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The Journal of Abnormal Psychology

EDITOR
MORTON PRINCE, M.D.. LL.D.
Tufts College Medical School

ASSISTANT EDITOR FOR BRITISH ISLES
ERNEST JONES, M.D., M.R.C.P.
London

ASSOCIATE EDITORS

HUGO MUNSTERBERG, M.D., PH.D.
Harvard University

JAMES J. PUTNAM, M.D.
Harvard Medical School

AUGUST HOCH, M.D.
New York State Hospitals

BORIS SIDIS, M.A., PH.D., M.D.
Brookline

CHARLES L. DANA, M.D.
Cornell University Medical School

ADOLPH MEYER, M.D.
Johns Hopkins University

WILLIAM McDOUGALL, M.B.
Oxford University

VOLUME X

1915-1916

RICHARD G. BADGER
THE GORHAM PRESS

BOSTON

Reprinted with the permission of The American Psychological
Association, Inc
JOHNSON REPRINT CORPORATION KRAUS REPRINT CORPORATION

Volumes 1-15 of this title were published as
The Journal of Abnormal Psychology.

Volumes 16-19 of this title were published as
The Journal of Abnormal Psychology and Social Psychology.

first reprinting, 1964

Printed in the United States of America

ORIGINAL ARTICLES--VOLUME X

Hysteria as a Weapon in Marital Conflicts. By. A. Myerson, M. D.
The Analysis of a Nightmare. By Raymond Bellamy
Analysis of a Single Dream as a Means of Unearthing the
Genesis of Psychopathic Affections. By Meyer Solomon, M. D.
An Act of Everyday Life Treated as a Pretended Dream and Interpreted by
Psychoanalysis. By Raymond Bellamy
Freud and His School (Concluded). By A. W. Van Rentergham, M. D.
Anger as a primary Emotion, and the Application of Freudian Mechanism to its
Phenomena. By G. Stanley Hall
The Necessity of Metaphysics. By James J. Putnam, M. D.
Aspects of Dream Life. The Contribution of a Woman Remarks Upon Dr. Coriat's
Paper, "Stammering as a Psychoneurosis." By Meyer Solomon, M. D.
Constructive Delusions. By John T. MacCurdy, M. D., and Walter L. Treadway,
M. D.
Socrates in the Light of Modern Psychopathology. By Morris J. Karpas, M. D.
Psychoneuroses Among Primitive Tribes. By Isador H. Coriat, M. D.
Two Interesting Cases of Illusion of Perception. By George F. Arps, M. D.
A Psychological Analysis of Stuttering. By Walter B. Swift, M. D.
The Origin of Supernatural Explanations. By Tom A. Williams, M. D.
Data Concerning Delusions of Personality. By E. E. Southard, M. D.
Sixth Annual Meeting of the American Psychopathological Association.
Discussion.
The Sex Worship and Symbolism of Primitive Races. By Sanger Brown II., M. D.
The Psychoanalytic Treatment of Hystero-Epilepsy. By L. E. Emerson, Ph. D.
On the Genesis and Meaning of Tics. By Meyer Solomon, M. D.
Scientific Method in the Interpretation of Dreams. By Lydiard Horton
A Case of Possession. By Donald Fraser
Sex Worship and Symbolism of Primitive Races (Concluded) by Sanger Brown
II., M. D.

INDEX TO SUBJECTS

(Figures with asterisks indicate original articles. Figures
without asterisks indicate abstracts, reviews, society reports,
correspondence and discussions. The names of the authors ar
given in parenthesis).

American Psychopathological Association, Sixth Annual Meeting
Anger (Hall)*
Backward Child (Morgan)
Brain, Study of (Fiske)
Character (Shand)
Christianity, (Hannay)
Continuity (Lodge)
Criminal Types (Wetzel & Wilmanns)
Daily Life, Psychology of (Seashore)
Delinquent, (Healy)
Delusions, Constructive (MacCurdy and Treadway)*
Development and Purpose (Hobhouse)
Dream Analysis (Solomon)*
Dream Life (Anon)*
Dreams, Interpretation of (Horton)*
Dreams, Meaning of (Coriat)*
Everyday life, Psycho Analysis of (Bellamy)*
Feeble Mindedness (Goddard)
Freud and his School (Van Renterghem)*
Human Motives (Putnam)
Hysteria as a Weapon (Meyerson)*
Hystero-Epilepsy, Psychoanalytic Treatment of (Emerson)*
Laughter (Bergson)
Mental Disorders (Harrington)
Metaphysics, Necessity of (Putnam)*
Nightmare, Analysis of (Bellamy)*
Perception, Illusions of (Arps)*
Personality, Delusions of (Southard)*
Phipps Psychiatric clinic
Possession (Fraser)
Post-traumatic Nervous and Mental Disorders (Benon)
Primitive Races, Sex Worship and Symbolism in (Brown)*
Primitive Tribes, Psychoneuroses among (Coriat)*
Psychical, Adventurings in (Bruce)
Psychobiology, (Dunlap)
Psychology, Educational (Thorndike)
Psychology, General and Applied (Munsterberg)
Psychoneuroses, Treatment of *
Sexual Tendencies in Monkeys, etc (Hamilton)
Sleep and Sleeplessness (Bruce)
Social Psychology (McDougall)

