FOOTNOTE:
[8] Prof. Ed. Claperèdé of Geneva University, Switzerland, and Anastay seem to favor some similar view.
[CHAPTER XIV]
HYPNOIDAL PSYCHOTHERAPY
Once the hypnoidal state is induced by any of the various methods of hypnoidization, we can either attempt to follow up the history of the development of the malady, or we may chiefly work for therapeutic effects. It is, however, advisable, from a purely practical, therapeutic purpose to combine the two procedures; the cure is then effective and far more stable. When the history of the origin and development of the disease can not be traced, on account of the age or unintelligence of the patient, the therapeutic effects alone of the hypnoidal states have been utilized.
The getting access to subconscious experiences, lost to the patient’s personal consciousness, makes the hypnoidal state a valuable instrument in the tracing of the origin and development of the symptoms of the psychopathic malady.
From a practical standpoint, however, the therapeutic value of the hypnoidal state is most important. Our experiments have revealed to us the significant fact that the hypnoidal state is the primordial rest-state; sleep is but a derivative form. In many conditions of disease it is advisable to have the patient revert to a simple and primitive mode of life. Similarly, in psychopathic diseases a reversion to a simple, primitive state proves to be of material help to the patient.
In plunging the patient into the hypnoidal state, we have him revert to a primitive rest-state with its consequent beneficial results. The suggestibility of the state, if skillfully handled, is apt to increase the therapeutic efficacy. Relaxation of nervous strain, rest from worry, abatement of emotional excitement are known to be of great help in the treatment of nervous troubles of the neurasthenic, or of the so-called “psychoasthenic” variety. That is what we precisely observe in the treatment of psychopathic or neurotic diseases by means of the agency of the hypnoidal state, the efficacy of which is all the greater on account of the presence of the important trait of suggestibility.
The most important fact, however, is the access gained through the hypnoidal state to the patient’s stores of subconscious reserve neuron energy, thus helping to bring about an association of disintegrated, dissociated mental-systems.
Dr. John Donley in his article, “The Clinical Use of Hypnoidization” (Journal of Abnormal Psychology for August-September, 1908), gives the following account of the method of hypnoidization:
“The treatment of that large group of disorders, forgotten memories, and emotions is operative in the production of mental disaggregation, but also in those numerous instances where the experience causing the obsessive idea or emotion is well known to the upper consciousness.
“In hypnoidal states they were made to reproduce their obsessive thoughts and images and then to describe them in words. When this had been accomplished and they had received further assurance and persuasion from the experimenter, although the purely intellectual content of their obsessions remained known to them, the insistent automatic character and disturbing emotional factors had disappeared. In this metamorphosis of emotional reaction we may observe one of the most interesting and useful attributes of the hypnoidal state.”
Dr. Donley gives a series of cases which he treated successfully from psychognostic and psychotherapeutic standpoints. The reader is referred to the original article.
“The value of hypnoidization,” says Dr. T. W. Mitchell, “in the resurrection of dissociated memories is that which is perhaps best established. And this applies not only to the restoration of the forgotten experiences of ordinary amnesia, but to the recovery of dissociated memories that are of pathogenic significance.... Sidis himself has insistently taught that the reassociation of dissociated complexes effects a cure of psychopathic disease.... My own experience, so far as it goes, tends to corroborate in every respect the claims put forward by Sidis....”
While in the hypnoidal state the patient hovers between the conscious and the subconscious, somewhat in the same way as in the half-drowsy condition one hovers between wakefulness and sleep. The patient keeps on fluctuating from moment to moment, now falling more deeply into a subconscious condition in which outlived experiences are easily aroused, and again rising to the level of the waking state. Experiences long submerged and forgotten rise to the full light of consciousness. They come in bits, in chips, in fragments, which may gradually coalesce and form a connected series of interrelated systems of experiences apparently long dead and buried. The resurrected experiences then stand out clear and distinct in the patient’s mind. The recognition is fresh, vivid, and instinct with life, as if the experiences had occurred the day before.
It cannot be insisted too much that the hypnoidal state is not a slight hypnosis. The hypnoidal state is a light sleep state, a twilight state. The hypnoidal state is the anabolic state of repose, characteristic of primitive life.
The hypnoidal state is an intermediary state between waking and sleep. Subwaking is an appropriate descriptive term of the character of the hypnoidal state.
The subwaking hypnoidal state, like sleep and hypnosis, may be of various depth and duration; it may range from the fully waking consciousness and again may closely approach and even merge into sleep or hypnosis. The same patient may at various times reach different levels, and hence subconscious experiences which are inaccessible at one time may become revealed at some subsequent time, when the patient happens to go into a deeper hypnoidal state.
On account of the instability of the hypnoidal state, and because of the continuous fluctuation and variation of its depth, the subconscious dissociated experiences come up in bits and scraps, and often may lack the sense of familiarity and recognition. The patient often loses the train of subconscious association. There is a constant struggle to maintain this highly unstable hypnoidal state.
One has again and again to return to the same subconscious train started into activity for a brief interval of time. One must pick his way among streams of disturbing associations before the dissociated subconscious experiences can be synthesized into a whole, reproducing the original experience that has given rise to the whole train of symptoms.
The hypnoidal state may sometimes reproduce the original experience which, at first struggling up in a broken, distorted form, and finally becoming synthesized, produces a full attack. The symptoms of the malady turn out to be portions, bits and chips of past experiences which have become dissociated, giving rise to a disaggregated subconsciousness.
The method of hypnoidization, and the hypnoidal states induced by it, enable us to trace the history and etiology of the symptoms, and also to effect a synthesis and a cure. The hypnoidal state may not be striking and sensational in its manifestations, but it is a powerful instrument in psychopathology and psychotherapeutics.
For many years my investigations of the hypnoidal state were carried out on subjects and patients, adults and children. Having found that during the hypnoidal state the condition of mental plasticity is quite pronounced for therapeutic purposes, and having effected many cures of severe psychopathic maladies, ranging throughout the whole domain of so-called hysterical affections, neurasthenia, obsessions, drug habits, especially alcoholic ones, the hypnoidal state has become in my practice quite an important therapeutic agent. Lately, others have obtained excellent results with the hypnoidal state in their treatment of various functional, psychopathic or neurotic maladies.
Perhaps it may be opportune here for the sake of further elucidation to give a few extracts from the Presidential address on “The Hypnoidal State of Sidis,” given by Dr. T. W. Mitchell before the Psycho-Medical Society of Great Britain, January 26, 1911.
“The history of science,” says Dr. Mitchell in his address, “affords us many instances in which the neglect of residual phenomena in experimental research has led to the overlooking of important facts, and prevented investigators from making discoveries which, had they paid attention to their residues, they could hardly have missed. The great chemist, Cavendish, probably missed the discovery of argon, because in his estimate of nitrogen of the air he neglected a residue which his experiments showed him could not be more than 1/120 part of the whole. More than a hundred years afterwards this residue was accounted for by the discovery of argon.
“Now in the history of Psychotherapeutics, from its earliest beginning down to our own time, we find many cases where the circumstances under which curative results have been obtained render it difficult for us to range these results under the category of the therapeutics of suggestion.
“Such cases as these may be regarded as the residual phenomena of the therapeutics of suggestion, and just as Cavendish and his successors too readily assumed that all the so-called nitrogen of the air was the same as the nitrogen of nitre, so we may be missing some important truth, if we too readily assume that all these therapeutic results are due solely to suggestion. The value of suggestion during hypnosis is well attested, and the possibility of effecting physiological and psychological changes by its means is supported by a large amount of experimental evidence. But evidence of this kind is lacking in regard to suggestion without hypnosis, and until it is forthcoming, we are justified in receiving with some suspicion the account of the therapeutic efficacy of suggestion in the waking state. We seem bound to consider whether some state of consciousness intermediate between waking and hypnosis may not be artificially induced and utilized for the purpose of giving therapeutic suggestion.
“The scientific investigation of states of consciousness intermediate between waking and hypnosis is a contribution to psychology and psychotherapy which we owe practically to one man—Dr. Sidis. A research into the nature of suggestibility led him to formulate certain laws and conditions of normal and abnormal suggestibility....
“By keeping the patient for a short time under the conditions of normal suggestibility we induce a peculiar mental state which Sidis named Hypnoidal state. The process by which it is induced is what Sidis calls, hypnoidization.
“By the use of various methods a state of consciousness is induced which differs from full waking, but is not hypnosis or ordinary sleep.
“The hypnoidal state is an intermediary territory, on the borderland of waking, sleep and hypnosis. In the course of a valuable experimental investigation of sleep in man and the lower animals, Sidis discovered that the hypnoidal state is a phase of consciousness which is passed through in every transition from one of these states to another. In passing from the waking state to ordinary sleep or hypnosis, there is always a longer or shorter hypnoidal stage. In the practice of hypnoidization the patient sometimes drops into hypnosis, or he may fall asleep without touching on hypnosis. And so also in awaking from sleep or from hypnosis, the hypnoidal state has to be passed through. Sidis found that the further we descend in the scale of animal life, the more important does the hypnoidal state become in relation to bodily rest and recuperation, and he concludes that it is the primitive rest-state out of which both sleep and hypnosis have been evolved.
“The relation to each other of waking, sleep, hypnosis and the hypnoidal state, may be represented in a diagram in which the primitive hypnoidal state is represented as a nucleus from which the segments of the larger circle, waking, sleep and hypnosis, have arisen. The transition from one of these segments to another can take place through the central territory with which they each have relations. (See diagram on [page 110.])
“The spontaneous occurrence of the hypnoidal state in man is as a rule merely a transitory stage in the alternation of waking and sleep. From the point of view of evolution it is a vestige derived from a long race of ancestors, a rudimentary function which has been superseded by the more highly specialized rest-state, sleep. But it can be artificially induced and maintained by the methods which have been described, and it can be utilized with effect in the treatment of psychopathic disorders.
DIAGRAM III
“The therapeutic use of the hypnoidal state is a somewhat complex subject, for hypnoidization may be employed as an adjunct to other methods or as a curative measure in itself.
