[227] "Minor Studies from the Psychological Laboratory of Wellesley College," _American Journal of Psychology_, vol. vii, No. 1. G.E. Partridge ("Reverie," _Pedagogical Seminary_, April, 1898) well describes the physical accompaniments of day-dreaming, especially in Normal School girls between sixteen and twenty-two. Pick ("Clinical Studies in Pathological Dreaming," _Journal of Mental Sciences_, July, 1901) records three more or less morbid cases of day-dreaming, usually with an erotic basis, all in apparently hysterical men. An important study of day-dreaming, based on the experiences of nearly 1,500 young people (more than two-thirds girls and women), has been published by Theodate L. Smith ("The Psychology of Day Dreams," _American Journal Psychology_, October, 1904). Continued stories were found to be rare--only one per cent. Healthy boys, before fifteen, had day-dreams in which sports, athletics, and adventure had a large part; girls put themselves in the place of their favorite heroines in novels. After seventeen, and earlier in the case of girls, day-dreams of love and marriage were found to be frequent. A typical confession is that of a girl of nineteen: "I seldom have time to build castles in Spain, but when I do, I am not different from most Southern girls; i.e., my dreams are usually about a pretty fair specimen of a six-foot three-inch biped."
[228] The case has been recorded of a married woman, in love with her doctor, who kept a day-dream diary, at last filling three bulky volumes, when it was discovered by her husband, and led to an action for divorce; it was shown that the doctor knew nothing of the romance in which he played the part of hero. Kiernan, in referring to this case (as recorded in John Paget's _Judicial Puzzles_), mentions a similar case in Chicago.
[230] The acute Anstie remarked, more than thirty years ago, in his work on _Neuralgia_: "It is a comparatively frequent thing to see an unsocial, solitary life (leading to the habit of masturbation) joined with the bad influence of an unhealthy ambition, prompting to premature and false work in literature and art." From the literary side, M. Léon Bazalgette has dealt with the tendency of much modern literature to devote itself to what he calls "mental onanism," of which the probable counterpart, he seems to hint, is a physical process of auto-erotism. (Léon Bazalgette, "L'onanisme considéré comme principe createur en art," _L'Esprit Nouveau_, 1898.)
[231] Pausanias, _Achaia_, Chapter XVII. The ancient Babylonians believed in a certain "maid of the night," who appeared to men in sleep and roused without satisfying their passions. (Jastrow, _Religion of Babylonia_, p. 262.) This succubus was the Assyrian Liler, connected with the Hebrew Lilith. There was a corresponding incubus, "the little night man," who had nocturnal intercourse with women. (Cf. Ploss, _Das Weib_, 7th ed., pp. 521 et seq.) The succubus and the incubus (the latter being more common) were adopted by Christendom; St. Augustine (_De Civitate Dei_, Bk. XV, Ch. XXIII) said that the wicked assaults of sylvans and fauns, otherwise called incubi, on women, are so generally affirmed that it would be impudent to deny them. Incubi flourished in mediæval belief, and can scarcely, indeed, be said to be extinct even to-day. They have been studied by many authors; see, e.g., Dufour, _Histoire de la Prostitution_, vol. v, Ch. XXV, Saint-André, physician-in-ordinary to the French King, pointed out in 1725 that the incubus was a dream. It may be added that the belief in the succubus and incubus appears to be widespread. Thus, the West African Yorubas (according to A.B. Ellis) believe that erotic dreams are due to the god Elegbra, who, either as a male or a female, consorts with men and women in sleep.
[232] "If any man's seed of copulation go out from him, then he shall bathe all his flesh in water and be unclean until the even. And every garment, and every skin, whereon is the seed of copulation, shall be washed with water and be unclean until the even." Leviticus, XV, v. 16-17.