INDEX TO SUBJECTS
Socrates, Psychopathology of (Karpas)*
Stammering, Remarks upon Dr. Coriat's paper (Solomon)*
Stuttering, Experimental Study of (Fletcher)
Stuttering, Psychological Analysis of (Swift)*
Supernatural Explanations (Williams)*
Tics (Solomon)*

CONTRIBUTORS TO VOLUME X
Anon.
Arps, George F.
Bellamy, Raymond
Brown, Sanger
Carrington, H.
Castle, W. E.
Clark, L. Pierce
Coriat, Isador H.
Dearborn, George V. N.
Elliott, R. M.
Emerson, L. E.
Fraser, Donald
Hall, G. Stanley
Harrington, Milton A.
Horton, Lydiard.
Holt, E. B.
Jones, Ernest
Karpas, Morns J.
MacCurdy, John T.
Myerson, A.
Putnam, James J.
Solomon, Meyer
Southard, E. E.
Swift, Walter B.
Taylor, E. W.
Treadway, Walter L.
Troland, Leonard T.
Van Renterghem, A. W.
Van Renterghem, A. W.
Williams, Tom A.

THE JOURNAL OF ABNORMAL PSYCHOLOGY

HYSTERIA AS A WEAPON IN MARITAL CONFLICTS

BY A. MYERSON, M.D.

Clinical Director and Pathologist, Taunton State Hospital Taunton State
Hospital Papers, 1914-5

THE progress in our understanding of hysteria has come largely through the
elaboration of the so-called mechanisms by which the symptoms arise. These
mechanisms have been declared to reside or to have their origin in the
subconsciousness or coconsciousness. The mechanisms range all the way from
the conception of Janet that the personality is disintegrated owing to
lowering of the psychical tension to that of Freud, who conceives all
hysterical symptoms as a result of dissociation arising through conflicts
between repressed sexual desires and experiences and the various censors
organized by the social life. Without in any way intending to set up any
other general mechanism or to enter into the controversy raging concerning
the Freudian mechanism, which at present is the storm center, the writer
reports a case in which the origin of the symptoms can be traced to a more
simple and fairly familiar mechanism, one which, in its essence, is merely
an intensification of a normal reaction of many women to marital
difficulties. In other words, women frequently resort to measures which
bring about an acute discomfort upon the part of their mate, through his
pity, compassion and self-accusation. They resort to tears as their
proverbial weapon for gaining their point. In this case the hysterical
symptoms seem to have been the substitute for tears in a domestic battle.

Case History--Patient is a woman, aged thirty-eight, of American birth and
ancestry. Family history is negative so far as mental disease is concerned,
but there seems to have been a decadence of stock as manifested in the
steady dropping of her family in the social scale. She is one of two
children, there being a brother, who, from all accounts, is a fairly
industrious, but poverty-stricken farmer. Her early childhood was spent in
a small village in Massachusetts. She received but little education,
largely because she had no desire to study and no aptitude for learning,
although she is by no means feeble-minded. The menstrual periods started at
fourteen, and have been without any noteworthy accompanying phenomena ever
since. History is negative so far as other diseases are concerned. She
worked as a domestic and in factories until she was married for the first
time at the age of twenty. She had no children by this marriage. It is
stated on good authority that she took preventive measures against
conception and if pregnant induced abortion by drugs and mechanical
measures. At the end of eight years there was a divorce. Just which one of
the partners was at fault is impossible to state, but that there was more
than mere incompatibility is evident by the reticence of all concerned.
Shortly afterward, she married her present husband with whom she has lived
for about nine years. He is a steady drinker, but is a good workman, has
never been discharged, and, apparently, his drinking habits do not interfere
with the main tenor of his life. He lives with the patient in a small house
of which they occupy two garret rooms, meagerly furnished, though without
evidence of dire poverty.

