As the cases which come under notice in the present paper are of a somewhat miscellaneous character, and as, moreover, no one of them could, by the widest interpretation of the term, be described as insane, one feels a certain hesitancy in contributing them to a journal avowedly devoted to psychiatry. Though varying in type, they have this in common, however— that there was in every case an underlying or concomitant mental factor which afforded a clue to the case, and the most reliable indication for the line of treatment to be adopted. Briefly they belong to the category of the psychoneuroses, and in the main were treated on psychotherapeutic lines. No uniform method was adopted, waking suggestion, persuasion, hypnosis, or the induction of a hypnoid state being utilised, separately or in combination, according to the exigencies of the particular case. Where necessary, it was supplemented by medicinal and general hygienic measures, but except in one case there was no attempt at psycho-analysis in the accepted sense. In most of the cases an attempt was made to induce hypnosis, but in Cases 3 and 6 it was only possible to attain what is called by American writers the hypnoidal or sub-waking state. In this state, according to Sidis (1), “Emotional excitement subsides, voluntary activity is changed to passivity, and suggestions meet with little resistance. The sub-waking state is above all a rest state, a state of physical and mental relaxation.” The utmost that was obtainable in these cases was a condition of passivity, and of cessation from voluntary activity, in which there was increased susceptibility to suggestion, and which lacked many of the characteristic phenomena of true hypnosis. Whether this is merely a mild degree of hypnosis, or a condition sui generis, as Sidis contends, is not practically important, though in favour of the latter view it is to be noted that it is difficult to pass from it into true hypnosis even after many sittings. Nor is there the tendency to attain deeper stages of “sleep,” which characterises the genuine hypnotic state. Apart from the increased suggestibility, the mere state of quiescence and tranquillity (which can be maintained for an indefinite period) affords a valuable means of nerve recuperation where psychomotor unrest and anxiety are prominent symptoms. Thus it is particularly useful in typical neurasthenia, mild degrees of melancholia, and conditions in which the nervous energy is depleted, and where physiological rest is the primary requisite.
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