  Copyright laws are changing all over the world, be sure to check the copyright laws for your country before posting these files!! Please take a look at the important information in this header. We encourage you to keep this file on your own disk, keeping an electronic path open for the next readers. Do not remove this. **Etexts Readable By Both Humans and By Computers, Since 1971** *These Etexts Prepared By Hundreds of Volunteers and Donations* The Journal of Abnormal Psychology Volume 10March, 1998 [Etext #1226] Scanned by Charles Keller with OmniPage Professional OCR software We are now trying to release all our books one month in advance of the official release dates, for time for better editing. We produce about two million dollars for each hour we work. 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[2] Honor the etext refund and replacement provisions of this "Small Print!" statement. *END*THE SMALL PRINT! FOR PUBLIC DOMAIN ETEXTS*Ver.04.29.93*END* Scanned by Charles Keller with OmniPage Professional OCR software The Journal of Abnormal Psychology EDITOR ASSISTANT EDITOR FOR BRITISH ISLES ASSOCIATE EDITORSHUGO MUNSTERBERG, M.D., PH.D. JAMES J. PUTNAM, M.D. AUGUST HOCH, M.D. BORIS SIDIS, M.A., PH.D., M.D. CHARLES L. DANA, M.D. ADOLPH MEYER, M.D. WILLIAM McDOUGALL, M.B. VOLUME X1915-1916 RICHARD G. BADGER THE GORHAM PRESSBOSTONReprinted with the permission of The American Psychological Volumes 1-15 of this title were published as Volumes 16-19 of this title were published as first reprinting, 1964 Printed in the United States of America ORIGINAL ARTICLES—VOLUME XHysteria as a Weapon in Marital Conflicts. By. A. Myerson, M. D. INDEX TO SUBJECTS(Figures with asterisks indicate original articles. Figures without asterisks indicate abstracts, reviews, society reports, correspondence and discussions. The names of the authors ar given in parenthesis). American Psychopathological Association, Sixth Annual Meeting INDEX TO SUBJECTS CONTRIBUTORS TO VOLUME X THE JOURNAL OF ABNORMAL PSYCHOLOGYHYSTERIA AS A WEAPON IN MARITAL CONFLICTSBY A. MYERSON, M.D.Clinical Director and Pathologist, Taunton State Hospital Taunton State THE progress in our understanding of hysteria has come largely through the elaboration of the so-called mechanisms by which the symptoms arise. These mechanisms have been declared to reside or to have their origin in the subconsciousness or coconsciousness. The mechanisms range all the way from the conception of Janet that the personality is disintegrated owing to lowering of the psychical tension to that of Freud, who conceives all hysterical symptoms as a result of dissociation arising through conflicts between repressed sexual desires and experiences and the various censors organized by the social life. Without in any way intending to set up any other general mechanism or to enter into the controversy raging concerning the Freudian mechanism, which at present is the storm center, the writer reports a case in which the origin of the symptoms can be traced to a more simple and fairly familiar mechanism, one which, in its essence, is merely an intensification of a normal reaction of many women to marital difficulties. In other words, women frequently resort to measures which bring about an acute discomfort upon the part of their mate, through his pity, compassion and self-accusation. They resort to tears as their proverbial weapon for gaining their point. In this case the hysterical symptoms seem to have been the substitute for tears in a domestic battle. Case History—Patient is a woman, aged thirty-eight, of American birth and ancestry. Family history is negative so far as mental disease is concerned, but there seems to have been a decadence of stock as manifested in the steady dropping of her family in the social scale. She is one of two children, there being a brother, who, from all accounts, is a fairly industrious, but poverty-stricken farmer. Her early childhood was spent in a small village in Massachusetts. She received but little education, largely because she had no desire to study and no aptitude for learning, although she is by no means feeble-minded. The menstrual periods started at fourteen, and have been without any noteworthy accompanying phenomena ever since. History is negative so far as other diseases are concerned. She worked as a domestic and in factories until she was married for the first time at the age of twenty. She had no children by this marriage. It is stated on good authority that she took preventive measures against conception and if pregnant induced abortion by drugs and mechanical measures. At the end of eight years there was a divorce. Just which one of the partners was at fault is impossible to state, but that there was more than mere incompatibility is evident by the reticence of all concerned. Shortly afterward, she married her present husband with whom she has lived for about nine years. He is a steady drinker, but is a good workman, has never been discharged, and, apparently, his drinking habits do not interfere with the main tenor of his life. He lives with the patient in a small house of which they occupy two garret rooms, meagerly furnished, though without evidence of dire poverty. From her fifteenth year the patient has been subject to fainting spells. By all accounts they come on usually after quarrels, disagreements or disappointments. They are not accompanied by blanching, by clonic or tonic movements of any kind, they last for uncertain periods ranging from five minutes to an hour or more, and consciousness does not seem to be totally lost. In addition she has vomiting spells, these likewise occurring when balked in her desires. She is subject to headaches, usually on one half of the head, but frequently frontal. There is no regular period of occurrence of these headaches except that there is also some relation to quarrels, etc. On several occasions the patient has lost her voice for short periods ranging from a few minutes to several hours following particularly stormy domestic scenes. On July 29 of this year she was suddenly paralyzed. That is to say, she was unable to move the right arm, the right leg, the right side of the face, and she lost the power of speech entirely; there was complete aphonia. This "stroke" was not accompanied by unconsciousness, but was preceded by severe headache and much nausea. During the three weeks that followed she remained in bed, recovering only the function of the arm. Her husband fed her by forcing open her mouth with a spoon. She did not lose control of the sphincters. As she manifested no other progress to recovery despite the administration of drugs, numerous-rubbings and liniments, the physician in charge called the writer into consultation. Physical Examination Aug. 20—A well-developed, fairly well nourished woman, appearing to be about thirty-five years of age. Face wears an anxious expression and she shuns the examiner's direct gaze. Movements of the right hand and arm are now fairly free. There is no appreciable difficulty in any of its functions according to tests made for ataxia, strength, recognition of form, finer movements, etc., in fact, she uses this hand to write with, as she cannot talk at all. Such writing is free, unaccompanied by errors in spelling, there is no elision of syllables and no difficulty in finding the words desired. The face is symmetrical on the