Hypostatic union

“ It was inferred that if a group of constitutional units belonging to one individual which have become moulded into relatively exact congruity with the organism and with one another by long co-operation, are mingled with some belonging to another individual which, differently circumstanced, has become somewhat different in itself and in its units, then the mass formed by the union of the two groups will be relatively unstable—relatively modifiable by incident forces. ”

“ The condition thus brought about is known as hypostatic congestion. One of the consequences of passive [p. 262] hyperæmia thus induced is a transudation of the serum of the blood into the air-cells and connective tissue of the lungs; and this is one way in which pulmonary oedema may be occasioned. When hypostatic congestion has lasted for some time, it may no longer be affected by changing the patient's position; and when this is the case it may be accompanied by exudation of fibrin into the air-cells and by proliferation of epithelium, thus producing the condition termed hypostatic pneumonia. ”

“ In the psychosomatic union of two individuals there is the same possibility of infinite variety in the physical and mental reactions, only if the union between them is, like the fusion of the two single cells, a complete total and exclusive union each with the other. ”

“ But as Weismann remarks, it is difficult to understand how one aged and debilitated individual can be rejuvenated and revitalized by union with another individual equally aged and debilitated. Another raison d'être must, I think, be sought for sexual conjugation. Weismann's hypothesis appears to be the most probable; he thinks that sexual union is very prevalent because by it is produced an increased amount of variability in the offspring. ”

“ That the hysterical pains originated simultaneously with the formation of these separate psychic groups, (2) that the patient exerted great resistance against the attempt to bring about the association between the separate psychic groups and the rest of the content of consciousness, and when the union was finally effected she perceived excessive psychic pain. Our conception of hysteria brings together these two moments with the fact of the splitting of consciousness, for (2) contains the indication for the motive for the splitting of consciousness while (1) shows the mechanism of the same. ”

“ But even here the position would not be altogether satisfactory, for we should be driven to regard the process of suppression to which the paralyses and anæsthesias are due as itself a mode of activity of the suppressed experience. If, in place of regarding dissociation as a state of independent activity, we hold independent consciousness to be a necessary part of the concept of dissociation, it is evident that hysteria wholly fails to answer to the definition, for there is no evidence whatever of such independent consciousness. ”

“ It cannot, therefore, become kinetic except through their union. To introduce one of these substances into the body without the other, would neither introduce the energy nor set it free. They must both be introduced into the body and there caused to unite. ”

“ The union of sexual nuclei not adapted for copulation appears, however, to be "the most frequent and most important cause of hereditary local malformations as well as of hereditary morbid tendencies, or of a defect in any system of the whole organism." If the nuclei are altogether unadapted to each other, sterility occurs, as in the sexual nuclei of distinct species. ”

“ Hemorrhages cannot be pressed out nor will hemorrhagic areas bleed as freely as hypostatic patches. In all medicolegal cases care should be taken to differentiate bruises and ecchymoses from hypostatic patches, as in the popular mind the latter are often regarded as evidences of trauma or violence. The location of the hypostasis is of importance in showing the position of the body after death; if the anterior portion of the body is hypostatic the cadaver must have been lying upon its face for some time after death ”

“ The absence of the Babinski and Oppenheim reflexes was against an organic hypothesis and the absence of hysterical stigmata and the non-characteristic sensory disorder, as well as the absence of any psychic shock in the history, spoke against hysteria. The hypoglossus paralysis spoke in favor of the organic nature of the disease. ”

“ In hypochondria the individual's thoughts are centred upon some supposed disease until a true delusional condition is developed; this does not often occur in hysteria. Hypochondria is seen with as great a frequency in the male as in the female, while hysteria prevails much more largely in the female sex. ”

“ During the last months of his residence in Paris, at the period when, utterly disillusioned, depressed by hypochondria, eaten up by spleen, he had reached such a pitch of nervous irritability that the mere sight of an unpleasant object or disagreeable person was deeply graven on his brain and several days were needed to efface the impress, even to a slight degree, of the human form that had formed one of his most agonizing torments when passed casually in the street. ”

“ There was a great consultation of doctors upon her case, and after it had taken place, the doctors came to the Bishop and said, 'The case of Madame de Salis is an extraordinary one; it is a most peculiar, but still a known form of hypochondria. She cannot rest because she always sees before her—not the horrible phantom which made her married life so miserable, but the room which was the scene of her suffering. And she never will rest; the image is, as it were, branded into her brain, and cannot be eradicated. There is only one remedy, and it is a very desperate one. ”

“ This neurosis, too, has no psychic mechanism, but regularly influences the psychic life, so that among its regular manifestations we have anxious expectation, phobias, hyperesthesias to pain, and other symptoms. This anxiety neurosis, as I take it, certainly corresponds in part to the neurosis called hypochondria, which in some features resembles hysteria and neurasthenia. Yet in none of the earlier works can I consider the demarcation of this neurosis as correct, and moreover, I find that the usefulness of the name hypochondria is impaired by its close relation to the symptom of "nosophobia." ”

“ A fine description of one aspect of hysteria and hypochondria may here be given as an example of his power in the delineation of disease: “The patients believe that they have to suffer all the evils that can befall humanity, all the troubles that the world can supply. They have melancholy forebodings, they brood over trifles, cherishing them in their anxious and unquiet bosoms. Fear, anger, jealousy, suspicion, and the worst passions of the mind arise without cause. ”

“ On the contrary, every thing is so connected and tied together in the living body, that no one part can be disordered in its functions, without being immediately perceived by the rest. All physicians have known the singular consent that exists between our different organs, both in a state of health and disease, but principally in the latter. ”

