Disorders Of Coenesthesia

By ccenesthesia or vital sense is understood "the general feeling which results from the state of the entire organism, from the normal or abnormal progress of the vital functions, particularly of the vegetative functions" (Hoffding). The stimuli which produce this sense are vague and poorly localized, and are perceived not individually, but together as a whole.

The harmony which normally exists between the diverse organic functions produces a vague sense of satisfaction and of well-being. All causes tending to destroy this harmony will produce in consciousness a feeling of malaise and of suffering more or less definite and more or less acute. Thus the disorders of ccenesthesia are intimately connected with disorders of affectivity; most of the depressed states have for their basis an alteration of the vital sense.

Disorders Of The Personality

Alterations of the personality constitute the symptom which, following Wernicke, we have termed autopsychic disorientation.

These disorders may be arranged in three principal groups:

(a) Weakening of the notion of personality;

(b) Transformation of the personality;

(c) Reduplication of the personality.

(a) The notion of personality may be incomplete or absent; it may have never been developed at all, or it may have been but incompletely developed, as in idiots and imbeciles, or it may have disappeared or become weakened under the influence of a pathogenic cause, as in mental confusion, epileptic delirium, depression with stupor, etc.

(b) Transformation of the personality may be complete or incomplete.

In the first case the patients forget or deny everything pertaining to their former personality. Thus one patient claimed that she was Mary Stuart, wanted to be addressed as "Her Majesty the Queen of Scotland," and attired herself in costumes similar to those of that time. She became furious when called by her own name, and obstinately refused to accept the visits of her husband and children, whom she called "impostors." Another patient, afflicted with hysteria, believed herself to have been transformed into a dog; she barked and walked on all fours. Still another patient at the Salpetriere referred to herself as " the person of myself."

Complete transformation of the personality may be permanent, constituting, according to the excellent expression of Ribot, a true alienation of the personality; or it may be transitory, so that the new ego disappears at a certain time to be replaced again by the former ego. In cases in which the normal personality and the pathological one replace each other mutually several times we have variation by alternation.1

Incomplete transformation of the personality exists in a great many cases in which the patients are led by their delusions to attribute to themselves imaginary talents, powers, or titles, without at the same time completely abolishing their real ego. One patient suffering from a chronic delusional state of old standing claimed that he was St. Peter, and explained that he had been incarnated in an earthly man for the purpose of bringing happiness to mankind. A general paralytic claimed that he was Emperor of Asia, reigning in Pekin, being at the same time aware of the fact that he was living in Paris, and was a newspaper vendor.

(c) Reduplication of the personality consists in the development of a new personality of a parasitic nature alongside of the real personality of the patient.

This reduplication is the origin of the idea of possession so frequent in chronic delusional states and results in a psychic disaggregation the most important manifestations of which are autochthonous ideas (psychic hallucinations) and motor hallucinations. As we have had occasion to indicate above, the patient, feeling that he is losing control of his own thoughts and movements, concludes that a strange personality has taken possession of him.

1 Ribot. The Diseases of Personality.