LECTURE XIVTHE PHYSIOLOGICAL MANIFESTATIONS OF EMOTION

Emotion,[196]more particularly fear, plays so large a part in the psychogenesis and symptomatology of the psychoses that it is desirable to have a clear realization of its physiological and psychological manifestations and of the disturbances of the organism which it can induce. It is not necessary for our purpose to discuss the various theories of the nature of emotion that have been propounded; we need deal only with themanifestationsof emotion and its effect upon the organism.[197]We will consider the physiological manifestations first.

When a strong emotion is awakened in consciousness there are a large number of physiological reactions, for the most part visceral, which can be noted. Some of these may be graphically recorded and measured by means of instruments of precision. These physiological reactions are numerous and have been extensively described by Féré[198]among others. The earlier work of Mosso upon the disturbancesof the respiration and vasomotor apparatus induced by sensory stimulation is well known.

More recently considerable experimental work has been done, particularly by German investigators, to determine the influence of affective states upon the circulation and respiration.

Modifications of theperipheral circulation, manifested through pallor or turgescence of the skin and measured by changes recorded by the plethismograph in the volume of the limbs; modifications of the volume of theheartand of the rhythm and force of the beats recorded by the sphygmograph, and of arterial tension measured by the sphygmomonometer are common phenomena. (Fear is more particularly accompanied by pallor, and shame by turgescence—blushing. Anger in some is manifested by pallor and in others by turgescence, and so on.) Changes in rate of the heart-beats belong to popular knowledge. It is not so well known, even to physiologists that the volume of the heart may be affected by emotion. In several series of observations made under conditions of emotional excitement upon a large number of healthy men, candidates for civil service appointments, I recorded in a high percentage not only alterations in the rate and rhythm and force of the heart-beat, but temporary dilatation of the heart lasting during the period of excitement.[199]This dilatation in somecases was sufficient to lead to insufficiency of the mitral valve and to give rise to murmurs. The examination was purposely conducted so as to induce a high degree of emotional excitement, at least in many men. In another series of observations (not published) the arterial tension was measured, and it was found, as would be expected, that an increase of tension accompanied the cardiac excitation under emotion.[200]

ecgFig. 2. J., acute katatonic stupor. b is a wave selected from theseries in which 6 is sudden call by name. The galvanometer curve (a)is slight, but the change in the pneumograph curve is notable.(Peterson and Jung.[201])

Fig. 2. J., acute katatonic stupor. b is a wave selected from theseries in which 6 is sudden call by name. The galvanometer curve (a)is slight, but the change in the pneumograph curve is notable.(Peterson and Jung.[201])

As to therespiratory apparatusthe effect of emotion in altering the rate and depth of respiration may be shown by the pneumograph; by this method the effects of slight emotion that otherwise would escape observation may be detected. Such a disturbance of respiration is shown in the tracing, Fig. 2.

That emotion will profoundly affect the respiration has of course been common knowledge from time immemorial, and has been made use of by writers of fiction and actors for dramatic effect. The same may be said of modifications of the functioning of the whole respiratory apparatus, including the nostrils and the mouth; and likewise of the decrease or increase of secretions (dryness of the mouth from fear, and “foaming” from anger). These are among the well known physiological effects of emotions.

Increase ofsweatsometimes amounting to an outpour, and alterations in the amount of the variousglandular secretions(salivary,gastric, etc.), andrigorare important phenomena.

The remarkable researches of Pawlow[202]and his co-workers in Russia on thework of the digestive glands, and those of Cannon[203]in America on themovements of the stomach and intestineshave revealedthat these functions are influenced in an astonishing degree by psychical factors.