From her fifteenth year the patient has been subject to fainting spells. By
all accounts they come on usually after quarrels, disagreements or
disappointments. They are not accompanied by blanching, by clonic or tonic
movements of any kind, they last for uncertain periods ranging from five
minutes to an hour or more, and consciousness does not seem to be totally
lost. In addition she has vomiting spells, these likewise occurring when
balked in her desires. She is subject to headaches, usually on one half of
the head, but frequently frontal. There is no regular period of occurrence
of these headaches except that there is also some relation to quarrels, etc.
On several occasions the patient has lost her voice for short periods
ranging from a few minutes to several hours following particularly stormy
domestic scenes.

On July 29 of this year she was suddenly paralyzed. That is to say, she was
unable to move the right arm, the right leg, the right side of the face, and
she lost the power of speech entirely; there was complete aphonia. This
"stroke" was not accompanied by unconsciousness, but was preceded by severe
headache and much nausea. During the three weeks that followed she remained
in bed, recovering only the function of the arm. Her husband fed her by
forcing open her mouth with a spoon. She did not lose control of the
sphincters. As she manifested no other progress to recovery despite the
administration of drugs, numerous-rubbings and liniments, the physician in
charge called the writer into consultation.

Physical Examination Aug. 20--A well-developed, fairly well nourished woman,
appearing to be about thirty-five years of age. Face wears an anxious
expression and she shuns the examiner's direct gaze. Movements of the right
hand and arm are now fairly free. There is no appreciable difficulty in any
of its functions according to tests made for ataxia, strength, recognition
of form, finer movements, etc., in fact, she uses this hand to write with,
as she cannot talk at all. Such writing is free, unaccompanied by errors in
spelling, there is no elision of syllables and no difficulty in finding the
words desired. The face is symmetrical on the two sides. There is no
evidence of paralysis of the facial muscles. In fact, the cranial nerves, by
detailed examination, are intact, except in so far as respiration and speech
are concerned. The right leg is held entirely spastic, the muscles on both
sides of the joints, that is, flexors and extensors, being equally
contracted. It is impossible to bend this leg at any joint except by the use
of very great force. The reflexes everywhere are lively but are equal on
the two sides, and none of the abnormal reflexes is present, including in
this term Babinski, Gordon and Oppenheim.

Sensation--There is very markedly diminished reaction to pin prick all over
the right side, including face, arm, chest, leg and tongue. In some places
complete analgesia obtains. Reaction to touch is likewise diminished and
recognition of heat and cold is impaired.

Speech--There is complete loss of the ability to make any sound, either
voiced or whispered; that is to say, there is complete aphonia,-- there is
loss of all voice. The patient understands everything, however, and writes
her answers to questions rapidly and correctly. She can read whatever is
written, there is no difficulty in the recognition of objects, no evidence
of any aphasia whatever.

The diagnosis--hysteria--can hardly be doubted. The history of headaches,
fainting spells without marked impairment of consciousness, vomiting spells,
hemianaesthesia, hemianalgesia, complete aphonia and an exaggerated
paralysis, not only of the right leg, but of the ability to thrust out the
tongue, while at the same time all other cranial functions were unimpaired
together with the apparent health of the individual in every other respect,
make up a syndrome hardly to pass unrecognized.

Treatment--The patient was entirely inaccessible to direct suggestion, for
no amount of assurance that her leg was all right enabled her to move it.
When such suggestions were made, she shook her head firmly and conclusively,
and this is true of suggestions concerning speech. This point is of
importance in the consideration of the mechanism. Attempts at hypnotism
failed ingloriously. Psychoanalysis was deferred for the time, and recourse
was had to indirect suggestion and re-education.

The first function to be restored was the power of bending the leg which
hitherto had been held entirely spastic. The patient was assured that while
she had lost the power of using the limb, a little relaxation of the muscles
of the front of the leg would permit it to be bent. Her attention was
distracted while at the same time a firm, steady pressure was put upon the
leg above and below the knee joint and advantage taken of every change in
the tone of the muscles involved in keeping the leg extended. Little by
little the leg was bent until finally it was completely flexed, this for the
first time in three weeks. Her attention was called to this fact and she was
assured that upon the physician's next attempt to bend her leg, resistance
would be lessened and she would be able to aid somewhat as well. This
proved true. Then the leg was only partly supported by the physician while
the patient was assured that with his help she would be able to bend it more
freely. From this, she passed on to the ability to move the leg without any
assistance on the part of the writer. After having been given exercise in
bending the leg for some twenty or thirty times, with complete restoration
of this ability, she was induced to get out of bed, and while standing erect
she was suddenly released by the physician. She swayed to and fro in a
rather perilous manner but did not fall. Finally, by gradation of tasks set,
by a judicious combination of encouragement and command, she was enabled to
walk. She was then put to bed and assured that upon the physician's next
visit she would be taught to walk freely. Meanwhile, the husband was
instructed that he must not allow her to stay in bed more than an hour at a
time and that she must come to the table for her meals.

