analysed. Moreover, the clinician should attempt to reconstruct the progress and development of the illness. Symptoms concealed stories.
In order to facilitate the detection of such stories, Janet established a number of guidelines for good clinical practice. Today, these would be regarded as routine; however, for a practitioner in the 1880s they were extremely thorough and systematic. Janet suggested that the clinician should be alone with the patient at the time of examination. He believed that an exact record of everything said in therapeutic sessions should be recorded. Finally, and most importantly, the clinician should obtain an entire life history and consider the effects of any prior treatment. An adage of Janet’s was that the clinician could never know enough about his patient. These recommendations show a strong inclination towards empiricism. Indeed, the collection of data, the formation of hypotheses – and experiment – were central to Janet’s method.
One of the first patients that Janet saw at the Salpêtrière was Marcelle, a twenty-year-old woman whose problems had begun in early adolescence. Her principal symptom was paralysis, most notably, difficulty moving her legs; however, she also suffered from disturbances of memory and thought. Janet noticed that habitual movements were accomplished without too much difficulty, whereas movements that were preceded by voluntary decisions were extremely difficult. When, for example, Marcelle decided to get up and walk, her thoughts became disturbed by what she described as ‘clouds’: the entry into awareness of muddled ideas and even hallucinations.
Marcelle’s memory problems were of an unusual nature. Her memory for events in her life up until the age of fifteen were good; from that age onwards her memories became intermittent or unclear. She could recall nothing of her life beyond the age of nineteen.
Janet began to piece together her personal history, which seemed to have considerable relevance to her symptoms. At the age of fourteen Marcelle had contracted typhoid. She became very ill and was unable to cope with life. Janet believed that at that point Marcelle had attempted to escape from her troubles by retreating into a world of daydreams and fantasy (a world, perhaps, of’clouds’). This tendency may have been amplified by her voracious appetite for ‘escapist’ literature. The following year Marcelle’s father – who had been paraplegic – died. The final telling event occurred when Marcelle was nineteen. An unsuccessful romantic involvement ended unhappily, and she became suicidal.
At first Janet tried to treat Marcelle by using the methods he had employed in Le Havre. He wanted to retrieve the ideas that Marcelle had formulated at various significant points in her life. To this end, he used hypnosis and automatic writing. Janet worked with the ideas and memories that became accessible; however, any improvement in Marcelle’s condition was only temporary. As one symptom disappeared, another would take its place.
When Janet used hypnosis and automatic writing on Marcelle she experienced ‘hysterical crises’, becoming severely disturbed. Nevertheless, Janet made two important observations. Firstly, Marcelle appeared to feel better immediately after a hysterical crisis had been induced and, secondly, the more severe these crises became, the more they released ideas that were formed earlier in life.
Janet began to work with these ideas in reverse order, working back from the most recently formed ideas to the most remote in time. He wrote:
By removing the superficial layer of the delusions, 1 favoured the appearance of old and tenacious fixed ideas which dwelt still at the bottom of her mind.
Once these older ideas were retrieved and modified, Marcelle’s improvement was significant and lasting.
Janet’s account suggests a number of interesting points. To treat a patient properly, it is necessary to retrieve and modify the most
In order to facilitate the detection of such stories, Janet established a number of guidelines for good clinical practice. Today, these would be regarded as routine; however, for a practitioner in the 1880s they were extremely thorough and systematic. Janet suggested that the clinician should be alone with the patient at the time of examination. He believed that an exact record of everything said in therapeutic sessions should be recorded. Finally, and most importantly, the clinician should obtain an entire life history and consider the effects of any prior treatment. An adage of Janet’s was that the clinician could never know enough about his patient. These recommendations show a strong inclination towards empiricism. Indeed, the collection of data, the formation of hypotheses – and experiment – were central to Janet’s method.
One of the first patients that Janet saw at the Salpêtrière was Marcelle, a twenty-year-old woman whose problems had begun in early adolescence. Her principal symptom was paralysis, most notably, difficulty moving her legs; however, she also suffered from disturbances of memory and thought. Janet noticed that habitual movements were accomplished without too much difficulty, whereas movements that were preceded by voluntary decisions were extremely difficult. When, for example, Marcelle decided to get up and walk, her thoughts became disturbed by what she described as ‘clouds’: the entry into awareness of muddled ideas and even hallucinations.
Marcelle’s memory problems were of an unusual nature. Her memory for events in her life up until the age of fifteen were good; from that age onwards her memories became intermittent or unclear. She could recall nothing of her life beyond the age of nineteen.
Janet began to piece together her personal history, which seemed to have considerable relevance to her symptoms. At the age of fourteen Marcelle had contracted typhoid. She became very ill and was unable to cope with life. Janet believed that at that point Marcelle had attempted to escape from her troubles by retreating into a world of daydreams and fantasy (a world, perhaps, of’clouds’). This tendency may have been amplified by her voracious appetite for ‘escapist’ literature. The following year Marcelle’s father – who had been paraplegic – died. The final telling event occurred when Marcelle was nineteen. An unsuccessful romantic involvement ended unhappily, and she became suicidal.
At first Janet tried to treat Marcelle by using the methods he had employed in Le Havre. He wanted to retrieve the ideas that Marcelle had formulated at various significant points in her life. To this end, he used hypnosis and automatic writing. Janet worked with the ideas and memories that became accessible; however, any improvement in Marcelle’s condition was only temporary. As one symptom disappeared, another would take its place.
When Janet used hypnosis and automatic writing on Marcelle she experienced ‘hysterical crises’, becoming severely disturbed. Nevertheless, Janet made two important observations. Firstly, Marcelle appeared to feel better immediately after a hysterical crisis had been induced and, secondly, the more severe these crises became, the more they released ideas that were formed earlier in life.
Janet began to work with these ideas in reverse order, working back from the most recently formed ideas to the most remote in time. He wrote:
By removing the superficial layer of the delusions, 1 favoured the appearance of old and tenacious fixed ideas which dwelt still at the bottom of her mind.
Once these older ideas were retrieved and modified, Marcelle’s improvement was significant and lasting.
Janet’s account suggests a number of interesting points. To treat a patient properly, it is necessary to retrieve and modify the most
Similar Books
My Big Fat Supernatural Wedding
Charlaine Harris, Sherrilyn Kenyon, Jim Butcher, P. N. Elrod, Rachel Caine, Esther M. Friesner, Susan Krinard, Lori Handeland, L. A. Banks