Although it has long been known that the sight of food under certain conditions would call forth a secretion of gastric juice in a hungry dog (Bidder and Smith, 1852), and common observation has told us that emotion strongly affects the gastrointestinal functions, increasing or diminishing the secretions of saliva and gastric juice, and even producing dyspeptic disturbances and diarrhœa, it has remained for Pawlow and his co-workers to demonstrate the important part which the “appetite,” as a psychical state, plays in the process of digestion. In hungry dogs a large quantity of gastric juice, rich in ferment, is poured out when food is swallowed, and even at the sight of food, and it was proved that this outpouring was due to psychical influences. Simply teasing and tempting the animal with food cause secretions, and food associations in the environment may have the same effect. “If the dog has not eaten for a long time every movement, the going out of the room, the appearance of the attendant who ordinarily feeds the animal—in a word, every triviality—may give rise to excitation of the gastric glands.” (Pawlow, p. 73.) This first secreted juice is called “appetite juice,” and is an important factor in the complicated process of digestion. “The appetite is the first and mightiest exciter of the secretory nerves of the stomach.” (Pawlow, p. 75.) Pawlow’s results have been confirmed in man by Hornborg, Umber, Bickel, andCade and Latarjet. The mere chewing of appetizing food, for instance, is followed by a copious discharge of gastric juice, while chewing of rubber and distasteful substances has a negative result. Depressing emotions inhibit the secretion of juice (Bickel). More than this, Cannon,[204]in his very remarkable experiments on the movements of the stomach and intestines, found that in animals (cat, rabbit, dog, etc.), gastric peristalsis is stopped whenever the animal manifests signs of rage, distress, or even anxiety. “Any signs of emotional disturbance, even the restlessness and continual mewing which may be taken to indicate uneasiness and discomfort, were accompanied in the cat by total cessation of the segmentation movements of the small intestines, and of antiperistalsis in the proximal colon.” Bickel and Sasaki have confirmed in dogs these emotional effects obtained by Pawlow and Cannon.

The effect of the emotions on the digestive processes is so important from the standpoint of clinical medicine that I quote the following summary of published observations from Cannon: "Hornborg found that when the boy whom he studied chewed agreeable food a more or less active secretion of the gastric juice was started, whereas the chewing of indifferent material was without influence.

"Not only is it true that normal secretion is favored by pleasurable sensations during mastication, but also that unpleasant feelings, such as vexation and some of the major emotions, are accompanied by a failure of secretion. Thus Hornborg was unable to confirm in his patient the observation of Pawlow that mere sight of food to a hungry subject causes the flow of gastric juice. Hornborg explains the difference between his and Pawlow’s results by the difference in the reaction of the subjects to the situation. When food was shown, but withheld, Pawlow’s hungry dogs were all eagerness to secure it, and the juice at once began to flow. Hornborg’s little boy, on the contrary, became vexed when he could not eat at once, and began to cry; then no secretion appeared. Bogen also reports that his patient, a child, aged three and a half years, sometimes fell into such a passion in consequence of vain hoping for food, that the giving of the food, after calming the child, was not followed by any secretion of the gastric juice.

"The observations of Bickel and Sasaki confirm and define more precisely the inhibitory effects of violent emotion ongastric secretion. They studied these effects on a dog with an œsophageal fistula, and with a side pouch of the stomach which, according to Pawlow’s method, opened only to the exterior. If the animal was permitted to eat while the œsophageal fistula was open the food passed out through the fistula and did not go to the stomach. Bickel and Sasaki confirmed the observation ofPawlow that this sham feeding is attended by a copious flow of gastric juice, a true ‘psychic secretion,’ resulting from the pleasurable taste of the food. In a typical instance the sham feeding lasted five minutes, and the secretion continued for twenty minutes, during which time 66.7 c. c. of pure gastric juice was produced.

"On another day a cat was brought into the presence of the dog, whereupon the dog flew into a great fury. The cat was soon removed, and the dog pacified. Now the dog was again given the sham feeding for five minutes. In spite of the fact that the animal was hungry and ate eagerly, there was no secretion worthy of mention. During a period of twenty minutes, corresponding to the previous observation, only 9 c. c. of acid fluid was produced, and this was rich in mucus. It is evident that in the dog, as in the boy observed by Bogen, strong emotions can so profoundly disarrange the mechanisms of secretion that the natural nervous excitation accompanying the taking of food cannot cause the normal flow.

