Somnambulism: Reactive Hysterical/Dissociative Psychosis.

[Pilgrim]

The early views of Breuer and Freud (1893/5) on hysteria and hysterical psychosis (HP) were strongly influenced by Janet, as Breuer (1895) testified. They emphasized, among other things, the traumatic origins of these disorders. Breuer (1895) also pointed to the dream-like nature of HP and to the often rapid alternation of such dreams with the normal waking state. He believed that patients dreaming these waking dreams were in a state of self-hypnosis that the French termed “somnambulism.” Unlike Freud, Breuer believed that such “psychotic states” could persist for a long time, as exemplified by his famous case of Anna O.


THE DECLINE OF HYSTERIA

At the beginning of the 20th century, interest in HP, hysteria and hypnosis vanished. That psychological trauma could be a major factor in the development of these disorders was also forgotten. The few attempts to establish the clinical validity of HP were not accepted (cf. Regis, 1906; Mairet and Salager, 1911). Two factors prompted this rejection: (1) The successful campaign against hysteria as a respectable mental disorder because it lacked an organic base (Villechenoux, 1968; Maleval, 1981). Babinski (1901, 1909) strongly advocated this position. This success led to regarding patients suffering from HP as malingerers or as following suggestions. (2) Bleuler’s introduction of the term “schizophrenia” (Bleuler, 1911/50) as a diagnostic entity encompassing widely divergent mental disorders, and the broad acceptance it gained (Rosenbaum, 1980; Maleval, 1981). Bleuler’s influence was so great, that after 1911 the majority of psychiatrists, including Freud, no longer used the diagnosis of HP (Maleval, 1981). Only very few authors continued to stress the importance of distinguishing between HP and other psychoses. The German psychiatrist Raecke (1915) emphasized the influence of extreme situational stress in the development of HP. The Dutch psychiatrist Breukink (1923) harked back to the work of Janet, other French masters, Breuer and Freud. According to Breukink, HP was characterized by the patient’s high hypnotizability. Therefore it was readily accessible and treatable by hypnosis. However, the all-encompassing label of “schizophrenia” prevailed, and many authors struggle with the clinical problem of hysteria and of diagnosing psychoses which did not completely fit the diagnostic criteria of schizophrenia (e.g., Carrot et al., 1945; Claude, 1937; Courbon, 1937; Mallett and Gold, 1964).


THE RETURN OF THE DIAGNOSIS OF HYSTERICAL PSYCHOSIS.

After World War II, several attempts were made to revive the concept of HP. In line with Janet’s dissociation model, the Dutch psychiatrist Hugenholz (1946) stated that HP can develop in individuals with hysterical characteristics who are exposed to traumatic events. These events evoke and reactivate earlier painful experiences and their associated affect such as resentment and hate.

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I think his acts may have been the consequence of something like a brief, reactive, dissociative psychosis, or what would have been called hysterical psychosis at that time, with the reestablisment of a "symbiotic state" as the core element of the fantasy. There would, then, not be much reason to assume any major deterioration of his faculties.
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According to Janet (1894/5), a psychosis could be considered hysterical if its dissociative nature could be established. The criteria for that are: (1) the psychosis is embedded in dissociative phenomena, (2) the psychosis itself should be a dissociated mental state, (3) a splitting or doubling of the mind (dédoublement de la personnalité) occurs, (4) subconscious phenomena exist, and (5) altered states of consciousness occur. As we understand Janet, the subject experiences HP as a waking dream based on a traumatic experience (Janet, 1894, 1898b).

Janet believed that hysterical psychoses can develop progressively. Initially, a certain sequence of images (e.g., the reenactment of a traumatic event) dominates the mind during an hysterical attack. This traumatic content may also occur during intervals between the attacks, finally manifesting as a chronic psychosis. Janet speculated that the latter represented the transformation from hysterical psychosis into another form of mental illness.

