Etiology, Pathogenesis, and Therapy

According to Pierre Janet Concerning

Conversion Disorders and
Dissociative Disorders

KARL-ERNST BÜHLER, Dr. med. habil., Dipl.-Psych.#

GERHARD HEIM, Dr. rer. soc., Dipl.-Psych.*
Pierre Janet’s works on conversion disorders or dissociative disorders has
mainly fallen to the wayside in favour of Freud’s works. In the first part of
this paper, Janet’s conception of hysteria is discussed and his place in French
psychiatry described. Different aspects of Janet’s diathesis-stress approach are
presented (particularly the pathogenic concept of fixed ideas), which refer not
only to a conception of hysteria but also to traumatic (stress) disorders and
other psychological disturbances. The second part of the paper details the
varieties of Janetian therapeutic treatments of these disorders: the “liquida-
tion” of fixed ideas by hypnosis and suggestion, confrontation techniques,
which resemble contemporary cognitive behavioural approaches, and special
cognitive (“logagogic”) interventions. Finally, we discuss the various treat-
ment strategies based on psychoeconomic considerations such as physical or
psycho-phyical therapies, psychoeducation, treatment through rest, and sim-
plification of life for dealing with basic disturbances of psychic disorders.

KEYWORDS: Pierre Janet, hysteria, dissociation, fixed ideas, liquidation,

simplification of life

INTRODUCTION
In the last few decades the formation of theories concerning conversion
disorders or dissociative disorders was mainly determined by Freudian
thought or its derivatives, whereas Pierre Janet’s works had fallen into
oblivion (though Janet took up his scientific career as philosopher, psy-
chologist, and psychotherapist long before Freud and continued to prac-

* Psychotherapie Praxis, Berlin, #Julius- Maximilians-Universität, Würzburg, Germany. Mailing

address: Prof. Dr. med. K.-E. Bühler, Haafstr. 12, D-97082, Würzburg, Germany. e-mail: karlernst
buehler@gmx.de
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tise it longer than Freud did). The reason for this disuse may be that Janet’s
scientific endeavours—like scientific theories in general—was not the
starting point for a wider movement. His works were less speculatively
conceived than Freud’s, which is why they now are appropriate as a
starting point at which to reformulate the scientific explanation and
treatment of conversion disorders and dissociative disorders (see: Bühler
and Heim, 2001).
In the Diagnostic and Statistical Manual of Mental Disorders ([DSM-
IV-TR] APA, see: Sadock, B. J. and Alcott Sadock, V., eds., 2003)
conversion disorders belong to the somatoform disorders whereas disso-
ciative disorders were classified in a category of their own. This split is
justified because the symptoms (or deficits) of voluntary motor or sensory
function and seizures or convulsions are the essential pathognomonic
features of conversion disorders. The psychological factors are assumed to
be converted into the bodily symptoms or deficits. In dissociative disor-
ders, however, only psychological symptoms are affected, for example, the
memory in dissociative amnesia, the unified consciousness in dissociative
fugue, dissociative stupor, or dissociative trance, and identity in dissocia-
tive identity or depersonalisation disorder.
JANET’S INTELLECTUAL BACKGROUND AND HIS PLACE IN
FRENCH PSYCHIATRY AND MEDICAL PSYCHOLOGY
Janet’s intellectual background is marked, first, by his training as to
teach philosophy in the tradition of French spiritualistic philosophy. This
school of philosophy had an enormous influence in 19th century France
and the politics of science. The principal exponent was Maine de Biran
(1766 –1824), who stressed—in his “subjective” conception of psycholo-
gy— emotional and volitive aspects of mental life in contradistinction to
contemporary sensualistic conceptions of this science (see: Heim, 2006;
Carroy, Ohayon, & Plas, 2006; Sjövall, 1967).
Secondly, positivism, represented by philosophers like Hippolyte Taine
and Théodule Ribot, strongly influenced Janet. Particularly, Ribot’s con-
tributions, e.g. his treatises on British and German psychology, strength-
ened the “pathopsycholgical” orientation of French psychology. Ribot
believed that Claude Bernard’s approach to research in physiology was the
model for the new “objective” psychology. In addition, Ribot made G.H.
Spencer’s evolutionistic philosophy public in France (see: Brooks III,
1998).
Thirdly, Janet belonged to the medical-psychological school of thought
or School of the Salpetrière, whose descriptive psychopathological ap-
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proach had been, since Esquirol, the dominant trend in psychiatry. This
school of thought, however, did not exclude psychological topics of the
spiritualistic tradition discussed by scholars of subjective philosophy. Until
nearly the middle of the 20th century, eminent French psychiatrists often
had, like Janet, a double qualification as philosophers and physicians and
were called “médecin-philosophes” (see: Bogousslavsky, 2011; Pichot,
1996; Postel & Quetel, 2004).
Janet’s philosophical dissertation of 1889, entitled “L’automatisme
psychologique,” was a pathopsychological investigation concerning psychi-
atric inpatients. This famous study— carried out between 1882 and
1888 — qualified Janet as a leading representative of objective psychology.
He was supported by his uncle Paul Janet, one of the politically most
influential spiritualistic philosophers, by Charles Richet, later Nobel-Prize
winner of medicine, by Théodule Ribot, holder of the chair in pathological
psychology at the reputable Collège de France, and, above all, by Jean-
Martin Charcot, the famous neurologist who treated then-dispised hyster-
ical patients with then-disapproved hypnosis. Janet, who meanwhile stud-
ied medicine, was appointed by Charcot as head of the psychological
department of the Salpetrière, and he remained head of this department
until he finally followed Ribot as holder of the chair of psychology at the
College de France in 1902 (See: Brooks III, 1993; Ellenberger, 1970).
ETIOLOGY OF CONVERSION DISORDERS AND DISSOCIATIVE
DISORDERS
BASIC DISTURBANCES OR STIGMATA
Pierre Janet proposes a diathesis-stress diathesis-model of conversion
disorders and dissociative disorders and presumes as causes, first: basic
disturbances, stigmata, or dispositional disorders, i.e. a fundamental vul-
nerability, and, second: accessory disorders like “fixed ideas” as effects of
traumatic experiences (see: Heim and Bühler, 2006). The fixed ideas are
highly variable and depend on the particular circumstances—including the
biography— of the patient but not the basic disturbances, stigmata, or
dispositional disorders
Because, basic disturbances, stigmata, or dispositional disorders and
fixed ideas constitute different factors in the causal network of conversion
disorders and dissociative disorders, the one may prevail on the other
concerning the beginning and development of the sickness. If basic
disturbances, stigmata, or dispositional disorders prevail, a “weakened
psychic constitution” is the main cause for the beginning and the devel-
opment of the sickness (Figure 1).
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Figure 1
PSYCHOGENESIS OF NEUROSES