two sides. There is no evidence of paralysis of the facial muscles. In fact, the cranial nerves, by detailed examination, are intact, except in so far as respiration and speech are concerned. The right leg is held entirely spastic, the muscles on both sides of the joints, that is, flexors and extensors, being equally contracted. It is impossible to bend this leg at any joint except by the use of very great force. The reflexes everywhere are lively but are equal on the two sides, and none of the abnormal reflexes is present, including in this term Babinski, Gordon and Oppenheim. Sensation—There is very markedly diminished reaction to pin prick all over the right side, including face, arm, chest, leg and tongue. In some places complete analgesia obtains. Reaction to touch is likewise diminished and recognition of heat and cold is impaired. Speech—There is complete loss of the ability to make any sound, either voiced or whispered; that is to say, there is complete aphonia,— there is loss of all voice. The patient understands everything, however, and writes her answers to questions rapidly and correctly. She can read whatever is written, there is no difficulty in the recognition of objects, no evidence of any aphasia whatever. The diagnosis—hysteria—can hardly be doubted. The history of headaches, fainting spells without marked impairment of consciousness, vomiting spells, hemianaesthesia, hemianalgesia, complete aphonia and an exaggerated paralysis, not only of the right leg, but of the ability to thrust out the tongue, while at the same time all other cranial functions were unimpaired together with the apparent health of the individual in every other respect, make up a syndrome hardly to pass unrecognized. Treatment—The patient was entirely inaccessible to direct suggestion, for no amount of assurance that her leg was all right enabled her to move it. When such suggestions were made, she shook her head firmly and conclusively, and this is true of suggestions concerning speech. This point is of importance in the consideration of the mechanism. Attempts at hypnotism failed ingloriously. Psychoanalysis was deferred for the time, and recourse was had to indirect suggestion and re-education. The first function to be restored was the power of bending the leg which hitherto had been held entirely spastic. The patient was assured that while she had lost the power of using the limb, a little relaxation of the muscles of the front of the leg would permit it to be bent. Her attention was distracted while at the same time a firm, steady pressure was put upon the leg above and below the knee joint and advantage taken of every change in the tone of the muscles involved in keeping the leg extended. Little by little the leg was bent until finally it was completely flexed, this for the first time in three weeks. Her attention was called to this fact and she was assured that upon the physician's next attempt to bend her leg, resistance would be lessened and she would be able to aid somewhat as well. This proved true. Then the leg was only partly supported by the physician while the patient was assured that with his help she would be able to bend it more freely. From this, she passed on to the ability to move the leg without any assistance on the part of the writer. After having been given exercise in bending the leg for some twenty or thirty times, with complete restoration of this ability, she was induced to get out of bed, and while standing erect she was suddenly released by the physician. She swayed to and fro in a rather perilous manner but did not fall. Finally, by gradation of tasks set, by a judicious combination of encouragement and command, she was enabled to walk. She was then put to bed and assured that upon the physician's next visit she would be taught to walk freely. Meanwhile, the husband was instructed that he must not allow her to stay in bed more than an hour at a time and that she must come to the table for her meals. On the physician's next visit, two days later, it was found that the husband had not been able to induce his wife to come to the table, and that he had been unable to get her to walk. The physician then commanded her to get out of bed, which she did with great effort. She was then put back to bed and instructed to get up more freely and without such effort, demonstration being a visual one, in that she was shown how best to accomplish the task set. Finally, at the end of the visit, she was walking quite freely and promised in writing, for she had not as yet learned to talk, that she would eat at the table. The next day instruction was commenced along the lines of speech. Upon being asked to thrust out her tongue, that organ was protruded only a short distance, and she claimed, in writing, to be unable to protrude it further. Thereupon it was taken hold of by a towel and alternately withdrawn from and replaced into the mouth. After a short period of such exercise she was enabled to thrust the tongue in and out. She was then instructed to breathe more freely; that is to say, to take short inspirations and to make long expirations, this in preparation for speech. She was unable to do this, the expiration being short, jerky and interrupted. Thereupon the examiner placed his two hands, one on each side of her chest, instructed her to inspire, and when she was instructed to expire forced his hands against her ribs in order to complete the expiratory act. After about fifteen or twenty minutes of this combination of instruction and help the patient was able to breathe by herself and freely. She was then instructed to make the sound "e" at the end of expiration. This she was unable to do at first, but upon persistence and passive placing of her mouth in the proper position for the sound, she was able to whisper "e." From this she rapidly went on to the other vowel sounds. Then the aspirate "h" was added, later the explosives, "p," etc., until at the end of about two hours she was enabled to whisper anything desired. Her husband was instructed not to allow her to use her pencil any more, and she promised faithfully to enter into whispered conversation with him, although it was evident that she promised this with reluctance. Upon the next visit, two days later, she was still whispering, and when asked if she could talk aloud, shook her head and whispered "No," that she was sure she could not. Efforts to have her make the sound "a," or any of the vowels in a voiced manner failed completely. She was then instructed to cough. Although it is evident that a cough is a voiced sound, she was able to do this, in a very low and indistinct manner. She was then instructed to add the sound "e" at the end of her cough. This she did, but with difficulty. Finally, after much the same manoeuvering which has been indicated in the account of how she was instructed to whisper, she talked freely and well. When this was accomplished the husband was instructed to have her dress herself and to take her to: some place of amusement, and to keep her out of doors almost continuously. At all times the patient had complained of a pain in her side which she claimed was the root of all her trouble. It had been "doctored," to use her term, by all the physicians in the city and, it was alleged, came after she had been lifting a paralyzed old lady in the house across the way. Despite all treatment this pain had