Dr. Janet is unrivalled in the delicate and elaborate psychological analysis of hysterical and neurasthenic mental states on the borderland of insanity. In the present paper he presents a well documented study of classes of obsession (which would by some be classed under folie du doute), marked by an excess of scrupulosity, more especially an excessively scrupulous body-consciousness or modesty, obsessions of crime and sacrilege, and hypochondriacal tendencies. Under this head he introduces an interesting discussion of hysterical anorexia. True hysterical anorexia, he states, is rare, and should not be diagnosed unless there is more or less complete suppression of hunger, and also an exaggerated tendency to physical exercise—both these symptoms resting on anæsthetic conditions. He then narrates the case of a young girl, Nadia, whose symptoms had been falsely diagnosed as those of hysterical anorexia, but were really what Janet would call an obsession of scruple. She refused to eat, but remained hungry, sometimes very hungry, so that she would sometimes devour greedily everything she could put her hands on, especially in private. But eating always causes horrible remorse. There is no suppression of hunger, nor is there any tendency to exaggerated movement; she takes exercise, but with an effort. Regarded superficially, the idea that animates her is the fear of becoming fat, like her mother. But that idea is not isolated, but really connected with a whole system of complex ideas. It is not a mere matter of coquetry; she looks on being fat as something almost immoral, something so shameful that it would prevent her from showing herself in public. She will not eat in the presence of others, nor can she even bear that others should hear her eating; she feels about eating (as she herself admits) as others feel about urinating. Nor is her feeling of shame confined to eating; from an early age she has been ashamed of her face, her hands, her legs, her feet, and regards them as ugly and badly made. But deeper, perhaps, than any other idea, is the desire to remain a little child, and be loved as a child. Such a case Janet regards as typical of this class of obsessions, very interesting from a clinical point of view, since they give rise to all sorts of symptoms—anorexia, chorea, writers' cramp, incontinence of urine, impotence, etc. Altogether they constitute a great neurosis, analogous in many respects to hysteria, but not to be confounded with it, the distinction being important both as regards prognosis and treatment. While such cases might be regarded as victims of a phobia, Janet thinks it better to regard them as primarily the victims of scruple—emphasising their troubles of will, and the ideas which they form of these troubles—and he regards the phobia as secondary. Janet considers John Bunyan as a fine type of obsession of scruple. He believes that suggestibility plays a very small part in such cases; they are endogenous, as he expresses it, rather than exogenous, and their obsessions are an index of the things that are most sacred to them.
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