Page:Mind (New Series) Volume 9.djvu/111

 p. JANET AND F. RAYMOND, Ntvroses et Idtfes Fixes. 97 As one reads through the records from simple recurrence of a limited obsession to the elaborate evolution of a " fugue " one conies to regard " fixed idea " as at once an obstruction to normal systematisation, or apperception, and the starting-point of rela- tively independent or dissociated apperception-systems. It is difficult to be perfectly certain of the limit between a normal permanency in consciousness and an abnormal fixture. In the detailed studies, however, practical distinguishing features emerge. One important feature is that the " fixed ideas" here analysed are always secondary, not primary ; they follow on some violent inter- ference with the mental organisation. Such interference may be emotional or intellectual, or it may be the result of physical exhaustion or injury. Dr. Janet insists on this many times in the course of his expositions ; not the " fixed idea " produces dissociation, but dissociation, following exhaustion, etc., results in the formation of fixed ideas. The dissociating neurosis, or rather the neuro-psychosis, is primary ; the fixed idea and its organic growth are secondary. This coheres with the general doctrine of causation in insanity, which is a function of "nervous stress". But the nature of the fixed idea is better seen in Dr. Janet's illustrations. The first study (i., pp. 1-68) is a case of Aboulia and fixed ideas. Dr. Janet first sketches the antecedents of the patient neurotic or insane ancestry, bad character and stupidity in infancy, attack of typhoid fever at fourteen, consequent inertness and melancholy, intensified by her father's death and " puis par une passion amoureuse qui provoqua d'interminables reveries et qui fut, je crois, le debut de ses idees de suicide " (p. 4). She then became peculiar in her actions, remaining motionless for long periods, requiring her brothers or mother to hand her objects that were quite near, seeming much distressed and excited on having to move (se deranger), and occasionally bursting out into violent rage, tearing her clothes and knocking the furniture about. To the alienist, this sequence is so familiar that he is usually content to record it as a full account of the facts. Not so Dr. Janet. He proceeds first to study the patient's movements. The first symptom is the singular difficulty of the movements. If she is asked to move an arm, to lift an article from the table, she refuses ; if the doctor insists, she says, "I cannot do it". She tries again and again, perhaps for a quarter or half an hour. So with other actions and movements. At first sight, one suggests physical disease of nerves ; but this is negatived by the peculiar effect of moral influences (or more properly mental influences), as attention, distraction, and the like. The trouble is essentially cerebral (and here be it said that, however modified in expression for con- venience, the psycho-physical point of view is steadily maintained through all the studies, "cerebral," for instance, being here associated with " mental"). Nor is the case one of " delire du contact," although it resembles that. " Ce qui est trouble, c'est 7