“The full record of hypnoidization is in the account of the well known Hanna case, given in his ‘Multiple Personality.’ This was a case of total amnesia, following a severe injury to the head. The patient, a cultured clergyman, was reduced to the mental condition of a new-born child. All his former acquisitions and memories had entirely disappeared, and he had to start learning everything again from the beginning. When he (the patient) was put into the hypnoidal state various fragmentary experiences of his past life emerged into consciousness, demonstrating to his observers that his lost memories were merely dissociated and not destroyed. This same method (hypnoidization) was made use of in other cases of amnesia, and it was found to be of great assistance in effecting the resurrection of dissociated mental material and its reintegration in consciousness.
“With the progress of his studies in Psychopathology, the reintegration of consciousness became, for Sidis, the aim of all therapeutic endeavor in connection with maladies that are associated with, or produced by, mental dissociation. The recurrent psycho-motor states of functional psychosis, insistent ideas, imperative concepts, persistent, or periodically appearing emotional states, so-called psychic epilepsy, and other states of dissociation all lent themselves to treatment by hypnoidization. By its means the dissociated complexes could be recovered, the psychogenesis of the malady could be traced, a synthesis of consciousness effected, and the patient thereby cured. As his confidence in his method increased, Sidis gradually extended its employment, until at the present time he seems to use it in every kind of disorder in which psychotherapy is indicated.
“I have no doubt that Dr. Bramwell induces in his patients a state of consciousness which is identical with the hypnoidal state of Sidis.
“My own experience, so far as it goes, tends to corroborate in every respect the therapeutic claims put forward by Sidis. I have observed the good effects of the hypnoidal state apart from any other measure.
“In his later writings Sidis insistently maintains that the use of hypnoidization alone is sufficient to cure certain morbid conditions. He bases this claim on the fact that he has found the hypnoidal state effective towards this end, and he interprets his results as being due to a release of reserve energy which has been locked up in the inhibited and dissociated systems or complexes.
“The principle of reserve energy is based upon a wide generalization of facts, namely, that far less energy is utilized by the individual than is actually at his disposal. In the struggle for existence, those forms of life which have accumulated a store of reserve energy that can be drawn upon in emergencies have the best chance for survival.”
According to my experimental and clinical work the waking state, sleep, hypnosis, and the hypnoidal state, may be differentiated as follows:
(I) In the waking state the upper, controlling consciousness predominates over the subconscious. In other words, in the waking state the conscious is more responsive and more active than the subconscious which as a rule under such conditions may be regarded as partially dormant.
(II) In sleep both the conscious and the subconscious are reduced in activity, often even inhibited in function. Motor consciousness is arrested; motor control is paralyzed. The personality is disintegrated.
(III) In hypnosis the upper, controlling consciousness is diminished in activity, while the subconscious activities are increased in extensity and intensity. In hypnosis the relationship of the conscious and subconscious is interchanged,—the conscious becomes subconscious, and vice versa. The habitual type of character may become changed by suggestion, giving rise to double and multiple personality, according to the crystallization of various association systems, while the habitual, critical attitude is reduced in intensity.
(IV) In the hypnoidal state both conscious and subconscious functions are lowered in activity with no decrease in the intensity of critical attitude, and with no change of personality.
The hypnoidal state is therefore not a light hypnosis, but rather a light sleeping state, a twilight state. The hypnoidal state is a primitive rest-state out of which sleep and hypnosis have arisen in the course of animal evolution.
[CHAPTER XV]
EGOTISM AND FEAR
As we have pointed out, the fear instinct is the arousal of the impulse of self-preservation. Psychopathic conditions are at bottom fear states interrelated with hypnoidal states and with an abnormal, pathological condition of the impulse of self-preservation. This is manifested in the fundamental trait of extreme selfishness characteristic of psychopathic patients. The patient is entirely absorbed in himself, and is ready to sacrifice every one to his terrors.
For many years, day after day and night after night, I lived with patients who were under my care, observation, and treatment. One trait always revealed to me the predominant characteristic under the constantly changing psychopathic symptom-complex and that is the extreme selfishness of the patients. There is no greater egotism to be found than in the typical cases of psychopathic disorders. This egotism runs parallel to the condition of the psychopathic state. This does not mean that every egotist is necessarily psychopathic, but every psychopathic case is essentially egotistic.
The psychopathic patient does not hesitate a moment to sacrifice to his “affection” father, mother, brother, sister, husband, wife, lover, friend, and children. In severe cases the patient stops at nothing and only fear of suffering, sickness, evil consequences, and punishments can restrain the patient. In some extreme cases the patient is almost diabolical in his selfishness.
The constant sympathy which the patients crave from others, and which they demand, if it is not given to them immediately, is but an expression of their extreme obsession by the impulse of self-preservation. In their struggle for self-preservation they forget everything else, nothing is remembered but themselves. This condition becomes the ground character which is often expressed in a frank, brutal way. Even in the best of patients one can find glimpses into the depths of the psychopathic soul which is nothing but the immense egotism of the beast, worsted in the struggle for existence, tortured by the agonizing pangs of the fear instinct.
In the vanity, conceit, arrogance, and overbearing attitude towards others, friend or stranger, as well as in the total indifference to the suffering of his intimate friends and acquaintances, we once more find the expression of that terrible selfishness which obsesses the psychopathic patient. In order to get rid of some small inconvenience, or to obtain some slight pleasure, the patient will put others as well as his “near and dear ones” not only to inconvenience, but to permanent pain, and even torture.
The patient lacks confidence, at least that is what he complains of, but he does not hesitate to demand of his best friends and even of total strangers all the services possible, if they are given to him, thinking that he is fully entitled to them. The patient has the conceit and vanity of his great worth in comparison with other people. The world and especially his family, physicians, attendants, friends, acquaintances, lovers, should offer their happiness and life for his comfort.
Even when the psychopathic patient does some altruistic act, it is only in so far as he himself can benefit by that deed. He is ready to drop it as soon as the work does not answer his selfish purposes. Himself first and last, that is the essence of psychopathic life.
The patient is convinced of his goodness and kindness, and of his human affections which are far superior to those of the common run. He adores himself and he is always ready to dwell in the glory of his delicacy and extraordinary sensitivity. This trait he is specially anxious to impress on his friends, on his family, and even on those whom he apparently loves. “I am the delicate being of whom you all, unappreciative, gross, insensible people should take care.” That is the principle on which the psychopathic patient lives. The patient will do anything to attract attention to this side of his personality. He will emphasize his sickness, exaggerate his symptoms, and even manufacture them for the benefit of those who dare to ignore him or who pay little attention to his condition, to his wants, needs, caprices, passing whims, and especially his fears, which underlie all his wishes and desires. There is nothing so tyrannical and merciless as the autocratic, fear-obsessed “weak” will of a psychopathic or neurotic patient.
The patient’s whole attention is concentrated on himself, or more specially on the symptoms of his psychopathic malady, symptoms which obsess him for the time being. Whatever the symptoms be, permanent or changing, the patient’s demand is to have others sympathize with the illness from which he suffers, to have them realize the “fearful” agonies which he undergoes. The selfishness of the patient is exacting and knows no bounds. The whole world is to serve him, and be at his command. The psychopathic patient is driven by the impulse of self-preservation and by the furies of the fear instinct.
Many of my psychopathic patients tell me that they feel sensitive as long as they witness the sufferings of other people, otherwise they do not care to know anything about them. They are anxious to have such things away from them as a nuisance. They insist on being surrounded only with pleasant things or with persons and objects that contribute to their health and happiness. Everything is absorbed by the worship of Moloch Health to whom the patients sacrifice everything. Pain, suffering, and distress of other people are looked at only from the standpoint of the possible effect they may have on the patient’s “precarious health.” Like Nero, who was probably a psychopathic character, the psychopathic patient is ready to burn others for his health; if necessary, to torture “health and happiness” out of his best friends.
One of my patients, who is highly intelligent, tells me frankly that he uses others to squeeze out of them strength for himself. As soon as he can no longer get it, or has obtained all he can, he is anxious to part with them, gets tired of them, and even begins to be resentful because they are in the way of his health. Another of my patients was ready to burn parks, stables, and destroy everything, if he knew that it was good for his health. Other patients of mine do not hesitate to wake up the whole house to help them in insomnia or indigestion. Many of my patients take pleasure in forming acquaintances and even friendship with people, ask for their sympathy, require their help and assistance, come to them early in the morning and late at night, disturb their sleep in the small hours of the morning, display all their symptoms of indigestion, nausea, eructation, and vomiting. The patients then turn round, abuse the person who helps them, telling him disagreeable things, because he is no longer useful. A few hours later the patients may turn again for help to the same person, because they find that they could still make use of him.
Psychopathic patients do not hesitate, for the alleviation of their pains, of depression, of insomnia, to take a bath in the early morning and wake up all the other patients. They are entirely absorbed in themselves. Self is the only object of their regard. A clever lawyer, aptly characterized one of my most severe and typical psychopathic cases as “egomaniac.” “When you talk of gravity, ‘I am gravity,’ she claims. Talk of the Trinity: ‘I am the Trinity.’” As a matter of fact every psychopathic patient is an egomaniac.
Bacon’s aphorisms about self-lovers may well apply to psychopathic patients: “And certainly it is in the nature of extreme self-lovers, as they will set a house on fire, and it were but to roast their eggs.... That which is specially to be noted is, that those which are sui amantes sine rivali, are many times unfortunate.”
Driven by the impulse of self-preservation and by the anguish of extreme fear, the psychopathic patient may be pitied as a most unfortunate, miserable wretch.
In the psychognosis of the particular condition, mental or nervous, be it object, idea, or action from which the patient suffers, the impulse of self-preservation with its instinctive emotion of fear can always be found in the background of consciousness or in the subconsciousness.
An insight into a series of cases will help best to understand the fundamental psychopathological processes that give rise to the different forms of psychoneuroses and somatopsychoses.
The inhibition of the patient’s activities, produced by the most primitive impulse of self-preservation with its instinct of fear, limits the patient’s life to such an extent that the interests and the activities are reduced to automatic repetition of reactions of a stereotyped character. The stimuli must be the same, otherwise the patient does not care to respond. He loses interest in his business, in reading, in his work, and games. The attention keeps on wandering. Games, pleasures, and hobbies in which he formerly used to take an interest lose their attraction for him. The life he is disposed to lead is of a vegetative existence. He is afraid of anything new. Things are done in an automatic way. Routine and automatisms are characteristic of his activities.