[233] It should be added that the term _pollutio_ also covers voluntary effusion of semen outside copulation. (Debreyne, _Moechialogie_, p. 8; for a full discussion of the opinions of theologians concerning nocturnal and diurnal pollutions, see the same author's _Essai sur la Théologie Morale_, pp. 100-149.)
[238] I may here refer to the curious opinion expressed by Dr. Elizabeth Blackwell, that, while the sexual impulse in man is usually relieved by seminal emissions during sleep, in women it is relieved by the occurrence of menstruation. This latter statement is flagrantly at variance with the facts; but it may perhaps be quoted in support of the view expressed above as to the comparative rarity of sexual excitement during sleep in young girls.
[239] Löwenfeld has recently expressed the same opinion. Rohleder believes that pollutions are physically impossible in a _real_ virgin, but that opinion is too extreme.
[240] It may be added that in more or less neurotic women and girls, erotic dreams may be very frequent and depressing. Thus, J.M. Fothergill (_West-Riding Asylum Report_, 1876, vol. vi) remarks: "These dreams are much more frequent than is ordinarily thought, and are the cause of a great deal of nervous depression among women. Women of a highly-nervous diathesis suffer much more from these drains than robust women. Not only are these involuntary orgasms more frequent among such women, but they cause more disturbance of the general health in them than in other women."
[241] I may remark here that a Russian correspondent considers that I have greatly underestimated the frequency of erotic manifestations during sleep in young girls. "All the women I have interrogated on this point," he informs me, "say that they have had such pollutions from the time of puberty, or even earlier, accompanied by erotic dreams. I have put the question to some twenty or thirty women. It is true that they were of southern race (Italian, Spanish, and French), and I believe that Southerners are, in this matter, franker than northern women, who consider the activity of the flesh as shameful, and seek to conceal it." My correspondent makes no reference to the chief point of sexual difference, so far as my observation goes, which is that erotic dreams are comparatively rare in those women "_who have yet had no sort of sexual experience in waking life_." Whether or not this is correct, I do not question the frequency of erotic dreams in girls who have had such experience.
[242] C.C. Hersman, "Medico-legal Aspects of Eroto-Choreic Insanities," _Alienist and Neurologist_, July, 1897. I may mention that Pitres (_Leçons cliniques sur l'Hystérie_, vol. ii, p. 34) records the almost identical case of a hysterical girl in one of his wards, who was at first grateful to the clinical clerk to whom her case was intrusted, but afterward changed her behavior, accused him of coming nightly through the window, lying beside her, caressing her, and then exerting violent coitus three or four times in succession, until she was utterly exhausted. I may here refer to the tendency to erotic excitement in women under the influence of chloroform and nitrous oxide, a tendency rarely or never noted in men, and of the frequency with which the phenomenon is attributed by the subject to actual assault. See H. Ellis, _Man and Woman_, pp. 269-274.
[243] In Australia, some years ago, a man was charged with rape, found guilty of "attempt," and sentenced to eighteen months' imprisonment, on the accusation of a girl of 13, who subsequently confessed that the charge was imaginary; in this case, the jury found it impossible to believe that so young a girl could have been lying, or hallucinated, because she narrated the details of the alleged offence with such circumstantial detail. Such cases are not uncommon, and in some measure, no doubt, they may be accounted for by auto-erotic nocturnal hallucinations.
[245] Pitres, _Leçons cliniques sur l'Hystérie_, vol. ii, pp. 37 et seq. The Lorraine inquisitor, Nicolas Remy, very carefully investigated the question of the feelings of witches when having intercourse with the Devil, questioning them minutely, and ascertained that such intercourse was usually extremely painful, filling them with icy horror (See, e.g., Dufour, _Histoire de la Prostitution_, vol. v, p. 127; the same author presents an interesting summary of the phenomena of the Witches' Sabbath). But intercourse with the Devil was by no means always painful. Isabel Gowdie, a Scotch witch, bore clear testimony to this point: "The youngest and lustiest women," she stated, "will have very great pleasure in their carnal copulation with him, yea, much more than with their own husbands...He is abler for us than any man can be. (Alack! that I should compare him to a man!)" Yet her description scarcely sounds attractive; he was a "large, black, hairy man, very cold, and I found his nature as cold within me as spring well-water." His foot was forked and cloven; he was sometimes like a deer, or a roe; and he would hold up his tail while the witches kissed that region (Pitcairn, _Criminal Trials in Scotland_, vol. iii, Appendix VII; see, also, the illustrations at the end of Dr. A. Marie's _Folie et Mysticisme_, 1907).
