Insistent and Fixed Ideas. 
BY 
EDWARD COWLES, M. D. 
Professor of Mental Diseases, Dartmouth Medical 
College. Medical Superintendent, McLean 
Asylum, Somerville, Mass. 
Reprint 
PROM 
THE AMERICAN JOURNAL OF PSYCHOLOGY, 
Baltimore, February, 1888. PRESS OF ISAAC FRIEDENWALD, 
BALTIMORE. INSISTENT AND FIXED IDEAS. 
EDWARD COWLES, M. D. 
The student of introspective psychology must assume 
a standard of cerebral and mental health as the basis 
of his study. It must be sought in the healthy mind 
in a healthy brain ; these are the inseparable subjects 
of the inquiry. 
The student of insanity must assume, in like man- 
ner, the same standard of soundness for that which is 
insane, and he must study it in the terms of psychol- 
ogy ; and the physiological basis is definite enough, if 
the communications with it are maintained, to permit 
safe and even bold excursions among the dangers of 
error that beset the path of the purely intuitional 
school. With practical reference to such a standard, 
modern psychiatry has the credit of having differ- 
entiated two general groups of idiopathic mental dis- 
orders. The first group includes those that may 
happen to any healthy mind in a healthy brain, and 
are manifested in typical and regular forms and courses 
of mental phenomena. The other contains those that 
occur in unstable minds correlative to constitutional 
brain defect—hereditary or acquired—and that are 
manifested in more or less irregular forms in which 
the phenomena are made distinctive by being modified 
and varied in their order and degree from those in the 
first group. The term “ordinary insanity” has been 2 
COWLES : 
applied to the disorders that spring from a relatively 
sound physical basis. The modern use of the term 
“paranoia” has been gradually enlarged till it tends 
to include all manifestations of hereditary and ac- 
quired chronic instability of mind. Thus there may 
he “ordinary insanity” in relation to the healthy 
brain, and “paranoia” in the unstable mind and 
defective brain. The general relation of these phys- 
ical and psychical elements may thus be stated in 
terms of function: as the stable mind is to the unstable 
one, so are the disorders—psychoses—incident to the 
former, to the degenerative psychoses in the latter— 
or so is ordinary insanity to paranoia. 
While pathology and psycho-physics are striving to 
let in the light upon the mechanism of mental phe- 
nomena, the clinical student must not wait for their 
guidance. His work is as essential to the elucidation 
of the truth, and his data are definite, tangible, and 
constant enough to endow them with scientific values. 
The science of psycho-pathology deals directly with 
the ce,ntral object itself ; the mind is the man, and the 
conservation of mental integrity is the aim. In the 
minute study of the psychical elements involved the 
clinical student has in his field as important a branch 
of the new psychology as the pathologist or the psycho- 
physicist; all must work together in the solution of 
the problems. 
The recent words of Sir James Paget, upon another 
subject, are as applicable here, that the sick-room is 
a laboratory with its crucial experiments as real as 
those in which “ culture experiments ” are instituted 
in bacteriology. Kraepelin, speaking of natural science 
as the great method in medicine, says that “ only by 
the inner connection of brain pathology with psycho- INSISTENT AND FIXED IDEAS. 
3 
pathology can we succeed in finding the laws of the 
reciprocal relation between somatic and psychic dis- 
turbance, and thus get to a really deeper understand- 
ing of the phenomena of insanity:”1 Sir J. Crichton 
Browne strongly stated, in 1878, the absurdity of rest- 
ing upon an intimate knowledge of brain-cells, or of 
the deviations from healthy mental states in which 
insanity consists. Advancement must be made on 
both these lines, which must converge and unite. 
“ But,” he also says, “ in that particular branch of 
psychology that is conversant with morbid mental 
states, little or no work is being done in Great Britain. 
In the literature of insanity of to-day there is no 
attempt at mental analysis, and only a most perfunc- 
tory attempt at a classification of the expressions and 
products of the diseased mind.”2 Exner also, in his 
remarkable study of cerebral localization, found reason 
to complain of the inadequacy with which clinical 
symptoms are described in asylum reports.3 
To a better purpose is Kandinsky’s very full and 
exceptionally fine study of three cases of hallucina- 
tions. He says : “ What is wanted, first of all, is a 
severe, accurate and detailed study of the phenomena 
of hallucinations, and but very few (three by Sander 
and one by Pick) have been studied with sufficient 
care.1 In modern psychiatry there is an evident ten- 
dency to return to the study of psychical phenomena 
and to break away somewhat from the dicta of the 
cerebralists. Insanity, in its origin at least, may be 
1 Kraepelin, Compendium der Psychiatrie, 1883, p. 3. 
2 Presidential Address, British Medico-Psychological Association, 
Journal of Mental Science, Oct., 1878. 
3 Exner, Localisation der Functioned, 1881, passim. 
4 Kandinsky, Kritische unci Klinische Betrachtunpen, 1885, p. 2 et seq. 4 
cowles : 
as much a matter of disorder of the mind as of disease 
of the brain.1 
Accepting the proposition that every manifestation 
of mind is correlated to a definite mode and sphere of 
brain activity, and the aim being a convention of the 
two lines of study, the indications are plain to the 
alienist. Psycho-pathology demands, upon one of 
these lines, careful and detailed analyses of morbid 
psychical reactions. This article is an attempt to 
comply with that demand. 
From the clinical point • of view the student finds 
himself in a region of ever-widening interest and nov- 
elty, for so much of it is unexplored. In examining 
these products, some salient or eccentric growth brings 
to light or emphasizes common factors of the whole 
that would otherwise remain obscure. The infinite 
variety of the human mind is in nowise more plainly 
revealed than in its aberrations. In the whole range 
of its special powers or qualities they may become, 
singly or in groups, more conspicuous by their relative 
luxuriance or exaggeration, or by their absence or 
weakness and impairment. In the broad borderland 
of minor and partial aberrations there is an instructive 
field for study. At the points of departure from the 
normal states of mind is to be sought the genesis of 
mental disorders, and their nature is shown by the 
study of their origins. The nature also of the normal 
faculties themselves may be thus made clearer. 
A most fertile source of such knowledge is to be 
found in that great group of limited disorders of 
ideation called “fixed ideas.” In the understanding 
of these affections a great advance has been made 
within the last few years. They have been studied, 
1 Cf. Savage, Insanity, 1S84, pp. 4, 21. INSISTENT AND FIXED IDEAS. 
5 
especially by the Germans, French, and Italians, 
during the last thirty years, and many names given to 
different varieties, but it remained for Tamburini1 to 
show the common relation of these affections under 
the term Zwangsvorstellungen, first applied by Krafft- 
Ebing. They include the “metaphysical insanity,” 
“insanity of doubting,” and the many forms of 
“ fears ” of places and things. 
Kandinsky mentions the difficulties of getting the 
intelligent co-operation of patients in his studies of 
hallucinations. The importance of the study of “ im- 
perative conceptions ” is as great; and while its profit 
may be relatively much greater as touching earlier 
stages or less degrees of aberration, in these cases also 
the comparative integrity of the intelligence, except 
as specially involved, is a great aid. It is curiously 
possible to enucleate, as it were, certain well defined 
ideas and feelings, and to study their reactions 
between each other and the will. 
The general characteristics of “ the cases yet de- 
scribed ” are thus briefly stated by Tamburini: “ 1st. 
That side by side with a fixed idea which is accom- 
panied by fears more or less distressing, and an over- 
powering impulsion to certain acts, consciousness of 
the absurdity of such acts usually remains complete. 
2d. That in all there is an almost absolute impotence 
of the will, not only to control the absurd ideas, but 
also an irrestrainable tendency to those acts. 3d. 
That in almost all the cases there was a very conspic- 
uous hereditary predisposition to psychopathic dis- 
orders.” 
1 Revista Sperimentale di Freniatria, Fascicolo 1, 1883. Translated 
by Joseph Workman, M. D., Alienist and Neurologist, January, 
' 1884. 6 
cowles : 
A varied collection of cases of these affections has 
afforded the writer a study of great interest for a 
number of years. In these cases the relation seems 
to be clearly shown of these limited ideational dis- 
orders to primary delusional insanity, as indicated by 
WestphaPs designation of them as “ abortive mono- 
mania.” Not only this, but in my observations there 
appears to be ample evidence that there may be every 
degree of development of these disorders, from the 
slightest departure from normal intellection to pro- 
nounced delusional conceptions. Also, that instead of 
passing in the typical way from stage to stage, the 
process may be arrested at any point in its progress 
and remain at a chronic stasis during the remainder of 
a lifetime. There is a multitude of the cases of the 
minor degree which, as far as they go, have all the 
essential characteristics of “ fixed ideas,” but in which 
the “idea” is not so “fixed” as to be always domi- 
nant ; it can be resisted more or less successfully at 
will, in the milder cases, which are in a large majority. 
The ideas are simply insistent, and the term “ insistent 
ideas” is here proposed as being the more generic, 
and as including all forms, some of which become 
“imperative” and “fixed.” Here the words “idea” 
and “fixed idea” are distinctive, in contrast with 
“delusion” or “fixed and limited delusion.” The 
one is not a belief, while the other has attained the 
pronounced degree of an insane belief. 
Again, contrary to the conclusions of writers on 
the subject, it would appear that these affections are 
not “ chiefly limited to a constitutional origin, espec- 
ially to heredity.” Here arises one of the most inter- 
esting questions. Primary systematized delusions so 
characterize paranoia, and so close is the relation INSISTENT AND FIXED IDEAS. 
between them and fixed ideas or imperative concep- 
tions, that these also are included in paranoia by 
many writers, with the implication that these affec- 
tions always signify a constitutional origin in either 
acquired or hereditary defect. But degenerative 
psychoses are not manifestations of new powers 
acquired by morbidity in the organism : there is not 
more mind in the paranoiac brain. The criterion of 
insanity is not essentially the formulation of incon- 
gruous, “insane” conceptions — this is common 
enough in the sane mind and healthy brain,—witness 
dreams, the play of the imagination, etc. The inability 
to correct some of these, or to inhibit others, consti- 
tutes the insanity. Of imperative conceptions we 
should expect, a priori, to find that the conceptions 
are common enough to sound minds. But where, in 
the scale of increasing insistence, fixedness, or im- 
perativeness, does evidence begin of their having a 
paranoiac basis of hereditary or acquired defect and 
mental instability ? So, too, of systematized delu- 
sions ; if but rare in a sound mind, this is enough to 
establish the premise. 
