Chapter Three: The First Dynamic
Psychiatry (1775-1900)
1.
The first dynamic psychiatry
gained official university recognition in 1880. Following that new schools
began to develop and the first dynamic psychiatry declined by 1900. However,
the new schools were very much rooted and indebted to the first dynamic
psychiatry. Although there was much variation in the first dynamic psychiatry,
the following points remained constant:
a.
Hypnotism was the royal road to
the unconscious. Other approaches, such as automatic writing, mediums and
crystal gazing, were supplementary. Psychotherapy mostly consisted of hypnosis
and suggestion, with particular attention given to the rapport between patient
and magnetizer/hypnotist.
b.
Attention was devoted to specific
clinical issues (or "magnetic diseases") such as, spontaneous
somnambulism, lethargy, catalepsy, multiple personality, and hysteria.
c.
A new model of the human mind was
developed. It viewed the mind as consisting of the duality of conscious and
unconscious psychism. Later the mind was viewed as a cluster of
sub-personalities underlying the conscious personality.
d.
New theories of the pathogenesis
of nervous illness were devised. First they were based on the concept of
magnetic fluid, and then on the concept of mental energy.
2.
As previously discussed, exorcism
(particularly the approach of Gassner) was a primary source of the first
dynamic psychiatry. However, other sources bear mentioning. The concept of
"imagination" (or Imaginatio) was widely discussed during the
Renaissance. Montaigne devoted a chapter in his Essays to the topic,
which discussed the power of the mind to cause physical and emotional
diseases/cures. Muratori wrote a treatise On the Power of Human Imagination
which discuses dreams, visions, delusions, fixed ideas, phobias and
somnambulism. Another source for the first dynamic psychiatry was the history
of hypnotism itself. It was used by the
ancient Egyptians and Renaissance students of natural magic.
3.
During this period the following
issues surrounding hypnotism were paramount:
a.
The disagreement between the
"fluidist" theory of magnetism and "animist" theory which
contended that the phenomenon was psychological in nature.
b.
The relationship between the
magnetizer and the magnetized: Puységur noticed that his patient Victor seemed
to anticipate his orders. The question arose as early as 1785 whether the
subject could oppose the magnetizer's will. This, of course, had legal
implications as well; could a person in hypnotic sleep be held accountable for
their actions?
c.
The influence of hypnotism
extended beyond the experience into normal conscious life. The phenomenon of
post-hypnotic suggestion, where the subject fulfills a command during the
waking state, was already described in 1787. Post-hypnotic amnesia was not
absolute; under certain circumstances the experience could be recalled.
d.
Various methods were devised to
induce magnetic sleep/hypnosis. The approach of "fascination" (e.g.
staring at a slightly moving point or into the eyes of the hypnotist) was used
by the Salpêtriére school. Other techniques included verbal orders (Faria) and
speaking in a gentle voice (Nancy school) were also used.
e.
It was understood that the subject
could not be hypnotized against his will. He must be made comfortable and
relaxed. It had been noticed early on that witnessing someone else in the
hypnotic state made it easier to be hypnotized as well. The group method had
been used since Mesmer. Early magnetizers, however, did not realize the extent
that hypnosis was molded by the magnetizer/hypnotist. Janet argued that the
state of hypnosis depended upon the subject's previous experiences,
pathologies, and the school and style of the hypnotist.
f.
It was noticed that the subjects
often displayed hypersensitivity to physical stimuli, greater physical
strength, physical changes (e.g. turning deaf,
paralyzed, or anesthetic), and an amazing ability to display emotions,
enact roles and change personalities. The first surgical operation under
magnetic anesthesia was performed in 1821 by Récamier.
g.
Scant attention was given to the
subjective experience of being hypnotized. Bleuler was one of the first to
describe the experience after being hypnotized by a colleague.
h.
One controversial aspect of
hypnotism was the phenomenon of age regression. The question was "is this
true regression or only an excellent imitation of what the subject believes
about the past?" Colonel de Rochas conducted hypnotic age regression
experiments even to the point of the fetal period, past lives and the future.
4.
During the first dynamic
psychiatry there were certain clinical cases that were given much attention.
The earliest focus was on somnambulism, then multiple personality, and then
hysteria.
a.
Ambulatory Automatism (now known as Fugue
state): Charcot classified these according to three etiologies — traumatic,
epileptic and hysterical. These states were sometimes viewed as a transient
multiple personality. Janet pointed out the sometimes unconscious motivations
that triggered these shifts in personality.
b.
Multiple personality: By the later
1800's this was often discussed by psychiatrists and philosophers, but
published cases can be found as early as 1791. After the
"disappearance" of possession these case studies began to emerge. Two
of the most important case studies at the time were Mary Reynolds case
published by Kearsley Mitchell and Plumer, and the case of Estelle published by
Despine Sr. Based on the latter case, Janet pointed out that the second
personality at times could be the healthier personality while the
"normal" personality pathological. The different types of cases can be
classified as such:
i. Simultaneous
multiple personalities: the coexistence of two personalities is a rare case and
is unlikely to last for long periods.
ii. Successive
multiple personalities
1.