[246] Gilles de la Tourette, loc. cit., p. 518. Erotic hallucinations have also been studied by Bellamy, in a Bordeaux thesis, _Hallucinations Erotiques_, 1900-1901.
[247] On one occasion, when still a girl, whenever an artist whom she admired touched her hand she felt erection and moisture of the sexual parts, but without any sensation of pleasure; a little later, when an uncle's knee casually came in contact with her thigh, ejaculation of mucus took place, though she disliked the uncle; again, when a nurse, on casually seeing a man's sexual organs, an electric shock went through her, though the sight was disgusting to her; and when she had once to assist a man to urinate, she became in the highest degree excited, though without pleasure, and lay down on a couch in the next room, while a conclusive ejaculation took place. (Moll, _Libido Sexualis_, Bd. I, p. 354.)
[249] Calmeil (_De la Folie_, vol. i, p. 252) called attention to the large part played by uterine sensations in the hallucinations of some famous women ascetics, and added: "It is well recognized that the narrative of such sensations nearly always occupies the first place in the divagations of hysterical virgins."
[250] H. Leuba, "Les Tendances Religieuses chez les Mystiques Chrétiens," _Revue Philosophique_, November, 1902, p. 465. St. Theresa herself states that physical sensations played a considerable part in this experience.
II.
Hysteria and the Question of Its Relation to the Sexual Emotions--The Early Greek Theories of its Nature and Causation--The Gradual Rise of Modern Views--Charcot--The Revolt Against Charcot's Too Absolute Conclusions--Fallacies Involved--Charcot's Attitude the Outcome of his Personal Temperament--Breuer and Freud--Their Views Supplement and Complete Charcot's--At the Same Time they Furnish a Justification for the Earlier Doctrine of Hysteria--But They Must Not be Regarded as Final--The Diffused Hysteroid Condition in Normal Persons--The Physiological Basis of Hysteria--True Pathological Hysteria is Linked on to almost Normal States, especially to Sex-hunger.
The nocturnal hallucinations of hysteria, as all careful students of this condition now seem to agree, are closely allied to the hysterical attack proper. Sollier, indeed, one of the ablest of the more recent investigators of hysteria, has argued with much force that the subjects of hysteria really live in a state of pathological sleep, of vigilambulism.[251] He regards all the various accidents of hysteria as having a common basis in disturbances of sensibility, in the widest sense of the word "sensibility,"--as the very foundation of personality,--while anæsthesia is "the real _sigillum hysteriæ_." Whatever the form of hysteria, we are thus only concerned with a more or less profound state of vigilambulism: a state in which the subject seems, often even to himself, to be more or less always asleep, whether the sleep may be regarded as local or general. Sollier agrees with Féré that the disorder of sensibility may be regarded as due to an exhaustion of the sensory centres of the brain, whether as the result of constitutional cerebral weakness, of the shock of a violent emotion, or of some toxic influence on the cerebral cells.
