"The trouble with this poor woman, gentlemen, is here, not in the region that we have been exploring. But we should not undeceive her. We will remove the appendix, on general principles, and that will probably be all that is needed to cure the trouble in her head."
Under the circ.u.mstances, it was excellent advice. But how much better it would have been for the unfortunate woman, whose life was thus endangered by the surgeon"s knife, if it had been recognized from the beginning that her malady was only a "hysterical simulation" of the symptoms of appendicitis. Some day, when physicians generally make themselves acquainted with the diagnostic methods of psychopathology, blunders like this will be, as they ought to be, most exceptional.
In point both of diagnosis and treatment, again, psychopathological knowledge is indispensable to the correct handling of such cases as the following, reported by Doctor Janet.[43] It is, I am ready to concede, an unusual case, but it is unusual only because it presents a complex of symptoms commonly found singly or in simpler combination.
[43] In "Nevroses et Idees Fixes," vol. i, pp. 1-68.
It would be impossible to estimate with any accuracy the number of persons who, afflicted only in scant degree like this poor Marcelle, have been obliged to drag out an existence worse than death, either in the care of their friends or immured in an inst.i.tution, simply because their medical attendants, ignorant of the workings of the law of dissociation, have been unable to fathom the true nature of their ills and adopt adequate curative measures.
Marcelle, as Doctor Janet calls her, was only nineteen years old when she began to astonish her relatives by developing what they were at first disposed to regard as nothing but an eccentric form of laziness.
She would constantly ask them to give her objects--a book, her crochet work, a plate--which she could easily have got for herself by stretching out her hand and picking them up. To all expostulations, she would calmly reply:
"I can"t help it. I can"t use my hands as I once did, and that"s all there is to it."
"You can"t use your hands! What nonsense! You can use them to eat with, well enough, and you are crocheting most of the time."
"Oh, but that"s different."
"What"s the difference? Tell us."
But Marcelle could not, or would not, tell them, and from joking with her the family soon pa.s.sed to a state of wrath, endeavoring in every way to overcome her "stupid obstinacy." Their anger in turn gave way to fear, when, one night, noticing a glimmer of light in her room, they entered, and found her standing, fully dressed, before the bed.
"But what is this!" they exclaimed, in amazement. "Why don"t you get your clothes off and go to bed?"
"Because," she cried, "I can"t undress!"
And, all arguments proving vain, it was necessary for her sister to disrobe her as though she were a tiny child. Next day a consultation was held, and it was decided to take her to the Salpetriere.
"She doesn"t seem insane," her mother explained, when applying to have her admitted. "She talks sensibly about most things. Can it be that she is really suffering from some kind of paralysis?"
"Most a.s.suredly," was the reply, "and we will do our best to discover what it is and cure it."
This turned out to be no easy matter. Doctor Janet, into whose care she came, had no difficulty in determining that the specific malady which afflicted her was an extreme form of "aboulia," a disease involving temporary paralysis of the will, and thereby preventing all muscular movement. But it was one thing to make a diagnosis, and another to effect a cure.
Presently, too, indications of mental disturbance developed. Doctor Janet had discovered that by distracting her attention he could induce her to rise, extend her hands, and perform other acts that were impossible to her when she concentrated her attention on them. He utilized this as an argument to try and persuade her that she could always control her limbs if she only made sufficient effort.
"But you are quite wrong," she calmly informed him. "I have not left my chair, I have not put out my hand."
"Most a.s.suredly you have. You know very well I did not give you that piece of crochet work. How, then, does it come into your hands?"
"I did not pick it up."
"Who did, then?"
"Somebody else--somebody acting in me."
A little later arose another complication. She refused to eat, and it became necessary to administer food to her forcibly. She kept saying to herself:
"You must die, you must die as soon as possible. You must not eat, you have no need of eating. You must not speak, you have no voice, you are paralyzed."
"Why do you say this?" Doctor Janet one day asked her.
"Why do I say what?"
He repeated her words.
"But I have said nothing of the sort."
"Oh, yes, you have."
"No, no, no--it was not I; it was somebody else acting in me."
Again that phrase--"somebody else acting in me." Greatly impressed, Doctor Janet threw her into deep hypnosis. Now, an unexpected and most pathetic pa.s.sage of personal history came to light. A year before, Marcelle had had a secret love affair, her lover had deserted her, she had determined to commit suicide. Failing to do this, she had, none the less--overwhelmed by the shock of the desertion, and giving herself wholly to grief and chagrin, which she felt obliged to allow no one to perceive--gradually pa.s.sed into a dissociated, dreamlike state, in which she subconsciously pictured herself to herself either as no longer existing or as about to perish.
Hence her "aboulia," hence the "somebody else acting in me," hence the refusal to take food. To Doctor Janet the situation was now almost as clear as the light of day--so, likewise, was the course which he would need to follow to restore the sufferer to her "real self," and rid her of all disease symptoms.