Following Moreau de Tours and others, Pierre Janet, the most important French authority on hysteria and HP, emphasized that HP constitutes a kind of waking dream in which the subject eventually cannot differentiate between the dream elements and normal perceptions (Janet, 394/5, 1901).

During the second half of the 19th century this disorder was wellknown and thoroughly studied, particularly in French psychiatry. In the early 20th century the diagnosis of hysteria, and of HP, fell into disuse. Patients formerly considered to suffer from HP were diagnosed schizophrenics or malingerers.

"Evidence exists that a Reactive Psychosis is not always brief" (Breuer, 1895; Janet, 1984/5; Van der Hart and Van der Velden, 1987)

FROM HYSTERICAL PSYCHOSIS TO REACTIVE DISSOCIATIVE PSYCHOSIS.

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Brief reactive psychosis - "a condition [that] usually spontaneously resolves itself within two weeks, and [where] the main goal of treatment is to prevent the patient from harming either themselves or others."
(http://en.wikipedia.org/wiki/Brief_reactive_psychosis)

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It seems to me that a state like that could also be well in keeping with Hervey Cleckley's theory of psychopathy as a a masked psychosis.

In many patients the disturbance classed as schizoid personality might be more accurately regarded as masked schizophrenia or, as has been sometimes said,"ambulatory" schizophrenia. Although the more gross technical signs of psychosis are not evident on the surface, many of these patients have a very serious disorder within. The tendency to call their condition schizoid personality (and therefore label them as definitely "sane") sometimes results in their being incorrectly treated. Very dangerous tendencies, well concealed, may emerge into tragic acts.

Hervey Cleckley, The Mask of Sanity, p.252.

[Pilgrim]

Peter Sutcliffe's "Epitaph".

"According to Broch, sleepwalkers are people living between vanishing and emerging ethical systems, just as the somnambulist exists in a state between sleeping and walking." The Absolute Novel - Times review.

The Sleepwalkers.1888-1918.

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“I go with the certainty of a sleepwalker along the path laid out for me by Providence” - Adolf Hitler, 1936.

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Sutcliffe told [the doctors] that when he was working at Bingley Cemetery he heard gods voice emanating from a gravestone which commanded him to kill prostitutes, even though not all of his victims were prostitutes. They also conducted a handwriting analysis from an epitaph found in Sutcliffe's lorry, which revealed him to have some schizophrenic tendencies.

Case File: Peter Sutcliffe - The Yorkshire Ripper.

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Peter Sutcliffe's "Epitaph":

[Pilgrim]

Pseudopsychopathic (latent) schizophrenia / Autism.

Forms of hypnotic somnambulism according to their clinical basis.

Three forms of hypnotic somnambulism were distinguished clinically: classical somnambulism in patients with hysterical neurosis on a juvenile-unstable basis (42 cases); sensual-lucid somnambulism in patients with hysterical neurosis on a primitive personality basis (46 cases) and sensual-split somnambulism in patients with pseudoneurotic schizophrenia with a hysteroid clinical picture (58 cases). The differential diagnostic importance of such forms of somnambulism is stressed. (Burno & Karavirt,1980)

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Bleuler: The Concept of Autism