We may, therefore, fitly turn from the auto-erotic phenomena of sleep which in women generally, and especially in hysterical women, seem to possess so much importance and significance, to the question--which has been so divergently answered at different periods and by different investigators--concerning the causation of hysteria, and especially concerning its alleged connection with conscious or unconscious sexual emotion.[252] It was the belief of the ancient Greeks that hysteria came from the womb; hence its name. We first find that statement in Plato's _Timæus_: "In men the organ of generation--becoming rebellious and masterful, like an animal disobedient to reason, and maddened with the sting of lust--seeks to gain absolute sway; and the same is the case with the so-called womb, or uterus, of women; the animal within them is desirous of procreating children, and, when remaining unfruitful long beyond its proper time, gets discontented and angry, and, wandering in every direction through the body, closes up the passages of the breath, and, by obstructing respiration,[253] drives them to extremity, causing all varieties of disease."
Plato, it is true, cannot be said to reveal anywhere a very scientific attitude toward Nature. Yet he was here probably only giving expression to the current medical doctrine of his day. We find precisely the same doctrine attributed to Hippocrates, though without a clear distinction between hysteria and epilepsy.[254] If we turn to the best Roman physicians we find again that Aretæus, "the Esquirol of antiquity," has set forth the same view, adding to his description of the movements of the womb in hysteria: "It delights, also, in fragrant smells, and advances toward them; and it has an aversion to foetid smells, and flies from them; and, on the whole, the womb is like an animal within an animal."[255] Consequently, the treatment was by applying foetid smells to the nose and rubbing fragrant ointments around the sexual parts.[256] The Arab physicians, who carried on the traditions of Greek medicine, appear to have said nothing new about hysteria, and possibly had little knowledge of it. In Christian mediæval Europe, also, nothing new was added to the theory of hysteria; it was, indeed, less known medically than it had ever been, and, in part it may be as a result of this ignorance, in part as a result of general wretchedness (the hysterical phenomena of witchcraft reaching their height, Michelet points out, in the fourteenth century, which was a period of special misery for the poor), it flourished more vigorously. Not alone have we the records of nervous epidemics, but illuminated manuscripts, ivories, miniatures, bas-reliefs, frescoes, and engravings furnish the most vivid iconographic evidence of the prevalence of hysteria in its most violent forms during the Middle Ages. Much of this evidence is brought to the service of science in the fascinating works of Dr. P. Richer, one of Charcot's pupils.[257] In the seventeenth century Ambroise Paré was still talking, like Hippocrates, about "suffocation of the womb"; Forestus was still, like Aretæus, applying friction to the vulva; Fernel was still reproaching Galen, who had denied that the movements of the womb produced hysteria.
It was in the seventeenth century (1618) that a French physician, Charles Lepois (Carolus Piso), physician to Henry II, trusting, as he said, to experience and reason, overthrew at one stroke the doctrine of hysteria that had ruled almost unquestioned for two thousand years, and showed that the malady occurred at all ages and in both sexes, that its seat was not in the womb, but in the brain, and that it must be considered a nervous disease.[258] So revolutionary a doctrine could not fail to meet with violent opposition, but it was confirmed by Willis, and in 1681, we owe to the genius of Sydenham a picture of hysteria which for lucidity, precision, and comprehensiveness has only been excelled in our own times.
It was not possible any longer to maintain the womb theory of Hippocrates in its crude form, but in modified forms, and especially with the object of preserving the connection which many observers continued to find between hysteria and the sexual emotions, it still found supporters in the eighteenth and even the nineteenth centuries. James, in the middle of the eighteenth century, returned to the classical view, and in his _Dictionary of Medicine_ maintained that the womb is the seat of hysteria. Louyer Villermay in 1816 asserted that the most frequent causes of hysteria are deprivation of the pleasures of love, griefs connected with this passion, and disorders of menstruation. Foville in 1833 and Landouzy in 1846 advocated somewhat similar views. The acute Laycock in 1840 quoted as "almost a medical proverb" the saying, "_Salacitas major, major ad hysteriam proclivitas_," fully indorsing it. More recently still Clouston has defined hysteria as "the loss of the inhibitory influence exercised on the reproductive and sexual instincts of women by the higher mental and moral functions" (a position evidently requiring some modification in view of the fact that hysteria is by no means confined to women), while the same authority remarks that more or less concealed sexual phenomena are the chief symptoms of "hysterical insanity."[259] Two gynæcologists of high position in different parts of the world, Hegar in Germany and Balls-Headley in Australia, attribute hysteria, as well as anæmia, largely to unsatisfied sexual desire, including the non-satisfaction of the "ideal feelings."[260] Lombroso and Ferrero, again, while admitting that the sexual feelings might be either heightened or depressed in hysteria, referred to the frequency of what they termed "a paradoxical sexual instinct" in the hysterical, by which, for instance, sexual frigidity is combined with intense sexual pre-occupations; and they also pointed out the significant fact that the crimes of the hysterical nearly always revolve around the sexual sphere.[261] Thus, even up to the time when the conception of hysteria which absolutely ignored and excluded any sexual relationship whatever had reached its height, independent views favoring such a relationship still found expression.