Proper conservatism, demands at least a stay of 
inferences and implications in this matter. It might 
be expected to be nearer the truth to say that insistent 
and fixed ideas, especially in their milder and often 
“ corrected ” forms, are common to healthy minds and 
brains, or to those which have no more “ acquired 
instability ” or neurasthenia than would be argued 
as existing in a melancholia or mania of an ordinary 
insanity. As forming a symptom group of ideational 
disorders in the prodromal or abortive stages of 
ordinary insanity, they become, like delusions, empha- 
sized in paranoia. Thus these affections being once 8 
COWLES : 
initiated, the gravest forms are simply more likely to 
be developed upon a basis of neurasthenia or the more 
radical paranoiac conditions ; in other words, when 
there is hereditary or acquired nervous and mental 
instability. 
In regard to other views that have been held of 
these affections, it does not seem necessary to delve 
deeply into the mysteries of “ the inconscient ” for an 
explanation of all these anomalies. Again, the com- 
mon kinship of the recognized varieties of these affec- 
tions, as shown by Tamburini, is finely demonstrated 
in a number of my cases, in which there have been 
developed, in succession in each individual case, several 
of the distinct forms. These transitions are not unusual, 
and it is probable that some of the forms now recog- 
nized as distinct, if it were possible to trace them to 
their origin, would be found to be secondary to the 
more common primitive ones. 
It is not the present intention to attempt a demonstra- 
tion of these propositions, which are thus broadly stated 
for the sake of indicating the nature and the interest 
of the questions that arise in these investigations. The 
limits of this article permit simply a detailed account 
of a case in which there is much to sustain the fore- 
going propositions. The unusual intelligence of the 
patient allowed a long series of mental phenomena, 
occupying years, to be traced even from their origin. 
At the outset the case was a common one of the 
“insanity of doubting,” in which the idea was that 
simple acts were not right and it was necessary to 
repeat them to make them so. The complications that 
followed, and the stages of the malady through which 
the patient passed, came partly by logical evolution 
from the false premises, and partly from the growth of INSISTENT AND FIXED IDEAS. 
9 
a habit of methodizing thought and action ; the latter 
was a characteristic process of circumvention of the 
limited imperative conception, against which the will 
was powerless for direct resistance. The processes of 
evasion were invented and systematized by a keen intel- 
ligence, and carried out by an otherwise efficient will, 
to the effect of accomplishing the desired purposes 
without directly antagonizing the fixed ideas. An 
interesting feature of the case is the unique combina- 
tion of the characteristic “fear” of the patient for 
herself, with a “ fear ” in behalf of, and a “ jealousy ” 
against, another person, for whom she had both 
“ love ” and “ admiration.” The interplay and compli- 
cation of these feelings are illustrations also of the 
probable fact that the abnormal association of “ ideas ” 
and their accompanying “feelings” may commonly 
enough involve in like manner other feelings than 
the “fears” of which so many varieties are named. 
This case with its extended details is here presented as 
a preliminary study of the subject. The medical “ re- 
porting ” of such a personal history is justified by the 
proffered permission of this lady and by other proper 
consent. 
Miss M. came under my care as an asylum patient 
at the age of 28 years. She was of a good family in 
heredity and otherwise ; and both the parents were 
then living, and over 70 years of age. She was the 
youngest of ten children, all of whom had been healthy 
except two sisters who died of phthisis after marriage. 
The patient had a good physique, was a little above 
the average stature, and in good bodily health in all 
particulars. She soon established herself, in a com- 
pany of lady patients of the better or convalescent 
class, as a person of more than ordinary intelligence 10 
cowles : 
and good sense, and as usually amiable, pleasing and 
dignified in manner; though reticent, she was not 
unsocial. She was disposed, however, to dress very 
plainly and to be negligent in this regard, in a way 
that was inconsistent with her evident appreciation of 
what was pleasing and proper. Her intellect was, 
to ordinary observation, apparently unimpaired, and 
for a period of more than two years she revealed her 
morbid mental peculiarities to none but two of her 
physicians. She was well informed, read good books, 
chose the most intelligent persons as companions, could 
easily follow and take part in a psychological analysis 
of her own case, was keen of insight and quick at 
repartee. She was depressed at times and inclined to 
seclude herself in her room, and later she was some- 
times irritable and sarcastic toward her associates ; 
but in general she was known to them only as possess- 
ing the creditable characteristics above described. In 
brief, she was in many respects an interesting person. 
To her physicians, however, she presented a medley 
of curious and inconsistent symptoms. She was 
admitted to the asylum as a case of suicidal melan- 
cholia, but as a “voluntary patient” (without a 
regular examination and commitment as an insane 
person). The immediate* cause of her coming was a 
suicidal act. It is of special interest and importance 
in the diagnosis of some cases of primary disorders of 
intellection to differentiate them from those of the 
feelings characterizing true melancholia; this case 
strikingly illustrates the relation and contrast between 
these two forms of mental disease. To make this plain 
it is necessary to give an outline of this patient’s 
history as it was received on her admission, and the 
earlier observations of the case before its riddle was 
solved. INSISTENT AND FIXED IDEAS. 
There was no known neurotic heredity in the family 
history. She had always been physically strong and 
healthy, and never employed a physician. At about 
the age of nineteen years she first attracted atten- 
tion to her mental disorder by secluding herself and 
refusing to see her friends. At about the age of twenty- 
five years her relatives became fully impressed that her 
condition was morbid and serious. She excluded them 
from her room, was difficult to manage, and spent her 
time in slovenly indolence. 
Four months before becoming my patient she was 
brought to a neighboring institution for the treatment 
of nervous diseases. It was said that while there she 
was shy and silent, exercised no care of her clothing 
or person, neither working nor reading, lying on the 
bed if not watched, and all efforts to interest her in 
anything were failures. At times she was much 
agitated and felt that she was “ going crazy ” and 
said, “my proper place is in an insane asylum.” She 
gradually became more depressed and suspicious, and 
entertained delusions of a gloomy character, of her 
own wickedness in relation to indiscretions of her early 
years, and of great wrong-doing. It was stated that 
“ she developed the delusion that all who have any- 
thing to do with her would suffer injury or death ; and 
that she made vows not to do certain things, and enter- 
tained the delusion that by breaking them she brought 
trouble, perhaps death, on a friend of hers.” Finally, 
she got access to a bottle of laudanum and took “ three 
or four teaspoonfuls,” apparently with suicidal intent. 
' “ She manifested no remorse, but sorrow for her failure. 
When remonstrated with was sullen, and threatened 
to do it again at the first opportunity.” 
Two days afterward she was brought to the asylum. 12 
cowles : 
Her intelligence, reasonableness and self-possession 
led to her being placed at once with the convalescent 
patients; and her manifest satisfaction with the change 
was significant in the light of later revelations. Her 
general demeanor was as has been described, but she 
was carefully watched, never allowed to seclude her- 
self, and by night as well as by day the door of her room 
was kept partly open. There were signs of mental 
depression at times, and she was very reticent at first; 
but soon she began to repeat to her physicians the self- 
accusation before mentioned, and later told a story of 
having attempted homicidal acts, and alluded to other 
events of her history which she regarded as evidences 
of depravity and loss of conscience ; this was not con- 
sistent with her daily, lady-like conduct. She spoke 
of herself as being insane, but at last discovered that 
she was unlike other patients who had melancholia. 
Indeed, the notable absence of the characteristic, under- 
lying depression of feelings piqued inquiry. Her 
keenness of intellect and bright-witted though re- 
spectful rejection of the customary comforting assur- 
ances of possible recovery were entertaining as well 
as baffling. The assemblage of symptoms seemed 
anomalous. She at length said to me, “ I have a mono- 
mania,” and gave me more fully than before a curious, 
puzzling account of a long-existing fear that her 
ordinary acts might do harm to a lady friend whom 
she had always loved and admired, and whom she said 
she had once maliciously attempted to injure ; and she 
manifested genuine grief about it. She readily under- 
stood and gladly accepted the explanation of the 
absurdity of these and other ideas, and tried to act 
upon this view of them. The characteristic qualities 
of a delusion appeared to be absent, and the depres- INSISTENT AND FIXED IDEAS. 
sion to be secondary, or, as Krafft-Ebing says, “ pro- 
ceeding from the sad consciousness of the formal 
disorder of ideation—almost always painful and some- 
times dangerous.” 
Soon after admission she began to insist that her 
previous suicidal act was not done with that intent, 
but gave a halting explanation of it. She finally over- 
came her reticence enough to give an intelligible and 
undoubtedly truthful account of the affair and its 
motive, essentially as follows : It appears that her 
intense pride had for years kept her from revealing 
the secret of her mental troubles ; and the only excep- 
tion to this was an intimation to her mother on one 
occasion. It was a new experience to have a sympa- 
thizing physician, and it became a source of comfort 
to her. Into her self-inquisition there finally came 
the idea of some impropriety, on her part, in finding 
the physician’s visits to be agreeable ; and upon this 
as a basis of self-accusation she finally determined to 
escape from the perfectly proper relation of which she 
morbidly thought herself ashamed. She thought she 
ought to bq placed among the insane, and so conceived 
the plan-of feigning the suicidal act, suggested by the 
opportunity that offered itself. She purposely limited 
the dose of laudanum to “ a moderate quantity, and 
chose a time when its effect would be discovered in 
season to prevent serious consequences.” She thought 
she would be sent to an asylum, and so conducted her- 
self after the event as to insure this result. All this 
being regarded as evidence of absence of true suicidal 
feeling and motive, it formed an important factor in 
determining the subsequent treatment of the case as 
not being one of true melancholia. 