“ In view of all the possible mixtures, permutations and combinations of the endocrine glands, that may construct an individual, it is possible to conceive a million types of normals. For normality means harmony, the harmonious equilibrium between the hormones, which tends to continue itself, because it does no harm to itself. ”

“ SECT. I. The Nature of the Disorder. To call the Hypochondriasis a fanciful malady, is ignorant and cruel. It is a real, and a sad disease: an obstruction of the spleen by thickened and distempered blood; extending itself often to the liver, and other parts; and unhappily is in England very frequent: physick scarce knows one more fertile in ill; or more difficult of cure. ”

“ Hysteria is distinguished from hypochondriasis, as in the latter there are no retrograde motions of the alimentary canal, but simply a debility or inirritability of it, with distention and flatulency. It is distinguished from apepsia and cardialgia by there being nothing ejected from the stomach by the retrograde motions of it, or of the œsophagus. ”

“ But it follows from this that it is hardly possible to take hysteria out of connection with the sexual neuroses, that hysteria as a rule presents only one side, one aspect of the complicated neurotic case, and that only, as it were, in the borderline case can it be found and treated as an isolated neurosis. ”

“ The chief importance in such cases lies in the nature of the trauma, to be sure in connection with the reaction of the person to the trauma. It is an indispensable condition for the acquirement of hysteria that there should arise a relation of incompatibility between the ego and some of its approaching presentations. I hope to be able to show in another place how a variety of neurotic disturbances originate from the different procedures which the "ego" pursues in order to free itself from that incompatibility. ”

“ It is really, one may point out, an argument in favor of such an element as one of the factors of hysteria. If there were no initial lesion of the sexual emotions, if the natural healthy sexual channel still remained free for the passage of the emotional overflow, then we should expect that it would much oftener come into play in the removal of hysteria. In the more healthy, merely hysteroid condition, the psychic sexual organism is not injured, and still responds normally, removing the abnormal symptoms when allowed to do so. ”

“ I must discuss the significance of these moments for the conception of the whole neurosis. However, I think that the assumption of a defense hysteria (abwehr hysterie) includes the requisite that at least one such moment has already occurred. For consciousness does not know in advance when such an unbearable idea will present itself. The unbearable idea which with its appendix is later excluded for the formation of a separate psychic group must have been originally in the mind, otherwise no conflict would have resulted leading to its exclusion. ”

“ The belief that hypochondriasis was a somatic condition persisted until [Pg iii] the second half of the seventeenth century at which time an innovation was made by Dr. Thomas Sydenham. In addition to showing that hypochondriasis and hysteria (thought previously by Sydenham to afflict women only) were the same disease, Sydenham noted that the external cause of both was a mental disturbance and not a physiological one. He also had a theory that the internal and immediate cause was a disorder of the animal spirits arising from a clot and resulting in pain, spasms, and bodily disorders. ”

“ The urging of the strange and inexperienced physician does not suffice for the "association resistance" in a grave hysteria. One must resort to more forceful means.
In the first place I make use of a small technical artifice. I inform the patient that I will in the next moment exert pressure on his forehead, I assure him that during this pressure he will see some reminiscence in the form of a picture, or some thought will occur to him, and I oblige him to communicate to me this picture or this thought, no matter what it may be. ”

“ You see, Sir, I am no hypochondriac, as my fool of a doctor wants to persuade me: a hypochondriac shudders at every breath of air, trembles when a door is open, and looks upon a window as the entrance of death. ”

“ It is clearly demonstrated that the physical sexual organs are not the seat of hysteria. It does not, however, follow that even physical sexual desire, when repressed, is not a cause of hysteria. The opinion that it was so formed an essential part of the early doctrine of hysteria, and was embodied in the ancient maxim: "Nubat illa et morbus effugiet." The womb, it seemed to the ancients, was crying out for satisfaction, and when that was received the disease vanished. ”

“ These excessive onanists no doubt do themselves harm in various ways, but the great error of taking sexual hypochondriasis for the type of onanists, is to confound cause with effect. Sexual hypochondriasis is in no way the effect of onanism, but precedes it, and onanism is rather its effect, or is simply associated with it. It is obvious that onanism, by its depressing effect, aggravates a mind beset with hypochondriacal anxieties. ”

“ You know that hysteria and compulsion-neurosis are the two chief factors in the group of transference neuroses. In hysteria, libidinous return to primary, incestuous sexual objects is quite regular, but regression to a former stage of sexual organization very rare. In the mechanism of hysteria suppression plays the chief part. ”

“ I had been instructed in the use of the hypodermic needle, and from time to time gave him the "hypnotic injunction," as he still called it. But it did not afford him entire relief. He could remain in no position for any length of time. Yet he never complained and thought only of the trouble he might be making. ”

“ Hypochondria and hysteria, as neurasthenia and hysteria, are sometimes united in the same subject; one sometimes begets the other, but they have certain points of distinction. Hypochondria more frequently passes into real organic disease than does hysteria; it is more frequently associated with organic disease than is hysteria. Hypochondria is in the majority of cases a true insanity, while hysteria can only be regarded as such in the special instances which have been discussed. ”

“ This mode of solution is one in which the sufferer regains happiness and comfort, if not health, by the occurrence of symptoms which enable him to escape from the conflict in place of facing it. The form of neurosis to which I refer is that usually known as hysteria. As this term is ordinarily used it applies to a very large and varied group of manifestations of which paralyses, contractures and anæsthesias are among the most frequent and characteristic. ”

“ The hypoblast can, in most instances, be traced as a distinct layer underneath the primitive streak, although it is usually less easy to follow it in that region than elsewhere, and in some cases it can hardly be distinctly separated from the superjacent cells. ”