Rewriting the Soul Review of External Book Review and Works Cited

 

            Rewriting the Soul: Multiple Personalities and the Sciences of Memory by Ian Hacking 

                                               Book Review: Review of External Book Review

           Review of Book Review by The American Journal of Clinical Hypnosis by Stephen E Braude.

The evidence is not in favor of child abuse being the foremost cause of Multiple Personality Disorder. The fact that child abuse is not the foremost cause of Mutliple Personality Disorder is made evident throught the book’s logical rebuttal of claims connecting the child abuse to the development of multiple personality disorder. Ian Hacking also suggests that our way of looking at the past is colored and even restructured by concpets such as child abuse.  Ian Hacking worries that calling oneself a multiple, with all the baggage that comes with it, can lead to a false self-knowledge that is created through therapy. He does not think that the consequences of therapy are against utilitarian mores, but he does morally object to them on the grounds of the fact that no one should have a false self-knowledge or a “false consciousness” (258). In response to this claim, Stephen E Braude asserts that it seems implausible that language, specifically the language used in the therapeutic process, should serve as a barrier to knowledge, particularly self-knowledge. I believe that false memories are a serious topic, according to Elizabeth Loftus, because false memories created by therapy and by reading various psychological self help books can lead to confirmation bias which leads therapists to only see evidence which corroborates their ideas of patients having trauma in their past. Interestingly, Braude does not seem to understand that therapy can be bad for patients in this respect. 

 

 Works Cited

 

Braude, Stephen E. “Hacking, Ian (1995). Rewriting the Soul: Multiple Personality and the Sciences of Memory.Princeton, N.J.: Princeton University Press, Pp. 336, $24.95.” American Journal of Clinical Hypnosis, vol. 38, no. 4, 1996, pp. 303–306., doi:10.1080/00029157.1996.10403357.

Loftus, Elizabeth F. “The Reality of Repressed Memories.” American Psychologist, vol. 48, no. 5, 1993, pp. 518–537., doi:10.1037//0003-066x.48.5.518.

Rewriting the Soul: Multiple Personality and the Sciences of Memory by Ian Hacking Book Review Chapter by Chapter Summary

 

Book Review Rewriting the Soul: Multiple Personality and the Sciences of Memory

Chapter 1

In 1972, multiple personality disorder (multiple personality) was a rare condition. Ten years later, in 1982, there were 6,000 people who had been diagnosed with multiple personality disorder, and it was considered an epidemic by clinicians who devoted clinics, wards, units, and entire hospitals to the treatment of multiple personality disorder. Multiple personality was considered an epidemic that surpassed belief, especially considering that it had been considered rare, ten years earlier. The notion has been made that the diagnosis was only made correctly in recent years. Early and repeated sexual abuse in childhood is elucidated by Ian Hacking as the principle cause of dissociated personalities. Multiple personality disorder’s validity has been contested by various sources, including the American Psychiatric Association in a 1988 debate regarding the veracity of claims that multiple personality disorder is a real illness.

