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satisfy a powerful
instinct. Her states of feeling always tended to a slight
exaggeration, alike of cheerfulness and gloom; hence she was
sometimes subject to moods. The element of sexuality was
astonishingly undeveloped in her. The patient, whose life became
known to me to an extent to which one person’s life is seldom
known to another, had never been in love; and in all the enormous
number of hallucinations which occurred during her illness that
element of mental life never emerged.
     
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    Studies On Hysteria
    22
     
       This girl, who was bubbling over
with intellectual vitality: led an extremely monotonous existence
in her puritanically-minded family. She embellished her life in a
manner which probably influenced her decisively in the direction of
her illness, by indulging in systematic day-dreaming, which she
described as her ‘private theatre’. While everyone
thought she was attending, she was living through fairy tales in
her imagination; but she was always on the spot when she was spoken
to, so that no one was aware of it. She pursued this activity
almost continuously while she was engaged on her household duties,
which she discharged unexceptionably. I shall presently have to
describe the way in which this habitual day-dreaming while she was
well passed over into illness without a break.
       The course of the illness fell
into several clearly separable phases:
       (A) Latent incubation. From the
middle of July, 1880, till about December 10. This phase of an
illness is usually hidden from us; but in this case, owing to its
peculiar character, it was completely accessible; and this in
itself lends no small pathological interest to the history, I shall
describe this phase presently.
       (B) The manifest illness. A
psychosis of a peculiar kind, paraphasia, a convergent squint,
severe disturbances of vision, paralyses (in the form of
contractures), complete in the right upper and both lower
extremities, partial in the left upper extremity, paresis of the
neck muscles. A gradual reduction of the contracture to the
right-hand extremities. Some improvement, interrupted by a severe
psychical trauma (the death of the patient’s father) in
April, after which there followed
       (C) A period of persisting
somnambulism, subsequently alternating with more normal states. A
number of chronic symptoms persisted till December, 1881.
       (D) Gradual cessation of the
pathological states and symptoms up to June, 1882.
     
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    Studies On Hysteria
    23
     
     
       In July, 1880, the
patient’s father, of whom she was passionately fond, fell ill
of a peripleuritic abscess which failed to clear up to which he
succumbed in April, 1881. During the first months of the illness
Anna devoted her whole energy to nursing her father, and no one was
much surprised when by degrees her own health greatly deteriorated.
No one, perhaps not even the patient herself, knew what was
happening to her; but eventually the state of weakness, anaemia and
distaste for food became so bad that to her great sorrow she was no
longer allowed to continue nursing the patient. The immediate cause
of this was a very severe cough, on account of which I examined her
for the first time. It was a typical tussis nervosa . She
soon began to display a marked craving for rest during the
afternoon, followed in the evening by a sleep-like state and
afterwards a highly excited condition.
       At the beginning of December a
convergent squint appeared. An ophthalmic surgeon explained this
(mistakenly) as being due to paresis of one abducens. On December
11 the patient took to her bed and remained there until April
1.
       There developed in rapid
succession a series of severe disturbances which were apparently quite new: left-sided occipital headache;
convergent squint (diplopia), markedly increased by excitement;
complaints that the walls of the room seemed to be falling over
(affection of the obliquus); disturbances of vision which it was
hard to analyse;