Causation and Treatment of Psychopathic Diseases

THE CAUSATION AND TREATMENT OF PSYCHOPATHIC DISEASES

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

THE subconscious working of the fear instinct is clearly revealed in the following psychopathic cases:

Mrs. A. Age 43. Family history is good. Patient has always been in good physical health. Married eight years ago. Has two children, both are well. Patient is possessed by an intense fear of her husband whom she suspects of some heinous crime.

The attacks come in waves, in seizures of brief duration with intense excitement, agonizing fear, palpitation of the heart, chattering of teeth, followed by a long period of depression and worry. When near her husband, she is excited and full of agonizing fear. She feels her husband must have committed something awful. “There is an insurmountable obstacle between us; what it is, I do not know.” When finally her husband confessed to her of some escapade of his youth, she was for a time quieted, but soon the fear of the mysterious sin or crime once more arose. The confession did not satisfy her. “There must be something more beyond.” This thought keeps on coming to her mind. “It turns like in a circle,” as she puts it. She herself is conscious of the predominance in her of the sense of the mysterious. “Even if my husband,” she tells me, “should confess to me the most awful of crimes I would still suspect him of worse ones. There is something mysterious. Nothing definite can satisfy me.”

A letter from the patient may best show her state of mind: “There is nothing new to tell you, it is the same old, pitiful story, only varied a little from day to day. I have no rest, not a moment’s peace of mind. I lie awake for hours at night, sometimes the whole night, and my days are full of anguish and unrest. I am not able to do anything, not even to read a newspaper. I am truly a crushed and heartbroken woman, and would almost be willing to give up the struggle were it not for the dear little children who are dependent on me. I also want to do my duty toward my husband. The question often arises in my mind: ‘What is my duty under these excruciating circumstances? Must I stay here and suffer through the long days and longer nights when there is a way of escape?’ Of course, it is my duty to stay, but I can assure you that my courage is taxed to the uttermost. I do not like to cut my husband adrift now that he needs me most, yet on the other hand when I am suffering like that I fail in all the duties of life.”

In another letter she writes: “I suffer intensely all the time and there are times when I become absolutely frantic. There are nights when my lids do not close for a moment and I walk the floor in a frenzy of excitement. I cannot endure the struggle. I would rather be dead than to go through the agony I have gone through the past three weeks. I shall undergo the most excruciating physical tortures rather than submit to this intolerable suffering.”

A few days later she writes: “My husband went away four days ago, parting with me under circumstances too sad to be expressed. Since he left me I have not been nervous or excited, but I have been lonely and broken-hearted, and in a state of almost complete collapse. Truly my situation is a strange one. I cannot live with my husband, and life seems to be worth nothing without him.”

This is a typical psychoneurotic case, the mental symptoms stand out prominent in the patient's mind, the physical troubles are scorned, nay even welcomed as a control, as a relief from the agony of fear. The patient manifests the inner struggle, the strangeness of the situation, mental dissociation, systematization of the symptom-complex round a nucleus, and periodicity or recurrence of the psychopathic states, all pathognomonic of psychoneurosis.

We may turn to the subconscious dispositions which form the genesis of psychoneurotic states. The patient had a strong religious training with a profound belief in mysterious agencies. The whole family has been Christian Scientists for years. The patient was specially imbued with the belief in one of the main dogmas of Christian Science, telepathic suggestive influences. She has faith in the transmission of evil influences, and is convinced of the telepathic powers of death-thoughts sent by wicked minds, possessed of special mental capacities. As a child she was dreamy, had a love of the mysterious, and obsessed by a highly developed fear of the unknown. She was prone to fears of an imaginative character and always had “the fear of the Lord” on her. The world was, to her imagination, peopled with spiritual powers, unseen forces, and mysterious agencies with unlimited possibilities for evil. Christian Science only made those original tendencies more pronounced and more intense.