The psychopathic or neurotic patient talks about his humanitarian ideals, about his great abilities superior to the common run of humanity, and how with his talents he is willing and has been willing to confer benefits on poor suffering humanity in spite of the fact that he has to struggle with his poor health, physical, nervous and mental. In spite of the overwhelming fatigue due to ill health, and in spite of the fearful ideas and impulses that have beset him day and night he still has succeeded in fighting his way through.
The patient hankers for notoriety, for praise, for appreciation by other people. He is apt to complain that the family, neighbors, acquaintances, friends cannot appreciate his good points, his good will, and his high ideals to which he conforms his life, tortured as it is with pains and suffering of poor health. The egocentric character of the psychopathic patient is bound up in his abnormally developed impulse of self-preservation and in his pathological state of the fear instinct.
Thus one patient opens his account with the phrase: “From boyhood I had a sensitive conscience.”
Another patient writes: “As a child I had a keener instinct as to the real unexpressed attitude of those about me toward each other than the average child.”
One of my patients, a puny being of mediocre intelligence, writes: “I have always, from the earliest childhood, felt that I was different from those about me; and I must acknowledge that it was not alone a feeling of inferiority on account of poor control, but a feeling that I understood more than they. I was, however, of a delicate constitution and suffered from ill health.”
Psychopathic patients subscribe to the “cheerful” effusions of “New Thought,” and plaster the walls of their rooms with elevating “Rules for Health and Happiness.” Psychoanalysis and Christian Science are the rage. The victims hide behind the veil of sickly, psychopathic “Love.”
The writings and accounts of the patients are full of introspection about health, and about the minutiae of their feelings in the various parts of their body. Some of the patients with a literary turn keep on writing volumes about the most minute symptoms of their troubles to which they happen at any moment to be subject. I have numbers of manuscripts, biographies, autobiographies, all telling the same old story of “blighted lives” due to ill health, drugs, and treatment, all describing with the over-scrupulous exactness of microscopic anatomy the different symptoms that plague them by night and by day. The patients tell of their talents and remarkable abilities, superior to the average run, of their ill luck and failures, due to their unfortunate state of ill health.
In quoting from some of the accounts given to me by the patients themselves I wish to attract attention to this side of the patient’s mental condition, the expression of the impulse of self-preservation, manifested in the general panic of health, or fear of disease, whether nervous or physical.
A patient of mine, a clerk of mediocre intelligence, with hardly any ability, but with plenty of selfishness, introspection, and immeasurable conceit, writes about his ideals in life:
“I would ask that this manuscript be considered in connection with my other two writings. I have already partially covered this ground in my autobiography. I should be glad to have my general outlook on life considered, and to receive suggestions relative to vocations and avocations, since my anxieties regarding these are inseparably intermingled with my thoughts of physical and mental health.
“Of course since childhood my ideals have undergone a gradual modification. First, there was the religious motive of life: I wanted to be a soldier of the cross and assist in the regeneration of souls and their preparation for the life beyond.... I began to meditate upon ethical theories.... It appears that in doing the world’s work the tendency is to specialize.... In the matter of choosing my employment my own interest is identical with the interest of society. At different times of my life I have fancied I had a liking for one calling or another.... My lines of thought have gradually drifted into the philosophical (patient means the various occult scribblings about ‘health metaphysics’). I now ask myself why I should be a lawyer, a physician, a minister, a philanthropist or any other special thing? I conceive that a man’s life is largely what circumstances make it, and it may be, therefore, that I shall always be a clerk in an office, trying to be useful in a small way; but now we are talking of influencing such matters as far as we can by choice. I imagine that perhaps my field is in the line of ethics, philosophy, or whatever words may be used to signify the general principles governing human affairs. My reasons for thinking so are as follows: First, I feel a strong interest in those principles comparing to no other interest in my life. Second, I find very few people who seem to feel any such interest in such matters. Third, I believe such principles to be of supreme importance. The question is,—Is my position in regard to general truths so peculiar that I should regard it my mission to give those subjects more attention in study and expression than do other men?
“The question I want to settle is,—Do other men feel this same philosophical interest, realize the broad field of human obligation, and come down to special occupations, not because they are more interesting to them than the general field, but because they realize they must specialize in order to properly assist in carrying on the world’s work? If this be so then I am mistaken in thinking I should give particular attention to general principles. But my observations have gone to show that the average physician, lawyer, merchant or politician is not interested in the broad questions of life, but only in medicine, law, business, or politics, caring little for the relation of his vocation to other vocations except as he makes his bread by it. Why then if the various departments of human activity must be correlated, and if the individuals making up those respective departments have no disposition to do the correlating,—should it not be done by those who are interested in the general field?”
It means that such work could be and should be done by the patient, by the philosophical clerk, interested in the general “metaphysics” of health.
Such confessions can be easily elicited from psychopathic patients even in their best states of apparent diffidence, humility. This paranoidal aspect of self-aggrandizement is present in all psychopathic cases. In some this trait stands out more clearly and distinctly than in others. It is, however, present in all psychopathic patients, if one observes them closely and attentively. It is the expression of an intensified state of the impulse of self-preservation and fear instinct. In other words, it is a state of an exaggerated, hypertrophied egotism.
“We must appeal to a law higher than the material law,” a patient writes in his account. “I worried much over it. Since that time the relation of mind and matter greatly interested me.... My health at this time failed, I lost appetite and strength, had hysterical symptoms. I was treated for general neurasthenia.” ... Psychopathic, philosophical and ethical speculations and interests have their sole source in fear of sickness and self-preservation.
“One of my anxieties,” another patient writes, “of my present life is connected with my business and my relationship to my partners. I am naturally conscientious and inclined to be not only earnest and sincere, but serious. My nature, instincts, and desires are not superficial. Yet my relation to the business is a superficial one. I am neither fitted by natural tastes nor by training for the indoor, rather mechanical, conventional, and routine processes upon which business and commercial success depends....
“Without the common motives of an ordinary merchant (greed) I am placed in the position of the one who lives not by the usual and conventional standards of right and wrong, but rather by a more exalted and more rigid one of his own making which, unsupported by habit, and institutions, requires a greater loyalty, a higher resolve, and a firmer will than is required of the conventional and conforming citizen. Emerson says it demands something Godlike in one who would essay such a task, not placing the same values on money, trade, commerce, and profits as the natural money maker and money lover, and not the opportunity to substitute and supplement the usual motives by and with the larger, and to me more compelling, of community betterment and employee welfare....” This man had abandoned his wife and three children.
Another patient writes of himself, “The hypersensitive nervous system with the initial shock has inhibited the development of my highest potentialities and my highest endeavors.” He summarizes his symptoms: “Dread and anxiety about being away from home and friends, self-consciousness, mental sluggishness, quick fatigue, inability for deep thought, general state of irritability.”
A neurotic patient tells me that he suffers from fatigue, insomnia, dullness, inability of concentration of attention, failure in studies, slowness of comprehension, and so on; and yet he gives his opinion with papal infallibility on every conceivable subject, and hints at being an undeveloped, unappreciated genius. The psychopathic, neurotic patient rarely, if ever, suffers from a complaint of inferiority. His real fear is that his superiority may be humbled.
Obsessed by the impulse of self-preservation and fear instinct, and with utter disregard of others, the patients are convinced of their extraordinary kindness, gentleness, sympathy, martyrdom, and even saintliness. It is from this class that neurotic philanthropists are recruited. Psychopathic patients are always ready “to sacrifice themselves for the good of humanity.” They talk endlessly about goodness, and may even devote themselves to charity and instruction of the “poor and degraded.” A patient of mine worked for three years for the “good of the poor,” had “high ideals and a sensitive conscience,” according to his accounts, but abandoned readily his wife and children.
Another young woman, a typical psychopathic, full of high ideals, ran away with a married man, had a child that died of exposure. This patient was interested in modern education and improvement of humanity. In reality she never cared to do anything for anybody, and without any hesitation took advantage of others in order to satisfy the least whim that might have crossed her mind, especially those whims that relate to health. She had all kinds of directions, prescriptions, exercises, requisite for the strength and health of the body and the nerves.
One of my patients used to be anxious about my going and coming. Was it love or devotion? I found out that he was afraid that I might be killed. This fear was developed in him by an actual accident in which his brother had died, but the same fear associated with me was due to the fact that the patient was sure that my treatment was requisite for his health and welfare. He was in fear lest I might be killed, he would be unable to get his treatments, and thus lose time in getting back his health.
For the sake of his “health” the patient will not stop at anything. Neurotics may well name their troubles “Health and Science.” The psychopathic, neurotic patient makes of health his science and religion, because self-preservation and fear are at the bottom of the psychopathic, neurotic constitution.
[CHAPTER XVI]
NEUROTIC PARASITISM
The psychopathic patient may be regarded as a case of parasitism. The parasite, living on his host, gradually loses all active functions, a condition followed by atrophy of organs no longer necessary to the life existence of the organism.
According to Demoor, “Atrophy begins with function when an organ has become useless. This uselessness may arise from two causes: the function may be no longer useful to the individual or to the species, or it may be assumed by another organ.” When an organism turns parasite it is an economy of nutrition and energy to save as much as possible. The tendency of parasitism is to dispense with unnecessary functions in the struggle for existence.
The loss of function is from the less useful, to the more useful, to the functions absolutely indispensable to survival; from the less essential, to the more essential, to functions absolutely essential to the life existence of the individual. The life activity of the parasite becomes more and more narrowed, circumscribed, and dwindles down to a few functions requisite to its life existence, namely self-preservation, nutrition, and reproduction.
With the further increase of parasitism even the digestive and reproductive functions become simplified, the parasitic individual becomes reduced to the most fundamental of all impulses, the impulse of self-preservation and reproduction.
The penalty of parasitic life is the simplification of organic activities, the atrophy of all higher and complex life processes. This is what takes place in the case of the psychopathic individual. All higher activities, all higher interests cease.
In many neurotic cases of the severe type even the sexual instinct becomes gradually atrophied. The patient’s life is narrowed down to the impulse which is absolutely requisite for individual life existence, namely the impulse of self-preservation with its concomitant fear instinct.
