Page:Mind (New Series) Volume 9.djvu/112

98 CKITICAL NOTICES: le contact actif, le fait d'accomplir un mouvement pour atteindre 1'objet." And the reasons for the hesitation are unknown to the patient herself. By similar and persistent elimination, Dr. Janet concludes that the trouble is primarily " un trouble psych ologique qui porte sur la faculte motrice, sur les phenomenes presidant aux mouvements " (p. 8). The patient herself, not knowing this, explains her refusals of notion as due to disgust with objects, and gradually this disgust gives rise to a fixed idea. "En un mot, il y a un delire du contact qui est une simple idee fixe et il y a un delire du contact qui est 1'expression d'un trouble general de 1'activite. . . . Le trouble du contact que presente Marcelle rentre dans cette derniere categorie." The isolation of the fixed idea is not always so easy, as the subsequent cases show. Dr. Janet next proceeds to discover the detailed constitution of the fixed idea. It cannot be due to a general exhaustion of motor centres or loss of motor images ; for certain motions are preserved, automatic movements, like respiration, reflex movements of knee, eye, mouth, etc., secondary automatic or acquired instinctive movements, like change of position, scratching ; habitual move- ments, like threading a needle, and, lastly, certain complicated movements, performed even against her will, as breaking objects, or tearing her clothes, or making caricature sketches on paper, or biting her nails, or the elaborate sequences of movements involved in varied efforts to commit suicide. One class of movements is not only not lost, but is distinctly exaggerated, namely, suggested movements. Movements that she cannot execute voluntarily, or on a mild request, she readily does on a firm command. Post- hypnotic suggestions are instantly carried out, even when the suggested actions are precisely the same as those requested in the normal state. On further analysis, it is found that habitual actions that is, past volitions are preserved ; anything involving fresh volition, that is novelty, fails. The essential fact, then, is aboulia. From analysis of the movements, Prof. Janet proceeds to " les idees fixes ". By watching the patient in various moods, sometimes semi-cataleptic, ending in tears, and by discovering her capacity for automatic writing, he was able to trace the fixed ideas to their origin. Certain " crises of ideas " occurred (p. 18). Some- times there were hallucinations. She complained that during the crisis, or nuage, " on lui parle dans la tete, que sa tete parle con- stamment". The basis of this hallucination is a disturbance of the psycho-motor mechanism of speech, the voice being none other than the patient's own. The phenomenon here, Dr. Janet maintains, consisted of " hallucinations kinesthesiques verbales ". The term " kinesthesiques " conveys a less disputable meaning than " sens musculaire ". By further examination, the " voices " were found to be associated with ideas of persecution, certain forbiddings to do this or that, and all these had their origin in some episodes of the past life, being, in fact, mainly repetitions. For instance, the command by the " voices " to " die " and " not