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Page 22
We, therefore, must not accept the outward and visible signs at their
face value but attempt to discover what past experiences in the life of
the patient have led to such disturbance of function, to such a change
in his mental activity.
It will possibly be of some assistance to provide one or two examples in
order to demonstrate the importance of the past experiences as agents
capable of producing such alterations.
The first case will illustrate the results produced by the development
of a dominant emotional tendency during early childhood. The patient up
to the fifth year of her life had been an ordinary, normal child,
attached to her mother, fond of her nurse, interested in her toys.
During the next two years she endured much bad treatment at the hands of
a new nurse which produced such an impression on her that she felt she
was a changed child. This nurse, described to me by the patient as a
handsome woman, having met the inevitable man, used frequently to meet
him clandestinely. The child was neglected, was sometimes left alone, on
one occasion in a graveyard, but she was forbidden to mention the
subject to any one under threats of being carried away by a "bogey-man."
The child became very frightened by this, to such an extent that one
night she had a severe nightmare in which a "bogey-man" came to carry
her away. At the end of two years a profound change had taken place in
her which she now describes thus: "I was a changed child; I was
separated from my mother and could no longer confide in her nor did I
wish to do things for her as I had done before; I could not enjoy my
toys; I had no confidence in myself; I was not like other children." And
from that time on, as girl and as woman, she has never felt that she has
been like others of her sex. Such a condition, being started and
confined by repetition, interfered with her free development and it was
remarkable how many incidents occurred in her life to confirm the
disability, but the germ of her serious breakdown thirty years later was
laid in her fifth and sixth years.
The second case is that of a patient who, as a child, had some
convulsive attacks. She was therefore considered delicate and was
thoroughly spoiled. When nearly thirty she lived through a sexual
experience which caused extreme anxiety; she broke down and was admitted
to an asylum. After admission she looked across the dormitory and saw a
head appearing above the bed-clothes, the hair of which had been cut
short for hygienic reasons. With a memory of her sexual indiscretion
still vivid in her mind she jumped to the conclusion that she was in a
place where men and women were crowded together in the same room. She
got out of bed, refused to return to it, fought against the nurses and
was transferred to a single room, with the mattress on the floor and the
window shuttered. She wondered where she was and came to the conclusion
that she was in a horse-box. Then arose a feeling of terror that she
would be at the disposal of the grooms when they returned from work. The
sound of heavy footsteps of the patients passing along the corridor to
the tea-room suggested that the grooms were returning and that her room
would soon be invaded. The feeling of terror increased and she tried to
hide in the corner, drawing the mattress and clothes over her. And so
on.
Months later when I had my first interview with her, her sole remark
during the hour was "How can I speak in a place like this?" This was
repeated almost without intermission throughout the hour. It formed a
good example of the origin of the process of perseveration, a process
frequently adopted by the patient to guard against the disclosure of a
troublesome secret.
If we attempt to trace out some of the mechanisms employed in these two
cases we shall see that in response to definite stimuli each reacted in
a manner which cannot be considered abnormal in kind. It was normal
reaction for the child to be distressed at being separated from her
mother in such a way, to be frightened by being left in the graveyard
alone, or at the threat of her being carried away by a "bogey-man" if
she dared to mention anything of the clandestine meetings to her mother.
It was not very abnormal that after her sexual experience the other
patient while still in a confused state caused by the intense emotional
condition of anxiety, should, on seeing a head with the hair cropped
short, jump to the conclusion that there was a man in a bed in the same
ward with herself, or that she should feel frightened and wish to leave
the room.
The mental activity in each case depended on mental content, that is,
memory of past experiences with their intense emotional states which
acted as the driving force and also made the recall of the experience go
extremely easy. The further developments after being placed in the
single room with mattresses on the floor and the window shuttered were
rationalizations also based on mental content, _i.e._, on the memory of
rooms somewhat similar to that in which she found herself and of the use
of such rooms. It is interesting to note also in the first case that in
her wildest delirium during an acute attack she lived through episodes
of her past life. One example may be given. In the course of her
delirium she thought that a "blackbird" had flown to her, touched her
left wrist and taken away all her vitality. This depended on an
experience of her going to Germany when a girl and meeting a young
German officer whom she did not like. A few years later she went to
Germany and met the officer again. Without going into full details I may
say that on one occasion when walking with him he seized her left wrist
with his right hand and attempted to kiss her; she struggled fiercely
and ran from him. Here we see that not only is her delirium based on a
past experience, but that the whole memory is symbolized in the
"blackbird" which was the emblem of the German nation in whose army the
officer was then serving. Connected with this there was also another
unpleasant episode which dated from her tenth year. Much of her delirium
was worked out in such a way that most of the details could be traced
back to experiences of her earlier life.
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