Causation and Treatment of Psychopathic Diseases

THE CAUSATION AND TREATMENT OF PSYCHOPATHIC DISEASES

Boris Sidis, Ph.D., M.D.
Boston: R. Badger, 1916

IT is by no means a matter of chance that one patient should be a psychosomatic while another is a psychoneurotic. This is found, by a psychogenetic examination of the conscious, and especially of the subconscious mind, to depend on the character, temperament, and the whole training of the patient, as well as on the nature of the event that has aroused the slumbering fear instinct. Patients of an introspective turn of mind, with their attention directed to mental and social accomplishments, early trained in the rigid school of religion, morals, and overrefined social traditions, sensitive to any deviations from the “categorical imperatives,”—the commandments given by the divine trinity of religion, morality, and society, as taught in the nursery, the Sunday school, and the market-place,—such patients, when subjected to experiences that touch their sensibilities, setting the primitive fear instinct to work, are confirmed psychoneurotics. Patients who are not mentally introspective, but have their attentions and fears turned to their physical needs and bodily functions, such patients are naturally psychosomatics.

From our present vantage-ground we can clearly realize why certain experiences become subconscious or dissociated and “present subconsciously,” as the clinical psychopathologist is apt to put it. Fear more than any other emotion brings about the factors favorable for the production of, subconscious states, limitation of voluntary movements, limitation of the field of consciousness, monotony, and inhibition. We know what a paralyzing effect on all the functions of the body and of the mind fear has. The man stricken by the fear instinct remains immovable, and his mind is a blank. All ideas except that of the danger at hand are inhibited, and possibly under no other condition is the factor of monotony so operative. All the factors requisite for the production of subconscious states are present in their full force, and the individual falls into a subconscious state, dissociated from the rest of waking life. So greatly is fear conducive to the production of subconscious states, so powerful is the fear instinct in its paralyzing effect on the waking consciousness, that it is often used as a means of bringing about hypnosis and allied conditions.

In all creeds of the “healing” variety, the faith that makes their devotees subject to all forms of subconscious states depends in reality upon the fear instinct. In the superficial love, goodness, and optimism of the mental and Christian scientist is hidden the baneful, the noxious, power of the primitive animal fear instinct. In a superstitious person, or in a person trained in fear from early childhood, an experience conceived in fear begets dissociation, and, as such, becomes subconscious, giving rise to the various forms of recurrent mental states of psychopathic maladies, somopsychosis and psychoneurosis.

The psychognosis of a series of cases are given here, obtained in the investigation of the etiology and pathological foundation of psychopathic disturbances. In the study of these cases one should pay attention to the underlying processes and causative agencies, such as the impulse of self-preservation with its instinct of fear, correlated with the principle of variations in the expenditure of neuron energy with consequent manifestations of psychopathic fatigue, accompanied by its long and ever changing train of psychopathic symptoms. The rich kaleidoscopic display of psychopathic symptoms is essentially based on these three factors, self-preservation, fear instinct, and variations of neuron energy.

At the same time it is of the utmost importance in the study and psychognosis of psychopathic affections to follow the action of the factors which have operated in the growth and development of the psychopathic aggregate, and which have brought the latter to its present state. The principles of the evolution of psychopathic aggregates will be understood more clearly by direct observation and psychognosis of concrete clinical material. It may be well to quote here the main psychopathological principles:

It is well to keep also in mind the laws of recession and reversion, and the general tendency of the process of mental degeneration.

Male, age thirty-one. Russian. Father is nervous; mother is also nervous and suffers from severe headaches, so does his sister, who is otherwise quite well. Physical examination is negative; reflexes are normal; memory, attention, recognition, are good; no sensori-motor disturbances.

Patient suffers occasionally from severe attacks of headache accompanied by vomiting; he has depressing nightmares and cries out in his sleep. He is timid and keeps away from company, communing with himself. In his childhood patient made the round of child diseases. He is physically well, but rather slightly built. Patient is religious and has “never masturbated.” About the age of eighteen he developed contrary thoughts in regard to God; he could not pray without associating in his mind the words of the prayer with filthy words and curses. Unaccountable fears took possession of his mind. At the same time sexual desires became developed, and his mind began to associate them with all kinds of improper relations, even with his sister and with his mother. He is miserable about these ideas, and the thoughts are not only repugnant to him, but simply torture him by their very presence. Since last year the patient has become worse,—his sexual and contrary religious ideas have become more insistent.

The insistent ideas have gained such a hold on the patient that he is distracted with mental anguish, with intense pangs of conscience. He can carry on the work of cigar making with great difficulty, and when he comes back from his work, he sits all by himself and is not doing anything, avoids company and keeps on brooding. Occasionally he gets irritable, cries and claims that the “evil one” has gotten possession of his heart and conscience. He is suspicious and gets easily frightened. The mental anguish of the fear instinct and the struggle with the insistent “evil” ideas become at times so acute that the patient is like one “crazy,” yells and screams like one possessed. Occasionally he experiences the sensation of some one pulling at his clothes. When on the point of falling asleep he hears “evil” voices. At night, when on the point of waking up, he is tortured by fearful nightmares, cries and moans before he can arouse himself, or be aroused. Patient wants to leave the city, wishes to get away from himself, wants to commit suicide. What keeps him back is his intense religious belief. The insistent sexual ideas have taken such a hold on his mind that patient is afraid to remain alone with his sister and even with his mother.

In one of our conversations the patient was asked the reason why he troubled himself about the thoughts when he was fully conscious that they were but “nonsense,” he replied: “I cannot help it; my head gets depressed and heavy; I should prefer to be in hell than to have this kind of nonsense. When I have these ideas my head is dark; all looks dark. When I attend to my natural wants I think of God and associate Him with it to anger Him. When I spit, for instance, I cannot help thinking ‘I spit on God’.”

Patient has bad nightmares. He feels that something is lying on him and pressing him; he is afraid of death. He has his eyes open, but he cannot move. On falling asleep, or rather when he finds it difficult to fall asleep, he can hear voices distinctly. The voices talk to him as one man to another; he cannot remember what the voices say. He can hear the voices near the ear, not inside. When patient walks in the street “dreams come to him,” then he seems to wake up and does not remember anything. When he goes to bed he talks to himself, and is even conscious that he answers questions. When he wakes he is sometimes under the impression that the “evil one” has gotten a firm hold on him. There is some one, the evil one, who laughs and jeers at him.

When a boy of fifteen, he used to have vivid dreams, could hear steps of “spirit people” in the room. He used also to be frightened by shadows, a fear which dates far back to his early childhood. When about the age of twenty, he was tantalized by the idea of death, though not of suicide, represented to himself the angel of death very clearly, and “the fear made him feel faint.” Last summer, to counteract the sexual thoughts and excitement, he attempted (on the principle of metathesis) to revive the image of the angel of death in order to feel faint, but he did not succeed.

About six years ago patient worked on the sewing machine; one day he suddenly lost the power of movement in the legs. This paralysis lasted three days. He improved and went to his work. Two years ago patient suddenly lost the use of the right hand and right leg. It was not so much an actual paralysis as an intense pain in moving the leg and hand. He could not raise the elbow and dragged the leg. This lasted from April, 1900, to February, 1901. A year ago a young girl came to visit the family and was placed to sleep in the adjoining room. This developed an intense sexual excitement, with thoughts of sexual character. When this fear developed, the pain and paralysis ceased. One fear was substituted for the other (on the principle of metathesis). The sexual thoughts are accompanied with “burnings” which cause the patient great sufferings. These thoughts come periodically. The evil and “nonsense” thoughts are almost always present and give him no rest.

Patient feels dazed; does not know where he is, what he is doing, whether he lives at all. Everything is “like nonsense.” His hypnagogic and hypnapagogic hallucinations consist of ugly faces without hands and feet and of other grotesque visions. The insistent ideas are somewhat like “voices,”—they call him names, they laugh and jeer at his religious beliefs, at all that he regards as moral and sacred. He feels that there is another person in him that instills in his mind those evil ideas against everything that is holy. The more he fights the more that evil person confuses his thoughts with “unholy ideas,” and finally even paralyzes his body. Patient can read well “profane writings,” such as newspapers, novels, but a religious book, and especially the scriptures, awaken in him the evil one who makes him suffer untold agonies, intolerable pangs of conscience.

“I give a short account of my life so as to help you to form an idea of my condition. I hope you will pardon me for putting you to so much trouble.

“In my early childhood and youth I suffered a good deal and many times I had to go without food. When I was about fourteen, I lost two brothers, one younger and one older than myself. The younger brother, a boy of three, I used to take care of and instructed him. I loved him more than my own life. Besides, my parents were at that time in very poor circumstances. I was greatly upset and felt deprived of bodily and mental strength.

“I began at that time to learn the trade of jeweler, but as my mind was weak I could not do the work, and after ten months of great suffering I fell sick and had to give up the work altogether.

“I then obtained a position as clerk in a small store and had trouble. You can see, therefore, that up to the time of my coming to this country I have suffered greatly and still continue to suffer.

“When I was eighteen years old it suddenly occurred to me to curse the Creator. The curses were awful. Since then my personality has changed. Confusion came into my mind. Evil thoughts got hold of me. I began to substitute contrary sentences; thus, instead of ‘The earth is full of His glory,’ I substituted ‘The earth is full of his filth.' During prayer these thoughts would come to me. The most indecent, filthy thoughts would come to torment me. I would cry for hours and struggle against them, but of no avail. The more I tried to drive those thoughts from my mind, the more persistent and unholy would they become. Since then I have become depressed and melancholy. I have lost all desire for life. I feel as if I would like to go into a desert and there die. I want to live and have a quiet, undisturbed mind. I am a human being; I cannot hide myself. I have eyes and ears, but everything I see and hear is transformed into evil.

“I cannot undertake to describe all the bad thoughts that enter into my mind. If you could drive all this nonsense from my mind without weakening my love for my people or my religion, if you could bring it about that I could read the Bible without changing the thoughts into evil, and my mind should be clear of horrible fears, you would save my life. Oh! if light should dawn upon me and my mental darkness should disappear!

“I have confessed to you everything, more than I would to my father and mother.”