not disappeared and the various diagnoses made—strain, liver trouble, nervous ache had not sufficed to console the patient or to relieve her. There was no local tenderness, no pain upon movement, but merely a steady ache. No physical basis whatever for this trouble could be found. Her medicine for the relief of it was discontinued, and so, too, were certain medicines she had been obtaining for sleep. Upon each visit the husband and wife had been informed by the physician that he did not believe the trouble was organic in its nature, that he believed it depended upon some ideas that the patient had, and that, furthermore, it was the result of some mental irritation, compared for the purpose of fixing the point to a festering sore and which, if removed, would permanently eliminate the liability of such seizures. The patient and her husband were informed that the physician intended to delve to the bottom of this trouble and, by deferring investigation as to its exact nature until the symptoms had practically disappeared, a way was cleared to obtain their complete confidence, and at the same time to overcome any unwillingness to accept a psychical explanation for such palpable physical ills. This latter point is of importance in dealing with uneducated persons. For the most part, they are intensely practical and materialistic, and a mere idea does not seem to them to account for paralysis although, of course, such skepticism is usually accompanied by superstitious credulity along other lines. Moreover, by establishing himself as a sort of miracle worker (for so the cure was regarded), it would be understood that curiosity was not the basis for the investigation into the domestic life of the patient and her husband, but that a desire to do more good inspired it. The physician started his investigation with the statement that he knew from past experience that some conflict was going on between husband and wife; that there was some source of irritation which caused these outbursts of symptoms on the part of the patient, and that unless they told him what was behind the matter his help would be limited to the relief of the present symptoms. It was firmly stated that any denial of such discord would not be believed, and that only a complete confidence would be helpful. The patient, who had been listening to this statement with lowered eyes and nervously intertwining fingers, then burst out as follows: There WAS trouble between them and there always would be until it was settled right,—this with much emphasis and emotional manifestation. So long as he insisted on living where they did, just so long would she quarrel with him. She did not like the neighbors, especially the woman downstairs, she did not like the room, she did not like anything about the place or the neighborhood, hated the very sight of it and would never cease attempting to move from there. It came out on further questioning that the woman downstairs, whom the patient particularly disliked, was a storm center in that the wife was jealous of her, although she adduced no very good reasons for her attitude. Moreover, the patient stated that she wished to move to a district where she had friends, though other sources of information showed that these friends were of a rather unsavory character. Her husband was absolutely determined not to move from his house. He stated that he would rather have her go away and stay away than move from there; that the rent was too high in the place where she wanted to move, and that the rent was suitable where they were. Moreover, for his part, he hated his wife's desired neighborhood and would never consent to changing his residence from the present place to the other. It came out that her fainting and vomiting spells and headaches usually followed bitter quarrels, and on other matters these symptoms usually placed the victory on her side. On this particular point, however, her husband had remained obdurate. It was shown that the present attack of paralysis and aphonia, symptoms of an unusually severe character, followed an unusually bitter quarrel which had lasted for a whole day and into the night of the attack. The question arises at this point, "Why did this attack take the form of a paralysis?" At first this seemed unaccountable, but later it was found that the old woman for whom the patient had been caring had a "stroke" with loss of the power to speak, though no aphonia. The patient had gone to work as a sort of nurse for the old woman under protest, for she did not wish to do anything outside of her own light housekeeping, although the added income was sorely needed since work was slack in her husband's place of employment. The pain in her side caused her to quit work as nurse, much to her husband's dissatisfaction until she convinced him that her pain and disability were marked. It was evident that despite the controversies and quarrels that prevailed in the household, her husband sincerely loved her, for he stayed away from his work during the three weeks of her illness to act as her nurse. Moreover, he spent his earnings quite freely in consulting various physicians in order to cure her. It was shown from what both the patient and her husband said, and from the whole history of their marital life, that she had used as a weapon, though not with definite conscious purpose, for the gaining of her point in whatever quarrel came up, symptoms that are usually called hysterical; that is to say, vomiting, fainting spells and pains without definite physical cause. This method usually assured her victory by playing upon her husband's alarm and concern as well as by causing him intense dissatisfaction. With the advent of a disagreement which could not be settled her way by her usual symptoms, there followed, not by any means through her volition or conscious purpose, more severe symptoms; namely, spastic paralysis and aphonia, which, in a general way, were suggested by her patient. There seems to have been, and there undoubtedly was, a sexual element entering into this last quarrel; namely, that she was jealous of the woman who lived downstairs, though without any proof of her husband's infidelity. Both patient and her husband finally agreed to the physician's statement that the symptoms were directly referable to the quarrels, although both claimed that it had never occurred to them before, a fact made evident by their questions and objections. No psychoanalysis was possible in this case, for the man and woman belong to that class of people who feel that they are cured when their symptoms are relieved. It may be argued, without any possibility of contradiction, that a psychoanalysis would have revealed a deeper reaching mechanism and that a closer relationship and connection between the paralysis and other symptoms with the past sexual experiences of the patient could have been established. This last claim may be doubted, however, for there is always a gap between the alleged "conversion" of mental states into physical symptoms, and this gap can in no case be bridged over even by Freud's own accounts. The conversion always remains as a mere statement and is a logical connection between the appearance of physical symptoms and the so-called conflicts; in other words, it is an explanation and not a FACT. Compared with the complex Freudian mechanism, with its repressions, compressions, censors, dreams, etc., the