She gave vague and partial accounts of many years 14 
COWLES 
of mental pain, declared her hopelessness of recovery, 
and that death offered the only possible relief. Look- 
ing significantly about her room for points of suspen- 
sion, she would say to me that she could not do it here, 
but if it were possible she would end her troubles. The 
consequent surveillance became annoying to her, and 
she begged to have her chamber door closed at night. 
When asked to promise that she would not attempt 
self-injury, she acknowledged the rightfulness of the 
request, but said, “You cannot trust me, my pledge is 
worth nothing; I have no conscience, and cannot 
trust myself; my life is ruined, and I justify myself 
in always gratifying my wicked desires regardless of 
right or wrong.” She was told that she was mistaken, 
that she showed more than ordinary keenness of con- 
science, and that it was only a morbid sensitiveness of 
it that prompted unjust and undeserved self-reproach ; 
that her sense of honor was so strong that I knew she 
could not betray my confidence, that she would be 
trusted, and must make the promise. The promise was 
made, her door closed at night, and the watching 
largely abated. 
New information now received from her relatives 
gave an interesting insight into her real character. 
She was described by her teacher, when at the age of 
ten or eleven years, as the brightest of a large class 
of girls, and remarkably conscientious, once refusing 
to wear a medal awarded to her, for the reason that 
she thought the honor belonged to another. “ She was 
the most truthful child” the teacher “ever knew, the 
life of the school, intelligent, high-spirited, and be- 
loved.” She maintained these characteristics until 
the age of twenty-five years. She was, as a school 
girl, mentally superior to her associates, and distin- INSISTENT AND FIXED IDEAS. 
15 
guished for her truthfulness and unselfishness. Though 
naturally reticent as to her personal feelings, she was 
bright and companionable, esteemed and admired by 
her friends. This corroborates the estimate made of 
her even under the adverse conditions of an asylum. 
All went well with her for several months under the 
enforced parole. She grew more cheerful, and less 
reticent as to the details of her previous history. Then 
one more incident occurred which is of interest, in the 
aspect of the case now under consideration, as to the 
significance of its bearing upon the question of melan- 
cholia. Five months after her admission, a suicidal 
accident happened in another part of the house, in my 
absence ; my assistants were naturally anxious. Just 
then this patient made, to one of them, a remark, the 
subject of which, when occasionally mentioned to me, 
had been treated as tabooed—that is, the allusion to 
suicide, and that she thought there was “no way 
here.” The revival of close watching was a natural 
consequence, and her offered promise “ not to attempt 
it here ” was not understood or accepted. 
Aggrieved by this she made one of her self-imposed 
vows, which will be hereafter described as character- 
istic, that she would never make another promise. 
Upon an appeal to me, she agreed to the soundness and 
justice of the position that there should rightly be the 
guaranty of her pledge before the restoration of her 
privileges. She begged that the promise should be 
waived, for, she said, “You know how dreadfully I 
shall suffer if I break my vow, but if you insist, I must 
do it.” With my practical belief in the true nature of 
her malady, she was told after some days of “ con- 
sidering” it, and setting forth my responsibility, that 
the nurse would be at once directed to restore her 16 
cowles : 
former privileges as if she had again given her parole ; 
but that if she accepted my renewed confidence, and 
still had it in her heart to betray it in any way, she 
had no right to let me commit myself to such a course. 
The reply was simply, “You are right, Doctor ! ” Her 
appreciation of this proof of confidence was such that 
from this time forth there was no more reticence with 
me, but she asked that none of her associates or nurses 
should know her secret. The subject of suicide was 
practically dropped. The analysis now to be given of 
the mental phenomena of the case was worked out, 
and our relations remained upon this trustful basis for 
two years. She became more cheerful, and even hope- 
ful. By dint of hours of talking, the earlier and later 
incidents of her mental history were made clear, and 
such was her intelligence that it was possible to trace 
to its origin the train of evolution of her morbid 
ideation ; also to unify, as parts of one process, the 
strange and apparently incomprehensible events of 
her life. Their consistency was also shown with a 
personal character of rare quality, which she was not 
only unconscious of possessing, but which she felt to 
be vicious, not as a matter of delusion, but from the 
intricate complication and confusion of her morbid 
intellection. Above all it revealed the extent to which, 
under the domination of a tyrannous, imperative con- 
ception, the obscuration of such qualities of character 
can go, and the pitiful havoc and unspeakable torment 
that can be created in a mind that remains intelligent 
and conscious of it all. The interest of the case lies 
largely in the clearness of the • differentiation it was 
possible to make between the earlier and later ideational 
elements that made up the psychological enigma. In a 
characteristic way, the earlier ones either disappeared INSISTENT AND FIXED IDEAS. 
17 
or became obscured in the later complications, and it 
is rare that their growth can be so clearly traced as in 
this instance. The peculiar details already given are 
not so trivial as might appear, but are valuable as 
representative of the mental qualities that are to be 
studied in this case. The array of symptoms, at first 
presented, was quite typical of melancholia with 
suicidal impulse, and such a diagnosis was justifiable ; 
but closer investigation made clear the distinctly idea- 
tional character of the disorder as being “ the insanity 
of fixed ideas” in an advanced stage. The plan of 
management of the case was to instruct the patient 
with a thorough understanding of the nature of her 
malady and how to set up a counter habit of motive 
and conduct; she was urged to take a “ new master” 
—the dictum of her physician as the antagonist of her 
“ fixed idea.” The results of her first efforts to do this 
and of the study of the case will be given in the form 
of a mental history of the patient. She left my care 
some time ago, but the narration is given as of the 
present time. 
During her early years, from ten to twelve, she 
remembers that she was sometimes depressed and had 
fears of harm, even of death, happening to herself or 
her relatives, and with no reason for them. The word 
“ trance ” became painful to her, because she had heard 
this and kindred subjects much talked about; so that 
this word in particular suggested thoughts of herself 
or friends being buried alive. In her twelfth year she 
was nervous and ill, and in consequence was taken 
from school for six months. She vaguely remembers 
having, during these two years, the fear of harm in 
connection with doubts as to whether some simple acts 
were right. She had to repeat some such acts ; but she 18 
COWLES : 
had become quite well of these morbid experiences 
before the age of fourteen years. In this year she 
survived a nearly fatal attack of typhoid fever and was 
a year or more in recovering from its consequences. 
It was during this convalescence that, for the first 
time, she confided to her mother her worries and 
troubles. It is necessary to make some allowance for 
her present disposition unduly to reproach herself, but 
she thinks that at that time there were two promi- 
nent features in her character : that she was at times 
depressed and conscience-smitten, and that she was 
always of a jealous disposition. She believes she over- 
came her reticence and revealed her feelings to her 
mother only because she was sick and weak. The next 
year, while still not strong, she resumed attendance at 
school. Being relatively backward, she studied very 
hard, but led in scholarship. Her daily journey to 
school was fatiguing, and there were irregularity of 
meals and study by night. During this year men- 
struation began. The feelings of hesitation in per- 
forming simple acts, like those of three years before, 
now reappeared. In walking, dressing or undressing, 
for example, she was obliged to repeat many such 
actions ; she did this, however, only when unobserved, 
and then could not help it. Here was the genesis of a 
common form of fixed ideas,—the idea that the act 
performed is not right, the accompanying vague fear 
that some harm will follow if it is not made right, and 
the necessity of repeating the act to make it so. From 
this point all the rest follows in its morbid train. 
One of her schoolmates, a distant relative, was a girl 
of her own age, called in this history C. She was 
beautiful in person, lovely in character, and destined 
to exercise an extraordinary influence upon the after- INSISTENT AND FIXED IDEAS. 
19 
life of the patient M. The latter was the intellectual 
superior, but became jealous, she says, of the attention 
C. received, although she admired and loved her very 
much. M. did not manifest this evil feeling in any 
way, but it gradually developed to one of strong hatred, 
or one that seemed to be such in her extreme conscien- 
tiousness. In connection with this feeling there were 
evolved thoughts of harmful things that might happen 
to C., and then of self-condemnation as if she were 
guilty of desiring them to happen. This seems to have 
begun in the natural feelings common to all conscien- 
tious persons. M. next questioned herself if she would 
not be tempted to do violence to C. should there be an 
opportunity. This became mixed with the repetition 
of her acts ; there was first a feeling of vague fear if 
she did not repeat them; then there came to be asso- 
ciated with the insistent idea a definite feeling of fear 
of harmful consequences to C. if the morbid impulse of 
repetition were not obeyed; then for a time this fear 
was dispelled by compelling herself to repeat the special 
act a certain number of times, more or less on different 
occasions. This fear of injuring C. was harmonized 
with her so-called hatred of her, as it was not so much 
because of the pain of contemplating possible harm to 
C. as because of the suffering M. feared would be 
inflicted upon herself by her offended conscience, if 
any such harm as she thought of did happen to C. It 
would be as if her thinking of harm in connection with 
C. had made it happen to her, and M. were to blame 
for it. Up to this point the morbid process had 
advanced through several stages of evolution and 
complication. M. realized all through this that she 
would not be even morally responsible perhaps, should 
such harm happen, but she went on all the same, yield- 20 
cowles : 
ing to the domination of the morbid idea, which her 
will was powerless to resist, and fearing the self- 
accusations of her conscience—both the actual and the 
possible. 