Bleuler's elaboration of autism had a major influence on the conceptualization of schizoidia (including Kretschmer's views). Autism was defined as a detachment from outer reality accompanied by the predominance of inner fantasy life, an unfortunate definition that did not account for apparently extraverted schizophrenics or schizophrenics with obvious paucity of mental life. Autism was considered to be diagnostically pathognomic for schizophrenia (schizoidia and latent schizophrenia as well) although it was seen as secondary from a pathogenic point of view. Despite its debatable abstract definition, autism was a central clinical concept of pre-World War II psychiatry. It was not a symptom or sign (Bleuler designated it as a "complex fundamental symptom"), but rather a generic term indicating a peculiar intersubjective displacement of a patient with schizophrenia, a displacement that could manifest itself in many domains of behaviour, expression and experience. This notion of "displacement" points to the fact that the intersubjective functioning or skill is not simply reduced but also qualitatively altered. The patient's world and the shared or intersubjective world are not superposable, but only overlapping by varying degree. Thus, under the heading of autism, Bleuler, Kretschmer and others described a variety of manifestations of this intersubjective deficit: poor ability to enter into contact with others; withdrawal and inaccessibility (in the extreme cases, negativism); indifference; rigid attitudes, opinions and behaviour (the patient was typically unyielding to external influences); overvalued and strongly held strange ideas; existential patterns with an altered hierarchy of values and goals; inappropriate behaviour, idiosyncratic logic and odd ways of thinking; and even a propensity to delusional thinking. Although Bleuler referred to the patients "inner life" in his definition of autism, all the clinical features were basically described as "third-person" phenomena (i.e. as observable "external" behaviour or "signs"), without systematic attempts to describe the patients subjectivity and world-view from his/her own perspective.

It is also important to note that the concept of "latent schizophrenia" was not introduced by Bleuler in order to designate yet another clinical subtype within his "group of schizophrenias", but rather in order to capture the constitutional ground, the potentiality of an individual to develop the disease. Such individuals may exhibit any of the autistic features described above, usually in attenuated form: they are often irritable, bizarre, "lunatic", lonely, and may present subtle catatonic or paranoid symptoms in a diluted, masked way. Latent and simple schizophrenia, according to Bleuler, was rarely diagnosed, although they were not infrequent among relatives of schizophrenics and among "reformers of the world, philosophers, writers, and artists". ... A "pseudo-psychopathic" variant of these disorders, typically encountered in forensic psychiatric contexts, was later described. It applied to seemingly anti-social offenders, who, on a closer evaluation, appeared to harbour autistic features, that also transpired through the nature of their offence, which was typically senseless, illogical or bizarre, and without (even a short-term) personal gain, normally characteristic of criminal conduct.

Mario Maj, Hagop S. Akiskal, Juan E. Mezzich, Ahmed Okasha, Personality Disorders, pp. 9-11.

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[Howard Brown]

Dear Pilgrim:

Thanks,as always ,for sharing.

Out of curiosity...do you feel that there is a or any possibility that the Ripper...perhaps not sleepwalking...but being in some sort of daze during the crimes?

Elsewhere,I noticed a former Forums member bringing up the name of an individual who was hanged in 1890....and who had appeared to be carrying on conversations with "someone else" while engaging in belligerent behavior. I know that the chap in question wasn't sleeping when he was conversing with his imaginary friend...but I think you understand the drift of what I am getting to.

Thanks P

[Pilgrim]

Alpha / Theta

In a daze... might well be one way of putting it, Howard. I find it most likely, anyway, that these crimes would have been committed within a certain altered state of mind.

...a state of self-hypnosis that the French termed “somnambulism.”

Alpha (9-13 Hz):

Relaxed, images & visuals, self-Introspection, day dreaming.

Theta (4-8 Hz):

Deep meditation, between awake/sleep, flow of ideas/creativity, shamanic states, bridge to the subconscious.

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Awake animals seemed to show theta rhythms when they were behaving in ways most crucial to their survival. In other words, theta rhythm appeared when they exhibited behaviour that was not genetically encoded - such as feeding or sexual behaviour - but rather a response to changing environmental information. Predatory behaviour in the cat, prey behaviour in the rabbit, and exploration in the rat are, respectively, most important to their survival... The observation of theta rhythm in all of these animals during REM sleep became the basis for Winson's hypothesis that laid the foundation for a neurobiology of the unconcscious and the evolutionary significance of dreaming.

Alondra Yvette Oubré, Instinct and Revelation - Reflections on the Origins of Numinous Perception, p. 156.