"On another occasion Bickel and Sasaki started gastric secretion in the dog by sham feeding, and when the flow of gastric juice had reached a certain height the dog was infuriated for five minutes by the presence of the cat. During the next fifteen minutes there appeared only a few drops of a very mucous secretion. Evidently in this instance a physiological process, started as an accompaniment of a psychic state quietly pleasurable in character,was almost entirely stopped by another psychic state violent in character.

"It is noteworthy that in both the positive and negative results of the emotional excitement illustrated in Bickel and Sasaki’s dog the effects persisted long after the removal of the exciting condition. This fact Bickel was able to confirm in a girl with œsophageal and gastric fistulas; the gastric secretion long outlasted the period of eating, although no food entered the stomach. The importance of these observations to personal economics is too obvious to require elaboration.

“Not only are the secretory activities of the stomach unfavorably affected by strong emotions; the movements of the stomach as well, and, indeed, the movements of almost the entire alimentary canal, are wholly stopped during excitement.”[205]

So you see that the proverb, “Better a dinner of herbs where love is than a stalled ox and hatred therewith,” has a physiological as well as a moral basis.

Nearly any sensory or psychical stimulus can be artificially made to excite thesecretion of salivaas determined by experimentation on animals by Pawlow.

It is probable that all theductless glands(thyroid, suprarenal, etc.), are likewise under the influence of the emotions. The suprarenal glands secrete a substance which in almost infinitesimal doses has a powerful effect upon the heart and blood vessels,increasing the force of the former and contracting the peripheral arterioles. The recent observations of Cannon and de la Paz have demonstrated in the cat that under the influence of fear or anger an increase of this substance is poured into the circulation.[206]Cannon, Shohl and Wright have also demonstrated that the glycosuria which was known to occur in animals experimented upon in the laboratory is due (in cats) to the influence of the emotions, very probably discharging through the sympathetic system on the adrenal glands and increasing their secretion.[207]The glycosuria is undoubtedly due to an increase of sugar in the blood. It is interesting to note, in this connection, that there is considerable clinical evidence that indicates that some cases of diabetes and glycosuria have an emotional origin. The same is true of disease of the thyroid gland (exophthalmic goiter).

Most of the viscera are innervated by the sympathetic system, and the visceral manifestations of emotion indicate the dominance of sympathetic impulses. “When, for example, a cat becomes frightened, the pupils dilate, the stomach and intestines are inhibited, the heart beats rapidly, the hairs of the back and tail stand erect—all signs of nervous discharge along sympathetic paths” (Cannon). Cannon and his co-workers have further made the acute suggestion that, as adrenalin itself is capableof working the effects evoked by sympathetic stimulation, “the persistence of the emotional state, after the exciting object has disappeared, can be explained” by the persistence of the adrenalin in the blood. There is reason to believe that some of the adrenal secretion set free by nervous stimulation returning in the blood stream to the glands stimulates them to further activity, and this would tend to continue the emotional effect after the emotion has subsided. “Indeed it was the lasting effect of excitement in digestive processes which suggested” to Cannon his investigations.[208]

According to Féré[209]thepupilsmay dilate under the influence of asthenic emotions and contract with sthenic emotions. However that may be, the dilatation of the pupils during states of fear may be demonstrated in animals.

exert force of which he is ordinarily incapable. Or this energy, instead of being discharged into the channels being made use of by the will, and so augmenting its effects, may be so discharged as to inhibit the will, and produce paralysis of the will and muscular action.

These muscular vasomotor and secretory changes need not surprise us, as indeed they have a biological meaning. As Sherrington[210]has pointed out, “there is a strong bond between emotion and muscular action. Emotion ‘moves’ us, hence the word itself. If developed in intensity, it impels toward vigorous movement. Every vigorous movement of the body ... involves also the less noticeable co-operation of the viscera, especially of the circulatory and respiratory [and, I would add, the secretory glands of the skin]. The extra demand made upon the muscles that move the frame involves a heightened action of the nutrient organs which supply to the muscles the material for their energy”; and also involves a heightened action of the sweat glands to maintain the thermic equilibrium. “We should expect,” Sherrington remarks, “visceral action to occur along with the muscular expression of emotion,” and we should expect, it may be added, that through this mechanism emotion should become integrated with vasomotor, secretory, and other visceral functions.