This overwhelming mass of associations, dating far back to early childhood has, with all its momentum, become interrelated with her emotions in regard to her husband. This, of course, should be expected, since this relation was the most important in her life; her subconscious experiences and emotions, by the psychological law of assimilation, became transmitted to the mental states which stood most prominently in her consciousness. Thus did the husband get the whole brunt of the trouble. He formed the centre round which her early associations became crystallized.

This crystallization was helped by the suggestive influence of a reader of one of the Christian Science churches, a lady who was in love with the patient’s husband. This Christian Science reader wrote letters to the patient and her father, and tried in all ways, by direct and indirect suggestion, to influence the patient and the family against the unfortunate husband. No wonder that, with all her faith in the mysterious and with all her early training in the belief of supernatural agencies, the patient fell an easy prey to the suggestions of her rival.

When our patient found out that the “lady reader” was giving her “evil influences,” the feelings of the mysterious, centred around her husband, became still more emphasized by the Christian Science belief in telepathic influences and transmission of death-thoughts. The suspicions in regard to her husband became still more accentuated and more developed by the confession made by the patient's husband in an hour of trial that he had had a liaison with a lady who had borne him children. This shock at first acted, by metathesis, as a modifying control, finally resulting in the fixation of the psychoneurotic fear.

“I met my husband about four years before I married him, though our actual courtship did not extend over a period of eight or nine months, and I doubt if there was ever a more unhappy courtship. It began with an interesting correspondence which continued for about two or three months after which we met, and he told me of his love for me, and his desire to marry me. I had previously grown to care for him, and the one wish of my heart was that he would ask me to marry him, yet, when lie did disclose his affection, that very moment a strange and unaccountable thing happened to me. I experienced a sudden revulsion of feeling. I began to think there was something dark and forbidding about him, and I flew into such a nervous panic that I felt obliged to go away a few days later to recover my equilibrium. I did not promise to marry him; on the contrary, I told him that I didn’t think I could, and I meant what I said. The day after I left I received a letter from him, in which he seemed to renounce all hope of winning me for his wife. It was the saddest and almost the most beautiful letter I ever read, and it seemed to me so absolutely sincere and true, that I was completely overcome and felt that I had made the greatest possible mistake in not giving him more encouragement. I sat down at once and wrote him reassuringly, but I soon found myself unhappy, and in a state of indecision again; and this was the history of our courtship from beginning to end. I could not give him up, and if I clung to him I was still unhappy. There seemed to be a mysterious, inevitable force which bound me to him in spite of everything, and almost against my own will, or so it seemed at times. I felt that I must marry him, though I could foresee, in a vague sort of way, the perilous path ahead. The conflict was terrible and in this state of mind, I prayed with all the sincerity and deep earnestness of my being for light and guidance, and a voice within whispered ‘marry him,’ and I was thus irresistibly drawn into marriage. I decided that when we were married and settled, things would adjust themselves, and there would probably be no further trouble, so I arranged to be married as soon as convenient.

“Perhaps I should say at this juncture that, as soon as our engagement became known, there was open and bitter opposition to our marriage on the part of a certain person, with whom we had both been friendly, my husband particularly so. She did everything in her power to prevent the marriage and almost succeeded. She made such insinuating accusations against my husband, that my father felt called upon to make a journey of several thousand miles to investigate these charges. After several interviews with her, and after seeing my husband, he became convinced that she was acting from purely selfish motives, and he fully believed in the integrity of my husband. I had every confidence in my father’s judgment and believed as he did that the whole thing was a conspiracy to break up our marriage. That problem being disposed of we were quickly married, but the happiness I had hoped for did not come to me. I was in the same nervous, apprehensive state as before and even worse. I distrusted my husband and had vague suspicions of him. It seemed to me that he had done some dark and dreadful thing that he was concealing from me. Sometimes I thought that he had hypnotized me into marrying him. I believed and was encouraged by others to believe, that I was under the hypnotic control of the woman to whom I have referred, who opposed our marriage. At any rate, I had no peace of mind. Whenever I was with my husband, I kept asking him again and again, if there was not something that he was concealing from me. He said ‘no.’

