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.
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 theoccasions. 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, accompaniedby 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 asomatopsychosis, 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 inlater life developedby thirty years’ cultivation.
Psychopathic or neurotic symptom complexes I observed in children whose early training was favorableto 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, hehad 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 gaveFaustto 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 tendencyto 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 wasobsessed 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 historyfull 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 theTrudifor 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 ofneurosis 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 themore 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 frightsof 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 duringthe 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 associatedwith 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 intothe 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 aneurosiswith 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 attackis 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, likepetit 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, earlierexperiences of childhood came to light, and then it became clear that theattack 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 typicalpsychoneurotic phrenophobiawith 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 religiousthought 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.
FOOTNOTE:[9]A full account of the cases is published in my volume “The Causation and Treatment of Psychopathic Diseases.”
[9]A full account of the cases is published in my volume “The Causation and Treatment of Psychopathic Diseases.”
[9]A full account of the cases is published in my volume “The Causation and Treatment of Psychopathic Diseases.”
A few “Confessions” made by psychopathic sufferers will help us best to understand the character, the mechanism, the factors, and principles of neurosis:
“As you are desirous of knowing more about my life and environment, I state concerning them as follows:
“You will remember that I told you that my step-father was a liquor dealer. Throughout all the time that he was in business we either lived over the bar-room or else right in the place where the liquor was sold. My step-father was a very heavy drinker, a man of violent nature, and decidedly pugnacious. As a child I have been scared to death by drunken brawls, and many nights have been dragged out of bed by my mother who would flee with me to the house of a neighbor for safety.
“I might say that until I was seventeen years old, I lived in continual terror of something goingto happen. If he was arrested by the police, as often happened, our home would be a scene of turmoil until the case was settled.
“I remember one incident very plainly, when he came home one night completely covered with blood as the result of being held up by thugs, and another time when he left the house to subdue some quarreling drunks with a pistol and returned after an exchange of shots with his hand shot through.
“As a child, I was inclined to study, and associated very little with other children. My mother tells me that I talked early, but when about three years old I began to stammer. This trouble bothered me a great deal, and I used to worry about it all the time, especially in school when I would try to recite. I might add that even now, when excited, I am troubled in the same way.
“My step-father has been subject to nightmares nearly all his life; when asleep he would cry and moan and would be unable to move until some one would shake him out of it. He was terribly afraid of them, and I remember he used to say that he expected to die in one of them. I used to be left alone with him quite frequently, and I stood in constant fear of his dying; and if he fell asleep, as he frequently did in the day time, I would wake him or watch his respiration to see if he was alive.
“At other times I have been awakened in the night by his cries and would assist my mother in bringinghim to consciousness. It was during one of these times that I became aware of my heart palpitating, and whenever he had such a spell, I would be in a state of fear and excitement for some time after. He would have these nightmares nearly every night and some times four or five times in one night, and I might add that he has them even now.
“I began to have attacks of dizziness in the streets, and finally one day, I had one, and all symptoms and fears of the attack came on in school, and from that time on I have watched my respiration and suffered from dizziness, mental depression, and sadness.
“You have asked me to tell you more in detail about the attacks or nightmares to which my step-father was subject, and which always frightened me greatly, especially when a child.
“My step-father had the habit of falling asleep quite often, even in the day time, and I have never known him to go to sleep without having an attack in some form. If one watched him asleep, as I often did, one could tell by his respiration when an attack was coming. His breathing would become slower and hardly perceptible, and finally he would begin to moan, and cry out; then, when shaken vigorously and spoken to, he would awaken in great fear and apparent suffering. If he had an attack, and we did not respond soon enough, he would be very angry and say that we cared not if he shoulddie. We were so afraid of these attacks that we had trained ourselves to be ever on the look-out for his cries, even at night.
“It really seemed as if his life rested in our hands. I might say that sometimes these attacks lasted several minutes, before he could be awakened. He used to say that at such times he always dreamed someone was choking, beating, or otherwise torturing him. He had been told by some physician that he would ultimately die in such an attack.
“These attacks were sufficient to precipitate a small panic in the house. I know not a single hour of the day or night, but that I have either been called or awakened by my mother in her efforts to awaken him. With the attack over, I would be trembling all over, and my heart would be beating madly. I can remember these attacks from my earliest childhood, and it seems to me that on one occasion, at your office, I was startled just as these attacks used to make me.”