Compared with normal subjects, those with basic disturbances have

dispositions to cognitive or psychic dissociation, i. e. to a weakening of the
ability to perform cognitive or psychic synthesis, to narrowing of the field
of personal consciousness, to absent-mindedness, to impairment of atten-
tion, to cognitive or psychic instability, to suggestibility, to reduction of
sensibility, and to enhanced readiness for conversion, i. e. to an increased
influence of cognitive or psychic factors on bodily processes.
The main or most basic disturbance of conversion disorders and
dissociative disorders is a weakening in the ability to perform cognitive or
psychic synthesis. This is the cause of the narrowing of the field of personal
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consciousness. Therefore, in conversion and dissociative disorders the

personal consciousness is impaired. These patients are able to synthesise
only a small part of psychic states or processes in a single personal
consciousness. The impairment of personal consciousness explains the
occurrence of dissociative amnesias because some psychic content may not
be remembered by a particular personal consciousness. It also explains the
occurrence of dissociative fugue, dissociative stupor, dissociative trance,
and dissociative identity or depersonalisation disorders.
The second (or the other) consciousness(es) in dissociative fugue,
dissociative stupor, dissociative trance, and dissociative identity or deper-
sonalisation disorders is (are) but of a rudimentary form, being able to
encompass only a limited number of sensations and ideas and, therefore,
less able to control itself. This is why fixed ideas may develop without
restriction in the rudimentary consciousness(es) and why they are even
more powerful than in normal consciousness. The second or the other
consciousness(es) is (are) similar to dream consciousness, which is a
rudimentary consciousness itself.
Again, the impairment of personal consciousness is the cause of
dissociative anesthesia. Dissociative anesthesia, however, is not a real
anesthesia—an extinction of sensations— but a dissociation of psychic
phenomena. The sensations that have left the normal personal conscious-
ness continue to exist as parts of a different consciousness(es) and may be
rediscovered there. Janet (1989) explains this as follows:
L’anesthésie systématisée ou même générale est comme une lésion un
affaiblissement, non de la sensation, mais de la faculté de synthétiser les
sensation en perception personelle, qui amène une véritable désagrégation
des phénomènes psychologiques (p. 314).
(The systematised or even general anesthesia is like a lesion, a weakening
not of the sensation but of the faculty to synthesise the sensations in a
personal perception that leads to a real disaggregation of psychic phenom-
ena. Translated by the authors.)
Elsewhere he remarked:
Dans l’hystérie, les phénomènes psychologiques ne pouvant plus être com-
plètement réunis, se séparent nettement en plusieurs groupes à peu près
indépendant l’un de l’autre. La personalité ne peut percevoir tous les
phénomènes, elle en sacrifie définitivement quelques uns; c’est une sorte
d’autonomie et ces phénomènes abandonnés se développent isolément sans
que le sujet ait connaissance de leur activité.
(Because the psychic phenomena may not be completely united in hysteria,
they clearly separate themselves in several more or less independently
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existing groups. The person is not able to perceive all the phenomena and
definitely sacrifices some of them; this is a sort of autonomy and these
abandoned phenomena develop in isolation without the person having
knowledge of their activity. Translated by the authors.)
Because of the restriction of the field of consciousness, the patients are
unable to enduringly unite all the sensations in one and the same personal
perception. Therefore, in order to be able to perceive, they must select,
and they select one or the other content of consciousness. This is the origin
of instable personal perception.
Concerning anesthesia, Janet differentiates three stages of hysteria:
● First stage: the beginning hysteria.
Here, the patients show no anesthesia but only some indifference
concerning sensations,
● Second stage: the developing hysteria.
Here exists a restriction in the field of consciousness but no unchange-
able anesthesia. The sensations are not exclusively subconscious. They may
become conscious through an enhancement of the stimulus or a change of
attention.
● Third stage: the fully developed hysteria.
The anesthesia is unchangeable.
In addition to disturbances in sensation, disturbances of voluntary
motor functions are also caused by the restriction of the field of conscious-
ness. The patients behave as if they were disturbed only in the voluntary,
conscious, and attentively performed movements, not in habitualised and
automatised movements, such as those movements performed in a absent-
minded manner. It seems that psychic automatisms are even more pro-
nounced. In general, these movements are slower and coarser in manner;
they are not performed as a reflex.
As such, the patients are not conscious to basic disturbances. They are
negatively characterised as a toning down or even suppression of sensa-
tions, memories, and movements. For Janet, these disturbances are proof
of a weakening and exhaustion of central-nervous functions. Strictly
speaking, these phenomena as such should be valued neither negatively
nor positively, but according to the circumstances. If a conversion or a
dissociation develops in an uncontrolled manner it is disturbing and
therefore, valued as a negative. But if they are more or less intentional, as
a yogi or fakir might show, no negative value is attached to them. For
instance, intentionally or voluntarily performed dissociations are even
strategies against torture, and as such they are positively valued faculties in
resistance to torture.
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The basic disturbances are based on hereditary dispositions or an

acquired biological vulnerability. Therefore, in combination with an im-
paired ability for coping, conversion and dissociative disorders belong to
the group of “adjustment or adaptation disorders” that should better be
called “coping disorders” because adjustment and adaptation are kinds of
coping.
PERSONALITY OF CONVERSION DISORDERS AND DISSOCIATIVE
DISORDERS
The personality of these disorders is affected, theatrical or histrionic,
and dramatising. The subjects work themselves into affects and emotions,
or they abandon themselves to them. Janet connects the personality of
conversion disorders and dissociative disorders with the basic distur-
bances, mainly weakening in the ability to perform cognitive or psychic
synthesis and restriction in the field of consciousness. He argues as follows:
Leurs enthousiasmes passager, leurs désespoirs exagérées et si vite consolées,
leur convictions irraisonnées, leurs impulsions, leurs caprices, en un mot ce
caractère excessif et instable, nous semble dépendre de ce fait fondamental
qu’elles se donnent toujours tout entières à l’idée présente sans aucune de ces
nuances, de ces réserves, de ces restrictions, qui donnent à la pensée sa
modération, son équilibre et ses transitions (Janet, 1909, p. 339).
(Their passing enthusiasm, their exaggerated and so easily consolable
despair, their unreasonable convictions, their impulsiveness, their whims,
in a word their excessive and unstable character seems to depend for us on
this fundamental fact that they wholly abandon themselves to the present
idea without any of these nuances, these reserves, these restrictions which
give to the thought its moderation, its equilibrium and its transition.
Translated by authors.)
Additionally, he describes supplementary personality features of con-
version disorders and dissociative disorders, which, however, partially
overlap with those of psychasthenic disorders (see: Janet, 1903) and are
adduced in Table 1. They are not pathognomonic for both kinds of
disorders. Some features are common to several disorders and thus
characterise a psychically vulnerable personality. Histrionic personality
features on the one hand and conversion disorders and dissociative
disorders on the other were originally causally connected with the pre-
sumption that only subjects with those features seem tricky, complex, and
ambiguous enough to sufficiently explain these polymorphous disorders.
This connection, however, does not exist immediately but only mediately.
Extraverted personality features prevail in polymorphous conversion dis-
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Table 1: COMPARISON OF HYSTERICAL VS. PSYCHASTHENIC PERSONALITY