The condition of this case can be understood in the light of the patient’s childhood, revealed by means of various intermediary states, and by indirect inquiry of the patient’s parents and sister. The patient passed his childhood and youth in extreme poverty and misery, in the midst of social, political, and religious oppressive fears. Living from his very babyhood in misery, extreme poverty, and squalor, often enduring cold and the pangs of hunger, surrounded by disease, sufferings, pains due to starvation, affected by sickness and death of those near and dear to him, the patient, with all his natural intelligence, had been fostered in the strict religious belief of a fearful Providence. With all his needs, desires, and instincts, thwarted and mocked at by the merciless conditions of life, subconscious protests began gradually to form by principle of contrast; the protests, gathering force, finally burst forth with the crisis of adolescence. It was a protest of subconscious mental activity against a life of misery, hallowed by a religion of fear.

Out of the chaos of discordant, dissociated elements we see the formation of an ill-shaped, maimed, but defiant, subconscious, secondary personality of nihilistic tendencies,—a state through which his country and countrymen are now passing. We witness here a struggle full of anguish and agony of fear between a shattered personality and a newly-forming self out of a chaotic, disaggregated subconsciousness.

Like the demoniacal possession of the Middle Ages, it is the reading of the sacred scriptures that throws the patient into a condition of distress and of inner combat of discordant elements. The patient is not fully aware of the why and wherefore of the “pangs of his conscience,” but still he seems to have some dim suspicion of the nature of his malady, when he asks for help “without weakening my love for my people and my religion.” The patient’s condition is the agony of a mortally wounded self struggling against the merciless onslaughts of a pitiless, secondary self formed out of chaotic states of a disaggregated subconsciousness,—the struggle of a terrorized animal.

In all such cases we find the workings of the impulse of self-preservation and the fear instinct, having a disaggregating influence on the human personality.

Mr. D., a young man of twenty-five, born in Poland. As far as can be ascertained, the parents, as well as the brothers and sisters, are well. A physical examination of the patient reveals nothing abnormal. There are no sensory, no motor disturbances. He complains of severe headaches, preceded by a feeling of indisposition, depression, vertigo, and distress. During the attack there is hyperesthesia to touch, pressure, temperature, and to visual and auditory stimulations. The patient shivers and looks pale. The cold experienced during the attack is so intense that the patient has to wrap himself in many blankets, as if suffering from a malarial paroxysm.

Fears have strong possession of the patient’s mind. He is afraid to remain in a closed place in the daytime and especially at night. When he has to remain alone at night, he is in agony of fear, and cannot go to sleep. Every passer-by is regarded as a robber or murderer, and he quakes at the least noise. When walking in the house in the dark, he has the feeling as if some one were after him, and occasionally even experiences the hallucination of some one tugging at his coat. He is mortally afraid of the dead and shuns a funeral. The patient has also a fear of dogs, a cynophobia. The fear is irresistible and is as involuntary as a reflex.

An investigation by means of the hypnoidal states, brought out of the patient's subconscious life the following data:

When a child of three years, the patient lived with his family in a small village near a large forest infested with wolves. In one of the intermediary states a faint memory, rather to say a vision, struggled up,—a vision of wolves and dogs. Some one cried out: “Run, wolves are coming!” Crazed with fear, he ran into the hut and fell fainting on the floor. It turned out to be dogs instead of a pack of wolves. It is that fright in early childhood which has persisted in the subconscious mind, and, having become associated with subsequent experiences of attacks of dogs, has found expression in the patient's consciousness as an instinctive fear of dogs.

But why was the patient in such abject terror of dead people? This found its answer in the experiences and training of his early life. When a young child, the patient heard all kinds of ghost stories and tales of wandering lost souls and of spirits of dead people hovering about the churchyard and burial grounds; he heard tales of ghouls and of evil spirits, inhabiting deserted places, dwelling in the graves of sinners and the wicked. He listened to stories of haunted houses and of apparitions stalking about in the dark. His social and religious environment has been saturated with the belief in the supernatural, as is usually the case among the superstitious populations of Eastern Europe. We cannot wonder, then, that an impressionable child brought up under such conditions should stand in mortal fear of the supernatural, especially of the dead.

When the patient was about nine years old, his parents noticed some prominences on his right chest. It was suggested to them that the hand of a dead person possessed the property of blighting life and of arresting all growth, and would therefore prove a “powerful medicine” for undesirable growths. It happened that an old woman in the neighborhood died. The little boy was taken into the room where the dead body was lying, and the cold hand of the corpse was put on the child's naked chest. The little fellow fainted away in great terror. The fear of dead people became subconsciously fixed and manifested itself as an insistent fear of the dead, and, in fact, of anything connected with the dead and the world of spirits.

The patient had hardly recovered from the shock of the “dead hand” when he had to pass through a still more severe experience. A party of drunken soldiers stationed in the little town invaded his house and beat his father unmercifully, almost crippling him; they knocked down his mother, killed a little brother of his, and he himself, in the very depth of a winter night, dressed in a little shirt and coat, made his escape to a deserted barn, where he passed the whole night. He was nearly frozen when found in the morning, crouching in a corner of the barn, shivering with fear and cold.

From that time on the headaches manifested themselves in full severity, with hyperesthesia and deathlike paleness and intense cold of the body.

The early cultivation of the fear instinct resulted in a psychoneurosis with its recurrent states.

Mrs. M. M., Armenian, Aintab, age 27, medical student: married, but divorced six years ago; has child by marriage. Last March (1913) had a serious attack of diphtheria: then about eight weeks had a lapse of personality, patient does not know where she is, does not recognize her face. Suffered from insomnia, had to take bromides; has shaking spells. Worked hard as interne, worried about child, about the work, about the future. Was very religious. Afraid of insanity; dreams of her morbid condition. Used to be afraid of the dark, of robbers, afraid of her face, cannot associate it with herself, had to look at herself to make sure that she was herself. One day was looking into a mirror to make sure of herself; a sudden attack of fright, did not know of what; had various fears at the age of ten. The attacks of fear occur about two or three times a week, afraid to remain alone. Suffers from headache, nervous chills, noises in the ear.

“During the last six years great deal of fear of kidnapping of the child by his father—hard work nursing all summer and going to school and during school terms working for board and room—no vacation during all this time (six years) and great deal of anxiety during the trial of separation and divorce case.

“Present sickness: Diphtheria-first of March—days in bed--no antitoxin given, because was vaccinated for smallpox twelve days previous to attack.”

“Had two days rest at home after the discharge from hospital and went back to school. Began to have dyspnoea, palpitation, tremors of the hands and feet, pulsation of superficial vessels, headaches, buzzing and ringing in the ears, vertigo, nervous discharge which seemed to depress and crush the brain and extend over the spine, and which caused a kind of dazed feeling for a few seconds, then disappeared, terminating in a cold perspiration. These attacks came on mostly after lectures; and had one or two a day. In this condition continued school for two weeks; at the end of this period one day at the lecture had this attack, but seemed as though was not able to use the right hand, tried to write, but was not able to hold pen, tried to walk, but was too weak, it seemed as though had eight feet—was taken away from lecture room and given some heart stimulant, then put to bed. At the end of half an hour had one more of those attacks, this time it seemed as though the right side of the body was helpless, it seemed like passing away, dying, was not able to speak for two to three minutes but didn’t last, at the end of a few minutes dyspnoea grew very much worse and also dizziness;—was sure it was the last moment of life.

“After a while hands and feet were ice cold and then came a chill just like an extremely bad malarial chill. It seemed as though all the bones would break or dislocate by shaking, the chill lasted twenty-five minutes, terminating with cold perspiration and discharge of great quantities of urine; during the attack was very frightened. After this attack was in bed two weeks; had four or five more attacks similar to this one, but very mild.

“During these two weeks was not able to write or talk for any length of time, was very much depressed, was sure was not going to live, and was making preparations for death. Had a very bad headache—sometimes continuous contraction and relaxation of all the muscles for two or three minutes. Noises in the ears. Spasm of muscles of mastication and of the muscles of the right eye, and symptoms of nervous prostration. The third week grew better and went back to school.

“On my third day at school left the room to go to school, suddenly became dizzy, it seemed as though I was wrapped in a black cloud, and separated from all the world, was completely lost to my surroundings. I then became stronger and stronger, it seemed as though I went away from this world and left my body behind. I was not able to decide where I was or who I was; then this question came to my mind, “I wonder where I am.’ ‘Am I dead and is this the second life?’ ‘Was it a true fact that I have been sick and dead and this is another stage of life?’ ‘Am I in Philadelphia or somewhere else?’ ‘Is this my own home?’ ‘Are these my own hands?’ ‘Is this my own dress?’ ‘Yes, I can remember where I bought this dress and these shoes so there must be something true about me, but where is my own self? What happened to me? Something went away from me, what was it? Was it my own soul or the thing we call self or personality? Where is my room—I must try to find it.”

Intense fear of loss of surroundings and fear of loss of personality are at the basis of the symptom complex. A morbid impulse of self-preservation and the fear instinct form the pathology of the case.

Patient is physically well developed; a well known professor of physics in one of the foremost institutions in this country. He suffers from attacks of loss of personality. The attack is of a periodical character, coming on at intervals of two weeks, occasionally disappearing for a few months, then reasserting itself with renewed energy and vigor. During the attack the patient experiences a void, a panic, which is sudden in its onset, like petit mal. The trouble was diagnosed as larval or psychic epilepsy; the patient was referred to me by Dr. Morton Prince as an interesting, but puzzling case.

Patient feels that his “self” is gone. He can carry on a conversation or a lecture during the attack, so that no outsider can notice any change in him, but his self is gone, and all that he does and says, even the demonstration of a highly complex problem in integral calculus is gone through in an automatic way. The fury of the attack lasts a few moments, but to him it appears of long duration. He is “beside himself,” as he puts it. He seems to stand beside himself and watch his body, “the other fellow,” as he describes it, carry on the conversation or the lecture. “He is knocked out of his body, which carries on all those complicated mental processes.” For days after he must keep on thinking of the attack, feels scared and miserable, thinking insistently, in great agony, over his awful attack, a recurrent, psychoneurotic phrenophobia.

