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Diseases Of The Subconscious

( Originally Published 1908 )

AROUND the problem of the subconscious is grouped the greater part of the researches and revelations of modern abnormal psychology. The term has been used rather loosely, however, and possesses many meanings for layman and scientist alike. It has proved a convenient talisman with which many of the newer medico-religious movements have conjured; it has become a byword to the layman to explain to his own satisfaction many of the mysterious workings of the mind; even by the psychologist there has been an unfortunate tendency to use the term rather loosely. Before we proceed further it will be well to arrive at a clear understanding of what constitutes the subconscious mind and to define its limitations. The problem is a difficult one, not only because of the varied ideas of different observers, but also because of the extreme complexity of the phenomena presented by subconscious states. Professor Jastrow has recently published a volume on the various aspects of the subconscious, both normal and abnormal, and Dr. Morton Prince's case of Miss Beauchamp in his " Dissociation of a Personality" analyzes in an illuminating manner the changes of personality brought about by subconscious or, as psychologists prefer to call them, dissociated states.

On account of the diversity of the views concerning the subconscious, Dr. Prince has recently ' invited a discussion on the question by several eminent psychologists.

The dominant theories of the subconscious have emanated either from physicians or from psychologists. The former have naturally dealt with the abnormal aspects of the subject; the latter with its normal manifestations. The view-point has been different in each case, whether the subconscious phenomena are studied in the diseased or in the normal individual. The so-called field of consciousness is that portion of our mental life of which one is aware by ordinary introspection. What lies outside or beneath this conscious field is split off or, in psychological terms, dissociated from consciousness. In other words, it is extra-conscious or subconscious. To call this a dissociated potion of consciousness is more accurate and scientific, for then we do not pledge ourselves in placing this extra conscious field in any portion of what we may call the mental space. The stream of thought is made up of consciousness, and consciousness itself is the result of the energy of the central nervous system. By some consciousness is considered the energy itself; by others as running parallel with it. This interaction of the mind on the body, and the body on the mind, forms one of the most important and fascinating fields of physiological psychology. When the nervous system ceases to functionate, consciousness likewise disappears, as in profound sleep or in ether or chloroform narcosis. A sound sleep is dreamless and dreams only occur in the half-waking state. When the nerve cells are diseased, as in the various insanities and in poisoning by such drugs as alcohol or morphine, consciousness becomes distorted and hallucinations or sense deceptions arise. When certain conscious processes go on below the "threshold of consciousness," we are not aware of them and here we have the physiological explanation of unconscious thinking. In other words, we are dealing with subconscious processes. By the "threshold of consciousness" is meant the lowest limit of thought of which we have any perception. If ideas or thoughts are not of sufficient intensity to be perceived by us, they remain below this threshold; they are subconscious or dissociated. This split-off, subconscious, dissociated portion may be a marginal state or a fringe of consciousness in its normal sense, or, if diseased or abnormal, this marginal state grows larger and, as a natural consequence, the dissociated field of consciousness enlarges. This process, of course, narrows the field of normal consciousness, and we shall see later on how important a part this narrowing of the field of consciousness plays in hysteria.

Therefore, the subconscious may mean one of several things :