Of recent years, however, such views usually aroused violent antagonism. The main current of opinion was with Briquet (1859), who, treating the matter with considerable ability and a wide induction of facts, indignantly repelled the idea that there is any connection between hysteria and the sexual facts of life, physical or psychic. As he himself admitted, Briquet was moved to deny a sexual causation of hysteria by the thought that such an origin would be degrading for women ("_a quelque chose de dégradant pour les femmes_").
It was, however, the genius of Charcot, and the influence of his able pupils, which finally secured the overthrow of the sexual theory of hysteria. Charcot emphatically anathematized the visceral origin of hysteria; he declared that it is a psychic disorder, and to leave no loop-hole of escape for those who maintained a sexual causation he asserted that there are no varieties of hysteria, that the disease is one and indivisible. Charcot recognized no primordial cause of hysteria beyond heredity, which here plays a more important part than in any other neuropathic condition. Such heredity is either direct or more occasionally by transformation, any deviation of nutrition found in the ancestors (gout, diabetes, arthritis) being a possible cause of hysteria in the descendants. "We do not know anything about the nature of hysteria," Charcot wrote in 1892; "we must make it objective in order to recognize it. The dominant idea for us in the etiology of hysteria is, in the widest sense, its hereditary predisposition. The greater number of those suffering from this affection are simply born _hystérisables_, and on them the occasional causes act directly, either through autosuggestion or by causing derangement of general nutrition, and more particularly of the nutrition of the nervous system."[262] These views were ably and decisively stated in Gilles de la Tourette's _Traité de l'Hystérie_, written under the inspiration of Charcot.
While Charcot's doctrine was thus being affirmed and generally accepted, there were at the same time workers in these fields who, though they by no means ignored this doctrine of hysteria or even rejected it, were inclined to think that it was too absolutely stated. Writing in the _Dictionary of Psychological Medicine_ at the same time as Charcot, Donkin, while deprecating any exclusive emphasis on the sexual causation, pointed out the enormous part played by the emotions in the production of hysteria, and the great influence of puberty in women due to the greater extent of the sexual organs, and the consequently large area of central innervation involved, and thus rendered liable to fall into a state of unstable equilibrium. Enforced abstinence from the gratification of any of the inherent and primitive desires, he pointed out, may be an adequate exciting cause. Such a view as this indicated that to set aside the ancient doctrine of a physical sexual cause of hysteria was by no means to exclude a psychic sexual cause. Ten years earlier Axenfeld and Huchard had pointed out that the reaction against the sexual origin of hysteria was becoming excessive, and they referred to the evidence brought forward by veterinary surgeons showing that unsatisfied sexual desire in animals may produce nervous symptoms very similar to hysteria.[263] The present writer, when in 1894 briefly discussing hysteria as an element in secondary sexual characterization, ventured to reflect the view, confirmed by his own observation, that there was a tendency to unduly minimize the sexual factor in hysteria, and further pointed out that the old error of a special connection between hysteria and the female sexual organs, probably arose from the fact that in woman the organic sexual sphere is larger than in man.