This debate introduces the point of whether multiple personality disorder is a real entity and what that question effectively means and what it can be said to mean for the truth of whether multiple personality disorder is an illness that can be diagnosed and catalogued as an illness in a similar manner to other mental illnesses. An illness often confused with multiple personality disorder is schizophrenia, because schizophrenia’s root words mean “split brain.” Schizophrenia is distinct from multiple personality disorder in that it probably is caused by neurochemical stimuluses and has a different symptom picture than multiple personality disorder. Multiple personality disorder may contain short periods of schizophreniform behavior, but these episodes are not of a long duration. Multiple personality disorder is currently classified by the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM-III had criteria for diagnosis of multiple personality disorder Including “A. The existence within the individual of two or more distinct personalities, each of which is dominant at a particular time. B. The personality that is dominant at any particular time determines the individual’s behavior.” An addition to the DSM-III that was not included in the DSM-III-R was that “C. Each individual personality is complex and integrated with its own unique behavior pattern and social relationships.” Frank Putnam, A researcher at the National Institute of Mental Health, revised the then current criteria for diagnosis of multiple personality disorder. Among the revised criteria were that “The diagnosing clinician must: 1. Witness a switch between two alter personality states; 2. Must meet a given alter personality on at least 3 separate occasions… and 3. Must establish that the patient has amnesias, either by witnessing amnesic behavior or by the patient’s report.” However, the DSM is not a good basis for answering questions on the veracity of claims that multiple personality disorder is a real and not culturally contrived illness. However, multiple personality disorder’s relationship to the questions “Is multiple personality a real disorder as opposed to a kind of behavior worked up by doctor and patient?” and “Is multiple personality a real disorder as opposed to a product of social circumstances, a culturally permissible way to express distress or unhappiness?” is complicated at best, and the answer to these questions is more nuanced than a simple yes or no answer can convey. In fact, there does not necessarily need to be a conflict between a mental illness only appearing in certain historical or geographical contexts and the illness being real. Multiple personalities (multiples or alters) were also difficult to pigeonhole as being real, perhaps because of the fact that doctors were confounded by the spread of multiple personality disorder to different continents through missionaries and clinicians who established multiple personality disorder overseas. Multiples can also recover scenes of a terrible nature in their path to uncovering their trauma. Most of these scenes seem too terrible to be true and have led to the False Memory Syndrome Foundation being established in 1992 to defame irresponsible psychotherapy. Multiples are also prone to being hypnotized, which is perhaps a reason why multiple personality disorder has been correlated with dissociation and is classified as a dissociative disorder, but the evidence in favor of dissociation being associated with multiple personality disorder is not convincing to scientists who hold the opposite view that the correlation of multiple personality disorder and dissociation is by no means translatable into an idea of dissociation being related to multiple personality disorder.

The word “disorder” is important to note because it presents an image of pathology which is orderly and fits into neat boxes on the DSM. Alters are considered not whole personalities, but personality fragments, by some authorities on multiple personality. Certain clinicians, most notably Spiegel, a clinician who was chair of the dissociative disorders committee for the 1994 DSM-IV, wrote that it is of vital importance to emphasize the fact that there is a difficulty integrating disparate elements of memory, identity, and consciousness, and that the “proliferation of personalities” was less important to mention when describing the condition. This led to the name being changed to dissociative identity disorder.

The diagnostic criteria was also changed after the change in name, with it now being the following:

“A. The presence of two or more distinct identities or personalities or personality states…

B. At least two of these identities or personality states recurrently take control of the person’s behavior.

C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.

D. The disturbance is not due to the direct physiological effects of a substance (e.g. blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (e.g. complex partial seizures)

Note: In children the symptoms are not attributable to imaginary playmates or other fantasy play”

The DSM definition of multiple personalities has also been changed to require the presence of multiple personalities rather than the existence of multiple personalities. This change is meant to parallel the wording used to describe the delusions of the various types of schizophrenia. This definition also shifts our attitude toward the experience of the patient and away from actual multiple personalities. Memories are seen to be essential to our understanding of multiple personalities, and memory is seen as being the key to the soul and development of multiple personalities.

Chapter 2

Doctor’s expectations shape the multiple personalities that were brought to them, and people who are classified as being a certain way develop in that way and also develop in their own ways, making a feedback loop that causes descriptions and classifications to be constantly changing.

Doctors are moving away from diagnosis as a definition or set of necessary and sufficient terms and towards a way of defining multiple personalities involving a set of words applying to a set of people, in this case, people with multiple personalities. The idea of a prototype is also important in psychiatry. In psychiatry, the prototype refers to a patient that is the best example of an illness. The Casebook, the companion to the DSM, illustrates many such best examples. An example of an important criterion of someone with multiples is the existence of lost time in the memory of the person. Mood swings and hallucinations between sleeping and being awake may also be present in these patients. Alters cannot be distinguished until they come out individually. Instead, alternate personalities mesh together under the behavior of whoever is in control of executive function. Multiples have also been featured on talk shows such as The Oprah Winfrey Show and The Geraldo Rivera Show. Multiples are important and ordinary Americans who are lost in the public sphere but are importantly mentioned in talk shows such as these two. People afflicted with this disorder deserve our empathy and respect, not our scrutiny and disbelief. There is also controversy as to whether the multiple movement is in any way similar to the gay movement in that the homosexual movement grew to become independent of society’s medical restraints, and being homosexual is no longer classified as a disease. The multiple personality movement can be seen by people as a way of life but may or may not reach a level where it can exist independently of the medical community.

