532 D. In a paper "On Imperative Ideas," published in Brain (Summer and Autumn, 1895), Dr. Bramwell gives a brief historical account and discussion of different varieties of phobies, etc, and a list of references to the most important papers on the subject. He describes the effect of hypnotic suggestion on many cases, including ten treated by himself. In one of these the patient, an athletic and strong man, whose mother had died from cancer of the breast, contracted a dread of this disease which developed into a firm conviction that his left breast was infected by it. He spent his days confined almost continually in one room, and would not pass into another without muffling himself up and putting on an overcoat. His health naturally suffered; his muscles were gradually wasting from disuse. All his morbid ideas were removed by hypnotic suggestion. He was entirely cured in a month, and suffered no relapse.

Another man suffered acutely from the fixed idea that every one noticed and criticised him, and he would blush whenever looked at. This morbid self-consciousness, which tortured him, and made him cherish ideas of suicide, was finally removed by hypnotic suggestion.

One lady, who had been a sleep-walker in girlhood, had so persistent a dread of having attacks of somnambulism, that she could not go to sleep unless she were securely tied to the bedposts. No argument, however much she might recognise its logical cogency, could avail to remove her baseless fears. She was first hypnotised for insomnia, and two months later a single suggestive treatment completely cured her morbid fears of sleep-walking.

The most remarkable case in this group, both from its clinical interest and its therapeutic importance, is undoubtedly that of Mr. G., aged twenty-eight.

His father was very nervous and passionate, and had suffered from "brain fever " and chorea. The patient is slight and undersized, and suffers from various neurasthenic symptoms. At the age of fourteen he had many religious doubts and fears, and believed he had committed the unpardonable sin. At the age of sixteen, while working in a cocoa manufactory, he began to fear that the red lead which was used in fastening certain hot pipes might get into the tins containing cocoa, and so poison people. This was the commencement of a folie du doute and délire du toucher which have never since left him. Instead of going on with his work, he was irresistibly impelled to clean and re-clean the tins. The following is taken from the letter of a friend to whom he confided his troubles: "On October 1st, 1891, he told me that he had attempted to commit suicide, as his life was so miserable [he had taken poison]. He had read of a case of poisoning through eating chocolate, and connected himself with it, though it was five years since he had helped to manufacture any.

He now believed he might have been careless with the moulds, and thus have produced a poisoned chocolate, which years afterwards had caused. the child's death! The grotesque absurdity of the story, as he related it to me, would have made me laugh, had I not felt how terribly real it was to him. His vivid imagination had pictured every incident of the tragedy; the child buying the chocolate, running home full of happiness, then becoming ill, and gradually sickening in awful agony till released by death. The keenness of mind with which he sought to prove the reasonableness of his belief that he had poisoned the child was extraordinary. He wrote: 'Yesterday I was unscrewing some gas burners in a provision shop and got some white lead on my hands, and I have been thinking that it may have got amongst the food.' I found that brooding over this fancy had brought him to the verge of despair, and for weeks his life was a perpetual agony. He worried himself about his work of fixing advertisement plates to walls, and can never persuade himself that they are securely fastened. He fancies the nails are bad, or the mortar loose, and makes himself ill over it. I have pointed out to him that if a plate fell, it would almost inevitably slide down the wall.

This has not prevented him from painting a most elaborate mental picture of the decapitation of an unfortunate youngster who happened to be playing marbles with his head against the wall. To enumerate all his troubles would take a small volume. I have a great pile of his letters before me now, and I suppose they constitute one of the most extraordinary analytical autobiographies it would be possible to find. In reading them I cannot help marvelling at the strange unshapely wonder of such an imagination. He makes every incident in his life the foundation stone of a castle of fancies, and of late years each castle has become a prison - a torture-chamber in which he has dissected his motives and his actions until he has ceased to believe in himself at all".

When I first saw this patient the folie du doute and délire du toucher were constant and most varied in their manifestations. If he accidentally touched persons in the street, he began to fear that he might have injured them, and exaggerated the touch into a more or less violent push. If the person touched were a woman, he feared that she might have been pregnant, and that he might have injured the child. If he saw a piece of orange peel on the pavement, he kicked it into the road, but soon afterwards began to think this was a more dangerous place, as any one slipping on it might strike his head against the curb-stone, and so he was irresistibly impelled to return and put it in its former position. At one time he used to bind himself to perform certain acts, by vowing he would give God his money if he did not do them. Then sometimes he was uncertain if he had vowed or not. Owing to this he gave sums to religious objects which were quite disproportionate to his income. Apart from his peculiar fancies I found the patient perfectly rational and intelligent, and though his délire du toucher hindered him greatly in his work, he generally managed to execute it, though on some occasions he was compelled to abandon the attempt.

