Functional psychosis or neurosis is an obsession, conscious and subconscious, of the fear instinct. Thus one of my patients became obsessed with fear of tuberculosis, manifesting most of the symptoms of “consumption,” after a visit to a tubercular friend. Another patient was obsessed by the fear of death after visiting a sick relative of his in one of the city hospitals. Another became obsessed with the fear of syphilis after having been in contact with a friend who had been under antiluetic treatment. Still another of my patients, in addition to the fear of darkness, became obsessed with the fear of stars, and also with a fear of comets, regarded by some people as poisoning the air with noxious gases.
In all such cases anxiety and dread were present, but in none of the patients have I found an insight into the real state of the mind. In all of them the fear was traced to early childhood, to early experiences of the fear instinct, fostered and fortified by unfavorable conditions. In all of those fears there was a long history of a well-developed subconscious fear instinct.
I may assert without hesitation that in all my cases of functional psychosis, I find the presence of the fear instinct to be the sole cause of the malady. Take away the fear and the psychosis or neurosis disappears.
The fear instinct arises from the impulse of self-preservation without which animal life cannot exist. The fear instinct is one of the most primitive and most fundamental of all instincts. Neither hunger, nor sex, nor maternal instinct, nor social instinct can compare with the potency of the fear instinct, rooted as it is in self-preservation,—the condition of life primordial.
When the instinct of fear is at its height, it sweeps before it all other instincts. Nothing can withstand a panic. Functional psychosis in its full development is essentially a panic,—it is the emergence of the most powerful of all instincts, the fear instinct.
Functional psychosis or neurosis is a veiled form of the fear of death, of destruction, of loss of what is deemed as essential to life, of fear of some unknown, impending evil. How many times has it fallen to my share to soothe and counteract the fear instinct of panic-stricken psychopathic patients! A psychogenetic examination of every case of functional psychosis brings one invariably to the fundamental fear instinct.
Conflicts, repressions, imperfections, sex-complexes, sex-aberrations, and others do not produce psychopathic symptoms or neurotic states. It is only when mental states become associated with an exaggerated impulse of self-preservation and an intensified fear instinct that neurosis arises.
A close study of every neurotic case clearly discloses the primary action of those two important factors of life activity,—self-preservation and fear instinct.