Mutually cognizant of each other:
this condition is also relatively rare. The case provided by Charles E. Cory
(1920) is an example.
2.
Mutually amnestic: in this type
both personalities know nothing about each other. One such case of Ansel Bourne
was examined by William James.
3.
One-way amnestic: in this group
personality A is aware of B but B is not aware of A. Most cases of multiple
personality belongs to this group. Azam provided a case, "Felida X.,"
in the late 19th century and published it with an introduction by Charcot. Also
of note is Morselli's patent Elena.
iii. Personality
clusters: The only cases on multiple personality were dual personality cases. However, in time the human mind came
to be later viewed as a matrix from which whole sets of sub-personalities could
emerge. The use of hypnosis could actually bring forth a third, fourth etc.
personality. Morton Prince published the case of Miss Beauchamp in which she
displayed four different states (which she called B I, II, III, IV). Likewise,
Walter Franklin Prince published the enigmatic case of Doris.
iv. There
were different explanatory theories of multiple personality. The
"associationists" thought that the mental split and loss of
connection between the groups of associations led to multiple personalities.
The "organicists" viewed it in terms of brain modification. Flournoy
emphasized the factors of motivation, role-playing, regression etc. Gardner
Murphey viewed it as "the organisms effort to live, at different times, in
terms of different systems of values." Following 1910 there was a wave of
reaction against the concept of multiple personalities with the claim that
previous researchers were duped. There was only a revival of interest following
the advent of EEG brain scans and other sensational cases.
c.
Hysteria (now known as Conversion
Disorder): This condition was considered a mysterious disease that afflicted
women and originated in the uterus. In the 16th century some physicians claimed
that it originated in the brain and could also afflict men. Briquet published
the first systematic exploration of hysteria in 1859. He defined it as "a
neurosis of the brain, the manifestations of it consisting chiefly in a
perturbation of those vital acts which are concerned with the expression of emotions
and passions." He claimed that 1 in 20 patients were men. He denied the
commonly held view that erotic frustration led to this disease. He viewed it
related to negative psychosocial experiences and a hypersensitivity and genetic
predisposition. Charcot conception of hysteria was mostly influenced by
Briquet. Nevertheless, the theory of sexual frustration maintained its power in
the scientific and general perception.
d.
By the end of the 19th century
hysteria came to be viewed as the synthesis between somnambulism, multiple
personality, catalepsy, lethargy, hallucinations and ecstasis; the hysteric
could demonstrate all of these symptoms. Moreover, hypnosis could produce all
of these states and, under favorable conditions, cure these symptoms. At times,
Charcot described hysteria as a permanent state of semi-somnambulism, while
Janet viewed it as a permanent state of multiple personality. Thus, the
understanding of hysteria effected a synthesis between the hypnotists and the
official psychiatry.
5.
Models of the Mind
a.
Dipsychism suggests that the mind
is fundamentally double. Early magnetizers believed this and it culminated in
Dessoir's famous book "The Double Ego" in 1890. Within this theory
there were two schools. One considered the hidden mind to be closed, that is,
it contained only things that went through the conscious mind. The other school
contended that the unconscious mind was open in that it could communicate with
a mysterious realm. It was hypothesized that this enabled
paranormal/extra-sensory perception and communication with the World Soul. This
appears to be a precursor to Jung's collective unconscious.
b.
Polypsychism, the belief that the
mind consists of a complex cluster of sub-personalities, also has its roots in
the early magnetizers. Duran de Gros and Reil were proponents of this approach.
Both Freud and Jung began with dipsychism and ended with polypsychism (e.g. id,
ego, superego)
6.
Concepts of Psychogenesis of
illness
a.
The Fluidic Theory: Mesmer
believed in the existence of a universal physical fluid, and disturbance
thereof caused disease. Although this theory was eventually abandoned other
concepts such as psychological forces or nervous energy replaced this
theory.
b.
Ideodynamism: The power of
hypnotic suggestion was recognized and it was thought that implanted
"fixed ideas" or a group of associates ideas ("complexes")
were the cause of pathology. This was recognized by Liébeault, Charcot, Janet,
and later, Jung.
7.
Psychotherapeutic Procedures
a.
In 1803 Reil presented a holistic
approach to psychotherapy, including
reform of mental health institutions, bodily and sensory stimulation,
pharmacology and surgical cures, psychodrama, and occupational therapy. He has
been called the founder of rational psychotherapy.
b.