“Finally, one day, he admitted that there was something and straightway told it to me. I was very much excited over this avowal, though it was nothing of a dreadful or criminal nature as I had supposed—nothing that could not be readily forgiven, and, in point of fact, I felt kindlier to my husband than ever before, because I knew that it had cost him something to make this disclosure to me, and I was not disposed to resent too deeply his tenderness in so doing. Immediately after this my health seemed to improve wonderfully, and I was confident that it was the fact of this information being withheld from me, that was the cause of all the trouble between me and my husband.

“My improvement, however, lasted only a week or ten days, at the end of which time I found myself as nervous as before. I believed that my husband had not told me all, that he was still concealing something from me, and I could not get rid of these ideas. We have been married almost nine years, and I have had three children, two of whom are living. During these nine years we have lived together very little, and have never been able to establish a home. Somehow I have clung to my husband and he to me through it all, though at times it has seemed impossible, but ‘Hope springs eternal in the human breast,’ and so great was my desire to hold my little family together, that I would return to my husband again and again, but a nervousness amounting to terror always seized me whenever I was with him, making it impossible for us to live together.

“When away from him I have been, if not happy, at least peaceful, and able to work and take care of my children. One morning about two months ago, something unusual happened. I received the news of the death of the woman to whom I have herein referred. This news came to me with startling surprise, as she was a comparatively young woman and I could not have anticipated her death. Almost immediately after that I felt a sense of freedom and noticed a change in my attitude of thought toward my husband, and when he was with me recently I felt decidedly better, though not wholly free from nervousness. The change however, has been great enough to cause me to believe that I may have been—probably have been—the victim of a long continued mental attempt to wreck my home and happiness.” The fear soon returned with renewed vigor. The patient had to come for treatment.

This account written by the patient gives an excellent insight into the workings of the psychoneurotic mind.

Mr. M., twenty-one years, Russian. The patient was referred to me for epileptiform attacks on the right side of the body. The attack is of the Jacksonian type. The spasms consisted of rhythmical movements, tonic and clonic contractures of the head, right hand and right leg. The whole right side was affected and anaesthetic. The attacks come annually, about the same time of the year and begin always at midnight. Last year (1903) the patient had four attacks. Even a few weeks after the attack it was possible to discover a difference in the sensibility of the two sides. The attack proper lasted from a few hours to a few minutes and even seconds.

The patient, as it is typical with psychosomatic cases, came for medical treatment of his physical attacks, namely his convulsions and anaesthesia. The simulation of Jacksonian epilepsy was almost perfect. As soon, however, as by means of hypnosis, we began to investigate the patient's subconscious life the whole history and origin of the disease became revealed.

A psychognostic examination of the case shows that about five years ago, when the patient was sixteen years of age, he attended a ball in his native town. After midnight he was sent out to look for a ring which he had lost on the way to the ball. The patient was very superstitious, his early training was saturated with beliefs in ghosts. It happened that on his way he had to pass a cemetery; he got frightened, it seemed to him that somebody was after him. He fell down and was picked up in an unconscious condition and brought home. It is from that time that his present attacks date. The attacks reproduce the original accident as well as the condition of fear, convulsions and anesthesia of the side on which he fell.

During the attacks he keeps on dreaming about the fright, fall, and about his illness. In short, he lives the original experience over again in his subconscious dream life. While examining him during trance, we happened to call attention to his anaesthesia. Suddenly, as if by the wand of a magician, his past personality of the accident emerged. Mr. M. went into one of his attacks, living over the same period of his life in Russia. He ceased to understand English, and was carried back to his sixteenth year. He cried out in great agony, as of one frightened to death, squirmed and twitched, and began to shake. “What happened to you?” he was asked. “I fell down,” he exclaimed in his native jargon: “I got frightened.” He then passed through the movements and shaking characteristics of the attacks. When asked where he was, he answered, “At home.” “With whom are you now?” “With my mamma.” When the attack ceased, with a shudder, he literally came to himself, his present personality returned, and to our question, “Where are you?” he promptly replied, “At the doctor’s.” Thus as in other psychosomatic cases, an investigation reveals the presence of a pathological focus of a purely psychic origin in an abnormal impulse of self-preservation, and morbid state of the fear instinct.