TRAITS

HYSTERICAL PERSONALITY PSYCHASTHENIC PERSONALITY

Apathy—indifference, tendency to boredom

Asthenia—weakness of will, lethargy, lack of stamina, monotonous
behaviour (ALSO SEE: BENHIMA, 2010)
● suggestibility, dependence, ● inability to make decisions,
submissiveness fearful of decision making
● unfocused (need for guidance) ● submissiveness
● inferiority ● inferiority, feelings of failure
● incompleteness, helplessness ● incompleteness, helplessness
● restlessness ● bustle
● stubbornness, obstinacy ● irritability, excitability
● absent-mindedness, inattentiveness ● anhedonia, dejection
● fickleness (need for change) ● feelings of an inner void
● instability, conflicted, exaggerated ● dissatisfaction, disgruntlement
● emotionality ● inability to enjoy
● histrionic-dramatisation, affected ● self-contempt
nature, unbridled enthusiasm ● feelings of insecurity
● unchecked despair and ● pessimism
desperation ● catastrophising
● inappropriate and unexpected ● worries, grief
behaviour ● moral self-deprecation
● inconsistent nature ● guiltiness
● loss of social feelings and social ● self-accusation
competence ● perfectionism
● egoism ● miserliness
● need for attention and affection ● social retreat
● need for moral support ● introversion
● insincerity, shiftiness
● jealousy

orders and dissociative disorders whereas introverted characteristics pre-

dominate in psychasthenic disorders.
The psychic strain by the particular personality itself is the connecting
link between personality on the one hand and the disorder on the other.
The personality features mentioned by Janet are factors of psychic vulner-
ability because they contradict the principle of psychic economy, i. e. they
highly waste “psychic energy” (i. e. tension or force). In his Harvard
lecture (1937), which was based on his works on psychotherapy (1919;
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1924) and on “La force et la faiblesse psychologiques” (1932), Janet

thoroughly deals with the concepts of “psychic tension” and “psychic
force” in the context of his general model of psychic resources concerning
psychic disorders.
The metaphorical concepts of “force” and “tension” are taken from the
language of electrophysics and transferred to psychology and, therefore,
need some explanation. We propose that “force” is explained as potential
energy (as opposed to actual, manifested energy) and “tension” is viewed
as potential rate and extent of the activation of “latent energy”.
Janet assumes that “psychic force” and “psychic tension” are impaired
differently in conversion disorders and dissociative disorders and psychas-
thenia. In psychasthenia the “psychic tension” is sufficient but not the
“psychic force,” therefore, the subjects quickly become exhausted. Feel-
ings of incompleteness, doubt, weakness of indecision, and other symp-
toms result from this imbalance of “psychic tension” and “psychic force”
(Janet 1903, p. 675 f, p. 784 ff.). With conversion disorders and dissocia-
tive disorders, the relation between “psychic tension” and “psychic force”
are inverse: the “psychic force” is sufficient but “psychic tension” is not.
This is the cause why the field of consciousness is restricted and limited to
few psychic states and processes.
The metaphors of “psychic tension” and “psychic force” need further
characterisation through neurophysiological and neurochemical factors
which, then, may explain the specificity of the disorders.
TRAUMATA
Charcot and later Janet took additional causes concerning psychic
disorders (besides organic and hereditary predispositions) into consider-
ation: psychic traumata in the sense of psychologically impressing events.
In his lectures during 1884 and 1885, Charcot was able to prove convinc-
ingly influence of these traumatic events on the genesis and the develop-
ment of “hysterical” attacks and symptoms. Psychic traumata are con-
ceived as life events triggering considerable affects and emotions (see:
Janet, 1925, p. 289). In addition, chronic affects and emotions increase the
effects of psychic traumata because, according to Janet, they are patho-
logical phenomena, maladaptations of behaviour sto particular situations.
So, affects and emotions are indispensable parts of psychic traumata.
Charcot showed that in some cases of “hysterical” paralysis caused by
an accident, the emotion immediately originated by the accident is not the
only cause of the disorder. The memories, the ideas, and the images of the
accident, combined with the accompanying emotions and worries about
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the accident are as influential on the disorder as the accident. Here, the
causes are mediate and not immediate ones (see: Janet, 1925, p. 208)
Concerning the diagnosis of disorders caused by traumata, Janet is
a very cautious scientist. He preferred to explain the genesis of the
symptoms of a disorder through their conformity to natural laws, not
through accidental painful memories (see: Janet, 1919, p. 263). Symp-
toms should be considered as originated by accidental biographical
causes only if such a consideration is indispensable, and taking the
clinical context into account. Janet warns psychiatrists against aban-
doning themselves to speculative thinking. They have to carefully
examine if the disorders necessarily take place in combination with the
particular event, if there exists a parallelism between the disorders and
the memories, and if both terms of the assumed causal relation are
actually connected with each other, so that it is possible to change one
by changing the other. For asserting a causal relation between event
and disorder the influence must exist in the present; it is not sufficient
that an event have had an influence in the past. All these precautions
did not stop Janet from looking in the patient’s biography if an
explanation of the disorders was not convincing in present findings.
However, traumatic memories should be taken into account only if they
recur in the present and if they convincingly condition enduring strain
that causes exhaustion. As a link between traumata and disorder, Janet
assumed a proneness or predisposition diathesis to affects or emotions.
The psychic traumata manifest it and thus give occasion to a progres-
sive loss of psychic energies (force or tension).
PATHOGENESIS OF CONVERSION DISORDERS AND
DISSOCIATIVE DISORDERS
FIXED IDEAS
Basic disturbances and psychic traumata are but partial causes of
conversion disorders and dissociative disorders. The fixed idea is an
additional cause. It results from an enduring loss of psychic energy
(force or tension) caused by traumatic affects or emotions. Janet
connects his theory of psychic traumata and his overall nosology of
conversion disorders and dissociative disorders. According to this
hybrid theory, a patient is unable to wholly better integrate an awkward
and painful experience of a life event into present life by coping with
it and by fitting it as a coherent part into of life. On the contrary, the
memory of the life event and the efforts to assimilate it into life
continue persistently because the problems connected with it remain
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unsolved. There never exist feelings of triumph that normally take place
after overcoming difficulties (see: Janet, P., 1919, p. 280).
The reiteration of the particular situation and the incessant endea-
vour to adapt or assimilate it into life, leads to a decrease of psychic
energy (force or tension), to tiredness, to exhaustion, and to the
origination of symptoms of sickness. This causes further affects and
emotions.
Patients with fixed ideas of a former life event do not really
remember this life event. Janet called this particular kind of memory
“traumatic memory” of unassimilated life events. Therefore, patients
are often unable to talk about this life event in a regular conversation,
as is the case with common memory. Instead, the traumatic memory has
to be inferred by psychological analysis of clues and hints. The fixed
idea refers to something unsettled, i. e. something uncompleted, which
Nietzsche named “resentment” and Viktor von Gebsattel called “pre-
sentification of the past” or “inhibition of becoming” (see: Bühler and
Rother, 1999). Therefore, it is not surprising that fixed ideas resist
changes, which Freud called “resistance.” And that resistance influ-
ences one’s conception of the world, of oneself and of the formation of
interpersonal relations, which were named “transference” by Freud.
Yet, it is not understandable why Freud attached so much significance
to both of these qualities of fixed ideas.
Affects and emotions, being themselves combined attached to the
senses, are of utmost importance in the genesis and development of
fixed ideas. These affects-and emotions disconnect the overall structure
of ideas and thus weaken the control of ideas by the person. Normally,
ideas do not exist in isolation from each other but build up complexes
as effects of a synthesis. In subjects with a sound psychic constitution,
these complexes nest to become a superordinate system. That is, they
become the system of the whole consciousness of a person. Traumatic
memories based on fixed ideas, however, primarily develop in isolation
from other psychic states or processes and without the knowledge or
control of the person. They act in a way comparable to autosuggestions.
The ideas become fixed and develop themselves autonomously and stay
outside the personal consciousness and will of the patient (Janet, 1901).
Therefore, the ideas may be characterised as subconscious (Bühler und
Heim 2009). Charcot and Janet compared such fixed ideas with a
parasite. Nowadays they would be called a harmful computer program,
a computer virus, or a computer worm.
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VULNERABILITY
Psychic traumata are not the only immediate causes of fixed idea
development. Often traumata are caused either by a hereditary predispo-
sition or an acquired weak psychic constitution. Exposure to external
traumas further weakens the already frail psychic constitution, which itself
is the source of increased affects and emotions, and thus continuing the
existence of fixed ideas. The result is more damage to the psychic
constitution and a vicious circle among affects, emotions, fixed ideas, and
psychic disturbance ensues. Janet describes this vicious circle accurately:
C’est la depression préexistante qui prépare l’émotivité et qui bien entendu
est augmentée encore par l’émotion nouvelle de telle manière que les troubles
nerveux et mentaux de la depression se précipitent en boule de neige (Janet,
1921, p. 221).
(The pre-existent depression paves the way for enhanced emotivity which,
of course, is increased even more by a new emotion in a way that the
nervous and mental troubles of a depression become faster and faster like
an avalanche Translated by the authors).
Janet conceived his diathese-stress model on this basis. If the initial life
event was very stressful then it occasioned severe emotions. In this case the
emotionally originated fixed idea is very important for the genesis and
development of the disorder. In other cases there is only a minor emotional
reaction at the beginning of the disorder. Here, the weakened psychic
constitution (faiblesse mental) is of utmost importance. It conditions an
unstable psychic equilibrium, a loss of the ability to perform psychic
synthesis, a paralysis of the association centers, and an impaired function
of the sensory centers (Janet, 1898a, p. 155 ff; 1898b). Occasionally Janet
compared psychic disorders with infectious diseases, the symptoms of
which partly persist even if the infectious agent has already disappeared, so
that a subsequent disinfection no longer has any influence on the process-
ing of the sickness or curing. Therefore, a psychic disorder does not always
disappear if a traumatically conditioned fixed idea has been removed. A
proneness or vulnerability to psychic traumata remains, causing multiple
relapses. The proneness or vulnerability to psychic traumata may be why
new fixed ideas emerge, grow in strength, and engender a new disorder.
The causal procedures of psychic traumata may be summed up as
follows. In the case of an already weakened psychic constitution, the
trauma originates marked affects and emotions. Because of inappropriate
patterns of reactions, the individuals are unable to cope with the difficult
situation. They continue with their coping efforts. These repeated efforts
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occasion an exhaustion of psychic energy (tension or force) resulting in

