The Foundations of Normal and Abnormal Psychology/Part 1/XXII

In stimulating a sense-organ we not only get sensory elements characteristic of that particular sense, but also sensory elements belonging to other sense-organs which have not been stimulated. What really takes place is this: the external excitation acting on a particular sense-organ produces its appropriate sensations, but the peripheral physiological process diffuses or rather to say gets irradiated along other neurons of other sense structures, awakening their appropriate sensations. Such sensations, not being directly but indirectly peripherally initiated should be regarded as secondary sensations. The phenomena of secondary sensations are well known in psychological literature. Some psychologists following the general fallacy of confusing image and sensation describe vivid images succeeding sensations under the category of secondary sensations. Barring such confusion we may say that the pure phenomena of secondary sensations are essentially sensory in character. When a sensation due to the stimulation of a peripheral sense-organ, instead of being followed by a train of association of ideas is followed by another sensation belonging to the domain of another sense-organ, the phenomenon is known as that of synaesthesia or of secondary sensations.

One image or representation relating to a sensation of one sense-organ may be associated and bring in its train of associations any other image relating to any other sensation of any other sense-organ. The series of ideas or images is a reproduction of stimulated sense-organs with their accompanying sensations, the ideas running parallel to the original psycho-physiological processes, somewhat on the Spinozistic principle of ‘Ordo et connexio idearum idem est ac ordo et connexio rerum.’ And again in other cases, when not reproducing a previous series of sensory experience, the series of associated images may be more irregular and apparently capricious―a process usually described as the work of fancy, or imagination. A sensation or image then may be followed by any series of images without the intermediacy of external excitations and peripheral physiological processes. A sensation, however, cannot be followed by a series of sensations without the intermediacy of external stimulations. A sensation can only be initiated by its own appropriate stimulus and by its own specialized peripheral physiological processes. The smell of a rose does not by simple association give rise to a series of sensations of touring in an automobile, nor does the eating of beefsteak give rise, through association, to the hearing of a symphony. In other words, there is an internal association of images or ideas, but there is not an internal association of sensations. Images once born can be reproduced endlessly and at will, sensations die almost immediately after they are born and must be renewed every time under the same conditions of external stimulations. Briefly stated, there is memory for images, but not for sensations. Sensations are independent, images are interconnected.

If we represent sensations by A, B, C, D and symbolize images by a, b, c, d, the A, B, C, D have no relations to one another, but each one bears a definite relation to each corresponding image, A to a, B to b, C to c, D to d, and so with the rest of the series. Sensation A will arouse image a which in turn may arouse the whole train of images, b, c, d, but A cannot give rise to any of the sensations B, C, D. The image series a, b, c, d can be reproduced at will, in fact after a series of repetition the whole chain of links may rattle off against will, but nothing of the kind occurs in the case of sensations. Sensations do not form links in a chain which becomes automatic after many reproductions. Repetition of sensations does not form associated series; sensations maintain their independence.

The difference between image and sensation in respect to association is, psychologically regarded, apparently flawless. Unfortunately as it is usually the case with flawless generalizations and descriptions of phenomena observed under normal conditions, there is an ungracious 'abnormal' that refuses to fall into line. There are cases apparently abnormal from the psychological standpoint, cases which refuse to be gathered into the normal psychological fold; these cases seem to run counter to all normal psychological introspection. The sensations seem to run riot,―instead of being linked with their respective images they really call up associated sensations; these are the so-called sound-photisms or light-phonisms, and similar odd combinations. It is true the sensations are rather awkwardly associated. One sensation always calls forth only a particular sensation and no other one, and besides the called forth sensation does not belong qualitatively to the same domain with the one that has initiated it. It is also acted by not entering into any association with any other sensation, and that, unlike images, no associative series can possibly be formed. Still the fact remains that a sensation can and does call forth another sensation. Evidently sensations can enter into associative bonds.