Chapter 3

Ralph Allison, a man who created his own model of multiple personality says that people with multiple personality disorder are not in touch with their inner selves. Ralph Allison believed in getting in touch with one’s inner self to obtain mental and spiritual health.

The leaders of the multiple personality movement were hosting workshops by 1979 at the American Psychiatric Association’s Annual Meetings. They then proceeded to make elaborate preparations for the Diagnostic and Statistical Manual’s 3rd edition, which stated that there were three characteristics, which I have mentioned before, that add together to become diagnostic criteria for the third DSM’s diagnosis of multiple personality disorder.

A later split occurred between the ideas of two groups of the multiple personality movement into one camp that consists of highly qualified clinicians and another camp that consists of a grassroots alliance of patients and therapists who welcome multiples. The appearance of the False Memory Foundation might be enough to heal the split between the two camps because they both can revel in the fact that memory is key to fully understanding this disorder.

Chapter 4

The concept of cruelty to children emerged in the Victorian era and did not span the same scope as the newer term “child abuse” spans. The term “child abuse” (versus cruelty to children) effectively medicalizes family violence and its causes as an object of scientific study. This medicalization can be known about and empirically reduced to types. The term of “child abuse” has not always existed; and the concept of child abuse also has not always existed, however, sexual, physical, and emotional, violence against children has always existed.

Deontology also plays a role in cracking down on child abuse because the deontologist point of view is that child abuse is an absolute evil and the consequences are less important for determining whether or not the evil is a true evil. Consequentialism has no role to play in deciding whether child abuse is moral or not. Regardless of the consequences, child abuse is and always will be immoral. The assumption that child abuse has profound effects on the developing child and the adult they will later become is an assumption that is important to understand when looking at the development and etiology of multiple personality, and to some extent, when looking at the soul itself.

Chapter 5

Some clinicians assert that the patient with multiple personalities’ victim status may dredge up further problems in painting the patient as a helpless, perpetual victim of the abuse experienced as a child. As the majority of multiples are women, and many of these women’s multiples are of a different and queerer sexuality than their “host,” these alters reveal social undertones in American society, undertones which are indicative of how masculinity and femininity play out in society, says Margo Rivera, in a feminist analysis of multiple personality and the etiology of the female multiple.

Chapter 6

Childhood abuse, especially sexual abuse, is considered one of the principal etiological causes of Multiple Personality. multiple personality. In fact, childhood sexual abuse makes upconstitutes part of the “best case”,” or prototype, of multiple personality. The theory of child abuse and levels of dissociation causing multiple personality is just one of many theories used to describe the etiology of mental illness. This theory is simply one of many theories that can be used to reveal the secrets of memory and the role that memory plays in multiple personalities.

Chapter 7Interestingly, Alfred Binet, one of the founders of intelligence testing, was fascinated with multiple personality at the beginning of his career. A crucial component of intelligence testing when Binet was formulating it was that intelligence testing results have to agree with common knowledge about who is intelligent or unintelligent. Tests agreeing with the standard body of knowledge as to what constitutes, in this case, a person of high intelligence, is a feature of Binet’s paradigm of intelligence testing. This is relevant to multiple personality disorder because multiple personality has also historically been studied through questionnaires similar to those used for intelligence testing. An example of one such questionnaire is the Dissociative Experiences Scale, introduced by Putnam and Bernstein. These researchers developed a scale that is flawed because it includes questions that give neurotypical people non-zero scores. The fact that it contains questions relating to normal phenomena gives normal people non-zero scores and also invalidates the test as a measure of whether normal people experience some type of dissociation or not.