different types of psychic disorders. In case of sufficient tension but
insufficient force, the ideas do not become subconscious but cause disor-
ders that Janet calls “psychasthenia.” In case of insufficient tension but
sufficient force, the ideas weaken the psychic synthesis and, by that, the
connection of consciousness. The ideas become fixed as well as subcon-
scious, the field of consciousness restricted, and the suggestibility in-
creased. Janet names the disorders resulting from this process “hysteria.”
These energetic conceptions of the aetiology of psychic disorders permit
the possibility of the summed up causal effects of similar but also of
different traumata as causes.
THERAPY OF CONVERSION DISORDERS AND DISSOCIATIVE
DISORDERS
Charcot noted that the success of a therapy depends to a considerable
extent on psychic hygiene, and having as an aim, among others, to
eliminate pathogenic thoughts, images, or presentations. In this vein, Janet
developed numerous therapeutic procedures. These procedures are pre-
sented here proceeding from the particular to the general.
UNCOVERING AND INFLUENCING FIXED IDEAS THROUGH PSYCHOLOGICAL ANALYSIS

Generally speaking, the method of psychological analysis in Janet’s

sense is not only appropriate for the treatment of conversion disorders and
dissociative disorders but also for the therapy of psychasthenia because
both maladaption disorders cause a weakening in the psychic constitution
(i.e. a weakening of force and tension in Pierre Janet’s language). This
psychic constitution should be strengthened through the liquidation of
unsettled experiences. If the causes of a disorder are not found in the
present life of a patient, it is justified to seek them in the past. This is done
through analysis of the deeper layers of consciousness. Janet discussed this
kind of treatment of traumatic disorders in his book Les médications
psychologiques (1919, vol. II, pp. 204 –307) under the heading “Treatment
by mental liquidation,” and he proposed an interesting version of catharsis,
i. e. abreaction (décharge), using the force of strong emotional reaction to
re-establish hitherto dysfunctional adaptive responses of higher mental
levels to traumatic experiences.
Psychological analysis in Janet’s sense of the term is apt to uncover
traumatic yet subsconscious memories. In-therapy a subconscious fixed
idea that wastes psychic energy (force or tension) is reintegrated into the
whole of personal consciousness so that the loss of psychic energy (force or
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tension) is reduced. The reduction of these losses through the “liquida-

tion”of fixed ideas explains the successes of psychological analysis. Janet
elucidates this effect:
Après cette liquidation quelquefois pénible et coûteuse (. . .), l’esprit cesse de
faire ces efforts d’adaptation qu’il répétait indéfiniment (Janet, 1924, p. 179).
(After this liquidation, sometimes painful and costly, the psyche stops
making the efforts of adaptation which it repeated indefinitely. Translated
by the authors.)
In many cases he recommends hypnosis and automatic writing as appro-
priate methods of psychological analysis because by activating tendencies
that are latent in the waking state it is possible to retrieve memories. Janet
also accepts dreams for this purpose, even if he definitely rejects sophistry
in interpreting them. This is why dream analysis is not the primary method
for investigating subconscious phenomena, though Janet accepts them as a
window to subconscious processes that exist in parallel to the conscious-
ness of the waking state. Dreaming is a kind of automatised psychic
processes, that is it happens unintentionally and without the will of a
person, and, therefore, it makes automatised psychic processes apparent.
The automatic nature of dreams is why Janet accepts the dream analysis in
psychotherapy, especially in cases of recurrent themes or content. Dreams
indicate traumatic experiences that may stay in direct connection to
psychic disorders because they are bound to latent (i. e. subconscious)
tendencies. Latent tendencies may trigger dreams that may be wholly or
partly remembered on awakening. In such cases the traumatic experiences
are manifest in dreams. The distortions of the dream contents are the result
of the nature of dream consciousness differing from waking consciousness
(Janet 1909, p. 31). For Janet a dream has no meaning other than its
manifest content. He rejects every symbolic interpretation of dreams. The
analysis of dreams has to confine itself to recognising the automatised and
recurrent processes in dreaming.
We, the authors, propose the following: Recognising automatised and
recurrent processes in dreaming may become easier by using more abstract
categories for description, thus enabling an optimal grasp of dream
content and a more comprehensive discovery of recurrent processes. The
use of more abstract categories for description is not, however, an inter-
pretation of dreams in the Freudian sense, i. e. no amplification, but a
reduction of the manifold of dream contents.
In particular cases Janet was able to show that discovering the subcon-
scious fixed idea and rendering it conscious is sufficient either to diminish
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symptoms of sicknesses or to heal them completely. The healing process is