After this there came the apprehension that some-, 
thing would happen to C., and M.’s mind became 
tormented with thoughts of her own probable suffer- 
ings from the blame of which she knew her conscience 
would accuse her. She soon became unable to read, 
or hear, or think of any painful thing, or of death, as 
happening to any human being, without feeling and 
fearing that it might happen and then was about to 
happen to C., and mentally anticipating her own con- 
sequent sufferings. Thus these processes kept her mind 
full of painful feelings. She found a way to allay them 
by forcing herself to think of some person known to 
her, other than C., whom she would mentally substitute 
for the latter, and whom she would set up in her mind, 
the moment the morbid idea came, to be the recipient 
of the imagined or suggested harm. This worked well 
for a while, but soon began to be refined upon. It 
became necessary to choose for the substituted person 
some one with many opposite characteristics to C.; for 
example, there had to be a difference in age, sometimes 
of sex, initials of name, color of eyes and hair, stature, 
distance as to residence from C., and at last peculiar 
requirements as to time, place, etc., etc., to an endless 
extent. Next it became necessary to have ready in 
mind a number of chosen persons, two, or three, or four 
of whom, as the case might be, must be thought of in 
a certain order, etc. After a while, thinking of these 
persons ceased to give mental relief and another set 
had to be chosen, to wear out in turn. The process was 
this :—if in reading or in conversation or in any way, INSISTENT AND FIXED IDEAS. 
21 
by direct suggestion, or by the law of association of 
ideas, the thought of personal harm to any one came 
into her mind, the thought of C. as suffering that harm 
came also. Before the mental action thus interrupted 
•could proceed she must call up the mentally prepared 
substitutes and imagine them as possessed of all the 
prescribed characteristics, and in the certain order, 
etc., as having the harmful thing thought of inflicted 
upon them. This imagining relieved her, but at last it 
became necessary to wish it to happen to them, then 
by degrees to imprecate it upon them with increasing 
intensity of oaths and cursing, although it shocked her 
very much. She became very expert in this process of 
exorcising the fear the morbid idea would arouse ; she 
could go on directly with the conversation, for example, 
and keep up appearances. Her pride in this regard, 
her perfect concealment of this whole matter from 
every one, was extraordinary and very characteristic of 
the malady. It was only after six years of suffering, 
and at the age of twenty-two, that she first revealed 
something of it to her mother. 
The process of relieving her mind of the painful idea 
when suggested in any way not connected with any 
acts of her own has been described. On the other 
hand, in regard to these, the hesitating and repeating 
impulse also grew upon her, and finally crept into all 
her acts. It will be remembered that she feared they 
would cause some harm to C. if not done right. She 
could at first relieve herself from this state of doubting 
or hesitating in an act, by exerting indirectly the 
inhibitory influence of self-control over the morbid 
repetition impulse, as for example, by intellectually 
prescribing that she should repeat the partial or full 
accomplishment of the interrupted act a certain number 22 
COWLES : 
of times, more or less on different occasions. As this 
process became more complicated and difficult to con- 
ceal, her intense pride in maintaining appearances led 
to devices for abbreviation. If she fell into a state of 
indecision in the attempted doing of any act, and 
needed to compel action to avoid betrayal of herself, 
she could succeed by strongly vowing that she would 
do it, adding the stimulus of harm to C. as the self- 
imprecated penalty of failure ; of course, this involved 
all the dreadful consequences to herself. To reinforce 
this process, also, vowing became swearing, and then 
came the necessity of the most fearful and blasphemous 
imprecations upon herself, to compel herself to do or 
not to do certain acts, then or thereafter, upon pain of 
inflicting injury upon her friend, and of all its dreadful 
consequences upon herself. All this was sufficiently 
complicated, hut she regards these things as primary 
in the sequences of complication and mental entangle- 
ment that were afterwards evolved. These two things, 
however, have run through all the phases of the fifteen 
years’ existence of the malady : “ the binding of her- 
self over,” as she says, by vows and oaths in a com- 
plicated system of methodizing all her acts, and the 
process of substituting vicarious sufferers of every 
harmful thing thought of, in order to shield her friend, 
and secondarily herself, from the consequences of 
imaginary harm to her friend. There was self-accu- 
sation, however, just as if she had maliciously wished 
the harm upon her friend. But all this was her secret. 
There was indeed a skeleton in her mental closet, 
animated by the Satanic double of her own mind, that 
tyrannized over her conscience and thoughts with a 
world of intricate formulae of thinking and doing. She 
says she has lived two lives. INSISTENT AND FIXED IDEAS. 
The conditions so far described were quite fully 
developed when she was eighteen years of age. She 
had become unable to study, and then left school; for 
two years she led a listless, aimless life, she says, with 
loss of her natural inclination for reading, acquiring 
accomplishments, etc. She maintained her social re- 
lations in every way, however, and was sufficiently 
cheerful and spirited in manner, except with members 
of her own family. New complications were then 
evolved. She began to be compelled to give up her 
dearest friends. An innocent remark made by one of 
them might suggest the painful association of ideas in 
M.’s mind ; or she might meet at a friend’s house some 
person against whom she had acquired an aversion 
through her morbid idea. To be rid of the distress the 
painful memory would cause on meeting her friend, or 
visiting her house again, she must be rid of such 
friends; thus, one by one, she had to avoid them. 
Otherwise, also, the morbid idea brought in its train 
many others, and these brought another set, and so 
on in a wide-spreading combination, the outcome 
of which would finally narrow down to imaginary 
harm to C. If M. tolerated her friend any longer, and 
thus necessarily all the bad company of harmful ideas, 
she felt that she became a party to the combination, 
and thus subject to blame by her conscience under the 
compulsion of the tyrannizing idea. 
The obstructive influence of the morbid association 
of ideas interfered with all the minor acts of her daily 
life. It affected the taking of certain articles of food, 
or going to certain places; interdicted certain things, 
or permitted them on certain days and not on others. 
Colors, pictures and ornaments were banished from 
her room. She was fond of dress, but certain materials 24 
cowles : 
and many colors could not be worn, although she most 
liked them. Certain days were tabooed for shopping, 
because they were anniversaries of painful events in 
her morbid calendar; and certain shops could not be 
entered. When the new dress was obtained, very 
likely it could not be worn because of some newly 
imagined danger of potential harm to her friend. 
Thus it became more and more difficult to keep up 
appearances among her well-dressed associates; and 
retaining all of her pride in this regard, she began to 
seclude herself. Later, this led to the neglectful 
personal habits before described. Acts relating to all 
these things were complicated or prevented by her 
vow. She would not reveal her troubles to her friends 
—in fact, was ashamed and afraid to do so. 
Finally, her relatives were made anxious by her 
peculiarities, and after a scene she submitted to the 
visit of a physician, who was told something of her 
physical condition. She was taken aw~ay to the 
country and greatly improved in a short time. But 
while there she heard of the death of a young neigh- 
bor, whom she had mentally used in the substitution 
process of wishing he might die to save her friend. 
This was a great shock to her, and she says that if 
she had deliberately killed the young man she could 
not have felt worse. For a year after that her con- 
dition was distressing; she secluded herself, became 
despondent and irritable. A new phase of her mental 
condition now developed, and there was a reaction 
from the unquestioning submission to her compulsive 
idea, and the growth of the feeling of resentful 
desperation. When about twenty years old she was 
again taken away to the country, and without any 
warning, “as if the fates had willed it,” she was INSISTENT AND FIXED IDEAS. 
25 
taken to visit at the home of her friend, C., where she 
spent three months. It was a dreadful experience; 
she felt that she must and did keep up appearances. 
All her former admiration of her friend’s character 
and beauty revived, but with it of course came the 
antagonizing jealousy, and these opposing feelings 
went on together. Her friend was lovely, fortunate 
and happy; she felt herself to be the contrary, and 
managed to evolve the notion that her friend was 
somehow to blame for her own sufferings. But again, 
a pleasant conversation would dispel the evil feelings, 
and she would wonder how such terrible things could 
exist in her mind. She does not know how the thought 
of injuring her friend arose, but the habit of mental 
vacillation between doing and not doing took up the 
thought and made her miserable. She knew the place 
where a razor was kept. She condemns herself un- 
sparingly for all that followed, but she sometimes 
thinks that she became involved in a mental obligation 
to put herself to the test of going as far as possible 
with the act of killing C. and stopping just short of 
really wounding her. One day, in a room that suited 
the purpose, she approached C. from behind and drew 
the razor close across her throat, greatly frightening 
her; but M. succeeded in laughing it off as a joke. 
After this there was, of course, new and real cause for 
self-reproach, and the feeling took possession of her 
that she was at heart a murderess, and that this 
was the result of her former wicked self-indulgence. 
Finally, after a year of this worry, she was forced to 
get a young friend to spend the night with her before 
whose throat, when asleep, she drew a razor. This 
cancelled, as it were, the former act. 
She spent the three years following the age of twenty 
with friends in various places, being unwilling to 26 
cowles : 
return home. Matters secretly went from bad to worse 
with her, and the hope of some outlet from her mental 
troubles grew less, but she preserved appearances fairly 
well. It was during this period that she made to her 
mother the partial confession already mentioned. A 
sister died, about whom she suffered great remorse 
because of some unkindness shown her a few years 
before, and she confessed her feelings to an older sister. 
This did her some good, but soon all was as before. 
During the next two years she gave up her social 
relations more and more, ceased attending church, 
making calls, etc., finally saw only two or three 
friends. 
During these five years a number of the persons 
died whom she had used in the process of mental 
substitution for C. ; this cut her off from her asso- 
ciations, if she had any, with the families of those 
persons, besides causing an increase of her unhappy 
feelings. She did some reading, was sometimes taken 
to places of amusement, and could laugh and be com- 
panionable, but this was always hard. She often 
wished that she might die, but the idea of suicide 
never suggested itself, except to excite wonder, quite 
in a normal way, that any one could have courage to 
commit the act. There was always the love of life 
and longing for freedom from her troubles. In the 
latter part of this period she remembers that sometimes 
when alone with a young, old, or weak person, the 
thought would seize her that she could kill that person, 
and that there was nothing to prevent it but her own 
weak will. It did not grow to be an impulse to do the 
act; it was only a thought of it. The morbid mental 
operations before described still went on, but became 
more systematized. Among a number of strange INSISTENT AND FIXED IDEAS. 
experiences at this time, the following may be men- 
tioned : On one occasion, in a public library, she read 
in one of Dickens’ stories a graphic account of a 
murder by cutting the throat. This affected her very 
painfully, as if it described a crime of her own. She 
had no peace till she went again to the library, and 
from the same book had secretly torn the leaves upon 
which the murder was described and rended them into 
shreds. Again, she found in a newspaper an announce- 
ment of the death of a person of the same name as C. 
