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during the
concluding and recuperative phase, when all the other symptoms
became active again after having been in abeyance for some time. In
the same way, they never came up in the hypnotic analyses and were
not traced back to emotional or imaginative sources. I am therefore
inclined to think that their appearance was not due to the same
psychical process as was that of the other symptoms, but is to be
attributed to a secondary extension of that unknown condition which
constitutes the somatic foundation of hysterical phenomena.
     
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    Studies On Hysteria
    44
     
       Throughout the entire illness her
two states of consciousness persisted side by side: the primary one
in which she was quite normal psychically, and the secondary one
which may well be likened to a dream in view of its wealth of
imaginative products and hallucinations, its large gaps of memory
and the lack of inhibition and control in its associations. In this
secondary state the patient was in a condition of alienation. The
fact that the patient’s mental condition was entirely
dependent on the intrusion of this secondary state into the normal
one seems to throw considerable light on at least one class of
hysterical psychosis. Every one of her hypnoses in the evening
afforded evidence that the patient was entirely clear and
well-ordered in her mind and normal as regards her feeling and
volition so long as none of the products of her secondary state was
acting as a stimulus ‘in the unconscious’. The
extremely marked psychosis which appeared whenever there was any
considerable interval in this unburdening process showed the degree
to which those products influenced the psychical events of her
‘normal’ state. It is hard to avoid expressing the
situation by saying that the patient was split into two
personalities of which one was mentally normal and the other
insane. The sharp division between the two states in the present
patient only exhibits more clearly, in my opinion, what has given
rise to a number of unexplained problems in many other hysterical
patients. It was especially noticeable in Anna O. how much the
products of her ‘bad self’, as she herself called it,
affected her moral habit of mind. If these products had not been
continually disposed of, we should have been faced by a hysteric of
the malicious type - refractory, lazy, disagreeable and
ill-natured; but, as it was, after the removal of those stimuli her
true character, which was the opposite of all these, always
reappeared at once.
     
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    Studies On Hysteria
    45
     
       Nevertheless, though her two
states were thus sharply separated, not only did the secondary
state intrude into the first one, but - and this was at all events
frequently true, and even when she was in a very bad condition - a
clear-sighted and calm observer sat, as she put it, in a corner of
her brain and looked on at all the mad business. This persistence
of clear thinking while the psychosis was actually going on found
expression in a very curious way. At a time when, after the
hysterical phenomena had ceased, the patient was passing through a
temporary depression, she brought up a number of childish fears and
self-reproaches, and among them the idea that she had not been ill
at all and that the whole business had been simulated. Similar
observations, as we know, have frequently been made. When a
disorder of this kind has cleared up and the two states of
consciousness have once more become merged into one, the patients,
looking back to the past, see themselves as the single undivided
personality which was aware of all the nonsense; they think they
could have prevented it if they had wanted to, and thus they feel
as though they had done all the mischief deliberately. - It should
be added that this normal thinking which persisted during the
secondary state must have fluctuated enormously in its amount and
must very often have been completely absent.
       I have already described the
astonishing fact that from