Statistics requires researchers to have a random sample of people to test the hypothesis that there is a smooth gradient of quantity of dissociative experiences from normal people to multiples. A random sample was not chosen for testing the Dissociative Experiences Scale, with the sample being chosen from limited groups such as college students and subgroups of people who had the same type of mental health diagnosis. Therefore, Putnam and Bernstein did not test that whether or not there must be a smooth flow of gradation in dissociation levels from normal to multiple personality. The authors of the study also incorrectly interpreted data that was stated to not normally distributed. They wrongly interpreted the data because they did not choose a sample group randomly, as is the procedure for data collection in order to determine if the distribution is normal or not.

Unfortunately for our understanding of dissociation and related disorders, no one has looked into the veracity of claims that the curve, or “hill” of dissociative experiences is Gaussian and, when a random population sample is used, the curve is seen to be smooth and hill-like, but no further inquiries were made as to whether the curve is Gaussian or not. In fact, the authors of the study said that it did appear similar to the curves for hypnotizability, although those curves are skewed and the curve generated by random sampling is smooth and like a camel’s hump. Unfortunately, the idea that dissociation exists on a spectrum was already imbedded in the ideas of the psychologists studying multiple personality.

To find the best way of determining whether or not a person is ill, when they really are ill, is important because it can help us screen the people who seem to be ill and see if they actually are ill. This conclusion can be calculated by using the base rate, or rate of occurrence in the population. Researchers Carlson et al. seem to have failed because they take the base rate to be five percent and do not say from where this data comes. These researchers also seem to take the survey as a fact, and they do not question the validity of the test as a way of distinguishing who is ill from who is not; in fact, apart from attempting to calibrate the test using a base rate, they do not engage in proper science. They also attempt to discriminate between high scores and low scores on the test, with the cutoff score for multiple personality or a dissociative disorder being thirty. The question is open as to what dissociation is, then, if as mentioned before, certain leaders in the field of multiple personality would like to make it into a scientific term, dependent on the construct of a dissociation continuum, where normal people dissociate a little and multiples dissociate more.

Chapter 10

Locke believed that there are two concepts of identity: One for a forensic concept and one for a bodily continuity based concept (p 146).  The forensic person has a role in the divine plan, same body in hereafter… but rewards or punishments are prepared for the same person. Another concept similar to Locke’s was the concept of there being one soul per body which was said by the Thomists. Anti-Thomists said there could be more than one soul in a body.

Chapter 12

Bourru and Burot said that there was a connection between personality and memory. After Bourru and Burot said this, Mabille and Ramadier, scientists who studied Louis Vivet thought there was a correlation between certain physical and nervous states and the psychological personality states. Bourru and Burot also expanded upon the theory postulated by Mabile and Ramadier by postulating that they could locate a normal state using the body parts associated with the normal state of mind. Bourru and Burot believed that using magnets and metals could wake the patient up into a normal state.

Chapter 14

We should not study a unitary moi, according to Ribot, a disciple of British associationist psychology who was trained in philosophy, not a neurologist or pathologist as others were at the time. In multiples, there was not a single self, or soul, thus challenging the existing non-scientific philosophical and religious monopoly on the soul and providing a frontier on which a scientific examination of the soul could begin.

Chapter 17

Mary Reynolds switched by her vivacious alter becoming principal in her personality (237). Effectively, as the multiple personality movement changes and people begin to move towards a dissociative identity disorder model, the intentionality of the change between alters is replaced by an involuntary “switching” concept that proposes that it is not an intentional decision on the part of a developed personality fragment that decides to come out. It is in fact an involuntary switching that occurs with alters.

Interestingly, categorizing certain relatively less severe abusive actions as child abuse may open the window to worse forms of child abuse in people who are predisposed to abuse. After things are put under the same name, child abuse, it is easier to believe that there is less separating the abuser from grosser forms of abuse entirely. The movement towards progressively worse child abuse is something that may be causing increasing rates of child abuse. Not just because there are more actions considered abusive or because more people are being discovered to have committed child abuse, but also because of the semantic contagion of actions under the heading of child abuse (238). 