The following cases are of interest on account of the recurrent fear which they present.

Mrs. J. A., age thirty-eight. Married. Parents of nervous temperament. Sister is well. Patient is of Irish descent, born in United States. She had a common school education, and is not very intelligent.

A physical examination shows the patient to be poorly nourished; she experiences peculiar noises in the right ear, and when she falls asleep she occasionally hears voices. As far as she can remember this persisted since her childhood. Pupils react well to light and accommodation; patellar reflexes are greatly exaggerated. She sees spots before her eyes and has vivid visual dreams. Menstruation normal, regular, and not painful. Sensibility to touch, pressure, pain, and temperature is in good condition. She has no headaches, no tremors, no motor disturbances.

The patient was put in the hypnoidal state. It took some time to quiet her, she felt intense anxiety. At last she became soothed, and sank into a deep hypnoidal state; but, as it is characteristic of this state, it is varying in its depth from moment to moment and is unstable. The instability was specially characteristic of this patient, on account of the nature of the case. Still, even under such unfavorable conditions, the hypnoidal state yielded some definite and interesting results, revealing subconscious systems of experiences which gave an insight into the nature of the symptoms.

The patient has been a sensitive and nervous child. She liked to listen with trepidation and shivers to all kinds of stories about spirits, hobgoblins, and ghosts, and used to be in mortal fear of evil influences. Darkness threw her into great fear, because she suspected the presence of all kinds of mysterious beings and spirits, especially evil ones. She used to hear strange noises in her ears, and was afraid of them, and ascribed them to the action of evil agencies. All the dark nooks and corners, cellar, loft, and every lonely room and place were peopled by her with ghostly shapes and ghastly figures,—with demons, devils, sprites, and gnomes. In her sleep she did not fare any better, since she suffered from frightful dreams and nightmares. The patient thus passed her childhood in continuous fear of unknown and mysterious powers, surrounding her on all sides. The child lived in constant terror of things she could not give an account of; she was afraid and did not know of what. It was really a cultivated form of panophobia developed in a sensitive child. Later on the fears apparently lapsed, but really did not disappear,—the fears became subconscious. It was those dissociated, subconscious fears of something indefinite and intangible of early childhood that were manifested in the stress and worries of fully developed womanhood as an inexpressible, unaccountable fear of some impending evil; in short, as panophobia.

Mrs. A. is twenty-two years old; Russian; married. She suffers periodically from attacks of violent headaches, lasting several days. Family history is good, parents are alive, and never suffered from any physical or mental diseases. Mrs. A. is easily frightened, and has suffered from headaches and pressure on head for quite a long time, but the pain became exacerbated some five years ago, The attack is sudden, without any premonitory feelings, and lasts from eight hours to two days. The headache often sets in at night, when she is asleep, and she wakes up with frightful pain. At the time of the first attack she was very much run down. Otherwise the patient is in good condition, but complains that her memory is getting bad. Patellar reflex is exaggerated. Field of vision is normal. The eyes show slight strabismus and astigmatism, corrected by glasses, which did not in the least diminish the intensity as well as the frequency of the headaches.