The growth of the impulse of self-preservation with its fear instinct brings about their hypertrophy which in turn hastens the degenerative processes or atrophy of all higher and more complex activities. The psychopathic patient in the process of degeneration and atrophy falls so low that not only moral, social, intellectual, but simpler psychomotor reactions become gradually diminished and atrophied. In severe cases even the instinct of sex, requisite for the preservation of the species, is made subservient to the impulse of self-preservation and the fear instinct.
In psychopathic life all activities are narrowed down to the pettiness of individual existence. It is not sex, it is not species-interests, nor conflicts, nor self-repressions that trouble the neurotic patient. An abnormal impulse of self-preservation and fear instinct are at the bottom of all psychopathic miseries. All psychopathic, neurotic interests are reduced to the sorry life of self and fear.
Lacking interest in anything but himself, terrorized by the fear of existence, the psychopathic patient lives a dreary, monotonous life out of which he seeks to escape. Monotony, ennui, indifference form the curse of his life. The patient is in a frantic condition, constantly in quest of interests which he cannot enjoy. Nothing can interest him, because he has no other interest but himself, and that is so narrow, that it can hardly fill existence.
As a matter of fact he is afraid to meet his fears, he is afraid of himself. He is afraid to come to a decision, never at peace, ever at war with himself. He is bored with himself, wearied with everything and with everybody. He is constantly eager to find new pastures and new excitements, so as to fill with some living interest his poor, narrow, mean, short existence obsessed by fear, misery, wretchedness, and brutish selfishness.
The patient is afraid to work, because it may “fatigue and exhaust” him, and may bring about a state of disease, while he looks for health. He has no interest, because he only thinks of his little self, reduced to digestion, evacuation, and sleeping. The psychopathic patient leads an inactive existence of a sluggard, a lazy, idle existence of a parasite, and still he is driven to life and activity which, from the very nature of his narrow, parasitic individuality, he can no longer enjoy. He has the ideals of a hero and lives the life of a coward. This puts the patient in a state of dissatisfaction, discontent, and ceaseless contest with himself and others. Fear and self never leave him at peace. He is ever in a state of agitation, restlessness, and anxiety.
Obsessed with the anxious fears of self-impulse, the patient avoids the terrors of life, and drags the grey, monotonous existence of a worm. Hence there is a tendency in the psychopathic patient to be on the lookout for ever new energetic personalities, lean on them, suck out all the energies he possibly can, then reject his new friends unhesitatingly and brutally, and be again in search for new personalities who can disperse, for ever so brief a time, the fearful monotony and dread of his miserable, psychopathic, neurotic existence.
The neurotic patient may be characterized as a psychopathic leech, or truer still, a psychopathic vampire. For it is on the life and blood of other people that the psychopathic ogre is enabled to carry on his bewitched, accursed, narrow, selfish existence, full of terror and anguish of life.
“When the attack is on,” exclaimed a psychopathic patient, affected with cardiac palpitation and intense fear, “I am too d——d scared about myself to think about her!” referring to the woman with whom he was in love. The psychopathic patient is a parasitic ogre with an hypertrophied ego.
Patients who claim to love children when the latter are well and healthy, avoid them, like a pest, when the children happen to fall sick, for fear of disease and for fear that the sick children may produce an evil influence on the patient’s “sensitive” nerves. The patient is afraid to come near sickness, or even afraid to hear of evil things, such as description of misfortunes, ailments, accidents, and sufferings, because they may upset him and arouse his fears of himself.
All the patient wants is to be surrounded with cheer, joy, merriment, excitement, and happiness which he is unable to enjoy. The psychopathic patient is in constant search after happiness. Not that he is interested in the problem of happiness from a moral, philosophical, or even purely religious standpoint. His interest is of the crudest, the meanest, the most selfish kind. It is happiness for self,—for a low, mean, short, and brutish self. Psychopathic search for happiness is the anguish of the beast, cornered by terror. The patient is tortured by an unsuccessful search for happiness, ever tantalized by self and fear. Egotism, fear, ennui, restlessness, anxiety, discord are the harpies of psychopathic, neurotic life.
The love of the psychopathic patient is at bottom self-love; it is like the love of the wolf for the lamb. Lover, husband, child, friend, father, mother, brother, sister, are all victims to the patient’s greedy self.
The fear instinct has a positive and negative aspect. There is the fear of life, fear of putting forth energy in meeting the exigencies of life. The patient is afraid to participate in the struggle of life. Struggle spells to him danger, peril,—fear of the external world. Struggle means to him fear, suffering, and misery. The patient avoids society, avoids not only strangers, but even his acquaintances, friends, and sometimes his own family.
While he constantly craves for ever new stimulations to his depleted nerves, he is at the same time in terror of everything that is new. The patient is afraid of life, he shirks duties, responsibilities, efforts, and joys of life struggle. Hence his love of automatism, routine, and fear-fatigue.
The fear manifests itself more often in the form of the negative side of life, such as fear of sickness, weakness, incapacity, degradation, loss of vitality, and generally the fear of death. Neurotic states are due to fear of life and fear of death.
[CHAPTER XVII]
FUNDAMENTAL PRINCIPLES
The following principles may be regarded as fundamental in the development of psychopathic or nervous ills:
I. The Principle of Embryonic Psychogenesis
The mental states of psychopathic or nervous ills are of an infantile, child type. In this respect the mental states simulate cancerous and other malignant growths of an embryonic character. The psychopathic mental states are not only of a childish character, but they are often associated with child experiences of early life. The psychopathic condition points to some early fear-producing experience, or fear awakening shock.
II. The Principle of Recurrence
Fear experiences tend to repeat themselves in consciousness, and especially in the subconscious states of the child. This repetition or recurrence keeps alive the psychopathic fear nucleus, and fixes it in the mind. Fixed fear systems become further developed by the subsequent experiences of life. The aroused fear instinct may either become weakened or strengthened. When the conditions of life are unfavorable and adverse, tending to further cultivation of the impulse of self-preservation and the fear instinct, the outcome is a psychopathic disposition, ending in a nervous state with typical symptoms of some definite nervous trouble, formed by the latest or ultimate fear experiences.
III. The Principle of Proliferation and Complication
With the growth of the child the fear experiences increase and multiply. These experiences become associated with the original child nucleus of fear and thus a complexity of fear systems is built up. Worries, depressions, and anxieties help to increase and develop the psychopathic system of groups of fear experiences. The morbid state grows like an avalanche in its progress downwards.
IV. The Principle of Fusion or of Synthesis
All the fear experiences become associated and grouped gradually around the original child fear experience which is often of a subconscious character. The long series of fear experiences becomes fused and synthesized by the central fear instinct and impulse of self-preservation, which are fundamental in every being, but which have been specially cultivated by the course of events and experiences in the neurotic patient. The experiences become fused, synthesized, and systematized, forming one complex network of closely interrelated fear obsessions with the fear instinct and impulse of self preservation in the background.
V. The Principle of Contrast
Feelings and emotions follow by contrast. Excitement is followed by depression, enjoyment by disgust, exhilaration by disappointment. This is well brought out in the changes observed in the psychopathic self and fear states.
Fear may be followed by anger, especially against those who are sure to show no opposition, or may even manifest fear. The excitement of fear in others is a way which diminishes fear in the patient and helps him to have confidence in himself, strengthening his impulse of self preservation.
The fear of the psychopathic may even resort to love so as to gain safety and protection from the tantalizing agonies of the fear instinct. That is why some physicians are deceived, and ascribe psychopathic troubles to love instead of to the real fundamental cause of all psychopathic disorders, namely self-preservation and the fear instinct.
Similarly mysticism, a psychopathic malady of a social character, has its origin in the impulse of self-preservation and the fear instinct, and takes refuge in “love” or in “union” with the Infinite which serves as a rock of protection, security, and salvation from all terrors of life. Psychopathic love is a neurotic fear delusion. There is nothing more deceptive and delusive than psychopathic love,—for it takes its origin in self and fear.
VI. The Principle of Recession
Experiences are blotted out from memory in the course of time. A very small percentage of impressions is registered by the brain, a still smaller percentage can be reproduced, and out of them a very small percentage carries recognition as memory, that is, of impressions experienced before. Forgetfulness is therefore a normal physiological function characteristic of the brain and mind.
Forgetfulness depends on at least three conditions, lack of registration, lack of reproduction, and lack of recognition.
There will correspondingly be at least three forms of amnesia or forgetfulness, amnesia of registration, amnesia of reproduction, and amnesia of recognition. The real problem of Psychology is not so much the lapses of memory, but the why and how of memory, and especially of recognitive memory.
This, however, we may establish as a law that when memory in regard to definite experiences weakens in the course of time, the lapse follows from recognition to reproduction, and finally to registration. Recognition fails first, then comes the failure of memory reproduction, and finally memory registration of the special experience becomes blurred and wiped out. This may be termed the law of memory decay, or of memory regression. This is the principle of memory recession.
Some, though by no means all, child memories or infantile experiences follow this law of regression or recession. Child experiences, like all old experiences, tend to recede in their course of decay or of regression below the threshold of consciousness. The experiences are not recognized on reproduction, or are reproduced with great difficulty, or have even lost the function of being reproduced. When under such conditions, the experiences are said to have become subconscious, or have receded into the subconscious.
On the other hand some of those subconscious experiences, or subconscious memories may, under favorable conditions, once more regain their functions of reproduction and recognition, and become fully conscious. This may occur in various trance states, subconscious states, and in various psychopathic conditions.
Such states, however, rarely fix the experiences in memory, because the states are instable, temporary, and the memories lapse with the disappearance of the states. This principle of recession may be regarded as one of the fundamental facts of the Psychopathology of the Subconscious. In fact, subconscious states may also be termed Recessive States.
VII. The Principle of Dissociation
Recessive states, becoming marginal and subconscious, lapse from voluntary control, they cannot be recalled deliberately and consciously by the activities of voluntary, recognitive, associative memories, constituting the mental life of personality, and hence may be regarded as mental systems in a state of dissociation. The lapsed states are present subconsciously when not completely blurred and obliterated by the process of decay or regression.
Dissociated, subconscious states, when affected by the impulse of self-preservation and the fear instinct, tend to become parasitic, and like malignant growths may suck the life energy of the affected individual. Under such conditions we have psychopathic, subconscious, dissociated states.