While in the hypnoidal state, patient exclaimed: “I am afraid. All my life I lived under terror.... This is just my disease,—fear.”
“I lived from infancy in a state of apprehension and fear. In my home there seemed to be always a tension. I don’t know that I ever relaxed there during my waking hours. I was never at peace mentally.This was largely brought about by my mother’s chronic condition of fear. I should not have had such a large development of the fear habit had there been any neutralizing influence. But my father was a weak character, living under fear, being afraid of responsibility, so that my character was closely molded on his. He gave me no moral fiber to resist fears of mother, and so did not help me to build any character of my own. I still carry with me the state of apprehension and fear that I contracted in my early life. I had only one serious illness in my life outside of my nervous troubles. Had an attack of bowel trouble somewhere near the age of six. I was once struck in the face by a dog’s teeth. I have had various cancer experiences.
“My father, when I was very young, had some irritation of the throat. A physician told him he was in danger of cancer. I can recall him anxiously looking at his throat. Later a neighbor went to a ‘plaster specialist’ to have a supposed cancer of the tongue removed. His wife was often at our home talking of his sufferings.
“While attending dental school I contracted some trouble. I went to a physician near where I lived. He talked to me of a possibility of syphilis. I became much frightened, and read all I could find on syphilis. The books scared me still more. At last on the advice of friends, I went to another physicianwho reassured me, and I lost part of my fear.
“After this I returned home for a summer vacation. This was in 1904. That summer my tongue felt sore, I looked at it, and found it peculiar. This aroused my fears of syphilis. Upon returning to Chicago in the fall (1904) I asked my physician to recommend a specialist. He sent me to a syphilographer, who told me I had no syphilis, but that the condition of my tongue was caused by gall bladder trouble. He wished me to have the gall bladder operated which I refused to do. I thought no more about my tongue until I studied cancer in oral surgery. I would then occasionally worry over my condition. About this time an actor whom I knew died of cancer of the tongue. I worried over my tongue, being afraid of cancer, for several days after this. I then went along for seven or eight years without much thought of my tongue.
“One day in February 1913, after some pain in my side which brought the thoughts of gall bladder and then of the tongue, I asked advice of a physician. He looked at my tongue and said: ‘I don’t wish to frighten you, but you should have that tongue attended to. You might some day have a cancer there.’ He sent me to a throat specialist who said the condition of my tongue was due to a back tooth. I had the tooth removed. I afterwards consulted Dr. L., a surgeon at Eau Claire, Wis., with the idea of having the gall bladder operated upon. He laughed at the gall bladder trouble, but sent me toBattle Creek Sanitarium with the idea, I think, that the change would relieve me of my fears. At Battle Creek I was told I had a mild case of colitis, and was put under treatment for it.
“While at Battle Creek my fears grew less. I remained at Battle Creek about two months. Shortly before leaving there I was given a Wasserman test. This they told me was faintly positive. I was then given three injections of Neo-Salvarsan. I then left Battle Creek and stopped at Chicago to see Dr. P. Dr. P. said any Wasserman would be positive, taken with no more care than mine had been. That there was no reason to think there was any syphilis anyway. He then sent me to Dr. W., an internist, who said I had hyperacidity of the stomach.
“I did not feel very badly at this time, although my fears of cancer persisted. I was carrying on the work in my office. Later in the summer I went to the Mayo Clinic at Rochester, Minn., where I was given a local application for my tongue. In the fall of 1913, while in Milwaukee I consulted an oral surgeon, Dr. B. He said ‘I will send you to Dr. F., a dermatologist who knows more about diseases of the tongue than any man I know.’ I consulted Dr. F. who said: ‘Geographical tongue, do not worry about it.’ My fears were instantly relieved. I seldom thought of my tongue in the next two years.
“In the fall of 1916 I had some trouble with my stomach. This seemed to bring my fears to mindand one day my fear of cancer returned. There was a connection between my fears and the stomach and gall bladder trouble diagnosed in regard to my tongue. At least the stomach trouble would bring thoughts of the tongue condition.