At this time I tried to hypnotise him on twenty-four occasions, but apparently without success, and he was then compelled to leave town. He returned on April 2nd, 1895, for a week's further treatment, and told me that since his former visit his morbid ideas had not been so frequent and marked, and were accompanied with less mental agony. His condition, however, leaves much to be desired.

Dr. Bramwell informs me that this patient has since recovered. 533 A. From Dr. J. Milne Bramwell's "What is Hypnotism?" Proceedings S.P.R., vol. xii. p. 241.

Although Braid and Bernheim differ on many points [with regard to the theory of hypnotism], they are in complete agreement as to the main factor in the problem. According to both, the essential condition is one of mono-ideism. The mind of the subject is concentrated on a single idea. Only one function is active at any one time; and intensely so, because all the attention is given to it. Other functions are inactive, other sensations unperceived, because the subject has no attention left to give to them....

In reference to this, Gurney says, " the energy of attention is not a fixed quantity, bound to be always in operation in one direction or another; nor does the human mind, any more truly than Nature, abhor a vacuum.... What do we gain, then, by employing a general term to describe such special effects ? When once the chandelier metaphor is abandoned - when once it is recognised that in a multitude of cases the quantity of attention turned on in one direction is in no way connected with the withdrawal from any other - the idea of a common psychic factor seems out of place and misleading." (See Proceedings S.P.R., vol. ii. pp. 276, 277).

This theoretical objection is in accordance with observed facts. Doubtless certain hypnotic states exist in which all the attention, so far as it is called into action, is concentrated upon one idea. In order to prove, however, that directing the attention upon a fresh point necessarily withdraws it entirely from another, it must be shown that the phenomenon which resulted from the first concentration inevitably ceased when the second one arose. A cutaneous analgesia of the arm might, with some show of reason, be said to result from attention directed to the muscles during suggested catalepsy, on the ground that no attention was left wherewith to attend to painful sensations. But, while the catalepsy still exists, how - on this theory - can one explain, for example, a cutaneous tactile hyperæsthesia of the same limb, by means of which the subject can distinguish the points of the compass at half the normal distance ? If the subject is unconscious of painful sensations because his attention is entirely concentrated on his muscular condition, this same lack of attention to the skin ought not only to have prevented abnormal distinctness of tactile impressions, but also to have inhibited the usual ones.

The experiment can be still further complicated, for, while still permitting the catalepsy to persist, the cutaneous tactile hyperæsthesia can be associated by suggestion with a cutaneous analgesia over the same area. Now the subject's whole attention cannot be directed to maintaining a condition of muscular rigidity, if he has still enough of it left to suffice, not only for the increased perception of certain tactile sensations, but also for the selection and inhibition of other painful ones. Further, the opposite of these phenomena can be simultaneously evoked on the other side of the body: the patient's muscles be paralysed by suggestion, his tactile sensibility abolished, and his sensibility to pain increased. The attention is now directed to six different points, and could with equal ease be simultaneously directed to many others. A psychic blindness, for example, could be suggested on one side; a psychic deafness on the other; hyperesthesia of the sense of smell and taste on one side, and diminished or abolished sensibility on the other, etc, etc. But this is not all, for while the attention is presumably turned in all these different directions, the subject may be engaged in the attempted solution of some intellectual problem. A still further complication is possible.

Let us suppose that a fortnight before, in a previous hypnosis, a suggestion to record the time at the expiration of 20,213 minutes had been made; this will be carried out, despite the existence of the various muscular and sensorial conditions already referred to, and the fact that at the moment of its fulfilment the patient is engaged in some other mental effort.

This picture of the hypnotic state is neither fanciful nor dependent solely on my own personal observation. The fact that numerous and varied hypnotic phenomena can be simultaneously evoked in the same subject has been repeatedly observed and recorded by others, and, strange to say, even by those who attempt to explain hypnosis by the concentration of the attention upon a single point. It is solely the importance of these facts with regard to this particular theory which has hitherto been so largely overlooked.

Granting that hypnotic phenomena are the result of changes in the attention, one is forced to conclude that these are the exact reverse of those stated by Bernheim as explanatory of the hypnotic state.... The hypnotic condition differs from the normal, not because only one phenomenon can be manifested in it at once, but because it may present simultaneously many and more varied phenomena than can be evoked in the normal state at any one time. In one word, hypnosis is a state of poly-ideism, not of mono-ideism.