Chapter 5 Chapter Five: The Signs of Madness

In this chapter, we do not want to discuss the history of the evolution of various ideas in psychiatry in the seventeenth and eighteenth centuries, but to show the specific forms by which classical thinking understands madness.These forms are still often attached to mythological images, but these mythological images are often very important in the formation of our practical knowledge.mania and depression In the sixteenth century the idea of ​​melancholia was defined by a certain symptom definition and by an explanatory principle contained in the word.Among those symptoms we find all the delusional thoughts a man can have about himself: "Some think they are beasts, and imitate their sounds and movements. Some think they are glass vessels, and avoid passers-by to prevent themselves from being shattered; some people are afraid of death, but they are more likely to kill themselves. Others imagine that they have committed some crime, and whenever someone approaches them, they tremble with fear, thinking that Those who come will arrest them for silence and sentence them to death." The thoughts of the committee members are always isolated and isolated, and they do not damage the rational whole.Thomas Sydenham (for even noting that melancholics "are such persons; in addition to complaining, some are cautious and reasonable, others are discerning and intelligent. Thus Aristotle De is quite right that depressed people are smarter than other people."

This clear and consistent disorder is expressed by a word that implies a complete causal system, melancholia: "I invite you to pay close attention to the thoughts, words, imaginations, and actions of the melancholic, and you will find that they Their entire senses are corrupted by the melancholy scheme that pervades their brains." A degree of delusion and the effects of black bile (i.e., melancholic juice) are juxtaposed in the concept of melancholia, but apart from a denotative noun The group symbols are put together in a jump, and there is no connection between the two for the time being.By the 18th century, some kind of bonding relationship was discovered, or some kind of communication took place.This cold, sombre quality of bile becomes the main feature of delirium, its positive value as distinct from mania, dementia, and mania, and the essential element of its coherence.Although Her-mann Boerhaave still defined melancholy only as "a long-lasting episode without a fever in which the patient is completely addicted to a single idea", Dufour made it a few years later shifted the focus of the definition of the disorder to "fear and sadness" as an explanation for some of the hallmarks of delirium: "Thus, melancholics prefer to be alone and avoid crowds; this makes them more preoccupied with the objects of their delirium or succumb to the feelings that dominate them, while at the same time they seem indifferent to everything else." The notion was settled, not by closer observation, nor by new discoveries in the field of etiology, but on the basis of a There is a transfer of a quality, from some cause implied by the name, to the apparent perception of the actual effect.

Before the beginning of the seventeenth century, for a long time, discussions of melancholy were confined to accounts of the four humors and their properties.It is generally believed that matter itself has various stable properties and that matter itself is the cause of these properties.According to JeaFernel, melancholic juice is associated with the earth and autumn, and is a "viscous, cold and dry" juice.But in the first half of the 17th century, a debate arose about the causes of melancholia: Is it necessary to have a melancholic temperament to suffer from melancholia?Are blue pieces always cold and dry?Could it never be warm and humid?Is this substance at work?Or are these properties transmitted?The debate was protracted, and the results were roughly as follows:

1.The causation of matter is gradually replaced by a movement of qualities.These qualities pass directly from body to soul, from humors to thought, from organ to action, without any medium.For example, in Duncan's defense, the best evidence that melancholy contributes to melancholia is the quality of the disease that can be found in the juice of melancholy: "Melancholy juice possesses the necessary conditions for producing It is the condition for people to be angry; because its coldness suppresses the amount of vitality, its dryness enables the spirit to preserve strong and lasting imagination for a long time; its darkness makes the spirit lose its natural brightness and sharpness."

2.In addition to this property mechanics, there is also a dynamics.The latter analyzes and exercises the power implied by a nature.For example, coldness and dryness will conflict with temperament, and this opposition will produce the symptoms of melancholia, and its intensity is directly proportional to this conflict, and its strength will overcome and sweep away any resistance.Women, for example, are by nature not prone to melancholy, but when they do fall into it they are worse: "They are cruelly toyed with and violently harassed by him, because melancholy is more at odds with their temperament, and thus draws them further from themselves." natural qualities."

3.However, conflicts sometimes arise within the nature itself.A nature changes in the course of its own development, becoming the opposite of itself.For example, "when the rage boils, the blood boils....?? all the bodily fluids are exhausted", this boiling state can turn into a cold melancholy - resulting in "almost upside down with the torch, burning wax crossflow And the same afterward. . . . This cooling of the flesh is the usual consequence of unbridled rage exhausted." There is a dialectic of quality here.Once these properties get rid of various shackles of matter and various predetermined orbits, inversion and contradiction will occur.

4.Finally, properties can change due to accidental events, circumstances, and living conditions.Thus, a person with dry and cold humors can become a person with warm and moist humors because of his lifestyle.Again in the case of women, if they "are always idle, their bodies will perspire less [than men], and their enthusiasm, energy, and fluids will be preserved" Thus, detached from its restrictive material basis, quality can play an organizing and integrating role in the idea of ​​melancholia.On the one hand, they can describe symptoms and phenomena such as sadness, pussy, dullness and dullness.On the other hand, they can suggest a causal principle.This causal principle is no longer about humoral physiology, but about the pathology of certain ideas, worries and fears.The pathology is not identified in terms of observed symptoms or supposed causes, but rather some qualitative connection perceived somewhere between and beyond the two.It has its own law of conduction, development and change.It is the mystical logic of this nature itself, rather than medical theory, that governs the development of the idea of ​​melancholia.This point has long been proved by the writings of Thomas Willis.

At first glance, their analysis is logically rigorous.Willis's interpretation relies entirely on vitality and its mechanical characteristics.Melancholia is "a madness without fever and madness, but with fear and sorrow".If it is delusional—that is, a radical break with truth—it has its roots in the chaotic movement of the qi and a defect in the brain.But can the fear and anxiety that make a melancholic "sad and cautious" be explained by this movement alone?Is there some kind of dynamism peculiar to the fear mechanism and grief?This seemed self-evident to Descartes, but Willis no longer sees it as such.Depression should not be viewed in the same way as paralysis, stroke, vertigo, or seizures.It cannot even be simply regarded as a kind of dementia, although blowing melancholia may be a similar disorder of vigor and movement; it is easy to explain it with a disorder of mechanism-but this disorder is all madness such as dementia or depression. Common—does not account for the peculiar nature of the affliction, nor the tones of sadness and fear that give the appearance of melancholia its distinctive appearance.We must delve into the secrets of pre-existing structures.After all, it is these fundamental properties underlying this subtlety that explain the seemingly paradoxical movement of qi.