“I tried to help myself out of my mental condition by reading articles on cancer. This made me worse. I went to Chicago where I was told by Dr. S., a dermatologist, that radium might remedy the condition of my tongue. I had several applications of radium. After this I still worried a great deal. I went through the spring and summer under a nervous strain, but still able to carry on my work. That fall (1917) I had such intense fear that I was attacked by acute insomnia. I was unable to sleep without Veronal. The day after my insomnia began I found myself very weak. I was pale, and my heart would pound on the least exertion. I had also a great deal of pain in my bowels. I went to Chicago and consulted Dr. E., Dean of Northwestern University Medical School. He told me such conditions usually traveled in a circle, that my nervous condition might leave me in a few months. I went through the winter in this condition.
“I began to have a great fear of the fact that it was necessary to use hypnotics. This fear of drugs was strong, and overshadowed my other fears. Iread an article on hypnotics as a habit; this added to my fear of them.
“Before using hypnotics I noticed my sexual power was less, or rather there was no pleasure in it. This did not trouble me as I thought it a part of my nervous condition.
“In April, 1918, I went again to Battle Creek. I did very well there for a week, but then got into a deep depression, became weak, and was frightened to think I was no better. I remained in Battle Creek for three weeks, and then went home. A month later I went to St. Paul and consulted a neurologist. He did not know what to do for me.
“I went to Milwaukee and consulted another neurologist. I was becoming more despondent all the time. I decided to go to a sanitarium to see if I could not get rid of my drug habit. I went to Wauwatosa, Wis., and remained there three weeks, but I could see they did not know what to do for me.
“In August I entered the Rest Hospital at Minneapolis and remained there for a while under the care of Dr. J. I managed to drag along, terrorized by my condition and by the fact that I could get no relief.
“The drug habit was my greatest obsession at this time. I used bromides and chloral hydrate,—changed hypnotics frequently.
“In January, 1919, I saw Dr. P. of Chicago, whosent me to a sanitarium where I received no help. I then hunted through magazines for articles on nervous diseases. I read of Dr. S. and his work and came under his care at Portsmouth in May, 1919. While there I learned to control my fears. I left Portsmouth in August feeling sure of myself. I would occasionally have a depression which would not frighten me and did not remain with me long. I was looking forward to a happy future.
“During the summer of 1921 I felt tired most of the time. However, I was still sure of being able to handle myself. One day after feeling very tired my fear of cancer returned. I got into a panic and started East to see Dr. S. On arriving in Boston I found he was in the West. I went to Dr. P.’s office; was sent to Dr. W. and by him to a psycho-analyst. The psycho-analyst said I had a ‘mother complex, without usual sexual features.’ Psycho-analysis proved a failure, and I abandoned the treatment with disgust, as useless and silly.”
The patient was under my care for five months. He is now back to his dental work. He writes to me that he is gaining rapidly in weight, and is in excellent condition.
“I am a married woman of fifty-two. All my life I have been imprisoned in the dungeon keep of fear.Fear paralyzes me in every effort. If I could once overcome my enemy, I would rejoice forever more.
“In childhood everything cowered me. I was bred in fear. At five or six my mother died, and I feared and distrusted a God who would so intimidate me and bereave me. I heard tales of burglars being discovered hiding under beds, and a terrified child retired nightly for years. I was in agony of fears. My fears I never told. Later I heard of the doctrines of God’s foreknowledge, and, as a little rebel, I would place dishes on the pantry shelves, changing from place to place, and then giving up in despair, knowing that if foreknowledge were true, God knew that I would go through with all that performance.
“Through childhood I feared suicide. It was a world of escape that appealed to me and yet appalled me. I also heard of somnambulism, and I never saw a keen bladed knife, but I dreaded that in my sleep I might do damage to myself or to my friends in a state of unconsciousness.
“In my twenties I did attempt suicide a number of times, but somehow they proved unsuccessful. I always aimed to have it appear an accident. I dreaded to have my death appear as a stain and disgrace to my family which I loved.
“I always fear to walk at any height, on a trestle over running walls, or even to walk on a bridge without side railings.
“As a child I was afraid of the dark, I was afraidof going out on the street in a dark night. In fact, even a moonlight night terrified me when I remained alone. I was afraid to go into dark places, such as cellars, or into lonely places even in the daytime.
“As a child I was always shy, fearful, timid, and self-conscious to a painful degree. Even as a grown-up woman I am often a sufferer from the same cause, although I have sufficient self-control to conceal it.
“I have to be careful of my state of health, as the latter is very delicate. I am a chronic sufferer from indigestion and constipation, although I somehow manage to regulate these troubles.