accomplished by reducing the strength of a fixed idea that has become
conscious through other conscious ideas, thus strengthening the psychic
constitution through inhibiting losses of psychic energy (force or tension).
Discovering unconscious traumata through psychological analysis is—
apart from rare exceptions— but a first step in healing because not all
psychic disorders vanish by making a subconscious fixed idea conscious. In
some cases a pathogenic fixed idea has to be removed and replaced by a
different nonpathogenic idea. Janet calls these quasi-surgical interventions
“extraction,” “substitution,” “isolation,” or “dissociation”. Besides other
techniques, for example, persuasion or explanation, hypnotic suggestions
are helpful for these purposes. They are insinuated while the patient is in
a subconscious state, and they are either induced by suggestions or occur
spontaneously. The patients awaken from this subconscious state and have
no memories of the processes that occurred. Another way to neutralise a
fixed idea is to relativise the pathogenic nature of it through making
positive aspects apparent.
INFLUENCING FIXED IDEAS THROUGH TREATMENT BY SUGGESTION
Because there is a disturbance in natural suggestibility in patients with
conversion and dissociative disorders, treatment through suggestion is very
important. Decreased ability for psychic synthesis, restriction of the field of
consciousness, and thus, increased dissociation, are the causes of this
natural suggestibility. Suggestions— conceived as the automatic develop-
ment of particular ideas outside the will and the personal consciousness of
patients—are clearly pathological phenomena. Such exaggerated develop-
ment of an idea occurs when it is isolated from other psychic states or
processes. Suggestions are, therefore, due to activation of a single tendency
that is not complemented or completed by other tendencies. Suggestible
persons never have more than a single idea in their restricted field of
consciousness. This is why they are unable to unite several ideas in a single,
personal consciousness. Janet explains:
En un mot, dans ce qu’on appelle suggestion, l’idée se développe complète-
ment jusqu’à se transformer en acte, en perception et en sentiment mais elle
semble se développer par elle-même, isolément, sans participation ni de la
volonté, ni de la conscience personelle du sujet (Janet, 1909, p. 302).
(In a word, with what is called suggestion, an idea completely develops
even to its conversion into an action, a perception, and an emotion but it
seems to develop for itself and in isolation without the involvement of the
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will or the personal consciousness of the subject. Translated by the

authors.)
The suggested idea develops as it does because it is isolated and does
not counter ideas in the field of consciousness that opposite it and able to
modify it. Consent to the suggestion takes place immediately and invol-
untarily without reflection or rational consideration. It happens like an
impulse. Janet comments as follows:
La provocation d’une impulsion, qui constitue l’essentiel de la suggestion
n’est en somme pas autre chose que l’activation d’une tendance sous une
forme inférieure, avec un degré moindre de perfection à la place d’une
activation de forme plus élevée (Janet, 1924, p. 126).
(All in all, the provocation of an impulse, which is the essential element of
a suggestion, is nothing but the activation of a tendency on a lower level
with a lesser degree of perfection instead of activation on a higher level.
Translated by the authors.)
The automatic association of psychic elements must be possible to
accomplish a suggestion, but the actual synthesis of these elements is
altered or restricted. A pre-existing illness is a prerequisite for the alter-
nation of psychic synthesis since psychically well persons maintain the
ability for synthesis.
Janet tried to influence fixed ideas through suggestions. If such an
influence is not immediately possible, then a fixed idea should likewise be
replaced through suggestions and transformed into a more harmless idea,
or dissected into its elements, which will be suggestively dissolved one by
one. Janet himself describes this procedure:
L’idée fixe nous a paru être une construction, une synthèse d’un très grand
nombre d’images; au lieu de l’attaquer dans son ensemble, il faut chercher à
la décomposer, à détruire, ou à transfomer ses éléments, et il est probable que
l’ensemble ne pourra plus subsister (Janet, 1894a, p. 128).
(For us the fixed idea seemed to be a construction, a synthesis of a great
number of images; instead of attacking it as a whole, one should try to
dissect it into single parts, to destroy or to transform its elements; then it
is probable that the whole will not persist any more. Translated by the
authors,)
Treatment through ordinary suggestion is complemented by hypnosis
through activation of automatic rather than higher cognitive tendencies.
This complement is very helpful because the natural suggestibility of
patients with conversion disorders and dissociative disorders is increased
during the hypnotic state. Through these procedures lower level tenden-
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cies are freed from the control of higher ones, and this occasions an
immediate (asseritif) consent rather than a reflected (reflechi) one. Janet’s
concept of hypnosis is connected with his overall psychological view of
psychic tendencies (see Heim and Bühler, 2006). The low level of the
middle tendencies or patterns of behaviour (conduites moyennes), i.e. the
pithiatic or assertive (automatic consent or affirmation) stage with its
suggestible imitation or unreflected consent, is very important for treat-
ment through suggestion.1 Shortcomings in this stage are obvious: some
steps leading to reflected beliefs are skipped and substitutions in the
patient’s beliefs go unchecked. Janet believes that the phenomenon of
suggestibility and suggestion may not be understood without in-depth
knowledge of the pithiatic state of consciousness.
However, treatment through suggestion, and a fortiori through hyp-
notic suggestions, is limited.
First, it would be a wholly wrong understanding of a psychic image or
presentation to restrict the cause of such disorders to a single fixed idea,
and to think that it would be sufficient to remove it through suggestions.
Secondary fixed ideas must not be overlooked. To do this would be to
misunderstand essential elements of these disorders and to have an incor-
rect conception of psychic images or presentations.
Second, the ease with which the suggestions relieve patient suffering is
simultaneously a symptom of a deep psychic dissociation. The more easily
the cure is accomplished, the deeper psychic condition is bound. There-
fore, Janet sees the treatment of conversion disorders and dissociative
disorders through suggestions, and a fortiori through hypnotic sugges-
tions, as problematic because these procedures replace “one evil with
another.” If one symptom is removed through suggestions, another may
emerge. The basic disturbances of patients with conversion disorders and
dissociative disorders (their increased suggestibility) would not be im-
proved by suggestions or hypnotic suggestions, but rather made worse. In
addition to these considerations, it is not certain if the fundamental fixed
idea is actually removed through the suggestive elimination of symptoms.
These objections do not imply, however, that treatment through sugges-
tions or hypnotic suggestions is not effective in particular cases (though it
may fail in many others). Therefore, a trial of treatment through sugges-
tions or hypnotic suggestions is always indicated.
1
The adjective pithiatic may derive from two different roots of the Greek language: first from peitho
meaning to persuade, to convince, and to prompt, or second, from pitheo meaning to obey as well as
to trust. Pithekos means ape, so that pithiatic may mean aping. In the theoretical context of tendencies,
aping would be the most appropriate translation of the adjective pithiatic.

