FOOTNOTE:
[3] See my work “The Source and Aim of Human Progress.”
[CHAPTER VI]
FEAR AND DISEASE
If we examine closely the symptoms of fear, we invariably find the symptoms of functional psychosis or neurosis. Fear affects the muscular and sensory systems, the vasomotor system, the respiratory system, the sudorific glands, the viscera, the heart, the intestines, all organs and functions of the organism.
Bain, in describing the emotions of fear or terror, says, “Terror on the physical side shows both a loss and a transfer of nervous energy. The appearances may be distributed between the effects of relaxation and effects of tension. The relaxation is seen, as regards the muscles, in the dropping of the jaw, in the collapse overtaking all organs not specially excited, in trembling of the lips and other parts, and in the loosening of the sphincters. Next, as regards the organic processes and viscera. The digestion is everywhere weakened; the flow of saliva is checked, the gastric secretion arrested (appetite failing), the bowels deranged; the respiration is enfeebled. The heart and circulation are disturbed; there is either a flushing of the face or a deadly pallor. The skin shows symptoms—the cold sweat, the altered odor of the perspiration, the creeping action that lifts the hair. The kidneys are directly or indirectly affected. The sexual organs feel the depressing influence. The secretion of milk in the mother’s breast is vitiated.”
Darwin gives the following description of fear:—
“The frightened man at first stands like a statue, motionless and breathless, or crouches down as if to escape observation. The heart beats quickly and violently, but it is very doubtful if it then works more efficiently than usual so as to send a greater supply of blood to the body; for the skin instantly becomes pale, as during incipient faintness. The paleness of the surface, however, is probably in large part or is exclusively due to the vasomotor center being affected in such a manner as to cause the contraction of the small arteries of the skin. That the skin is much affected under the sense of great fear we see in the marvelous manner in which the perspiration immediately exudes from it. This exudation is all the more remarkable as the surface is then cold, and hence the term, a cold sweat; whereas the sudorofic glands are properly excited into action when the surface is heated. The hairs also on the skin stand erect, and the superficial muscles shiver. In connection with the disturbed action of the heart the breathing is hurried. The salivary glands act imperfectly; the mouth becomes dry and is often opened and shut. I have also noticed that under slight fear there is a slight tendency to yawn. One of the best symptoms is the trembling of all the muscles of the body. From this cause and from the dryness of the mouth, the voice becomes husky or indistinct, or may altogether fail.”
If we turn now to the manifestations of psychopathic maladies, we meet with the same fear symptoms:—
(a) The attacks may be muscular, involving symptoms such as trembling, shaking, paresis, paralysis, or rigidity; there may be affection of locomotion or of muscular co-ordination.
(b) There may be sensory disturbances,—anesthesia, paresthesia, analgesia, or hyperalgesia as well as affection of muscular sense and kinesthesia.
(c) There may be skin disturbances, such as arrest of perspiration or profuse perspiration, especially under the influence of emotions, worry, and fatigue; such perspiration may also occur at night, and in some cases the fear of tuberculosis may be associated with such conditions.
(d) The lungs may become affected functionally, and there may occur respiratory disturbances; coughing, hawking, apnea, dyspnea, and asthmatic troubles.
(e) The heart becomes affected, bringing about precordial pain; palpitation of the heart, bradycardia, tachycardia, and cardiac arrhythmia.
(f) The stomach and intestines become affected, indigestion and vague fugitive soreness and pain may be experienced all over or in special regions of the abdomen; constipation or diarrhea may ensue.
(g) The renal apparatus may become affected and its activity arrested, or, as is more often the case in the milder forms of psychopathic troubles, there may be present an alteration in the amount or frequency of micturition, such as is found in the conditions of anuria and polyuria.
(h) Menstruation becomes disturbed, and we may meet with conditions of dysmenorrhea, amenorrhea, menorrhagia, and other disturbances of the tubes, ovaries, and uterus.
(i) There are disturbances of the nervous system, such as headache and a general dull sensation of fatigue and paresis of all mental functions, with dizziness and vertigo.
On the mental side we find in the psychopathies the following disturbances:—
(a) Affections of perceptual activity,—illusions and hallucinations.