conception of hysterical symptoms as a marital weapon as comparable with the tears of more normal women seems very simple and probably too simple. In fact, it does not explain the hysteria, it merely gives a USE for its symptoms, and the writer is driven back to the statement that the neuropathic person is characterized by his or her bizarre and prolonged emotional reactions, which, in turn, brings us back to a defect ab origine. And the Freudians, starting out to prove that the experiences of the individual ALONE cause hysteria, by pushing back the TIME of those experiences to INFANCY (and lately to foetal life), have proved the contrary, that is, the inborn nature of the disease. THE ANALYSIS OF A NIGHTMAREBY RAYMOND BELLAMYProfessor of Education, Emory and Henry College, Emory, Va. A FEW nights ago I experienced a very interesting nightmare, and, immediately on awakening, I got up and recorded it, analyzing it as fully as I was able. This is the first nightmare I have had for several years, and I never was especially addicted to them. Two years ago I made an introductory study of dreams,[1] and at that time dreamed profusely, but recently I have been dreaming very rarely, and when I do dream the experiences are not at all vivid. I use the term "nightmare" in a somewhat popular sense to mean a painful or frightful dream accompanied by physical disturbances, such as heart flutter and disturbances of breathing, and followed on awakening by a certain amount of the painful emotion which was a part of the dream. Accepting this definition, the experience which I have to relate was a typical nightmare. A few words of explanation are necessary to give the proper setting for the experience. At present I am teaching in the summer school at this place and my wife is visiting her folks; during her absence, in order to keep from getting too lonesome, I invited one of the young men in the summer school to come and room with me and keep me company. With this as an explanation, I shall copy the original account of the dream as nearly as possible, making a few corrections of the barbarous language I used in the half-asleep state. [1] At Clark University, 1912-1913. On the night of August 9, 1914, I went to bed at 11.40 o'clock and was soon asleep. About 3.40 in the morning, the young man, F. K. S., roused me and I awoke weak, scared, and with a fluttering heart; he said I had been making a distressing sort of noise, but he could not distinguish any words. Immediately, I judged that the dream was caused by my lying on my back, and in an uncomfortable position. As a rule I do not sleep on my back, but for some reason I had gone to sleep that way this time. Also, it had been raining when I went to bed, and I had put the windows down, and the ventilation was bad. The dream, as nearly as it was remembered, was as follows: I was with somebody in a buggy and we drove down a hill, across a little stream, and up the other hill, where we arrived at our destination. I seemed to find trouble in getting a place to hitch, and I had to take the horse out of the buggy and I think take the harness off. I distinctly remember that in the dream this was a hardship to me, as it would have been in waking life, for I am not a good hand with horses, and do not like to work with them. All this is very hazy to me, and I do not know with whom I was driving, but think it was a lady, possibly my wife. There were other people at this place and other horses and buggies. (Could it be called a case of reversion to childhood, in that there were only horses and buggies and no automobiles?) There is a break in the dream here, and we were within some kind of a building where there was a crowd of people. As it seems now, we were around some kind of a rotunda, but this is very vague. The important part seems to be that there were two people, a man and a woman, who were talking very stealthily and earnestly to each other, and they soon drew me into the conversation. It runs in my head now that the man was my father (who has been dead for some years), though I am not sure about this, while there is no recollection of who the woman was. Now it appeared that there was some woman in the crowd who had some peculiar evil influence over every one and whom everybody feared. This man and woman were planning to slip off from this wicked woman and meet me and the one with me on the road, and in some way, which is not now clear, we were to circumvent this bad woman and break her power. The man explained and explained to me that we were to meet at certain springs which were at the side of the road, but it seemed that I could not get it into my head where they were, and I was afraid I would not stop at the right place. At last I thought I knew where he meant, and told him that I would stop there and wait until he came up, but then I happened to think that he might be ahead of me anyhow, and could stop and wait for me; then I was sure he would be ahead, for I remembered that I had to harness and hitch up the horse and his was all ready. And now we seemed to be getting our horses, and I remarked to him that I was not a bit good hand at working with horses, and he expressed his sympathy that I had this work to do. Here was a second break in the dream, and I was standing in a hallway, looking through a window into a room. In this room sat my wife and the evil woman whom everybody feared. She had learned our play (I was conscious of this in the dream), and was determined to have her revenge, and prevent us carrying out our plan. She had hypnotized my wife, and had her scared so that she was in great mental agony. I heard her saying, "Now you are a big black cat," or something much like this, at any rate making her think she was a cat and at the same time leaving her partly conscious of who she was. This woman looked exactly like a woman who lives in the neighborhood where my wife is now visiting and of whom she has always been somewhat afraid because of her sharp tongue and unpleasant ways. Immediately, I was filled with a great fear for my wife and with a raging anger against the woman. I broke out into calling her all kinds of names, especially saying, "You devil, you devil," and trying to get through the window to her. I tore out the screen, but had a great deal of difficulty in doing so. When I had finally succeeded in tearing the screen out, I threw it at her head, but she did not dodge, but sat boldly upright and seemed to defy me. Then I tried to jump through the window to get to her, but was so weak that I could not do so; this seems strange since the window was not more than three feet from the floor. I was making unsuccessful attempts to get through, and was railing at the woman when S. awoke me. I awoke weak, and for some time continued to feel frightened, though not enough so to keep me from talking and writing out the dream. I got up and put up the windows (since the rain had stopped), and about this time a very fair explanation of parts of the dream came to me. I immediately told it to S., in order to keep from forgetting it, and then decided to write it down, which I proceeded to do. Parts of the dream seem to analyze very nicely, but there are parts which seem to resist analysis; I did not try to force the analysis but gave only the part which came spontaneously. In the first part of the dream I was driving in a buggy, I