VIII. The Principle of Irradiation and Diffusion
In the dormant, subconscious states the fear instinct gradually extends to other subconscious states. The fear instinct acts like a malignant growth, like a fermenting enzyme. The subconscious fear instinct gradually infiltrates, diffuses, irradiates its affective state throughout the subconscious life of the patient, finally giving rise to a psychopathic disposition with its selfishness, apparent repressions, apprehension, anxiety, anguish, terror, and panic. This may also give rise to the general psychopathic character of doubt, indecision, and conflicting states, all being determined by the underlying fear instinct.
IX. The Principle of Differentiation
With the growth of the impulse of self preservation and with the development of an exaggerated fear instinct, the individual becomes more and more neurotic and psychopathic. This general, neurotic, mental state attaches itself to various events in the life of the individual. The psychopathic disposition keeps on progressing from one event to another. Each one may be regarded as a separate fear state, or phobia. Finally the disposition may settle on the last event in the patient’s life experience. This last event may often become the nucleus, or rather the apparent nucleus of the neurosis.
The last experience appears to be central. As a matter of fact there is a great number of fear states or of phobias in the neurotic patient. A few only appear to predominate in the network of fear events. The network of fears is woven into an incongruous whole by the impulse of self-preservation and the fear instinct. This network becomes differentiated into a tangle of numerous fear states.
X. The Principle of Dominance
The last fear states or Ultimate Fear States which stand out clearly and distinctly in the patient’s mind become the leading, the dominant abnormal, pathological states. The patient thinks that they are the real source of all his troubles, and if they were removed he would be cured. As a matter of fact the ultimate states are not causes, but occasions. The real causes of the psychopathic constitution are the exaggerated impulse of self-preservation and the intensified fear instinct.
XI. The Principle of Dynamogenesis
Recessive, and especially dissociated systems, being dormant subconsciously, may become envigorated, may accumulate emotion, and when the opportunity comes, may react to external stimuli with vigor and energy. The attacks may occur like epileptic fits. They often so well simulate epileptic maladies that even good clinicians have classed such attacks under the term of larval epilepsy, psychic epilepsy, hystero-epilepsy, or psychic equivalent of epilepsy. This subconscious energy manifestation may be termed Dynamogenesis.
XII. The Principle of Inhibition
Self-preservation and the fear instinct inhibit associated mental systems, producing morbid states. Morbid mental states, however, are not produced by inhibitions, or repressions. It is only when the inhibitive factors are self and fear that a true morbid mental state, or neurosis arises. To regard self repression as a bad condition and leading to diseases is to misapprehend the nature of man, to falsify psychology, and to misrepresent the development of humanity. The self should not become hypertrophied. Self-preservation should not become overgrown. The self must be kept within limits. The self impulse should be kept under control by the individual. For true happiness is to be a law unto oneself. As the great Greek thinkers put it: Happiness is in self rule. The unruly are miserable. In fact, self-control is absolutely requisite to mental health, to sanity. Self-repression is requisite for happiness. Self-repression never leads to disease. It is only when self-repression is produced and dominated by selfishness and fear that morbid states of a psychopathic, neurotic character are sure to arise. It is not inhibitions that produce fear, but it is fear that produces inhibitions. To ascribe neurosis to self-repression and to conflict is like attributing malaria or tuberculosis to air and light.
XIII. The Principle of Mental Contest and Discord
Mental states associated with intense emotions tend to take a dominant lead in consciousness. This, however, may be totally opposed by the general character of the individual. In such cases the whole mental set, being in opposition to the total individuality, is in contest with the character of the person who is then in state of discord. A mental set in contest with the make-up of the person is usually inhibited, becomes subconscious, and as a rule fades away from the mind, often leaving no trace even in memory, conscious or subconscious. In some cases where a compromise is possible, a reconciliation is effected. The mental set is assimilated, and disappears from consciousness as an independent, functioning state.
When, however, the opposing or contesting mental set is based on a fundamental impulse and accompanying instinct, such as the impulse of self-preservation and the fear instinct, a total inhibition is not always possible, even a compromise may not be successful, because the mental set is in association with the core of the individual,—namely self-preservation. The contesting mental set remains, in what Galton terms, “the antechamber of consciousness.” The mind is in a state of tension, in a state of anxiety, in restless, uneasy discord, due to the fear instinct, the companion of the impulse of self-preservation. The contesting mental set, charged with intense fear emotion, presses into the foreground of consciousness, and a contest, a discord, ensues in the mind of the individual, a contest, a discord, a conflict which keeps the person in a state of indecision and lack of will power.
The partly inhibited, contesting mental set, when not fading away, may thus remain in the mind, and act like a splinter in the flesh, giving rise to a state of discomfort. This is just what happens when the individual has not been trained to assimilate fear states, and is unable to adjust fear reactions to the welfare of total psycho-physiological life activity.
In cases where the impulse of self-preservation and the fear instinct have become aroused, the contesting fear set of mental states presses again and again to the foreground of consciousness. When no compromise of the contesting states can be brought about, when the fear set cannot be assimilated, the mind is in a state of restless discord. It is not, however, the discord that produces the neurosis, it is the impulse of self-preservation and the fear instinct that constitute the cause of the psychopathic, neurotic condition.
XIV. The Principle of Diminishing Resistance
In proportion as the neurotic attacks keep on recurring the formed pathological system is gaining in energy and in ease of manifestation. The psychopathic attacks with their symptoms emerge at an ever diminishing intensity of stimulation. The resistance of healthy normal associations is ever on the decrease until a point is reached when all power of resistance is lost. The conscious and subconscious groups which enter into the psychopathic system, forming the neurosis, get control over the patient’s life, and become an uncontrollable, psychopathic obsession.
XV. The Principle of Modification
The patient attempts to control or alleviate his fear state by a totally different fear state. In the long run this is a losing game. For the general fear disposition becomes ultimately reinforced. Finally he may land in the mystic regions of love or of an Infinite Love in which he expects to find safety, protection, and salvation from the miseries of exaggerated self impulse and intensified fear instinct. Such a course, however, leads to a swamp in which the patient’s individuality becomes engulfed and obliterated. The end is mental suicide.
These fundamental principles of neurosis-development should be kept in mind in the examination and study of psychopathic cases. The cases adduced in this volume will help one to understand the mechanism of the main factors and principles of neurosis.
[CHAPTER XVIII]
ILLUSTRATIONS, NEUROTIC HISTORIES
The psychopathic character appears to be full of contradictions, “a house divided against itself.” Neurotics are like “the troubled ocean which never rests.” Some of my patients complain of fatigue, physical and especially intellectual, inability of concentration of attention, and yet they hint at being undeveloped, unappreciated geniuses. The patient may be said to suffer from a paradoxical state of “humble superiority.”
A few of my cases may help one to form some faint idea of the intensity of the impulse of self-preservation and fear instinct which obsess the psychopathic sufferer.
M. A. Age 43, female, married; sister and brother died of tuberculosis. When young, she herself had an attack of tuberculosis from which, however, she entirely recovered. This made her, from her very childhood, think of herself and of the fear of death. She suffers from headaches, backaches, indigestion, and intestinal pains. Her mind is entirely engrossed with herself. The whole world is for her sake, and she does not scruple to utilize anyone who is willing to serve her. She takes advantage of everybody and does not care what the feeling of others might be about her extreme selfishness. If she were sure that no fine or punishment would follow, she would not hesitate to take anything that belongs to others, no matter whether it be a friend or enemy, provided it does her good, drives away some of her discomforts, fear of disease, or gives pleasure to her, even at the expense of other people’s agonies. If there were a prize for selfishness, she would be sure to get it. She is sure to take advantage of people who do not know her and who practice the ordinary activities and amenities of life in regard to her. She does not get offended when people refuse her demands. She goes to look for other victims who have as yet no knowledge of her temperament and “sickness.” Everything is legitimate to her in order to get well and healthy.
The patient talks of high ideals and of service to humanity, and yet she has not hesitated to lure away a man who had a wife and three children. She made him divorce his wife who was her bosom friend, and marry herself. She spends all his money on her “artistic dresses,” while his former wife and his little family are allowed just enough to keep them from starvation. The patient goes around travelling, visits physicians, cures herself, keeps on being sick in various health resorts, learning all kinds of fads, modes of “healthy living.”
The patient is in terror of disease and of old age. She fears even to think of such things. She carries around with her all kinds of prescriptions and directions as to how to preserve youth. I was especially instructed by her husband not to inquire for her age. Everything must be subservient to her impulse of self-preservation and instinct of fear. She has dwindled to a parasitic existence, obsessed with the lowest instincts of life. She avoids all responsibilities. She wants to get as much as she can in order to obtain for herself the highest possible benefit. When she meets people who do not know her, she is quick in taking advantage of them. Life to her has no duties but rights. Patient is a typical Nero, a Caligula. She would cheerfully sacrifice a nation to get out a mite of pleasure, comfort, and health.
V. S. Age 49, female. Married; no children. She has three sisters and two brothers who are all well. As a child she lived in great poverty. She was neglected and met with accidents and scares; suffered from sickness until her little body was emaciated from privation. She managed, however, to go through school and become a clerk in a small store; she was very careful of her appearance which meant to her a good marriage, comfortable life. She also took care of her health which was rather precarious, on account of the many colds accompanied by severe headaches. At the same time on account of the poor life led, she also suffered from some obscure troubles. After years of precarious health and quests for happiness, for marriage, she succeeded in capturing a well-to-do merchant in whose store she had worked as a clerk. Immediately after marriage she rigged up a beautiful home with “rich mahogany furniture” which the husband regarded with a gasp, settled down to a life of leisure, to complete idleness, and began to attend to her health....
The patient began to find more and more troubles with her organs, from the top of her head to the pelvis and intestines. Nothing was quite right. Things could be improved. The impulse of self-preservation gained more and more control over her. Along with this impulse the fear instinct gained in strength, became more and more extensive.
