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Monday, June 8, 2015

The Discovery of the Unconscious By Henri F. Ellenberger (1970): Summary of Chapter Three

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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