crossed a creek and had trouble with unharnessing a horse. Several times recently, I have mentioned the fact that I never liked to work with horses, even when on the farm at home. I do not remember of having mentioned this fact on the day of the dream, but Mr. C. had stopped in to call on me that evening and had mentioned that he drove in in a buggy. I had not seen the buggy and had wondered what he did with it, and had not remembered to ask him. He had also told me that he was going to a place called Yellow Springs; I knew about where Yellow Springs are, but could not quite place them and had tried to figure out what direction he would go. This seemed to come out very clearly in the dream, when I was trying to find out where these unknown springs by the side of the road were. I had related during the evening how I recently fell into a creek with my clothes on and this probably accounted for the creek over which I drove in the dream. In the dim second part of the dream, the rotunda seems to have resembled the chapel of the new college building which is being builded, and about which I was talking that afternoon. The last part of the dream seems to have been the important part, and in it several of the Freudian mechanisms show up very plainly. Just before going to bed, I had read an article about Vera Cheberiak, the Russian murderess of the Mendel Beilis case, and how she is now engaged in suing different people for slander. The article had described her as coolly and impudently sitting up in court and seeming to realize her power over her enemies, and it had also made a point of the great fear in which she is held. I had read another article about the city of Salem, which has recently burned, and I had remembered that it was the "witch" town of colonial days where people were supposed to be turned into black cats. I had read still another article, descriptive of country life, which described how a man had climbed a tree after a cat which was eating young robins. I had just a day or two before received a letter from my wife, which contained the news that she was going to visit this woman whom she fears, but whom she must visit because of their social relation As already mentioned, the woman in the dream looked just like this one, and it will readily be recognized that the dream woman was a condensation of Vera Cheberiak, a Salem "witch," and the woman whom my wife fears. The fact that she was hypnotized into thinking she was a cat would naturally accompany the Salem witch, and the cat in the apple tree, concerning which I had read, might also have entered the dream. Aside from these, there is another element which may have been instrumental in causing my wife to be punished by thinking she was a cat. I once saw a woman who was suffering from melancholia who thought she was a cat, and her mental suffering seemed to me to be about the keenest of any that I have ever observed, this possibly caused the dream-making factor to represent her as thinking she was a cat. The hall, window and screen are also easy of explanation. That evening I had examined a window which opens from our bedroom into a hall, and had wondered whether we would continue to keep it curtained this year or take the curtains away. When I put down the windows to keep out the driving rain, I had had trouble with a screen much as I did in the dream. The heart of the dream seems to be in this last scene. That morning (it was Sunday) I had very unwillingly, and from a sense of duty, gone to a tiresome and long-drawn-out church service. I had become so fatigued during the service, and so disagreed with some of the things the preacher said, that I was conscious of a mild desire to swear and throw something. I had humorously mentioned this fact after the service, but there was quite an element of truth in the jest. The dream gave me the chance of my life to fulfil this desire, and I seized the opportunity by breaking into a stream of profanity (not very successful profanity, I fear, as I never use it when awake and therefore was not in good practice) and throwing the screen at the woman. But was there not a deeper meaning than this in the dream? I think so decidedly; it seems that it would be a lot of trouble to construct such a tremendous nightmare just to give me an opportunity to swear and throw something, because a preacher had been somewhat tiresome. There was evidently a deeper and more subtle wish which was also fulfilled. That evening I had walked up the railroad track with a crowd of young people and where the paths crossed we had all split up and gone different directions. Two young ladies had gone back to their boarding places across the campus, and I had suggested to the young fellow with me that we go along with them. However, he objected, and we walked back down the railroad track. Now, it had occurred to me that he probably thought I was not within my bounds as a married man when I wanted to walk back with these young ladies; something of the same idea had come to me that day when some one had said in a conversation, "Professor B. is the most satisfied man on the campus whose wife is away." I had wondered if they thought I did not care for my wife and vaguely wished I had some way of showing my love for her, and, more than that, these suggestions had very naturally made me wonder if I really care for her as much as I should. I could not have asked for a better opportunity to serve and show my love for my wife than the dream gave me, and at the same time it assured me of my affection for her. There is still another element of repression in this and that is that I have for some time been wanting to forcibly express myself against the unpleasant ways of this lady whom my wife so fears. In the dream, I very freely and fully followed this desire. This far I can go in the analysis and feel sure of my ground. It will be noticed that I have not resorted to symbolism, and have made very little technical use even of the Freudian mechanisms. I could very easily plunge into symbolism and more elaborate analysis, but should I do so I fear I would be in the same condition as a bright young scholar who made an elaborate study of Freudian theories. He expressed himself by saying that it was a "chaotic inferno." This analysis will seem very unfinished to many of the well-trained readers of the JOURNAL, and so, in a way, it does to me, but it may be interesting as the work of a layman rather than a trained physician. I have not used the word "sexual" in this paper, but the reader can judge for himself if the impulses would come under this heading, either in the more narrow use of the term or in the broader meaning which Freud has given it. For myself, I see no possible objection in employing the word "sexual" in this connection. The uncertain parts of the dream are as interesting in a way as the others. Why did I not know with whom I was riding, and why were the persons with whom I talked more certain in their identity? Here, of course, is the place where it would be easy to find a repression if such existed and—I believe—if it did not exist. Whether there is such a repression there or not I do not know, but I see no necessity for considering that there is one there just because there is a dim place in the dream. In the study which I made of dreams a year or so ago, I became convinced that there is a principle of dream-making which