In melancholia, the vitality (spirit) is completely immersed in some kind of restlessness, but this is a weak restlessness, without any violent power, but a feeble agitation.This agitation does not advance along the obvious or overt pathway (apert. percula), but travels through the brain by continually creating new pores.But Genki didn't wander very far in its path.As soon as the agitation subsides and subsides, the vigor languishes, and the movement ceases: "They do not travel very far." (93 Hence, this agitation, common to all kinds of delusion, produces neither violent action on the surface of the body , and does not produce the crying that is seen in catatonia and frenzy. Melancholia never reaches the level of frenzy. It is impotent madness. This contradiction is the result of secret changes in vitality. Usually Vitality has an almost immediate quick response and absolute transparency. But in melancholia, they are permeated by darkness and become "fuzzy, cloudy and dark". The images they transmit to the brain are obscured by "shadows". They Becomes heavy, similar to chemical black smoke rather than pure light and shadow. This is an acid smoke, not fluidized gas into alcohol fog. Because the molecules of acid smoke are mobile, they can't even stand still, but their activity is very Weak, without effect. When they evaporate, nothing remains in the still but a little odorless sticky wave. If alcohol fumes can explode at any moment into flames, reminiscent of frenzy, sulphurous gas Doesn't acid fume, which is associated with mania in vigorous, restless exercise, also characterize melancholia? If one wishes to inquire about the "official reasons and causes" of melancholia, one should consider this rise from the blood to The brain and gradually decays into an acidic and corrosive gas. On the surface, Willis' analysis is biased towards a melancholy of vitality, a chemical change of body fluids. But, in fact, the main line of thought is caused by the painful symptoms of melancholia What the immediate nature offers: the impotent confusion, the cloudiness of the mind, the bitterness that eats away at thought and emotion.Acid chemistry is not an explanation of symptoms but a qualitative approach, a phenomenology of the melancholic experience.

After about seventy years, Yuanqi theory lost its scientific predominance.Instead, people searched for the secrets of disease in the liquid and solid components of man.James published the "Dictionary of Medicine" in England in 1743.The article on "Mania" in the book proposes a comparative etiology of mania and depression: "It is clear that the brain is the seat of these diseases, . . . The soul, the spirit, the faculties, the imagination, the memory, and the senses of all kinds are settled in an inconceivable manner.  … If the quality and quantity of the blood and humors are impaired, they no longer flow evenly and moderately to the brain, but in Vigorously circulated in the brain or diffused with difficulty and slowness, all noble functions were altered, corrupted, weakened, and destroyed altogether." If the heart pumped this weakening, heavy, and stagnant blood to the whole organism, If this blood is the fine arteries which seep with difficulty into the brain, which requires rapid circulation to maintain the activity of thought, an unfortunate blockage results.This explains depression.Here, the basic properties of hysteresis and obstruction remain the guiding concepts for analysis.The explanation begins to turn to the mechanisms of the qualities perceived in the patient's condition, words and deeds.We have moved from an understanding of properties to a hypothetical explanation.But this understanding still reigns supreme and always trumps theoretical logic.Lowry distinguishes two main types of depression by listing two main medical explanations (from a solid component and from a liquid component) and finally making them run side by side.Of solid origin is neuromelancholia.The process is that a particularly strong sensation stimulates the nerve fibers that receive it, and as a result, other nerve fibers tense up, become stiff, and can vibrate at the same time.However, if this feeling becomes stronger, other nerve fibers become more tense and cannot vibrate.This state of stiffness stops the flow of blood and the movement of vitality.Depression arises.In another type of "fluid" depression, bodily fluids are saturated with black bile and become viscous.The blood, filled with this fluid, also becomes viscous and stays in the meninges until it compresses the main organs of the nervous system.Here again we see a stiffening of the nerve fibers, but this is entirely a consequence of the humoral phenomenon.Lowry thus distinguished between two types of depression.In fact, he successfully employs in both systems of explanation the same set of properties which give melancholia an actual identity.The theoretical edifice has doubled, but the empirical qualitative base remains the same.