At first the patient could trace this attack only as far back as his seventh year. Later on, earlier experiences of childhood came to light, and then it became clear that the attack developed out of the primitive, instinctive fear of early childhood, fear of the unfamiliar, fears of the dark, of the unknown, of the mysterious, to which he had been subjected in his tender years. This state was further reinforced by the early death of his parents, it was hammered in and fixed by hard conditions of life, full of apprehension and anxiety. Life became to the child one big mysterious fear of the unknown. The fear instinct formed the pathological focus of the attack. As the patient puts it: “It is the mystical fear of the attacks which overpowers me.”

With the disintegration of the focus the symptom complex of the attacks disappeared. The patient is in excellent condition, he is doing brilliant research work in physics and chemistry.

H. T. K., twenty-five, married. Father died of Bright’s disease. Mother died of appendicitis. Only child. At age of seven walking down street with uncle, things and persons became suddenly peculiar. The attacks seem to date from that time. During the brief attack patient can keep on with his work, the senses are not affected. It seems as if life is gone, it is a sort of emotional attack. Intellectual activity goes on. At the age of thirteen began to have attacks very hard. Fixed ideas of having “narrow shoulders at seventeen.” This lasted about six months.

The attack lasts about a fraction of a second. Feeling of fear. Keeps on thinking, “what am I?”

Between attacks has the feeling of fear, does not know of what. Has been treated for years in the city hospital. Physicians regarded attacks as petit mal, and treated him for epilepsy.

September 6, 1908. Hypnoidal state: patient very quiet. Remembers that when about age of four in school was excited, and was afraid when teacher called him out.

Patient remembers distinctly walking with his uncle; electric lights shining, then all appeared queer. Was always afraid of the dark. At waterfall in New Hampshire, he was about this time riding in carriage in the daytime. Old grandmother was afraid of railroad tracks and he was worked up, suffered mentally. During the walk that he had with his uncle some such feeling came about. During the same visit had met a hermit who scared him. Remembers suddenly that a little child died there by being lost in snow storm. Saw the grave. This happened when he went up Mount Washington.

Remembers distinctly that he was much excited when he was about four. Had to imitate the teacher, did not know whether he would be able to recite. Kept on asking himself whether he could do the things. Since that time used to put himself questions whether he was able to accomplish certain acts, such as swallowing.

Once patient went to father and said, “Papa, I am afraid.” “Afraid? Of what?” asked his father. Did not know of what.

When his father sent him on a dark night to drug store, patient had the fear of loss of personality. Kept the fear to himself. Always got that feeling.

Was afraid of unreal things, fear of ghosts. Does not remember whether he had fear of darkness before age of seven.

Patient eight years when mother died; he remembers his mother’s death. He knew his mother was dead. Sat on steps the whole day while mother was in coffin; was much frightened.

Patient finds that in his spontaneous hypnoidal states after meal or when going to sleep, he can remind himself of these experiences: Went to see a play, “The Fall of Pompeii,” picture of the lava overcoming the people. This experience stands now out clear and distinct in memory. Next is seeing some tragedy; remembers father and mother cried over the fate of the heroine. After these experiences had his attacks. The experiences were frightful.

In one of his hypnoidal states patient emphasizes the feeling of something that is worrying, something that he must think of. He has this feeling every time; he must think of something awful, and then the something indefinable, unknown melts away, the fear and the crises set on.

Patient went into deep hypnoidal state with shivering, kept on shivering, could not answer questions. September 12. Has anxious feeling, begins to think of something. Has feeling of something, trying to remember, of something forgotten which gradually passes into loss of personality.

He thinks that on the average the good period lasts ten days. Has indefinite tantalizing feeling, feeling of unreality.

I put him in a deep hypnoidal state. Intense fright, shivering. Respiration became heavy, rapid, the whole body is hypoaesthetic, could not catch his breath. Sees red light. “Something is going to happen to me, I would like it should.”

Sees flickering lights, bright lights with dark spots. Suddenly memory came, long forgotten. Mother and grandmother used to give him piano lessons, went to attic, before going to bed saying his prayers, scared in the dark.

Father used to make him play alone in dark room. Patient was afraid to remain alone. This memory came to him suddenly.

September 14. Begins to feel as if he wants to induce the attack so as to be sure that it is weakened. Last night worked in laboratory, turned out lights, just as he came out had hallucination of grizzly man, who had an awful face, small in stature, all grizzly and crusty. As if he came from another planet. Fears not earthly, but supernatural things. This is a reproduction of a child fear.

Another experience (September 12): At night when going from bed to bath idea came: “Don’t go! it will be fatal!” This is another of his child fears.

September 14. Went into hypnosis, the whole body became sensitive. Respiration irregular.

Later on (after he woke up) said he remembered (though he knew before) an old man he visited in the mountains, a hermit. “That (he said) might have had to do with the hallucination of a grizzly man.”

September 17. Had attack on the fourteenth, it keeps on again and again, coming on when he gives up his work; it is like something he has to remember. Something forces him to think, ‘what am I?”

In hypnoidal state he remembers went up hill with his father; was very small; had same feeling of fear of loss of self. Does not remember whether it was night or day.

Since the hallucination of the old man patient is afraid to remain alone in the laboratory.

He knows he was very sensitive as a child, much frightened when he saw the waterfall. The waterfall looked awful; patient was scared, “hair standing on end.” Walked up a great flight and looked down (idea came suddenly). Patient was appalled, it looked supernatural. His father was nervous, and he was excited when he saw his father.

Dates the frequent oncoming of his attacks to time when he and his wife were in Berlin; he and she played tennis, suddenly she fell down, she had hallucination of her lost brother. Patient became frightened and had many attacks since.

September 19. Feels miserable; has attacks quite often; feels as if he was in a strange country; may have five to ten of fear attacks in an hour.

Hypnoidal state induced by pressure on carotids. After a few minutes, memory emerged. Walking in back alley; was frightened; memory is vague. Back of the house was high fence; thinks he had his first attack near that fence, someone might have chased him. Did not know it before. This experience flashed upon his mind, cannot get the details. Some boys chased him, drove him to climb fence, frightened, had attack. Sees pictures distinctly.

Remembers he was a little fellow, then heard something strike the floor, thought lost a bone; was frightened; sink over his head, must have been about five.

September 21. Patient had attack of short duration. Hypnoidal state, by pressure on carotids; felt calm, but soon told me he had an attack, “saw himself beside himself.” Attack of short duration.

Patient was in hypnoidal state. Suddenly told me “that back yard keeps on coming,” “can see myself in the back yard, blind alley, something bad; afraid, does not know of what, I can see it clearly.”

Thinks that the New Hampshire experience and the “Fall of Pompeii” laid the foundation of his attacks but bicycle ride experience was much stronger. This attack came like from a clear sky; attack passed off as soon as he came home. Bicycle ride took place about ninth year. Patient had been riding to South Framington; had been riding the whole day; was afraid his father would worry; would look for him at the police station. Then he was afraid to go away far. The attack came on, then repeated itself a few times. That was after the uncle experience.

Patient thinks that this uncle experience was because patient was away from home at night. It was raining, saw row of lights, things appeared to him queer, dizziness. Anything brilliant, anything strange will affect him that way. Coney Island, St. Louis Exposition brought attacks.

New Hampshire experience was about the time the patient went to kindergarten. He was in grammar school about seven years old. Patient has letter which he wrote after New Hampshire experience. He clearly remembers the experience of the ride and of his fright; nothing stands out so sharp in his life.

“It is like one nagging,” he must think of something, does not know what; loss of feeling of reality. From October to February, patient is getting fewer attacks, but occasionally gets a prolonged one, with short ones following.

November 8, 1908. In hypnoidal state suddenly came to him that when he was about four, thought about not being able to read in school (kindergarten). Greatly affected. Ran home, something happened. Thinks first attack happened then.

In hypnoidal state, it suddenly appeared to him that he was told that about the age of four he was buried alive; does not remember it though; but it occurred to him now. Added that this might be connected with the fact that the worst thing with him is the feeling of being smothered alive.

Patient has attacks when in the dark (going to station) or in light (when playing piano.) Solitude may bring this on. When interested in problems, enthusiastic in work, when reserve energy comes out, attacks disappear.

Thinks that under given circumstances can induce an attack. When eight to nine years, going down the street (dark), strong light in front used to induce attacks. Thinks first “what am I,” then gets the attack of lapse of personality.

Hypnoidal state, attack set on with hallucinations of being in the White Mountains. “I think I was brought up to be introspective, to look at myself from the outside, selfish.”

Attacks of loss of personality occur in his sleep. The personality attacks appear in dreams.

When he says his prayers he is predisposed to have attacks; at any rate he is apt to get into trouble.

If he is in one of the moods and says his prayers then he gets an attack. Gets his fear when in intermediate states, especially on waking up.

December 24, 1908. Patient has some vague attack-dreams in sleep. Wards off attacks during the day.

The attacks or lapses started at a very early age, due to intense fear on the part of the patient; the earliest one definitely in mind is that which occurred when walking at night down a street with long rows of lights. Another early one was in New Hampshire (age eight) and again at the “Pompeii performance” (age ten). All of these were promptly forgotten as soon as over and the following day was lived with no thought of them. Even when (age ten and a half) the attacks came regularly from night to night when sent out alone in the dark on errands. Immediately upon returning home the experience was forgotten and the following day was lived, as if nothing happened.

When at the age of thirteen the attacks came on once more (in school yard), they made a deep impression. The patient deliberately brooded over them at that time and would spend hours alone, buried in the mystery of them, for to him they were unusual, disconnected with anything else in his career and consequently seemed essentially mysterious. The question, “What am I?” seemed to be the central idea and the attack itself seemed more or less secondary. The patient used to insist, when questioned by physicians, that he asked himself the philosophical question, “What am I?” and then afterwards experienced the attack. It was a positive relief later to be convinced that the attack “really came,” that is, that it was an emotional state and not the result of a mental trouble. In short, the whole matter was bound up in mystery in the mind of the patient; the question, “What am I?” indicating that he felt that his personality was involved in some mysterious manner.

This brooding mystery has been the fuel which subsequently has fed these attacks. Similar ones, naturally of most varied character, among various children, are extremely common, but are usually completely lost and forgotten as the child grows older, and in this case they would have died out naturally for want of attention had not this mysterious feeling and attitude concerning them caused them to be kept constantly in mind.