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Like every drug, suggestions are, according to Janet, useful in some

cases and harmful in others. They are useful in weakening or suppress-
ing subconscious fixed ideas that individuals cannot influence, and this
enables the patients to recover from the loss of psychic energy (force
and tension). Apart from these cases, Janet considers treatment through
suggestion or hypnotic suggestion as harmful because it increases
psychic dissociation, which is the cause of all dissociative symptoms.
Janet remarks:
Du moment que vous pouvez guérir le sujet par suggestion, c’est qu’il est
encore malade. Sauf des cas très rares, il ne me semble pas que l’on puisse
arriver à guérir par suggestion l’état même de misère psychologique, qui est
une condition essentielle de l’exécution des suggestions (Janet, P., 1889,
p. 456).
(In the same moment as it is possible for you to heal persons through
suggestion, they are still sick. Apart from very rare exceptions, it seems to
me that it is not possible to heal the real condition of psychic suffering
which is the essential precondition for suggestions to be effective, through
suggestion. Translated by the authors.)
Janet even compares the craving to be hypnotised with morphine
addiction and makes it responsible for a part of the disturbances of these
patients. He argues:
Ces rechutes semblent fréquemment se compliquer par un besoin très intense
qu’éprove le sujet, celui d’être hypnotisé de nouveau, d’être de nouveau
commander, suggestionné par la personne qui l’avait guéri précédemment.
C’est ce sentiment analogue à bien des points de vue à la morphinomanie,
que j’ai étudié sous le nom passion somnambulique (Janet, 1911, p. 664).
(Many times these relapses seem to become even more complicated by a
very strong desire of the patient to get hypnotised, led, and suggested by
the person having cured them before. This craving which I have investi-
gated using the expression “somnambulic passion” is comparable in many
respects with morphine addiction. Translated by the authors.)
All in all, treatment through suggestion is a symptomatic therapy with
many limitations, such as patient resistance to suggestions, transient relief,
or the generation of additional symptoms, including dependence or even
addiction. An additional qualifier: If fixed ideas influence interpersonal
relations (or are triggered by them), an immediate effect on fixed ideas
through suggestion or hypnotic suggestion is hardly possible, but a medi-
ate one is possible through implicit shaping of interpersonal relations or
explicit reinterpretation of them.
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INFLUENCING FIXED IDEAS THROUGH TREATMENT BY IMAGES OR PRESENTATIONS

Antagonistic-ideas, which are opposed to the pathologic fixed ideas,
trigger deep emotions or affects so that a new equilibrium is affected in the
whole system of consciousness. Janet recommends the concrete proce-
dures of common counselling, words of encouragement, incentives, and
specialised exercises with strengthening or constructive cognitions. He has
summed up the procedures of his times used in treating traumatic disor-
ders:
Les meillieurs procédés sont ceux qui déterminent l’assimilation de
l’événement émotionnant, qui amènent le sujet à comprendre par la réfléx-
ion, à y réagir correctement, à s’y résigner (Janet, 1924, p. 101).
(The best methods are those which determine the assimilation of the
shocking events through inducing the subject to understand them through
reflection, to react to them appropriately, and to learn to live with them.
Translated by the authors.)
However, Janet viewed these methods only applicable in a limited way
because of their shortcomings: high rates of relapse, fast habituation, high
variability concerning persons and situations, and low transferability to
other cases. In addition, fixed ideas are not fundamentally changed by
these procedures because they, the fixed ideas, do not depend on the will
and the rational affectability of the patients.
JANET, COGNITIVE THERAPY, AND OTHER CURRENT
BEHAVIOURAL THERAPIES
It is not our intent to demonstrate that many ideas in modern psycho-
therapy were anticipated by Janet because psychotherapy has many “par-
ents.” But Janet may be called a precursor of behaviour therapy and
cognitive therapy. We can appreciate Janet’s holistic approach, including
his model of personality, as paradigmatic in that it was engendered by
extensive, careful clinical descriptions and cautious, theoretical “top-
down” hypotheses were open to modification by empirical research. Not
only was Janet’s inductive approach to studies similar to Eugen Bleuler’s
influential conceptualization of schizophrenias, but also, Bleuler was
deeply influenced by Janet’s studies of hysteria and psychasthenia than was
hitherto assumed (see: Moskowitz & Heim 2011).The same influences
hold for other conceptions of psychological disorders. Additionally, one
should not ignore the usefulness of Janet’s conceptions bearing in mind the
relevance of Albert Bandura’s “self-efficacy” model (1977) or Frederick
Kanfer’s (1991) “self-management” model for the cognitive-behavioural
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therapies, as well as the recent shift to constructivist and dynamic concep-

tions (“third wave”) in cognitive-behavioural therapies.
In general, Janet’s methods resemble today’s cognitive-behavioural
procedures for treating dysfunctional and affectively tinted thoughts and
cognition complexes. His methods correspond the principles of cognitive-
behavioural therapy that a therapeutically structured re-experiencing of
traumata to neutralize phobic behaviour, will oppose fixed ideas and
integrate the traumatic experience, thus allowing an appropriate reap-
praisal [of the trauma]. For instance, the cognitive-behavioural “narrative”
method for treating posttraumatic stress disorders (PTSD) is implicitly
based on Janet’s conception of subconsciousness (Janet, 1907a; Bühler &
Heim, 2009; Fiedler, 2008). It consists of reintegrating dissociated emo-
tional memories of traumata, conceived as temporarily unrelated elements
that are context-free, into a chronological autobiographical context. Most
modern approaches are congruent with Janet’s views that during traumatic
experience there is a lowering of “mental strength,” that is, pathogenic
associative learning processes prevent the synthetic processing of the
trauma. Traumatic memories return because they are dissociated (or
dis-integrated) fixed ideas evoked by stimulation. That is, deficient inhib-
itory processes (rather than voluntary recall) in autobiographic memory,
lead to involuntary re-experiencing of the event. Janet also proposed a
three-phase therapeutic strategy in PTSD: stabilization of the patient,
synthesis of memory, and integration into daily life.
In addition, Janet’s approach resembles neo-behaviourism because of
his reference to covert processes as well as overt behaviour. His concept
may be understood as a dynamic resource-allocation model, which implies
a functional model of psychological disorders. His blue print of a socio-
genetic hierarchy of behavioural “tendencies” could represent a stimulat-
ing elaboration of the concept of behaviour. Janet also made systematic
descriptions of psychotherapeutic interventions (Janet, 1919; 1924) which
have similar differential-therapeutic objectives similar to present endeav-
ours to integrate empirically supported therapies into a common psycho-
logical framework (see: Grawe 2002).
Nowadays, there exist a multitude of new cognitive– behavioural (or
other somewhat related) approaches that focus on concepts like “schema,”
“mindfulness,” “emotional regulation and processing.” They use narrative,
imagery, and body-related procedures to promote assimilative processes in
the treatment of traumatic disorders. They seem to confirm Janet’s pre-
diction made in 1907 summarising his lessons about “Psychological anal-
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ysis and the critics of psychotherapeutic methods” at the Collège de