“When I need my nerves in good control so frequently, they are in a state of utter collapse. My brain is in a state of confusion, in a state of whirl just when I need to think the clearest. My poor brain feels as if a tight band encircled and contracted it. It seems to me as if the brain has shrunken from the temples.
“My memory is unreliable. Often I read quite carefully, but I am unable to recall what I have read. Especially is this so, if called upon without previous warning. My brain goes into a panic of an extremely alarming kind.
“I was told that I was a woman of a good brain and of great talent, that all I needed was to exercise my will and determination, and that I would succeed. I lack concentration and I lack confidence.
“In my childhood hell fire was preached. Fore-ordinationand an arbitrary God were held up to my childish comprehension. I was bred in fear, and self destruction resulted.”
The following valuable account given by an eminent physician brings out well the factors and principles of neurosis expounded in this volume:
“You ask me to write about my fears. I give you a brief account.
“As a child, as far as memory carries, I had a fear of ghosts, of giants, of monsters, and of all kinds of mysterious and diabolical agencies and witchcraft of which I had heard a number of tales and stories in my early childhood. I was afraid of thieves, of robbers, and of all forms of evil agencies. The fears were stronger at daytime, but more so at night. Strange noises, unexpected voices and sounds made a cold shiver run down my back.
“I was afraid to remain alone in a closed room, or in the dark, or in a strange place. It seemed to me as if I was left and abandoned by everybody, and that something awful was going to happen to me. When I happened to be left alone under such conditions I was often in a state of helplessness, paralyzing terror. Such states of fear sweep occasionally over me even at present. I find, however, that they are far more complicated with associations of amore developed personal life. I know that in some form or other the fears are present, but are inhibited by counteracting impulses and associations. I still feel a cold shiver running down my back, when I happen to go into a dark cellar in the dead of night, or happen to remain alone in a dark, empty house. Such fears date back to my fourth year, and possibly to an earlier time of my childhood.
“As a matter of contrast-inhibitions of such fears I may either brace myself and put myself in a state of courage and exaltation, or when this does not succeed, I let my mind dwell on other fears and troubles. I find that the last method is often far more effective in the inhibition of fear states which at the moment are present with me. All I need is to press the button, so to say, and awaken some other fears, the present fears diminish in intensity, and fade away for the time being. I actually favor, and welcome, and even look for disagreeable and painful experiences so as to overcome some of my present fears. The new fears are then treated in the same way.
“As I became older, about the age of eight, I began to fear disease and death. This may be due to the infectious diseases that attacked many members of our family, about this time. In fact, I have been present at the death bed of some of them, and the impression was one of terror, mysterious horror. I was afraid I might get diseases from which I mightdie. After my witnessing the last agonizing moment of death, my elders thought of removing me to a safer place; their fears and precautions still more impressed the fear of danger of disease and death. I may say that I really never freed myself from the fear of disease and death. The latter fear is always present with me in a vague form, always ready to crop up at any favorable opportunity. This fear, in so far as it is extending its tentacles in various directions, is often the bane of my life. Even at my best there is always a kind of vague fear of possible danger, lurking in various objects which may be infected or possibly poisonous.
“This fear has been spreading and has become quite extensive, involving my family, my children, my friends, my acquaintances, and my patients. Usually I ignore these fears, or get control over them by an effort of will. When, however, I happen to be fatigued, or worried over small things in the course of my work, or happen to be in low spirits by petty reversals of life, these fears may become aroused. Under such conditions I may become afraid, for instance, of drinking milk, because it may be tuberculous.
“This fear may spread and involve fear for my children and my patients; or again I may be afraid of eating oysters and other shell fish, because they may be infected with typhoid fever germs. I may refuse to eat mushrooms, because they may be poisonous.The other day I was actually taken sick with nausea and with disposition to vomiting after eating of otherwise good mushrooms. The fear seized on me that they all might be poisonous ‘toadstools.’ Such fears may extend to ever new reactions and to ever new associations, and are possibly the worst feature of the trouble.
“I have a fear of coming in contact with strangers, lest I get infected by them, giving me tuberculosis, influenza, scarlet fever, and so on. This mysophobia involves my children and my friends, inasmuch that I am afraid that strangers may communicate some contagious diseases. A similar fear I have in regard to animals, that they may possibly be infected with rabies, or with glanders, or with some other deadly, pathogenic micro-organism. I am afraid of mosquito bites, lest they give me malaria, or yellow fever. The fears, in the course of their extension, may become ever more intense and more insidious than the original states.