Such psychic states appear uncanny and are regarded as abnormal. The phenomena are regarded as freaks belonging to the domain of pathology. Now curiously enough our study reveals the fact that what has been regarded as the pathological and exceptional turns out to be the ordinary and the normal. The stone which the builders neglected has become the comer stone. The exception has turned out to be the rule. Far from being the case that secondary sensations are rare and abnormal, they are quite common, since they constitute the very flesh and blood of the percept. Secondary sensations constitute the texture of the percept. The reason why they appear so strange is just because they are so common and so familiar.

The secondary sensation, when appearing alone out of its perceptual complex, cannot be recognized as the old familiar attendant belonging to the indissoluble retinue of the humdrum percept. Dissociated from its perceptual sphere the secondary sensation appears ghostly, hallucinatory. As a matter of fact the secondary sensation, hallucinatory and spooky as its manifestations are, constitutes part and parcel of perceptual experience. In fact, the main content of the percept consists of hallucinatory secondary sensations. Percepts and hallucinations are of the same grain. A percept is a hallucination with the primary nuclear sensory elements present, a hallucination is a 'real' percept with the primary sensory elements absent. When secondary sensory elements become dissociated from the perceptual synthesis with the primary sensory elements, the elements, thus dissociated, not being related to any peripheral physiological process of their appropriate sense-organ, are regarded as central phenomena, as secondary sensations which are described as unusual, abnormal events of mental life. What, however, is abnormal is not the secondary sensation per se, but the fact of its dissociation. A secondary sensory element dissociated from its perceptual system becomes manifested as a secondary sensation.

Secondary sensations are free secondary sensory elements, dissociated from the perceptual aggregate into the synthetic unity of which they enter as important components forming the organic whole of the percept. When appearing isolated, secondary sensations are the simplest form of hallucinations which become more and more complex as the secondary sensory elements, dissociated from the primary elements, become manifested in complex systems. Hallucinations are systems of secondary sensations or of secondary sensory elements.

Sensory elements are, as a rule, not free, they usually appear as perceptual compounds, and this holds specially true of secondary sensory elements. When, therefore, dissociated from their perceptual compounds, they appear as ghosts of the 'real' percept, as hallucinations. To quote from a previous work of mine: "The integration of the groups and especially of the secondary presentative groups is not of that unmodifiable organic character. Around a nucleus formed by a group, or combinations of groups of primary elements, groups of secondary sensory elements become aggregated, and the total aggregate gives rise to a consolidated and unified system of groups, resulting in a percept. In perceiving the chair yonder only the visual sensations constitute the true sensory groups that form the nucleus of the percept. The other psychic groups that are crystallized round the percept, such as weight, resistance, volume, size, shape, distance are really visuo-tacto motor groups they are largely tacto-muscular groups tinged by the sensory quality of the nucleus; they are tacto-motor groups sensorially visualized, seen indirectly. Though these secondary sensory groups are firmly integrated, still their integration is not of such a character as not to become disintegrated and rearranged into new systems of groups. Such a disintegration is no doubt effected with difficulty, but it is by no means impossible.

Perceptual compounds, unlike sensory, admit of decomposition into elementary primary and secondary sensory groups. The component elementary sensory groups can be experienced separately under different conditions and circumstances. We can close our eyes and walk up to the object of perception, say the chair, and thus experience the free muscular sensations of distance, or we may push our hand against the chair and experience the sensation of resistance, or take the chair in the hand arid experience the muscular sensations of weight and shape. The primary and secondary groups going to make up the percept can be isolated by withdrawing the organizing nuclear group of primary sensations, thus bringing about a disintegration of the particular aggregate.