has not been noticed. I will throw out a suggestion here in the hope that some one will study it further, but will give no elaborate discussion in this paper. Briefly, it is that only those things appear in a dream which are necessary to express the meaning of the dream. A few illustrations may make this clear. Every one has noticed the rarity with which colors and sunshine appear in dreams; I have found, however, that colors and sunshine always appear if there is any necessity for their doing so. Some one dreams of a melon and looks to see if it is ripe; he sees the red color; he dreams of a stream which he thinks is a sewer and smells it to see if it gives off an odor and finds that it does; he dreams of pulling his fishing line to see if there is a fish on it and senses the pull of the fish; I have examples in abundance which go to indicate that taste, smell, tactual, kinaesthetic, color sensation or any other kind will appear in a dream when they are called for to complete the meaning of the dream, but they are not common because they are very rarely needed. Even in waking life we rarely think in these terms. If this little principle prove true, it would be easy to understand why certain parts of a dream are dim without going to the doubtful process of positing a repression. The persons in the dream were not recognized simply because there was no need for them to be; the dream expressed the pertinent meaning just as well without them as with them. They were observed just as many of us would observe the occupants of a street car in waking life; we could possibly not describe, even partly, any one of the occupants of the car which we used on our way to the office or home. Before leaving this nightmare, I want to call attention again to the somatic elements. I was lying on my back and in a cramped position, the air was closer than usual, and my circulation was naturally deranged. When I awoke I was strongly inclined to give the physical elements a large amount of the responsibility for the dream, and I have not found occasion to change my mind in this matter. I think that even the inability to jump through the window in the dream was caused by the weak and exhausted state of my body, due to the poor circulation and cramped position. ANALYSIS OF A SINGLE DREAM AS A MEANS OF UNEARTHING THE GENESIS OF PSYCHOPATHIC AFFECTIONSBY MEYER SOLOMON, MD., CHICAGOTHOSE; of us who have devoted a certain amount of our time and energy to the study of dreams have early come to realize the value of a dream as a starting-point in the analysis of certain mental states, particularly those of an abnormal character. Frequently, in the hopeless tangle of symptoms, complaints and disconnected facts in the history as originally obtained, especially in old-standing cases, one does not really know just where to begin, what to start with in the first efforts to struggle with the problem of the ultimate genesis and evolution of the condition which is presented to him at the particular moment. Of course, by a careful review of the patient's past life history, gone over by persistent questioning and cross-examination, one can begin with the family history and step by step trace the history of the patient from earliest childhood or infancy through the various stages and phases of activity and development up to the very moment of examination. This may at times appear quite dull, quite uninteresting and entirely unnecessary to certain patients. For this reason and also for many other reasons, which I shall not enumerate at this point it is at times well to resort to dream analysis. And in analyzing dreams it is well to remember a fact, with which I believe all psychoanalysts will agree, namely, that by a most thorough and far-reaching analysis of a SINGLE DREAM, we can, by following out to the ultimate ends the various clues which are given us and the various by-paths which offer themselves to us in the course of the analysis—we can, I repeat, should we be so inclined, root up the entire life history of the dreamer. This may not be necessary in all cases. But, at any rate, if we desired so to do for scientific purposes, we could arrive at such results. In such an analysis we would, of course, first take up, individually, every portion and every element of every portion of the dream, and by means of each such lesser or greater element of the dream, we could arrive at a mass of material, a wealth of information concerning the past experiential, emotional, mental and moral life of the individual whose dream we were at the moment analyzing. In fact, one could ferret out the full life history in great detail, thus obtaining a complete autobiography leading far down into the depths of the dreamer's mental life and into the inner world of his own. With the material so obtained one could truly reconstruct the complete life history, piecemeal, until the wonderful and inspiring structure of the mental world of the dreamer would be reared, reaching far back to early childhood and perhaps even to infancy, extending so far forward as to give us a prophecy, based on the dreamer's dynamic trends and emotional trends and leanings, of the probable future, stretching forth its tentacles in all directions, and, uncovering the psychic underworld in its every part, holding up before our eyes the naked mind, in its length, its breadth and its thickness. I am not referring here particularly to the employment of the method of hypnosis, especially as practiced by Prince, or to Freud's so-called free association (which is frequently really forced association) or Jung's word association methods. I am speaking only of analysis of the dream by ordinary conversation and introspection, in the normal waking state. Of course, were the latter method supplemented by these other methods, the results would be so much the more complete and far-reaching. I may mention, specifically, that the employment of Freud's free association method would be helpful here in gathering information because, when employing this method, one practically forces the one being analyzed to think by analogy and by comparison, insisting that he tell you what a certain word or name or scene or experience or what not reminds him of, what it resembles, what he can compare it to, no matter how remote its connection, no matter how unrelated, how far-fetched or how silly the association may appear in his own eyes—in other words, we demand that he co-operate by suspending critical selection and judgment. Although, as I say, Freud's, Jung's, Prince's and other methods may be advantageously employed, still, it seems to me, although I cannot yet state this in final or positive terms, that, at least in most cases, such an unravelment and resurrection of the past life history can be obtained by an analysis of the dream conducted in the ordinary, waking state, and the usual conversational mode of history-taking and daily oral intercourse. It needs no repetition or elaboration to convince psychoanalysts (I use the term "psychoanalyst" in the broad, unrestricted sense of the word, including the supporters of all possible schools or standpoints or methods in psychoanalysis or mental analysis, and not limiting it to Freud's psychoanalysis) of the essential and fundamental truth of this statement. I shall, therefore, not unnecessarily lengthen this paper by endeavoring to bring forth complete