The Mesmerists, as mentioned,
provoked crises as the first step towards their resolution. This may be branded
a type of cathartic theory. At times hypnosis was later used in this sense as
well. However, hypnotic sleep in-and-of-itself could be also therapeutic, with
some patients describing it as the "most absolute rest one can
imagine." Hypnotism also acted through suggestion — the direct
implantation of an idea into the passive mind of the patient. Sometimes,
though, there would be a kind of bargaining between the hypnotist and patient
with the patient foretelling the end of the symptoms and prescribing the
treatment.
8.
Rapport: The Therapeutic Channel
a.
Psychotherapeutic procedures
notwithstanding, they all utilized rapport. The term rapport has developed
since its use by Mesmer. He borrowed it from contemporary physics experiments
where people formed human chains and transmitted to each other an electrical
current originating in a machine. Thus, magnetizer and patient formed a
connection where the magnetizer can transmit magnetic fluid. The magnetized
became hypersensitive to the magnetizer. The French magnetizes emphasized that
the influence of the magnetizer continued in between sessions. At times the
magnetized patient would become fascinated with the magnetizer to the extent
that they would have visions of him or might adopt their personal behaviors or
medical theories.
b.
By 1784 the term "magnetic
reciprocity" was introduced, indicating that the magnetizer also become
extremely sensitive to the magnetized.
c.
From the beginning of magnetism
the suspicion of eroticism implicit in rapport was discussed and even
investigated. Other magnetizers compared magnetic rapport to the relationship
between mother and child or brother and sister.
d.
Charcot and Bernheim did not pay
much attention to rapport and it was
reintroduced by Janet. At the International Congress of Psychology in 1896
Janet elaborated a theory of rapport. He distinguished between two phases of
rapport: hypnotic influence and passion. In the first phase the patient
generally improved and was freed of most symptoms. In the second phase there is
an increased need to see the hypnotist; this could develop into jealousy, fear,
profound respect, love. It could manifest in dreams and hallucinations. Of
therapeutic interest, he found that posthypnotic suggestions were obeyed in the
first, not the second, phase. In a paper in 1897, Janet suggested that the
second phase was influenced by a certain type of love towards to the hypnotist
(erotic, maternal, filial etc.) and by their need to be directed. He therefore
suggested that the therapist must first gain command of the patients mind and
then, in the second phase of treatment, teach the patient to do without him. He
would accomplish this by lengthening the intervals between sessions and by
exploring the feelings the patient has towards the therapist.
9.
The Psychotherapist
a.
The magnetizer and hypnotist
constituted a new type of healer. They quickly developed their own journals,
textbooks, societies and professional ethics. We can gain insight into what
they were like by a number of autobiographies (mosty of stage magnetizers) and
textbooks, especially that of Aubin Gauthier:
i. The
magnetizer must be a good health lest he transmit his own diseases to his
patients. If should become ill he needs to purify himself before returning to
work. He must lead a "wise and well regulated life." His personality
should be calm, reserved, kind, and with measured speech.
ii. Gauthier rejected Puységur position that magnetizers should
practice without pay. Other professional ethics include keeping a journal of
sessions, completing the course of treatment, prohibiting a male magnetizing a
woman without her husband or another witness present, and abstaining from
clinical experimentation.
10.
The Cultural Impact of the First
Dynamic Psychiatry
a.
As early as 1787 a novel was
written on magnetism. Some well-known novelists incorporated magnetism and dual
personality into their works, such as
Balzac, Stevenson (The Strange Case of Dr. Jekyll and Mr. Hyde) and
Marcel Proust.
b.
Poets, such as E.T.A. Hoffmann and
Edgar Allan Poe, were influenced by magnetism and dual personality.
c.
As will be discussed in next
chapter, magnetism also greatly influenced philosophy, especially the Romantic
philosophers (Schelling, Fichte, Schopenhauer). Bergson himself experimented
with hypnosis.
d.
It also influenced Protestant and
Catholic theologians and Christian medicine. In France was met with fierce
resistance by many religious circles, but in 1846 Father Lacordaire gave a
sermon in Notre Dame Cathedral supporting magnetism as an antidote to
materialism.
11.
The Decline of the First Dynamic
Psychiatry
a.
It is paradoxical that relatively
soon after the new discoveries of the first dynamic psychiatry became accepted
as official medicine they began to decline and were eventually abandoned. After
1882 the subject of hypnotism flooded publications and interest declined.
However, there were other factors to the decline. Simply put, the reliability
of hypnotism was questioned due to subjects feigning the hypnotic state or
unconsciously simulating the state. Again it was realized that results were
based on the expectations of the hypnotist, and vice versa, the hypnotist was influenced
by the subject.
b.
Both Janet and Fredrick Myers were
well aware of the pitfalls of hypnotism. However, they believed that our
knowledge could be expanded. The new dynamic psychiatry, in fact, incorporated
much from the first. To better understand the new dynamic psychiatry a survey
of the sociological and cultural background of the 19th century is necessary.
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