreamy states,
pathological lying, etc.
These states are sometimes attributed to epilepsy, sometimes to hysteria,
sometimes to exhaustion of the nervous system, or neurasthenia, sometimes
they are allowed all the dignity of a disease sui generis. Patients occasionally
work through a whole graduated scale of diagnoses, from epilepsy, through
hysteria, up to simulation. In practice, on the one hand, these conditions can
only be separated with great difficulty from the so-called neuroses, sometimes
even are indistinguishable from them; on the other, certain features in the
region of pathological deficiency present more than a mere analogical
relationship not only with phenomena of normal psychology, but also with the
psychology of the supernormal, of genius. Various as are the individual
phenomena in this region, there is certainly no case that cannot be connected
by some intermediate example with the other typical cases. This relationship in
the pictures presented by hysteria and epilepsy is very close. Recently the view
has even been maintained that there is no clean-cut frontier between epilepsy
and hysteria, and that a difference is only to be noted in extreme cases.
Steffens says, for example "We are forced to the conclusion that in essence
hysteria and epilepsy are not fundamentally different, but that the cause of the
disease is the same but is manifest in a diverse form, in different intensity and
permanence."
The demarcation of hysteria and certain borderline cases of epilepsy, from
congenital and acquired psychopathic mental deficiency, likewise presents the
greatest difficulties. The symptoms of one or other disease everywhere invade
the neighbouring realm, so violence is done to the facts when they are split off
and considered as belonging to one or other realm. The demarcation of
psychopathic mental deficiency from the normal is an absolutely impossible
task, the difference is everywhere only " more or less." The classification in the
region of mental deficiency itself is confronted by the same difficulty. At the
most, certain classes can be separated off which crystallise round some well-
marked nucleus through having peculiarly typical features. Turning away from
the two large groups of intellectual and emotional deficiency, there remain
those deficiencies coloured pre-eminently by hysteria or epilepsy (epileptoid)
or neurasthenia, which are not notably deficiency of the intellect or of feeling.
It is pre-eminently in this region, insusceptible of any absolute classification,
that the above-named conditions play their part. As is well known, they can
appear as part manifestations of a typical epilepsy or hysteria, or can exist
separately in the realm of psychopathic mental deficiency, where their
qualifications of epileptic or hysterical are often due to the non-essential
accessory features. It is thus the rule to count somnambulism among
hysterical diseases, because it is occasionally a phenomenon of severe
hysteria, or because mild so-called hysterical symptoms may accompany it.
Binet says: " Il n'y a pas une somnambulisme, etat nerveux toujours identique
a lui-meme, il y a des somnambulismes." As one of the manifestations of a
severe hysteria, somnambulism is not an unknown phenomenon, but as a
pathological entity, as a disease sui generis, it must be somewhat rare, to
judge by its infrequency in German literature on the subject. So-called
spontaneous somnambulism, resting upon a foundation of hysterically-tinged
psychopathic deficiency, is not a very common occurrence and it is worth while
to devote closer study to these cases, for they occasionally present a mass of
interesting observations.
Case of Miss Elise K
., aged 40, single ; book-keeper in a large business ; no
hereditary taint, except that it is alleged a brother became slightly nervous
after family misfortune and illness. Well educated, of a cheerful, joyous nature,
not of a saving disposition, she was always occupied with some big idea. She
was very kind-hearted and gentle, did a great deal both for her parents, who
were living in very modest circumstances, and for strangers. Nevertheless she
was not happy, because she thought she did not understand herself. She had
always enjoyed good health till a few years ago, when she is said to have been
treated for dilatation of the stomach and tapeworm. During this illness her hair
became rapidly white, later she had typhoid fever. An engagement was
terminated by the death of her fiance from paralysis. She had been very
nervous for a year and a half. In the summer of 1897 she went away for
change of air and treatment by hydropathy. She herself says that for about a
year she has had moments during work when her thoughts seem to stand still,
but she does not fall asleep. Nevertheless she makes no mistakes in the
accounts at such times. She has often been to the wrong street and then
suddenly noticed that she was not in the right place. She has had no giddiness
or attacks of fainting. Formerly menstruation occurred regularly every four
weeks, and without any pain, but since she has been nervous and overworked
it has come every fourteen days. For a long time she has suffered from
constant headache. As accountant and book-keeper in a large establishment,
the patient has had very strenuous work, which she performs well and
conscientiously. In addition to the strenuous character of her work, in the last
year she had various new worries. The brother was suddenly divorced.
In addition to her own work, she looked after his housekeeping, nursed him
and his child in a serious illness, and so on. To recuperate, she took a journey
on the 13th September to see a woman friend in South Germany. The great
joy at seeing her friend, from whom she had been long separated, and her
participation in some festivities, deprived her of her rest. On the 15th, she and
her friend drank half a bottle of claret. This was contrary to her usual habit.
They then went for a walk in a cemetery, where she began to tear up flowers
and to scratch at the graves. She remembered absolutely nothing of this
afterwards. On the 16th she remained with her friend without anything of
importance happening. On the 17th her friend brought her to Zurich. An
acquaintance came with her to the Asylum ; on the way she spoke quite
sensibly, but was very tired. Outside the Asylum they met three boys, whom
she described as the " three dead people she had dug up." She then wanted to
go to the neighbouring cemetery, but was persuaded to come to the Asylum.
She is small, delicately formed, slightly anaemic. The heart is slightly enlarged
to the left, there are no murmurs, but some reduplication of the sounds, the
mitral being markedly accentuated. The liver dulness reaches to the border of
the ribs. Patella-reflex is somewhat increased, but otherwise no tendon-
reflexes. There is neither anaesthesia, analgesia, nor paralysis. Rough
examination of the field of vision with the hands shows no contraction. The
patient's hair is a very light yellow- white colour; on the whole she looks her
years. She gives her history and tells recent events quite clearly, but has no
recollection of what took place in the cemetery at C. or outside the Asylum.
During the night of the 17th-18th she spoke to the attendant and declared she
saw the whole room full of dead people looking like skeletons. She was not at
all frightened, but was rather surprised that the attendant did not see them
too. Once she ran to the window, but was otherwise quiet. The next morning
while still in bed, she saw skeletons, but not in the afternoon. The following
night at four o'clock she awoke and heard the dead children in the
neighbouring cemetery cry out that they had been buried alive. She wanted to
go out to dig them up, but allowed herself to be restrained. Next morning at
seven o'clock she was still delirious, but recalled accurately the events in the
cemetery at C. and those on approaching the Asylum. She stated that at C.
she wanted to dig up the dead children who were calling her. She had only torn
up the flowers to free the graves and to be able to get at them. In this state
Professor Bleuler explained to her that later on, when in a normal state again,
she would remember everything. The patient slept in the morning, afterwards
was quite clear, and felt herself relatively well. She did indeed remember the
attacks, but maintained a remarkable indifference towards them. The following
nights, with the exception of those of the 22nd and the 25th September, she
again had slight attacks of delirium, when once more she had to deal with the
dead. The details of the attacks differed, however. Twice she saw the dead in
her bed, but she did not appear to be afraid of them, but she got out of bed
frequently because she did not want "to inconvenience the dead" ; several
times she wanted to leave the room.
After a few nights free from attacks, there was a slight one on the 30th Sept.,
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