Feedback effects cause people to rebel against authorities who tell them that they are a certain kind of person or the science that makes them seem to be a certain kind of person. THe process of being viewed to be a certain kind of person or of being viewed to be someone who commits certain acts, may also affect the person involved in a similar form. The manner in which things affect people who are subjected to certain definitions of who they are and the standards that uphold these definitions is called the feedback effect (239).

Mad Travelers Book Review: Summary of External Review and Personal Reflection on Book Review + Works Cited

 

Summary of External Review

Dr. Dalby of the University of Calgary writes an interesting review of the book Mad Travelers: Reflections on the Reality of Transient Mental Illnesses. This review briefly summarizes key points from Mad Travelers: Reflections of the Reality of Transient Mental Illnesses, and then provides us with a summary of his thoughts regarding the quality of the book and a summary of Dr. Dalby’s thoughts regarding the main message of the book and what we can take away from Mad Travelers: Reflections of the Reality of Transient Mental Illnesses. 

Dr. Dalby references the question of precisely what old fuguers suffered from in his review. Some examples of answers to this question include epilepsy and temporal lobe lesions.  Along with referencing the question of what exactly old fuguers suffered from, Dr. Dalby also mentions the question of whether the doctors of the day were warranted in creating a diagnosis for hysterical fugue as a real illness. The third question Dr. Dalby emphasizes as “most important” is whether similar conclusions to those drawn about fugue can be drawn about specific mental illnesses today (Dalby, 2001). 

Dr. Dalby praises the “scholarship” of the book and states that one can appreciate the supplementary material that allows one to create a personal opinion about the transient mental illness Hacking describes (Dalby, 2001). Dr. Dalby reaches the final conclusion that medical progress could be made in psychiatry by studying the medical disorders of the past which have yet to be fully studied, rather than focusing on new medical disorders that catch our interest. Dr. Dalby also writes that the clinical psychologist pathway of investigating a mental illness is highlighted in Hacking’s book Mad Travelers: Reflections of the Reality of Transient Mental Illnesses.  Dr. Dalby paints a picture of Hacking as a very strong scholar gifted with “clarity, humility and wit (Dalby, 2001).”

Personal Reflection on Book Review

Generally, it is true that Hacking writes with insight and wit, however, it does not seem that the purpose of the book is the same purpose that Dr. Dalby believes it to be. Dr. Dalby states that medical progress can be advanced by studying unsolved mysteries in past diagnoses, rather than current “syndromes (Dalby, 2001).” Hacking would not agree with this statement because he believes his work is of vital importance not because of the historical aspects of his work, but because of the relevance to current studies of illness. 

Hacking would argue that it is important to study new syndromes, and that some old syndromes can be left unsolved. It is likely that Hacking chose the illness of fugue in order to illustrate a broader idea of illness being situated in an ecological niche. It seems as though Hacking chose to cover the ecological niche because he believes that future models of mental illlness can benefit from his philosophical take on mental illness. I disagree with Dr. Dalby because I believe that it will be of crucial importance to study illnesses of the future with the knowledge we have gleaned from the past, not to study only the past and not the current illnesses and ecological niches. It seems as though Dr. Dalby may have said that it is important to study past and not current illnesses in error. 

Works Cited

Dalby, J. Thomas. “Mad Travelers: Reflections on the Reality of Transient Mental Illnesses.” Journal of the History of the Behavioral Sciences, vol. 37, no. 4, 2001, pp. 398–398., doi:10.1002/jhbs.1072.

Hacking, Ian. Mad Travelers: Reflections on the Reality of Transient Mental Illnesses. Harvard Univ. Press, 2006.

Kelly, Mark. “Michel Foucault:Political Thought.” Internet Encyclopedia of Philosophy, www.iep.utm.edu/fouc-pol/.