The patient became full of fear which, by the principle of proliferation and diffusion, kept on growing and diffusing in ever new directions, and spreading to ever new associations and systems. The central fear was poverty. The patient was afraid she might become poor. This was naturally a fear from her early childhood,—the fear of suffering in poverty, a fear which persisted throughout her life. The fear became accentuated and developed with time. She was afraid to spend money, especially sums above a five dollar bill. No matter how much she tried to reason with herself this fear persisted. She was afraid to buy new things which she regarded more or less expensive. She was afraid to put on new dresses, to buy new furniture, to spend money in any way. In fact, quite often the fear was so uncontrollable that even when she had no thought of threatening poverty she was in a panic of being confronted with expensive purchases.
The fears then began to spread to other things,—such as giving away small articles or loaning books, or presenting any things or objects that might be regarded as expensive and valuable. The fears spread to other objects of importance and value.
Along with it she had fears of indigestion and nutrition, nausea, vomiting, intestinal pains, discomfort, and especially an inordinate amount of distress when in a state of nervous excitement.
The patient was as obstinate as a mule, though claiming that she was doing her best and trying everything in her power to co-operate. She was doing everything in her power to frustrate the physician’s directions, claiming at the same time that she was doing her best to follow scrupulously the doctor’s orders. She claimed she was nice to people when she was nasty and offensive to everybody who in any way happened not to fall in with her whims and caprices. In fact, even those who went out of their way to please her and did everything in attending to her, and helping her in every way day and night, even those she treated with lack of consideration, even positive disdain and contempt. She was the incarnation of demoniacal obsession of psychopathic meanness and egotism.
She abused and dominated her husband by her sickness, trouble, fainting and crying spells, headaches, moans and weeping. She made him do everything she pleased. In fact, she tyrannized over her husband, and kept on claiming she loved him. She could not for a moment be without him, and complained that on account of her extreme devotion to him, “her will was broken.”
She was a regular termagant, a demon incarnate. She knew how to make a scene and put the blame on her “dear ones.” It was enough for her to suspect what her friends wanted her to do, she was sure out of sheer malice, to act the contrary. She was distrustful, spying on others, sneaky and lying without any scruples; and yet “no one was so mild, so ideal, so kind, so affectionate, so considerate, so calm as she was.” She went around reciting poetry about ideals, health, and happiness. She persuaded herself that she was highly educated, that she was the best business woman, the best critic, appreciative of poetry and of art in general. She was a veritable Nero, an “egomaniac” devoid of all love and human sympathy. She suffered so much, because she was so unusually altruistic. A coyote in her fear, a tigress in her rage, she claimed the gentleness of the dove and the innocence of the babe.
Not for a moment could she fix her attention on anything but herself, eating, drinking, sleeping, and feeling. Nothing interested her but herself. She avoided work, however short and easy. She could, however, talk of herself, of her achievements, of her moral, intellectual qualities by the hour and by the day. Even games did not interest her, nothing but herself, and self. This was so evident that one of the attendants noticed this characteristic psychopathic trait, and described her as “egomaniac.” She was the “Great I am.” “The Ego-person is the reflection of the Ego-god.” ...
Whenever one spoke of a great man, she was sure to have her opinion of him. She was at any rate superior to him. She could give her opinion on any conceivable subject in literature, economics, and politics.
She was as cunning as a savage, and as treacherous as a wild brute, and yet she was to all appearances a veritable saint, full of suffering for the sins of humanity, and for the faults of her husband who was “boyish and foolish, whom she had to manage,” and whom she did control and handle with an iron rod.
There is no doubt, however, that she herself was driven by her intense, uncontrollable impulse of self-preservation and by the instinct of fear. What especially terrorized her was the slow but sure extension of the fear instinct to more and more objects and acts. The fear instinct kept on creeping on her, slowly choking the life sources of her being. To call the patient “egocentric” is a mild descriptive term,—“tigress,” “satan,” “fiend,” would be more appropriate appellations. In her terror of self-preservation she tormented herself and others. She was a firebrand from hell, a firebrand fanned by the furies of self and fear.
F. W. Age 47; female, married; has no children. The patient claims to have been an invalid from childhood; that she was of extremely delicate health; she always had to take care of her health, and had to go through all kinds of diseases, especially gastro-intestinal troubles. At the age of eighteen she got married and then her family felicity began. She began to complain of all kinds of infirmities. The gynecologist humored her with operations and treatments. The fear disease became strengthened, and finally she cultivated a typical pathophobia; she was in terror of some fearful malady that might possibly take possession of her.
The patient always wanted to have someone near her. This fear of remaining alone dated from childhood, when at the least discomfort, she asked and screamed in terror for help. A companion, or nurse had to be with her day and night, so as to protect her from any impending evil.
Occasionally, to relieve her feelings, in the middle of a conversation, whether for the sake of impressing her family, her husband or her physicians with the gravity of her disease, or as a vent for the rising instinct of fear, she emitted a scream, wild and weird, reminding one of the howling of a timber wolf, or of a wild whoop of an Indian. This was a habit she kept up from childhood. It was a reaction of her fears, and a protection, it was a call for help which was sure to attract attention. The family could not refuse help at hearing such an unearthly call. Later on, it was consciously and unconsciously utilized by the patient as a rod to rule the family and especially her husband, when the latter happened to become refractory. The fear reaction was thus used as a protection and as a weapon of defense.
Things had to run according to her pleasure, or else she was put in a state of nervous excitement and fear with its awful yell of which the family and the husband were in perfect terror; they yielded unconditionally. The patient literally subjugated her husband by her spells of fear, especially by the fearful acoustic performance, the aura, the harbinger of a psychopathic attack.
The patient was always discontented and grumpy. Nothing could satisfy her, nothing was good enough for her. Everybody was criticized. No matter how one tried to please her, she always found fault with the person. In fact, the fault-finding was in proportion to the eagerness one tried to serve and oblige her. The nurses are not good, the servants intolerable, and people in general are bad, mean, stupid, and vulgar. She claims she comes from an “old New England family, from good stock.” Her grandfather was a fisherman, and her father a petty tradesman. The patient makes pretensions to education, poetry, art, and drawing. In reality, she is quite dull and ignorant.
G. A. Female, age 63; the patient was obsessed with pathophobia for over thirty-five years. She has been to a number of physicians, and to many sanitariums, looking for health everywhere, not finding it anywhere. The fears date to her early childhood. She was regarded as a delicate child, the fear of disease was strongly impressed on her. She went through a number of children’s diseases. Although she had several sisters and brothers, the child’s supposed delicate constitution was the fear and worry of the parents. This fear was communicated to the child, who for the rest of her life became a psychopathic patient with the characteristic developed impulse of self-preservation and intense fear of disease. She could not think of anybody but herself, everything had to be arranged for her,—for her food, for her sleep, and for her rest. She kept on complaining at the slightest change either in herself, in others, about the arrangements of the house, or about the weather. Everything had to be arranged just as she demanded, otherwise she was sick, or was going to become dangerously ill.
When about the age of thirty, she married a widower with two children. She trained the children to obey her commands implicitly, otherwise she resorted to the rod of sickness. The pathophobia, consciously or unconsciously, became a power which she wielded in the most tyrannical way. The children had to sacrifice themselves for the pleasure of the sick step-mother. They had to stay with her, and minister to all her whims and fears. The very individuality of the children became almost obliterated by the persistent, egotistic tyranny of the sick, old step-mother. She was like a regular vampire, sucking the life blood of her family.
It goes without saying that the same fear of disease tamed her husband over whom she ruled with an iron hand. The least opposition to her whims, or to her fears of possible disease made her so sick with all kinds of pains that the family and the husband were driven into submission.
The woman was obese as a hippopotamus, well nourished, with a florid complexion, and with an appetite that would shame a Gargantua. The rarest, the best, and the most appetizing dainties had to be on her table. She made of her meals a form of worship, requisite to propitiate the goddess of maladies. She did not hesitate to take the best morsels from the plates of her daughter and son in order to satisfy her appetite which was supposed to be “delicate and small.”
The patient was conscious of every square inch in her body; she was afraid that some form of malady may lurk there. She was a typical case of pathophobia. Fear of disease and quest of health were ever in her mind. She could not talk, or think of anything else, but herself and her symptoms. She made of her step-daughter a poor, colorless being, a day and night nurse, tyrannized over by pitiful, neurotic whimpering.
When the patient happened to wake during the night for ever so short a period of time, she did not hesitate to wake her step-daughter, tired as the latter was by constant attendance on this psychopathic shrew. The daughter had to wake up everybody who could in any way bring comfort to that “poor, old, suffering invalid.” After much groaning, moaning, and bewailing her bitter lot the invalid took some medicine to appease the fear of disease, partook of some nourishing food to keep up her strength and health, and went to sleep for the rest of the night.
Years ago, the patient was under the care of Weir Mitchell who sent her to me as a last resort. Dr. Weir Mitchell characterized the patient as an “American humbug.” As a matter of fact, the patient herself was convinced that she was on the verge of death, and was in terrible agony of her fears of disease, fears which made her quest for health a matter of life and death. The patient was obsessed by parasitic egotism, the quintessence of psychopathic affections.
Many times during the day she paced the room reciting elevating passages from the Bible, from “great poets,”—Emerson being her favorite writer.
I have heard neurotics with their “Mortal Mind,” “Sin and Error,” “Disease and Nothing,” recite edifying phrases such as: “The decaying flower, the blighted bud, the gnarled oak, the ferocious beast, like the discords of disease, sin, and death are unnatural” ... “Fear is inflammation, error” ... “Adam, a-dam, a-dam, dam, dam”....
A man, thirty-eight years old, married, highly sensitive, suffers from migraine; he is irritable and restless. When about eight years old, he wandered in the woods near his house. An Italian ran after him, flourishing a big knife. The boy ran away in terror. When he reached home he dropped from exhaustion and fear. Once or twice, on account of the fear of sharp objects, he actually hurt himself while handling knives. This increased his terror and fixed his fear. The instinct of fear was still further developed and stimulated by a series of events, such as falling into a river, from which he was saved. He does not like to take baths, he is afraid to enter a river, and he is in terror of sharp objects, such as knives and razors.
The patient is extremely selfish. He insists on playing games which he likes much, irrespective of the pleasure of his friends and acquaintances. All he cares for is to have a good time, to neglect his duties to his family. In his business he is exacting of others, although he himself is rather slovenly in his work, and slow in the performance of his obligations. He always insists on having his own way. Other people’s rights do not trouble him, provided his rights are carefully and scrupulously observed. He always demands services from others, especially from his friends.