1. Any portion of consciousness outside the field of attention.

2. Ideas split off from the main stream of consciousness.

3. Split-off personalities.

4. Forgotten experiences, i.e., experiences and memories out of mind.

5. A great tank of consciousness exists within us, but we are conscious of only a portion of it (the subliminal self).

6. Unconscious brain action or thinking.

It would lead us too far into technicalities to discuss the complex theories given above, of which only the simplest outlines are indicated. One fundamental idea seems to underlie them all, however, namely, that certain portions of consciousness are or may become detached from the main stream. These portions have all the attributes of our entire conscious stream of thought, and the difference in interpretation becomes either purely psychological or purely physiological. The psychological interpretation is the one usually accepted today. A lack of feeling, of awareness," on the part of the individual is the distinguishing characteristic of these subconscious or dissociated states. For our purpose, however, it will be best to consider the subconscious as consisting of dissociated states, memories, emotions, and personalities; in fact, any portion of mental activity in its entirety, split off from the main stream of consciousness. These dissociated states have a mental activity and independence in every way analogous to our normal conscious states. Sometimes only ideas are dissociated, and then the patient is tortured by fixed ideas or obsessions which act as a mental thorn. In other cases, it is the emotions and emotional storms that take place, as shown by attacks of irritability, excitement, depression, or even convulsions. Sometimes certain memories are dissociated and then we have the condition known as amnesia. Entire groups of thought may be split off and in these cases the phenomena of automatic writing or crystal gazing may take place. Finally, in the most highly developed forms the personality itself, with its thoughts, memories, emotions, complete in themselves, may become completely dissociated, and it is here that we have the wonderful phenomena of double or multiple personality.

Before we enter into a discussion of abnormal subconscious phenomena, it will be well to inquire briefly into the question — Do subconscious states exist normally or are they always abnormal? Dr. Prince says: "The ease with which the mind in perfectly healthy persons can be dissociated and the dissociated states synthetized shows that subconscious synthetized states are not always evidences of disease." Janet strongly maintains the pathological nature of subconscious states, but experimental evidence shows that the process may be purely a normal one.

Before proceeding further, therefore, it will be necessary to give a few examples of the normal subconscious working. In every-day language, this is known as "absent-mindedness." People speak of doing things unconsciously, when in reality they mean subconsciously. A woman in opening eggs throws the yolk away and proceeds to beat the shells; another discards the inside of a banana and eats the skin; a third, in working, stirs with the poker of the stove instead of a spoon. The perennial joke of the professor inquiring for himself at his own house is another example of absent-mindedness or dissociation of consciousness. These are very simple examples. Far more complex, but in reality having the same underlying mechanism, is the following. When one is intently absorbed in the contents of an interesting book one becomes totally oblivious to passing sights and sounds. This is what occurs in hypnosis. But is this real oblivion, is consciousness totally blotted out, or is it merely narrowed upon one topic and has it reached a state of dissociation ? Let us see. While a person is reading, the telephone bell rings or some one asks a question. He apparently pays no attention to it. Yet it is really perceived, but perceived by the subconscious or dissociated self. A few minutes later he comes to himself, suddenly starts out of his day dream or reverie, shakes himself together, answers the telephone without knowing why, or gives an intelligent reply to something he knows not what. When the bell rang or the question was asked, his consciousness was dissociated; when he answered the bell or replied to the question, the consciousness had become synthetized or reassociated. The fact that an intelligent reaction did take place is proof that he subconsciously perceived the stimulus which brought forth the reaction. Now the disease hysteria, the phenomena of hypnosis or of multiple personality, of amnesia, are merely more or less protracted forms of this absent-mindedness. The under-lying principle of all absent-mindedness is dissociation. The striking points of all are these — that the gaps in memory or personality or thought are not real gaps at all, but merely chips of consciousness carrying memories or ideas that have floated off from the main stream of conscious thought. In other words, they are subconscious, dissociated. These subconscious fragments of consciousness in their own narrow way act like the full content of the stream of thought.

