when he sat down, lowered his head and vividly conjured up the image of a flower, he saw it undergoing changes of its own accord, as if entering into new combinations.
In half-waking states these manifestations are relatively frequent in the so-called hypnagogic hallucinations. The automatisms which the Goethe example illustrates, are differentiated from the truly somnambulic, inasmuch as the primary presentation is a conscious one in this case; the further development of the automatism is maintained within the definite limits of the original presentation, that is, within the purely motor or visual region.
If the primary presentation disappears, or if it is never conscious at all, and if the automatic development overlaps neighbouring regions, we lose every possibility of a demarcation between waking automatisms and those of the somnambulic state; this will occur, for instance, if the presentation of a hand plucking the flower gets joined to the perception of the flower or the presentation of the smell of the flower. We can then only differentiate it by the more or less. In one case we then speak of the “waking hallucinations of the normal,” in the other, of the dream-vision of the somnambulists. The interpretation of our patient’s attacks as hysterical becomes more certain by the demonstration of a probably psychogenic origin of the hallucination. This is confirmed by her troubles, headache and tenosynovitis, which have shown themselves amenable to suggestive treatment. The ætiological factor alone is not sufficient for the diagnosis of hysteria; it might really be expected a priori that in the course of a disease which is so suitably treated by rest, as in the treatment of an exhaustion-state, features would be observed here and there which could be interpreted as manifestations of exhaustion. The question arises whether the early lapses and later somnambulic attacks could not be conceived as states of exhaustion, so-called “neurasthenic crises.” We know that in the realm of psychopathic mental deficiency, there can arise the most diverse epileptoid accidents, whose classification under epilepsy or hysteria is at least doubtful. To quote C. Westphal: “On the basis of