“As a child I had some bad experiences with dogs; I was attacked by dogs and badly bitten. Although this fear is no longer so intense as it was in my childhood, still I know it is present. My heart sometimes comes to a sudden standstill, when I happen to come on a strange dog. When the strange dog growls and barks, all my courage is lost, and I beat an inglorious retreat. It is only in the presence of other people that I can rise to the effort of walkingalong and apparently paying no attention to the dog. This is because I fear the opinion of others more even than I fear the growls of dogs. My social and moral fears are far greater than my purely physical fears.
“When I became older, about the age of eighteen to twenty, a new form of fear appeared, like a new sprout added to the main trunk, or possibly growing out of the main fear of disease and death, that is the fear of some vague, impending evil. The fear of some terrible accident to myself and more so to my family, or to any of the people of whom I happen to take care, is constantly present in the margin of my consciousness, or as you would put it, in my subconsciousness. Sometimes the fears leave me for a while, sometimes they are very mild, and sometimes again they flare up with an intensity that is truly alarming and uncontrollable. The energy with which those fears become insistent in consciousness, and the motor excitement to which they give rise are really extraordinary. The fear comes like a sudden flood. The energy with which those fears rise into consciousness is often overwhelming.
“Fear gets possession of me under circumstances in which my suspicions are, for some reason or other, aroused to activity, all the more so if the suspicions of possible impending evil are awakened suddenly. In other words, the fears arise with stimulations of associations of threatening danger to myself and tomy family. I am afraid that something may happen to my children; I fear that they may fall sick suddenly; I fear that some terrible accident may happen to them; I fear that they may fall down from some place, and be maimed or be killed. I fear that my children and other members of my family may be poisoned by people who are not well disposed towards them. I am afraid that they may pick up some food that was infected, or that they may be infected in school by children who happen to suffer from some infectious maladies. I am afraid that my children may be overrun by some vehicles, by automobiles, or that they may be killed in an accident, that they may be killed by a street car, or even that the house may collapse. This latter event has actually taken place when I was a child. In fact, many, if not all of those fears have actually their origin in my experience.
“As I write you these lines, memories of such events come crowding upon my mind. Are they the noxious seeds that have been planted on the soil of fear? I am afraid sometimes that even the food I and my children as well as other people eat may give rise to toxic products and thus produce disease. Often in the dead of night, I may come to see my children in order to convince myself that they have no fever, and that they are not threatened by any terrible disease. The very words ‘sickness,’ ‘disease,’ ‘not feeling well,’ ‘death,’ arouse my feeling and sometimesthrow me into a panic. I am afraid to use such words in connection with any of my children. I am afraid that the evil mentioned may actually happen.
“When a child I learned about testing and omens. If a test comes through in a certain way, it is an omen of good luck, otherwise it means bad luck. This superstitious testing and omens have remained with me, and that in spite of my liberal training and knowledge of the absurdity of such superstitions. I may test by opening the Bible at any page, or I may test by anything that might occur, according to my guesses. All of these fears I know have no meaning for me, they are senseless and absurd, but they are so rooted in my early childhood, they have been so often repeated, they have accumulated round them so much emotion of fear that they come to my mind with a force which is truly irresistible. Many of the fears have multiplied to such an extent that I cannot touch anything without rousing some slumbering fear.
“To continue with my fears; I am often afraid that the doors are not well locked, and I must try them over and over again; I go away and come back again, and try and try again, and once more. It is tiresome, but as the fear is constantly with me, and is born again and again, I cannot be satisfied, and must repeat the whole process over and over until I get tired, and give up the whole affair in sheer despair. In such cases a contrary and differentfear comes in handy. One devil banishes another. I am afraid that the gas jet is left open, and I must try it over and over, and test the jets with matches. This process of testing may go on endlessly. The fear remains and the process must begin again until it is stopped by sheer effort of will as something meaningless, automatic, and absurd. The performance must be stopped and substituted by something else.
“Colds, or attacks of influenza of the mildest character have given rise to fears of pneumonia. Pain in the abdomen, or a little intestinal distress has awakened fears of possible appendicitis, or of tumor, or intestinal obstruction. The least suspicion of blood in the stools awakens the fear of possible cancer. Vomiting or even nausea brings fears of cancer of the stomach. There is no disease from which I have not suffered.