The patient’s mind is occupied with his health, his fears, and his ailments. The interest he takes in his friends and acquaintances is how far they may serve his purposes of pleasure, game, health, and avoidance of fear of disease. His wife and child are regarded from a personal standpoint of his own good, otherwise they are totally ignored. When they interfere with him, or arouse his fears, he becomes impatient, angry, and furious. He claims to be the most considerate and kindest of men, brimful of humanitarian ideals. He thinks that he can accomplish more than anyone else in his circumstances. Nothing is too good for him, nobody is superior to him. As a rule things are badly conducted, he finds fault with everybody and with everything. He is driven by psychopathic furies,—discord, fear, and maddening egotism.
[CHAPTER XIX]
HYPNOIDAL TREATMENT
Psychopathic or neurotic maladies do not depend on the abnormal action of some one organ or function, but on a general condition common to all bodily and mental functions,—the fundamental primitive fear instinct which relates to life in general.
The deranged functions, cardiac, respiratory, or sexual,—fatigue, conflict, shock, repression and others are only the occasions. To regard any of these occasions as the sources of psychopathic maladies is like regarding the weather-cock as the cause of the wind. Self-preservation and the fear instinct alone form the source of all psychopathic maladies.
I adduce here a few cases which may be taken as typical:
Mrs. M. C., aged thirty-two years. Family history good; well developed physically and mentally. A year before the present trouble set in, patient suffered from a severe attack of grippe. Menstruation, which was before painless and normal in amount, became painful and scanty, accompanied by headaches, indisposition, irritability, crying spells and backache which lasted long after the menstrual period was over. The family physician ascribed the symptoms to endometritis, mainly cervical and treated her with absolute rest, fomentations, injections, scarification and dilatation of the cervix, and finally curetted the uterus. As the patient grew worse under the treatment, she was taken to a gynecologist, who after an examination suggested an operation. The operation was duly performed, with the result that the nervous symptoms became intensified, and the attacks increased in violence and duration. The turn of the nerve specialist came next. Hysteria, neurasthenia, and the more fashionable “psychasthenia” have been diagnosed by various neurologists. A year of psychoanalysis made of the patient a complete wreck, with depression, introspection and morbid self-analysis. Patient was put by neurologist under Weir Mitchell’s treatment.
When the patient came under my care, she was in mental agonies, a complete wreck. I gave up the Weir Mitchell rest treatment, sent away the nurse, released the patient from solitary bed confinement, told her to leave the sick room, to give up dieting and medicines, and to return to a normal, active life. I kept on treating her by the hypnoidal state. The patient began to improve rapidly, and finally all her physical and mental symptoms disappeared; she has continued for over six years in excellent condition of health.
A study of the case traced the fear instinct to experiences of early childhood, fears accentuated and developed into morbid states by the deleterious tendencies of the treatment, giving rise to a somatopsychosis, the physical symptoms mainly predominating.
A lady, aged fifty-nine years, suffered from kynophobia. When about the age of twenty-nine years she was bitten by a dog; since then she was afraid of hydrophobia. She kept on reading in the papers about cases of hydrophobia until the fear became developed to an extraordinary degree and became fixed and uncontrollable. According to the principles of evolution of psychopathic states, the fear kept on extending. The fear psychosis included all objects that might possibly carry the germ of hydrophobia. The neurosis became a mysophobia.
As in all other cases of psychopathic states the psychosis was traced to the fear instinct, the germ of which was laid in the patient’s early history. The patient was a timid child, and was afraid of strange animals. In the village where she lived there were a few cases of hydrophobia which impressed her when a child. This germ was in later life developed by thirty years’ cultivation.
Psychopathic or neurotic symptom complexes I observed in children whose early training was favorable to the awakening and development of the fear instinct. In children affected with fear of animals I traced the fear psychosis to the parents who were afraid of animals, on account of actual traumas in their life history, the child being influenced by imitation, by suggestion, often subconscious, by the behavior of the parents in the presence of animals. Such children are predisposed to recurrent psychopathic states.
In all such cases the etiology is easy to find, if the patient is carefully examined. In many cases the fear instinct with its symptom complex is associated with external objects, giving rise to the so-called phobias. Instead, however, of being associated with external objects, the fear instinct is frequently associated with somatic functions (pathophobia), or with mental activities (phrenophobia).
Man, aged forty-seven years; actor; family neurotic. Patient suffered from anorexia, indigestion, choking, vomiting, gagging, eructation, gastralgia, and occasional pains in the limbs. He led a rather gay and irregular life up to the age of thirty-two years, when he had syphilis, for which he was under treatment for two years. This scared him because he had the opportunity to see the consequences of syphilis in many of his friends. He had been under continual fear of the possibility of development of parasyphilitic diseases.
Seven years ago, at the age of forty years, he had to watch at the bedside of an intimate friend, who had been suffering from severe gastric crises of tabes dorsalis. After one specially exhausting night of vigil, worry and fear, he went to bed for a short nap and woke up with the idea of general paresis and intense fear. From that time he began to suffer from symptoms of tabes with fear of general paresis.
The patient had been an imaginative child; he had his fear instinct cultivated from early childhood by stories of frights, scares, and horrible accidents. When ten years old, his grandfather gave Faust to him to read. Since then the patient was troubled with the fear of selling his soul to Satan. The patient was religious in his childhood, prayed much, and was possessed by the fear of committing sins. “It has now all come back,” he complained. A great number of fears could be traced to his early childhood. The somatic symptoms were the manifestations of association of experiences of parasyphilitic diseases, based on the pathological state of the fear instinct, a case of pathophobia, a somatopsychosis.
A few hypnoidal treatments effected a cure. The patient returned to his occupation, free from any distressing symptoms.
H. M. aged twenty-seven years, male, Canadian. Family history good; looked pale, anemic, and frail; very intelligent, sensitive, restless, and had a tendency to worry. About a year ago, he began to feel depressed, to worry about his health; thought he suffered from tuberculosis. His physician assured him that nothing was the matter, but he had an uncontrollable fear of consumption; and the idea kept on recurring. Up to the age of nineteen years he was perfectly well. He was then laid up with a sore knee for a few weeks. He had time enough to brood over the knee, and read some literature on the subject. He thought it was tuberculosis and worried much. The knee, however, got well, and gradually he forgot all about it, although the idea of tuberculosis often made him feel uncomfortable, and the idea of “water in the knee” used to flash through his mind, to pass away the next moment.
A year ago, however, he happened to lose his work, became despondent, began to worry and to brood over his financial troubles, slept restlessly, suffered from anorexia, and began to lose flesh. The idea of the knee and the fear of tuberculosis got possession of him. He could not rid himself of the idea of tuberculosis. If in the clinic the physician assured him that he was all right, he felt better for a couple of hours; but often it did not last even as long as that. The least pain, cough, heart beat, a feeling of chill or heat, and the like, brought the idea and fear of tuberculosis back to his mind with renewed energy. He was obsessed by the fear of tuberculosis and felt he was doomed to certain death, a psychosomatic pathophobia.
Hypnoidal states did good service. The patient’s mental condition began to improve rapidly. He was no longer troubled with depression, insomnia, and fears; began to gain in weight, appetite improved, felt energy flowing in; began to look for work in real earnest, finally found it, and kept at it.
Man, aged forty-three years, suffered from palpitation of the heart, fainted easily, especially on physical examination by physician, or at the beginning of medical treatment. He suffered from indigestion for which he had been under treatment for a number of years by physicians who gave him medicine for his bowels and also from time to time kept on washing his stomach. He had a great fear of becoming a victim of cardiac troubles, especially of some unknown, terrible, valvular affection. When under my care he kept on asking to be taken to heart and stomach specialists, to be examined, and have some radical operation performed. Frequently under the influence of the fear states and obsession of heart and stomach trouble, especially the heart, he would collapse suddenly, be unable to walk, and be afraid that he suffered from some paralysis.
On examination the patient revealed a history full of various traumas which, from his very childhood until he came under my care, helped to bring about his psychopathic condition, and developed the fear instinct to an extraordinary degree.
Physicians had the lion’s share in this special case by their rearing of the fear instinct, and by their favoring the patient’s phobias by their examinations, by their prescriptions, and by the diet and treatment. The patient was in such a panic that he kept on taking his pulse on the least occasion, was feeling his heart, stomach, and intestines at every opportunity. The hypertrophied growth of his morbid self and fear instinct had invaded and dominated the patient’s whole personality, developed a typical psychosomatic pathophobia with its recurrent states. The patient was cured by hypnoidal states.
In the Trudi for 1913 of the University of Moscow, Russia, Doctor Ribakov made an extensive study of a series of cases of psychopathic or psychoneurotic asthma, and arrived at a conclusion similar to my own, although he was no doubt unaware of my work and publications on the same subject. He came to the same conclusion as I that the etiology of neurosis is to be found in fear, which alone forms the basis of psychopathic neurosis. All other factors, social, professional, sexual, religious, repressions, conflicts are only occasions of the disease. It is fear, and fear alone that forms the pathology of the psychopathic neurotic symptom complex.
A young lady was afflicted with ornithophobia, fear of birds, fear of chickens. The sight of a chicken set her into a panic. The patient is very timid, and this timidity can be traced to her early childhood. When at the age of six, a play-mate threw a live chicken at her in the dark. The child was terribly frightened, screamed, and fainted. The mother used to tell her fairy stories full of adventure, of ghosts, of dragons, and of monsters. This prepared the patient to react so violently to the sudden attack made by the flight, struggling, and feel of the chicken in the dark. Since that time, patient has formed an uncontrollable fear of live birds.
Another patient of mine, a lady of forty-nine years, single, suffered from potamophobia, a fear of going into rivers, or into the ocean. When about seven years old she was thrown into water by one of her elder sisters. She was nearly drowned and was half dead with fear when rescued. Since then she has been in terror of water, or rather of rivers and oceans. Several times she made conscious efforts to get rid of the fear, but the attempts were unsuccessful. In fact, the more she was forced or forced herself consciously to get into the water, the greater was the fear. This fear became all the more intensified, when some of her intimate friends were drowned in a boat. This fixed the fear which became uncontrollable.