The stagnation of liquids, the depression of animal vitality and the shadows it casts on objects, the stagnation of blood that is struggling to flow in blood vessels, the darkening, the thickening of toxic and corrosive gases, the slowing down of visceral functions, etc. , forming a symbolic unity.This unity is not so much a product of thought, of theory, as of sensation.It is it that gives the melancholia its characteristic stamp. It is this kind of research, rather than faithful observation, that has reprogrammed the symptoms and presentation patterns of depression.The notion that some degree of well-being was a cardinal symptom of the melancholic (so that it could be used as a qualitative basis like sadness, pain, withdrawn, dullness) gradually disappeared.At the end of the eighteenth century, madness without delirium but characterized by dullness, despair, and a certain trance was often classified as melancholy.In addition, apoplexy depression has been discussed as early as James' "Dictionary of Medicine".Such patients "reluctant to get out of bed . . . and even when standing, are unwilling to move unless compelled by relatives, friends or caregivers. They never hide from people, but when people speak to them they seem absent-minded and say nothing Answer." If in such cases dullness and silence stand out and can therefore be diagnosed as melancholia, there are also cases in which only pain, lethargy, and withdrawal are observed.But observers do not fail to notice their agitation, nor do they rashly diagnose mania.These patients must have suffered from depression, because "they avoid relatives and friends, prefer to be alone, and wander aimlessly. His face was gloomy, with an expression of fear and sadness." The analysis of mania and its evolution in the classical period followed the same principle of consistency. Willis contrasted mania with depression.The mind of the melancholic is so absorbed in reflection that his imagination rests in a state of idle rest.In contrast, the imagination of the manic patient is filled with a constant stream of thoughts.The melancholic mind fixes on one object and exaggerates it only unreasonably, while the manic distorts all concepts and thoughts.Both have lost the ability to harmonize, or in other words, the values ​​​​expressed by both are unfounded.In short, the fundamental connection between intellectual integrity and truth is disturbed.Finally, melancholia is always accompanied by sadness and fear, while mania shows insolence and rage.Whether it is mania or depression, the cause is always the movement of animal energy.But, in mania, this movement is special.It's constant, violent, always poking new holes in the brain.As the physical basis of incoherent thought, it produces the violent mannerisms and eloquence which manifest itself as mania.This pernicious motion is also that of that infernal water, that sulfurous liquid, that Styxic water of sulfurous liquid, glass liquid, antimony liquid, and other liquids: its particles are in eternal motion. Medium; these particles can create new pores and new channels in any object.They are powerful enough to spread themselves, just as manic emotions can stir up every part of the body.A stream of hell brings together the concrete objects of mania in a secret movement.It constructed its own chemical myths and kinetic truths, making the two inextricably linked. In the 18th century, the imagery of animal vigor in the nervous system, with its mechanical and metaphysical implications, was often replaced by the imagery of tension (tension) of nerves, vessels, and the entire fibrous system of tissue.Tension imagery has a stricter physical meaning and more symbolic value.Mania is one such state of nervous tension that leads to sudden attacks.A manic patient is like a musical instrument, the strings of which are taut and begin to vibrate when a stimulus is far and weak.Mania and delirium are caused by the constant vibration of emotions.Through this imagery, the difference between mania and depression becomes clear.These differences constitute a strict contrast: the melancholic never resonates with the outside world because his nerve fibers are too relaxed, or become stiff from being too tense (we saw how tension mechanisms explain both The sluggishness of mania explains the turmoil of mania): only a few nerve fibers are vibrating in melancholic patients, and these vibrating nerve fibers coincide with the excitement of patients with delirium.Conversely, in manic patients the nerves vibrate with any stimulation.His accusations are all-encompassing.In the melancholic, stimuli are swallowed up by a dull state of heaviness.On the contrary, when the manic man's body responds to the stimulus, the stimulus becomes more and more intense, as if he had already accumulated supplementary energy in the state of nervous tension.Moreover, it is this very condition that in turn makes the manic person numbed, not the lethargic torpor of the melancholic, but the nervous torpor of the inner vibration.Undoubtedly, this is the reason why manic patients "have no fear of heat and cold, but sleep in torn clothes in severe cold, naked on