This so worked upon her mind that she had to select 
the name of a young lady friend, and adding a letter 
to it, ‘‘to protect herself,” she wrote an obituary 
notice and had it published in the same paper. This 
caused a great deal of talk, but M. held her peace. 
On the principle of substitution this act relieved her 
mind of the suffering she had been enduring. It had 
been just as if C. had really died and by M.’s own 
hand—or what was the same thing, because of her 
own thoughts ; she cancelled the idea by the vicarious 
sacrifice of the other person. 
This brings her history to the age of twenty-five 
years, the time when her relatives recognized her 
morbid condition, as was stated in the account first 
obtained. By that time she had reduced herself to 
the practice of staying much at home and in her room. 
She did not leave the house for ten months, and again 
did not leave her room for a year. She became very 
neglectful of personal care, with all which that im- 
plies. At the beginning of this period she had much 
insomnia, demanded and obtained sedative medicines. 
These were increased in strength as they lost their 
effect, till a narcotic mixture was furnished her which 
she took at will. She “would have it, and did have 28 
cowles : 
it! ” She took stimulants also. It can only be learned 
that the medicine was given at the suggestion of the 
druggist who prepared it, and was a “ preparation of 
valerian and other strong nervine remedies.” It was 
probably not so potent as she supposed, but the family 
physician, whom she utterly refused to see, thought 
“too much of it would be injurious.” She could not 
be induced to give it up, because while taking it she 
had some peace of mind. In fact, it was the only way 
of peace for all concerned. She was not thought to be 
insane. Under its effect and that of stimulants she 
“ could review and analyze, with calm indifference to 
the suffering, the mental operations of the past ten 
years.” It came clear to her, she says, that her con- 
dition was one of insanity. She called it a case of 
“monomania,” and regarded the ideas associated with 
C. as delusional. She had a comfortable feeling of 
independence in regard to her conscience, but if the 
influence of the medicine was not kept up, the mental 
pain came back. At the end of two years she had 
increased the medicine largely. Then she also called 
her father to account for a conversation she thought 
she overheard, which she found to be a hallucination, 
and ascribed it to the medicine. She readily recog- 
nized it to be such, and this is undoubtedly the only 
instance of the kind in her history. This, with the 
druggist’s repeated warnings of harm, led to a strenu- 
ous effort to stop the narcotic. This made her angry, 
an unusual event with her; in a characteristic way 
she vowed she would take no more, and stopped at 
once. She was sent to the country with an intelligent 
companion, where she spent a month with great bodily 
improvement. She was perfectly correct in conduct 
and attracted much respectful attention. Soon after 
this, by her own desire, she was placed under special INSISTENT AND FIXED IDEAS. 
29 
treatment, and what followed has been narrated. In 
the first four months she gained physically, in weight 
and otherwise. Then came the affair of the laudanum 
and the diagnosis of insanity. Immediately before 
this she had written a long and interesting letter to 
her home. The physician’s telegram to her relatives 
announcing her transfer to the asylum was followed 
by one from herself saying that she was well and 
telling them not to worry themselves. 
The events of her first five months in the asylum 
have been described with sufficient detail, including 
the incident which led to a free revelation of her mental 
history. True to the characteristic habit of negation 
and antithesis, her pride and reticence had long 
been accompanied by a fear lest she should betray 
her secret, and then by an impulse to do so. Both the 
fear and the impulse grew upon her. But to detail her 
troubles to me soon came to be a great relief and 
comfort. Thus was developed another characteristic 
of these cases—the desire for never-ending repetition. 
Once engaged in conversation with me, there was no 
embarrassment in discussing the painful ideas—no 
process of stopping for vows, etc. There was but 
little material change in her mental operations for 
the year and a half while the analysis of them which 
has been given was going on. In general she was 
much more comfortable, she said, than before her 
long seclusion at home. This period of comfort repre- 
sents a remission of the malady which is another of its 
characteristics ; such remissions may last for months, 
or even years. She occupied her time very well in 
reading, sewing limited however to a few articles, etc. 
Later she was able to have some bits of ornament or 
color in her room. The morbid ideas continued oppres- 30 
COWLES : 
sive, but they were managed, more methodically and 
readily than formerly. She was continually having- 
distressing experiences, because of such circumstances 
as that the name of one nurse and the color of the 
eyes of another called up painful associations. She 
preferred that my wishes should be made known to 
her as directions rather than as requests, because she 
was thus saved from the difficulty always attending 
any voluntary action ; but the aid gained in this way 
never amounted to much. Any act that was made a 
matter of my explicit command could only be obeyed 
through the system of vows ; she could not follow the 
advice to act under a “ new master,” as against the 
imperative idea. The following description charac- 
terizes her mental habits fairly well. When she “ came 
up against ” any question of doing or not doing some- 
thing, the thought of the act seemed instantly attended 
by a great crowd of associated ideas. There was, as 
it were, a first series of things of which she had to 
think in a certain order, because they were directly 
involved in some way with the contemplated act. 
Then the first series involved another series, and so on 
through a permutation of very diverse ideas, narrowing 
at last to the one idea, that through all this indirec- 
tion the act would carry harm to C. Then, if strongly 
impelled to do the act, as for example if she wished it 
or needed to maintain appearances before others, etc., 
she had to “bind herself over” in the way heretofore 
described to protect C. from the possible harm. It 
sometimes happened that after she had bound herself 
to do or not to do some act, the contrary became 
imperative. Then there was a dreadful process of 
counter-vows and “ binding over.” The associated 
assemblage of ideas varied for different acts and from INSISTENT AND FIXED IDEAS. 
time to time. When the ideas arose she had to run them 
all over in her mind in a recitative way, always to the 
same central and final idea. She became very expert 
at this, and speed was acquired by methodizing the 
process and by practice, so that she mentally touched 
the heads of things as she ran through the mental 
formula. Yet, strangely enough, she could carry 
herself with perfect serenity and self-possession in the 
eyes of all but her physicians. It required a great 
deal of study and analysis to disentangle the thread 
of evolution of all these subtle and complicated 
phenomena. She declared that she was then able to 
talk of them for the first time, but that she could give 
only the most meagre idea of it all. This writing 
itself is inadequate in representing what she did give. 
She said, “ When I try to describe my years of trouble, 
so many distressing thoughts come into my mind that 
I cannot prune my words of what is not essential.” 
She always declared that she had no conscience, 
that no question of moral right or wrong influenced 
her ; that ceased long ago. Her only criterion was to 
do as near her liking as was permitted by the tyranny 
of her controlling ideas. She said that in her despera- 
tion she did not hesitate in her thoughts to do any- 
thing, however wrong it might be, if she desired it, 
and she could accomplish it by her process of “ bind- 
ing herself over ” under penalties for not doing it. In 
this way see could sometimes defy or rather evade the 
consequences of acts that at first seemed likely to be 
harmful. She said, if a duty came in conflict with 
the ruling ideas she yielded the duty, but if a selfish 
inclination came up she could evade the harmful 
consequences. She said also that she had long led 
two distinct lives : one was entirely within herself, 32 
cowles : 
with its great complication of motives, ideas, and sug- 
gestions, and the other was a false pretense ; she was 
a walking hypocrisy, possessed by an insane idea, 
without any rightness of conscience or natural affec- 
tion, selfish and wicked and without repentance for 
many wrong and disgraceful acts intelligently com- 
mitted. She betrayed her real conscientiousness by be- 
wailing the wickedness of her conduct. She charged 
herself with misusing the system of vows which she 
thought should have been reserved for proper purposes 
of relief from her painful feelings, when trying to do 
right things; she misused a blessing, she said, in 
employing it to get indulgences for doing wrong. 
But she made too much of the questions of right and 
wrong in regard to ordinary matters. Her bewail- 
ment, however, was more a matter of intellection than 
of depth of feeling ; the former was so forceful that it 
Avas accompanied by a large measure of the corres- 
ponding feelings which she knew she ought to have 
under such circumstances, were they real ones. The 
depression of feelings was from a sense of oppression 
of ideas. But through it all there was evidence that 
all of this was qualified by some consciousness of the 
fictitious character of that which dominated her mind. 
In other words, it was still true that, were the domi- 
nation removed and normal ideation made possible 
with relation to its limited disorder, she Avould have 
been a well and happy woman. 
In regard to abstract, painful ideas, not connected 
with any acts, the like need of her special system 
continued. Certain words always troubled her in her 
reading. During the comfortable period of a year and 
a half now being described she became able to read 
quite freely until the last, when it was almost impos- INSISTENT AND FIXED IDEAS. 
33 
sible. The word “murder” was the worst, and all 
others expressing acts of violence were almost as 
bad ; next came such words as “ jealousy,” “ hatred,” 
“malice,” “sin,” and “shame.” If, when reading, 
such a word appeared before her eyes, there was 
instantly in her consciousness the crowd of associated 
ideas, and along with them the thought of C. as the 
object of the act or the subject of the feeling indicated 
by the word, as if it were M.’s own act or feeling. 
Thus through some one of a multitude of chains of 
associated ideas the thought of harm to C. was reached 
from the “jealousy,” “hatred” or “murder-thought.” 
The effect of this had then to be annulled by the self- 
imprecation of some penalty upon herself if harm did 
happen to C. It appeared from this that the process 
of substitution of vicarious sufferers had been changed 
to one of self-imprecation after the time when she felt 
herself to be guilty of the deaths of the substitutes 
and had enacted the murder scenes. To avoid the 
pain that the future deaths of such persons might 
cause she chose the new method,—and it was as if she 
said, on all these occasions, “Let me be punished as 
guilty of all those acts and the new harmful thoughts, 
should anything happen to C.” This substitution of 
herself protected C.; then, C. being protected, her own 
possible future remorse was warded off. When in the 
presence of others, this process might be dispatched 
quickly and unobserved ; or,’ if reading, it might be 
necessary for her to put the book away and go to her 
room, and there, walking agitatedly to and fro, the 
whole process had to be gone over many times. On 
many occasions, at last, she had to find the book and 
the word repeatedly, and as many times begin anew. 