The influence upon the patient of the sense of the mysterious in connection with this trouble is of the greatest significance. This sense of the mysterious is shown to be a deep-rooted part of his make-up, in his attitude toward many other more or less commonplace subjects, notably his general fear of the dark. It is this sense of the mystery, surrounding these attacks that has made it possible for them to assume so much importance in his mind and consequently to develop. In his early life the attacks were relegated to the mysterious and the hours of brooding and thought, which he spent concerning them, were executed in a state of great emotion, particularly of fear, due to the apparent mystery of the whole affair. Each subsequent attack immediately aroused this associated, mystical fear which became the habitual after-effect of every attack. Gradually the fearful, uncertain state of mind became more stable and stronger than the attack proper, because it persisted over long intervals of time and was a cause of great anguish and depression. With proper comprehensive treatment this great mass of associated fears which the attack arouses should no longer continue and consequently its main source of annoyance should be removed.

The attack comes in a very trifling manner, often by some little twist of thought under just the proper external conditions. Without the after effect of fear, which can only come when the patient's mind regards the whole matter as being dark and mysterious, they would gradually dwindle away and disappear.

Lately, the patient, while being tolerably free from attacks proper, experiences more the direct sensation of fear without any apparent definite cause. This is the outcome of the long continued habit of being fearful which has been developed as a result of the brooding and consideration of the mysterious attacks.

It is still the mystical fear concerning these attacks which overpowers him. The attack is a momentary intense fear, perpetuated from child experiences, such as was aroused in him when out alone at night in the dark on errands. The patient retains consciousness and memory. The attack itself is of brief duration, and if it were not for the after-effects, would be comparatively easy. As a child, the experience was one of true, natural, instinctive fear, causing a disturbance in the form of the present attacks, which, owing to later conditions, was never outgrown or forgotten. Instead, it has actually been cultivated by deliberate brooding, and by thoughts analagous to “What am I?”

The attacks are short in duration. It is only the fear of them and the after anxiety which is terrible. This could not exist, if the attacks were deprived of their mystery. The terrible pang that comes with them or when thinking of them sometimes is a “panic” of fear. Many daily experiences in the patient's life show his subconscious suggestibility. This helps him to understand that the sudden attacks, when in strange surroundings, are due to his early experiences. This condition of worrying has persisted for so long a time that it has become a fixed habit and has gathered with it a tremendous amount of momentum. Lately the attacks come infrequently, but the remembrance or idea of them which comes frequently, arouses the patient to a state of mental anguish. This is because during all the past years, this attack has been associated with the fearful and the mysterious, and now each time it flashes across his mind, it brings those associations with it in the form of a vague fear.

“The earliest recollections¹ I have of nervous troubles are in connection with being sent to kindergarten school at the age of four. I am told that I disliked to go to school and persistently fought against it, often running away from the school. I now confided much in my parents and do not remember that I told them the following, but it probably was responsible for my dislike of school. I used to be called upon by the teacher to read aloud before the class, consisting of my little playmates. This I did with terrible dread, for I was extremely self-conscious and was nearly overcome with the thought ‘Suppose I should not be able to speak and read how terrible it would be before all the children.’ This led me to think ‘How do I speak?’ which thought troubled me greatly, and at times almost interfered with my speaking.

“I was buried in a snow-bank about this time (age four years) and rescued by a little playmate in an almost smothered condition. I have absolutely no recollection of this event, but remember having heard it spoken of a few years after it happened by my rescuer while we were both very small boys. I have corroborated this by speaking of it to the same person, now a young man about thirty years of age. All through my life I have entertained a most morbid dread of stifling or choking or smothering. At one time (age twelve) I used to ask myself, ‘How do I swallow,’ until I nearly choked at meals. At another time (age twenty) I called a physician in the night fearing I was smothering, when I had in reality only a cold. A little bromide gave me immediate relief.

“There were certain streets and places near my home which always seemed gloomy and depressing, although for no definite reason. (Age four to eight.) During this period (six to eight) I was taken to the White Mountains with my mother, father, and grandmother. My father was quick-tempered, high strung, nervous, and intellectual. I was always striving to please him and hiding from him everything which would disquiet him. He was much excited about the change of trains on going to New Hampshire and I suffered mentally the whole responsibility of the trip of caring for my mother and grandmother. My grandmother was mortally afraid of train crossings of which there were plenty, and I suffered for her all the time without saying a word. Finally on one of our trips to a deep waterfall gorge in the mountains, while walking along between the great rock cliffs, I was overcome with a most queer sensation. I felt disconnected from myself—my personality was unreal—I had an attack similar to my later ones which frightened and disturbed me. This repeated itself at least once again during the trip; I worried and thought about it some, but still I never told anybody of it.

“Either shortly before or shortly after the N. H. trip I experienced a series of similar attacks while out walking one night with my uncle. I remember the long row of lamps on the street, and how strange and frightened I felt, but I said nothing about it.

“These early attacks were forgotten the next day and left no particular ill effects.

“My grandmother cared for me for the most part and used to hear me say my prayers each night upon going to bed. I can remember nothing unpleasant about her nor her method of training me, although it might well be that the following characteristics of later life are due to her religious influence. I never miss saying prayers upon retiring and often have a mild attack at the time. This used to be true at the age of thirteen to fourteen more than nowadays. Sometimes perverse notions such as, ‘Suppose in my prayer I should curse, etc.,’ often disturb me. Neither of these has been a great source of trouble to me.

I have always had a great fear of the supernatural when left alone. I am never afraid of robbers when alone at home or animals when alone in the woods, but am mortally afraid of the sudden appearance of some mysterious unknown, or of someone departed, as for instance the ghost of one of my parents. This was always so and is so today, perhaps because I was very much alive to the situation at the time of my mother’s death (age eight) and of my father's death (age eleven). This also never disturbed me seriously, although it is most persistent and characteristic.

“One early event (age seven or eight) is very clear in my memory. I was at the theatre with my mother and father to see the terrible tragedy of Soudan. I remember the terrible death struggle of the leading lady. This together with the apparent unreality of the whole situation within the theatre—the crowd, the lights, etc., caused me to have a definite attack, which however, like the other early ones was promptly forgotten.

“Considerably later (age ten) I had the same experience when witnessing the Fall of Pompeii at night in an open air theatre. I seemed appalled by the unnatural artificiality of the situation—the lights, the crowd, the dreamlikeness of the play, all made me subtly question my own reality; and the result was an attack.

“In later years I have at times been suddenly thrown into an attack by looking into a moving picture machine, by witnessing moving pictures at the theatre or by the great display at a place like the St. Louis World’s Fair. A strange, crowded city street often does the same. Recently I had the same tendency, but I can usually avoid the strenuous attack, because I realize what it is, and am not thrown into a panic of fear at the first slight effect.

“The year before my father's death (age eleven) I had a number of attacks. He used to send me to the store alone at night, and invariably at a certain hill, as I looked down upon the lighted square below, I had an attack. I was terribly frightened to go out alone. These were probably the first systematic attacks. Again, when far from home on a bicycle ride, and often on the way back to the city from the beach with him, I had attacks. I used to be sent upstairs alone at night to practice on the piano for an hour. I was afraid to be alone, and was tired. The light seemed too bright, at times, almost as if it shone into my head through holes. I would suddenly stand up from the piano stool in the midst of an attack.

“None of these left after-effects the next day, nor did I tell anyone about them.

“One day I returned home from playing all morning, and was waiting with my father for dinner. I had no attack, but a terrible anxiety or fear hung on me. For the first time I confided in him saying, ‘I am afraid.’ This was promptly forgotten like the rest. I was a vigorous, active boy, unusually bright at school, and advanced for my age. This was not interfered with by my attacks, although I recall many occasions when I seemed strange and greatly depressed. When I was at the age of eleven, my father died and I was left with a guardian whose family felt little sympathy for me. I had occasional attacks of small consequence until I was thirteen years of age.

“At this age, one day in the bright sunshine, while entering the school yard, I had an extremely severe attack. I yielded to this and returned home, having several other attacks on the way. For days I could not relieve my mind of the matter. In some way I got hold of the question, ‘What am I’ in connection with the sensation of the attack. My guardian laughed at my plight, and I would lie alone in my room for hours, brooding and thinking about the attack and ‘what am I’ Physicians were visited who neither understood my condition nor interested themselves particularly in me. I used to say, ‘I think “what am I,” and then I don’t know what I am and have an attack.’ I used to answer after much reasoning that I am just what is asking the question, ‘What am I’ and desiring an answer to it and feeling so badly. This answer relieved me temporarily. In this way I went on for months having almost daily attacks at intervals. I finally persuaded myself that this was a real attack. The attacks came, too numerous to tell. Dr. T. gave me bottle after bottle of bromide. This severe condition lasted about six months (age thirteen). Often at the dinner table which was brightly lighted from overhead and at which I was an insignificant unit among a very large family, I would disturb the meal by rising from my place in the midst of an attack. I received no sympathy, and would return to my room to brood.

“During the summer months I went to a seaside resort with the family and improved somewhat. Upon returning I entered high school for the first time. At the first exercise I was obliged to leave the room, because of an attack. That was the last attack for three years. For some reason I was absolutely free from them during the next two years at high school and the following first year at business. I was fascinated with my work, making scholarship records, winning prizes, etc., and I practically forgot that I ever had an attack.

“After a year in business (age seventeen) the. old trouble came on again, at first in a peculiar form. I had grown very rapidly and I was very tall and lean. I got the idea that my shoulders were too narrow and the idea tormented me. I would look on every possible occasion to see my image in mirrors, in store windows, and I asked everybody's opinion. I would convince myself that I was all right, which would satisfy me for an hour or so, and then I would circle through the same old chain of thoughts and worries about my shoulders again and again. I soon began to have attacks of the old type which displaced the shoulder affair. This continued off and on for a year. Then I left the business world to enter the Institute of Technology. (Age, eighteen.)

“Again I had a long period of well-being which lasted for four years. I was absorbed in and enthusiastic about my work and ambitious to win scholarships. I had during this time a few isolated attacks, as for instance, upon visiting Coney Island for the first time, but in general I enjoyed vigorous health until near the end of the fourth year. At that time I had a severe pressure on the top of my head, probably from overwork during the preceding years. Towards the very end I had one or two attacks, but they were light and left no after effects.