Another physiological effect of emotion ought to be mentioned, as of recent years it has been the objectof much and intensive study by numerous students and has been frequently made use of in the clinical study of mental derangements and in the study of subconscious phenomena. I refer to the so-called “psycho-galvanic reflex.” As an outcome of all the investigations which have been made by numerous students into this phenomenon, it now seems clear that there are two types of galvanic reactions, distinct from each other, which can be recognized. The one type first described by Féré[211]consists in an increase, brought about by emotion, of a galvanic current made to pass through the body from a galvanic cell. If a very sensitive galvanometer is put in circuit with the body and such a cell, a certain deviation of the needle of course may be noted varying in amplitude according to the resistance of the body. Now, if an idea associated with emotion—i.e., possessing a sufficient amount of affective tone—is made to enter the consciousness of the person experimented upon, there is observed an increased deflection of the needle, showing an increase of current under the influence of the emotion. The generally accepted interpretation of this increase is that it is due to diminished resistance of the skin (with which the electrodes are in contact) caused by an increase of the secretions of the sweat glands. A similar increase of current follows various sensory stimulations, such as the pricking of apin, loud noises, etc. It may be interesting for historical reasons to quote here Féré’s statement of his observations, as they seem to be generally overlooked. In his volume, “La Pathologie des Emotions,” in 1892, he thus sums up his earlier and later observations: "I then produce various sensory stimulations—visual (colored glasses), auditory (tuning fork), gustatory, olfactory, etc. Whereupon there results a sudden deviation of the needle of the galvanometer which, for the strongest stimulations, may travel fifteen divisions (milliampères). The same deviation may also be produced under the influence of sthenic emotions, that is to say, it is produced under all the conditions where I have previously noticed an augmentation of the size of the limbs, made evident through the plethysmograph. Absence of stimulation, on the contrary, increases the resistance; in one subject the deviation was reduced by simply closing the eyes.

“Since these facts were first described at the Biological Society I have been enabled to make more exact observations by using the process recommended by A. Vigouroux (De la résistance électriquechezchezles mélancoliques, Th. 1890, p. 17), and I have ascertained that under the influence of painful emotions or tonic emotions the electrical resistance may, in hystericals, instantaneously vary from 4,000 to 60,000 ohms.”

It will be noticed that Féré attributed the variations of the current to variations of resistance of the body induced by sensations and emotions.

The method of obtaining the psycho-galvanic reaction may be varied in many ways, the underlying principle being the same, namely, the arousing of an emotion of some kind. This may be simply through imagined ideas, or by expectant attention, sensory stimulation, suggested thoughts, verbal stimuli, etc. According to Peterson and Jung,[212]“excluding the effect of attention, we find that every stimulus accompanied by an emotion causes a rise in the electric curve, and directly in proportion to the liveliness and actuality of the emotion aroused. The galvanometer is therefore a measurer of the amount of emotional tone, and becomes a new instrument of precision in psychological research.” This last statement can hardly be said to be justified, as we have no means of measuring the “liveliness and actuality” of an emotion and, therefore, of co-relating it with a galvanic current, nor have we any grounds for assuming that the secretion of sweat (upon which the diminished resistance of the body presumably depends) is proportionate to the liveliness of the emotion, or, indeed, even that it always occurs. It is enough to say that the galvanic current is in general a means of detecting the presence of emotion.

The second type of galvanic reaction, as shown by Sidis and Kalmus,[213]does not depend upon the diminishedresistance of the body to a galvanic current passing from without through the body, but is a current originating within the body under the influence of emotion. Sidis and Kalmus concluded that “active psycho-physiological processes, sensory and emotional processes, with the exception of purely ideational ones, initiated in a living organism, bring about electromotive forces with consequent galvanometric deflections.” In a later series of experiments Sidis and Nelson[214]came to the conclusion that the origin of the electromotive force causing the galvanic deflection was in the muscles.[215]Wells and Forbes,[216]on the other hand, conclude from their own investigation that the origin of the galvanic current is to be found in the sweat gland activity and believe the muscular origin improbable. From a clinical standpoint the question is unimportant.

