[12] Leonard Hill—The Cerebral Circulation.
She had married happily at the age of nineteen years, had a family of eight children, but had been a widow for about twenty years. Her husband died suddenly abroad, where she had lived with her family for two years after his death, and acting on the advice of her friends, she came back to this country bringing all her children with her. This involved her in years of struggle and anxiety to bring them up creditably, which she managed to do. During all these years of widowhood and stress she was mentally well, and latterly she described her life as a happy one surrounded as she was by an affectionate and well doing family. She had been brought up in a puritan household. Her father and her husband had been deeply and consistently religious though strict in their belief and observance of the letter. This upbringing favoured a natural tendency towards religious mysticism which was also promoted by the creed of the church to which she latterly belonged, and of which she was a deaconess. In this church the "gift of tongues" and of "prophesying" was recognized as a part of its heritage, and as she informed me in one of her normal times, she occasionally spoke or prophesied in the public assemblies of the congregation. I gathered that her utterances were generally but a word or two of exhortation or pious aspiration, given expression to in a moment of exaltation. From her description of her state at such times, she was carried out of herself, was oblivious for the moment of the presence and actions of those about her, was in short in a state of ecstasy when she "prophesied." A natural tendency to self-depreciation, and to ideas of unworthiness asserted themselves outside of those periods of exaltation, which were generally followed by doubts as to her fitness to take part in such work, and by the feeling as she expressed it "that she had presumed as she was unworthy," and that God would be angry with her for her presumption. Throughout her religious life she had been always lacking in "assurance." Latterly this feeling had grown in her and was evidently part of a deeper feeling of mental depression, as she began to think often, and with a feeling of dread that she had been surely too happy these later years which stood in such contrast to the poverty, struggles and disappointments of the early years of her widowhood. This was her mental condition for some little time before her attack of acute mental disturbance which began one night a month before admission to the asylum. She went to bed feeling ill and shivering as if from a chill. In the middle of the night she woke up in a fright from a vivid dream the contents of which merged in a strong sensation as of a hand being pressed on her shoulder. She described the sensation as being that of a positive feeling of pressure, and with it came a feeling of dread, and the conviction that it was the hand of Satan, so that she cried out aloud to him to go out of the house, as it was blessed, referring to the fact, as is the custom in her church that the minister had blessed the house when she went to live in it. She thought of calling to her daughter who was asleep near her, but did not, and after a time fell asleep again being "comforted by the feeling that the Lord would take care of her." Next morning the effects of the "chill" had passed off, but there was left a more or less constant feeling of vague dread and fear of death, and with this a haunting idea born of this strongly felt hallucination of external touch that Satan was within her. The feelings of dread and fear grew steadily and became too strong for her faith in the Lord taking care of her, and very quickly her obsession as to possession by Satan, became the definite delusion it was on admission to the asylum. Hallucinations of what might be termed internal touch leading to this idea of possession, are not unknown in the annals of mysticism of the more morbid types of it. Indeed the more ecstatic the mystic becomes, the more he merges himself in his feelings and tends to develop hallucinatory sensations. He is possessed, and desires to be possessed, fortunately for him, by the Divine and not the evil spirit. Hallucinations of external touch are as might be expected more rare, though not uncommon we understand in the more abnormal types, and occur in people supposed to be normal. Havelock Ellis tells of a "Farmer's daughter who dreamt that she saw a brother, dead some years, with blood streaming from his fingers. She awoke in a fright and was comforting herself with the thought that it was only a dream when she felt a hand grip her shoulder three times in succession. There was no one in the room, the door was locked and no explanation seemed possible to her. She was very frightened, got up at once, dressed, and spent the rest of that night downstairs working. She was so convinced that a real hand had touched her, that although it seemed impossible, she asked her brothers if they had not been playing a trick on her. The nervous shock was considerable, and she was unable to sleep well for some weeks afterwards." The writer's[13] explanation is:—"it is well recognized that involuntary muscular twitches may occur in the shoulder, especially after it has become subject to pressure, and that in some cases such contractions may simulate a touch." In illustration of this he quotes from the Psychical Society's Report on the "Census of Hallucination" the case of an overworked, and overworried man who, a few minutes after leaving a car, had the vivid feeling that someone