“Immediately upon graduation I left Boston for San Francisco to accept a position as a teacher. On the way west I stopped over at Philadelphia, Washington, St. Louis Exposition, etc., and at each place had terrible attacks. As soon as I was located in San Francisco I was free from them again for nearly a year.

“Toward the close of the San Francisco year, which had been an exceptionally busy and hard one, I began to get attacks regularly in the evening, and in particular situations. I had been well for so long that I paid but little attention to them. I was then sent to Germany for two years by the M. I. Technology for advanced study. I sailed with my wife and Dr. C., for what should have been the best years of my life, but they were spoiled by continued attacks and depressions.

“I couldn’t go out to walk at night in Berlin without an attack. The same was true at Zurich. In the mountains during vacations it was the same. A week of peace and then two weeks of depression, worry, and attacks. I brooded over my condition and grew steadily worse. I consulted Dr. Von Monakow and just before returning home, Dr. P. Janet. These were my twenty-fourth and twenty-fifth years.

“I was given electrical treatments, baths, diets, etc., but to no avail. The idea, ‘what am I’ no longer concerned me, but the attack was so strange, so unusual, so uncorrelated, so mysterious, and so terrifying, and fearful! I could get no satisfactory idea about what it was or what caused it. Consequently, the after effects of an attack were prolonged for days by brooding and fear concerning them. I was simply waiting for them to stop in the same mysterious manner in which they apparently had come.

“One day in France I fairly shrieked with the pangs of fear with which I was seized without apparent cause. “I returned to Boston (age twenty-five). For a few months after my return I was somewhat better under the stress of new conditions. But I soon fell back into the same rut. The steady depression and worry between attacks were wearing upon me.

“After visiting several physicians, with very little if any benefit, I visited Dr. Sidis. He threw an entirely new light upon the whole affair. It has taken three years (age twenty-five to twenty-eight) of persistent work with me to break my old habits of mind concerning myself and the attacks. By completely changing my attitude toward myself, my condition and my attacks, by furnishing me with a new point of view, Dr. Sidis has caused the trouble to be robbed of its terrors, and the attacks to dwindle away.

“From my point of view the main steps along the road of improvement with Dr. Sidis were as follows:

“It was a revelation to me to be told when I first described an attack by saying that my ‘personality was gone’ that I ‘lost myself,’ that that was meaningless except for a state of unconsciousness, that it was only a panic of fear which overcame me and which paralyzed my sense of reality or familiarity for a very brief interval. ‘Granted a second modification of personality—what of it? What a small fraction of one’s day after all, if only the after-worry be suppressed.’ That was an extremely new idea and a powerful tool for me. It robbed the attack of most of its mystery, for it was now merely a temporarily modified ‘me’ in a state of peculiar fear, and not a mysteriously lost ‘me’. ‘I was there all the time.’ ‘Only a very small part of the great complex of personality is affected during an attack,’ was a powerful sentence for me.

“I soon wanted to know the cause of these sudden onrushes of fear which came without apparent cause. Might not Dr. Sidis be mistaken? Might they not be due to something organic about which it was best not to inform me? I think nothing but months of consistently repeated answers to my torrent of questions could have persuaded me about these points. Had I been able just once to get the upper hand of the argument, all would have been lost.

The critical answers were—(1) It can't be organic or how could the event of the attacks depend as they do upon exterior surroundings. (2) The fear is due to a series of events in early childhood, which events were traced down in the hypnoidal state and by long periods of reflection on my part. It seems reasonable and probable, since the personality of a child is not very rigid and depends largely upon familiar surroundings for its normality, that the peculiar manifestation (the attack) might at first be entirely due to fear. I still remembered continued events such as the night errands with accompanying attacks immediately forgotten upon return home which assured me of this point. It is easier to understand repetitions, if the first ones are explained.

“The first attacks, then, are the result of childish fear. The sensation was so unique that it seemed mysterious. It was like a taste of another world. So long as it seemed mysterious it was brooded over, deemed all-important and exaggerated, until it occupied the whole mental horizon. As soon as it was robbed of its mystery and regarded as a brief acute fear state which manifested itself acutely, because of having begun in an undeveloped personality of a child, it was robbed of its sting of terror.

“Another important point which I have lately begun to appreciate is as follows: Since these attacks were for so many years associated with ideas of mystery and enormous importance, the slightest trace of one arouses a flood of emotion. These emotions are anxieties and fears, and are due to their frequency of repetition, they now come with tremendous momentum. Sometimes the anxieties and fears come without the attacks. The temptation is to start thinking about my condition, revolving in my mind much of my history in connection with the attacks. It seems as if there must be something more behind which could be thought out, and which would satisfy me, if I could only grasp it. If I yield to this temptation, I soon have a cloud hanging over me which persists for days during which I am subject to attacks. The mere remembrance of my previous condition which often strikes me with great force after a period of well-being, as when one suddenly remembers something of importance which has been forgotten, is enough to start me off, if I yield to the temptation.

“The point is not to yield to that critical moment. Put it off for a few minutes. Then the flood of emotions has passed away, the matter is considered reasonably and calmly, and its importance is gone. It doesn’t seem worth considering then. Dr. Sidis has made this possible.

“Sometimes the thought that, although I have practically all my life been subject to these attacks, yet they have not interfered with my career, which has been an unusually full and busy one, satisfies me that they cannot be so all-important and worthy of much attention. This reflection has at times a soothing effect, and often is just sufficient to enable me to keep from meddling with the affair until I work myself into a state of depression.

“It is important to understand that the severity of an attack, the determining factors as to whether it ‘takes hold’ to cause its terrible wake of after effects or not, is largely what I put into it at the time of its recurrence. Like most phenomena, these attacks always have an immediate and a remote cause. In the beginning the immediate cause was fear induced by unfamiliar surroundings, darkness, etc., inducing a fear which in an undeveloped personality of a child gave rise to a sensation of disconnected or lost self. The fundamental cause which made this possible was my fearful, anxious, mystical temperament, due to my manner of bringing up. This is illustrated by the case of a very young child first hearing thunder. Whether or not it will leave vague fears of that apparently terrifying and mysterious sound for ever after, depends largely upon the attitude of those older persons present when it is first experienced.

“This temperament is like the fuel or gun powder, while the immediate cause is like the spark, in the case of an explosion.

“Later on (age thirteen-seventeen) the same immediate cause, i.e. darkness, etc., would not induce an attack. Peculiar special surroundings or subtle suggestions, certain trains of thought or effects of light (reminded [?] me of the early attacks) and induced new ones. These induced attacks might be consciously self-induced, consciously externally induced, or subconsciously induced. Most of them were the latter, and came suddenly. During this period, however, the attack visited a different personality. It seemed strange and mysterious, causing the thought, ‘What am I’ This the simple mind of a child could not add to the brief attack proper, and it soon was forgotten. Now, however, (age thirteen-seventeen) these new thoughts and attendant fearful emotions were habitually indulged in after an attack, and they made a different attack of it. At one interval it seemed that the thought, ‘What am I,’ preceded and caused each attack (age thirteen).

“Recently (27-8) the immediate cause of an attack, when it is not purely subconscious, is subtle effects of light, the confusion of a crowded street, etc. This causes a peculiar sensation to be experienced which, when not understood, is very frightening, that of changed connection between mind and body, as if the body were operating without the control of the mind, in short, a change in personality. The effect is now upon a very different personality from that of old. It is the same picture on a different background. The attack visits a new, older, more experienced and stabler personality. This present personality realizes the history of its development and that of the attack, and of its habits of fear and fright, due to its attitude of mystery toward the attacks. Consequently, it now does not regard the attacks as fearful or mystical. The result is that the sting and the after effect are gone and the attack seems unimportant. It is no longer a fundamental question of ‘What am I’, bound in feverish, mystical anxiety, but an explained panic of fear, overwhelming only for a fraction of a second, due to childish experiences and habit.

“The whole matter may be summed up in three words Fear, mystery, and importance. Natural instinctive fear starting in childhood was the early origin of the attack about which, as time passed, a network of mystery was woven. While mystical and not understood, the effect seemed all important and was given a tremendous amount of attention of the vague, anxious, fearing, emotional kind, which further cultivated the attacks.

“The attack proper has always been quite uniform in its nature, but it has been surrounded through twenty years off and on of practice with great quantities of moss. This moss varied in kind and quantity, and is the real source of trouble. So oft repeated has the attack and its after effects of worry, etc., been, that this worrying tendency has acquired tremendous momentum.

“The important cause of suffering has not been the brief attack itself, but it has been the after effect of fear and worry. It has been the attitude of my personality toward this brief acute sensation which has built a fortification of mystery about it, so that it has become more oft repeated and apparently more intense. More and more possibilities of suggesting or inducing an attack were on hand the more I brooded about it and the more strange things I connected it with in my thoughts.

“While young and with a simple mind, I saw nothing special in the attacks and they were readily forgotten. As my mind developed I regarded them in ever so many new ways, and particularly from the view-point of the fearful and the mystical. This aroused new emotions, and the study and worry were repeated and repeated, always resulting in fresh depressions and attacks, because no satisfying conclusions were reached. The more this continued, the more important the attack seemed, and the more channels to suggest the sensation were opened to me.

“Only recently, with a clear conviction that the first cause was fear, that the chief fuel had been mystery and my own attitude, has their importance waned, and with this the whole matter is gradually losing itself in the stream of now apparently more important matters.”

The history of this case written by the patient from his own present standpoint needs no further interpretation. For, as the patient clearly realizes it,—fear and mystery are at the basis of his trouble, as, in fact, they are at the basis of all psychopathic maladies.

Patient is a young man of twenty-seven years. His parents, though slightly neurotic, have reached a good old age. Patient is physically well. Since early childhood, as far back as the age of eight, he has suffered from intense melancholic depression, often reaching a state of agony. He is obsessed by the fear of having committed the unpardonable sin. He thinks he is damned to suffer tortures in hell for all eternity. He keeps on testing any chance combinations, and if his guesses turn out correct, he is wrought up to a pitch of excitement and panic. For it is to him a communication coming from an unseen world by unknown mysterious powers. Diagnosed as “paranoidal dementia praecox,” the patient was committed to an insane asylum, from which he was subsequently released.