Again, the book must be taken to her room, and there cowles : 
the reading of the word initiated a repetition of the 
process ; she must seek the word and repeat the pro- 
cess many times. There were so many special words, 
and suggestions of painful ideas in innocent words, 
that reading became too painful to be attempted. 
In the constant mental conflict that was going on 
the negations of conduct frequently involved ques- 
tions as to what she ought to do and ought not to do. 
In this more comfortable period she once told me that 
a case like hers would be found in Mr. Howells’s last 
book. She said, “ Penelope Lapham had the same 
trouble I have, hut not a millionth part as bad,” and 
referred me to Penelope’s struggle with her dilemma 
after Corey, contrary to expectation, had proposed to 
her instead of her sister, much to her own mental dis- 
tress. Some time after this event Penelope said : “ It’s 
easy enough being sensible for other people. But when 
it comes to myself there I am ! Especially, when I 
want to do what I oughtn’t, so much that it seems as 
if doing what I didn’t want to do, must be doing wdiat 
I ought.” This saying, and others like it, were so 
true to nature as to make Penelope’s case distinctly 
one of the “ insanity of doubting” in one of its more 
common and milder forms ; but fortunately she “ re- 
covered,” and this was by the logical process of the 
substitution of the more dominant idea strengthened 
by the deeper feeling. 
During the latter part of this period she was allowed 
to go about alone in the neighborhood of the asylum 
“on parole.” ISTo explicit promise was exacted, how- 
ever ; she was directed not to go beyond certain limits, 
with a tacit obligation on her part not to do so. She 
was better for this, and the privilege was continued for 
a number of months after she entered upon the next 
period, which is now to be described. INSISTENT AND FIXED IDEAS. 
35 
She afterward said of herself that a crisis seemed to 
come in her mental condition. All the complications 
and agitations reached such a tangle of difficulties 
that she felt powerless to cope with them and seemed 
to come to a standstill. She said that her conscience 
reasserted itself in a natural way and began to punish 
her for her wickedness by compelling her to do every- 
thing contrary to her wishes. There was now a real 
depth of feeling, though morbid, that she deserved 
punishment, and her conscience seized upon every 
opportunity for inflicting mental pain ; this she felt 
to be simple justice. At this point in the case there 
is to be recognized an exacerbation common in the 
course of such maladies; but more than this, there was 
now initiated a state that more nearly resembled true 
melancholia—an essential disorder of the feelings. 
The gloom and despondency became more pronounced. 
She had to make herself disagreeable and hateful to 
the people she liked the best and respected the most, 
just because they were sources of comfort to her. She 
said : “It is as if all the wrong things I have ever 
desperately allowed myself to do and think about 
now stand around me as creditors of my conscience.” 
A denial of everything pleasant or desirable was 
thus commanded. She had to speak unkindly to her 
favorite nurse, for example, and then cried because 
she had been compelled to do what would make her 
appear ungrateful. 
A change now came about in regard to her relations 
to me. At first, as has been said, her revelations to me 
were satisfying, and she had little of the temptation 
to tell her story to others, which she formerly feared 
she might be compelled to do. Her sole source of 
comfort was in such conversations, but the need of 
this grew upon her, and at last it became impossible to 36 
cowles : 
give her time enough to satisfy her. The temptation 
to tell others returned with the worry about it, and in 
the end she yielded to it in some degree. It also came 
about that she felt the comfort she gained from my 
visits should be forfeited as one of her punishments. 
This became the prime issue in her struggle with her 
avenging conscience. She fought it for months, avoid- 
ing meetings with me, “vowing” she would never 
tell me another word of her troubles, but just as often 
breaking her vows and talking freely whenever in my 
presence. Her sufferings increased because these 
things involved harm to C., and new penalties, and 
only grew from bad to worse. She began to say, “ I 
must go from here to avoid this suffering ; there is no 
other way. The only hope I ever had has been here, 
hut this I must abandon ; anything is better than the 
suffering I endure here. I must he deprived of my 
greatest blessing.” She felt that if she went away 
she must leave hope behind. And so the culmination 
of this phase of the mental phenomena was gradually 
reached. 
All this state of things was believed to be a passing 
phase of her malady, and she was urged to hope that 
another remission would come. She could possess 
herself of this while it was being told to her. A curi- 
ous thing came about at this time. Hot only was the 
comfort of hopeful words intensified to her, but it was 
reinforced by telling her how foolish and absurd her 
mental performances were. But, true to the habit of 
growth of her morbid mentation, there was need of 
greater emphasis in the telling to give her equal 
comfort. At this time an interview usually ended by 
her saying, “ Now, before you go, you know what I 
want you to tell me—tell me what you think of me. 
It helps me to hold on to the idea; what you say seems 37 
INSISTENT AND FIXED IDEAS. 
all real and true to me, but it goes when you go, and 
I am as helpless as before.” As the effect of this, the 
kinship of human minds had an illustration. My 
gentler characterizations became chidings and rebukes, 
and at last denunciations, which exhausted my polite 
vocabulary. It was curious to observe the calm content 
with which these objurgations were received, and a 
little startling to realize the personal comfort of such 
an unwonted outlet for sentiments that must be habit- 
ually repressed. Thus it came to pass that this poor 
patient brought it upon herself to be the “ vicarious 
object ” of stinging words which might have been more 
fitly spoken. 
But now there came a climax in this pitiful history. 
Like a law of mental habit, the idea of vicarious 
atonement or substitution that had run all through 
all these phenomena from the first came into play 
again. What was told her made her seek for hope 
though she could not have it. It occurred to her that 
she might substitute physical for mental suffering— 
some serious illness or great calamity—some personal 
injury that would stand in her mind as a lasting token 
of ample punishment ; then the demand for penalties 
would be satisfied, and her mind would be left free to 
enjoy in peace the common comforts of life. She 
invented a plan which bore some resemblance to her 
former suicidal scheme. On taking a morning walk 
outside the asylum, she procured a small pistol, and 
late in the-evening, when her neighbor, whom she did 
not wish to disturb, was out of her room, she shot her- 
self in two places, the shoulder and the hip, making 
simply flesh wounds. She was perfectly calm about 
it and explained that she tried to wound the joints, 
which she thought would cause permanently painful 
and crippling injuries. She protested that she care- 38 
COWLES : 
fully avoided endangering her life ; for she had virtu- 
ally pledged herself not to do that. The wounds were 
trifling and soon healed, her disappointment knew no 
bounds; the last hope was gone, as she felt; her 
mental depression rapidly deepened in a kind and 
degree unknown before; in death was her only relief; 
she regretted the lost opportunity when she had the 
pistol. There was now a condition like true melan- 
cholia ; the suicidal impulse was pronounced, and 
honestly declared. 
She was of course closely watched. Her former 
state continued and grew worse; she punished her- 
self in every way—in regard to taking food, and in 
personal care, etc. She would stand in a fixed atti- 
tude unable to move for a long time. She contrived 
new ways of mental punishment—for example, 
another patient thought she had committed the un- 
pardonable sin, and M. assuming this to be the worst 
of all sins, imprecated upon herself the punishment, 
whatever it might be, due to that sin. This idea, 
however, was so intangible to her that it failed to 
become embodied in her system of thought. Even in 
her state of true melancholia there was yet something 
lacking of the profound feelings of depression and 
self-condemnation characteristic of that state. 
On a later occasion several attempts were made to 
hypnotize her—to try the effect of “therapeutic sug- 
gestion.” She did her best to aid in this, but was more 
amused than otherwise by her swift conclusion of its 
futility. She said it never could be done, the prime ob- 
stacle being that she could ordinarily never go to sleep 
without having first cleared, or exorcised, from her 
mind all the thoughts of evil consequences which had 
attached themselves to the events of the day and to 
which she felt that she might perhaps not have done INSISTENT AND FIXED IDEAS. 
39 
full justice. The poor woman’s prayers even had been 
for years imprecatory. She had, at times, piously 
prayed for help and strength, but the thought of pos- 
sible consolation from this source made such relief a 
subject of punitive deprivation ; moreover, her dread- 
ful misuse of the privilege of addressing the Deity de- 
barred her from the proper use of it. Another of her 
peculiar methods was in some respects not unlike the 
last. There were times when she could gain herself a 
respite for a day by first binding herself over to do 
everything in the natural way for twenty-four hours 
and not to make any “ vows.” She occasionally got a 
great deal of comfort from this device, but at the end 
of the period she always had to review it and balance 
accounts in detail. At last, however, after her con- 
science “ had turned upon her,” there was an end to 
this expedient. 
This history, already a long one, must be ended 
here. In this, M.’s last and worst state, it finally 
seemed best to try the effect of some change, which 
she earnestly desired, and she was transferred to 
another asylum. She bore herself passively, but with 
an evident feeling of regret and as if she had indeed 
left hope behind. There was immediate improvement 
in manner, and in the course of a few months her con- 
dition became much more comfortable. The change 
to new surroundings to which she felt indifferent was 
a great relief. Freed from the oppression of the ques- 
tionings as to talking with me, she remembered help- 
fully my explanations, reasonings, and advice. A year 
later she was as well as I had ever seen her, appearing 
very well, intelligent, and ladylike to all who knew 
her. The secret mental processes went on, however, 
and, though more submissive, she had little hope. She 
said her coming to meet me was opposed in her thoughts 40 
COWLES : 
as formerly, but in her strong desire for the interview 
there was no hesitation in determining to have it in 
spite of all consequences. There were no preliminary 
vows, but she knew she would “ have to pay for it 
afterward.” It was natural, vivacious, and most inter- 
esting in the abundant proof it gave of mental integ- 
rity aside from the limited derangement. At its close 
she begged me, in the old way, to assure her that it 
was right to have seen me. No definite information 
as to her subsequent history has come to my knowledge. 