Mad Travelers Book Review- Chapter by Chapter Summary Including Supplemental Materials prepared for BA at UWF

 

 

Mad Travelers Book Review

Chapter-by-Chapter Summary including Supplemental Materials 

 

                The book Mad Travelers: Reflections on the Reality of Transient Mental Illnesses is about the mental illness commonly known as fugue. Fugue refers to the condition where a person will walk long distances in a dissociative state, and without a particular purpose in mind. Fugue can be classified as a particular mental disorder and was classified as a form of hysteria. In this book, it becomes apparent that fugue can present very similarly to other mental illnesses and it has frequently been conflated with multiple personality disorder. It is also strongly related to the 19th and 20th century illness of hysteria which no longer exists in this day. Many possible theories have been advanced as to why hysteria no longer exists. One of these theories is that hysteria is now diagnosed as many separate illnesses. The theory that hysteria is now diagnosed as many separate illnesses is supported by the fact that many people afflicted with fugue may now be said to be bipolar, with the fugue occuring at the beginning of a phase of mania. However, the theory that hysteria is now diagnosed as many separate illnesses is not supported by the ideas of Kuhn, specifically the inability to translate kinds from a previous paradigm into the ideology of a new paradigm (87). 

The term “transient mental illness” is used in reference to mental illnesses that appear in times and places and later disappear. The term transient mental illness can be used to describe illnesses that are endemic to certain social classes or genders, or that can spread from place to place and reappear with the passage of time. This term generally refers to illnesses that are endemic to certain conditions, namely, certain times and places. 

Shadow syndromes are so named because the people who posses this type of syndrome, according to a book published in 1997 regarding the subset of disorders which cause difficulties in functioning and meet some criteria for a disorder, but fail to meet all criteria for a disorder. 

Thomas Cook and Son are a popular tourist group at this time. They began by hiring railway coaches to take evangelicals to temperance meetings. Later, they evolved into processing 7 million tickets for the railroad. 

It seems like fugue has been an important part of society for a long time. Hence the tale of Albert, a patient diagnosed with fugue, gives us an interesting point of view on the difficulty of ascribing fugue something great and powerful. We cannot ascribe it to something great and powerful, like Michel Foucault when he says that madness is the mirror of the age of reason and an essential part of the arrangement of ideas (27). 

To get to the root of the fugue epidemic, one must look at the development of fugue in America. It was first described as drapetomania or the tendency of black slaves to try to run away from their masters. Ambulatory automatism was a later diagnosis for people exhibiting fugue-like symptoms. 

Interestingly, different symptoms were emphasized in France versus the United States. People exhibiting specific symptoms of fugue were viewed as being people who lost their old identity. These people would exhibit a need to travel and they would travel large distances. Interestingly, the identity could be restored by hypnosis. The diagnosis for people with these issues was Multiple Personality 

The fugue epidemic lasted 22 years, according to Ian Hacking. Mark Micale is a leading proponent of theories which regard books as instrumental in creating a consensus about the diagnosis and treatment of mental illness. Furthermore, the diagnosis and treatment of mental illness, in the case of fugue, is difficult to pinpoint because the doctors diagnosing illnesses were labeling people who would be seen in France as fuguers as sufferers of multiple personality disorder. 

It is important to note that Charles Davenport,  a leader in the eugenics movement of the early 20th century, was working to make sure that only northern Europeans and British people immigrated to America. He engaged in this work because particular races were supposedly of purer genetic stock than Eastern and Southern Europeans. Charles Davenport, apart from being involved in the eugenics movement, ran a study sponsored by Rockefeller and Miss Harriman on fugue like states. Davenport saw the nomadic impulse as being caused by a fundamental attribute of human nature. Davenport saw this fundamental attribute as something tamed by civilization.  