(b) Affections of intellectual activity,—argumentativeness in regard to insignificant things.
(c) Affections of the moral sense,—scrupulousness, over-conscientiousness, not living up to ideal states.
(d) Affections of religious life,—fear of commission of sins and terror of punishment.
(e) Affections of social life,—timidity, blushing, etc.
(f) Affections in regard to objects, such as astrophobia, acmephobia, agoraphobia, claustrophobia, etc.
(g) Affections of conceptual life,—insistent ideas.
(h) Affections of the attention,—aprosexia.
(i) Affections of the will,—states of aboulia, indecision, discord, conflicts, and uncontrollable impulses.
(j) Affections of the memory,—amnesic and paramnesic states.
(k) General mental fatigue.
(l) Affections of sexual life,—impotence, perversion, and inversion.
(m) Affections in regard to marital relations.
(n) Affections in regard to personal life,—diffidence, self-condemnation, self-depreciation.
(o) Affections of apparent loss of personality,—feeling of self gone.
(p) Formation of new personalities,—dual and multiple personality.
In connection with all such neurotic affections we find invariably present a feeling of unrest, hesitation, doubt, conflict, discord, uneasiness, a feeling of anxiety, conscious or subconscious, feeling of some impending evil. In all such affections we find the brooding spirit of the most powerful of all animal instincts,—the fear instinct. Neurosis is a disease of self-preservation and fear.
[CHAPTER VII]
FORMS OF NEUROSIS
A brief outline of a classification of nervous and mental diseases, made by me in my various works, may be of help towards a clear understanding of neurotic disturbances.
The different forms of nervous and mental diseases may be classified into Organic and Functional.
By organic affections I mean to indicate pathological modifications of the neuron and its processes taking place in the very structure (probably the cytoreticulum) of the nerve cell. Under this category come such maladies as general paresis, dementia praecox, all mental and nervous affections of a degenerative and involutionary character. Such diseases are termed by me Organopathies, or Necropathies.
By functional affections I mean to indicate all neuron changes in which the functions of the neuron and its reactions to external and internal stimulations are involved in the pathological process without, however, affecting the anatomical structure of the nerve cell. The pathological changes are not permanent,—recovery of normal function is possible with the restitution of favorable conditions of nutrition and elimination.
Functional nervous and mental diseases are in turn subdivided into Neuropathies and Psychopathies.
Neuropathic diseases are disturbances of functioning activity, due to defective neuron matabolism, brought about by external stimuli, and more specially by harmful internal stimuli—glandular secretions, hormones, toxic and autotoxic agencies. The pathological, neuropathic process produces few, if any anatomical, changes in the structure of the neuron. The pathology of neuropathic diseases, (probably of the cytoplasm) is essentially chemico-physiological in nature.
Neuropathic diseases include maladies in which the neuron undergoes degenerative changes. At first there is an apparent increase, then an inhibition, and finally a complete suspension of neuron function, not terminating in the destruction of the neuron. Neuron restitution is possible.
Such affections are produced by mild poisons, organic, or inorganic, by autotoxic products, by hyposecretion or hypersecretion, or by absence of hormones in the economy of the organism. Here belong all the temporary, or recurrent maniacal, melancholic, delusional states, puerperal mania, epileptic insanity, the mental aberrations of adolescent and climacteric periods, periodic insanity, alternating insanities, and in general all the mental affections known under the description of manic-depressive insanity.
Where the disease depends on the interrelation of neurons in a complex group, on association of systems of neurons, the condition is psychopathic in nature.
In psychopathic troubles the neuron itself may remain unaffected, may be perfectly normal and healthy. The disorder is due to association with systems of neurons which are usually not called into action by the function of that particular neuron system.
By Organopathies or Necropathies I indicate a group of psychophysiological symptoms, accompanied by structural, necrotic changes of the neuron, terminating in the ultimate death of the neuron systems, involved in the pathological process.
By Neuropathies I indicate a group of psychophysiological manifestations due to pathological functional neuron modifications, capable of restitution through normal metabolism.
By Psychopathies I designate pathological phenomena of psychophysiological dissociation and disaggregation of neuron systems and their functions in clusters, the neuron itself and its special function remaining undamaged.