France:
Enfin les educations de l’attention, les traitements de l’émotivité, les diverses
excitations qui se proposent de relever le niveau mental, constitutent les
méthodes qui sont encre employées un peu au hasard, mais qui joueront un
rôle de plus en plus grand dans l’education et dans le traitement de l’esprit
(Janet 1907b, p. 710).
(“Finally the education of attention, the treatment of emotionality, the
various excitations which intend to raise the mental level, form methods
which are already applied a bit by chance, but which will play a more and
more important role in education and in the treatment of the mind”.
Translated by the authors.)
Such plausible links to current cognitive-behavioural therapies exist
for the treatment of Posttraumatic Stress Disorder (PTSD), obsessive
compulsive disorder (OCD), and depression as well as to behaviour
therapy in general (see: Heim & Bühler, 2003; Heim & Bühler, 2006).
Usually, almost no explicit references are made to Janet by authors of
cognitive-behavioural therapy. One exception to this is Hoffmann
(1998), who has developed an OCD treatment program based on
Janet’s key-concept of “feeling of incompleteness,” which was further
elaborated on by Ecker & Gönner (2008). In the same vein, Australian
researchers (O’Connor et al. 2005) have discussed the therapeutic
consequences of the Janetian view that OCD should not be conceptu-
alized simply as an anxiety disorder. Additionally, Greenberg’s (2004)
“Emotion-focused therapy” conceives of emotions or feelings in a
manner that resembles Janet’s notion of feelings as secondary actions
that regulate primary ones. For example, in Janet’s terminology, fear
helps in avoiding dangerous ventures, thus preventing harm, fatigue
assists by resigning oneself from endless efforts, thus preventing ex-
haustion, and effort assists in reaching a goal, and joy helps in finishing
the action. All these emotions contain bodily felt sensations that bestow
meaning to acting in concrete situations and these become part of an
autobiographical storytelling. In Janet’s view they confer a substantial
momentum to the evolution of personality. Greenberg’s “dialectical-
constructivist” concept regards such a bottom-up process as essential in
changing automatic emotional responding. His approach (including
training in emotional awareness, regulation, and transformation) is a
paradigm of Janet’s above-mentioned vision of “treatment of emotion-
ality,” which is perceived as one important element of modern psycho-
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therapy. Mentioned must be made that Janet’s pioneering role for those
body-oriented therapies was worked out by Boadella (1997).
In the tradition of cognitive and hypnotherapeutic approaches, a group
of Dutch and American researchers and therapists (Van der Hart, Nijen-
huis, & Steele, 2006) has designed a comprehensive multimodal concep-
tion for treating chronic, severe traumatic disorders. The authors explicitly
refer to Janet’s model of a dynamic personality, with its key concepts of
action and its adaptive regulation by feelings. The authors conceive of
dissociation as the manifestation of a disturbed interaction between adap-
tive action-systems of the person (i. e. the relation between actions directed
to the demands of daily needs and the action systems necessary for
extraordinary situations like defences against danger). Their comprehen-
sive multimodal idea for treatment fosters harmony between the appar-
ently normal personality (ANP) and the emotional personality (EP) dis-
sociated from ANP, which causes secondary dissociations within the
defensive systems of the EP and tertiary dissociations within the action
systems of the ANP.
Another form of intervention in cognitive restructuring is Logagogy
(Bühler, 2003, 2004). It is a demanding type of psychophilosophical
intervention aimed at the spiritual sphere, insight, and reasoning of human
beings to influence emotions and affects by means of verbal interventions
and dialogue. It also includes written instructions such as aphorisms,
epigrams, apophthegmata, paremias, gnomes, adages, proverbs, or sayings.
The aim of Clinical Logagogy is the conduct of one’s life and the
prevention of, as well as guidance for and support in, hopeless-seeming life
crises or in insoluble-seeming conflicts. It is directed at thoughtful persons
who are open to education and culture and willing to grasp their particular
situation and to attempt to relativise the problems and conflicts by fitting
them into general considerations. In his textbook of psychotherapy, Pierre
Janet (1919, 1925) dedicated a chapter, “Philosophical Psychotherapy,” to
forms of psychophilosophical intervention. However, he was sceptical
about such interventions because he felt they depended too much on the
particular therapist and training could not be generalized. We do not share
his scepticism, though we acknowledging the limits of Logagogy.
According to Janet’s diathesis-stress model of dissociative disorders
and conversion disorders, therapy for fixed ideas is more important than
the treatment procedures of basic disturbances or stigmata. However, in
cases of high vulnerability, principle demands that the basic disorders or
stigmata receive equal treatment.
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Pierre Janet on Conversion and Dissociative Disorders

Treatment of Dissociative Stigmata (Basic Disturbances)

In the case of a still severely disturbed psychic constitution, a cure
after having treated fixed ideas is not always lasting. In addition to the
therapy for fixed ideas, basic disturbances or stigmata have to be
treated because the general psychic constitution is a collateral cause of
suggestibility and the fixed ideas themselves. Therefore, treatment has
to cure the basic disturbances in, for example, psychic synthesis. All
general treatment procedures help the psychic constitution in prevent-
ing or minimising unnecessary expenditures of psychic force and
tension.
PHYSICAL OR PSYCHOPHYICAL THERAPIES
Janet recommends general treatment procedures like physiotherapy,
hydrotherapy, balneology, nutrition, and other methods to enhance sen-
sibility. According to Janet, the physical or psychophysical as well as
dietetic procedures are very helpful because they strengthen health in
general and the nervous system or the psychic synthesis ability in partic-
ular. They prevent relapses after a treatment through psychological anal-
ysis or through suggestion.
PSYCHOEDUCATION
In addition to the other methods, Janet recommends psychoeducation
as a therapeutic procedure (Janet, 1911). In order to overcome the effects
of unsuccessful adaptation, patients have to find new coping strategies that
foster the ability to solve problems or to learn to live with the inevitable.
Psychoeducative methods range from the uncomplicated method of
“economizing” energy, for example, treatment through rest or isolation,
and the more complex, such as activation of the other. Training of
attention (L’éducation de l’attention) is especially worth mentioning here.
Comparable to pedagogy, it is a kind of mental gymnastics that improves
the patient’s ability to perform psychic synthesis through exercises. In
turn, the increased ability to perform psychic synthesis prevents suggest-
ibility and fixed ideas. Janet describes the training of attention (L’éducation
de l’attention) as follows:
. . . [C’est] une méthode de traitement qui consiste à les (les hystériques) faire
travailler cérébralemant d’une manière régulière, comme des enfants à l’école
(Janet, 1911, p. 675).
(. . . [It is] a method of treatment which consists in getting them (the
hysterics) to do regular mental work like children in school. Translated by
the authors.)
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Here, modern cognitive or hypnotherapeutic procedures for treating