Mrs. A. suffers from bad dreams and distressing nightmares, the content of which she cannot recall in her waking state. She also often has hallucinations, visions of two women wrapped in white, pointing their fingers at her and running after her. She never had any fall, nor any special worry or anxiety, never suffered from any infectious diseases. After a persistent inquiry, however, she gave an account of an accident she met with when a child of eight. Opposite her house there lived an insane woman of whom she was mortally afraid. Once when the parents happened to be away, the insane woman entered the house and caught the child in her arms and greatly frightened her. Another time she was sent out by her parents to buy something in a grocery store. It was night and very dark. She bought the things and on the way back she saw two women in white with hands stretched out running after her. She screamed from great fright and ran home.

Mrs. A. is very much afraid to remain alone, and especially in the dark. She is not so much afraid in the street as in the house. The two women appear to her now and then, and she is mortally afraid of them.

The patient was put into hypnotic state. There was marked catalepsy; the eyes were firmly closed, and she could not open them when challenged. Suggestion of general well-being was given and she was awakened. On awakening, she could not remember what had taken place in the hypnotic state.

Next day she was again put into hypnosis and went into a deeper state than the day before. She was asked whether she thought of the crazy woman occasionally, she replied in the negative. The patient spoke in a low, suppressed voice, the words coming out slowly, as if with effort and with fear. It was then insisted that she should tell one of her recent dreams. After some pause, she said: “Last night I had a bad dream; I dreamed that I stood near a window and a cat came up to the same window. I saw it was crazy. I ran away and the cat ran after me and bit me and scratched me. Then I knew that I was crazy. My friends said that there was no help for me. I dropped the baby, ran, and jumped down stairs. I remember now that when I fell asleep I saw a woman, maybe the crazy woman. I covered myself; I knew I was only afraid, and that she was not real. Six weeks ago I saw the same woman, when falling asleep or when asleep. I ran away and she ran after me and wanted to catch me.” Mrs. A. in relating these dreams, shivered all over and was afraid, as if actually living the dream-experience over again. “It was this woman who caught me in her arms and kissed me, and embraced me and did not let me go, until my screams brought friends and my father, and they took me away from her by force.”

Gradually some more dreams emerged. “I dreamed some time ago that the woman came to me and spilled hot water on me. Another time I dreamed that I was in the insane asylum; she came out, told me she was well; I was greatly frightened and ran away.” Mrs. A. then became quiet. After awhile she began to relate a series of dreams. Sometime ago she dreamed that the woman entered the room where her father was and ran up to him, evidently with the intention of hurting him. Her father ran away, and she hid herself in a closet in the next room. “I also dreamed that the woman was shadowing me in an alley. She wanted to get hold of me, while I was trying to get away from her. I turned round, and she gave me such a fierce look. It was so fierce. I ran and she could not catch me. I should die, if she catches me.” Mrs. A. shivered, “Are you afraid of her?” “Not now, she is not here. I did not dream of the woman much before, but sometime before my marriage I began to dream of her quite often. In one of my dreams out her I saw peoplee putting cold water on her, and could hear her scream. It was awful! I dreamed I went upstairs, opened the door and met her face to face. I was badly frightened, but could not run away, so I jumped out of the window, If I could only not dream about her.”

This is an extract from a letter sent to me by the patient's husband: “ . . . She had another attack, it did not last long, and it was not severe. She dreamt several times this week. I shall try to relate them as accurately as possible. She dreamt that I left the room for a while. Our baby was sleeping in the next room. All of a sudden she heard baby cry out: ‘Mamma I am afraid!’ She told the baby to come to her as she herself was afraid to leave the bed. Baby came to her. The child looked frightened, her face pale with fear, exclaiming ‘Mamma, a devil!’ As the child cried out, my wife heard a noise in ,the room, something moved close by. She became very much frightened. It seemed to her that something terrible and unknown was after her. She wanted to scream for help, but could not. A hand was stretched out after her to catch her. She woke up in great terror. Another time she dreamt that she was in a hallway, she saw a woman and became frightened. It was the same crazy woman. My wife is exceedingly nervous and in fear that something awful is going to happen to her or to the family. . . .”