A patient of mine, a man of thirty-five years, was afraid of going out in the dark. This was traced to early associations of fears of the dark, to superstitious beliefs in ghosts and spirits cultivated in the patient’s early childhood. He was afraid to remain alone in the dark or to go down at night into cellars or other secluded places. This fear was unfortunately still more intensified by an accident. At the age of twenty-seven, one night when returning late from a visit, he was assaulted from behind by foot-pads. This accident fixed the fear of darkness.
A lady of sixty-seven years, with pronounced arteriosclerosis, had an attack of hemiplegia of the left side. She suffered from motor aphasia, but did not lose consciousness. The paralysis cleared up in a few days, but the sudden attack demoralized her. Since that time she is in terror of another attack. She watches for symptoms, and the least sensation of faintness throws her into a panic. The patient is the wife of a general and was in China during the Boxer riots, in the Spanish American war, in the Philippines, and other military engagements. The fear instinct was cultivated in her by all such conditions.
In her early childhood there were fears and frights of child character, enough to arouse the fear instinct, which was gradually developed and cultivated by the circumstances of life and by worries in the course of the various wars, of which she was a witness. Finally the fear culminated by the stroke of paralysis.
Similarly, I had patients who suffered from tuberculosis, from asthma, from heart trouble, and from all kinds of intestinal affections which specially abound in psychopathic cases. All such cases can be clearly traced to various somatic symptoms based on the fear instinct. The etiology is fear, the arousal and development of the fear instinct in respect to the special symptom complex.
A patient, aged twenty-six years, suffered from agoraphobia at various intervals. As a child of nine years, he was attacked by rough boys. He freed himself and ran in great terror. The boys threatened him with another “licking” when he appeared again on the street. He was afraid to go out for several weeks. The parents forced him to go and buy some things. Living in a rough neighborhood, on account of his father’s circumstances, he had been many times subjected to knocks, blows, and assaults by rough boys, until the fear of the open street became fixed into the well known form of agoraphobia.
Another case, that of a lady of thirty-eight years, married, suffers from ailurophobia, or fear of cats. This can be traced to the patient’s early childhood. When she was a child her brothers and sisters went through attacks of diphtheria, which was ascribed to infection caused or transmitted by cats. The patient was specially impressed with the danger from cats. Under such training and suggestion given in early childhood, the patient gradually formed a fear of cats. This fear was still more intensified and became a panic when she was put into a dark room and a cat was let loose on the poor victim by her mischievous companions, who knew of the patient’s fear. When the patient had children of her own, she was still more affected by the fear of cats, on account of the subconscious and conscious fear of the possibility of infection transmitted by cats to her children.
All those cases were investigated and cured by hypnoidal states.
Mr. D., a young man of twenty-five years, was born in Poland. As far as can be ascertained, the parents as well as the brothers and sisters are well. A physical examination of the patient reveals nothing abnormal. There are no sensory, no motor disturbances. He complains of severe headaches, preceded by a feeling of indisposition, depression, vertigo and distress. During the attack there is hyperesthesia to touch, pressure, temperature, and to visual and auditory stimulations. The patient shivers and looks pale. The cold experienced during the attack is so intense that the patient has to wrap himself in many blankets, as if suffering from a malarial paroxysm.
Fears have strong possession of the patient’s mind. He is afraid to remain in a closed place in the daytime and especially at night. When he has to remain alone at night, he is in an agony of fear, and cannot go to sleep. Every passer-by is regarded as a robber or murderer, and he quakes at the least noise. When walking in the house in the dark, he has the feeling as if someone were after him, and occasionally even experiences the hallucination of some one tugging at his coat. He is mortally afraid of the dead and shuns a funeral. The patient has also a fear of dogs, a kynophobia. The fear is irresistible, and is as involuntary as a reflex.
An investigation, by means of the hypnoidal states, brought out of the patient’s subconscious life the following data: When a child of three years, the patient lived with his family in a small village near a large forest infested with wolves. In one of the intermediary states a faint memory, rather to say a vision, struggled up, a vision of wolves and dogs. Some one cried out: “Run, wolves are coming!” Crazed with fear, he ran into the hut and fell fainting on the floor. It turned out to be dogs instead of a pack of wolves. It is that fright in early childhood which has persisted in the subconscious mind, and, having become associated with subsequent experiences of attacks of dogs, has found expression in the patient’s consciousness as an instinctive fear of dogs.
But why was the patient in such abject terror of dead people? This found its answer in the experiences and training of his early life. When a young child, the patient heard all kinds of ghost stories, and tales of wandering lost souls and of spirits of dead people hovering about the churchyard and burial grounds; he heard tales of ghouls and of evil spirits inhabiting deserted places, dwelling in the graves of sinners and the wicked. He listened to stories of haunted houses and of apparitions stalking about in the dark. His social and religious environment has been saturated with the belief in the supernatural, as is usually the case among the superstitious populations of Eastern Europe. We cannot wonder, then, that an impressionable child brought up under such conditions should stand in mortal fear of the supernatural, especially of the dead.
When the patient was about nine years old, his parents noticed some prominences on his right chest. It was suggested to them that the hand of a dead person possessed the property of blighting life and arresting all growth, and would, therefore, prove a “powerful medicine” for undesirable growths. It happened that an old woman in the neighborhood died. The little boy was taken into the room where the dead body was lying, and the cold hand of the corpse was put on the child’s naked chest. The little fellow fainted away in terror. The fear of dead people became subconsciously fixed, and manifested itself as an insistent fear of the dead, and, in fact, of anything connected with the dead and the world of spirits.
The patient had hardly recovered from the shock of the “dead hand,” when he had to pass through a still more severe experience. A party of drunken soldiers, stationed in the little town, invaded his house and beat his father unmercifully, almost crippled him: they knocked down his mother, killed a little brother of his, and he himself, in the very depth of a winter night, dressed in a little shirt and coat, made his escape to a deserted barn, where he passed the whole night. He was nearly frozen when found in the morning, crouching in a corner of the barn, shivering with fear and cold.
From that time on the headaches manifested themselves in full severity, with hyperesthesia and death-like paleness and intense cold of the body. The early cultivation of the fear instinct resulted in a neurosis with its recurrent states.
Another patient is a man of thirty years; his family history is good. He is physically well developed, a well known professor of physics in one of the foremost institutions in this country. He suffers from attacks of loss of personality. The attack is of a periodical character, coming on at intervals of two weeks, occasionally disappearing for a few months, then reasserting itself with renewed energy and vigor. During the attack the patient experiences a void, a panic, which is sudden in its onset, like petit mal. The trouble was diagnosed as larval or psychic epilepsy; the man was referred to me by Dr. Morton Prince as an extremely interesting, but puzzling neurological case.
Patient feels that his “self” is gone. He can carry on a conversation or a lecture during the attack, so that no outsider can notice any change in him, but his self is gone, and all that he does and says, even the demonstration of a highly complex problem in integral calculus is gone through in an automatic way. The fury of the attack lasts a few moments, but to him it appears of long duration. He is “beside himself,” as he puts it. He seems to stand beside himself and watch his body, “the other fellow,” as he describes it, carry on the conversation or the lecture. He is “knocked out of his body, which carries on all those complicated mental processes.” For days after he must keep on thinking of the attack, feels scared and miserable, thinking insistently, in great agony, over his awful attack, a recurrent psychoneurotic phrenophobia.
At first the patient could trace this attack only as far back as his seventh year. Later on, earlier experiences of childhood came to light, and then it became clear that the attack developed out of the primitive instinctive fear of early childhood, fear of the unfamiliar, fear of the dark, of the unknown, of the mysterious, fears to which he had been subjected in his tender years.
This state was further reinforced by the early death of his parents, it was hammered in and fixed by hard conditions of life, full of apprehension and anxiety. Life became to the child one big mysterious fear of the unknown. The fear instinct formed the pathological focus of the attack. As the patient puts it: “It is the mystical fear of the attacks which overpowers me.”
With the disintegration of the focus the symptom complex of the attacks disappeared. The patient is in excellent condition, he is doing brilliant work in physics and chemistry and is professor in one of the largest universities in Canada.
I present another case apparently “paranoidal,” a case interesting from our standpoint. The patient is a man of twenty-seven years; his parents are neurotic, religious revivalists. As far back as the age of eight he suffered from agonizing fears of perdition and scares of tortures in hell, impressed on his sensitive, young mind during the revivals. He is very religious, obsessed with the fear of having committed an unpardonable sin. He thinks he is damned to suffer tortures in hell for all eternity. He keeps on testing any chance combinations, and if his guesses turn out correct, he is wrought up to a pitch of excitement and panic. For to him it means a communication coming from an unseen world of unknown mysterious powers. With his condition diagnosed as “paranoidal dementia praecox,” the patient was committed to an insane asylum, from which he was subsequently released.
The attack comes in pulses of brief duration, followed by long periods of brooding, depression, and worry. The primitive fear of pain, of danger and death, and the sense of the mysterious cultivated by his religious training, reached here an extraordinary degree of development. Among the earliest memories that have come up in the hypnoidal state was the memory of a Sunday school teacher, who cultivated in the patient, then but five years of age, those virulent germs which, grown on the soil of the primitive instinctive fear and the highly developed sense of the unknown and the mysterious, have brought forth poisonous fruits which now form the curse of his life. The case is a typical psychoneurotic phrenophobia with its characteristic recurrent states.
“It is difficult,” the patient writes, “to place the beginning of my abnormal fear. It certainly originated from doctrines of hell which I heard in early childhood, particularly from a rather ignorant teacher who taught Sunday school. My early religious thought was chiefly concerned with the direful eternity of torture that might be awaiting me, if I was not good enough to be saved.”
After a couple of years of persistent treatment by means of the hypnoidal state and by methods of association and disintegration of the active subconscious systems, the patient recovered. He entered a well known medical school and took the foremost rank among the medical students.[9]
In the investigation or psychognosis of psychopathic cases I invariably find the psychopathology to be a morbid condition of the fear instinct, rooted in the primordial impulse of self-preservation. The psychognosis of this underlying pathological state and disintegration of the latter are of the utmost consequence in the domain of psychopathology and psychotherapeutics.