by Corry Shores
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[The following is not summary. It simply catalogs particular parts of the text that I take note of, with a brief summary of all these notes. Proofreading is incomplete, so please forgive all my various mistakes. Section divisions are my own and do not reflect partitions in the text.]
Notes and Quotes from
Sigmund Freud
Standard Edition of the Complete Psychological Works
Volume 1
1886-1889
Pre-Psycho-Analytic Publications and Unpublished Drafts
6
“Observations of a Severe Case of Hemi-Anaesthesia in a Hysterical Male”
(1886)
Very brief summary of the notes:
Hysterical patients can have (anaesthetic) parts of their body that provide absolutely no sensation whatsoever, while also having “hysterogenic zones” that are highly oversensitive and when touched even slightly can trigger a hysterical episode. Overall, this account of the patient’s anaesthesia and hyperaesthesia gives us medical descriptions that resonate with Deleuze’s discussions of the body without organs in the context of hysteria; for, we see a high variability in the ways that the parts of the body handle sensations and operate in conjunction with one another, with odd places on the body becoming something like temporary, provisional organs (the “hysterogenic zones”).
Brief summary of the notes (collecting those below):
(6.1) Editor’s note: This text is mostly about the physiological symptomology of hysteria from Charcot’s perspective. (6.2) Freud will discuss a case of male hysteria where the physiological symptoms are very pronounced and obvious. The patient’s symptoms were brought on by a traumatic event (being attacked by his brother who tried to kill him with a knife), and he suffers acute hemi-anaesthesia (the loss of sensation in one side of the body). While this side of the body cannot provide sensations, not even kinaesthetic ones when moving, the patient also has “hysterogenic zones” (which are supersensitive parts of the body that when touched even slightly can provoke a hysterical attack.) There is also variability in these conditions. Using electricity, Freud was able to make a part of the anaesthic zone become sensitive and also thereby to cause variability in other parts of the body: “Thus, in a test for electrical sensitivity, contrary to my intention, I made a piece of skin at the left elbow sensitive; and repeated tests showed that the extent of the painful zones on the trunk and the disturbances of the sense of vision oscillated in their intensity.” (We note that much of the description Freud gives here of the patient’s physiological symptomology is reminiscent of what Deleuze says about the “body without organs” in the “Hysteria” chapter of his Francis Bacon book.)
[The Limited Focus of This Text on the Topic of Psychological Factors Involved in Hysteria]
[Anaesthesia and Hysterogenic Zones in Hysterical Patients]
Text Information
BEOBACHTUNG EINER HOCHGRADIGEN HEMI-ANÄTHESIE BEI EINEM HYSTERISCHEN MANNE
(a) German Edition:
1886 Wien. med. Wschr., 36 (49), 1633-38. (December 4.)
This paper seems never to have been reprinted. The present translation, by James Strachey, is the first into English. It was apparently intended that this should be the first of a series of papers, since there is a superscription which reads ‘Beiträge zur Kasuistik der Hysterie, I’ (Contributions to the Clinical Study of Hysteria, I). But the series was not continued.
(24)
Summary
[The Limited Focus of This Text on the Topic of Psychological Factors Involved in Hysteria]
[Editor’s note: This text is mostly about the physiological symptomology of hysteria from Charcot’s perspective.]
[ditto] [Recall from “Report on My Studies in Paris and Berlin” that Freud had been studying at the Hospice de la Salpêtrière in Paris under Jean-Martin Charcot, who was using hypnotism and other means to greatly advance our knowledge of the neurosis hysteria.]
The greater part of the paper, it will be seen, is concerned with the physical phenomena of hysteria, on the lines characteristic of Charcot's attitude to the condition. There are only some very slight indications of an interest in psychological factors.