“The same fears have naturally been extended to my children, and to all those who are under my care. The least symptom is sufficient to arouse in me fears of possible terror and horrible consequences.
“I am afraid that suits may be brought against me, or that some of my own people, patients and even employees whom I discharged, may bring legal action against me in court, or blackmail me. When I leave home, I am afraid that something terrible has happened. The fear of impending evil is always with me. The fears have invaded every part of my being.It seems as if there is no resistance in my mind to those terrible fear states.
“Perhaps it may interest you to know that, although I am quite liberal, and even regarded as irreligious, still I am afraid to express any word against God, Christ, saints, martyrs of any church and denomination, be they Christian, Mohammedan, Buddhist, or pagan. I am afraid lest they may hear me and do me harm; I fear to say a word even against the devil or Satan. I am obsessed by fears. Fears pursue me as long as I am awake, and do not leave me alone in my sleep and dreams. Fears are the curse of my life, and yet I have control of them, none but you has any suspicion of them. I go about my work in a seemingly cheerful and happy way. The fears, however, are the bane of my life, and torture me by their continued presence.
“I tried to find whether or not those fears had any relation to my wishes or to my sexual experiences. I must say that I find they bear no relation whatever to wish or sex. My mental states grow on fear, take their origin in fear, and feed on fear. Fear is the seed and the soil of all those infinite individual phobias that keep on torturing me unless opposed by a supreme effort of my will.
“Truly the Biblical curse well applies to my life.
“‘The Lord will make thy plagues wonderful, and the plagues of thy seed, even great plagues, and of long continuance, and sore sickness, and of longcontinuance. Moreover, he will bring upon thee all the diseases of Egypt, which thou wast afraid of, and they shall cleave unto thee. And every sickness and every plague, which is not written in the book of this law, them will the law bring upon thee, until thou be destroyed. Thou shalt find no ease, neither shall the sole of thy foot have rest; but the Lord shall give thee a trembling heart, and failing of eyes, and sorrow of mind. And thy life shall hang in doubt before thee, and thou shalt fear day and night and shall have none assurance of thy life. In the morning thou shalt say, Would God it were even! and at even thou shalt say, Would God it were morning! for the fear of thine heart wherewith thou shalt fear....’
“I laid bare my soul before you. I permit you to do with this document whatever you may think fit.”
“I was born of healthy parents; grand-parents were also healthy. All lived to a ripe old age, and died of natural causes. Father is still living; I was a healthy normal child with little sickness up to the age of 16. A few years prior I belonged to a gymnasium and enjoyed superb physical strength and health, though I was from childhood somewhat of a coward. I then became associated with some youngsterswho liked night life. This association influenced me to join them in their nightly escapades.
“Between overtaxing myself in my work and trying to keep up with the boys socially my system was drained. This was kept up for about five years. I was working for a dry cleaning establishment the owner of which did not appreciate my hard work. I gave ten hours a day service, but he required even more, so that I spent as many as fifteen and eighteen hours a day, and kept that up for about five years.
“It was in January, 1911, at the age of twenty while sitting in a restaurant eating my lunch, I felt a strange sensation coming over me, such as blood rushing to my head, followed by weakness, trembling, and fainting spells. I summoned up what will power I had left, shook my head in effort to brace up, and tried to finish my meal, but without success. I left the restaurant and coming outside felt the same sensation. I leaned against a building, and my knees gave way from under me until I was compelled to lie down. I made an attempt to get up, boarded a street car, and started for my father’s store which was about a mile down the street. As I stepped on the platform I felt the same spell coming over me. Some of the men standing on the back platform saw my condition, and helped me. I arrived at the store where I collapsed.
“An ambulance was called, and I was taken to thecity hospital. The interne diagnosed the case as acute indigestion. He prescribed some soda tablets, and told me to be careful with my diet. I felt relieved at what he told me, because I thought it was not so serious as I had expected. For I thought the end was near. My brother who accompanied me spoke kind and encouraging words which soothed my nerves.
“On the street car my thoughts started to go over the whole of what had occurred. I could not control myself and gave way again. When I got home I could not eat. I lay down and tried to get some sleep, but sleep was out of the question. My thoughts always wandered back to these spells, and that would bring back another spell. I took the tablets prescribed by the physician, but they did not help me any.