On the physician's next visit, two days later, it was found that the husband
had not been able to induce his wife to come to the table, and that he had
been unable to get her to walk. The physician then commanded her to get out
of bed, which she did with great effort. She was then put back to bed and
instructed to get up more freely and without such effort, demonstration
being a visual one, in that she was shown how best to accomplish the task
set. Finally, at the end of the visit, she was walking quite freely and
promised in writing, for she had not as yet learned to talk, that she would
eat at the table.

The next day instruction was commenced along the lines of speech. Upon being
asked to thrust out her tongue, that organ was protruded only a short
distance, and she claimed, in writing, to be unable to protrude it further.
Thereupon it was taken hold of by a towel and alternately withdrawn from and
replaced into the mouth. After a short period of such exercise she was
enabled to thrust the tongue in and out. She was then instructed to breathe
more freely; that is to say, to take short inspirations and to make long
expirations, this in preparation for speech. She was unable to do this, the
expiration being short, jerky and interrupted. Thereupon the examiner placed
his two hands, one on each side of her chest, instructed her to inspire, and
when she was instructed to expire forced his hands against her ribs in order
to complete the expiratory act. After about fifteen or twenty minutes of
this combination of instruction and help the patient was able to breathe by
herself and freely. She was then instructed to make the sound "e" at the end
of expiration. This she was unable to do at first, but upon persistence and
passive placing of her mouth in the proper position for the sound, she was
able to whisper "e." From this she rapidly went on to the other vowel
sounds. Then the aspirate "h" was added, later the explosives, "p," etc.,
until at the end of about two hours she was enabled to whisper anything
desired. Her husband was instructed not to allow her to use her pencil any
more, and she promised faithfully to enter into whispered conversation with
him, although it was evident that she promised this with reluctance.

Upon the next visit, two days later, she was still whispering, and when
asked if she could talk aloud, shook her head and whispered "No," that she
was sure she could not. Efforts to have her make the sound "a," or any of
the vowels in a voiced manner failed completely. She was then instructed to
cough. Although it is evident that a cough is a voiced sound, she was able
to do this, in a very low and indistinct manner. She was then instructed to
add the sound "e" at the end of her cough. This she did, but with
difficulty. Finally, after much the same manoeuvering which has been
indicated in the account of how she was instructed to whisper, she talked
freely and well. When this was accomplished the husband was instructed to
have her dress herself and to take her to: some place of amusement, and to
keep her out of doors almost continuously.

At all times the patient had complained of a pain in her side which she
claimed was the root of all her trouble. It had been "doctored," to use her
term, by all the physicians in the city and, it was alleged, came after she
had been lifting a paralyzed old lady in the house across the way. Despite
all treatment this pain had not disappeared and the various diagnoses
made--strain, liver trouble, nervous ache had not sufficed to console the
patient or to relieve her. There was no local tenderness, no pain upon
movement, but merely a steady ache. No physical basis whatever for this
trouble could be found. Her medicine for the relief of it was discontinued,
and so, too, were certain medicines she had been obtaining for sleep.

Upon each visit the husband and wife had been informed by the physician that
he did not believe the trouble was organic in its nature, that he believed
it depended upon some ideas that the patient had, and that, furthermore, it
was the result of some mental irritation, compared for the purpose of fixing
the point to a festering sore and which, if removed, would permanently
eliminate the liability of such seizures. The patient and her husband were
informed that the physician intended to delve to the bottom of this trouble
and, by deferring investigation as to its exact nature until the symptoms
had practically disappeared, a way was cleared to obtain their complete
confidence, and at the same time to overcome any unwillingness to accept a
psychical explanation for such palpable physical ills. This latter point is
of importance in dealing with uneducated persons. For the most part, they
are intensely practical and materialistic, and a mere idea does not seem to
them to account for paralysis although, of course, such skepticism is
usually accompanied by superstitious credulity along other lines. Moreover,
by establishing himself as a sort of miracle worker (for so the cure was
regarded), it would be understood that curiosity was not the basis for the
investigation into the domestic life of the patient and her husband, but
that a desire to do more good inspired it.

The physician started his investigation with the statement that he knew from
past experience that some conflict was going on between husband and wife;
that there was some source of irritation which caused these outbursts of
symptoms on the part of the patient, and that unless they told him what was
behind the matter his help would be limited to the relief of the present
symptoms. It was firmly stated that any denial of such discord would not be
believed, and that only a complete confidence would be helpful.

