DIAGRAM III
DIAGRAM III
“The therapeutic use of the hypnoidal state is a somewhat complex subject, for hypnoidization maybe 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 lentthemselves 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.
“Theprinciple of reserve energyis 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, thoseforms 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 consciousnesspredominatesover 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 sleepboththe conscious and the subconscious arereducedin activity, often eveninhibitedin function. Motor consciousness isarrested; motor control is paralyzed. The personality isdisintegrated.
(III)In hypnosis the upper, controlling consciousness isdiminishedin activity, while the subconscious activities areincreasedin extensity and intensity. In hypnosis the relationship of the conscious and subconscious is interchanged,—the conscious becomes subconscious, andvice versa. The habitual type of character may become changed by suggestion, giving rise to double and multiple personality, accordingto the crystallizationof various association systems, while the habitual, critical attitude is reduced in intensity.
(IV)In the hypnoidal state both conscious andsubconscious functions areloweredin activity with no decrease in the intensity of critical attitude, and withno changeof personality.
The hypnoidal state is therefore not a light hypnosis, but rather alight 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.
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 isthe 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, butevery 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 wellas 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 anythingto 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 contributeto 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 disagreeablethings, 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 aresui 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-preservationwith 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 ofthe 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. Theegocentriccharacter 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 ChristianScience 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 largelywhat 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 thegeneral principlesgoverning 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 inmedicine, 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 treatedfor 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 andwith 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 aboutgoodness, 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.
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 morenarrowed, 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 thesimplificationof 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 eventhe 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 subservientto 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 tocarry 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 torturedby 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 isnew. 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.
The following principles may be regarded as fundamental in the development of psychopathic or nervous ills:
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.
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, andfixesit in the mind. Fixed fear systems become furtherdeveloped 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 thelatestorultimatefear experiences.
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.
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 cultivatedby 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.
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 byanger, 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 takesrefuge 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.
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 carriesrecognitionas 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 thewhyandhowof 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 followsfrom 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 termedthe 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 Psychopathologyof the Subconscious. In fact,subconscious states may also be termed Recessive States.
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 ofdissociation. 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.
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 psychopathicdisposition with its selfishness, apparent repressions, apprehension, anxiety, anguish, terror, and panic. This may also give rise to the general psychopathic character of doubt, indecision, andconflictingstates, all being determined by the underlying fear instinct.
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.
The last fear states orUltimate Fear Stateswhich 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 notcauses, butoccasions. The real causes of the psychopathic constitution are the exaggerated impulse of self-preservation and the intensified fear instinct.
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 termedDynamogenesis.
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, butit is fear that produces inhibitions. To ascribe neurosis to self-repression and to conflict is like attributing malaria or tuberculosis to air and light.
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 inthe 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.
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 emergeat 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.
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.
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 worldis 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 ratherprecarious, 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 withher 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 humansympathy. 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 wasdriven by her intense, uncontrollable impulse of self-preservation and by the instinct of fear. What especially terrorized her was the slow but sureextension 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 nursehad 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.
Thepatient was alwaysdiscontented and grumpy. Nothing could satisfy her, nothing was good enoughfor 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 herrest. 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 daintieshad 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 byparasitic egotism, thequintessence 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.