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Another phenomenon usually considered in the psychology of serial murder is the dissociative state or disorder. Dissociation (Egger, 1990) is the lack of integration of thoughts, feelings and experiences into the stream of consciousness. In other words, it is a mental "separation" from the physical place of an individual. Dissociation has been cited as an example of spontaneous self-hypnosis. (Bliss, 1986, p.166) ... Drawing a parallell between a psychopathic personality and the dissociated demeanor of a serial murderer, Meloy (1992) noted that "psychopathy is, among other things, a disorder of profound detachment. He added that "from this conscienceless, detached psychology emerges a heightened risk of violence, most notably a capacity for predation" (p. xvii)

Stephen J. Giannangelo, The psychopathology of serial murder, pp. 13-14.

[Howard Brown]

Thank you for your observations,Pilgrim. I can envision the Whitechapel Murderer conducting conversations with imaginary people...even when on the prowl for a victim...very scary mental picture I get.

[Pilgrim]

Numinous perception / temporal lobe lability.

Alondra Yvette Oubré, Instinct and Revelation - Reflections on the Origins of Numinous Perception

The Trial - Week 2. Monday, May 11, 1981.

Mr Chadwin: "What was it that happened at Bingley cemetery that you particularly remember?"

Mr Sutcliffe: "Something that I felt was very wonderful at the time. I heard what I believed then and believe now to have been God's voice. I was in the process of digging a grave. I was digging and I just paused for a minute. It was very hard ground. I just heard something - it sounded like a voice similar to a human voice - like an echo. I looked round to see if there was anyone there, but there was no one in sight. I was in the grave with my feet about five feet below the surface. There was no one in sight when I looked round from where I was. Then I got out of the grave. The voice was not very clear. I got out and walked - the ground rose up. It was quite a steep slope. I walked to the top, but there was no one there at all. I heard again the same sound. It was like a voice saying something, but the words were all imposed on top of each other. I could not make them out, it was like echoes. The voices were coming directly in front of me from the top of a gravestone, which was Polish. I remember the name on the grave to this day. It was a man called Zipolski. Stanislaw Zipolski." (Note: The name on the gravestone is really Bronislaw Zapolski.)

...

Mr Chadwin: "What effect did all this have on you?"

Mr Sutcliffe: "It had a terrific impact on me. I went down the slope after standing there for a while. It was starting to rain. I remember going to the top of the slope overlooking the valley and I felt as though I had just experienced something fantastic. I looked across the valley and all around and thought of heaven and earth and how insignificant we all are. But I felt so important at the moment."

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"It's a sad fact that people in a sense won't trust their own valuing of their numinous experiences; they think it isn't really as good as it seems unless it's from God, unless it's some kind of proof of religion. NO; it's just as wonderful as it seems, it's just as important; it IS the best moment of your life, it's the moment when you FORGET yourself and become better than you thought you COULD BE, in some way, and see in all humbleness the wonderfulness of nature. That's it." --Daniel Dennett (The Four Horsemen: Dawkins, Dennett, Harris, Hitchens)

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Temporal lobe lability is known to vary widely between individuals. In the most extreme cases, violent, synchronized electrical storms flair up in the temporal lobes and cause epileptic fits. Immediately before a seizure, epilepsy sufferers sometimes report strange feelings such as dejá vu or a mystical oneness with their surroundings. Other people who are not epileptic but who nevertheless have a high lability as measured by an electroencephalograph tend on the whole to be unusually artistic and imaginative. They are also more prone than normal to having out-of-the-body experiences and other such dramatic psychotic episodes. Research by Persinger suggests that these effects can be induced in anyone by artificially stimulating the temporal lobes. At Laurentian, Persinger has set up an isolation chamber in an effort to simulate such experiences. Subjects relax in the darkened room while wearing a helmet in which three solenoids are used to produce a pulsating electromagnetic field. Although effects vary from one person to the next, frequently reported sensations include the feeling that others are present, of being pulled by someone or something, and of sudden, powerful bursts of emotion – fear or anger – over which the individual has no control.