If we inspect more closely this process of isolation, we find that the constituent secondary sensory groups are not really isolated, so as to stand out all by themselves. What actually happens in this seeming process of isolation is simply the formation of a series of new perceptual aggregates in which the particular sensory groups that are isolated and specially brought out become the nuclei, the foci. For in the perceptual aggregate it is always the character of the nucleus that is specially brought out, and it is the nuclear aggregate that tinges with its sensory color all the other aggregates. To revert to our previous example, to the percept chair. In passing the finger over the chair, the touch may form the nucleus of the moment, but around this primary nuclear sensory group other secondary sensory groups, such as thermal and muscular sensory elements become organized to form the synthesis of the perceptual moment. If we try to find out the shape of the chair by a series of touches, we really form a series of percepts, the sensory nuclei of which are not visual, but tacto-muscular in their nature. A sensory group then cannot in reality appear in a purely isolated form. In other words, sensory elements appear in groups,* and this holds specially true of secondary sensory elements or of secondary sensations. Secondary sensations, though present in every percept, rarely appear in isolation. The affinity of secondary sensory elements to run into compounds becoming synthetized with primary elements makes it difficult to observe them, except in the peculiar phenomena of synaesthesia and in the abnormal states of hallucination.

If secondary sensations are simple hallucinations, hallucinations are compound secondary sensations. As we have pointed out a close examination of hallucinations shows them to be systems of secondary sensations dissociated from their primary nuclear elements. In states of dissociation a peripheral stimulation with its physiological process and concomitant primary sensory elements may become dissociated from systems of secondary sensory elements which alone stand out in consciousness as hallucinations. A close examination reveals the presence of some obscure pathological conditions which by irritation and by irradiation awaken secondary sensory elements giving rise to full fledged hallucinations.

In the cases of hallucinations investigated by me have found pathological processes which gave rise to secondary sensations crystallized into hallucinations. Thus one of my cases suffered from auditory hallucinations. The patient heard voices telling her all kinds of disagreeable things. She complained that the voices came not through the ear, but through a spot located over the Fallopian tubes. An examination of the ear showed nothing abnormal. Physical examination revealed nothing abnormal in any of the other sense organs. The Fallopian tubes, however, were very tender and painful to pressure. The patient suffered from an old chronic salpingitis. The hallucinations, which were of a sexual character, became more severe at regular intervals coinciding with monthly periodicities.

One case of mine suffered from visual hallucinations. He saw spirits, ghosts and visions of saints. When he travelled in a car, he could see little men with benevolent faces, and for some religious reason he regarded them as saints who came to his help. He could see them splitting the rocks and disappearing there, or sometimes the rocks split open and the saintly little men came to the surface. Occasionally apparitions of the dead visited him. The visions were never quiet, but always in motion, they did not stay long and rapidly disappeared, giving rise to new visions. An examination of his special sense-organs showed nothing abnormal. The sense of touch, pressure and kinaesthetic sensibility manifested peculiar abnormalities. The skin of the body was very sensitive and that of the scalp was extremely tender to touch. The patient could not bear any pressure of the scalp and was mostly bareheaded, though he was very sensitive to draughts and to changes of temperature. Occasionally he experienced a sense of fornication all over the body, especially in the scalp and in the region of the neck, the muscles of which were extremely sensitive to pressure. Now when the head was inclined to one side or pressed hard or kept in a tense state for a couple of minutes at a stretch, he could see spirits floating in the air, he could see the little men with their saintly faces coming out of the ground and disappearing into it again.

One case of functional psychosis, with epileptiform attacks presenting phenomena of dissociated states with distinct tendencies toward the formation of multiple personality, suffered a good deal from auditory hallucinations. It will take too much space to give an account of the details of the different seizures and of the various dissociated states manifested by the patient. For our present purpose it is enough to refer to the hallucinations. The patient complained that she could hear voices talking to her, her mother and brothers communicating with her from a distance. An examination of the auditory apparatus proved it to be in excellent condition. In this case the phenomena of unconscious phonation were quite well developed, the patient was observed to move her lips and whisper―the whisper becoming sometimes quite loud so that many words which the patient referred to the voices of the mother and brothers were really uttered by the patient. An examination of the eye revealed the presence of an astigmatic condition and a limitation of the field of vision. When the patient was made to count or to read aloud or when absorbed in a conversation, the auditory hallucinations ceased. The auditory hallucinations considerably diminished, both in frequency and intensity, when the astigmatism was corrected by eye glasses.

