The major symptoms of hysteria : fifteen lectures given in the Medical School of Harvard University [between the fifteenth of October and the end of November, 1906] / by Pierre Janet.

  • Janet, Pierre, 1859-1947.
Date:
1907
    look at an object while touching it, and appreciate the contact without having consciousness of the surrounding noises. At the third moment, he will write at dictation, having the perception of the sound of the voice, of the vision of the letters and of the muscular movements, but forgetting and neglecting all the other elementary sensations, as T, V, T", M', M", V, V", A', A". This individual is absent-minded, and this (Figure 22) is an attempt to schematize what is called normal absent- mindedness. Let us suppose that the field of consciousness becomes still more contracted. The patient can no longer perceive more than two elementary sensations at once. Of necessity too, he reserves this small share of per- ception for the sensations which seem to him, whether right or wrong, the most important, the sensations of sight and hearing. To have consciousness of what is seen or heard is of paramount necessity, and he neglects to perceive the tactile and muscular sensations, thinking he can do without them (Figure 23). At the outset, he might perhaps still turn to them and take them into his field of personal perception, at least for a moment; but, the chance not presenting itself, the bad psychological habit is slowly formed. Nothing is more serious, more obstinate than these moral habits. There is a crowd of maladies that are only psychological tics. One day the patient (for he has truly become one now) is examined by the physician. The latter pinches his left arm, and asks him if he feels it, and the patient, to his great surprise, is obliged to confess that he can no longer feel consciously. The too long-neg-
    lected sensations have escaped his personal perception; he has become anesthetic. You may easily understand that the same notion of the contraction of the field of consciousness equally t' t" M + T ■I- T' + M 4- T' + rp" + M + Fig. 23. — Schema of the contraction of the field of consciousness in hysterical anesthesia. sums up the last phenomenon, that of alternations. It is because the field of consciousness remains contracted, that you can never add one phenomenon on one side without taking one away from another side. If you force the subject, by attracting his attention, to recover
    the sensibility of the left side, he loses it on the right side. If you obtain the total tactile sensibility, the reduction of the visual field increases so much that the subject becomes momentarily blind, a thing we have observed a number of times without having foreseen it. If you wish to enlarge the visual field, the tactile anesthesia will increase. The feebleness of these patients' thinking continues, and they lose on one side what they seem to have regained on another. I am therefore inclined to think that this notion of the retraction of the field of consciousness summarizes the preceding stigmata, and we may say that their funda- mental mental state is characterized by a special moral weakness, consisting in the lack of power, on the part of the feeble subject, to gather, to condense his psychological phenomena, and assimilate them to his ,s?; personality. /,,; I B in i(12 Formerly I stopped at this point my description of the hysterical mental state, implying that all the other disturbances of their character could be connected with the preceding ones. It no longer seems to me absolutely true to-day. The hysteric malady is not absolutely isolated, like other mental disturbances. It is a special form, which constitutes a part of a much more considerable group, and which is more or less distin- guished from the other diseases belonging to this group. The patients we consider are first and above all neuro- paths, individuals whose central nervous system is weakened; then they are hystericals, when their en-
    feeblement takes a particular form. I even affirm that they are more or less hysterical according as their malady takes a more or less decided turn in this determinate direction. The result is that, besides the properly hysterical stigmata, they have general vague disturb- ances, at once psychological and physiological, which belong to all neuropathic individuals. We cannot enter into the enumeration of these disturbances, which, besides, would be more interesting in connection with other subjects, but we must indicate them shortly under the title of common stigmata which you understand now. I will point out to you in this connection certain feel- ings that play a role in the popular conception of hysteria. These subjects feel weak, dissatisfied with themselves; their actions, ideas, feelings, appear to them reduced, covered with a kind of veil. They are, therefore, per- petually tormented by a vague ennui which they cannot overcome. Ennui is the great stigma of all neuropaths. You must not believe that it depends on surroundings; the neuropath feels dull everywhere and always, for no impression any longer brings about with him lively thoughts that make him pleased with himself. These general sentiments of dissatisfaction, these sentiments of incompleteness, as I have christened them elsewhere,1 almost always give to the patient a peculiar attitude or conduct. Either he is sunk in despondency and exhibits a doleful air, or he seeks everywhere for something that can draw him out of this state. Now he has but very few means at his disposal to rouse himself, to come out of such a painful state. Either 1 "Obsessions et psychasthenic," 1903, I, p. 264.
    he will use physical and moral processes of excitation, walking, jumping, crying, or he will appeal to other persons, and will incessantly ask them to excite him, to revive him through encouragements, through praises, and especially through devotion and love. You see what will result from these needs. These patients will be, at the same time, plaintive and agitated, they will commit all kinds of eccen- tricities, because eccentricity excites them and draws attention to them. They must needs attract atten- tion to themselves, in order that people may take an interest in them, speak to them, praise, and, above all, love them. This need of attracting attention, of being praised and loved, is one of the things that have been most remarked. In my opinion it has always been wrongly interpreted. First of all, it is a clinical error to ascribe this char- acter to hysteria. It sometimes exists in a very high degree with hystericals, but it is by no means a stigma peculiar to this malady; it exists as well in the psy- chasthenic. The amorous manias of doubters and of patients laboring under obsessions, their mania of jealousy, their need of attracting attention to themselves, are often much stronger and especially more enduring than with hystericals. This remark has very often caused errors of diagnosis. Besides these feelings of incompleteness, we might enumerate with our hystericals, as with all neurasthenics whatsoever, the innumerable lapses of all the mental junctions. We note in the intelligence a certain ap- parent vivacity, associated with a fundamental state of