A middle-aged woman entered one of the Boston hospitals and complained of severe abdominal pains, which she attributed to cancer of the stomach or intestines. She was obviously greatly frightened, and suffering intense agony. A diagnosis of appendicitis was made, and an immediate operation deemed imperative.
But, to the surprise of the surgeons, the appendix was found to be in a normal condition. At once they directed their attention to the other abdominal organs, examining them one by one. None showed any sign of disease. Finally, with a rueful smile, one of the surgeons straightened up, and, touching a finger to his head, said:
“The trouble with this poor woman, gentlemen, is here, not in the region that we have been exploring. But we should not undeceive her. We will remove the appendix, on general principles, and that will probably be all that is needed to cure the trouble in her head.”
Under the circumstances, it was excellent advice. But how much better it would have been for the unfortunate woman, whose life was thus endangered by the surgeon’s knife, if it had been recognized from the beginning that her malady was only a “hysterical simulation” of the symptoms of appendicitis. Some day, when physicians generally make themselves acquainted with the diagnostic methods of psychopathology, blunders like this will be, as they ought to be, most exceptional.
In point both of diagnosis and treatment, again, psychopathological knowledge is indispensable to the correct handling of such cases as the following, reported by Doctor Janet.[43] It is, I am ready to concede, an unusual case, but it is unusual only because it presents a complex of symptoms commonly found singly or in simpler combination.
It would be impossible to estimate with any accuracy the number of persons who, afflicted only in scant degree like this poor Marcelle, have been obliged to drag out an existence worse than death, either in the care of their friends or immured in an institution, simply because their medical attendants, ignorant of the workings of the law of dissociation, have been unable to fathom the true nature of their ills and adopt adequate curative measures.
Marcelle, as Doctor Janet calls her, was only nineteen years old when she began to astonish her relatives by developing what they were at first disposed to regard as nothing but an eccentric form of laziness. She would constantly ask them to give her objects—a book, her crochet work, a plate—which she could easily have got for herself by stretching out her hand and picking them up. To all expostulations, she would calmly reply:
“I can’t help it. I can’t use my hands as I once did, and that’s all there is to it.”
“You can’t use your hands! What nonsense! You can use them to eat with, well enough, and you are crocheting most of the time.”
“Oh, but that’s different.”