(23)
[Anaesthesia and Hysterogenic Zones in Hysterical Patients]
[Freud will discuss a case of male hysteria where the physiological symptoms are very pronounced and obvious. The patient’s symptoms were brought on by a traumatic event (being attacked by his brother who tried to kill him with a knife), and he suffers acute hemi-anaesthesia (the loss of sensation in one side of the body). While this side of the body cannot provide sensations, not even kinaesthetic ones when moving, the patient also has “hysterogenic zones” (which are supersensitive parts of the body that when touched even slightly can provoke a hysterical attack.) There is also variability in these conditions. Using electricity, Freud was able to make a part of the anaesthic zone become sensitive and also thereby to cause variability in other parts of the body: “Thus, in a test for electrical sensitivity, contrary to my intention, I made a piece of skin at the left elbow sensitive; and repeated tests showed that the extent of the painful zones on the trunk and the disturbances of the sense of vision oscillated in their intensity.” (We note that much of the description Freud gives here of the patient’s physiological symptomology is reminiscent of what Deleuze says about the “body without organs” in the “Hysteria” chapter of his Francis Bacon book.)]
[ditto]
GENTLEMEN, – When, on October 15, I had the honour of claiming your attention to a short report on Charcot’s recent work in the field of male hysteria, I was challenged by my respected teacher, Hofrat Professor Meynert, to present before the society some cases in which the somatic indications of hysteria – the ‘hysterical stigmata’ by which Charcot characterizes this neurosis – could be observed in a clearly marked form. I am meeting this challenge to-day – insufficiently, it is true, but so far as the clinical material at my disposal permits – by presenting before you a hysterical man, who exhibits the symptom of hemi-anaesthesia to what may almost be described as the highest degree.
(25)
The patient is a 29-year-old engraver, August P.
(25)
His present illness dates back for some three years. At that time he fell into a dispute with his dissolute brother, who refused to pay him back a sum of money he had lent him. His brother threatened to stab him and ran at him with a knife. This threw the patient into indescribable fear; he felt a ringing in his head as though it was going to burst; he hurried home without being able to tell how he got there, and fell to the ground unconscious in front of his do0r. It was reported afterwards that for two hours he had the most violent spasms and had spoken during them of the scene with his brother. When he woke up, he felt very feeble; during the next six weeks he suffered from violent left-sided headaches and intra-cranial pressure. The feeling in the left half of his body seemed to him altered, and his eyes got easily tired at his work, which he soon took up again. With a few oscillations, his condition remained like this for three years, until, seven weeks ago, a fresh agitation brought on a change for the worse. The patient was accused by a woman of a theft, | had violent palpitations, was so depressed for about a fortnight that he thought of suicide, and at the same time a fairly severe tremor set in in his left extremities. The left half of his body felt as though it had been affected by a slight stroke; his eyes became very weak and often made him see everything grey; his sleep was interrupted by terrifying apparitions and by dreams in which he thought he was falling from a great height; pains started in the left side of his throat, in his left groin, in the sacral region and in other areas; his stomach was often ‘as though it was blown out’, and he found himself obliged to stop working. A further worsening of all these symptoms dates from the last week. In addition, the patient is subject to violent pains in his left knee and his left sole if he walks for some time; he has a peculiar feeling in his throat as though his tongue was fastened up, he has frequent singing in his ears, and more of the same sort. His memory is impaired for his experiences during his illness, but is good for earlier events. The attacks of convulsions have been repeated from six to nine times during the three years; but most of them were very slight; only one attack at night last August was accompanied by fairly severe ‘shaking’.
