Etiology, Pathogenesis, and Therapy According to Pierre Janet Concerning Conversion Disorders and Dissociative Disorders
Abstract
Introduction
Janet’s Intellectual Background and His Place in French Psychiatry and Medical Psychology
Etiology of Conversion Disorders and Dissociative Disorders
Basic Disturbances or Stigmata
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L’anesthésie systématisée ou même générale est comme une lésion un affaiblissement, non de la sensation, mais de la faculte de synthétiser les sensation en perception personelle, qui amène une véritable désagrégation des phénomènes psychologiques (p. 314).(The systematised or even general anesthesia is like a lesion, a weakening not of the sensation but of the faculty to synthesise the sensations in a personal perception that leads to a real disaggregation of psychic phenomena. Translated by the authors.)
Dans l’hystérie, les phénomènes psychologiques ne pouvant plus être complèment réunis, se séparent nettement en plusieurs groupes à peu près indépendant l’un de l’autre. La personalié ne peut percevoir tous les phénomènes, elle en sacrifie définitivement quelques uns; c’est une sorte d’autonomie et ces phénomènes abandonnés se développent isolément sans que le sujet ait connaissance de leur activité.(Because the psychic phenomena may not be completely united in hysteria, they clearly separate themselves in several more or less independently existing groups. The person is not able to perceive all the phenomena and definitely sacrifices some of them; this is a sort of autonomy and these abandoned phenomena develop in isolation without the person having knowledge of their activity. Translated by the authors.)
Personality of Conversion Disorders and Dissociative Disorders
Leurs enthousiasmes passager, leurs désespoirs exagérées et si vite consolées, leur convictions irraisonnées, leurs impulsions, leurs caprices, en un mot ce caractère excessif et instable, nous semble dépendre de ce fait fondamental qu’elles se donnent toujours tout entières à l’idée présente sans aucune de ces nuances, de ces réserves, de ces restrictions, qui donnent á la pensée sa moderation, son équilibre et ses transitions (Janet, 1909, p. 339).(Their passing enthusiasm, their exaggerated and so easily consolable despair, their unreasonable convictions, their impulsiveness, their whims, in a word their excessive and unstable character seems to depend for us on this fundamental fact that they wholly abandon themselves to the present idea without any of these nuances, these reserves, these restrictions which give to the thought its moderation, its equilibrium and its transition. Translated by authors.)
Hysterical Personality | Psychasthenic Personality |
Apathy—indifference, tendency to boredom | |
Asthenia—weakness of will, lethargy, lack of stamina, monotonous behaviour (ALSO SEE: BENHIMA, 2010) | |
• suggestibility, dependence, submissiveness • unfocused (need for guidance) • inferiority • incompleteness, helplessness • restlessness • stubbornness, obstinacy • absent-mindedness, inattentiveness • fickleness (need for change) • instability, conflicted, exaggerated • emotionality • histrionic-dramatisation, affected nature, unbridled enthusiasm • unchecked despair and desperation • inappropriate and unexpected behaviour • inconsistent nature • loss of social feelings and social competence • egoism • need for attention and affection • need for moral support • insincerity, shiftiness • jealousy | • inability to make decisions, fearful of decision making • submissiveness • inferiority, feelings of failure • incompleteness, helplessness • bustle • irritability, excitability • anhedonia, dejection • feelings of an inner void • dissatisfaction, disgruntlement • inability to enjoy • self-contempt • feelings of insecurity • pessimism • catastrophising • worries, grief • moral self-deprecation • guiltiness • self-accusation • perfectionism • miserliness • social retreat • introversion |
Traumata
Pathogenesis of Conversion Disorders and Dissociative Disorders
Fixed Ideas
Vulnerability
C’est la depression préexistante qui prépare l’émotivite et qui bien entendu est augmentée encore par l’émotion nouvelle de telle manière que les troubles nerveux et mentaux de la depression se preécipitent en boule de neige (Janet, 1921, p. 221).(The pre-existent depression paves the way for enhanced emotivity which, of course, is increased even more by a new emotion in a way that the nervous and mental troubles of a depression become faster and faster like an avalanche Translated by the authors).
Therapy of Conversion Disorders and Dissociative Disorders
Uncovering and influencing fixed ideas through psychological analysis
Après cette liquidation quelquefois pénible et coûteuse (. . .), l’esprit cesse de faire ces efforts d’adaptation qu’il répétait indéfiniment (Janet, 1924, p. 179).(After this liquidation, sometimes painful and costly, the psyche stops making the efforts of adaptation which it repeated indefinitely. Translated by the authors.)
Influencing Fixed Ideas Through Treatment by Suggestion
En un mot, dans ce qu’on appelle suggestion, l’idée se développe complètement jusqu’à se transformer en acte, en perception et en sentiment mais elle semble se développer par elle-même, isolément, sans participation ni de la volonté, ni de la conscience personelle du sujet (Janet, 1909, p. 302).(In a word, with what is called suggestion, an idea completely develops even to its conversion into an action, a perception, and an emotion but it seems to develop for itself and in isolation without the involvement of the will or the personal consciousness of the subject. Translated by the authors.)
La provocation d’une impulsion, qui constitue l’essentiel de la suggestion n’est en somme pas autre chose que l’activation d’une tendance sous une forme inférieure, avec un degré moindre de perfection à la place d’une activation de forme plus élevée (Janet, 1924, p. 126).(All in all, the provocation of an impulse, which is the essential element of a suggestion, is nothing but the activation of a tendency on a lower level with a lesser degree of perfection instead of activation on a higher level. Translated by the authors.)