In Chapter 4, the author of this book, Ian Hacking, makes clear that in his opinion fugue is caused by “an ecological niche” including “medical taxonomy, cultural polarity, observability, and release” (80). Hacking argues that physicians were interested in fugue in part due to the controversy over where in the medical taxonomy it belonged. This is the medical taxonomy portion of the ecological niche of fugue. Fugue was situated between two cultural poles, one with romantic tourism which the wealthy engaged in, and the other which was only engaged in by criminal vagrants, criminal vagrancy (82), thereby creating the cultural polarity portion of the ecological niche. Hacking also argues that in order for a mental illness to be diagnosed, it must be “observable” or visible to the medical authorities diagnosing. This is the observability portion of the ecological niche. Hacking also claims that it was an inviting escape for men who were not able to travel due to family and financial reasons or due to having enough respect not to become a criminal who wanders. This escape is the release portion of the ecological niche. 

In the 19th century there was substantial debate over whether fugue should be classified as a form of latent epilepsy or hysteria. Charcot was a leading neurologist in 1887. Unlike most physicians of his time, he held that male hysteria as well as the classic female hysteria could exist. The idea of male hysteria was a concept developed in large part due to Charcot’s wanting to study hysteria as a  neurological disorder. Charcot was famous for being an excellent researcher and neurologist. In fact, one of his colleagues was Hughlings Jackson, a neurologist who was still famous 103 years after his publishing of a study of epileptic amnesia and fugue. Charcot held Hughlings Jackson in high regard, but Charcot was also recognized as a masterful neurologist of this time. In fact, one of Charcot’s students was Freud. One of Charcot’s claims to fame was his development of his Tuesday lectures in which he went through a case of a particular patient in front of adoring crowds. One of these patients was “Mén,” A 37 year old delivery man (35). 

Charcot believed that the man’s illness was epileptic in origin because he was too old for a hysterical outbreak and had not suffered any kind of head trauma. He called Mén’s illness ambulatory automatism based on the fact that he walked automatically and didn’t show external signs of being unconscious while walking, despite the fact that most fuguers only remember their fugue with hypnosis and are essentially walking about unconsciously. Charcot did not cure Mén, but nevertheless Mén became the basis for all further epileptic diagnosis of fugue. 

In light of the new distinction between the cause of fugue being epileptic or hysterical, new terminology was developed to reflect that sometimes ambulatory automatism is epileptic in nature and other times it is hysterical in nature. The hysterical fuguer was seen as hypnotically suggestible. The hysterical and epileptic fuguers were both seen to respond well to different medications, as well. The patients that fell out of the categories of hysterical and epileptic fugues were considered neurasthenic patients. 

Dromomania was another term for the disorder of fugue, and became the preferred term over automatisme ambulatorie. Hysteria and epilepsy had theory behind them, but dromomania did not. Dromomania was simply a catch all term for all types of fugue, without the ideas that hysterical and epileptic fugue carried with them. Also, a new term was introduced in 1895 by Fulgence Raymond. Fulgence Raymond believed that fugue patients who were both epileptic and hysterical should be treated with hypnosis and suggestion, not chemical medicines. Fulgence Raymond also used Pierre Janet, another psychologist’s terminology and used the term psychasthenic to create a new category of fugues. The psychasthenic fugue was a type of fugue which denotes the existence of a strong urge to travel missing the traditional hallmarks of fugue. Psychasthenic fugue was a type of fugue in which the fuguer did not lose consciousness of the trip in the form of later amnesia. This type of fugue was considered a form of degeneracy, a term coined to mark the decline of France which was also used as a descriptor of the vagrancy and mental illness of fugue affected patients. 

Interestingly, in Lecture 3, Titled Niches, the author of the book Mad Travelers: Reflections on the Reality of Transient Mental Illnesses, says that the word illness brings with it the idea of medical doctors. It carries with it the medical precedents of other entities titled illness. This medical precedent connotes doctors, or professionals who can help with the illness.

One later becomes aware of a debate between Ronald Simons, who  argues that latah, a form of mental illness that is positioned in an ecological niche in Indonesia, is biological in nature, and Michael Kenny who argues that latah is social in nature and that any similarities upon looking at worldwide instances of this disease are coincidental in nature. 