the ground, and do not feel the cold at all".That is why, although the real world still seduces them, they replace it with their own imaginary world: "The basic symptom of mania arises from the fact that the patient perceives objects that are different from what they really are." 12 Mania The angst of the manic patient is not caused by some abnormal judgment error, but by a defect in the process of transmitting sensory impressions to the brain, a defect in conduction.In this psychology of madness, the old idea of ​​truth, the idea that "thoughts agree with things," becomes a metaphor for a certain resonance, the feeling that nerve fibers vibrate as faithfully as a musical instrument. This idea of ​​manic tension developed into a solid medicine, and also formed a stronger intuition of nature.The nervousness of a manic patient always feels dry.Tramples are usually accompanied by depletion of body fluids, dry heat throughout the fat body.The essence of mania is sandy.In his "Anatomy of a Graveyard," Bonnet declared that, so far as he observed, the brains of schizophrenics always appeared dry and brittle.Later, Haller also discovered that the brains of people with trample mania are weak.Men. ret reiterated the findings of a study by Forestter.The study showed that drying of blood vessels and nerve fibers, as well as excessive loss of certain body fluids, can cause mania.For example, a young man "takes a wife in the summer and suffers from mania from excessive copulation". Some hypothesize, some perceive, and Dufour confirms, quantifies, and names.During an autopsy, he removed a piece of the medullary body from the brain of a man who had died in a manic state, and cut off "a half-inch cube" weighing 3j. g. , while the weight of the same volume taken from the average human brain is 3ig. "This weight difference does not seem very significant at first glance, but if we take into account that the total brain mass of an ordinary person is generally three French pound It's not that insignificant anymore." Trample maniacs are dry and light, even on the scales. This dry heat in the body is further confirmed by the cold tolerance of manic patients.They are known to walk naked in the snow under the eyes of others, they need no warmth in the shelters, they are even healed by the cold.The practice of immersing manic patients in ice water has been widely practiced since Jean-Baptiste van Helmont.Menurai recounts an example of a manic man he knew who had escaped from prison "without a hat and almost naked, walked a few leagues in a torrential rain, and recovered completely from it." Health." When Montchau was treating a manic patient, he "threw ice water on him from a height" and the patient was cured.Moncho is not surprised by the good results.In explaining this, he synthesized various concurrent views on body heat that have prevailed since the 17th century; It is not surprising that such a quick and thorough cure"; by the effect of the cold, "the vessels constrict more violently, the filling fluid is displaced, and the disturbance of the solid parts by the high temperature of the fluid subsides, and, As the nerves are relaxed, the disordered vitality has also returned to its normal state." The world of melancholia is dank and stagnant, while the world of mania is hot and dry, restless and crunchy.In the latter world heat—imperceptible to man, but visible everywhere—causes dryness and crunchiness, but this world can at any moment relax under the influence of clammy cold.In the development of these simplistic qualitative understandings, people have determined the connotation and extension of mania.No doubt the expression of the early seventeenth century survives, namely, "fury without fever."But besides these two completely descriptive features, there arises a perceptual perception that really dominates clinical practice.Once the explanatory myth disappears, terms such as body fluid, vitality, solid, and liquid are no longer popular, and what remains will only be systems of related nature.And those systems aren't even named anymore.The system of manic traits gradually constructed by this dynamic of heat and movement will now be seen as a natural system, as an immediate truth of psychological research.The heat felt in the past, the imbalance of vitality imagined, and the nervous tension imagined will be replaced by psychological concepts that lose their transparency, such as overactive introspective impressions, rapid associations, and numbness to the external world.Reeve has clearly described it; "External objects do not make the same impressions on the mind of a sick man as do those of a healthy man. The impressions are so faint that the patient hardly pays attention to them. His mind is almost entirely absorbed by the Thoughts. These thoughts are so active that the patient thinks they reflect real objects and judges accordingly." We should not forget, however, that this manic psychological structure emerged and established at the end of the eighteenth century, and it is only It is a superficial sketch of a complete