(26-27)
The examination of his internal organs reveals nothing pathological apart from dull cardiac sounds. If I press on the point of exit of the supraorbital, infra-orbital or mental nerves on the left side, the patient turns his head with an expression of severe pain. There is therefore, we might suppose, a neuralgic change in the left trigeminal. The cranial vault too is very susceptible to percussion in its left half. The skin of the left half of the head behaves, however, quite differently to our expectation: it is completely insensitive to stimuli of any kind. I can prick it, pinch it, twist the lobe of the ear between my fingers, without the patient even noticing the touch. Here, then, there is a very high degree of anaesthesia; but this affects not merely the skin but also the mucous membranes, as I will show you in the case of the patient’s lips and tongue. If I insert a small roll of paper into his left external auditory meatus and then through his left nostril, no reaction is produced. I now repeat the experiment on the right side and show that there the patient’s sensibility is normal. In accordance with the anaesthesia, the sensory reflexes, too, are abolished or reduced. Thus I can introduce my finger and touch all the pharyngeal tissues on the left side without the result being retching; the pharyngeal reflexes on the right side are, however, also reduced; only when I reach the epiglottis on the right side is there a reaction. Touching the | left conjunctiva palpebrarum and bulbi produces scarcely any closure of the lids; on the other hand, the corneal reflex is present, though very considerably reduced. Incidentally, the conjunctival and corneal reflexes on the right side are also reduced, though only to a lesser degree; and this behaviour of the reflexes is enough to enable me to conclude that the disturbances of vision need not be limited to the one (left) eye. And in fact, when I examined the patient for the first time, he exhibited in both eyes the peculiar polyopia monocularis of hysterical patients and disturbances of the colour-sense. With his right eye he recognized all the colours except violet, which he named as grey; with his left eye he recognized only a light red and yellow, while he regarded all the other colours as grey if they were light and black if they were dark. Dr. Konigstein was kind enough to submit the patient’s eyes to a thorough examination and will himself report later on his findings. [See p. 24 above.] Turning to the other sense organs, smell and taste are entirely lost on the left side. Only hearing has been spared by the cerebral hemi-anaesthesia. It will be recalled that the efficiency of his right ear has been seriously impaired since an accident to the patient at the age of eight; his left ear is the better one; the reduction in hearing present in it is (according to a kind communication from Professor Gruber) sufficiently explained by a visible material affection of the tympanic membrane.
If we now proceed to an examination of the trunk and extremities, here again we find an absolute anaesthesia, in the first place in the left arm. As you see, I can push a pointed needle through a fold of the skin without the patient reacting against it. The deep parts – muscles, ligaments, joints – must also be insensitive to an equally high degree, since I can twist the wrist-joint and stretch the ligaments without provoking any feeling in the patient. It tallies with this anaesthesia of the deep parts that the patient, if his eyes are bandaged, also has no notion of the position of his left arm in space or of any movement that I perform with it. I bandage his eyes and then ask him what I have done with his left hand. He cannot tell. I tell him to take hold of his left thumb, elbow, shoulder, with his right hand. He feels about in the air, will perhaps take my hand, which I offer him, for his own, and then admits that he does not know whose hand he has hold of.
It must be especially interesting to find out whether the patient is able to find the parts of the left half of his face. One would suppose that this would offer him no difficulties, since, after all, the left half of his face is, so to speak, firmly cemented to the intact right half. But experiment shows the contrary. The patient | misses his aim at his left eye, the lobe of his left ear, and so on; indeed he seems to find his way about worse in groping with his right hand for the anaesthetic parts of his face than if he were touching a part of someone else’s body. The blame for this is not a disorder in his right hand, which he is using for feeling about, for you can see with what certainty and speed he finds the spot when I tell him to touch places in the right half of his face.
(28-29)
The same anaesthesia is present in his trunk and left leg. We observe there that the loss of sensation has its limit at the midline or extends a trace beyond it.
Special interest seems to me to lie in the analysis of the disturbances of movement which the patient exhibits in his anaesthetic limbs. I believe that these disturbances of movement are to be ascribed wholly and solely to the anaesthesia. There is certainly no paralysis – of his left arm, for instance. A paralysed arm either falls limply down or is held rigid by contractures in forced positions. Here it is otherwise. If I bandage the patient’s eyes, his left arm remains in the position it had taken up before. The disturbances of mobility are changeable and depend on several conditions. At first, those of you who noticed how the patient undressed himself with both hands and how he closed his left nostril with the fingers of his left hand, will not have formed an impression of any serious disturbance of movement. On closer observation it will be found that the left arm, and in particular the fingers, are moved more slowly and with less skill, as though they are stiff, and with a slight tremor. But every movement, even the most complicated, is performed and this is always so if the patient's attention is diverted from the organs of movement and directed solely to the aim of the movement. It is quite otherwise if I tell him to carry out separate movements with his left arm without any remoter aim – for instance, to bend his arm at the elbow-joint while he follows the movement with his eyes. In that case his left arm appears much more inhibited than before, the movement is performed very slowly, incompletely, in separate stages, as though there were a great resistance to be overcome, and is accompanied by a lively tremor. The movements of the fingers are extraordinarily weak in these circumstances. A third kind of disturbance of movement, and the severest, is exhibited, finally, if he is expected to carry out separate movements with closed eyes. Something results, to be sure, with the limb which is absolutely anaesthetic, for, as you see, the motor innervation is independent of any sensory | moved; this movement, however, is minimal, not in any way directed to a particular segment, and not determinable in its direction by the patient. Do not assume, however, that this last kind of disturbance of movement is a necessary consequence of anaesthesia; precisely in this respect far-reaching individual differences are to be found. We have observed anaesthetic patients at the Salpêtrière who, if their eyes were closed, retained a much more far-reaching control over a limb that was lost to consciousness.