The dissociation, to put it briefly, had in this case been so complete as to cause an actual disruption of the sense of personality. Nor is this malady of "loss of personality" as rare as one might be tempted to think. I could mention many cases not unlike that of Marcelle"s, and some far surpa.s.sing it in astounding developments. There is, for example, the singular case of BCA. But this is so remarkable, so weirdly fascinating, and so instructive that it deserves to be treated, as I shall treat it in the next chapter, entirely by itself.
CHAPTER VIII
THE SINGULAR CASE OF BCA
During his long career as a specialist in the treatment of nervous and mental diseases, Doctor Morton Prince, the celebrated Boston psychopathologist, has been called upon to deal with many puzzling human riddles, and to solve mysteries which, in their way, have been quite as complicated and baffling as any that ever taxed the ingenuity of that most ingenious of story-book detectives, Mr. Sherlock Holmes. In fact, some of the problems laid before the New England specialist surpa.s.s even the most astonishing of the adventures of Sherlock Holmes, thus proving once more that truth is stranger than fiction. This particularly applies to the BCA affair.
In the beginning, however, there was nothing in the BCA affair to suggest to Doctor Prince that it had features which would test to the utmost his psychopathological skill. It opened in a prosaic, matter-of-fact way, with the arrival at his office of a young woman who wished to be treated for what she described as a "nervous breakdown."
The story she told was a sad one, but he had heard many quite like it before, and it did not impress him as involving anything out of the ordinary.
"My trouble," she said, in describing the evolution of her malady, "began when my husband was attacked with an incurable disease. For four years my life was altogether given up to caring for him, striving to make him as comfortable as possible, and endeavoring to conceal from him my grief and anxiety. You can imagine the strain put upon me all that time. Finally he died, under circ.u.mstances that caused me a great shock.
"Within less than a week after his death, I lost twenty pounds in weight. For nearly three months I ate scarcely anything, and did not average more than three or four hours" sleep out of the twenty-four. I was depressed, overwhelmed; felt that I had lost all that made life worth living; and, in short, wished to die. I became highly nervous, tired easily, and suffered almost constantly from headaches.
"This went on for many months. Then there came a period of temporary recovery. Strangely enough, it followed an occurrence that brought to me suddenly a realization that my position in life was entirely changed, that I was quite alone, desolate, and helpless. For a few minutes these ideas flashed through my mind, and then all seemed changed. I no longer minded what, a moment before, had caused me so much distress; and, what is more, I immediately began to improve in health, until I was able to mingle with my friends, take long walks, go driving, and really enjoy life as I had formerly done. Alas, there soon was a relapse, and now I am feeling worse than ever."
Listening to her recital, and examining carefully her mental and physical condition, Doctor Prince felt justified in a.s.suring her that there was nothing seriously the matter, and that he would ere long have her on the highway to health. In fact, he regarded her case as one presenting "the ordinary picture of so-called neurasthenia, characterized by persistent fatigue and the usual somatic symptoms, and by moral doubts and scruples"; and planned a course of treatment which he expected would speedily result in a cure. It was, to describe it briefly, treatment by hypnotic suggestion--a method often employed by psychopathologists in handling cases of neurasthenia, for they have discovered that it is perfectly feasible to "suggest away" the fatigue, insomnia, and other symptoms connected with this widespread and distressing malady.
The use of hypnotism in the present instance, though, was attended by consequences vastly different from any Doctor Prince had antic.i.p.ated, since it revealed to him that his patient was, in reality, suffering from something infinitely more serious than ordinary neurasthenia, and infinitely more difficult to overcome. Put into the hypnotic state, her ills, to Doctor Prince"s amazement, disappeared as though by a miracle.
Her whole expression was altered. She looked, and declared that she felt, entirely well. It was hard to believe that this radiant, vigorous, brightly smiling woman was the one who had entered his office so short a time before, a typical nervous wreck, her features haggard and careworn, her eyes dull and heavy, her hands trembling. And, most astonishing of all, the hypnotized patient herself insisted that, in a very literal sense, she was not the same person.
The tone, the language, the manner--all were changed. Struck with sudden apprehension, Doctor Prince quickly brought her out of hypnosis.
Immediately there was another transformation, and she was neurasthenic once more, without the slightest remnant of the strength, independence, and self-a.s.sertiveness she had just been displaying. Nor, although she was sharply questioned, could she remember anything she had said while hypnotized; still, this proved nothing, for it is seldom that what goes on during hypnosis is recalled in the waking state.
But, comparing her latest declarations with her prior account of the course her malady had run, Doctor Prince could not help asking himself whether she might not actually be a victim of what is technically designated "total dissociation of personality," whether the second emotional shock of which she had spoken, acting on a system already disorganized by the severe and prolonged strain imposed upon her by her husband"s illness, might not have resulted in a psychical upheaval so catastrophic as to involve the disintegration of her ego, or "self," and the creation of a secondary self markedly differing from her original personality.
In such an event, the period of temporary recovery would, indeed, represent a period when the secondary self had obtained at least partial control of the patient"s organism; and it was quite conceivable that there might come a time when, momentarily, at any rate, the secondary self would become wholly dominant. In that case, the young woman"s plight would be appalling, for she would be in ignorance of all she said and did while in the secondary state. This was precisely what occurred.