A rich, subconscious dream-life of agonizing fears was thus revealed, a life of fears of which the patient was unaware in her waking state. The dreams referred to the same central nucleus, the shock and fears of her early childhood. Worries about self and family kept up and intensified the present fear states. The symptom complex, as in all other psychopathic cases, took its origin in the impulse of self-preservation with its accompanying fundamental fear instinct.

C. Age sixty-one. Italian. Family history is good. Has two children. Patient’s trouble dates back forty years. It is intermittent in character, appearing every year or every two years and lasting for a period of two weeks. The length of the attacks has gradually increased. The attack he is suffering from at present (1903, July 17) lasted for about a year and a half, and incapacitated him from carrying on his occupation as hair-dresser.

When the patient came to this country, he worked in a barber shop. He strongly objected to the occupation and had an intense dislike to the place he worked in so that even now he describes it with a shiver and speaks of it in terms of disgust as “dark, gloomy, and horrid.” Patient used to suffer then from attacks of depression which would last for several weeks. He conceived a hatred, a sort of terror of the razor which was constantly before his eyes. He could not assure himself that the razor was in proper condition, or that it was really well cleaned, and he would keep on wiping it incessantly. From this “barber period” date all sorts of insistent ideas; all kinds of forms of uncontrollable impulses gradually began to take possession of the patient’s mind. The patient specially suffered from those recurrent mental states during the attacks of depression. We can give here but a few examples of them as their number and full description would require, as a the patient put it, “big volumes.”

In one of his attacks he conceived an incense dread of “hands in his pocket.” By accident his wife chanced to put a handkerchief into the patient’s overcoat pocket; the patient was forced to give the new overcoat away and have a special overcoat made “without pockets.” Once he took a walk with his children and a stone on the way “troubled” him. “It was not in the right place. I cheated my children as I did not want them to suspect my trouble. I sent them ahead on some pretext and remained behind, removed the stone, and then was satisfied.” On another occasion a carpenter fixed the steps in his shop. Patient noticed two nails which made him feel uneasy, and finally tantalized him. He called the carpenter again and on the pretext that there were some dead rats, he had him remove the nails and the plank. He did not permit the planks with the nails to be replaced. On another occasion a hole under the sink was plugged up with paper and then cemented. The patient became restless and full of anxiety until he opened the hole again and with great difficulty took the obnoxious paper out. When the house was repaired the plumber would plug up the hole in a similar fashion and he watched him the whole day, standing close to the plumber, fearing the plumber might plug up the hole with paper. During this watch the patient was in a state of fear, and when the work was over he was exhausted from his anxious vigil.

Two years ago patient was more or less free from these insistent ideas and impulses, but the landlord took it in his head to make some alterations in the house, and since that time patient became worse, the ideas and impulses torture him constantly. “Oh my God, that landlord made those changes!” When the ideas and impulses are not carried out the patient becomes restless, feeling of anxiety grows into intolerable fear. A terror of some unknown evil possesses him. There is an increased pressure on the head and he is in agony until the impulse is carried out, then with a sigh of relief he says: “Now I am satisfied. Have you ever seen anything like it?”

The patient has a general unaccountable fear, panophobia, gets easily frightened―he is fear obsessed—nails, strings, bits of paper, pins, stones on the road and other things perturb his mind greatly, and must be removed before he can be at rest.

The patient must do things over and over again before he can assure himself that the things are all right. Folie du doute is quite pronounced in him. He must rise from bed some fifteen times and more to assure himself that the door is locked, or that the gas is turned down. The emotion of fear with the feeling of insecurity and anxiety seems to be always present and associated with his active life. He is never sure that things, however trivial, are done the right way.

The patient has a special dread of giving his address or giving his name, and he is terrorized when he is asked to write his name. When he is forced to give it, on account of business, or to his friends, he suffers agony the whole day. While taking the history, the patient was asked his name. He started as one shot. “Oh, my God! Do not ask me!” He took out an envelope from his pocket, and told me to copy his name. He watched closely, looking the paper over and over again to assure himself that the name was correctly copied. When asked for his address he was scared, ran out into the hall; the wife had to give the address.

