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.”