The details of this long story were corroborated in 
many ways by the agreement of their many repetitions 
when discussed from different points of approach. 
Like most persons under the control of morbid ideation, 
she was in the habit of saying to me, “You would have 
a different opinion of these things if you could only 
know more about them; they are so many and so 
complicated that they cannot be told.” Every new 
and often repeated analysis of the essential nature of 
her mental processes was readily understood and 
gladly accepted by her, only to be followed by some 
new phase of ideation, or memory of past trouble, 
which would stand more positively in her consciousness 
than the clear explanation of it all, which she con- 
stantly tried and failed to apply. 
This history may be briefly summed up. The telling 
of the story is meant to show the natural and logical 
growth of complicated phenomena from the central 
morbid idea; they depended upon this as the limbs, 
twigs and leaves hang upon a tree. However distinct 
and strange any newly revealed product of her system 
of thought might seem to be, its unity with the rest 
clearly appeared upon analysis. The minor formulae 
of her mental operations were all more or less insistent 
or imperative, strictly according to the closeness of INSISTENT AND FIXED IDEAS. 
association of the ideas with the central and ruling one ; 
and corresponding also to the degree of fixation of such 
methods of mentation, by repetition, practice and habit. 
All these products of mental phenomena are explain- 
able upon the basis of normal psychical law. 
The problem of this case was to discover the genesis, 
the growth and the fixation of the central idea, which 
in this instance had the peculiarity of being unusually 
complicated. In the first place, there was probably 
no special hereditary influence in its origin; the para- 
noiac element is excluded ; certainly the right to infer 
it must be questioned. If it be said to have been 
“acquired” because of the typhoid fever at the pub- 
ertic period, etc., a neurasthenia must be admitted. 
But if acquired organic defect be admitted also—while 
inquiry is excited as to the consistency of this inference 
—it remains that the “ fixed idea ” was conceived some 
years before, disappeared, and was revived and devel- 
oped when the supposable new factor of paranoiac 
defect came in.1 But not only was the conservative 
1 There seems to be confusion and inconsistency in the meaning 
of terms used in the discussions of this subject. The terms psychosis 
and degenerative psychosis admirably characterize certain general 
notions of the mental states they represent, but as definitions there 
is danger of their use as cloaks for conjecture. Most writers hold 
that fixed ideas “almost always” have a neurasthenic basis; this 
rates them as psychoses and functional. But as ideational psychoses 
they lie in the foreground of primary systematized delusions typical 
of the admitted degeneracies in paranoia. Hence the temptation to 
unify the view and to regard all the “imperative conceptions” as 
degenerative psychoses ; under cover of this term they are brought 
into the category of paranoia. But this term distinctly introduces 
among the psychoses the new notion of chronic hereditarv or 
acquired defect in the organism. Upon a foundation of heredity it 
is easy to conceive such organic defect; to invoke a like foundation 
as “ acquired ” through a simple concurring neurasthenia has the 
vagueness of assumption and conjecture. These, therefore, have 
really no support, in the case of fixed ideas, except the fact of the 
ideational origin of the latter and their kinship to paranoiac delusions. 
But the clinical fact remains that their milder forms, at least, are 
commonly incident to healthy minds ; often independent of neuras- 
thenia, they make no trouble, and fail of recognition because they 42 
COWLES : 
tendency to maintain intellectual integrity significant; 
so also was the absence of the characteristic habit 
of symbolism. Paranoiacs are prone to symbolism, 
whereby meanings are betokened by trivial things, 
and delusional ideas are quickly conceived—for ex- 
ample, the accidental placing of three apples in a 
row might be believed to represent the Holy Trinity. 
For this reason there was a negative importance in 
the limitation of the strong disposition to substitute 
persons and things the one for another. This did not 
bring out any innate tendency to symbolism, as was 
likely to have happened had it existed. There was 
always validity in the factors of her mental equa- 
tions ; the thing substituted was equivalent to the 
other in quality or effect, and there was logic in the 
process. 
At the root of the whole matter there was a bodily 
condition somewhat neurasthenic. There was also an 
unusual intellectual endowment and rare conscien- 
tiousness. Upon the mental plasticity of childhood 
are so little out of harmony with concurrent conditions. Starting 
with these mild forms, may they not he purely functional, even 
along with neurasthenia, for some degrees in the scale towards their 
culmination in the admitted degeneracies ? The recognition of two 
general degrees of fixed ideas (answering to psychoses and degen- 
erative psychoses, between which differentiation is as impossible as 
to mark the changes from youth to old age) is not out of analogy 
with the same division that is claimed as necessary in describing 
delusions. Cf. pp. 6-7. 
The Journal of Mental Science for January, 1888, received just as 
this article is going to press, contains the conclusions, p. 582, of 
Professor Kovalewsky in an interesting article on Folie du Doute. 
He recognizes several degrees, and conditions of origin, of these affec- 
tions. But he starts with neurasthenia as the common soil from 
which they spring, belonging to the group of degenerative psychoses 
including pathophobia and the other forms of these ideational dis- 
orders ; and neurasthenia itself is regarded as rarely acquired or 
other than purely hereditary in relation to these cases. This fails to 
recognize the larger background in the normal field of intellection, 
where the accidental and irregular coordinations of idea and feeling, 
indulged, or otherwise fixed by habit, are the germs and often 
growths which are not degenerative hut spring up more readily in 
soils of purely acquired neurasthenia, or of hereditary degeneracies. 43 
strong impressions were made by unpleasant ideas 
about “trance” and the horror of being “buried 
alive.” Apprehensions for herself and relatives were 
engendered in this regard. Here was a quick soil for 
the natural questionings as to the right and wrong of 
her conduct to grow to be questionings as to whether 
her acts were right in respect to their effect upon 
herself or those dear to her. It was but a shade of 
change to conceive that her acts were not right in the 
sense of not being safe, which includes the idea of 
harm as a consequence. This is the usual significance 
of the phrase “not right” in these cases. The at- 
tendant fear of harm was natural and logical. This 
combination of the idea and its attendant feeling once 
formulated, the “ impression ” once made, the idea 
became “ insistent ” and then “ fixed,” and the “ path ” 
was formed by repetition and habit. Here then was 
the “fixed idea” that some of her acts were not right, 
which included the idea of harm. This is a common 
and primitive form of fixed ideas ; it was the root of 
all that grew up afterwards. Next followed the neces- 
sity, common in such cases, of repeating acts to make 
them right, which led to the doubting and hesitating 
over an act as to whether it was right or not, and to 
the repeating, doing and undoing of acts. Thus is 
explained the paradoxical “ doubting ” associated with 
“fixed ideas.” Here next was the basis of the habi- 
tual negations of thought and conduct—the doing off- 
set by undoing, the balancing or cancelling of one 
thought or act by another thought or act—the substi- 
tution of one thing for another. From the root-idea 
that an act was not right came its larger growth and 
its offshoots, intensifying the impression of the primary 
idea upon the organism. This was further intensified 
by the feeling of fear normally attending the idea of 
INSISTENT AND FIXED IDEAS. 44 
cowles : 
harm, the impression of the whole being deepened by 
habit; its hold upon the soil being strengthened by 
its growth. 
At the beginning, before the age of twelve, the seed 
of the malady was planted. Its growth was arrested 
and she appeared to be well till three years later. It 
might not have appeared again had it no't been favored 
by physical debility. A new growth began; she 
repeated her acts to make them right. She was 
relatively backward in her studies, and had a natural 
desire to excel her companions, which she did. Her 
love of admiration and attention was perfectly natural, 
as was her feeling of rivalry towards C., whose 
unusual loveliness of character and person was more 
attractive than her own superiority of intellect. Such 
was Madame de Staol’s life-long envy of beautiful 
women. Such thoughts and feelings are common 
enough among the young ; it was natural enough that 
her sensitive conscience should reproach her. Thus, 
with the mental habit already formed there was set 
up a self-inquisition as to her feeling toward her 
friend, whom she was afraid of hating, as she soon 
morbidly accused herself of actually doing. It was 
but a step then to the thought of harmful things that 
might happen to her friend, and but another to self- 
condemnation for thinking of them, as making her 
equally guilty as if wishing them to happen. Of 
course there was exaggeration of feeling in this, but 
so far in its development there was not, necessarily, 
anything that might not be common to many consci- 
entious young people. This idea of harm attending 
her acts, and the accompanying feeling of fear, readily 
became a concrete idea of harm to C., and to this was 
added the conception of her remorse as a consequence 
of harm to C., as if she had wished it. This of course INSISTENT AND FIXED IDEAS. 
45 
strengthened her specific fear of harm to C., and rein- 
forced the general idea of harm, and therefore the 
impulse to repeat her acts. Ultimately the question 
of harm to C. attended all her acts. This established 
the central idea and mental habit out of which came 
all its after-growth. From this point the evolution of 
the mental phenomena was plain enough, as given 
in the details of its history. The need of repeating 
acts and “ vows ” many times—often a definite number 
—for the sake of emphasis, was a manifestation which 
characterizes what is called the “counting” variety 
of cases of fixed ideas. This did not become a promi- 
nent feature of this case because it was left behind by 
larger complications. The substitution process was 
most curious and constant, but it only an out- 
growth of the primary fact in these cases of doubting, 
balancing and offsetting one thing against another in 
an endless series of negations. This process was also 
one of the remarkable devices for circumventing the 
dominating idea, as if the characteristic paralysis of 
the will was limited in respect to that, and the fixed 
idea stood as an irresistible intruder in her conscious- 
ness, while otherwise the will and the intellect were 
free to evade its control. The murder-acts were simply 
dramatic as far as homicidal impulse was concerned. 