“The next day I tried to go to work, but could not on account of these spells. I then decided to call our family physician. He told me it was a nervous breakdown, and prescribed bromides. I kept on having these spells in spite of the bromides. I was at a loss what to do. From then on I became afraid to venture anywhere, to go to any place, for fear of these spells. My real trouble began. I was afraid to live, and afraid to die, afraid to go out, afraid to lie down, always afraid of these spells.
“I remained at home for a couple of weeks, but thespells continued. I then decided to try another doctor. This time a stomach specialist, and as might be expected he claimed my stomach was the cause of my disturbances. The news was gratifying to me. I knew that stomach troubles could be cured, and the thought helped to quiet some of the fears. I went back to work after a few weeks. The belief in the efficacy of the drug enabled me to get down town to work, but I kept on having spells, losing weight, and feeling miserable.
“I decided to try another physician. This time a nerve specialist. After examination he diagnosed the case as nervous prostration. He gave me what he called a good nerve tonic. In addition to it he used to stripe my back with red hot instruments. I was under this doctor’s care for about a year. I kept on going to work whenever I could, but the spells continued right along, at home in the night, or at work in the daytime. After a year of treatment I felt no better.
“I decided to try another nerve specialist,—his diagnosis was depletion of the nerves. He advised me to come in a couple of times a week for electric treatment. I followed instructions for a couple of months, but the spells continued just the same.
“One April day there was an electric storm. The lightning caused in me a great dread and fear. The wind broke some of the windows in our house. Ihad then the worst spell. I lost consciousness. When I awoke I was worse than ever. I was just choked up with tear of everything and everybody.
“I found I could no longer live in C., for the last bit of life was ebbing right out of me. I started on the train for Los Angeles. No one can realize the suffering I had to endure on my trip out West.
“Everybody on the train talked about accidents, wrecks, and robberies. After arriving in Los Angeles I felt somewhat relieved, but the spells kept on just the same. I consulted a great nerve specialist in Los Angeles. He claimed I had neurasthenia, and that I was much run down. His method of therapy was different from the rest. He suggested renting a cottage along the ocean front, and he would furnish a trainer whose wife was to take care of the cottage. The trainer was supposed to have some knowledge of physical culture and massage. After being in this camp for three months I saw no improvement in my condition.
“I went to another doctor who employed a different method. He would inject pig serum into my arm three times a week. After a thorough trial I found no relief.
“I then decided to try Christian Science for a while, but I had no relief from all my woe and misery. (When asked why he went to Christian Science while he was of Jewish faith, he replied that he was insuch a state of fear that had he been ordered to be a cockroach he would have tried to become one).
“I tried another nerve doctor. After a while it was the same old story. I then tried chiropractice. After three months’ trial I found out that I had to give it up, because the manipulator aggravated my condition. Towards the end I felt such pains in my back and spine that I was compelled to lie in bed for a week before I could recover enough strength to sit up. I then tried Osteopathy. I felt no better, so I had to abandon that.
“In search for health I could not stop here, so I went to another nerve specialist who after examination claimed to have discovered something different from any other physician. He discovered I had a pair of tonsils in my mouth which did not look well to him. He ordered them removed; that meant an operation under an anesthetic. Can you imagine my feeling when he told me the news? I had a terrible time in making up my mind what to do. Bad as I felt I made up my mind that I might as well die under ether as in any other way. I consented to the operation. It is needless to go into details here of what took place after the operation. Words cannot express it. All the tortures of hell would have been paradise towards what I went through after this operation.
“I have been going since from physician to physician,each one claiming that I haven’t been to the right one, and that he was the proper physician who understood my case and could cure me. No one has been able to effect a cure.”
As an example of the patient’s state of extreme fear the following instance may be given. One day he came to me, a picture of misery and depression. He told me he had suffered agonies for the last couple of days, on account of an “ingrowing hair.” It turned out that the patient overheard a conversation among his gossips, that some one died of an “ingrowing hair.” This news strongly impressed him, and aroused his fear instinct, since he discovered an “ingrowing hair” on his throat. I found his throat was wrapped around with cotton, and covered with adhesive plaster. On unwrapping the mess I found just an ordinary little pimple. I threw away the wrappings, and gave the patient a scolding, and ridiculed him for his silliness. He felt as he said in “paradise.” A competent observer will find this trait of trivial fears, characteristic, in various degrees, of every psychopathic patient.
By a series of trance states the patient was freed from his psycholeptic fear attacks; he is now in good health, and attending successfully to his business.