--David Darling (Internet Encyclopedia of Science)

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[Howard Brown]

Dear Jon:

Good question for Pilgrim...and may I just add this to the mix?

We know of the attempt made by one of the Hillside Stranglers to feign a second personality ( A top psychologist who also specialized in hypnosis who taught at the University of Pennsyvania tricked Kenneth Bianchi as Bianchi feigned talking to an imaginary person next to him...which hypnotized people cannot do...and as a result,Bianchi was found not insane as he had intended to plea)...and this excerpt you kindly provided reminded me of that.

Do you or Pilgrim think that its likely that killers such as Sutcliffe learn of the 'tricks' that have worked on psychiatrists and psychologists by other cons and criminals.... in order for the killer to be percieved as insane and therefore avoiding the death penalty?

Thank you.

[Big Jon]

Do you or Pilgrim think that its likely that killers such as Sutcliffe learn of the 'tricks' that have worked on psychiatrists and psychologists by other cons and criminals.... in order for the killer to be percieved as insane and therefore avoiding the death penalty?

Wouldn't make any difference to Sutcliffe as the UK doesn't have the death penalty!

[Howard Brown]

Good and quick thinking,Jon ! I forgot about that condition.

[Pilgrim]

Rage and Incredible Calm.

Hi Pilgrim

Thanks for posting those articles. The Sutcliffe case is interesting. Have you read the transcript of his lengthy interview following his arrest? At first it is difficult to reconcile his behaviour with any kind of dissociation or psychotic behaviour. But in his interview, and this was before he came out with his insanity claims, he does mention sudden, powerful bursts of emotion – fear or anger – over which the individual has no control., in his own words the anger would well up in him. He mentions a number of times when he was not aware of people who were nearby until after attacking a victim, one time he was lying across the victim on the grass and he looked up and there were people walking on the path near him and the lights of passing cars lit up the area he was lying. He does seem to be experiencing some kind of altered state of mind.

Jon,

Thanks to your question, I've finally read the entire confession and trial transcripts. Sutcliffe did, on the one hand, refer to these states of anger/rage suddenly welling up in him. On the other hand, and I'd say no less striking, he also maintained this seemingly great calm:

I couldn't have intercourse at a moment's notice, I had to be aroused. She said, 'I am going. It's going to take you all ****ing day. You are ****ing useless.' I felt myself seething with rage. I wanted to hit her. I told her to hang on a minute and not to go off like that. She said, 'Oh you can manage it now, can you!' It sounded as though she was taunting me. I said, 'Can we do it on the grass!' This was my idea to start hitting her." Mr Sutcliffe: "She stormed off up the field. I had a hammer in the tool box and I followed her up the field. I had the hammer in my right hand and put my coat on the grass.

...

"I sat in the car and could see her arm moving. I was in a numb panic. I half expected her to get up and realised I would be in serious trouble. I felt the best way to get out of the mess was to make sure she couldn't tell anyone. I thought to make sure she was dead I would stab her in places like her lungs and throat. I was in a blind panic when I was stabbing her, just to make sure she would not tell anybody. I was very frightened and I can't remember driving back. I thought I was bound to get caught. I looked over my clothing before I went into the house, then I went straight upstairs to the bathroom, washed my hands and went to bed. I carried on as normal, living with my wife. After that first time I developed and built up a hatred for prostitutes in order to justify within myself the reason why I had attacked and killed Wilma McCann.

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I stabbed her frenziedly without thought with a Phillips screwdriver all over her body. I had taken the screwdriver with the hammer in the well of the driving seat. I was seething with hate for her.

(murder of Emily Jackson)

He had seen Miss Walls walking towards him from a distance of about 60 yards. Mr Sutcliffe told [the] police: "I was already in some kind of rage and it was just unfortunate for her she was there at the time." He then parked the car and caught up to her over a distance of about 400 yards.