“The omen testing,” he writes in his account to me, “had a monstrous growth. The tests have been concerned with the letters in my reading, with people walking on the street, with carriages and automobiles, fire alarms, sounds of all kinds, the sound of the voice and of birds, hymns in church, the weather, the arrangement of letters in conversation, etc. The general principle has been the same throughout, which is briefly this: If the normal course of events is interfered with in a special way that I arbitrarily arrange in my mind before the happening, I infer, or rather fear, that it is a signal from some extraneous intelligence. As to a signal of what, that also is arbitrarily arranged beforehand. For instance, I considered it was not the normal course of events to be able to predict on what day of the week several people would arrive at the hotel, and still I predicted it. I feared either that I had a supernatural power of prediction or that the people themselves were in some supernatural way forced to fall in with the day I predicted.”

The attack proper comes in pulses of brief duration followed by long periods of brooding, depression, and worry. The primitive fear of danger and death, and the sense of the mysterious, cultivated by his religious training, reached an extraordinary degree of development.

Among the earliest memories that have come up in the hypnoidal state was the memory of a Sunday-school teacher who cultivated in the patient, then but five years of age, those virulent religious germs which, grown on the soil of the primitive instinctive fear and the highly developed sense of the unknown and the mysterious, have brought forth those poisonous fruits which now form the curse of his life.

Another paragraph from the patient's account: “It is difficult to place the beginning of my abnormal fear. It certainly originated from doctrines of hell which I heard in early childhood, particularly from a rather ignorant elderly woman who taught Sunday-school. My early religious thought was chiefly concerned with the direful eternity of torture that might be awaiting me, if I was not good enough to be saved.

“a. To sum up briefly an account of the fear which is the bane of my life. The most general way to express that fear is to say, it is a fear of some dreadful calamity happening to my conscious self after death. That is to say, a fear that my present suffering will continue or something worse, perhaps infinitely worse, will come. This feeling is always very closely allied to the early theological doctrine of hell.

“b. The intellectual processes leading up to this fear are two: first, that I may deserve this punishment at the hands of justice, on account of failure to attain the moral standard which is required of everybody who knows enough; second, that I am receiving communications from discarnate intelligence, confirming this fear.

“c. Taking first the idea of moral failure, it seems to me that God, justice, or whatever you choose to call it, requires from every individual who is intelligent enough, a certain standard of goodness or morality, failing which the individual suffers corresponding to the magnitude of failure. I believe that I have failed to reach this standard to a very great degree and am so continuing, for I am constantly neglecting the duties around me which other people have the moral courage to do.

“d. Taking up the second point, that of spiritual communication, I must admit that the general principle seems fundamentally irrational, and yet many highly intelligent men of modern times admit the possibility of communication with the spirits of the dead. My difficulty in this respect is that the results I get from testing, while not intrinsically impossible or miraculous, are such that it is difficult for me to explain them by chance or anything else other than outside intelligent design.”

I give here some of my clinical notes of the case: When young, patient used to think of eternity; got it from the “old teacher.” Wondered that things should have no beginning and no end. Connected it with hell, in that maze early fear began. The patient thinks that the idea of “endless” was at that time his great trouble.

Had dream: catching dogfish, fish horrible, snake-like; men ridiculing him. Snake and dog—horrible experience which patient undergoes. (Patient has fear of dogs, his mother too has it.) Snake-serpent-devil, damnation-feeling, devil is damned, he is the devil.

Testing in dreams is rare. The testing of respiration in conversation does not enter into dreams. Guessing in odd or even numbers may come up. Memorizes letters, odd and even letters, and tests them whether odd or even, beginning of sentence or middle of sentence or fifth letter. Sense of depression in dreams expresses itself in the form of damnation.

In the church, if the 40th letter is t, it is confirmatory, so it was, the 20th s, the 12th o—confirmatory. From church took hymn-book—the 70th will be d—found word “diadem.”

In conversation with me, while I talked to him about his state of fear of damnation and testing, he kept on testing the letters of my conversation, “whether the fifth letter of my words will be a certain letter?”

Told me of a superstitious fear that when parents went away they will not return, not that they will meet with an accident, but that they will simply disappear. It was not a natural fear, but a superstition. Then if such a thing should happen it would be a sign of “divine wrath.” The fixed fear was tenacious. If parents went away with other people the feeling was not so intense, because they (the parents) could be traced naturally. It is only the mysterious that appealed. In school looked out of the window to see carriages, maybe parents disappear. When left alone, “solitude,” or with stranger, something terrible may happen. (Compare other cases.) Kept up this fear until twenty. When very young, parents went away, left him with servant, cried very much. Went to sleep. When they returned, he woke, but he thought he was dreaming, not real. Was about six years old. The fear instinct developed. Damnation was torturing in “fire,” all alone in solitude and away from parents (natural childish fear). Hell is to be all alone in a dark place. Had fear of walking in a dark room without having helping hand or some object—was afraid he may go on so to eternity. Even the year before, when in “Wonderland,” had to go through dark tombs, fear had been resurrected.

The fear became occasionally exacerbated by the different forms of testing. Then employed dates and letters as a test. The date is even or odd.

Dreamt I was in his dream, spring was coming, birds would come singing, patient testing their song on expiration and inspiration. I told him something, could not remember at first what, “was worried about testing, I explained him the insight of it.” It was some actual physical disturbance, superstition, strange. There was a feeling of oppression—the same as waking depression.

Between eight and fifteen liked excitement, but then the excitement made him think he is diabolical.

Dreamt he was in a boat with religious people discussing about God, resurrection, and damnation; saw figures computing the time between now and resurrection; the people were Universalists. The Sunday school teacher used to dwell on the length of time to resurrection, a day being a thousand years.

I said “I shall subject all that to test to see whether it is true or false.” Came across a phrase relief to him: the present fears are realized. Always sees the same phrase, sees it always the same day in the week. This must surely have “a meaning”, keeps a diary. Found that the phrases occurred on Tuesday. Still the probability is one in seven. Then continued testing in other ways. He kept playing the chance-game. Could not attribute results to mere chance. Now he keeps on testing nearly all the time in relation to the condemnation. Came down to odd and even, got so that he must follow it up.

Before he conceived the idea of blaspheming against the Holy Ghost he used to go over in his mind that he was not good during the day, making decisions of being better next day. The people around him used Biblical testing. There was an atmosphere of religious and other superstitions in the place. Mother superstitious. Mother used the Bible, opening it to test the outcome of events, especially when in trouble. Even last summer mother showed him verse which just came by opening the Bible; the verse was very favorable. Bible stories hammered into his head. When rain, was afraid of flood.

When about the age of nine, a fear, a horror used to come over him, it was intense, awful. This came on suddenly, more real than usual, so intense that it could not last, reaction; this occurred before testing was systematized at Harvard (1902, age twenty). Was very depressed; then the phrase “worst fear true,” then in reading the worst came which is unusual. Seemed significant—origin of testing, felt at the same time that the testing was “absurd and even dangerous.” Depression partly ascribed by patient to homesickness, and keeping away from people and friends, loneliness in a crowd. Did not take an interest in his work. The fear became overwhelming, when passing a sand heap each unit meant a year of damnation; when near a hot radiator thought of the “fire of hell.” Any depression emphasized the fear of “damnation.” Had to use resisting power to the dominant idea. Anything of a depressing character hardly diverted his attention from the “fear.” Now the “testing” shows that he is in a constant state of doubt and indecision.

About four years ago when tired and depressed a fearful feeling of unreality came over him.

Often dreams of seeing dead people, because of experience of being buried alive, also connected with his ideas of sin and damnation.

Testing as to whether he could suffer vicarious suffering when about the age of sixteen. “Sacrifice myself for others.”

Dreamt about a funeral (has frequent dreams of funerals). Thinks it was due to the incident he remembers distinctly of the funeral of his grandmother, but does not remember his grandmother herself. Says his dreams are mixed up with death and funerals. The hymn was: “Is my name written there?” which had to do with patient’s testing.

The place of fear of the grandmother where he was at the funeral, that place was a “huge hole.” This probably helped the formation of fear of funerals, also dreams of burials and resurrections.

Had a dream about salvation. Evidently the subconscious still retains the prejudices. Also dreamt of the death of a friend of his. The dream-experience is of the supernatural. He thinks that there is an experience which he has forgotten, which may account for the whole thing. Thinks he had something of the terrible in it, had great mental “terror.” He reminded himself that when about six years he had fearful “shaking,” terrors on awakening. Used to call them “shaking spells,” his folks used to call it the same way.

Begins to dream about testing in sleep. Being aboard on ship, listening to bells.

Dreams much of death. Dreamt of the death of a friend of his who died just about the time when patient was in bad condition. Dreamt that he was to be buried, and still was alive. The whole patient’s life hinges on death (experiences of life after death). Something flashed in his mind: “The world burnt up! People lie in the ground a long time before resurrection.” His whole childish system is built on life after death, salvation, damnation.

Feels strain in the presence of strangers, thinks lacks vitality. The knowledge of the history of his case not sufficient, must allay fears by other considerations. Tells me he does not feel any more, as if he is a lost soul.

Dreamt of death of aunt, looked into casket, body alive, moved, felt anxiety, when woke up had words “B. M.” name of his old early Sunday school teacher who influenced him strongly in his religious life.

The details of the “dream death” keep on varying. Had experience of funerals, saw one brought out through window, because the door was too narrow.

The “test dream” which he has besides the “funeral dream” is more depressing than the “funeral dream,” because the first deals with himself, the second with others, and yet both are connected with his general fear of damnation.

I have to discuss with him on “sin,” “suffering,” “adjustment to life,” and other metaphysical and theological subjects. Alphabet is expressed to him in number. Has attacks when the testing comes.

Has dreams of false recognition, saw friends whom he recognized in dream having known them, turned out he had never seen those faces.

Feels well after a series of relapses; but dreams about Waverly and does testing, wakes up with relief. Begins to experience enthusiasm about his work.

After a couple of years of persistent treatment by means of the hypnoidal state and methods of association and disintegration of the active subconscious systems, the patient recovered. He entered a well-known medical school and took a high rank among the medical students.