Sensory disturbances.On the sensory side the effect of emotions, particularly unpleasant ones, inawakening “thrills” and all sorts of sensations in different parts of the body is a matter of everyday observation.Nausea,dizziness,headache,painsof different kinds are common accompaniments. Such reactions, however, largely vary as idiosyncrasies of the individual, and are obviously not open to experimentation or measurement. Whether they should be spoken of as physiological or aberrant reactions is a matter of terminology. They are, however, of common occurrence. In pathological conditions disagreeable sensations accompanying fear, grief, disgust, and other distressing forms of emotion often play a prominent part, and as symptoms contribute to the syndromes of the psychosis. The following quaintly described case quoted by Cannon from Burton’s Anatomy of Melancholy is as good as a more modern illustration: “A gentlewoman of the same city saw a fat hog cut up; when the entrails were opened, and a noisome savour offended her nose, she much disliked, and would not longer abide; a physician in presence told her, as that hog, so was she full of filthy excrements, and aggravated the matter by some other loathsome instances, insomuch this nice gentlewoman apprehended it so deeply that she fell forthwith a vomiting; was so mightily distempered in mind and body that, with all his art and persuasion, for some months after, he could not restore her to herself again; she could not forget or remove the object out of her sight.” Cannon remarks: “Truly, here was a moving circle of causation, in which the physician himself probably playedthe part of a recurrent augmenter of the trouble. The first disgust disturbed the stomach, and the disturbance of the stomach, in turn, aroused in the mind greater disgust, and thus between them the influences continued to and fro until digestion was impaired and serious functional derangement supervened. The stomach is ‘king of the belly,’ quotes Burton, ‘for if he is affected all the rest suffer with him.’”

Such cases could be multiplied many fold from the records of every psychopathologist. I happen by chance to be interrupted while writing this page by a patient who presents herself suffering from a phobia of fainting. When this fear (possibly with other emotions) is awakened she is attacked by nausea and eructation of the gastric contents, and, if she takes food, by vomiting of the meal. (Owing to a misunderstanding of the true pathology by her physician, her stomach was washed out constantly for a period of two years without relief!)

General psychopathology.—In the light of all these well-known physiological effects of emotion it is apparent that when an idea possessing a strong emotional tone, such as fear or its variants, enters consciousness, it is accompanied by a complex of physiological reactions. In other words, fear,as a biological reactionof the organism to a stimulus, does not consist of the psychical element alone, but includes a large syndrome of physiological processes.We can, indeed, theoretically construct a schema which would represent the emotional reaction. This schema would undoubtedly vary in detail in particular cases, according to the excitability of the different visceral functions involved in different individuals and to the mixture of the emotions taking part (fear, disgust, shame, anger, etc.). As one type, for instance, of a schema, taking only the most obtrusive phenomena which do not require special technique for their detection, we would have:

Fear (or one of its variants, anxiety, apprehension, etc., or a compound emotion that includes fear).

Inhibition of thought (confusion).

Pallor of the skin.

Increased perspiration.

Cardiac palpitation.

Respiratory disturbances.

Tremor.

Muscular weakness.

Gastric and intestinal disturbances.

(Blushing or congestion of the skin would replace pallor if the fear was represented or accompanied by shame or bashfulness, etc. (self-debasement and self-consciousness),[217]or if the affective state was anger.)

On the sensory side we would have various paresthesiæ varying with the idiosyncrasies of the individual,and apparently dependent upon the paths through which the emotional energy is discharged:

“Thrills.”

Feeling of oppression in the chest.

Headache.

Nausea (with or without vomiting).

Pains, fatigue, etc.

It is of practical importance to note that attacks of powerful emotions, according to common experience, are apt to be followed by exhaustion; consequently in morbid fears fatigue is a frequent sequela.