evidence of the truth of this assertion. As a matter of fact, this conclusion or generalization applies not alone to dreams but to any single element in the objective or subjective world which may be seized upon as the initial stimulus and from which, as a starting-point, association of ideas, in ordinary conversation or aided by any of the more or less experimental or artificial but valuable methods heretofore mentioned, may be begun and continued ad libitum or even ad infinitum, under the tactful guidance and judgment of the investigator. For example, if I may be permitted to tread upon the dangerous path of near-sensationalism or extremism, I may mention that were I to take even so common, so widely used, and so relatively insignificant a word as the definite article "the" as the initial stimulus, and have one of my fellowmen or fellow-women (whose full co-operation, it is assumed, I have previously obtained) give me one or more free or random word associations, and thereafter, with these newly acquired elements, continued to forge my way into the thickly wooded and unexplored recesses of the unknown and mysterious forest of the mind, I doubt not but that I should achieve the same results as if I had started upon my journey with a dream. If this be true, and I firmly believe that it is, in the case of that universally used and apparently inconsequential word "the," to which the normal person can be expected to have such a large number of associations, of varying degrees of intimacy or remoteness, how much truer is it when we have such a definite mental fact or mental state as a dream as the starting-point of our hunting expedition? The dream gives us something tangible to start with, something near at home to the dreamer or patient, something interesting and amusing to him, something baffling and so frequently unintelligible to him, and, as a consequence, a more conscientious, earnest and wholehearted co-operation can be obtained from the person whose mental life is being investigated. Here is something vivid to him, something of personal interest to him. And so we can look to him to lend us his aid in better spirit and in fuller measure than might otherwise be obtainable. I have been referring in my previous remarks, for the most part, to unravelment of the normal individual's life history. But my remarks are equally applicable to a mentally disturbed individual's life history and to the genesis of abnormal psychic states, particularly those to be met with in the neuroses and psychoneuroses. So true is the generalization, indeed the truism or dictum here laid down, that, in only the psychoanalyst knows how many instances, by the analysis of a single, even the very first dream, one can arrive at the rock-bottom depth of the trouble at hand—yes, at the very genesis of the condition. It is not my intention in this paper to report such cases in full detail, since the presentation of even a single such case would be too lengthy for publication in an ordinary medical or other journal, and in many instances might well go to make a good-sized book, a real autobiography of more or less interest, if not to the average reader, at least to the psychoanalyst and to the person who has undergone the psychoanalysis. Without attempting to present an elaborate history or complete analysis, but rather merely to call attention to the truth of the general problem which is being discussed in this paper, I shall, however, mention a few definite illustrations of this sort. A man of sixty was brought to my dispensary clinic by his wife (I say "brought" and not "accompanied" by his wife, advisedly). She accompanied him into my examining room. He had an almost complete aphonia, spoke hoarsely and in a whisper and presented all the signs of abductor laryngeal paralysis; added to which there was a partial hemiplegia of the right side involving the upper and lower extremities, but not the face or any of the cranial nerves other than that supplying the right laryngeal abductor. I shall not give any other points in the history except that this paralysis was of four months' duration, there was some resistance to movements at the elbow and knee, but Babinski and other indications of a central organic lesion were absent. The results of the rest of the physical examination need not be mentioned except that the patient presented evidences of arteriosclerosis. The patient was of dull mentality, meek humble and subservient; he was much below par mentally (I did not put him through any special intelligence tests), had little information to offer, constantly resorted to "I don't know" as a reply, and could co-operate but little. I did, however, obtain the important bit of information that seventeen years ago he had had an almost complete aphonia of several weeks' duration and that one day, while on board ship, he became seasick, vomited, became frightened, went to his room, and suddenly his voice returned to him. So sudden was the transformation that many of his fellow-passengers insisted that he had been deceiving them and had purposely simulated the condition he had previously presented. The case was one of hysteria, the patient presenting at the time of my examination signs of abductor laryngeal paralysis (laryngological examination disclosed a right-sided abductor palsy) and right-sided partial hemiplegia. For the next two visits the wife accompanied, or rather, brought the patient to the clinic and I could get but little information and consequently progressed but little. I asked him, in her presence, to come alone the next time—which he did. The description of the onset of the attack, which was furnished me on his previous visits, proved the hysterical nature of the condition: he had suddenly been attacked by nausea and vomiting, fell to the floor, lay there, more or less unconscious (as he described it) for five or ten or more minutes, was assisted to his feet, went to his bed with practically no assistance, a few hours later found that he could speak little more than above a whisper, and in another few hours or more his right side became weak and failed him. He had insisted that the onset came on suddenly. He had denied any quarrels or trouble at home. Nothing could be obtained from him as to his thoughts just prior to the attack or as to any special emotional shocks. On his fourth visit I asked him to tell me any dream he had had recently and which had made an impression upon him. He could give me no aid. Nothing came to mind. I asked him if he had dreamed the night before, and he told me he had had a dream the afternoon of the preceding day, during an afternoon nap. Here is the dream: He found himself struggling with a tremendous snake, the upper part of which was in human form, the features being very hazy and not at all recalled. The snake was vigorously endeavoring to enwrap itself about him and to strangle him, and he was desperately and fiercely struggling to defend himself against it and to free himself from it—and yet he could not fight it off. In desperation and in fear he cried aloud for help. This was the end of the dream, for, at this point, members of his family came rushing toward him to inquire what was wrong with him, and due partly to shock and his own activity in the dream, and partly perhaps to the noise of the footsteps and of the conversation of those who came running toward him to