Similarly in another case the patient suffered from auditory hallucinations. Here the patient was observed talking to himself. This was so pronounced that now and then he himself became conscious of the fact that he was talking to himself. He describes this experience of automatic talk which seems to be uncontrollable and of which he is often unconscious by the term of 'auto-vocalization.' In this case the patient now and then can catch himself telling things to himself which he takes for the voices of other people as he is then conscious of the hearing, but not of the utterance of the words and phrases. This, however, is not always the case in fact in a good many cases where unconscious phonation is present, as, for instance, in the case of the patient with the epileptiform seizures described above, the patient is entirely unconscious of the fact of 'whispering.' When attention was drawn to the phenomenon, the whisper and the hallucination disappeared.

Another patient of mine suffers from auditory hallucinations. He hears people abusing him and calling him names. The hallucinations occur when he is awake, but they are frequent when he is on the point of falling asleep, or when he wakes up. He thinks, in fact he hears that people whisper about him. The voices are observed to increase in frequency and intensity with the presence of external noises, such as noises made in the hall, or sounds made by cars passing by. The patient was observed having subconscious or unconscious movements of lips, tongue and even of the jaws. When he hears the voices the subconscious movements increase so that they may be perceived at a distance. Even the nurse could not help perceiving the subconscious whispering made by the patient. When the patient looks through a printed or written page the subconscious whispering increases. The same is observed when the patient is very much interested in something or absorbed in deep thought. During such times he complains that he hears voices. With his mouth wide open and holding his tongue stationary, the unconscious whispering ceases and along with it the auditory hallucinations disappear.

One of my cases, a lady of about sixty, suffered for about fourteen years from auditory and visual hallucinations. She complained that she was surrounded by ghosts of departed family members who did not leave her alone. The spirits talk to her, they give her advice which is often against her interests. Her departed husband and his brother are the chief leaders, the 'guides' so to say. They talk to her on all important occasions and try to guide her in life. The patient resents such interferences. When the voices became insistent she also had visions of the spirits and could hear them talk to her, a proceeding which she always attempted to discourage, but she admitted that the voices and the spirits had the best of her, and she was forced to follow their instructions. An examination of the patient revealed the fact that the hearing on the left side was rather defective, the tympanic membrane was thickened and there was present a chronic pathological process due to a former condition of middle ear disease. Any continuous and prolonged irritation of the diseased ear started the voices, increased their intensity, and caused the manifestations of the visions.

I may also refer to a patient under my care who suffered from auditory hallucinations and thought herself possessed by demons. From her ninth year she suffered at various intervals from those voices which sometimes told her unpleasant things. Along with the hallucinations she also had attacks of automatic speech. Now and then she simply heard voices and was not conscious of any involuntary speech, but occasionally the involuntary utterance took such possession of her that she could not control it. She felt as if some other being got possession of her organs of speech. This frightened her even more than the hallucinations. She kept away from her friends fearing sudden attacks of involuntary speech. It appeared to the patient, as if some other beings made her talk against her will. She shunned society, because the other beings forced her to tell aloud what she thought of the people in whose company she was present. When she was not conscious of the forced speech, she often heard voices which she ascribed to the same demons. There was nothing of the delusion of paranoia in it as she could not account for the involuntary origin they are induced by peripheral excitations giving rise to peripheral physiological processes, awakening primary sensory elements which are subconscious or fall out entirely of the patient's consciousness, leaving the groups of secondary sensory elements to stand out as fully developed hallucinations. The hallucinatory secondary sensory elements may be tinged with the qualitative aspect of the dissociated primary sensory elements; thus pathological processes in the auditory sense organ may give rise to voices; or morbid processes of the visual apparatus may give rise to visions. Quite often, however, the dissociation is so deep and extensive that the synthetized system of secondary sensory elements does not bear the least trace of the qualitative aspect of the primary sensory elements; thus a morbid condition of the pharynx, for example, may give rise to an auditory and even to a visual hallucination. Whatever may be the qualitative character of the sensory compounds one thing stands out clear and distinct, and that is the fact that the percept, whether normal or abnormal, does not consist of images, but of sensations, primary and secondary.