This paper presents the results of an action research study into the acute care experience of Dissociative Identity Disorder. The study, which was grounded in principles of critical social science, utilized focus group interviews and narrative construction. Nurses and patients are under-represented in all clinical evaluation and their voices need to be heard if services are to be truly collaborative. Findings of the study extend intrapsychic theories of trauma to emphasize the interpersonal relationship between nurse and person who can work together to facilitate recovery from trauma, make connections both intra and interpersonally and build resilience.

In the following stray notes and remarks, the writer details a trip to various places of medical and psychological interest which he made, in company with Professor Laycock, through some parts of France, Savoy, and Switzerland.

The various forms under which morbid impulses and perverted instincts present themselves have generally been classed by authors under “Moral Insanity” † and “Emotional Insanity,” † or each has been titled a mania or monomania. Their occurrence is found to be regulated by the degree of civilisation, mode of life–whether in town or country–and the prevailing tendencies of the age, which indelibly stamps them with its characteristic features. The classification adopted in the following pages is that of Professor Laycock, § which leads us first to examine those connected with the nourishment of the being.

At a time when so much public interest is manifested in lunatic asylums and their inmates, it scarcely requires the memory of the illustrious Pinel, Esquirol, and Guislain, or the knowledge of what has been done by the present Morel, Baillarger, Falret, Moreau, &c., to tempt one over the Channel, more especially when a visit to the far-famed Gheel is contemplated. So in July and August last, having leave of absence from my duties to spend some weeks in rest and recreation, I resolved to find both in a visit to the French and Belgian asylums, having learned by experience that to travel without an object is neither profitable nor pleasant. Believing that what interested me, and regarding which my curiosity had sometimes been excited at home, might not be devoid of interest to others, I made “notes” regularly of what I observed, recording facts and impressions on the spot and on the day, rather in the order of observation than of coherence, and striving only to observe well, and to state the exact truth.

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Fever and other diseases amongst the insane attract attention in their mental as well as in their physical relations; and if at the same time both sane and insane suffer, a comparison of the cases is interesting. Besides, in an asylum the patients are especially under charge from the first faint indications of the malady, and the previous history, habits, and constitution of the individual arc familiar. In ordinary cases of fever amongst the community at large, the particular currents of the patient's thoughts and volitions do not attract special attention, save in protecting him from injury; and if insanity or other brain disease subsequently occurs, the features of the fever-poisoned brain are generally unknown and forgotten. Additional light might be thrown upon mental pathology and treatment, if such observations, sufficiently extensive, were correctly made and recorded. Alienists, on the other hand, have long noted the influence of physical diseases in the course of an attack of insanity; and recently cases from foreign journals were given by Dr. Arlidge,* where recovery has followed from wounds causing profuse suppuration in melancholia and general paralysis, from scarlatina in suicidal melancholia, from dysentery in mania and melancholia, from dysentery and acute rheumatism in monomania, from dysentery and a compound fracture of the elbow in religious monomania; lastly, profuse intestinal hæmorrhage is mentioned by M. Baillarger as ushering in recovery in a case of painful hallucination of vision consequent upon injury from a railway accident. Numerous other interesting cases are mentioned in the pages of our medico-psychological literature. Professor Laycock lately made known to me the case of a young girl, set. 15, an epileptic, who had typhus fever for five weeks, and never had a fit all that time. As she recovered, the fits returned as before (several daily), and ultimately the patient became acutely maniacal.

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