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in
her condition seconde than in her normal state, that the
hysterical phenomena extended to the latter as well and changed
from intermittent acute symptoms into chronic ones.
     
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    Studies On Hysteria
    42
     
       The question now arises how far
the patient’s statements are to be trusted and whether the
occasions and mode of origin of the phenomena were really as she
represented them. So far as the more important and fundamental
events are concerned, the trustworthiness of her account seems to
me to be beyond question. As regards the symptoms disappearing
after being ‘talked away’, I cannot use this as
evidence; it may very well be explained by suggestion. But I always
found the patient entirely truthful and trustworthy. The things she
told me were intimately bound up with what was most sacred to her.
Whatever could be checked by other people was fully confirmed. Even
the most highly gifted girl would be incapable of concocting a
tissue of data with such a degree of internal consistency as was
exhibited in the history of this case. It cannot be disputed,
however, that precisely her consistency may have led her (in
perfectly good faith) to assign to some of her symptoms a
precipitating cause which they did not in fact possess. But this
suspicion, too, I consider unjustified. The very insignificance of
so many of those causes, the irrational character of so many of the
connections involved, argue in favour of their reality. The patient
could not understand how it was that dance music made her cough;
such a construction is too meaningless to have been deliberate. (It
seemed very likely to me, incidentally, that each of her twinges of
conscience brought on one of her regular spasms of the glottis and
that the motor impulses which she felt - for she was very fond of
dancing - transformed the spasm into a tussis nervosa .)
Accordingly, in my view the patient’s statements were
entirely trustworthy and corresponded to the facts.
     
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    Studies On Hysteria
    43
     
       And now we must consider how far
it is justifiable to suppose that hysteria is produced in an
analogous way in other patients, and that the process is similar
where no such clearly distinct condition seconde has become
organized. I may advance in support of this view the fact that in
the present case, too, the story of the development of the illness
would have remained completely unknown alike to the patient and the
physician if it had not been for her peculiarity of remembering
things in hypnosis, as I have described, and of relating what she
remembered. While she was in her waking state she knew nothing of
all this. Thus it is impossible to arrive at what is happening in
other cases from an examination of the patients while in a waking
state, for with the best will in the world they can give one no
information. And I have already pointed out how little those
surrounding the present patient were able to observe of what was
going on. Accordingly, it would only be possible to discover the
state of affairs in other patients by means of some such procedure
as was provided in the case of Anna O. by her auto-hypnoses.
Provisionally we can only express the view that trains of events
similar to those here described occur more commonly than our
ignorance of the pathogenic mechanism concerned has led us to
suppose.
       When the patient had become
confined to her bed, and her consciousness was constantly
oscillating between her normal and her ‘secondary’
state, the whole host of hysterical symptoms, which had arisen
separately and had hitherto been latent, became manifest, as we
have already seen, as chronic symptoms. There was now added to
these a new group of phenomena which seemed to have had a different
origin: the paralytic contractures of her left extremities and the
paresis of the muscles raising her head. I distinguish them from
the other phenomena because when once they had disappeared they
never returned, even in the briefest or mildest form or