Author Ian Hacking raises serious questions as to whether latah is diagnosed based on current societal trends which overpower the public and medical consciousness. It seems like latah could be diagnosed as either fugue or hysteria, depending on the whims and confirmation bias of the doctor diagnosing the illness. 

For Michel Foucault, people are products of  the governmental structures that exercise power (Kelly). In no way is governmental structures producing people of certain kinds true more so than in circumstances in France during the 19th century. In a striking parallel with the current political situation in France, mentally ill patients were labeled degenerate, as France declined compared to Britain and Germany. Hacking argues that the reason why fugue was not a common descriptor in America is that there was no degenerate program in America. The categorization of mental illness was not linked to the decline of a nation as it was in France. 

In 1900s America after degeneracy appeared in France, Nomadism appeared as an idea linking race and tribe to fugue like states. The appearance of nomadism heralded an era of racial division. Racial division was augmented by the fact that nomadic tendencies were considered inherited, and all inherited traits were considered to be race based. 

After 1870, vagrancy was seen as part of the degeneracy movement. Beaune, a thinker at the time of the evolution of vagrancy, called the institutionalization of homeless people and the view of homelessness as a medical problem a genocide. 

The meeting of psychological professionals at Nantes in August 1909 regarding mental illness in the military and fugue marked the end of French fugue. 

In Chapter 4 of Mad Travelers, Hacking answers the fourth question of whether hysterical fugue was a real mental illness. It certainly exists in the diagnostic codes of today’s psychiatrists, but more so to prop up a category of dissociative disorders than because physicians are currently using the diagnosis of fugue in their everyday practice, Hacking argues. However, when we see fugue in a pragmatist light, it seems like it is not real because pragmatists define real as the object of a fact upon which all parties reach a consensus. Hacking proceeds to mention an ideal world in which genetic disorders are agreed upon by all as being a “real disorder.” In this imaginary world, if fugue proves to be a genetic disorder, it would be “real.” It seems like an inconclusive answer to say that no, fugue is not a real mental illness, because we prefer an objective reality that we can confidently say exists, rather than a reality which evolves with our language and the development of our life. 

In answering the final question regarding whether analogous conclusions are to be drawn about transient mental illnesses today, Hacking calls upon his knowledge of multiple personality disorder. It is said that there was cultural polarity implied in the emergence of a great number of multiple personality cases in America in the 1970s. One of these cultural poles was child abuse, which was seen as being destructive of identity. The other of these cultural poles was a romantic challenge to identity and selfhood which is a version of German romanticism and is postmodern in nature. This cultural pole is liberation from contemporary social and political notions of the self. In the final portions of his final lecture in Mad Travelers, Hacking implies that dissociative fugue is not constructed, and even if one is to argue that dissociation lobbyists constructed the diagnosis and patients, this does not construct the ecological niche where dissociative fugue flourished. Hacking says the model of diagnosis and patients of dissociation thrived “until dissociation theorists ate their own nest, multiplying personalities beyond necessity, teaching fantasies to the innocent and escapes to the guilty” (101).

Supplemental Materials

Supplement 1, titled What Ailed Albert, begins by saying that the initial thoughts about Albert were that he was an epileptic, which later transitioned to a hysterical fuguer. Upon further reading, we find that Albert seriously injured his head upon falling out of a tree as a child. This and other somatic complaints lead us to the conclusion that Albert was suffering from some sort of brain injury. 

Hacking very obviously paints a picture in Supplement one of the question of what ailed Albert being pointless because of a relationship between the patient and physician working such that patient and physician accommodate each other. This accommodation occurs much like a small child who assists his parents in covering up something although the small child knows what the truth is. In fact, Joseph Debouef described a phenomenon by which the hypnotizer and hypnotized accommodated each other like the small child and his parents. Functionally, this accomodation made both patient and physician work together during experiments and generated an influence of Tissié, the physician, over Albert, the patient where Albert dreamed of a cycling fugue and talked to imaginary companions. This is strange because Tissié, not Albert, was a cyclist, and Albert always went on fugues alone.