and profound structure.It was developed according to the laws of half-sensation, half-picture about a world of qualities, which will eventually collapse. Undoubtedly, this whole universe of hot and cold, dry and wet reminds medical thought, which is heading towards positivism, not to forget the environment of its own origin. However, this symbol composed of images not only expresses nostalgia but also expresses project.In order to form an actual experience of mania or melancholia, the gravitational attraction of qualities to one another, in the context of a certain image, is of the utmost importance by a system of sensory and emotional affinities.If mania or depression have since taken on the form we now recognize to science, it is not because over the centuries we have learned to "look" at the actual symptoms, not because we have purified our feelings to such a degree that , but because, in the experience of madness, these concepts are organized around certain statements of quality, and thus united, have important relations with each other, and ultimately enable perception.In this way, we have entered a field of nature from a simple description of pure ideas (fury without fever, stubborn ideas based on delusions).On the surface, this field is less rigorous, simpler, and without too strict boundaries, but it is fully capable of constructing the recognizable and perceptible units that actually appear in the entire experience of madness.This field of study is divided into two areas, ambiguously giving the two diseases their own type and structure.On the one hand, a dank, flooded world, in which man is deaf, blind, and insensitive to all horrors that are not his own, simplistic to the extreme and unreasonably exaggerated in it. a detail ofOn the other is a scorched, desert-like world, a frightened world where everything is fleeting and chaotic.These two themes in the cosmic schema of mania and depression cover precisely the experience (which is almost the same as our present experience) of these two disorders. Willis is fully qualified to be hailed as the "discoverer" of the alternating phenomenon of mania and melancholy because of his own research spirit and keen sense of medicine.Admittedly, Willis' approach is remarkable, especially at this point: the transition from one disease to another was not treated as an observed phenomenon - the problem was to find information about not to be interpreted—but to be seen as the result of a deep natural relationship.That natural relationship is determined by the structure of the hidden nature of the two diseases.Willis does not cite examples of alternation that he occasionally observes.One of the first things he discovered was an inner connection that caused the bizarre metamorphosis: "After discussing depression, we must consider mania, which is so inextricably linked that the two disorders often transform each other." In reality, it happens that when the melancholic tendency develops seriously, it turns into frenzy, and on the contrary, the frenzy gradually weakens, finally subsides, and turns into melancholy.A strict empiricist would see here a connection between the two diseases, or even two successive symptoms of the same disease.However, Willis does not ask the question from the point of view of symptoms, nor from the point of view of the disease itself, but only explores the link that connects the two states in the movement of animal vitality.We know that in melancholia the qi are gloomy; they cast shadows over objects and form a dark current.In mania, on the other hand, the energy is seething, its movements are erratic and cyclical, and heat is expended and given off even without fever.There is a clear affinity between mania and depression.It is not the affinity of symptoms linked by experience, but the stronger affinity, more evident in the imaginary picture, which unites smoke and flame in one and the same fire. "If it may be said that in melancholia the brain and animal energy are clouded with smoke, mania is like lighting a fire which was previously suppressed by the smoke." The flames drive the smoke away, and the falling smoke extinguishes the flames, remove its shine.For Gallis, the combination of mania and melancholia is not a disease, but a secret fire with conflicting smoke and flames, a mixture of light and shadow. Virtually all eighteenth-century physicians recognized the adjacency of mania and melancholia.Some, however, refuse to call the two phenomena of the same disease.Many people see an alternation but fail to perceive a unity of symptoms.Sydenham preferred to divide mania into two, a common mania arising from "an excessive boiling and rapid circulation of the blood", and a mania which tended to "grow into dementia", "The cause is that the blood is weakened by prolonged turmoil that has drained most of its essence." And more people admit that the alternation of mania and depression is either a metamorphic phenomenon or a deeper reason. The phenomenon.For example, Josephl-ieutaud believes that when melancholia lasts for a long time