[264] When, indeed, we analyze the foundation of the once predominant opinions of Charcot and his school regarding the sexual relationships of hysteria, it becomes clear that many fallacies and misunderstandings were involved. Briquet, Charcot's chief predecessor, acknowledged that his own view was that a sexual origin of hysteria would be "degrading to women"; that is to say, he admitted that he was influenced by a foolish and improper prejudice, for the belief that the unconscious and involuntary morbid reaction of the nervous system to any disturbance of a great primary instinct can have "_quelque chose de dégradant_" is itself an immoral belief; such disturbance of the nervous system might or might not be caused, but in any case the alleged "degradation" could only be the fiction of a distorted imagination. Again, confusion had been caused by the ancient error of making the physical sexual organs responsible for hysteria, first the womb, more recently the ovaries; the outcome of this belief was the extirpation of the sexual organs for the cure of hysteria. Charcot condemned absolutely all such operations as unscientific and dangerous, declaring that there is no such thing as hysteria of menstrual origin.[265] Subsequently, Angelucci and Pierracini carried out an international inquiry into the results of the surgical treatment of hysteria, and condemned it in the most unqualified manner.[266] 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.[267] But when it became clear that sexual desire, though ultimately founded on the sexual apparatus, is a nervous and psychic fact, to put the sexual organs out of count was not sufficient; for the sexual emotions may exist before puberty, and persist after complete removal of the sexual organs. Thus it has been the object of many writers to repel the idea that unsatisfied sexual desire can be a cause of hysteria. Briquet pointed out that hysteria is rare among nuns and frequent among prostitutes. Krafft-Ebing believed that most hysterical women are not anxious for sexual satisfaction, and declared that "hysteria caused through the non-satisfaction of the coarse sensual sexual impulse I have never seen,"[268] while Pitres and others refer to the frequently painful nature of sexual hallucinations in the hysterical. But it soon becomes obvious that the psychic sexual sphere is not confined to the gratification of conscious physical sexual desire. It is not true that hysteria is rare among nuns, some of the most tremendous epidemics of hysteria, and the most carefully studied, having occurred in convents,[269] while the hysterical phenomena sometimes associated with revivals are well known. The supposed prevalence among prostitutes would not be evidence against the sexual relationships of hysteria; it has, however, been denied, even by so great an authority as Parent-Duchâtelet who found it very rare, even in prostitutes in hospitals, when it was often associated with masturbation; in prostitutes, however, who returned to a respectable life, giving up their old habits, he found hysteria common and severe.[270] The frequent absence of physical sexual feeling, again, may quite reasonably be taken as evidence of a disorder of the sexual emotions, while the undoubted fact that sexual intercourse usually has little beneficial effect on pronounced hysteria, and that sexual excitement during sleep and sexual hallucinations are often painful in the same condition, is far from showing that injury or repression of the sexual emotions had nothing to do with the production of the hysteria. It would be as reasonable to argue that the evil effect of a heavy meal on a starving man must be taken as evidence that he was not suffering from starvation. The fact, indeed, on which Gilles de la Tourette and others have remarked, that the hysterical often desire not so much sexual intercourse as simple affection, would tend to show that there is here a real analogy, and that starvation or lesion of the sexual emotions may produce, like bodily starvation, a rejection of those satisfactions which are demanded in health. Thus, even a mainly _a priori_ examination of the matter may lead us to see that many arguments brought forward in favor of Charcot's position on this point fall to the ground when we realize that the sexual emotions may constitute a highly complex sphere, often hidden from observation, sometimes not conscious at all, and liable to many lesions besides that due to the non-satisfaction of sexual desire. At the same time we are not thus enabled to overthrow any of the positive results attained by Charcot and his school.