Take a still more complex condition from the abnormal standpoint. In the case of Miss Beauchamp (The Dissociation of a Personality), one of the personalities who called herself " Sally" was wont to do all sorts of pranks, of which the original Miss B. knew nothing. On one occasion Sally smoked a cigarette, and when the Sally personality changed to Miss B. there was no recollection of the act. But when Miss B. was asked to gaze into a crystal, she saw therein a vision of herself smoking a cigarette. She was naturally horrified at seeing herself at an act of which she had absolutely no recollection. Now what had happened ? Sally was one of the dissociated personalities and although she knew the acts of Miss B., yet Miss B. knew nothing of Sally. The crystal gazing had produced in Miss B. a state of abstraction or absent-mindedness, and in consequence there arose a reversion to the Sally personality with all her acts. Miss B. by this means was able to penetrate to regions that her conscious, waking memory was unable to reach. The dissociation had disappeared and with it came the vision of Sally's behavior. On another occasion Sally destroyed some bank notes belonging to Miss B., and the latter was astonished to see herself, in the crystal vision, in the act of tearing the bank notes into fragments. In reality we are dealing in both these episodes with sub-conscious hallucinations, Miss B. was the unfortunate victim of her subconscious behavior of which she knew nothing and consequently was unable to understand her conduct in the Sally personality. We have thus indicated and explained, as clearly as the nature of the subject will allow, what is meant by the subconscious in all its degrees, from the most simple manifestations of every-day life to the complex phenomena of multiple personality. In an interesting little volume, Freud has shown how great an influence is exerted by the subconscious on our every-day life. According to him all dreams originate in our subconscious mental life, while certain familiar daily events, the forgetting of proper names, the slips of the tongue, etc., are also examples of this mental dissociation. Thus there are no gaps between the normal and abnormal subconscious workings; the phenomena shade almost imperceptibly into one another.

We are now prepared to briefly discuss the abnormal manifestations of mental dissociation, or what we shall call the diseases of the subconscious. We have given examples and explanations of the normal workings of the subconscious, all of them taken from the happenings of everyday life with one exception, and this was introduced in order to complete the series of subconscious phenomena from the simple to the complex. It now remains to point out the principal aspects of the abnormal workings of the subconscious, their causes and the indications for a rational scientific treatment. For it is the diseases of the subconscious that in all ages have offered the most baffling problems to physicians. The many-sided disease, hysteria, is dependent upon a dissociation of consciousness; the phenomena of hypnosis can be utilized as powerful therapeutic and experimental factors; neurasthenia is the curse of modern civilization; and lately there has arisen the conception of psychasthenia, as indicating the peculiar mental state accompanying obsessions and fixed ideas. The cases of multiple personality and of amnesia (a systematized loss of memory) are dependent upon dissociations of consciousness, and the cure of these conditions by proper methods is one of the triumphs of purely psychological principles. These are all diseases or artifacts or abnormal aspects of the subconscious. The very mention of their names at once indicates their importance.

Hypnosis is not really a disease of the subconscious, but is rather an artificially induced state of absent-mindedness. It is so important that a separate chapter will be devoted to its consideration. The most important of all the diseases of dissociation or of the subconscious is that protean malady called hysteria. Many-sided it really is, for in no nervous disease are the symptoms so diverse. Hysteria can simulate almost anything from the paralysis of brain disease to complete loss of voice (aphonia). Two of the most distinguished investigators, Prince in America and Janet in France, look upon hysteria as a dissociation of the personality. Dr. Prince says: "Hysteria is a manifestation of disintegration, and the neurasthenic state, one of the stigmata of hysteria, is pathologically a type of dissociation of the personality." According to Janet,' "Hysteria is a form of mental depression characterized by the retraction of the field of personal consciousness and a tendency to the dissociation and emancipation of the systems of ideas and functions that constitute personality." These are purely psychological definitions and are based on sound experimental evidence. Clinically this dissociation is manifested in many different ways. There may be a paralysis of one or more limbs, losses of sensation in various parts of the body may arise (hysterical anesthesia), the memory for certain periods may disappear (amnesia), complex acts of somnambulism may take place, the voice may become suddenly lost (aphonia), there may be convulsions, phantom tumors may suddenly appear, and finally there may be disturbances of vision, from an extreme narrowing of the visual field to complete blindness. But these symptoms when carefully studied are found to have their peculiarities, and the chief of these is their inconsistency. It is this inconsistency which gives the appearance of simulation to many of the acts and symptoms of the hysterical. The paralysis and anesthesia may show anatomical impossibilities, the right arm or the left leg or vice versa may be paralyzed; the patient may be able to move the legs in bed without a trace of muscular weakness and yet be totally unable to walk; the anesthesia does not follow the distribution of any nerve; the patient may be unable to feel a painful sensation over an area resembling a glove or stocking, or it may be sharply limited to one side of the body, even the tongue being involved. The peculiarities that hold for one group of symptoms hold for all the others, so there is no need to enumerate them all. The hysteric who has lost the voice will scream on a sudden emotion; if tests show almost complete blindness, yet obstacles are intelligently avoided. What is the meaning of all these symptoms ? An account of a few experiments is necessary to illustrate the psychology of hysteria more clearly. Take an hysteric who has lost all sensation in the right hand.