The patient is easily thrown into a state of fear and terror; he is restless; he would every time rise from his chair and exclaim: “Oh, my God! Think what I have to suffer!” He says he cannot describe all his experiences. He wishes that some one who is a good writer should have his experience for at least thirty days, and then describe it all. The patient had no cuff-buttons on, he was afraid he would lose them; he did not want to go to the box in which the buttons were, and he could not let anyone else take them.

The patient does not complain of any other trouble; appetite is good, though his sleep is disturbed; has lost somewhat in weight recently. He is a tall, well developed man, he is somewhat pale and has a careworn expression on the face; his mind is clear. He fully realizes the absurdity of his insistent ideas and impulses and laughs at them, calls them “foolish, ridiculous.” Physical examination is negative. Knee jerks exaggerated. No clonus. Pupils react to light and accommodation. Field of vision normal.

While patient was being examined he happened to catch sight of a piece of string on the gas-jet, he started, became agitated and exclaimed: “Oh, my God! There is a string! I won't look at it,” and he turned his head away, but it was of no avail. The string seemed to have had an irresistible attraction, he looked at it and watched it from the corner of his eye. Finally, he could not stand it and began to beg for permission to cut the string. When the string was cut he felt relieved. “It is all right now,” he said, and added, “isn’t it foolish?”

Patient asked me if there was any danger of his wife catching his disease; he was assured that there was no danger, and he felt satisfied. A few minutes later he wanted to be reassured that there was no danger.

Patient saw me write his name, he examined the writing minutely to make sure that every thing was all right. He did not feel satisfied however. “Have you made the dot on the ‘i’?” “Are you sure? Let me see it again, please. Make the dots over again.” The dots had to be emphasized and made quite big so as to satisfy him. “Now it is good, all right.” He was asked to write his name; he refused to do it, and finally after long persuasion he agreed to write on his own paper. He was very particular about the dots and as soon as he finished writing, he put the paper immediately into his pocket. When asked to write his name on the paper given to him he positively refused. Said, “I will not be able to go home and will have no rest. I may do it next time.”

Patient was then asked to write 24, 42, and make an addition. He at first hesitated, but finally wrote, though with an air of extreme unwillingness. He first took out a slip of paper from his own pocket and wanted to write on it, but it was insisted that he should write on our paper. The numbers were written down and the addition correctly performed. No sooner was the operation completed then he exclaimed: “No, let me write it over, it is not well.” He tore off the paper on which it was written and put it in his pocket. He wrote the numbers again and looked at them hesitatingly. “I think those numbers ought to be a little further apart.” He was assured that it was all right, and the paper was taken away from him. His attention was distracted by some electricity which was given to him. Immediately after the treatment he began to plead that the paper on which the numbers were written be returned to him. His fear was intense. “Oh, my God, I must have the paper. I will have no rest without it.” He grasped my hand and began to kiss it, imploring me for the paper. As soon as the paper was given to him he eagerly grasped it. His expression was that of intense delight. “I am very much pleased with you,” he said, ”I like you.”

Patient was questioned about his dreams. Said that about fifteen years ago used to have many bad dreams, but he could not remember any of them. Was asked, if he ever had any dreams about nails or strings. Patient grew restless and uneasy at this question. He said that he did, but could not remember them. While patient was talking he saw a pin in a chink of the floor. He grew uneasy, took out a knife, and with some efforts succeeded in getting at the object which turned out to be a piece of wood. The patient realized fully the absurdity of his action. “Is it not foolish?” he said. “I call that ridiculous.” Patient says that if he were rich would have a house built in which no nails could be seen, or better still, with any nails.

