The most striking characteristic of the second stage in our case is the change in character. We meet many cases in the literature which have offered the symptom of spontaneous character-change. The first case in a scientific publication is Weir-Mitchell's[56] case of Mary Reynolds.
This was the case of a young woman living in Pennsylvania in 1811. After a deep sleep of about twenty hours she had totally forgotten her entire past and everything she had learnt; even the words she spoke had lost their meaning. She no longer knew her relatives. Slowly she re-learnt to read and write, but her writing was from right to left. More striking still was the change in her character. Instead of being melancholy, she was now cheerful in the extreme. Instead of being reserved, she was buoyant and sociable. Formerly taciturn and retiring, she was now merry and jocose. Her disposition was totally changed.[57]
In this state she renounced her former retired life and liked to undertake adventurous excursions unarmed, through wood and mountain, on foot and horseback. In one of these excursions she encountered a large black bear, which she took for a pig. The bear raised himself on his hind legs and gnashed his teeth at her. As she could not drive her horse on any further, she took an ordinary stick and hit the bear until it took to flight. Five weeks later, after a deep sleep, she returned to her earlier state with amnesia for the interval. These states alternated for about sixteen years. _But her last twenty-five years Mary Reynolds passed exclusively in her second state._
Schroeder von der Kalk[58] reports on the following case: The patient became ill at the age of sixteen with periodic amnesia, after a previous tedious illness of three years. Sometimes in the morning after waking she passed through a peculiar choreic state, during which she made rhythmical movements with her arms. Throughout the whole day she would then exhibit a childish, silly behaviour and lost all her educated capabilities. (When normal she is very intelligent, well-read, speaks French well.) In the second state she begins to speak faulty French. On the second day she is again at times normal. The two states are completely separated by amnesia.[59]
Hoefelt[60] reports on a case of spontaneous somnambulism in a girl who, in her normal state, was submissive and modest, but in somnambulism was impertinent, rude and violent. Azam's[61] Felida was, in her normal state, depressed, inhibited, timid; and in the second state lively, confident, enterprising to recklessness. _The second state gradually became the chief one, and finally so far suppressed the first state that the patient called her normal states, lasting now but a short time, "crises."_ The amnesic attacks had begun at 14 1/2. In time the second state became milder and there was a certain approximation between the character of the two states. A very striking example of change in character is that worked out by Camuset, Ribot, Legrand du Saulle, Richer, Voisin, and put together by Bourru and Burot.[62] It is that of Louis V., a severe male hysteric with amnesic alternating character. In the first stage he is rude, cheeky, querulous, greedy, thievish, inconsiderate. In the second state he is an agreeable, sympathetic character, industrious, docile and obedient. This amnesic change of character has been used by Paul Lindau[63] in his drama "Der Andere" (The Other One).
Rieger[64] reports on a case parallel to Lindau's criminal lawyer. The unconscious personalities of Janet's Lucie and Léonie (Janet, _l.c._) and Morton Prince's[65] may also be regarded as parallel with our case. There are, however, therapeutic artificial products whose importance lies in the domain of the dissociation of consciousness and of memory.
In the above cases, the second state is always separated from the first by an amnesic dissociation, and the change in character is, at times, accompanied by a break in the continuity of consciousness. In our case there is no amnesic disturbance; the passage from the first to the second stage follows quite gradually and the continuity of consciousness remains. The patient carries out in her waking state everything, otherwise unknown to her, from the field of the unconscious that she has experienced during hallucinations in the second stage.
Periodic changes in personality without amnesic dissociation are found in the region of _folie circulaire_, but are rarely seen in hysterics, as Renaudin's[66] case shows. A young man, whose behaviour had always been excellent, suddenly began to display the worst tendencies. There were no symptoms of insanity, but, on the other hand, the whole surface of the body was anæsthetic. This state showed periodic intervals, and in the same way the patient's character was subject to vacillations. As soon as the anæsthesia disappeared he was manageable and friendly. When the anæsthesia returned he was overcome by the worst instincts, which, it was observed, even included the wish to murder.