and its symptoms become more and more intensified, it loses its usual symptoms and becomes similar to mania: "Melancholia and mania in the final stage There are many similarities." But he does not expand on this similarity.In Dufour's view, the connection is not so close, but an indirect causal link.Melancholia can cause mania as much as "worms in the frontal sinuses or varicose vessels."At that time no study could transform the alternation into the elaborate and necessary structure of symptoms without the aid of an image. Of course, the images of smoke and flame have disappeared in Willis's successors, but images are still used in order to form a coherent result.The more these images are functional in nature, the more anchored in the big psychological ideas of circulation and heating, the more they move away from the cosmic images that Willis had borrowed.For example, Burhav and his commentator Gerard van Swieten argue that trample mania is quite naturally a melancholy of the highest degree, not just as a result of constant metamorphosis, but as The result of the necessary functioning; the stagnant cerebral fluid in melancholia becomes active after a while, as the black bile in the viscera becomes "healed and bitter" by standing still, and a more acidic The stronger and more toxic components, which are transported by the blood to the brain, cause intense anxiety in manic patients.Thus mania and melancholia differ only in degree, mania being a natural consequence of melancholy, arising from the same causes, and therefore generally receiving the same treatment.According to Frledrich Hoffmann, the unity of mania and melancholia is the result of the laws of motion and shock.But, with him, purely mechanical principles become a dialectic of the development of life and disease.Melancholia is actually characterized by immobility.In other words, or tuned blood fills the brain.Blood must circulate in the brain, but it is so thick that it is easily stagnated.If the thickness of the blood retards movement, it also sometimes creates a stronger shock.The more strongly the brain, cerebral blood vessels, and brain body are stimulated, the more resistant they are, and therefore the easier it is to harden.This hardening makes the thick blood flow back more violently.The movement intensified and soon became involved in that manic tumult.In this way, we naturally pass from a static blood-filled image to images of dryness, hardness, and rapid movement. Principles are revised and distorted at every stage. So one will add other images, but they are not constructive.They are merely many different interpretations of the achieved unity.For example, the explanation proposed by Snengler for the alternation of mania and melancholia borrows the principle of the battery.First, nerve energy and nerve fluid are concentrated in one place in the system.Only this section is stirred, the rest is dormant.This is the depression stage.But when this local load reaches a certain intensity, it will suddenly spread to the whole system and strongly stimulate the whole system for a certain period of time until the load is exhausted.This is the manic phase.From this level of interpretation, this image is too complex and complete, and the model it borrows is too indirect, so it cannot play an organizational role in the perception of a pathological unity.On the contrary, it is the association caused after the perceptual knowledge itself is based on the image with a preliminary unifying function. These unifying images have quietly appeared in James's "Dictionary of Medicine".One of them exhibits a phenomenon easily detectable by objective and fine-grained observation; the manic-depressive cycle. "It is absolutely necessary to classify mania and depression into one disease, to see them in the same light. For we have found from experiments and day-to-day observations that they both have the same cause . . . very strictly This is confirmed by our observations and our daily experience, for we see that melancholic patients, especially chronic ones, easily become manic, and that when the mania subsides, the melancholia resumes, every once in a while There will be such a repetition.” Therefore, in Hehe and the eighteenth century, what was constructed under the influence of imagery was a perceptual knowledge structure, not a system of ideas, nor even a set of symptoms.The evidence for this is that, as in perceptual knowledge, the transfer of qualities does not affect the integrity of the image itself.Thus Karen was able to find in mania as in melancholia "a principal object of the radium committee" and conversely attributing melancholy to "a hardening of the tissues of a certain part of the brain and body".What is important is that observations do not develop into constructions of explanatory images; rather, images reinforce the dominant role of synthesis, and their organizing power creates a perceptual structure in which symptoms eventually acquire their importance. value, and organized into visible truths. 