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psychical
characteristics present in the girl while she was still completely
healthy which acted as predisposing causes for her subsequent
hysterical illness:
       (1) Her monotonous family life
and the absence of adequate intellectual occupation left her with
an unemployed surplus of mental liveliness and energy, and this
found an outlet in the constant activity of her imagination.
       (2) This led to a habit of
day-dreaming (her ‘private theatre’), which laid the
foundations for a dissociation of her mental personality.
Nevertheless a dissociation of this degree is still within the
bounds of normality. Reveries and reflections during a more or less
mechanical occupation do not in themselves imply a pathological
splitting of consciousness, since if they are interrupted - if, for
instance, the subject is spoken to - the normal unity of
consciousness is restored; nor, presumably, is any amnesia present.
In the case of Anna O., however, this habit prepared the ground
upon which the affect of anxiety and dread was able to establish
itself in the way I have described, when once that affect had
transformed the patient’s habitual day-dreaming into a
hallucinatory absence . It is remarkable how completely the
earliest manifestation of her illness in its beginnings already
exhibited its main characteristics, which afterwards remained
unchanged for almost two years. These comprised the existence of a
second state of consciousness which first emerged as a temporary absence and later became organized into a ‘ double
conscience ’; an inhibition of speech, determined by the
affect of anxiety, which found a chance discharge in the English
verses; later on, paraphasia and loss of her mother-tongue, which
was replaced by excellent English; and lastly the accidental
paralysis of her right arm, due to pressure, which later developed
into a contractural paresis and anaesthesia on her right side. The
mechanism by which this latter affection came into being agreed
entirely with Charcot’s theory of traumatic hysteria - a
slight trauma occurring during a state of hypnosis.
     
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    Studies On Hysteria
    41
     
       But whereas the paralysis
experimentally provoked by Charcot in his patients became
stabilized immediately, and whereas the paralysis caused in
sufferers from traumatic neuroses by a severe traumatic shock sets
in at once, the nervous system of this girl put up a successful
resistance for four months. Her contracture, as well as the other
disturbances which accompanied it set in only during the short absences in her condition seconde , and left her
during her normal state in full control of her body and possession
of her senses; so that nothing was noticed either by herself or by
those around her, though it is true that the attention of the
latter was centred upon the patient’s sick father and was
consequently diverted from her.
       Since, however, her absences with
their total amnesia and accompanying hysterical phenomena grew more
and more frequent from the time of her first hallucinatory
auto-hypnosis, the opportunities multiplied for the formation of
new symptoms of the same kind, and those that had already been
formed became more strongly entrenched by frequent repetition. In
addition to this, it gradually came about that any sudden
distressing affect would have the same result as an absence (though, indeed, it is possible that such affects actually caused a temporary absence in every case); chance
coincidences set up pathological associations and sensory or motor
disturbances, which thenceforward appeared along with the affect.
But hitherto this only occurred for fleeting moments. Before the
patient took permanently to her bed she had already developed the
whole assemblage of hysterical phenomena, without anyone knowing
it. It was only after the patient had broken down completely owing
to exhaustion brought about by lack of nourishment, insomnia and
constant anxiety, and only after she had begun to pass more time