All psychasthenic patients exhibit, at some time or other, certain symptoms which appear suddenly, under certain conditions, and which seem, at first to be completely inexplicable. The symptom may take the form of general discomfort, fear or anxiety, or be more physical - pain, dizziness, nausea, palpitations, etc.

The inexplicable cause of such a symptom is actually an ancient impression, crystallized in the brain so to speak, which always produces the same symptom through an unconscious mechanism. Patients are therefore almost always unaware of this mechanism or, if they do know about it, do not connect it to the symptom. We call this the "cliché mechanism" because of its persistence.

Here are a few examples:

1. Mrs. N... suffered for ten years from a stomach disorder characterized by vomiting at mealtimes. She had no organic illness, and could not find any plausible reason for the symptom herself. After a minute scrutiny of her past, she remembered suffering from a violent emotional shock ten years before, just as she sat down to a meal. It was this incident, buried in her subconscious, that was causing her nausea: once the cliché was identified, the symptom disappeared.

2. In addition to the usual symptoms associated with psychasthe-nia, a certain Mr. B... presented the following behavior: after twenty minutes of walking, he would always start sweating profusely, his legs would start trembling, and he would have to sit down and rest for some time before continuing. This had been going on for seven years, and was probably the result of a severe flu he had once contracted, which had kept him in bed for three weeks. The first time he took a walk after recovering, he developed the symptoms, which persisted, although there was no organic reason. However, as soon as he became aware of the cliché, the symptoms ceased.

3. Another case concerns Mr. L... who suffered for a number of years from palpitations, brought on by the slightest effort. We identified the cause as a medical consultation during which the physician told him to be careful about his heart. The palpitations disappeared as soon as Mr. L became aware of their origin.

We could cite many more examples, since almost all patients have a certain number of cliché symptoms which are more or less pronounced.

In addition to symptoms like vomiting, diarrhea etc. a cliché can cause psychological symptoms, particularly fear, depression and anxiety. Identifying a cliché usually happens in the patient's subconscious memory of the original event, without there being any obvious connection between the event and the symptoms as they continue to arise - at least it is impossible to determine through what process of deduction the brain connects the two. However, in some cases the connection can be identified, as we will see from the following:

One of my patients could not stand seeing or hearing the number 3, which always caused her to experience violent feelings of anxiety. We found the key by accident: a relative, to whom she felt very close, had had a serious accident a number of years before, on the third day of the month. The patient had completely forgotten about the cause, but still exhibited the symptom - a subconscious aversion for the number three.

The cliché symptom will usually disappear as soon as patients become aware that it is only a reaction to a past impression, and has no relation to the present moment. However, in some cases the cliché is so strong that it cannot be gotten rid of so easily.

In these cases, patients must make a voluntary effort to remember the event, until the brain is under control. When the cliché is consciously and voluntarily recalled, it does not produce any psychological or physical symptom.

It is therefore important to look for these clichés and make them conscious again, so that patients can modify them be exercising their judgment and willpower.

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