2.hysteria and hypochondriac As far as these two diseases are concerned, there are two problems first. 1.To what extent are they justifiably considered mental illnesses or some kind of madness? 2.我们是否有根据把它们放在一起，把它们视为类似躁狂症和忧郁症那样的真正的对偶关系？ 要回答这些问题，只须简单地考察一下各种分类。人们对疑病症并不总是与痴呆症和躁狂症相提并论；歇斯底里更是很少与它们并列。布莱特（Felix Blater）根本没有把这二者列入感官病变之中。在古典时期末期，卡伦依然把它们列入非精神病的范畴：疑病症属于"体力衰竭，或因虚弱或因生命机能运转失灵而导致的疾病"；歇斯底里则属于"生理机能的控孪性疾病"。 此外，在病情图表上，人们很难发现这两种疾病因一种逻辑关系而被列为一组，甚至很难发现它们被列为相反的一对。索瓦热将疑病症列入幻觉——“仅仅关注自身健康的幻觉”，将歇斯底里列入痉孪。林亲（I－innaeus）田地采用同样的划分。看来，这俩人都是威利斯的忠实信徒。威利斯是在《痉挛病》一书中研究歇斯底里，而在论述头部疾病的《禽兽之魂》中研究疑病症，给它起名为"绞痛感"。这里无疑是在谈两种调然不同的疾病。在歇斯底里中，亢奋的精神受到相应的压力，从而造成一种印象；它们正在爆炸，正在引起超常的不规律运动。这种运动在精神方面表现为歇斯底里惊厥。反之，在"绞痛感"中，由于有一种东西有害干和不适于精神，因此精神激动不安，然后引起敏感的神经的骚动、失调和皱授。因此，威利斯告诫我们不必因症状上的某些相似而大惊小怪；诚然，我们看到痉孪会产生疼痛，似乎是歇斯底里的剧烈活动会引起疑病症的痛苦。但是这些相似是虚假的。"实质并不相同，而是小有区别。" 然而，在这些病情学家所做的固定分类的现象背后，有一种缓慢的努力正愈益频向于把歇斯底里和疑病症视为同一种疾病的两种形式。布莱克默（Richard Blackmore）于1725年发表《论疑病症和歇斯底里》。文中，这两种病被定义为同一种病的两种形式--"精神的病态"和"精神的外溢和消耗"。怀特（Whytt）认为，在18世纪中期，鉴别工作已经完成，从此症状系统统一了，包括"对冷热和身体某些部位疼痛的特殊感觉；晕厥和歇斯底里惊厥；强直性昏厥和痉挛；胃气和肠气；贪食；呕吐；小便清白但又急又多；消瘦和精神萎靡；神经性咳嗽；小零脉搏不齐；间发性头疼；间发性晕眩；视力衰退；压抑、绝望、忧郁以至疯癫；梦魔。" 另外，在古典时期，歇斯底里和疑病症逐渐被纳入精神疾病领域。米德（Richard Mead）在论述疑病症时还在说："这是一种全身性疾病。"而且，我们必须恢复威利斯关于歇斯底里论述的真正价值："在妇女疾病中，歇斯底里的名声很坏，就像是人已半入地狱一般（semi －damnati），它必须承担无数其他疾病的过失。如果一个妇女患上一种莫名其妙的病，我们既查不出原因，又不能确定治疗方法，我们马上就会归罪于子宫，而其实子宫往往受到冤枉。当我们碰到一种少见的症状时，我们就宣布，其中必有歇斯底里的踪影。这往往是掩饰我们对医疗对象无知的遁词。"凡是研究歇斯底里的材料都会引用这段文字。对于所有循规蹈矩的注释者来说，这段话绝不意味着威利斯认为歇斯底里症状没有器官基础。他仅仅明确地说，歇斯底里概念成了各种不切实际的想法的容器。这些想法不是病人的，也不是自以为有病的人的，而是本来无知却装作高明的医生的。实际上，如果说威利斯把歇斯底里视为一种精神错乱，那并不是因为他把歇斯底里列入了头部疾病，而是因为他认为歇斯底里的根源在于动物元气的性质、起因和初始过程发生了一种变化。 然而，到18世纪末，疑病症和歇斯底里已几乎毫无争议地成为精神病。一七五五年，阿尔贝蒂（Alberti）在哈雷城（Halle）发表论文《论疑病症病人的臆想症》（De morbis imagi －nariis hyPoch。driacorum）。接着，利厄托在确定疑病症的痉孪特征时，承认"精神上受到的影响不亚于、甚至重于肉体上的疾病；因此，疑病症一词几乎成了一个会得罪人的名称，想讨好的医生尽量避而不用。"至于歇斯底里，劳兰（JosePhRan！in）认为它没有任何器官上的原因，至少他在根本定义中从一开始就把它确定为一种臆想变态："患这种病的妇女虚构、夸大和重复各种胡思乱想，这种病有时具有流行性和传染性。" 因此，在古典时期，歇斯底里和疑病症有两个基本发展路线。一个是将二者统一为一个普通概念，即“神经病”，另一个是改变其含义和由其名称所充分显示的传统的病理基础，而倾向于将它们逐渐纳入精神疾病领域，与躁狂症和忧郁症相提并论。但是，后一种整合不是像在躁狂症和忧郁症中那样在图像价值中所感觉到的和所想像的原始性质的层面上实现的。我们这里面对的是一种完全不同的整合。 诚然，古典时期的医生也试图发现歇斯底里和疑病症所特有的性质。但是，他们从未能感知到类似躁狂症和忧郁症中标示出特点的性质上的相关性或紧密联系。人们所发现的各种性质是相互矛盾、相互否定的，因而无法解决这两种病的根本性质是什么这一问题。 歇斯底里常常被认为是遍及全身的内热的效果，一种兴奋状态，一种不断地表现为惊厥痉孪的迸发状态。例如，求仍的少女和年轻丧偶的寡妇，她们的歇斯底里常常与炽烈的情欲有关。而炽烈的情欲难道不是与这种内热有关吗？就本性而言，歇斯底里是狂热的；其症状更容易使人想起一种意象，而不是使人想到一种疾病。费朗17世纪初精细地描绘了这种意象。他在《相思病或爱欲忧郁症》中宣称，女人比男人更容易陷入爱情而不能自拔，而且她们很善于掩饰这一点。"此时她们的表情很像端放在圆筒上的蒸馏器，人们无法从外面看到火焰。但是如果人捆着蒸馏器的正下方，用手探摸一个女人的心，就会发现在这两个地方都有一个炽烈的火炉。"无论从象征意义还是从感情色彩或从比喻的手法来看，这是一个绝妙的意象。在费朗之后，过了很久，人们用湿热来描述歇斯底里和疑病症的隐秘的蒸馏过程。但是这个意象从属于一个更抽象的主题。在谢诺那里，这种雌性蒸馏器的火焰早已变成无色的了："我认为，歇斯底里并不是一种单一的病，在这个名称下包含着因一种有害雾气引起的几种疾病，这种雾气以不同的方式产生，受到污染，并经历了异常的沸腾状态。"而在其他人看来，从疑病区发出的这种高热完全是干燥的：疑病性忧郁是一种"干热"病，是由"类似性质的体液"引起的。但是也有些人在歇斯底里和疑病症中都没有发现高热现象，相反，这些病的性质是衰弱、迟钝和阴湿的，如同那些惰性体液的性质："我认为，这些病（疑病症和歇斯底里）若能持续一段时间的话，那就是出自大脑和神经纤维。由于它们怠情而衰弱、失去活力和弹性，神经液也变得虚弱无力，引起这些病。"也许对歇斯底里的性质的不稳定性做出最明确论证的是切恩的著作《英吉利病》。在切恩看来，这种病只能以抽象方式来维系自己的统一性。其症状散布在不同的性质领域，起因于各领域的各自不同的机制。各种痉孪的症状都源出于由"有害的苦涩的有强烈刺激的气体"所象征的一种发烧病理。反之，各种心理或器官虚弱的症状--"压抑、晕厥、大脑迟钝、昏沉、忧郁和悲伤"--显示了变得潮湿或虚弱的神经纤维的状况，神经纤维无疑是受到了阴冷勤稠体液的影响，这种体液堵塞了浆液腺和血管。麻痹则意味着神经纤维的僵滞，即通常所说的因固体惰性的冻结而造成的"颤动中断"。 确定躁狂症和忧郁症的性质特征是很容易的，而对于歇斯底里和疑病症则很难做到。 运动医学在论述它们时是很不明确的，其分析也动摇不定。显然，至少对于任何不否定自己的印象的感觉来说，躁狂症与一种过度的运动有关，而忧郁症则与运动的减弱有关。但是，关于歇斯底里和疑病症，则很难做出选择。施塔尔选择了血液会愈益沉重的说法，认为血液会愈益增多变浓，以致无法正常地流过门静脉；血液有一种在门静脉滞留和汇集的趋势，由于“血液力图在较高或较低部位打开一个出口”而造成了危机。相反地，布尔哈夫和范?斯维腾则认为，歇斯底里运动起因于各种液体的一种过分的流动性。这些液体变得十分不稳定，很容易被搅动起来。范?斯维腾解释道：“由于结构层弱，血液很容易被分解；它勉强凝结在一起，因此血清的浓度和质量都很差；淋巴液类似于血清的状况，血清所提供的液体也是一样。……在这种情况下，所谓无实体性的歇斯底里和疑病症就可能从神经纤维的这种特殊状态的部署中产生。”我们应该把“面色苍白的少女、用脑过度的人”很容易有的不适、控孪和疼痛归因于这种敏感性和流动性。歇斯底里既是活动的又是静止的，既有流动性又有动滞性，既起因于不稳定的振动又受到惰性体液的阻滞。谁也没有发现其运动的真实性质。 我们在化学类比领域看到同样的情况。在朗格看来，歇斯底里是发酵的结果，是由于“被送到身体不同部位的盐分”与“那里原有的体液”混合发酵的产物。另一些人则认为歇斯底里是碱性的。而埃特级勒（MichaelEttmtiler）则认为，这种病属于酸性反应，"直接原因是青的固有酸性；乳糜是酸性的，因此血液的性质受到腐蚀，不再能贻养元气；淋巴液是酸性的，胆汁也萎靡不振；神经系统备受刺激，而消化发酵成分因变质而不易挥发和酸性过强。"韦立德（Viridet）着手重构了关于"我们所体验到的雾气"的一种酸和碱的辩证关系，认为这二者在大脑和神经中的运动和剧烈冲突引起了歇斯底里和疑病症的症状。有些特别易挥发的动物元气是碱性盐，当它们十分稀薄时，流动极快，变成雾气。但是也有酸盐挥发成的雾气；乙醚使酸雾足以抵达大脑和神经，在那里"与碱遭遇，引起各种疾病"。 歇斯底里和疑病症的性质的不稳定性是令人不可思议的；它们的力学特性与其化学上的隐秘性质的混淆不清也是令人不可思议的。如果说从性质上对躁狂症和忧郁症做出诊断显得轻而易举的话，那么对歇斯底里和疑病症的辨别则显得犹豫不决。无疑，想像出来的性质图像对于构成忧郁症一躁狂症的对偶关系具有决定性作用，而在歇斯底里和疑病症的历史上则只有第二位的作用，可能只是不断变幻的布景。与躁狂症不同，歇斯底里的研究进展并没有引导人们走出以医学意象反映出来的这个领域的模糊性质。它的活动空间属于另一种类型，是机体作用和道德价值相互粘合的身体。 人们通常认为，是勒普瓦和威利斯将歇斯底里从所谓的子宫错位的古老神话中解放出来。李耶鲍（Jeanl．iebault）翻译或者说改写了马里涅罗（Marinello）的著作，以适应17世纪的标准。同时他有保留地接受了关于子宫的自发运动的观点，认为如果子宫改变了位置，“这是为了更自在一些；这不是出于某种慎思、吩咐或感官刺激，而是为了保障健康和体验某种享受”。无疑，子宫不可能像过去人们所认为的那样在人体大翻转时在全身移动，因为它被子宫颈、韧带、脉管以及腹膜“严格固定住”。但是它仍能改变位置：“尽管子宫严格固定在我们所说的那些部件上，因而不能改变所处空间，但它还是常常改变位置，在女人体内造成古怪的、任性的运动。这些运动是各式各样的：上升、下降、痉孪、游移、脱垂。子宫会上升到肝、脾、隔、胃、乳房、心、肺、咽喉和头。”古典时期的医生几乎一致反对这种解释。 在17世纪初，勒普瓦在谈到歇斯底里痉挛时写道："在各种病源中，有一个是最根本的，它不是通过交感而是通过原发病发挥作用。"更准确地说，这种痉挛惊厥的根源在于后脑积水："正如细流汇成大河，位于大脑表层和终止于后脑的空腔因处于头部的倾斜位置而大量积水。这些部位的热量使液体升温，影响了神经起端。"威利斯则对子宫说进行了细致的批判，认为，主要是大脑和神经系统疾病造成了"患这种病时血液运动的紊乱失调"。但是这些分析都没有彻底否定歇斯底里和子宫有一种基本联系的观点，而是改变了角度，不再认为这种联系是一种通过全身的实际错位，而是一种通过肌体的各种脉络，通过类似的功能脉络的秘密扩散。我们不能说病源已经变为大脑了，也不能说威利斯已为一种歇斯底里的心理分析创造了条件。但是，现在大脑对一种起源于内脏的疾病是起了一种中继站和配电器的作用。直至18世纪末，直至皮内尔之前，子宫一直出现在歇斯底里的病理分析之中，但不是因自身的性质而具有特殊重要性，而是作为体液和神经的特殊扩散的一个结果。 施塔尔通过对月经和痔疮的奇特比较，证明歇斯底里和疑病症的相似性。