“I propose here to put down, as far as memory serves me, a detailed account of my early impressions which resulted later in a very troublesome mental condition. My recollections of this early period are rather hazy. As I remember it, the first person to present religious themes to my mind was an ignorant woman who lived about one hundred yards from the home where I was born and brought up. She was a middle-aged or elderly housewife who had a crudely religious turn of mind. She used to hold family prayer meetings where prayers were said and hymns sung. This woman was a great smoker of a blackened clay pipe. It was principally through her grandchildren that I became acquainted with her. In her efforts to bring her grandchildren up in the straight and narrow way she quite naturally sought to include their young friends of whom I was one.

“According to my memory, the very first time that this woman, or anybody else, broached religious subjects to me was one morning when I was in her house. I will relate the exact incident as my somewhat foggy memory recalls it. I had gone into her house, for what reason I have no idea. She asked me if I supposed I should always go on living just as I was. I suppose I said ‘yes.’ She said ‘no,’ and then went on to tell me of death. Had she stopped at that, it would have not been so bad, but she went on to tell me all about the rising from the dead and the frightful judgment which followed. The good went to heaven, of course, but the wicked (as I remember it ‘wicked’ was a favorite word of hers) were burned up. Of course, painful fire and brimstone were to be visited on the ‘wicked.’ From what I know of the woman’s character, I have no doubt she added to the grewsome tale many a hair-raising detail, but I do not definitely remember much of these. I do remember one thing plainly; she said those who went to heaven would not be able to take their money or their goods with them. My old schoolhouse was directly opposite this woman’s house and I have a dim recollection of being in the playground of the school very soon after my conversation about the future life and still thinking over the situation. It is hard for me to say how old I was at this time, but I should estimate five years.

“I suppose the woman's doctrine was perpetuated, if not amplified by the grandchildren and other proselytes who received it at the same time that I did. My brother in particular, who was four years older than I, I think was impressed by the current religious doctrine and he naturally might have thought it his bounden duty to instruct me.

“Another source from which I imbibed of a similar decoction of ideas is my early Sunday school. The influences which I came under were undoubtedly more generally intelligent, but the theological doctrine was, I think, not cheerful to a child’s mind.

My Sunday school days do not leave a pleasant flavor in my mind. I have a Bible that was presented to me, for committing to memory the Ten Commandments, by the Sunday school teacher. I was just eight years old at the time this Bible was given. I know this positively by the inscription in the front. I think, however, my Sunday school career had preceded this by some years. Through this period my idea of religion was a nightmare to be kept in the background as far as possible. The whole purpose of life was to escape hell at the end.

“I cannot be sure of what I am about to say, but it is my impression that so far as I broached to my family my ideas of the dreadful doctrine, they did not attempt to rid my mind of it. I was naturally rather secretive with my thoughts and they had no means of knowing the damage that was being done. They probably took it as an evidence of early piety, and thought it was more or less healthy.

“Another source from which I imbibed some ‘orthodox’ doctrine was that of revival and evangelical meetings which were sometimes held in the hall over my father’s store and other places. There was in particular one woman evangelist who used to come around occasionally, preaching the immediate ending of the world and the day of judgment. I think she sometimes had the exact date figured. While my family ridiculed this woman, and had but little sympathy with the other evangelistic seances, still I was more or less impressed with the possibility of there being some truth in the matter. With so dreadful a thing as hell in the balance, any possibility at all was enough to make one take notice. I remember that one day this woman evangelist (she was a Seventh-day Adventist) undertook to prove to my father in my presence the date on which the world would end. She took certain numbers from the Bible and apparently made certain combinations, the result of which proved conclusively that the day of judgment was at hand.

“In all my early religious experiences it was always the doctrine of hell that stuck in my ears. Everything else was so insignificant that it made little impression in comparison. I am inclined to believe that this fear was gradually stamped on my mind. I do not think it was due to any single impression or impressions. First came the old woman’s doctrine, the woman who smoked the pipe, this was confirmed probably by her grand-children and other playmates who had received the same ideas from her or others of her stamp, then my home and Sunday school teaching, and last of all the revival meetings.

“One abnormal trait of my childhood was the undue fear and emotion which the absence of my family caused. Unless the entire family was involved, the emotion was very much reduced, if not altogether done away. The fear was that some terrible accident could happen to them, and that I should be left alone. In this emotion a certain sense of mystery was required, generally, to have a strong effect. If I knew just where my family were and whom they were with, this emotion was greatly reduced. I think the most exciting thought was one of disappearance rather than of accident, a vague notion that once my folks were out of reach, even for an hour or less, they might in some mysterious way disappear and I would be unable to find them or trace them. As I have said, if one member of the family (there were three altogether, father, mother, and brother) was still with me, then the excitement was very much lessened, though there was still an abnormal concern lest something should happen to the absent one or ones. However, then I should not be left a lonely survivor. And again the emotion was much less if some acquaintance was with them in their absence, for then they could be traced. In this way the idea of mysterious disappearance was more or less disabled, for mysterious disappearance did not apply to anybody but my father, mother, and brother.

“Naturally, other things being equal, these emotions concerned themselves more strongly with my parents than my brother. I have spent many hours of anxiety in the country school where we lived worrying, lest I should find the house empty when I got home from school. Of course, frequently my folks would be out, then the immediate task was to locate, if possible, where they had gone, by examining the wheel tracks out from the stable, asking neighbors, etc. To know where they had gone, even, was a gain. This abnormal habit of mind was very persistent. It gave me no little trouble when I was in the ‘teens, and to this day it will sometimes crop out as an emotional anachronism.

“For a time in childhood I had the obsession that I could not swallow beefsteak. If I chewed potato, however, at the same time with the steak, I had no difficulty. If I went out to visit with my parents and steak was served, unless potatoes were promptly served along with it, there might be trouble at the table. For a period in childhood and again for another period at about twelve or thirteen years, I had a morbid fear of poison, a fear carried to fantastically absurd lengths.

“At the age of eleven or before, I began to be troubled, for the first time, with a perfectly definite religious fear. Hitherto my religious fears had been general. At the time I began to fear that I had committed what the Bible speaks of as the unpardonable sin or blasphemy against the Holy Ghost. I had actually made some remark about God which I afterwards feared might be blasphemy. Here was a definite reason why I should be damned. All other sins could be forgiven, but never this. At this time I think I was eleven and a half years old. My mental disturbance at this time was great. This particular idea persisted for a long time, but now other ideas began to crowd in thick and fast even before this one disappeared, all leading up to the same ultimate fear, damnation.

“There were many different theories formed as to why I was in danger of damnation between the age of eleven and sixteen. A playmate of my early life had died of a somewhat mysterious disease. I used to tease her, and now I feared that in some way I might have caused her death and was a murderer. In my morbid fear of poison I had subjected other people to frightful risks of being poisoned to death. My early sexual imaginings perhaps had been a deadly sin. The ideas in connection with poison were very troublesome in this connection. I did not suppose I had actually poisoned anybody, but since poison was on my clothes, hands, and possessions, I was constantly subjecting the people around me to great danger, and I did not have moral courage enough to warn them of this danger, because I had a sort of idea the poison theory was foolish. Still this lack of courage to warn them was a source of untold anxiety, lest on account of it I should be doomed. I, of course, knew the danger of poison and could and did avoid it, but to endanger the lives of poor unsuspecting people was a hideous crime. I cannot remember all the theories that entered my mind leading to the fear of hell. They were manifold. When I was sixteen the foremost one was a fear that my faith was not sufficient for salvation.

“This fear of lack of saving faith very soon gave place to a general idea which proved to be permanent. The idea was this: that if I was called upon for an exercise of great self-sacrifice for some very great necessary purpose, my moral courage, or perhaps physical courage is the better term, would prove so far below the required standard that in consequence I should be condemned. Whether the occasion for a display of sacrifice arose or not, I felt that the weakness was present. I argued that as a rotten rope is just as weak whether it is ever pulled or not, it did not matter whether I failed to sacrifice in a definite case or whether simply the weakness existed. I could easily think of numberless experiences at which my courage stood still and shuddered. To be sure, there was no probability, perhaps no possibility, of my being called on to choose such an experience, but suppose some enormously great cause, outside of myself, should demand such a sacrifice, some cause so infinitely greater than my bit of suffering that the two could not be compared. This fear of lack of faith and courage tortured me.

“During an attack of measles, contracted in college, my mental suffering was acute.

“Having once initiated the principle of receiving supernatural information, the means of applying this system had no bounds other than lack of ingenuity. At first the omens were not significant unless the nature of them had some apparent meaning, having to do with damnation. But after a time this property of direct significance was not necessary to make the omen valid. For instance, a few months after I had got over my attack of measles, I made the following test: I said, mentally, that if several people (designating the particular ones) of the persons who were coming to the hotel where I was living should arrive on a Tuesday, I would regard it as possibly a revelation confirming my fear. Of course, I recognized that there was not the slightest connection between the arrival of persons at the hotel and my salvation. I simply figured this method as an arbitrarily arranged means of conveying information from some spiritual individuality to my individuality, just as the dots and dashes of telegraphy, meaningless in themselves, have a purely arbitrary meaning. As a matter of fact the first two arrivals at the hotel that I had put in the test did come on Tuesdays, though I had made the test weeks before they came, not knowing anything at all about their plans beyond the simple fact that they were coming. In the case of one arrival, I had one chance in seven of getting it right by coincidence, and as I hit the first two, the chances were one in forty-nine that it might have been more chance. This caused another period of intense mental distress, but another one of my arrival tests failing, I was immensely relieved and assumed as well as I could that the other hits had been merely coincidence.

“The tremendous emotions raised by these stormy periods stamped the tendency so deeply in the brain that the deadly habit was slowly getting a firm hold on my mental life. The word ‘deadly’ is not too strong to apply to this tendency, for it has been a withering blight on other activities.

“I became afraid to go much away from home, or at least to get out of touch with home, for the fear connected with the testing had been a terrible thing even when I had been surrounded by my family and friends, what would it be if I had to meet it with only my own mental resources which were absolutely demoralized? The presence of my own people and intimate friends who tried to show me the error of my fears was a great palliative, even though they could not absolutely persuade me that I had nothing to fear.