had touched him on the shoulder, though on turning round he had found no one near. He then remembered that on the car he had been leaning on an iron bolt, and therefore what he had experienced was doubtless a spontaneous muscular contraction excited by the pressure. Touches felt on awakening in correspondence with a dream are not so very uncommon. We think as to this likely enough explanation, that whatever the local sensation may have been, or however slight, as it probably was, it could only give rise to an hallucination of having been touched by some external personality when it was absorbed into, and became a part of a considerable emotional disturbance as in the case of the girl above referred to, and of my patient, in both cases associated with a frightsome dream. The illness of the latter began with a dream, and its continuance was in our opinion, largely due to dreams of a painful character. During the whole period of her residence it was noted that she dreamt a great deal, and that they were terrifying or alarming dreams, and that her bad days were generally preceded by a bad dream. Notes of her dreams were regularly made, at one time for ten consecutive nights, and only three of them were so far as she remembered free from dreams. All of her dreams she described as "awful." Many of them were of being mixed up with objectionable people who behaved roughly and used profane language, but, and of this she was very certain, who never talked or acted obscenely. She frequently dreamt of being on high precipitous places from which she was either falling, or could not get away from. She described one vivid dream during which she suffered great misery, and awoke from in great distress. She dreamt that she was listening to a preacher with open Bible in his hand, that he spoke about Peter whom he was accusing of disobedience; a number of people were present but she saw particularly only one man who looked very happy; the sermon ended, and she awoke in "agony," this feeling being due, she said, to the conviction present with her, that the sermon, and the man's happiness were intended to show her how much she had lost since she was cut off from "grace" by Satan dwelling in her body. Again she dreamt of a near relative whom she heard singing, "And they all speak in tongues to magnify the Lord." This brought sorrow to her of which she was conscious during the dream and after she awoke as she thought Satan was putting this before her to show her what she had lost. In another dream she saw three unpleasant looking men talking together. The worst looking of them of Jewish appearance, came close to her face, and argued with her about the evil spirit. She said "he was in her body," and he answered "away with him." She fell asleep and dreamt the same dream again. These dreams were obviously governed by her dread and fear as to her religious position. The following one is somewhat different:—"A big brown beast came up to her and pressed against her face; she slept again and dreamt she was in a big ship sailing in black and dirty water; that she tried hard to get out of the ship, but could not, and awoke in great distress." We presume Freudians would find in the latent content of all these dreams, particularly in this last one, evidence in favour of their positions, though to us they reveal only, in the blurred and broken way dreams do, the prevailing trend of thoughts governed by morbid religious fears and garbed in the phraseology and symbolism of a judaic faith. The sameness of their ending and meaning to her being obviously due to their relation to the dream which ushered in her illness to which indeed most of them were closely related in geneses and content. No doubt Freudian psychoanalysis would be able to carry her memory back into the region of long forgotten infantile or early sex memories where, as in every normal human being they lie, the shadowy outlines of instinctive feelings whose roots are in a far away, phylogenetic past, having apart from suggestion no role as factors in the production of morbid fears or fancies. The fantastical and too often repulsive dream interpretations of this school forcibly remind us of the words of Lord Bacon, "With regard to the interpretation of natural dreams it is a thing that has been laboriously handled by many writers, but it is full of follies." All kinds of trivial incidents of childhood and early youth are stored up by all of us, and are recalled in sudden and unexpected ways, but not because of any relaxation of a supposed "censor," nor necessarily because of any content of a sex nature, but because they are more often than not associated with fear, chief of the coarser emotions, and a more primitive and more enduring emotion than any of those connected with reproduction, and more alien to the organism than sex memories even of a perverse order, their resurrection being due to some subtle association between the present and the past, generally a sensory one, visual or auditory most frequently. In our own case the earliest recollections of childhood are so associated and recollected. Sunshine amongst trees, and birds singing bring back to us at very long intervals a country scene where as a child we were frightened by threats of a "bogie man." The only childish incidents which unexpectedly recur with us were associated with childish fears and disappointments of a usual and ordinary character never with morbid elements or emotional complexes which were repressed or censored in the Freudian sense, and in this we are not singular.
[13]"The World of Dreams," p. 182.