(29-30)
The same influence of diverted attention and of looking applies to the left leg. For a good hour to-day the patient walked along the streets with me at a rapid pace, without looking at his feet as he walked. And all I could notice was that he put his left foot down turning it rather outwards and that he often dragged it along the ground. But if I order him to walk, then he has to follow every movement of his anaesthetic leg with his eyes, and the movement occurs slowly and uncertainly and tires him very soon. Finally, with his eyes closed he walks altogether uncertainly, and he pushes himself along with both feet staying on the ground, as one of us would do in the dark on unknown territory. He also has great difficulty in remaining upright on his left leg only; if he shuts his eyes in that position, he immediately falls down.
I will go on to describe the behaviour of his reflexes. They are in general brisker than the normal, and moreover show little consistency with one another. The triceps and flexor reflexes are decidedly brisker in the right, non-anaesthetic extremity. The patellar reflex seems brisker on the left; the Achilles tendon reflex is equal on both sides. It is also possible to elicit a slight patellar response which is more clearly observable on the right. The cremasteric reflexes are absent; on the other hand the abdominal reflexes are brisk, and the left one immensely increased, so that the lightest stroking of an area of the abdominal skin provokes a maximal contraction of the left rectus abdominis.
In accordance with a hysterical herni-anaesthesia, our patient exhibits, both spontaneously and on pressure, painful areas on what is otherwise the insensitive side of his body – what are known as ‘hysterogenic zones’, though in this case their con-| nection with the provoking of attacks is not marked. Thus the trigeminal nerve, whose terminal branches, as I showed you earlier, are sensitive to pressure, is the seat of a hysterogenic zone of this kind; also a narrow area in the left medial cervical fossa, a broader strip in the left wall of the thorax (where the skin too is still sensitive), the lumbar portion of the spine and the middle portion of the ossacrum (the skin is sensitive over the former of these as well). Finally, the left spermatic cord is very sensitive to pain, and this zone is continued along the course of the spermatic cord into the abdominal cavity to the area which in women is so often the site of ‘ovaralgia’.
(30-31)
I must add two remarks relating to deviations of our case from the typical picture of hysterical hemi-anaesthesia. The first is that the right side of the patient's body is also not free from anaesthesia, though this is not of a high degree and seems to affect only the skin. Thus there is a zone of reduced sensitivity to pain (and feeling of temperature) over the dome of the right shoulder, another passes in a band round the peripheral end of the lower arm; the right leg is hypaesthetic on the outer side of the thigh and on the back of the calf.
A second remark relates to the fact that the hemi-anaesthesia in our patient exhibits very clearly the characteristic of instability. Thus, in a test for electrical sensitivity, contrary to my intention, I made a piece of skin at the left elbow sensitive; and repeated tests showed that the extent of the painful zones on the trunk and the disturbances of the sense of vision oscillated in their intensity. It is on this instability of the disturbance of sensitivity that I found my hope of being able to restore the patient in a short time to normal sensitivity.
Freud, Sigmund. “Observations of a Severe Case of Hemi-Anaesthesia in a Hysterical Male (1886).” In The Standard Edition of the Complete Psychological Works, Vol. 1, (1886–1899): Pre-Psycho-Analytic Publications and Unpublished Drafts, edited and translated by James Strachey, 23–31. London: Hogarth, 1966.
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