他在分析痉挛时解释道，歇斯底里是一种剧痛，“伴有紧张和压迫感，因此主要在疑病区以下被感受到”。当男人受到该病侵袭时，“会本能地通过呕吐或痔疮发作将过剩的血液排出”。这时就被称为疑病症。当女人受到该病侵袭时，“月经周期就会不正常”。这时就被称为歇斯底里。“这两种病没有实质上的区别。”霍夫曼的观点与之十分类似，但在理论上有许多不同之处。在他看来，歇斯底里的病因在于子宫的松弛和虚弱，但是与疑病症一样，其发病部位还需要在肠胃里寻找；血液和生命液在“肠胃的包膜和神经股”开始滞留；引起胃部紊乱，并由此蔓延到全身。处于机体中心的胃就像一个中继站，把出自腹腔下半部的各种疾病扩散到全身：“无疑，疑病症患者和歇斯底里患者所体验的痉挛，其位置在神经部分，尤其在肠胃的包膜上，病状由此通过肋间神经散布到头、胸、肾、肝以及全身各主要器官。” 霍夫曼赋予肠胃和助间神经的作用典型地表现出古典时期处理该问题的方式。这种方式不仅避开在子宫内寻找病因的旧传统，而且更重要的是致力于发现一种散布全身的、令状复杂的疾病的本原和散发途径。这里所要考虑的这种病是既能侵袭头部又能侵袭腿脚、表现为麻痹或运动僵硬的病，是能够造成强直性昏厥或失眠的病，简言之，这种病能迅速而巧妙地穿越肉体空间，在全身都有实实在在的体现。 那种坚持认为从马里涅罗到霍夫曼医学视野发生了变化的观点是徒劳无益的。在希波克拉底（HIPPocrates）传统中著名的子宫流动说三片平不存。或许只有某种主题还存在。这种主题现在变得更清晰了，即它不再局限于某一种医学理论，而是始终不变地贯穿于理论概念和解释性图式的速增过程之中。这个主题就是，肉体空间的运动起伏、下部力量的涌动。这些力量蓄之已久，过分充盈，便开始沸腾，最终不管是否经过大脑调节而把自身的无序扩散到全身。尽管生理学概念已经完全改组，但是这个主题却几乎一直不变地延续到18世纪初。十分奇怪的是，在18世纪，病理学中没有任何理论或实验上的革新，但是这个主题却突然受到修正，改变了方向，即肉体空间的动力学被情感道德取而代之。正是在这个时候，也只有到了这个时候，关干歇斯底里和疑病症的观念开始转向，明确地进入了疯癫领域。 我们现在应该试着来描述这个主题在其三个阶段的演变： 1.关于肌体和道德渗透的动力学； 2.关于肉体连续性的生理学； 3.关于神经敏感性的伦理学。 如果肉体空间被想像成一个坚实的、紧密联系的整体，那么歇斯底里和疑病症的无序运动只能出自于一种极其稀薄而且流动不止的成分，这种成分能够渗透进固体所占据的空间。正如海默尔（Nathanel Hishmore）指出的，动物元气"因自身火焰般的稀薄而能渗透密度最大的实体，......而且因自身的活跃而能在瞬间渗透整个微观宇宙。"如果这种元气流动性增强，而且以极其混乱的方式渗透到身体中各个不适当的部位，那么就会引起无数复杂的失调症状。不论对海默尔，还是对其反对者威利斯或对西德纳姆来说，歇斯底里是一种肉体疾病，因为肉体能被元气以各种方式渗透，因此有着内在秩序的器官变成了一堆消极地屈从于元气的混乱运动的物质所寄寓的松散空间。这些元气"猛烈地涌到某个部位，在那里造成痉挛甚至疼痛，......并使器官功能失调，无论是被元气遗弃的器官，还是元气所涌入的器官，都会因元气分布的不均衡而受到严重损害，因为这种不均衡完全违背了生理系统的法则。"处于歇斯底里状态的身体就是这样听命于无序的元气。元气完全不受任何肌体法则和任何功能要求的束缚，因此能连续地侵袭身体的各个空间。 各个区域受到的影响各不相同，后果也不相同。这种疾病的运动根源是没有分殊的，但是因其穿越的空间和在身体表面显现的部位不同而具有不同的形态。“它们在胃里积聚，然后突然涌到咽喉部的肌肉，在所穿越的整个区域造成痉挛，在胃里造成肿胀，如同一个大球。”歇斯底里在稍高的位置上，“侵袭结肠以及心脏下面的区域，引起难以忍受的疼痛，很像骼骨区的疾病。”如果该病升得更高一些，就会侵袭“中枢部位，引起剧烈的心悸。病人此时确信，护理人员应能听到他的心脏撞击肋骨的声音。”最后，如果疾病侵袭“头部的外围、头骨之间的部分，并固定在一个地方，就会引起刚烈的疼痛，并伴有剧烈的呕吐。”'刀'身体的各个部位因本身的情况和特点而决定了症状的不同表现。因此，歇斯底里显得是最真实又最有欺骗性的疾病。它是真实的，因为它是以动物元气的运动为基础的；但它又是虚幻的，因为它所产生的症状似乎是由器官内在的无序造成的，而这些症状其实是一种中枢的或普遍的无序在器官层面上的形成物。正是一种内在流动的错乱在身体的表面表现为局部症状。器官实际上是被无序而过分的元气运动所侵扰，但却装作自己出了毛病；从内部空间运动的某一缺陷开始，器官完全模仿自身才会产生的错乱；歇斯底里用这种方式“模仿出人的肉体的几乎所有疾病，因为它在人体中无所不在，它能立刻造成符合该部位的症状。如果医生既不聪慧又无经验，就很容易被欺骗，会把歇斯底里的症状归因于该部位的某种常见病。”'凹'这种病的策略就是，它以同一形式的运动穿越肉体空间，表现出不同的外观，但是这里的性状不是本质，而是身体耍的一个花招。 体内空间越容易被渗透，歇斯底里就越频繁，其外观也越变化多端；如果身体健壮，抵抗力强，如果体内空间紧密，而且不同区域的质地参差不齐，那么歇斯底里的症状就很罕见，其效果也单一。不正是这一点使女性歇斯底里与男性歇斯底里，或者说；使歇斯底里与疑病症有所区分吗？实际上，不是症状，也不是病因，而是身体的空间坚实性或者说内部密度构成这些病的区分原则。“除了由可感觉的各种部件组成的所谓'外在的人'，还有一个由动物元气系统构成的'内在的人'，后者只能用精神的眼睛看到。后者与体质紧密相联，因人的状态不同而或多或少有些紊乱，其程度取决于构成这架机器的本原的自然坚固性。这就是为什么步入比男人更容易受到这种病的侵袭，因为女人的体质更纤细而不那么坚固，因为她们过着较温和的生活，因为她们习惯于舒适的生活，而不习惯于受苦。”就在上面这段文字中，已经包含着空间密度的一个涵义：它也是一种道德密度；器官对元气的无序渗透的抵抗力可能也是灵魂保持思想和欲望的井然状态的能力。这种变得疏松的空间，可能完全是心灵的松懈造成的。这就解释了为什么习惯于艰苦劳作的女人很少患歇斯底里，而当她们生活舒适、闲散时，或当某种悲苦压倒她们的意志时，就非常容易患歇斯底里。“当一些妇女向我咨询某种我无法判断的疾病时，我便问她们，是否只是在心情悲痛时才引发这种病，…如果她们大体上承认这一点，那么我就能断定，她们急的是一种歇斯底里。” 这样，我们就对古老的道德直觉有了一个新的概括。希波克拉底和柏拉图的时代起，这种直觉就把子宫当作一个有生命的、运动不止的动物，并且对其运动的空间加以规定；这种直觉在歇斯底里中感受到一种不能控制的欲望骚动，因为病人既不能满足它们又不能驾驭它们；女性器官意象上升到胸部和头部的说法反映了柏拉图主义的灵魂三元说中的一种剧变和力图确保自身静止不变的等级序列中的一种剧变。对于西德纳姆来说，对于衡卡儿的信徒来说，道德直党始终如一，但是借以表达道德在觉的空间画面发生了变化；柏拉图的垂直的等级秩序被一个立体空间所取代。这个空间被不停的运动来回横切。这种无序的运动不再是底层上升到高层的革命，而是在一个混乱空间中的无规律的旋风。西德纳姆试图用“精神的眼睛”洞察这个“内在的身体”，因为它不是客观视察的迟钝目光所能看到的客观身体，而是一个场所，在那里，一种想像这种身体和译解其内在运动的方式同一种赋予它道德价值的方式紧密结合。在这种伦理知觉层次上的发展到此完成。在这种知觉中，一贯柔顺的医学理论意象发生了曲折和变化；在这种知觉中，重大的道德主题也得到系统的表达，并逐渐更新了原初的面貌。 然而，这种易渗透的身体应该是一个紧密结合的实体。疾病在各器官的弥散反过来说则是一种允许其扩散并连续影响各器官的传播运动的结果。如果说疑病症患者或歇斯底里患者的身体是一种疏松的、自我分离的、因疾病侵袭而膨胀的实体，那么这种侵袭则必须借助于某种连续空间才能实现。疾病借以循环流动的实体应该有不同于扩散的症状借以显现的身体的特性。 这个问题困扰着18世纪的医学，导致人们将疑病症和歇斯底里视为"神经方面"的疾病，即一切交感作用的一般媒介的原发病。 神经纤维被赋予某些引人注目的特性，从而能够将异质因素整合在一起。神经传送着各种迥然不同的印象，而它在任何地方、任何器官里都应该有同一性质。这样说能不令人惊异吗？“神经在眼珠后面的伸展使人能够接收微妙的光亮；听觉器官的神经对发声物体的振颤十分敏感；但是就性质而言，它们与触觉、味觉和嗅觉等较迟钝的感觉神经毫无区别。”这种功能各异而性质同一的特性，保障了相距最远的和生理上调然不同的器官之间进行交流的可能性。“人体神经的同质性以及各种相互维系的器官之间的无限交流……确立了器官之间的和谐，从而常常导致一处有病，多处受害。”但是，更令人赞叹的是，同一神经纤维能同时传送某种无意识运动的刺激和感觉给器官留下的印象。梯索（Simon－Andr6TISS。t）认为，这种同一神经的双重功能是两种运动的结合。一种是造成无意识刺激的波荡运动（"这是一种装在弹性容器中的液体运动，比如，液体装在皮囊中，挤压皮囊，液体就会通过一个管道喷出。"）另一种是造成感觉的粒子运动（"这是一连串象牙球的运动。"）因此，同一神经能够同时产生感觉和运动。正如我们在各种神经疾病中观察到的，神经的紧张和放松都会同时改变那些运动和感觉。 然而，尽管神经系统有这些统一的性状，我们是否就一定能用神经纤维的实际网络来解释歇斯底里和疑病症的如此纷繁的紊乱之间的内在联系呢？如何来设想披露了某种神经疾病的各个部位的症状之间的联系呢？如何通过探究这种联系解释某些“极其敏感”的女人会因闻到一股浓烈的香味、听到关于一个悲惨事件的生动描述或看到一个厮杀场面而“晕厥”？人们的探寻是徒劳无益的：没有发现任何明确的神经联系，也没有发现任何从这种根源延伸出来的途径，而只是发现了一种基于生理相关性秩序的、间接的作用。这是因为身体的各个部分都具有“十分确定的官能，这些官能要么是普遍的，遍及整个人体，要么是特殊的，主要影响某些部位。”感觉和运动的双重官能使器官互相交流、同甘共苦，并能对来自远处的刺激做出反应。这种特性就是交感作用。实际上，怀特既未能将交感作用完全归因于整个神经系统，也未能从与感觉和与运动的关系上来界定它。交感作用在器官中的存在完全取决于它在那里是否能通过神经的中介而被接收到；神经越灵活，交感作用就表现得越明显，与此同时，交感也是感觉中的一种：“各种交感都以情绪为前提，因此只能透过神经的中介而存在，而神经完全是感觉借以运作的上具。”然而，神经系统在此不是被用于解释对运动或感觉的传送，而是被笼统地用于确认身体对自身现象的敏感性、确认身体在肌体空间的各个部分产生的共鸣。 神经疾病本质上是交感的混乱；其前提是神经系统的普通警觉状态，这种状态使各个器官都可能与其他器官产生交感：“在神经系统的这种敏感状态下，刻骨铭心的激情、饮食习惯的破坏、气候冷热湿闷的突然变化，都很容易产生病状；在那种状态中，人们也不能保持身体健康，通常会有各种连续不断的疼痛感。”无疑，这种过度的敏感都会伴有迟钝、困倦；一般而言，歇斯底里患者的内向感觉是极度敏锐的，而疑病症患者的敏感程度要小些。当然，女人属于前一类，因为子宫以及大脑是与整个肌体发生交感的主要器官。“子宫发炎通常都伴有呕吐；怀孕会引起恶心、反胃；分娩时阴道隔膜和腹肌会阵缩；月经期间会出现头痛、轻微发烧、腰背疼痛和腹痛。”女性全身都遍布着不可思议的模糊而直接的交感通道。女性的身体总是处于自我交流之中，从而形成一种对于交感绝对有利的场所。女性的肌体空间永远包含着歇斯底里的可能性。女性肌体的交感感觉散射到其全身，使女性易于患上被称为忧郁症的神经疾病。“女人的身体系统通常比男人更灵活，因此更容易患神经疾病，而且女人的神经疾病也更严重些。”怀特言之凿凿地说，他曾目睹“一个神经脆弱的少女因牙疼而昏厥，持续几个小时不省人事，直至疼痛更剧烈时才醒过来。” 神经疾病是相连肉体的疾病。自我感觉过于敏感的身体，各部位过于紧密的身体，在某种意义上不可思议地紧缩的肌体空间，此时已成为歇斯底里和疑病症的共同母题。对于某些人来说，身体与自身的亲密关系表现了一种准确的意象，如庞默所描述的“神经系统的萎缩