The patient, who had been listening to this statement with lowered eyes and
nervously intertwining fingers, then burst out as follows: There WAS trouble
between them and there always would be until it was settled right,--this
with much emphasis and emotional manifestation. So long as he insisted on
living where they did, just so long would she quarrel with him. She did not
like the neighbors, especially the woman downstairs, she did not like the
room, she did not like anything about the place or the neighborhood, hated
the very sight of it and would never cease attempting to move from there. It
came out on further questioning that the woman downstairs, whom the patient
particularly disliked, was a storm center in that the wife was jealous of
her, although she adduced no very good reasons for her attitude. Moreover,
the patient stated that she wished to move to a district where she had
friends, though other sources of information showed that these friends were
of a rather unsavory character. Her husband was absolutely determined not to
move from his house. He stated that he would rather have her go away and
stay away than move from there; that the rent was too high in the place
where she wanted to move, and that the rent was suitable where they were.
Moreover, for his part, he hated his wife's desired neighborhood and would
never consent to changing his residence from the present place to the other.
It came out that her fainting and vomiting spells and headaches usually
followed bitter quarrels, and on other matters these symptoms usually placed
the victory on her side. On this particular point, however, her husband had
remained obdurate. It was shown that the present attack of paralysis and
aphonia, symptoms of an unusually severe character, followed an unusually
bitter quarrel which had lasted for a whole day and into the night of the
attack.

The question arises at this point, "Why did this attack take the form of a
paralysis?" At first this seemed unaccountable, but later it was found that
the old woman for whom the patient had been caring had a "stroke" with loss
of the power to speak, though no aphonia. The patient had gone to work as a
sort of nurse for the old woman under protest, for she did not wish to do
anything outside of her own light housekeeping, although the added income
was sorely needed since work was slack in her husband's place of employment.
The pain in her side caused her to quit work as nurse, much to her husband's
dissatisfaction until she convinced him that her pain and disability were
marked. It was evident that despite the controversies and quarrels that
prevailed in the household, her husband sincerely loved her, for he stayed
away from his work during the three weeks of her illness to act as her
nurse. Moreover, he spent his earnings quite freely in consulting various
physicians in order to cure her.

It was shown from what both the patient and her husband said, and from the
whole history of their marital life, that she had used as a weapon, though
not with definite conscious purpose, for the gaining of her point in
whatever quarrel came up, symptoms that are usually called hysterical; that
is to say, vomiting, fainting spells and pains without definite physical
cause. This method usually assured her victory by playing upon her husband's
alarm and concern as well as by causing him intense dissatisfaction. With
the advent of a disagreement which could not be settled her way by her usual
symptoms, there followed, not by any means through her volition or conscious
purpose, more severe symptoms; namely, spastic paralysis and aphonia, which,
in a general way, were suggested by her patient. There seems to have been,
and there undoubtedly was, a sexual element entering into this last quarrel;
namely, that she was jealous of the woman who lived downstairs, though
without any proof of her husband's infidelity.

Both patient and her husband finally agreed to the physician's statement
that the symptoms were directly referable to the quarrels, although both
claimed that it had never occurred to them before, a fact made evident by
their questions and objections. No psychoanalysis was possible in this case,
for the man and woman belong to that class of people who feel that they are
cured when their symptoms are relieved. It may be argued, without any
possibility of contradiction, that a psychoanalysis would have revealed a
deeper reaching mechanism and that a closer relationship and connection
between the paralysis and other symptoms with the past sexual experiences of
the patient could have been established. This last claim may be doubted,
however, for there is always a gap between the alleged "conversion" of
mental states into physical symptoms, and this gap can in no case be bridged
over even by Freud's own accounts. The conversion always remains as a mere
statement and is a logical connection between the appearance of physical
symptoms and the so-called conflicts; in other words, it is an explanation
and not a FACT. Compared with the complex Freudian mechanism, with its
repressions, compressions, censors, dreams, etc., the conception of
hysterical symptoms as a marital weapon as comparable with the tears of more
normal women seems very simple and probably too simple. In fact, it does not
explain the hysteria, it merely gives a USE for its symptoms, and the writer
is driven back to the statement that the neuropathic person is characterized
by his or her bizarre and prolonged emotional reactions, which, in turn,
brings us back to a defect ab origine. And the Freudians, starting out to
prove that the experiences of the individual ALONE cause hysteria, by
pushing back the TIME of those experiences to INFANCY (and lately to foetal
life), have proved the contrary, that is, the inborn nature of the disease.

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