L’idée fixe nous a paru être une construction, une synthèse d’un très grand nombre d’images; au lieu de l’attaquer dans son ensemble, il faut chercher à la décomposer, à détruire, ou à transfomer ses éléments, et il est probable que l’ensemble ne pourra plus subsister (Janet, 1894a, p. 128).(For us the fixed idea seemed to be a construction, a synthesis of a great number of images; instead of attacking it as a whole, one should try to dissect it into single parts, to destroy or to transform its elements; then it is probable that the whole will not persist any more. Translated by the authors,)
Du moment que vous pouvez guérir le sujet par suggestion, c’est qu’il est encore malade. Sauf des cas très rares, il ne me semble pas que l’on puisse arriver à guérir par suggestion l’état même de misère psychologique, qui estune condition essentielle de l’exécution des suggestions (Janet, P., 1889, p. 456).(In the same moment as it is possible for you to heal persons through suggestion, they are still sick. Apart from very rare exceptions, it seems to me that it is not possible to heal the real condition of psychic suffering which is the essential precondition for suggestions to be effective, through suggestion. Translated by the authors.)
Ces rechutes semblent fréquemment se compliquer par un besoin très intense qu’éprove le sujet, celui d’être hypnotisé de nouveau, d’être de nouveau commander, suggestionné par la personne qui l’avait guéri précédemment. C’est ce sentiment analogue à bien des points de vue à la morphinomanie, que j’ai étudié sous le nom passion somnambulique (Janet, 1911, p. 664).(Many times these relapses seem to become even more complicated by a very strong desire of the patient to get hypnotised, led, and suggested by the person having cured them before. This craving which I have investigated using the expression “somnambulic passion” is comparable in many respects with morphine addiction. Translated by the authors.)
Influencing Fixed Ideas Through Treatment by Images or Presentations
Les meillieurs procédés sont ceux qui déterminent l’assimilation de l’événement émotionnant, qui aménent le sujet à comprendre par la réfléxion, à y réagir correctement, à s’y résigner (Janet, 1924, p. 101).(The best methods are those which determine the assimilation of the shocking events through inducing the subject to understand them through reflection, to react to them appropriately, and to learn to live with them. Translated by the authors.)
Janet, Cognitive Therapy, and Other Current Behavioural Therapies
Enfin les educations de l’attention, les traitements de l’émotivité, les diverses excitations qui se proposent de relever le niveau mental, constitutent les méthodes qui sont encre employées un peu au hasard, mais qui joueront un rôle de plus en plus grand dans l’education et dans le traitement de l’esprit (Janet 1907b, p. 710).(“Finally the education of attention, the treatment of emotionality, the various excitations which intend to raise the mental level, form methods which are already applied a bit by chance, but which will play a more and more important role in education and in the treatment of the mind”. Translated by the authors.)
Treatment of Dissociative Stigmata (Basic Disturbances)
Physical or Psychophyical Therapies
Psychoeducation
. . . [C’est] une méthode de traitement qui consiste à les (les hystériques) faire travailler céréralemant d’une manière régulière, comme des enfants à l’école (Janet, 1911, p. 675).(. . . [It is] a method of treatment which consists in getting them (the hysterics) to do regular mental work like children in school. Translated by the authors.)
Treatment through Rest
L’isolément consiste tout simplement à retirer le malade de sa famille, de son milieu habituel et à le transporter brusquement dans un endroit tout à fait inconnu pour lui (Janet, 1911, p. 642).(Isolation simply consists in taking the patients away from their families, their ordinary social environment and bring them immediately to a place wholly unknown to them. Translated by the authors).
C’est dans leur famille, dans la présence de certains personnes, dans la conversation que se trouve l’origine de leurs idées fixes. Ces idées fixes sont sans cesse éveillées et alimentées par des fait journaliers et ne peuvent que grandir dans le milieu où elles ont pris naissance (Janet, 1911, S. 643).(The origin of their fixed ideas is to be found in their family, in the presence of particular persons, in conversations. These fixed ideas are incessantly activated and nurtured by everyday incidents and become stronger and stronger in the milieu where they originated. Translated by the authors).
Un modificateur puissant des phénomènes psychologiques, capable de déterminer dans l’esprit, dans les souvenir, dans les actes des bouleversements remarquables (Janet, 1911, p. 654).(A strong modificator of psychic phenomena able to provoke remarkable modifications of the psychic constitution in general, of memories, and of actions. Translated by the authors,).
Le sommeil hypnotique est surtout utilisé pour que le sujet exprime ses émotions persistantes, indique leur origine et consente à se laisser imposer des efforts de volonté et d’attention nécessaires pour modifier son équilibre cérébral (Janet, 1911, p. 651).The hypnotic sleep is mainly used to make the subjects express their persistent emotions, show their origins, and consent to impose on themselves efforts of the will and attention necessary to modify the cerebral equilibrium. Translated by the authors).
Simplification of Life
Je le résumerai en un mot, c’est la vie facile dans laquelle tous les problémes de la famille, de l’amour, de la religion, de la fortune sont réduit au minimum, dans laquelle sont soigneusement écartées les luttes de chaquejour toujours nouvelles, les préoccupations de l’avenir, et les combinaisons compliquées (Janet, P., 1911, p. 678).I sum up: In simple life all difficulties with the family, love, religion, fortune, and happiness are reduced to a minimum. In it the daily struggle for life, the worries about the future, as well as other complications and confusions of life are removed. Translated by the authors).
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