Now, theoretically, one or more of these physiological disturbances might be so obtrusive as to be the predominant feature of the syndrome and to mask the psychical element which might then be overlooked. Gastric and intestinal disturbances, for instance, or cardiac distress, might be so marked as not to be recognized as simply manifestations of an emotion, but be mistaken for true gastric, intestinal, or heart disease. Going one step further, if a person had a frequently recurring fear, as is so common, and the physiological symptoms were obtrusively predominant, these latter would necessarily recur in attacks and, overshadowing the psychical element, might well have all the appearance (both to the subject and the observer) of true disease of the viscera.

Now, as a fact this theoretical possibility is justwhat happens. It is one of the commonest of occurrences, although it is too frequently misunderstood.[218]A person, we will say, has acquired—owing to no matter what psychogenetic factor—a recurrent fear. This fear, or, in less obtrusive form, anxiety, or apprehension, is, we will say, of disease—heart disease or insanity or fainting or cancer or epilepsy or what not. It recurs from time to time when awakened by some thought or stimulus from the environment. At once there is an outburst of physiological, i.e., functional disturbances, in the form of an “attack.” There may be violent cardiac and respiratory disease, tremor, flushing, perspiration, diarrhœa,sensory disturbances, etc., followed by more or less lasting exhaustion. On the principle of complex building, which we have discussed in a previous lecture, the various physiological reactions embraced in such a scheme as I have outlined tend to become welded into a complex (or association psycho-neurosis), and this complex of reactions in consequence recurs as a syndrome every time the fear is reëxcited. On every occasion when the anxiety recurs, a group of symptoms recurs which is made up of these physical manifestations of emotion which are peculiar to the individual case. The symptoms, unless a searching inquiry is made into their mode of onset, sequence, and associative relations, will appear a chaotic mass of unrelated phenomena; or only certain obtrusive ones, which in the mind of the patient point to disease of a particular organ, are described by him. The remainder have to be specifically sought for by the investigator. The latter, if experienced in such psycho-neuroses, can often from his knowledge of the phenomena of emotion anticipate the facts and in a large degree foretell to the patient the list of symptoms from which he suffers. By those who lack familiarity with these functional disturbances mistakes in diagnosis are frequently made. Disease of the heart, or of the stomach, or of the nervous system is frequently diagnosed when the symptoms are simply the product of emotion. Quite commonly, when the symptoms are less related to particular organs, but more conspicuously embrace vasomotor, sensory,digestive disturbances (inhibition of function), and fatigue, the syndrome is mistaken for so-calledneurasthenia.[219]Thus it happens that in recurrent morbid fears—known as the phobias or obsessions—a group of symptoms are met with which at first sight appear to be unrelated bodily disturbances, but which when analyzed are seen to be only a certain number of physiological manifestations of emotion welded into a complex. On every occasion that the fear recurs this complex is reproduced.

It now remains to study the effect of the emotions on the psychical side. This we shall do in the next lecture.

196. I use the word, not in the strict but in the popular and general sense, to include feeling, indeed all affective states, excepting where the context gives the strict meaning.

197. The James-Lange theory is disregarded here as untenable.

198. La Pathologie des Emotions, 1892.

199. Physiological Dilatation and the Mitral Sphincter as Factors in Functional and Organic Disturbances of the Heart,The American Journal of the Medical Sciences, February, 1901; also, The Occurrence and Mechanism of Physiological Heart Murmurs (Endocardial) in Healthy Individuals,The Medical Record, April 20, 1889.

200. The emotional factor is a source of possible fallacy in all observations on arterial tension and must be guarded against.

201. Frederick Peterson and C. G. Jung: Psycho-Physical Investigations with the Galvanometer and Pneumograph,Brain, Vol. XXX, July, 1907, p. 153.

202. The Work of the Digestive Glands (English Translation), London, 02.

203. For a summary of Cannon’s work, see his article, Recent Advances in the Physiology of the Digestive Organs Bearing on Medicine and Surgery,The Medical Journal of Medical Sciences, 1906, New Series, Vol. CXXXI, pp. 563-578.

204.American Journal of Medical Sciences, 1906, p. 566. See also “The Influence of Emotional States on the Functions of the Alimentary Canal,” by the same writer (ibid., April, 1909) for an interesting résumé of the subject.