histrionic personality disorders should be mentioned. In this connection
the “ego state” is a core concept. Watkins and Watkins (1997), for
example, define it as an organised system of experiences and behaviours
connected by a common principle and separated by somewhat permeable
borderline from different “ego-states.” As a psychotherapeutic approach
for histrionic personality disorders, Watkins and Watkins (1997) propose
a multilevel description of situations (encompassing thoughts, emotions
and affects, bodily sensations, tendencies of behaviour, and feedback
information of the [social] environment) activating mostly conflicting “ego
states.” This approach can be combined with cognitive therapy connected
with behaviour modification. The patients learn to be aware of their ego
states by means of analyses of cognitive experiences and behaviours, and as
a consequence, they learn to prevent, moderate, or adaptively change the
effects of these mostly conflicting “ego states.”
Janet also proposed work therapy (a modification of it nowadays is
called ergotherapy). The basic idea of such a therapy is to train higher
tendencies, to broaden the field of consciousness, and to enable it to take
in several ideas simultaneously as well as to synthesise them or oppose one
another. Therefore, mechanical activities that may be carried out with low
attention should be avoided. Rather, activities should be graded according
to the attention required and the number of elements to be synthesized,
i.e. according to their complexity. The tasks must neither be too unde-
manding nor too demanding. Here, parallels to Morita therapy are obvi-
ous.
TREATMENT THROUGH REST
As general procedures to strengthen the psychic constitution, Janet
suggests treatment through rest, isolation, and hypnotic sleep. In modern
times Charcot was the first to introduce them as cures for treating psychic
disorders. Treatment through rest is self-evident and needs no further
characterisation. Isolation is characterised by Janet:
L’isolement consiste tout simplement à retirer le malade de sa famille, de son
milieu habituel et à le transporter brusquement dans un endroit tout à fait
inconnu pour lui (Janet, 1911, p. 642).
(Isolation simply consists in taking the patients away from their families,
their ordinary social environment and bring them immediately to a place
wholly unknown to them. Translated by the authors).
The basic idea is very simple, namely, to remove the patients from their
pathological milieu. Through isolation the exhaustion caused by influences
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from the ordinary social environment of the patients can be reduced. Janet
argues:
C’est dans leur famille, dans la présence de certains personnes, dans la
conversation que se trouve l’origine de leurs idées fixes. Ces idées fixes sont
sans cesse éveillées et alimentées par des fait journaliers et ne peuvent que
grandir dans le milieu où elles ont pris naissance (Janet, 1911, S. 643).
(The origin of their fixed ideas is to be found in their family, in the
presence of particular persons, in conversations. These fixed ideas are
incessantly activated and nurtured by everyday incidents and become
stronger and stronger in the milieu where they originated. Translated by
the authors).
To distance the patient from the stressful environment, treatment
through rest and isolation takes place in a sanatorium. To this extent,
treatment through rest and isolation is another parallel to Morita
therapy, however, the patients are not left to fend for themselves but
they enter a therapeutic milieu. Without a doubt the patients take their
fixed ideas with them to the new environment, but while there they do
not think of them as much. Therefore, the fixed ideas are not inces-
santly activated by associations, and in a best-case scenario are forgot-
ten. Additionally, isolation simplifies of the patients’ lives. This is no
small advantage for patients whose ability for psychic synthesis is
impaired.
Concerning treatment through rest by means of hypnotic sleep, Janet
proposes three steps:
1) Initiation
2) Induction of hypnotic sleep, and
3) Termination with the wakening phase.
Janet calls this procedure:
Un modificateur puissant des phénomènes psychologiques, capable de déter-
miner dans l’esprit, dans les souvenir, dans les actes des bouleversements
remarquables (Janet, 1911, p. 654).
(A strong modificator of psychic phenomena able to provoke remarkable
modifications of the psychic constitution in general, of memories, and of
actions. Translated by the authors,).
He also writes:
Le sommeil hypnotique est surtout utilisé pour que le sujet exprime ses
émotions persistantes, indique leur origine et consente à se laisser imposer
des efforts de volonté et d’attention nécessaires pour modifier son équilibre
cérébral (Janet, 1911, p. 651).
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The hypnotic sleep is mainly used to make the subjects express their
persistent emotions, show their origins, and consent to impose on them-
selves efforts of the will and attention necessary to modify the cerebral
equilibrium. Translated by the authors).
Treatment through rest and isolation is but a first step. Another one has
to follow: simplification of life.
SIMPLIFICATION OF LIFE
Janet proposes simplification of life (simplification de la vie) as the most
general procedure for treating the basic disturbances of dissociative dis-
orders and conversion disorders. Yet simplification of life as an unspecific
therapeutic procedure is not only appropriate for dissociative disorders
and conversion disorders but also for psychic disorders in general, e. g.
depression, schizophrenia, anxiety disorders, or some personality disor-
ders. Simplification of life is even more important than ordinary treatment
through rest and isolation because the faults and shortcomings of lifestyle
and the conduct of one’s life become particularly obvious in psychic,
psychosomatic, and even somatic disorders. They are symptoms of deeper-
lying failings of the human constitution and like measuring instruments,
are appropriate and sensitive indicators of the faults and shortcomings in
lifestyle and the conduct of one’s life. Janet mentions simplification de la
vie:
Je le résumerai en un mot, c’est la vie facile dans laquelle tous les problèmes
de la famille, de l’amour, de la religion, de la fortune sont réduit au
minimum, dans laquelle sont soigneusement écartées les luttes de chaque jour
toujours nouvelles, les préoccupations de l’avenir, et les combinaisons com-
pliquées (Janet, P., 1911, p. 678).
I sum up: In simple life all difficulties with the family, love, religion,
fortune, and happiness are reduced to a minimum. In it the daily struggle
for life, the worries about the future, as well as other complications and
confusions of life are removed. Translated by the authors).
Because patients often get stuck (accrochés) in seemingly hopeless
situations, the basic principle of life simplification is reducing unnecessary
stress and keeping life as unaffected as possible They have to be freed
(désaccrocher) of their seemingly hopeless situations by solving as many of
their mostly complex problems of life as possible. One means of achieving
this goal is to organise and structure life. This kind of treatment is also
carried out by psychogogic or psychotherapeutic councelling and instruc-
tion in strategies for problem solving. Sometimes such a therapeutic
approach becomes very difficult or even impossible, since for therapists
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Pierre Janet on Conversion and Dissociative Disorders

may not be able to solve all the problems of their patients. Often the
therapists can only give hints about heuristics for problem solving.
Although Janet discussed many treatment modalities, he did not have
at his disposal should be mentioned an additional, rather unspecific
treatment for basic disturbances of psychic disorders: psychopharmaceu-
ticals.

REFERENCES
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