Blindfold the patient, prick or pinch the hand, the patient asserts that he feels absolutely nothing. Repeat the experiment and pinch or prick the hand a definite number of times, then ask the patient to tell you the first number that comes into his mind, and it will be found that this number will correspond to the times the hand has been pinched or pricked. Repeat the experiment any number of times and under all variations and the result will be the same. What does this mean? It means that the patient subconsciously perceived what was done to him and how many times. In other words, there is not a real anćsthesia, such as would follow if a nerve were cut or diseased, but a subconscious anesthesia, a psychic one. The feeling of the limb is only split off, dissociated, but is clearly perceived by the subconscious self. It is this inability to call up the idea of a motion of a limb or its feeling, or the failure of the faculty of recollection, that causes the paralyses, the anesthesia's, the amnesias. What is true of one symptom or group of symptoms in hysteria is true of all. They are merely dissociations. One peculiarity of the hysterical symptoms is their sudden appearance and disappearance. Hysterical phantom tumors resemble a real tumor, but get well without surgical operation. The sudden onset of blindness, and its just as sudden recovery after months or years, is usually hysterical. The paralyses of years' duration that recover under the stress of a strong emotion, or even in a single night, are always hysterical.

These motor and sensory dissociations are the result of a morbid auto-suggestion. The hysteric is above all highly suggestible. That is why he can be so easily hypnotized and why the symptoms will disappear in hypnosis. Sometimes painful ideas of a disagreeable nature are suppressed during the day, to appear again at night in sleep-walking or somnambulism, as in the case of Lady Macbeth. In one of Janet's cases the young woman obstinately refused to eat, because she immediately vomited any food or drink. Furthermore, she was insensible all over the body. When this young woman was hypnotized, in the hypnotic state the insensibility of the body disappeared, the vomiting ceased and she accepted food and drink. The only way in which this patient could be nourished was by placing her in the hypnotic state, otherwise death would have resulted by starvation. One of our cases was an hysterical boy, who suffered from convulsions and one-half of his body was anaesthetic, even the tongue and mucous membrane of the mouth being involved. Furthermore, he had attacks of hysterical paralyses and contractures involving the left arm and leg. All these paralyses, contractures, and in-sensibility of the body could be made to appear or disappear at will, by mere waking suggestion. Ultimately, as a result of suggestion, all the hysterical symptoms, even the convulsions, disappeared.

An example of crystal gazing has already been given. In automatic writing the hand unconsciously produces weird drawings, words, sentences, anecdotes, often scraps of knowledge written in some outlandish tongue. There is nothing supernormal in these productions, the hand merely writes previous knowledge and experiences, which in some way have become dissociated. The content of the writing may represent a mechanical repetition of the dissociated knowledge, or there may be considerable elaboration or even fabrication. In these subconscious ideas we see the resurrection of some forgotten knowledge. In most cases the subject is in a state of deep abstraction during the process, the movement of the hand is unperceived, and there is no memory of what has been written. In reviewing a series of automatic writings by Mrs. A. W. Verrall 1 it was stated that there was nothing to show that the content of the writings either did not represent the previous knowledge and experiences of the subject or was not a pure fabrication. The source of this knowledge, however, in most instances, had been long forgotten, in reality had become subconscious, but later was reproduced in a condition of abstraction.