“This habit of omen testing has had a monstrous growth, continuing into the present. As to the details of arranging the tests, without exaggeration, it would take volumes to report them, for they have been interminable and constantly changing. They have been concerned with the letters in my reading, with people walking on the street, with carriages and automobiles, fire alarms, sounds of all kinds, even the sound of the voice and of birds, hymns in church, the weather, the arrangements of letters in conversation, etc., etc. Having accepted the principle, it has been simply a matter of ingenuity to apply it to any form of activity or inactivity whatsoever, and if the variety and intricacy of this testing system is any measure of ingenuity, I have good reason to be well puffed up with conceit.

“The general principle has been the same throughout, which is, briefly, this: If the normal course of events is interfered with in the special way that I arbitrarily arrange in my mind, before the happening, I infer, or rather fear, that it is a signal from some extraneous intelligence. As to a signal of what, that also is arbitrarily arranged beforehand. For instance, I considered it was not the normal course of events for me to be able to predict on what day of the week several people would arrive at the hotel, for I feared either that I had a supernatural power of prediction or that the people themselves were in some supernatural way forced to fall in with the day I had predicted.

“This testing went on with varying intensity from the time it started at the age of about nineteen or twenty and is still continuing in one way and another. During these years my activities have been greatly hampered. I have stood in such fear that I have spent my time for the most part with my family, dreading to take any step at all that would increase my emotion. Any definite idea of starting out on a career of any kind has never even been seriously entertained. I have realized that the problem has only been dodged, not settled, by this course, but it was better to stay in the frying pan than to jump into the fire.

“After all, I date the last and present phase of my troubles from last May, just about a year ago. At the beginning of May a year ago I was in fairly good condition for me. I was not aware that my mental disorder was very different from what it had been. To be sure, I had observed that the testing had been growing more extended and troublesome, but there had been times in the past when it had been extremely troublesome.

“I will describe in detail, as well as possible, the beginning of the last stage in this miserable business. I was destroying some old letters one morning which I had had stowed away for years. They were in tied-up packages, each letter dated on the back. A strong idea of making tests on those dates suddenly took possession on my mind, so I took one of the packets of letters and predicted whether the date on the top letter would be an even or an odd number. Having hit the top number right, I continued down through the packet, and it was some little time before I made a failure, though there was apparently no natural means whatsoever by which I could foresee the dates. I had not looked over these letters in years, and there was no systematic arrangement as to dates anyhow. It might have occurred by coincidence, but the chances were large against this. This circumstance aroused a good deal of apprehension and as usual in such cases, gave the testing fresh impetus.

“I began immediately to make other tests some of which seemed to defy the laws of chance. Within a day or two I had a result in testing on the dates of some post-marks which to this day I regard as phenomenal. At this time nearly all the testing was done on things where the chances were about even of my hitting or missing, therefore it was not the individual times that the test came out as I had predicted that made the impression on my mind, it was the series which piled in succession. This odd and even testing was the result of a long evolution. At first I made tests where the chances of my getting them right by ordinary coincidence were very much smaller. There were plenty of individual failures now, but in spite of these, there were results that I could hardly reasonably attribute to chance. I got new points of view, which I had not had before, and which lead me to see in a new light how contrary to the laws of chance my testing came out. And now my testing began to branch out amazingly, and began to involve all my activities.

“It was at this time that I first went to Dr. P. He asked me if there was anything that I would like especially to do, and I told him I should like very much to go to visit some friends in New York. He said “go and come back here, if you don’t feel better.” It may appear strange that I should have wanted to go away from home at a time when my emotions were most aroused. The explanation is this: I had been visiting these same people in New York the preceding winter, and had grown to be very fond of them. They were intimate friends, so much so that they seemed more like my own family than mere friends. Therefore, I was rather going from one home to another than going away from home, and moreover, the home I was going to had apparently been better adapted to my mental state, for I had got along there better than I was now getting on at York Harbor, my permanent home.

“I did not have the courage to make even the short railway journey to New York alone, but insisted on my mother’s going along. She did so and returned in a few days, leaving me with my friends. At first the change seemed to agree with me, but only very briefly. I now went rapidly from bad to worse, and my mental suffering became really terrible. It was the same fear of supernatural suffering intensified. I was in New York nearly a month, growing worse. I was simply a mental fragment of myself. Activity was pretty much at a standstill, though sometimes after suffering the limits of agony, there would be a mental reaction and I would feel better temporarily. The whole theme of the trouble was fear-testing. New forms of this arose. At this time one of the most troublesome forms, which had its beginning then, was a test on sounds with respect to the inhalation or exhalation of my breath. If sounds, such as whistles, bells, or any other arbitrary sounds, reached my ear at that period of the respiration that I had predicted it would come at, it was ominous to me and intensified my fear. Sometimes I had almost paroxysms of fear at the times when the tests seemed to be certainly directed by some intelligence other than my own. My friends were good to me, and without the presence of some people like these or my own folks, I cannot imagine how I could have got through such a period. I say period, but it was simply the beginning of trouble.

“In June my brother came to New York and took me home. Here my sufferings continued. Still newer forms of testing arose which restricted my activity still more. All manner of work I renounced, and as for recreation, the testing and great suffering put a stop to that. Sometimes I lay in bed nearly all day, for there was nothing else I wanted to do, and furthermore, I could get away from testing better this way, for I would not have to see any printed letters, and I could muffle my ears somewhat with the bedclothes to prevent my hearing sounds to test on. It is impossible to convey to the mind of any individual the horror and agony that I experienced. To say that I was beset with extreme fear means nothing to the normal person’s mind, for the greatest fear he can clearly imagine is perhaps to be chased by a lion, to fall off Brooklyn Bridge, to lose all his property, or to lose some dear friend by death. Any of these are calamities, but to compare them with the wild terror which I felt makes them insignificant.

“This state of affairs continued till some time in July, when my consent was most reluctantly obtained to go to the McLean Hospital, at Waverly. My brother had been advised by Dr. P. that I should go to a hospital (afterwards Dr. P. said Waverly would not have been his choice). I had reached such a state of despair that the prospect of having something done for me raised a faint aura of hope that perhaps I could be relieved. Furthermore, the McLean Hospital did not present itself to my mind as being really a private insane hospital. Dr. A., who had been looking after me as well as he could during these fearful days, had told me that there were two departments at the hospital, one for insane cases, and a separate one for nervous afflictions, and that I was going to the latter. He said distinctly that there would be no confinement. Perhaps he thought he was telling the truth, but whether or no, I do not blame him, for he and my family were at their wits' end and were completely demoralized.

“Accordingly, one bright July morning I started out for Waverly. I believe it is the Lady Macbeth who says ‘So foul and fair a day I have not seen.’ That is not inappropriate here. I signed a voluntary commitment somewhat unsuspectingly. Thirty minutes after I had signed I would have given all my possessions and much more if I had not signed. My brother and one of my New York friends had accompanied me to the hospital, and on them I used what powers of argument I possessed to induce them to believe this was not the place for me, but quite naturally they took the opposite view. I spent four days there. It is useless to attempt to describe my fear agony during this period, for its intensity baffles description. Enough to say that I was thrown suddenly on my own resources, unable to read or do anything else, fearful of every whistle, the slamming of every door, made tremendously afraid by conversation, not only because it was a sound, but from the arrangement of the letters. I would walk around the circle of the yard's liberty, then lie abed as long as I could stand the agony, then walk. I doubt if I was sensible to ordinary physical pain at this time.

“The suffering was all that the crude conception of the inferno would ask for, therefore the feeling grew that it was hell and might continue. The idea of spending a lifetime there was unendurable, but in addition to that I was afraid that I should be unable to die, and live on indefinitely, get to be sixty, seventy, eighty, a hundred years old, and still not relieved by death. I doubt whether such excess of mental suffering can be experienced without leaving permanent scars in the nervous system.

“During the four days I was at the hospital I was writing letters home which were couched in the most urgent phraseology that my command of the English language permitted. I discovered through the head nurse of my ward that a voluntary patient could give notice that he would not remain, but that before his discharge his people must be communicated with, giving them the opportunity to have him legally committed. I was afraid to insist on my rights, lest I should be committed by law, in which case I knew my chances of regaining liberty would be very much reduced, for I was afraid in that case I could not be legally liberated, even with the consent of my people. By this time I had little doubt that I was insane, though this realization did not make my fears any the less real to me.

“My father, worried to death by the character of the letters I was writing, sent a physician friend of his to Boston to see, in consulting with Dr. J. P., what was best to be done in the matter. Accordingly, Dr. H. and Dr. J. P. came out to Waverly together, held a consultation with the McLean officials, and decided that I should be removed from such a place. I therefore went home with Dr. H.

“My relief of mind at getting out cannot be expressed. At the announcement I was at first suspicious that Dr. H. might be deceiving me, then I was afraid that some unlooked-for contingency would yet prevent my getting out. It was not till I was outside the bolts and bars that I felt absolutely sure of release. During this period at Waverly nearly everyone showed me consideration and kindness, particularly the head-nurse of my ward who was one of the most gentlemanly young men it has been my good fortune to meet.

“After going home my mental condition was the same as before the Waverly venture. My sufferings were terrific. At times they were so great that I would do nothing but toss and moan on the bed. Frequently after the exhaustive emotions of the day I would be pretty well worn out by bed-time, and the sleepy feeling of unconciousness creeping on was the greatest pleasure of the day. But it was a tragedy to wake up in the morning and realize that it would be fourteen or sixteen hours before I could have unconsciousness again.

“In October I may safely say that I was very much improved over the summer, but still life was hardly worth while living, and, with all my improvement, I was much harassed with my fears. At this time I came to Dr. Sidis, under whose care I have since been. With my coming to Dr. Sidis this autobiography ceases. I have tried to present an outline of my abnormal mental history, though necessarily I cannot represent it as vividly as it has been present to my mind, and, of course, numberless details have been omitted. From my point of view it is the story of a blighted life; not only that, but a recounting of suffering of the first magnitude, pain such as I believe very few individuals are ever called upon to suffer, and pain which, by reason of its abnormality, very few persons can appreciate.”

“In this case the fundamental fear-instinct intertwined with the religious sense of the mysterious, trained in early childhood, stands out clear and distinct. The process of cure was by means of the hypnoidal state and by a long, painstaking, psychotherapeutic process of dissipating the sense of the mysterious and disintegrating the complex systems, reared on the basis of the fear instinct and the morbid impulse of self-preservation.”