The psychopathies are further subdivided into Somatopsychoses and Psychoneuroses or Neuropsychoses.
The Somatopsychoses are characterized by somatic symptoms, by disturbances of bodily functions, such as paralysis, contractures, convulsions, anesthesia, analgesia, hyperalgesia, and other sensory disturbances, as well as by intestinal, cardiac, respiratory, and genito-urinary troubles.
The psychoneuroses or Neuropsychoses are characterized by mental symptoms. The patient’s whole mind is occupied with mental troubles.
Such conditions are found in obsessions, fixed ideas, imperative impulses, emotional compulsions, and other allied mental and nervous maladies.
Somatopsychoses simulate physical and organic nervous troubles. Thus, many “hysterical” forms simulate tabes, or paralysis agitans, hemiplegia, paraplegia, or epilepsy, while many of the neurasthenic, hypochondriacal, and their allied states may simulate tumor, cancer, intestinal and glandular derangements, cardiac, laryngeal, pneumonic, hepatic, splanchnic ovarian, tubal, uterine, renal, and other bodily afflictions.
The neuropsychoses or psychoneuroses simulate all forms of mental disease, beginning with melancholia and mania, and ending with general paresis and dementia.
Psychoneurosis and somatopsychosis are diseases of the subconscious; in the former mental, in the latter physical symptoms predominate.
Psychopathic states should be rigidly differentiated from other disturbances, such as neuropathies and organopathies, or necropathies. The following diagram may be of help:
Nervous and Mental Diseases
DIAGRAM I
[CHAPTER VIII]
FEAR AND THE HYPNOIDAL STATE
In my work on “Sleep” I report a series of interesting experiments carried out by me on guinea pigs, rabbits, cats, dogs, children, and adults.[4] I discovered one of the most important states of animal life, a state which I termed hypnoidal.
The study shows that in almost every animal, from the lowest to the highest, from frog to man, a somewhat sudden change of the usual environment deprives that animal of its activities and its functions. If the change is not too intense and prolonged, the animal merges into the hypnoidal state in which the lost functions are restored. During this hypnoidal state the functions are weakened, the animal may be regarded in a state of invalidism, its reactions being enfeebled, practically speaking, paretic.
Perhaps it is advisable to approach the phenomena from their more striking aspect. In seizing a triton, salamander, or frog, and stretching it on the table, one will observe with surprise that the animal remains in the same position given it. The most uncomfortable and bizarre position may be given to the limbs, and still the animal will not move. Testing the extremities one finds them rigid and resisting. Something similar we find in the hypnotic condition, when under the suggestion that the extremities are rigid, and they cannot be moved by the subject. The same can be done with a lobster and other animals of the same type.
Everyone has heard of the experimentum mirabile made by Kirchner in the seventeenth century. A rooster or hen is seized, the legs are tied with a string and the bird is put on the ground. A piece of chalk is passed over the beak,—the chalk tracing a line from beak to some distant point on the ground. When the bird is released, it remains in the same position. Some explain that the animal is kept prisoner, because it “imagines” that it is bound by the line of chalk. The chalk, however, is unnecessary. The animal may be seized, shouted in its ear, or kept down forcibly, and the same result will happen. This state has been termed by Preyer “cataplexy.” The phenomenon can also be produced in insects, in mollusca.
Many investigators have been interested in this phenomenon. I have devoted a good deal of work to this condition which is also found in mammals in which it is induced by the fear instinct. In mammals, however, the state of cataplexy is not necessarily accompanied by rigidity, although it may be present, but there is a complete loss of voluntary activity. Horses tremble violently and become paralyzed at the sight of a beast of prey, such as a tiger or a lion. At the sight of a serpent, monkeys are known to be in such an intense state of fear that they are unable to move, and thus fall easy victims to the reptile.
Under similar conditions birds are so paralyzed by fear that they are unable to fly away from the source of danger, and fall a prey to the threatening serpent. The birds resemble very much the hypnotized subject in a state of catalepsy. Although the gibbons are the most agile of all the simians, they are easily taken by surprise, and captured without any resistance,—they are paralyzed by fear. Seals when pursued on land become so frightened that they are unable to offer any opposition to their pursuers, and let themselves easily be captured and killed.