Remembering that our patient's age at the beginning of the disturbances was 14 1/2, that is, the age of puberty had just been reached, one must suppose that there was some connection between the disturbances and the physiological character-changes at puberty. "There appears in the consciousness of the individual during this period of life a new group of sensations, together with the feelings and ideas arising therefrom; this continuous pressure of unaccustomed mental states makes itself constantly felt because the cause is always at work; the states are co-ordinated because they arise from one and the same source, and must little by little bring about deep-seated changes in the ego."[67] Vacillating moods are easily recognisable; the confused new, strong feelings, the inclination towards idealism, to exalted religiosity and mysticism, side by side with the falling back into childishness, all this gives to adolescence its prevailing character. At this epoch the human being first makes clumsy attempts at independence in every direction; for the first time uses for his own purposes all that family and school have contributed hitherto; he conceives ideals, constructs far-reaching plans for the future, lives in dreams whose content is ambitious and egotistic. This is all physiological. The puberty of a psychopathic is a crisis of more serious import. Not only do the psychophysical changes run a stormy course, but features of a hereditary degenerate character become fixed. In the child these do not appear at all, or but sporadically. For the explanation of our case we are bound to consider a specific disturbance of puberty. The reasons for this view will appear from a further study of the second personality. (For the sake of brevity we shall call the second personality IVENES--as the patient baptised her higher ego).
Ivenes is the exact continuation of the everyday ego. She includes the whole of her conscious content. In the semi-somnambulic state her intercourse with the real external world is analogous to that of the waking state, that is, she is influenced by recurrent hallucinations, but no more than persons who are subject to non-confusional psychotic hallucinations. The continuity of Ivenes obviously extends to the hysterical attack with its dramatic scenes, visionary events, etc. During the attack itself she is generally isolated from the external world; she does not notice what is going on around her, does not know that she is talking loudly, etc. But she has no amnesia for the dream-content of her attack. Amnesia for her motor expressions and for the changes in her surroundings is not always present. That this is dependent upon the degree of intensity of her somnambulic state and that there is sometimes partial paralysis of individual sense organs is proved by the occasion when she did not notice me; her eyes were then open, and most probably she saw the others, although she only perceived me when I spoke to her. This is a case of so-called _systematised anæsthesia_ (negative hallucination) which is often observed in hysterics.
Flournoy,[68] for instance, reports of Helen Smith that during the séances she suddenly ceased to see those taking part, although she still heard their voices and felt their touch; sometimes she no longer heard, although she saw the movements of the lips of the speakers, etc.
Ivenes is just the continuation of the waking self. She contains the entire consciousness of S. W.'s waking state. Her remarkable behaviour tells decidedly against any analogy with cases of _double consciousness_. The characteristics of Ivenes contrast favourably with the patient's ordinary self. She is a calmer, more composed personality; her pleasing modesty and accuracy, her uniform intelligence, her confident way of talking must be regarded as an improvement of the whole being; thus far there is analogy with Janet's Léonie. But this is the extent of the similarity. Apart from the amnesia, they are divided by a deep psychological difference. Léonie II. is the healthier, the more normal; she has regained her natural capabilities, she shows remarkable improvement upon her chronic condition of hysteria. Ivenes rather gives the impression of a more artificial product; there is something thought out; despite all her excellences she gives the impression of playing a part excellently; her world-sorrow, her yearning for the other side of things, are not merely piety but the attributes of saintliness. Ivenes is no mere human, but a mystic being who only partly belongs to reality. The mournful features, the attachment to sorrow, her mysterious fate, lead us to the historic prototype of Ivenes--Justinus Kerner's "Prophetess of Prevorst." Kerner's book must be taken as known, and therefore I omit any references to these common traits. But Ivenes is no copy of the prophetess; she lacks the resignation and the saintly piety of the latter. The prophetess is merely used by her as a study for her own original conception. The patient pours her own soul into the _rôle_ of the prophetess, thus seeking to create an ideal of virtue and perfection. She anticipates her future. She incarnates in Ivenes what she wishes to be in twenty years--the assured, influential, wise, gracious, pious lady. It is in the construction of the second person that there lies the far-reaching difference between Léonie II. and Ivenes. Both are psychogenic. But Léonie I. receives in Léonie II. what really belongs to her, while S. W. builds up a person beyond herself. It cannot be said "she deceives herself" into, but that "she dreams herself" into the higher ideal state.[69]
The realisation of this dream recalls vividly the psychology of the pathological cheat. Delbruck[70] and Forel[71] have indicated the importance of auto-suggestion in the formation of pathological cheating and reverie. Pick[72] regards intense auto-suggestibility as the first symptom of the hysterical dreamer, making possible the realisation of the "day-dream." One of Pick's patients dreamt that she was in a morally dangerous situation, and finally carried out an attempt at rape on herself; she lay on the floor naked and fastened herself to a table and chairs. Or some dramatic person will be created with whom the patient enters into correspondence by letter, as in Bohn's case.[73] The patient dreamt herself into an engagement with a totally imaginary lawyer in Nice, from whom she received letters which she had herself written in disguised handwriting. This pathological dreaming, with auto-suggestive deceptions of memory amounting to real delusions and hallucinations, is pre-eminently to be found in the lives of many saints.[74]
It is only a step from the dreamlike images strongly stamped by the senses to the true complex hallucinations.[75] In Pick's case, for instance, one sees that the patient, who persuades herself that she is the Empress Elizabeth, gradually loses herself in her dreams to such an extent that her condition must be regarded as a true "twilight" state. Later it passes over into hysterical delirium, when her dream-phantasies become typical hallucinations. The pathological liar, who becomes involved through his phantasies, behaves exactly like a child who loses himself in his play, or like the actor who loses himself in his part.[76] There is here no fundamental distinction from somnambulic dissociation of personality, but only a difference of degree, which rests upon the intensity of the primary auto-suggestibility or disintegration of the psychic elements. _The more consciousness becomes dissociated, the greater becomes the plasticity of the dream situation, the less becomes the amount of conscious lying and of consciousness in general._ This being carried away by interest in the object is what Freud calls _hysterical identification_. For instance, to Erler's[77] acutely hysterical patient there appeared hypnagogically little riders made of paper, who so took possession of her imagination that she had the feeling of being herself one of them. Similar phenomena normally occur to us in dreams in general, in which we think like "hysterics."[78]
The complete abandonment to the interesting image explains also the wonderful naturalness of pseudological or somnambulic representation--a degree unattainable in conscious acting. The less waking consciousness intervenes by reflection and reasoning, the more certain and convincing becomes the objectivation of the dream, e.g. the roof-climbing of somnambulists.