Again and again, association tests, as prescribed by Jung, and repeated examinations of a psychological character were made without our being able to obtain the slightest indication of their being erotic or similar influences of the slightest value as factors in the causation of her mental disturbance. The chief value of Jung's Tests we have found to be the suggestion of lines of inquiry or the confirmation of evidence obtained in other ways. The results here were negative and in that confirmed what we knew from the history and character of our patient as a pure minded woman of blameless life. She was constitutionally timid, and all her life liable to doubts and fears of a morbid type. As an instance of this she told us that when twelve years of age while influenced by the death of her step-mother, which had just taken place, one morning early her father went out to his work leaving her in bed, and alone in the house. Immediately after he left she heard or more likely thought she heard, someone lift the latch of the door, as if to come in, but though no one came in she was left in a state of great fear, so marked that for long afterwards she dreaded being left alone, and still remembers vividly her feelings during that experience. This temperament she carried into her religious life which as we have seen was marked by fears and doubts. "No one will deny that fear is the type of asthenic manifestations. Yet is it not the mother of phantoms of numberless superstitions, of altogether irrational and chimerical religious practices."[14] The strength and character of her beliefs as well as the religious teachings and influences to which she had been subjected from her earliest years, all tended to develop the mystical in a temperament ready for the dissociation necessary to enable the mystic to attain to that ecstasy or absorption in something outside and beyond the self which is the essence of that state. Why the ecstasy which she knew and desired should pass into its opposite is not difficult to understand when the above history is considered.
[14] Ribot "The Creative Imagination." p. 34.
The shock which originated the attack gave form and reality to fears and doubts which had been assailing her for some time, and to the influence of which she was specially liable at this time by the lowered physiological tension, the result of her previous menorrhagia, and by the fact that the comparative ease and comfort of her later life had given her opportunities for introspection absent during her previous life of struggle for and interest in others. She was then scrupulous, timid and superstitious, a mystical, a psychopathic temperament, taking her place all the same with John Bunyan and other chief of sinners whose self-depreciation and absorption in the struggle for salvation from sin and the power of the Devil, though morbid in character was not pathological. But when Satan became not merely a spirit influencing her, but had entered bodily into her, the border was crossed, and she was to herself literally possessed, and became filled with fear, a fear pathological in action, dominating her mentally and physically during her dissociated states. Once initiated it is not difficult to see how these dissociated states which recurred so regularly and persisted so long were kept up by her temperament, and her constantly recurring dreams of a terrifying or depressing character, which were, as we have already indicated, but representations of the original shock. The following quotation applies closely to her case. "On this view an intense, sudden painful experience, especially if the significance of it can be dimly felt, but not understood, may persist long and latently unassimilated by the central consciousness and without fusion with it, almost as if it were a foreign body in the psychic system."[15] Professor James has termed the pathological emotion an objectless emotion, but as Professor Dewey puts it "from its own standpoint it is not objectless; it goes on at once to supply itself with an object, with a rational excuse for being."[16] Here the sensations in the left hypochondrium which she had described as "grippings at the heart," became the object which, under the influence of the initial shock with its unusual and alarming sensations and feelings, she interpreted as she did.
[15] Stanley Hall on Fear—The American Journal of Psychology, April 1914.
[16] Psychological Review, Vol. I, page 562.
Her recovery was very gradual and marked by many relapses. In her treatment as in our ideas as to the causation of the disorder, we put the accent on the psychic rather than on the physical factors. We did not however underrate the latter but constantly sought to improve her bodily health and condition. When at her worst in 1911 her weight, taken monthly, was round about one hundred and sixty pounds. In 1912 it went up from one hundred and sixty-six to one hundred and eighty-eight pounds and averaged one hundred and seventy-six pounds. But as in the case of her blood pressure, the rise was due largely to her mental improvement. It may be of interest to note here that during and after a somewhat severe attack of diarrhoea with hemorrhage from the bowels, her mental condition was better than usual, as might even have been expected considering the mental distraction the attack involved.
We were satisfied that we could have shortened materially the duration of her illness—two years,—by hypnotic suggestion, but unfortunately her friends objected to this mode of treatment. Suggestion in the waking state had been abundantly used, but with little apparent effect of an immediate kind.