(murder of Marguerite Walls)

http://www.execulink.com/~kbrannen/trialall.pdf

I stayed still petrified with fear while the car was there. When the car had gone I was seething with rage. Her jeans were nearly off because she had undone them at the car and when I was pulling her by the feet I nearly pulled them off. I pulled her jeans right off. I think I kicked her hard to the head and body I was senseless with rage and I was kicking away furiously at her. After this I remember acting very strangely, I talked to her and apologised for what I had done but she was dead.

(murder of Yvonne Pearson)

http://www.execulink.com/~kbrannen/confessn.htm

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Mr Birdsall also agreed that Mr Sutcliffe had been quiet and calm for someone who had moments before apparently struck a woman on the head. Mr Birdsall said that Mr Sutcliffe tended to be a rather quiet person: "with a shy attitude to women generally."
...

Describing Sutcliffe's manner during the interview, Mr O'Boyle said: "He was very calm and pleasant and cooperative".
...

Mr Boyle also agree that Sutcliffe remained calm, at times incredible calm, throughout the interview. Mr Chadwin: "Did you at any stage see Sutcliffe in all these interviews become excited or distressed?" Mr Boyle: "No."

...

Mr Smith said that during the interviews Mr Sutcliffe had remained calm, polite and had never become angry.
...

Dr Milne also mentioned over−controlled behaviour. In Mr Sutcliffe case it applied to his ability to remain completely calm in the most stressful situation, such as giving evidence. Mr Sutcliffe had also been completely calm during interviews and questioning by the police and by doctors. Dr Milne: "He always showed a tremendous degree of control, which to my mind, was to an abnormal degree".
...

She looked like a prostitute and was walking at a snail's pace. I killed her with no doubt. The voice shouted 'Filthy prostitute'. It wasn't like my voice it was filthy and angry. Not like me. I don't get angry. I knew it was me who had done what I had done with my own hands.
...

http://www.execulink.com/~kbrannen/trialall.pdf

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Howard,

Mr Sutcliffe had seemed highly amused that the doctors thought he was disturbed, and told the officer: "I'm as normal as anyone." Asked by Mr Ognall what the court was to make of that statement, Dr Milne: "Perhaps he does believe he has fooled us and he believes that we think he's mad, yet he knows he is not mad. This is a very long 'Catch 22 ' situation where he has set out to make us think he is ill. If this is so he has finished up by making us accept he is ill and now denies it. If it is a simulation it is a very incredible simulation where he has completely lost insight and does think he is normal."

[Howard Brown]

Thanks for posting the previous, Pilgrim. Very interesting.

Sutcliffe was very calm around his male interviewers,isn't he? To even think of letting something like him out of prison makes me sick.

[Pilgrim]

Insomnia & Paranoia.

Macbeth's Curse: Link Between Sleeplessness And Paranoia Identified.

Research funded by the Wellcome Trust has identified a link between sleeplessness and paranoid thinking, a theme highlighted in Shakespeare’s ‘Macbeth’. In a study published online in the journal ‘Schizophrenia Research’, researchers show that a potential consequence of insomnia is increased suspiciousness. The study - the first to examine insomnia and persecutory thoughts - found that in the general population individuals with insomnia were five times more likely to have high levels of paranoid thinking than people who were sleeping well. In an extension of the research, over half the individuals attending psychiatric services for severe paranoia were found to have clinical insomnia.

ScienceDaily (Jan. 9, 2009)

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The rates of sleep difficulties in the community sample were consistent with the epidemiological literature; almost 30% had symptoms of insomnia and approximately 10% were in the clinical range. But the unique focus of the study was on a potential association between sleep difficulties and paranoid thinking. The results were clear: higher levels of insomnia were associated with higher levels of persecutory thinking. Confirmation was provided by the high prevalence of insomnia in the individuals with clinical paranoia. Insomnia is most likely an overlooked problem in psychiatric services for individuals with persecutory delusions.

Schizophrenia Research 108 (2009) 280–284, Insomnia and paranoia. (PDF)

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