The best example in which the automatic writing was a purely subconscious fabrication is found in Flournoy's study of Mlle. Heléne Smith.' In the Martian Cycle of Mlle. Smith the subject made drawings of an alleged Martian landscape, a Martian alphabet was produced, and finally a large number of rather fragmentary Martian texts. This "subliminal astronomy" Flournoy traces back to his subject's interest some years previously in the Martian canals, although he admits that the original elements have been recombined and molded in a very original fashion. In Hyslop's case of Mrs. Smead, there were also alleged communications of life on the planet Mars, and later a hieroglyphic language was developed.

The amnesias or systematized losses of memory are of great theoretical and practical importance. Sometimes this loss is for a few days only; sometimes it compresses an entire period of life. But in the functional amnesias, as distinct from those dependent on organic brain disease, the memory is really not lost, it is dissociated merely; it exists in its entirety in the subconscious. By proper psychological devices, the subconscious memories can be synthetized with the normal consciousness and thus the memories for the lost period can be permanently restored. These losses of memory occur frequently in hysteria and in alcoholism, but are occasionally found in those who are neither hysteric nor alcoholic. Accounts are occasionally published of a person suddenly disappearing, foul play is suspected, and for weeks or months the person will be unheard of. Suddenly, in some strange, remote place, this person will suddenly come to himself, will wonder how he reached there and will find that he has been passing under another name. The entire past for several months will be a blank. Now it is of the utmost importance sometimes, for social and therapeutic reasons, that this blank period should be restored. It is not a real blank, however, for the memories of the lost period are merely dissociated, subconscious. Now these lost memories can be fully and permanently restored, and, in fact, this has been successfully accomplished. In one case, following a blow on the head, a man of wide learning became like a child in intellect; another wandered to a distant city without any recollection of the act; in still another, an educated woman, after several exciting episodes, went into a deep stupor, and on awakening it was found that all memory of her previous life had been obliterated.'

Modern researches have established that neurasthenia and psychasthenia are merely diseases of the subconscious. All the symptoms of neurasthenia can be referred to a dissociation, — the fatigue, headaches, dizziness, heart and gastric symptoms, the mental state and the fleeting pains. This dissociation probably originates in an exhaustion of the brain. Occasionally the neurasthenic state is merely a symptom of hysteria.

Sometimes, however, after the strong emotional shock of a railway accident, with its harassing experiences, there develops a peculiar group of symptoms, partly hysterical, partly neurasthenic in nature, known as the traumatic neuroses. The injury may be slight or severe, in fact the development of the symptoms, or their intensity, seems to bear no relation to the severity of the injury. The ultimate cause, therefore, of these traumatic neuroses seems to be the very sudden emotional disturbance. Much of the litigation in our courts is based on this particular form of nervous disease.

Psychasthenia can also be interpreted psychologically. It is a disease of the mental level, and when the mental level sinks below a certain point we have the phenomena of psychasthenia. It is to the great credit of Janet, that he succeeded in unifying many diverse symptoms which had previously been described separately, and established that psychasthenia is really the mental state accompanying obsessions and fixed ideas. It has many features common to epilepsy, hysteria, and neurasthenia. There are depressions, various obsessions, often a feeling of unreality and peculiar crises and convulsive attacks. The obsessions or fixed ideas may be those of crime, disgrace of self or body; frequently absurd ideas of violence arise. The patient may become agitated, perplexed, over-scrupulous, ask many peculiar questions, develop all sorts of fears, such as a fear of open places (agoraphobia), a fear of contamination by dirt (mysophobia), etc. In addition there are frequently attacks of intense anxiety and the mental condition shows a marked indecision.