It may, however, be pointed out that Charcot's attitude toward hysteria was the outcome of his own temperament. He was primarily a neurologist, the bent of his genius was toward the investigation of facts that could be objectively demonstrated. His first interest in hysteria, dating from as far back as 1862, was in hystero-epileptic convulsive attacks, and to the last he remained indifferent to all facts which could not be objectively demonstrated. That was the secret of the advances he was enabled to make in neurology. For purely psychological investigation he had no liking, and probably no aptitude. Anyone who was privileged to observe his methods of work at the Salpêtrière will easily recall the great master's towering figure; the disdainful expression, sometimes, even, it seemed, a little sour; the lofty bearing which enthusiastic admirers called Napoleonic. The questions addressed to the patient were cold, distant, sometimes impatient. Charcot clearly had little faith in the value of any results so attained. One may well believe, also, that a man whose superficial personality was so haughty and awe-inspiring to strangers would, in any case, have had the greatest difficulty in penetrating the mysteries of a psychic world so obscure and elusive as that presented by the hysterical.[271] The way was thus opened for further investigations on the psychic side. Charcot had affirmed the power, not only of physical traumatism, but even of psychic lesions--of moral shocks--to provoke its manifestations, but his sole contribution to the psychology of this psychic malady,--and this was borrowed from the Nancy school,--lay in the one word "suggestibility"; the nature and mechanism of this psychic process he left wholly unexplained. This step has been taken by others, in part by Janet, who, from 1889 onward, has not only insisted that the emotions stand in the first line among the causes of hysteria, but has also pointed out some portion of the mechanism of this process; thus, he saw the significance of the fact, already recognized, that strong emotions tend to produce anæsthesia and to lead to a condition of mental disaggregation, favorable to abulia, or abolition of will-power. It remained to show in detail the mechanism by which the most potent of all the emotions effects its influence, and, by attempting to do this, the Viennese investigators, Breuer and especially Freud, have greatly aided the study of hysteria.[272] They have not, it is important to remark, overturned the positive elements in their great forerunner's work. Freud began as a disciple of Charcot, and he himself remarks that, in his earlier investigations of hysteria, he had no thought of finding any sexual etiology for that malady; he would have regarded any such suggestion as an insult to his patient. The results reached by these workers were the outcome of long and detailed investigation. Freud has investigated many cases of hysteria in minute detail, often devoting to a single case over a hundred hours of work. The patients, unlike those on whom the results of the French school have been mainly founded, all belonged to the educated classes, and it was thus possible to carry out an elaborate psychic investigation which would be impossible among the uneducated. Breuer and Freud insist on the fine qualities of mind and character frequently found among the hysterical. They cannot accept suggestibility as an invariable characteristic of hysteria, only abnormal excitability; they are far from agreeing with Janet (although on many points at one with him), that psychic weakness marks hysteria; there is merely an appearance of mental weakness, they say, because the mental activity of the hysterical is split up, and only a part of it is conscious.[273] The superiority of character of the hysterical is indicated by the fact that the conflict between their ideas of right and the bent of their inclinations is often an element in the constitution of the hysterical state. Breuer and Freud are prepared to assert that the hysterical are among "the flower of humanity," and they refer to those qualities of combined imaginative genius and practical energy which characterized St. Theresa, "the patron saint of the hysterical."
To understand the position of Breuer and Freud we may start from the phenomenon of "nervous shock" produced by physical traumatism, often of a very slight character. Charcot had shown that such "nervous shock," with the chain of resulting symptoms, is nothing more or less than hysteria. Breuer and Freud may be linked on to Charcot at this point. They began by regarding the most typical hysteria as really a _psychic traumatism_; that is to say, that it starts in a lesion, or rather in repeated lesions, of the emotional organism. It is true that the school of Charcot admitted the influence of moral shock, especially of the emotion of fear, but that merely as an "_agent provocateur_," and with a curious perversity Gilles de la Tourette, certainly reflecting the attitude of Charcot, in his elaborate treatise on hysteria fails to refer to the sphere of the sexual emotions even when enumerating the "_agents provocateurs_."[274]