In large cities one can often witness nervous people affected suddenly by the presence of danger; they remain immobile, in the middle of the street, becoming exposed to fatal accidents. The fear instinct paralyzes their activities, they are petrified with terror.
I was told by people who have experienced the effects of earthquakes, that during the time of the earthquakes they were unable to move, and the same condition was observed in animals, especially in young dogs. It is hard to move cattle and horses from a burning stable, on account of the fear of fire which obsesses the animals, so that they become paralyzed, suffocated and burnt to death. So vital is the fear instinct that the least deviation from the normal state is apt to play havoc with the safety of the individual.
The fear instinct is the most primitive, the most fundamental, and the most powerful of all instincts. When the fear instinct is let loose, the animal succumbs. We should not wonder, therefore, that with the aberration of the fear instinct, the life guardian of the individual, all orientation is lost, the animal becomes demoralized, and the organism goes to destruction. No other instinct can surpass the fear instinct in its fatal effects.
The more one studies the facts, the more one examines various psychopathic, functional maladies, without going into any speculations and without being blinded by foregone conclusions and pseudo-scientific hypotheses, the more one is driven to the conclusion that the fear instinct is at the bottom of all those nervous and mental aberrations, conscious and subconscious.
The infinite varieties of functional psychopathic diseases are the consequences of some abnormal association with the fear instinct which alone gives rise to the infirmities characteristic of functional mental maladies.
President Stanley Hall accepts my view of the subject. In a recent paper he writes: “If there be a vital principle, fear must be one of its close allies as one of the chief springs of the mind”.... In spite of his former psychoanalytic inclinations President Hall asserts now that “Freud is wrong in interpreting this most generic form of fear as rooted in sex. Sex anxieties themselves are rooted in the larger fundamental impulse of self-preservation with its concomitant instinct of fear.” This is precisely the factor and the teaching which I have been expounding in all my works on Psychopathology.
So deeply convinced is Professor Stanley Hall of the primitive and fundamental character of the fear instinct, that he refers to the facts that “if the cerebrum is removed, animals, as Goltz and Bechterev have proved, manifest very intense symptoms of fear, and so do human monsters born without brains, of hemicephalic children, as Sternberg and Lotzko have demonstrated.”
The fear instinct is of such vital importance that it is found in animals after decerebration, and persists in animals after spino-vago-sympathetic section. Sherrington found the fear instinct present in dogs after section of the spinal cord and also after complete section of the vago-sympathetic nerves, thus removing all sensations coming from the viscera, muscles, and skin, below the shoulder, leaving only the sensations from the front paws, head and cerebral activity. The dog was a sort of cerebral animal. The whole body below the shoulder, skin, muscle, viscera, were all anaesthetic, and yet the fear instinct remained intact.
On the other hand, after complete ablation of the cerebral hemispheres of the dog, so that the animal became spinal, all cerebral functions being totally wiped out, Goltz invariably found that the fear instinct remained unimpaired. The fear instinct is inherent in animal life—existence. As long as there is life, there is fear.
So potent, all embracing, and all pervading is the fear instinct, that the physician must reckon with it in his private office, in the hospital, and in the surgical operating room. In a number of my cases psychognosis, the study and examination of mental states, clearly reveals the fact that even where the neurosis has not originated in a surgical trauma, surgical operations reinforced, developed, and fixed psychopathic conditions.
The fear instinct is one of the most primitive and most fundamental of all instincts. Neither hunger, nor sex, nor maternal instinct, nor social instinct can compare with the potency of the fear instinct, rooted as it is in the conditions of life primordial.
When the instinct of fear is at its height it sweeps before it all other instincts. Nothing can withstand a panic. Functional psychosis in its full development is essentially a panic. A psychogenetic examination of every case of functional psychosis brings one invariably to the basic instinct of life, self preservation and the fear instinct.
As Whittier puts it:
Still behind the tread I hear
Of my life companion, Fear,
Still a shadow, deep and vast
From my westering feet is cast;
Wavering, doubtful, undefined,
Never shapen, nor outlined.
From myself the Fear has grown,
And the shadow is my own.