There is another point. Attacks closely resembling epilepsy are sometimes observed, which are not real epilepsy at all, but only outwardly resembling it. Neither have they any relation to hysteria or psychasthenia. On close study it will be found that these attacks have a sub-conscious origin. They do not yield to the usual treat-ment for epilepsy, but some form of psychotherapy is very beneficial and in most cases curative.

We have left for the end the subject of multiple personality. The subject is so large and complex, however, that only the barest outlines can be indicated. All cases of multiple personality are accompanied by amnesia or loss of memory, and much that was stated about the latter will be found to be true of the former. In fact, there may be a transition from one to the other. Those who are interested in the subject will do well to read Dr. Prince's narrative of Miss Beauchamp in his Dissociation of a Personality. The final synthesis of Miss Beauchamp's several personalities into one healthy self furnishes a splendid example of the efficiency of purely psychological methods in bringing about a cure. These methods were based upon the modern theories of the subconscious. In this patient, an intelligent young woman of twenty-three, there was presented at first nothing but the symptoms of ordinary neurasthenia. One by one, however, four distinct personalities appeared, and in their unfolding a complex drama was enacted. The various personalities are analyzed with great skill. One of these, designated by the name of "Sally," played all sorts of pranks and tricks, of which the other personalities were ignorant. Examples have already been given in the paragraphs on crystal gazing. The origin of the dissociation was due to a strong emotional shock. Each personality was an organized, subconscious self, and each acted according to its own memories, moods, and intelligence. Each shifted and replaced the other from time to time, although "Sally" was the most successful in this shifting and seemed to take an impish delight in remaining "on top of the heap." The case is a perfect mine of abnormal psychological phenomena, ecstasy and sudden religious conversion, alterations of character, losses of memory, hysterical and neurasthenic symptoms, automatic writing and crystal vision; in fact, nearly all the manifestations of a subconscious mental life. In the end, the original Miss Beauchamp was re-constructed.

There is one more curious fact of the subconscious that merits notice. In amnesia, the lost memories reappear in sleep, but are looked upon by the patient as pure imaginative creations, as dreams. In one of Janet's cases, the patient talked in her sleep and pronounced names of which she knew nothing in her waking state; the dreams of two of the personalities of Miss Beauchamp were alike and each remembered them as her own; in the Lowell case of amnesia the patient's dreams were those of experiences that occurred in her former life, but of which she had no memory on awakening except as a dream.

Now what causes these dissociations? Exhaustion may fail to synthetize the consciousness; certain emotional shocks may split the personality; alcohol may cause extensive losses of memory; fixed ideas may exist sub-consciously and act as a constant psychic irritation by turning the mind topsy-turvy. Even convulsions resembling real epilepsy may occur. When these functional conditions once occur, they can recur a second time more easily. The ideas break through on slight provocation and then we have the hysterical attack or the loss of memory or the change of personality.

What can science do for these diseases of the subconscious? Everything, but by psychological methods exclusively, not by drugs. If certain diseases are caused by a dissociation of consciousness, it naturally follows that a state of healthy-mindedness can only be secured by a reassociation, a synthesis of this split consciousness.

Figuratively, we must "tap the subconscious" and synthetize the dissociated portion with the main stream. This can be accomplished by many psychological devices: psychic re-education; utilization of reserve energy; suggestions given in hypnosis or in states of deep abstraction, etc. These must be frequently repeated, for it is a well-known law that a state of dissociation once established can more easily take place again. By these methods there follows a reassociation, a synthesis of the dissociated state. The attention becomes strengthened, the subconscious field again enters consciousness and is perceived, whereas before it lay outside of consciousness and consequently was not perceived. Thus memories of lost periods may be restored, multiple personalities may be blended into one healthy personality, hysterical symptoms may be made to disappear and fixed ideas may be permanently destroyed. Certain hidden emotional states may be brought to light and curious disease manifestations of otherwise obscure origin, such as paralyses and convulsions, may be permanently benefited.

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