205.American Journal of the Medical Sciences, April, 1909.

206. Cannon and de la Paz:American Journal of Physiology, April 1, 1911.

207. Cannon, Shohl, and Wright, Ibid., December 1, 1911.

208. These effects of adrenalin suggest that the secretion may take some part in pathological anxiety states.

209.Pathologie des Emotions, 1892.The influence of emotion on themuscular systemneed hardly be more than referred to. Tremor, twitchings, particularly of the facial muscles, and other involuntary movements, as well as modifications of the tonus of the muscles, are common effects. All sorts of disturbances occur, ranging from increase of excitability to paralysis. Everyone knows that under the influence of powerful emotion, whether of joy, anger, or fear, there is discharged an increase of energy to the muscles, sometimes of an intensity which enables an individual to

209.Pathologie des Emotions, 1892.

The influence of emotion on themuscular systemneed hardly be more than referred to. Tremor, twitchings, particularly of the facial muscles, and other involuntary movements, as well as modifications of the tonus of the muscles, are common effects. All sorts of disturbances occur, ranging from increase of excitability to paralysis. Everyone knows that under the influence of powerful emotion, whether of joy, anger, or fear, there is discharged an increase of energy to the muscles, sometimes of an intensity which enables an individual to

210. The Integrative Action of the Nervous System, p. 266.

211.Note sur les modifications de la résistance électrique sous l’influence des excitations sensorielles et des émotions,C. R. Soc. de Biologie, 1888, p. 217.

212. Psycho-Physical Investigations with the Galvanometer and Pneumograph in Normal and Insane Individuals,Brain, Vol. XXX, July, 1907.

213.Psychological Review, November, 1908, and January, 1909.

214. The Nature and Causation of the Galvanic Phenomena,Psychological Review, March, 1910,Journal of Abnormal Psychology, June-July, 1910.

215. Having demonstrated the development of electromotive force within the body, these experimenters assumed that every psycho-galvanic reaction was of this type. But plainly, their results do not contradict the phenomenon of diminished resistance of the body to an electric current brought about by emotion stimulating the sweat glands. The evidence indicates, as I have said, two types of psycho-galvanic phenomena.

216. On Certain Electrical Processes in the Human Body and Their Relation to Emotional Reactions,Archives of Psychology, March, 1911.

217. Morbid self-consciousness is commonly accompanied by fear and other emotions. Nausea, although the specific manifestation of disgust, not rarely is induced by fear.

218. A good example is that of an extreme “neurasthenic,” who had been reduced to a condition of severe inanition from inability to take a proper amount of food because of failure of digestion, nausea, and vomiting. Examined by numerous and able physicians in this country and Europe, none had been able to recognize any organic disease or the true cause of the gastric difficulty which remained a puzzle. As a therapeutic measure her stomach had been continuously and regularly washed out. Yet it was not difficult to recognize, after analyzing the symptoms and the conditions of their occurrence, that the disturbances of the gastric functions were due to complex mental factors, the chief of which, emotion, inhibited the gastric function, as in Cannon’s experiments, and indirectly or directly, induced the nausea and vomiting. The correctness of this diagnosis was recognized by the attending physician and patient. Sometimes a phobia complicates a true organic disease and produces symptoms which mimic the symptoms of the latter—heart disease, for example. In this case it is often difficult to recognize the purely phobic character of the symptoms. O. H. C. was such a case. Though there was severe valvular disease of the heart, compensation was good and there was little if any cardiac disability. The attacks of dyspnœa and other symptoms were unmistakably the physical manifestation of a phobia of the disease. The phobia had been artificially created by overcautious physicians.

219. One has only to compare routine out-patient hospital records with the actual state of patients to verify the truth of this statement. For purposes of instruction I have frequently done this before the class. The true nature of the psycho-neurosis and the irrelevancy of the routine record and diagnosis have, I believe, been commonly made manifest. Sometimes, however, of course, phobias complicate other diseases, and we have a mixed symptomatology.

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