Janet titled his book
Obsessions and Psychasthenia
Janet titled his book Obsessions and Psychasthenia |
Pierre Janet (1859-1947), a French psychiatrist, published a book concerning obsessions and compulsions in 1903. His 750-page tome has never been translated into English. However, a detailed English-language synopsis is available, from which this excerpt is taken.
In interviews [Janet wrote], obsessive patients usually experience great difficulty and reluctance in divulging the content of their obsessions and compulsions, which often involve forbidden thoughts and acts of a sacrilegious, violent, or sexual nature. Their reporting is universally accompanied by remorse, as if the imagined acts had actually been committed. Some patients feel remorse about every action they perform. Obsessions of shame of the self and the body are common. There is often a sense of doing things wrongly and imperfectly.
If the sufferer can admit to having done a good deed, he will impugn the motive behind it. Everything is doubted....
Obsessives tend not to worry about things outside their control but rather about things within their (imagined) control.... These actions are generally bad, the opposite of what the patient wishes to do. One patient, asked why she thought of killing her daughter and not her husband, responded, "Oh, my husband, I don't love him enough to think of killing him." Thus obsessions and compulsions often involve the thought or action that is most objectionable to the patient and causes him the most horror; this has been referred to as "association by contrast."
... One property of obsessions is their easy evocability, even by peripherally connected ideas. For example, the patient Jean avoided wearing a certain pair of shoes because they made him think of a woman with whom he was obsessed. The connection was that the shoes had the number "49" on them, and the woman had been age 49 when his obsession with her had begun. Obsessional ideas may spread like an oil slick to include more and more peripherally related ideas.
[Another class of symptoms] demonstrate a need for precision or perfection in perceptions and actions. They include manias of order and symmetry. If Jean on arising, chances to view a red object on his right, he needs to find one on his left. Arithmetic manias arise because numbers are seen as precise. Symbolism plays a large role in the malady and the mania of symbolism is also related to the need for precision, to express with sharpness feelings and ideas about which the patient is uncertain. For Lod . . . pivoting on the heels symbolizes religion "because one turns sideways to bow before the altar when one passes in front of it."... The mania of slowness arises from the fear that an action done quickly won't be done precisely, and the mania of repetition arises from the feeling of discontent with the way an action was previously performed; as does the mania of going back (checking)....
These patients are characteristically thin, pale, and drawn and frequently have dry skin and bad breath, all of which tend to improve when their psychological troubles do....
[Their personality] is generally one of timidity. They often have a horror of physical exercise, are awkward, and don't know what to do with their hands. If there's anything they find more painful than a decision, it's a fight, and they will sacrifice their own interests to avoid one. They think in terms of perfectly honest and ideal worlds and wouldn't dream of injuring anyone. Their dispositions are usually melancholic....
Somatic treatment. When a psychasthenic [a broader term that encompassed OCD sufferers] does come to the attention of a physician, because he is likely to consider himself unique and not amenable to treatment, the physician should not express surprise at the symptoms but rather demonstrate familiarity with them.... Proper nutrition, sleeping habits, fresh air, and avoidance of fatigue should be emphasized, and any underlying medical conditions treated. Bromides in high doses may be useful for agitation. The author has infrequently prescribed opium for those suffering from great anxiety, though the danger of addiction usually outweighs the potential benefits. Because the patient's excitation is secondary and a manifestation of a diminution of central nervous activity, tonic medications and cold hydrotherapy may be helpful. (pp. 293-5, 302, 309, 312)
*See Pitman, 1991, for a comparison of Freud's and Janet's theories of obsessional illness.