They were extreme examples of what is common 
in such cases, particularly in the “metaphysical” 
variety,—an idea at first repulsive worries by its in- 
sistence, becomes involved in a process of negations, 
and at last reasons itself into dominance. Such tran- 
sitions from one extreme to another of thought and 
feeling are but exaggerated examples of the law whose 
order we follow when 
“We first endure, then pity, then embrace.” 46 
COWLES : 
The kindred nature of the great variety of these 
affections is well indicated by the broad designation 
of “ insistent ideas,” as was suggested in the intro- 
duction to this article. These aberrations from the 
normal of well-balanced ideation and feeling, being 
once initiated, may develop graver forms in cases of 
the more positively degenerative type, because of para- 
noiac heredity or acquired defect,— in other words, 
when there is hereditary or acquired nervous and 
mental instability ; and such cases may more or less 
quickly develop primary delusional insanity. The com- 
monness of these affections in their milder forms as 
simply insistent ideas, and their outgrowth from the 
ordinary and natural operations of the mind, is a 
matter of great interest. The commonest supersti- 
tions, and idiosyncrasies of formulations of ideas and 
feelings, which control conduct and enforce habitudes, 
are of this order in their slight departures from sound 
reasoning. There may be many degrees of these 
affections before they are recognized as positive dis- 
orders. This view of their common origin can best be 
illustrated by a series of cases in which the early 
phenomena are more nearly within the range of 
observation. But even the history of this case is not 
inconsistent with this view; nor is it so, as against 
that of their origin being usually constitutional. For 
the same reasons it is hardly necessary to search the 
mysteries of “ the inconscient ” for the genesis of 
phenomena which admit a simpler explanation. Many 
of these affections are to be easily understood as simply 
accidents or idiosyncrasies of ideation, arising from an 
incongruous association of ideas, happening according 
to the common law of contiguity, and becoming fixed 
in proportion to the intensity of the impressions and 
by the laws of habit. This may happen in a healthy INSISTENT AND FIXED IDEAS. 
47 
brain, by mental shock, or by a slower process. This 
case is an example of the operation of these laws in a 
plastic organism, with the qualities of a sensitive con- 
scientiousness and fertility of thought, favoring the 
particular idiosyncrasy. The morbid premise of the 
fixed idea being once established, it had its own logical 
sequences. The collateral ideation was normal enough 
and continued so for many years. There was normal 
sensibility and feeling except in relation to the fixed 
ideas and their complications. The will was domi- 
nated only in respect to these, and otherwise free and 
efficient. 
The origin of these affections is distinctly ideational, 
but they well illustrate the inseparable nature of 
thought and feeling, especially when their genesis is 
favored by disordered states of feeling. The laws of 
habit play a most important part in the fixation of such 
ideas, and much is here to be learned of the nature of 
the great influence of habit in all forms of insanity. 
These affections, through the possibility of their com- 
parative isolation, permit the study of the formation of 
delusions. Again, the r61e of the attention is a leading 
one in these mental phenomena; the attention is com- 
manded in proportion to the insistence of the ideas. 
In extreme cases of this kind of limitation of the at- 
tention there is, side by side with it, more or less 
activity of consciousness. But it is in this direction 
that these mental states merge with those described 
as characteristic of the hypnotic state in its varying 
degrees of unconsciousness, and of the “ limited atten- 
tion ” peculiar to that state. That condition character- 
ized by Professor Stanley Hall’s phrase, “ tonic cramp 
of the attention,” is most strikingly shown in these 
affections. The law of suggestion of ideas is active, 
and even by auto-suggestion the mental attitudes are 48 
COWLES : 
induced so analogous to physical “ cramp.” Also the 
relation of these attitudes to physical reactions is 
striking. “ A diffusive action in the nervous system 
accompanies all emotion”; for example, a common 
sequence is fixed idea, fear, pallor, and heart disturb- 
ance, etc. It seems in many cases as if the “path” 
between the ideation and the sympathetic nerve 
became so open and direct that there is the changed 
sequence of fixed idea, heart-quake, and last the con- 
scious fear. At all events this last is swiftly over- 
taken by the automatic organic attitude of fear ; and 
this quick reflex from the idea undoubtedly increases 
the fear. The man is frightened by his own trem- 
bling ; he is “ a coward upon instinct.” This amounts 
to mental suggestion from the physical field, just as 
when the hypnotized are put into bodily attitudes that 
suggest hallucinations. Again, the alliance of these 
mental states with some forms of “hysteria” is un- 
doubted, and explanatory of it. The medico-legal 
importance of these conditions occupies a wide field ; 
this very case presents interesting features in this 
regard. 
All these things show the unity of the great problem 
into which the clinical study of mental phenomena 
leads. The propositions here advanced involve such 
important questions, and more than these, in the in- 
vestigation of this subject; and this case is interesting 
as presenting so much of the evidence that has led to 
these views. AMERICAN JOURNAL OF PSYCHOLOGY. 
“The first number of the Journal proves beyond a doubt that, for a 
time at least, material will not be wanting, and quite as certainly shows 
that the movement in favor of an experimental psychology is strong and 
important enough to merit a separate organ of publication We 
seem justified in welcoming the Journal as an ornament to American 
science, and as promising to mark an era in the development of one of 
the most significant movements of our age.”—Science, November 18,1887. 
“A few years ago the physician—even he who makes a specialty of 
mental and nervous diseases—could have safely disregarded a journal of 
psychology. For psychologists used to confine themselves to the introspec- 
tive method, and to speculation on the results thereof, which hardly came 
within the sphere of practical medicine. Since Wundt, however, began 
the series of researches in psycho-physics .... the physician, and 
especially the alienist and neurologist, may find contributions of the utmost 
moment to him in purely psychological journals. Professor Stanley 
Hall, of Johns Hopkins, is the most advanced representative on the 
continent of this school of psychology, and the new journal which is to 
be issued under his superintendence is therefore worthy the attention 
of our readers We trust the Journal, which has made such 
a successful debut, has a bright future in store for it.”—Canadian Prac- 
titioner, Toronto, December, 1887. 
“It begins more and more to appear what a stimulus to psycho-physical 
research Prof. Stanley Hall has been able, alike by precept and example, 
to communicate during the years he has spent in organizing the depart- 
ment of psychological instruction in the young and lusty university of 
Baltimore.”—Mind, January, 1888. 
“ Ich begriisse freudig dieses Unternehmen, das, wie die erste Nummer 
zeigt, so gut geleitet und ausgefiihrt ist.”—Prof. W. Wundt, Leipzig, 
December 20, 1887. 
“It supplies a genuine want, and if the first number is a fair sample, 
its work will be well done and a great credit to American science. Since 
the publication of Mind was commenced, no periodical has appeared of 
such fair promise for the promotion of psychological knowledge and in- 
quiry. Professor Hall has made his mark in this department of science, 
and is thoroughly equipped for the work of conducting such a journal.” 
—Popular Science Monthly, February, 1888. 
“One thing is certain, the new method will do much for biology and. 
medicine, possibly as much or more than for the solution of the great* 
problems of mind ; for this reason, most of all, we welcome this new 
journal and wish it well. With the prestige of the wealthy and vigorous 
University where the new psychology has its chief seat in America ; with 
the learning and ability of the leader and the enthusiasm of its cultivators, 
we feel justified in looking to the new science during the next ten years to 
show what it is capable of doing for the thought and progress of the age. 
That it will accomplish much we feel certain.”—Canada Medical and 
Surgical Journal, Montreal, January, 1888. 
“It is just in this [the scientific] way that Professor Hall and his 
colleagues propose to invade the territory of sensation and thought. 
They will not undertake to tell you what the mind is, but they will apply 
instruments of precision, graphic methods, and statistics to feeling and 
thinking We hail with delight this accession to specialized 
journalism, and see promise of great good in the future awaiting Pro- 
fessor Hall and his collaborators.”—[Professor Otis T. Mason.] The 
Epoch, January 13, 1888. 
“Ce nouveau recueil . . . . est consacre a la psychologie scientifique. 
Plusieurs departements de la science, si distincts les uns des autres qu'ils 
ne se connaissent souvent pas, ont, dans ces dernieres annees enriche la 
psychologie : le but de la nouvelle revue, c’est de grouper ces informations 
diverses et de sollicker des nouvelles recherches. Chaque numero com- 
prendra trois parties: le des contributions originales d’un caractere 
scientifique (psychophysique, association des images, volition, innerva- 
tion, etudes sur les animaux et les enfants psychologie morbide, hypno- 
tisme, histologie du systeme nerveux et des sens, embryologie, etc.); 
2e bibliographic consacree a la litterature psychologique de tous les pays; 
3e. notes, nouvelles, information. Ses comptes rendus sont etendus et 
faits avec beuacoup de soin.”—Revue Philosophique, Janvier, 1888. THE AMERICAN JOURNAL OF PSYCHOLOGY 
BALTIMORE. 
This Journal is addressed largely to physicians interested 
in neurology, insanity, and nervous diseases. It occupies an 
entirely unique position among such journals in that it is 
exclusively scientific. Half of all its material consists of 
carefully written digests of important books and articles from 
leading medical and other journals which are too numerous 
and too widely scattered to be generally accessible. The 
Journal aims to make itself indispensable to physicians who 
wish to keep fully abreast of the great and increasing work 
now being done in European countries in the experimental 
physiology of the senses and central nervous system, the 
study of morbid psychoses, hypnotism and dreams, as well 
as the histology of the nervous system. Among the original 
articles printed or accepted are the following : 
Hyperaesthesia Experimentally Investigated. 
Insistent or Imperative Ideas. 
Recent Methods and Results in the Histology of the 
Brain. 
The Psycho-physic Law : A Criticism of its Methods 
and Results and its Application to the Determination of 
Star Magnitudes. 
An Experimental Study of the Knee-Jerk or Patellar 
Reflex. 
Gradual Increments of Sensation. 
A New Binocular Phenomenon. 
An Empirical Study of the Dreams of Four Years. 
The first number of the Journal (November, 1887) con- 
tains 206 pages. The second number (February, 1888) 
will contain about 160-170 pages. 
The Journal is edited by G. Stanley Hall, Professor of 
Psychology in the Johns Hopkins University, and appears 
quarterly at $3.00 per annum. 
Orders should be sent to 
N. MURRAY, Publisher, Baltimore, Md.