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Tuesday, February 3, 2015

Rebbe Nachman and Pierre Janet: Entering the Delusion

A prince once became mad and thought that he was a turkey. He felt compelled to sit naked under the table, pecking at bones and pieces of bread, like a turkey. All the royal physicians gave up hope of  curing him of this madness. The king grieved tremendously.
A sage arrived and said, “I will undertake to cure him.”
The sage undressed and sat naked under the table, next to the prince, picking crumbs and bones.
“Who are you?” asked the prince. “What are you doing here?”
“And you?” replied the sage. “What are you doing here?”
“I am a turkey,” said the prince.
“I’m also a turkey,” answered the sage.
They sat together like this for some time, until they became good friends. One day, the sage signaled the king’s servants to throw him shirts. He said to the prince, “What makes you think that a turkey can’t wear a shirt? You can wear a shirt and still be a turkey.” With that, the two of them put on shirts.
After a while, the sage again signaled and they threw him pants. As before, he asked, “What makes you think that you can't be a turkey if you wear pants?”
The sage continued in this manner until they were both completely dressed. Then he signaled for regular food, from the table. The sage then asked the prince, “What makes you think that you will stop being a turkey if you eat good food? You can eat whatever you want and still be a turkey!” They both ate the food.
Finally, the sage said, “What makes you think a turkey must sit under the table? Even a turkey can sit at the table.” The sage continued in this manner until the prince was completely cured.
- Rebbe Nachman of Breslov, The Turkey Prince
Another of [Pierre] Janet's first patients in Paris was Justine, a forty-year-old married woman...For several years she had a morbid fear of cholera and would shout repeatedly, "'s taking me!" which would signal a hysterical crises. As a child she already had a morbid fear of death, probably because she sometimes helped her mother who was a nurse and who had to watch dying patients. She also once saw the corpses of two patients who had died of cholera. Janet treated Justine as an out-patient for three years and achieved one of his most celebrated cures with her. Here too psychological analysis could not be separated from the therapeutic process.

Janet began by analyzing the content of the hysterical crises. It was useless trying to talk to Justine during her crises. She did not seem to hear. Janet therefore entered the private drama of her crises and a second actor. When the patient cried, "Cholera! He will take me!" Janet answered, "Yes, he holds you by the right leg!" and the patient withdrew that leg. Janet then asked, "Where is he, your cholera?" to which she would reply, "Here! See him, he's bluish, and he stinks!" Janet could then begin a dialogue with her and was able to carry it on throughout the crises and gradually transform her crisis into an ordinary hypnotic state. Later he could easily elicit hypnosis directly and obtain a full description of her subjective experience during the crises. She saw two corpses standing nearby, one of whom stood closer to her, an ugly naked old man of greenish shade with a stench of putrefaction. Simultaneously she heard bells tolling and shouts of "Cholera, cholera!" Once the crises was over, Justine seemed to  have forgotten everything but the idea of cholera, which remained constant in her mind. Janet elaborated on how hypnosis could be used in such a case. Commands given to the hypnotized patient were of limited usefulness. The breaking down of the hallucinatory picture was more effective but it was a slow procedure and also had limitations. The most effective method proved to be substitution, that is, suggestions of a gradual transformations of the hallucinatory picture. The naked corpse was provided with clothes and identified with a Chinese general whom Justine had been greatly impressed to see at the Universal Exposition. The Chinese general started to walk and act so that instead of being terrifying his picture became comical. The hysterical attack changed in that it now consisted of a few cries followed by fits of laughter. Then the cries disappeared, and the visions of cholera persisted only when she dreamed, until Janet expelled them in turn by suggesting innocuous dreams. This result had required about one year of treatment. But the fixed idea of cholera persisted both on the conscious and subconscious level. Sometimes Justine was observed whispering the word "cholera" while her mind was taken up with some other activity. Attempts with automatic writing produced nothing but endless repetitions of the word "cholera, cholera..." Janet now directed his attack against the word itself, and suggested that Cho-le-ra was the name of the Chinese general. The syllable cho was associated with other terminations until the day arrived when the word "cholera" lost its evil connotations.

-Henri F. Ellenberger, The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry, p. 369

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