inquire into the cause of his distressful cries, he awoke. The thoughts and reveries just preceding the dream and the thoughts and experiences during the morning preceding the dream, although the true inciters of the dream, and although concerned with the central figure (his wife) in this little drama, need not be detailed since the dream has a wider and more deeply arising significance. I could not learn definitely from him whether the series of associated thoughts turned first from his wife to his troubles with her, to her attitude toward him, and then to her resemblance in this respect (her nagging, pestering persistence and actual persecution of him) to a snake which is endeavoring to enwrap itself about him, to strangle him, to withdraw from him his very life's blood, etc. This may or may not have been the line of associations just preceding the dream. He had no idea as to what the dream meant. Using free association, in ordinary face-to-face conversation, I asked him what "snake" reminded him of. The association came in a moment. He smiled, became embarrassed, said it was foolish of him to tell me this, but it reminded him of his wife. He had always looked upon his wife as a snake in human form. He had frequently called her "snake" because of her conduct toward him. She had wound herself about his life in snake-like fashion. And then came the story of their troubles. This was his second wife. She was fifteen years his junior. He was meek, feeble, of weak will-power, without initiative. She was domineering. Although his wife never told him so openly and in so many words, he felt convinced that the trouble had begun more or less because his wife's sexual libido was not satisfied in her sexual relations with him. He admits that she is a passionate woman, her sexual libido was of such strength that he, much older than she, and not too strong physically, could but little gratify her. The first complaints and the sole trouble which appeared on the surface were financial—he barely made a living and she complained thereat continually, bitterly and tyrannically. It seems that her complaint in this direction was justified. It is difficult to determine just what role her lack of sexual gratification played— whether it only acted as stirring up the embers of dissatisfaction (with his weekly earnings) which already existed, or whether it was the basic factor, led to her dissatisfaction with her matrimonial choice, and caused her to seek some more or less valid cause for complaint, in that way permitting her, more or less consciously, to transfer her dissatisfaction and discontent from the lack of sexual gratification to the hard pressed financial condition (which perhaps she might, for that matter, have been willing to endure, did she but obtain the full gratification of her sexual craving). At any rate, both of these factors played their role in causing domestic disagreement, one factor being openly acknowledged as the cause by his wife, the other factor never mentioned by her, but believed by him to be an important accessory, if not the main, fundamental and primary source of the trouble. His wife, using his poor earning capacity as a weapon, and with the demand for "more money" as her battle-cry, carried on a campaign of complaint, grumbling, nagging, fault-finding, insult and abuse, but little short of persecution, making conditions wretched and miserable at home. Things at length became quite unbearable to him—so much so that, feeble in willpower and lacking in initiative as he was and is, he was compelled to leave home and live with his aunt, since his wife had practically deserted him. Although she had sold out the furniture and the rest of the furnishings of the home, and had pocketed the money thus received, she repeatedly called at his aunt's home for no other purpose than to force him to pay her sums of money for her weekly maintenance. On each such visit she would act the tyrant, would storm and rage furiously, would subject him to stinging rebukes and deliver biting tongue-lashings, causing him in consequence to be much upset and nervous the rest of the day. The very morning on which he had had the attack, which was followed by his present trouble (partial aphonia and partial hemiplegia) his wife had paid him one of these unusually stormy and noisy, and, to say the least, unwelcome visits. She had carried the attack to such a point that our patient became so emotionally upset (he is a harmless, emotional, kindly, unassuming and indifferent sort of old fellow) that he suddenly was attacked with nausea and vomiting, and, frightened, fell to the floor, with the consequences above detailed. I need not go further into the history and analysis of this case, but the story thus far elicited is more than sufficient to show that here we have a specific instance in which, by the analysis of a single dream, we have arrived at the genesis of an hysterical paralytic syndrome of four months' duration. The analysis took but a few minutes. It may be mentioned, in parentheses, that a full knowledge of the cause of the condition did not lead to a disappearance of the palsy. In other words, as we all know, knowledge per se does not lead to action or to the assertion or development of the will-power. I may say, also, that the events here related were not suppressed or repressed, for, as soon as the question of his wife was taken up, the patient admitted that it was she who was the real cause of his present conditions, and he thereupon detailed the story above related. He assured me that he had always been fully aware that it was she who had brought about his present condition, although, of course, he did not know whether he had had an hysterical, apoplectic or other sort of attack. In fact he believed his condition was permanent and incurable— especially since he had been treated at various neurological clinics for many weeks past without the slightest improvement or progress. Were we to follow up this history we could unearth the full life history of this patient, including the genesis of his early attack of aphonia. But I deem this unnecessary and inadvisable in this paper, as mentioned previously. Here, then, we have a definite case in which by the analysis of a single and incidentally the first dream we have arrived at the genesis of the psychoneurotic disorder. From this same standpoint I have studied another case, a married woman of twenty-nine, with marked neurasthenic and hysterical symptoms (including astasia-abasia, anesthesias, palpitation of the heart, throbbing sensations in the stomach and a great many other symptoms). This case I studied for upwards of four months, with almost daily visits to the hospital where she was being cared for. I made quite an intensive study of her dream life and of her past life history, and I find that had I taken the very first dream which I obtained from her and conducted a thorough analysis with this dream as my first mile-post, I would have arrived at a full genesis of the condition, which was of ten years' duration. In this case, also, I must repeat, there was no indication of repression, the patient having always understood very well the origin and cause of her condition. Here, too, we find that the knowledge alone did not lead to her recovery. This case I shall report in detail at a later date. |
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