Our case has another analogy with _pseudologia phantastica_: _The development of the phantasies during the attacks._ Many cases are known in the literature where the pathological lying comes on in attacks and during serious hysterical trouble.[79]
Our patient develops her systems exclusively in the attack. In her normal state she is quite incapable of giving any new ideas or explanations; she must either transpose herself into somnambulism or await its spontaneous appearance. This exhausts the affinity to _pseudologia phantastica_ and to pathological dream-states.
Our patient's state is even differentiated from pathological dreaming, since it could never be proved that her dream-weavings had at any time previously been the objects of her interest during the day. Her dreams occur explosively, break forth with bewildering completeness from the darkness of the unconscious. Exactly the same was the case in Flournoy's Helen Smith. In many cases (see below), however, links with the perceptions of the normal states can be demonstrated: it seems therefore probable that the roots of every dream were originally images with an emotional accentuation, which, however, only occupied waking consciousness for a short time.[80] We must allow that in the origin of such dreams hysterical forgetfulness[81] plays a _part not to be underestimated_.
Many images are buried which would be sufficient to put the consciousness on guard; associated classes of ideas are lost and go on spinning their web in the unconscious, thanks to the psychic dissociation; this is a process which we meet again in the genesis of our dreams.
"Our conscious reflection teaches us that when exercising attention we pursue a definite course. But if that course leads us to an idea which does not meet with our approval, we discontinue and cease to apply our attention. Now, apparently, the chain of thought thus started and abandoned, may go on without regaining attention unless it reaches a spot of especially marked intensity, which compels renewed attention. An initial rejection, perhaps consciously brought about by the judgment on the ground of incorrectness or unfitness for the actual purpose of the mental act, may therefore account for the fact that a mental process continues unnoticed by consciousness until the onset of sleep."[82]
In this way we may explain the apparently sudden and direct appearance of dream-states. The entire carrying over of the conscious personality into the dream-_rôle_ involves indirectly the development of simultaneous automatisms. "Une seconde condition peut amener la division de conscience; ce n'est pas une altération de la sensibilité, c'est une attitude particulière de l'esprit, la concentration de l'attention pour un point unique; il résulte de cet état de concentration que l'esprit devient distrait pour la reste et en quelque sorte insensible, ce qui ouvre la carrière aux actions automatiques, et ces actions peuvent prendre un caractère psychique et constituer des intelligences parasites, vivant côte à côte avec la personnalité normale qui ne les connaît pas."[83]
Our subject's romances throw a most significant light on the subjective roots of her dreams. They swarm with secret and open love-affairs, with illegitimate births and other sexual insinuations. The central point of all these ambiguous stories is a lady whom she dislikes, who is gradually made to assume the form of her polar opposite, and whilst Ivenes becomes the pinnacle of virtue, this lady is a sink of iniquity. _But her reincarnation doctrines, in which she appears as the mother of countless thousands, arises in its naïve nakedness from an exuberant phantasy which is, of course, very characteristic of the period of puberty. It is the woman's premonition of the sexual feeling, the dream of fruitfulness, which the patient has turned into these monstrous ideas._ We shall not go wrong if we seek for the curious form of the disease in the teeming sexuality of this too-rich soil. Viewed from this standpoint, the whole creation of Ivenes, with her enormous family, is nothing but a dream of sexual wish-fulfilment, differentiated from the dream of a night only in that it persists for months and years.