Patient was put in hypnosis. After a few minutes of fixation, his eyes closed. Condition was that of complete relaxation. Eyes were firmly closed. When challenged to open them he could not do so. Catalepsy was readily induced. While in hypnosis he was questioned about his dreams. The result was striking. While in his waking state he could not recall a single dream, in the hypnotic condition the dreams came to the surface with great ease. He related one dream after another. Dreams of fifteen or twenty years ago came up apparently without any effort. The dreams were about people who wanted to kill him with revolvers or clubs. At other times again he dreamt that he was falling from high places. It was insisted that he should remind himself of any frights or accidents that he ever had. It was found that when fifteen years old while walking through the streets of his native town he saw from a distance a large stone and thought it was a coffin; it was during the time of the cholera, this frightened him greatly. Another fright he had was twenty years ago. He was going on a train to Rockaway. The train ahead of him got wrecked, and he saw many bodies, dead and wounded. This affected him greatly,—the fear psychosis became fixed and predominant in his emotional life.

The psychopathology of the case is a diseased impulse of self-preservation and a morbid state of the fear instinct.

Mrs. C. C., thirty-five years old; married three years. Father is of neurotic, passionate temperament; mother is nervous, seems to suffer from some kind of epileptiform attacks, and periodically from severe hemicrania. Brother and sister are well, though also nervous and excitable.

Patient is quite intelligent, but very emotional,—cries at the least provocation; her attention is easily distracted; mental processes are normal. Desultory memory for numbers and syllables is poor, but logical memory for events past and present is well preserved. There are no perceptual disturbances,—no illusions, no hallucinations. Sleep is light, and is disturbed by dreams.

Physical examination is negative; except for the fact of marked ill-nutrition and flabbiness of muscles, nothing special could be observed. Patellar reflex is exaggerated. Pupillary reaction and accommodation to light and distance are normal. Field of vision is normal. No motor disturbances. She complains of creeping sensations in the extremities, in the hands and legs, also of tingling sensations and numbness in the body and of pains in the back. An examination, however, shows that the patient’s sensitivity to all forms of stimulations is normal. At times she suffers much from pains in the back, from paraesthesia, tingling sensations, and numbness of the extremities and from paresis of the whole body. Motor imitation is marked, the patient frequently copies and imitates motor habits that specially impress her. During the course of her life patient has taken up all kinds of motor habits and twitchings, although she succeeds in arresting them. The motor automatisms are not of an insistent character.

What the patient, however, specially complains of is insistent ideas and feelings which torture her, and from which she is unable to free herself. Thus, she has an extreme abhorrence of women. Woman to the patient is impurity, filth; woman to her is the very incarnation of degradation and vice. She would not pass a woman, if she could help it. Patient tells me she would not have come up to my office had a woman been standing on the steps. She cannot pass a woman without a sense of nauseating disgust. The house-wash must not be given to a laundry where women work.

The patient’s husband corroborated the general symptoms and gave additional data. They had to break up house and remove to another one, because carriages opposite their window happened to be hitched in knots and in angles which the patient could not tolerate. Pencils, sticks, books and other objects must be put parallel to the wall and not so as to form an angle or be brought in relation with any of the angles of the room. In kissing her, the husband must be careful that the kisses should not be in a vertical position, nor form any angles, but all must be arranged in rows, parallel to the wall. When dining in a restaurant, should a gentleman and a lady happen to come near them, the table must be immediately left in the very middle of the meal.

Patient has certain formulae and phrases which she seems to regard with superstitious awe, although she is conscious of their absurdity. She insists that the husband should repeat verbatim the phrases, and if he happens to substitute another word, or phrases the terms differently, she is much disturbed; he has to help himself out with a dictionary, she is not supposed to tell him the words. When she attempts to counteract her insistent ideas and impulses, she has crises of crying and of intense depression and suffers agony.¹

Patient feels unhappy and is distressed over the misery she is in, and of the pain she causes her husband. She bewails her lot, regards herself as insane, but the ideas and impulses are irresistible and uncontrollable. Mr. C. tells me that his wife experiences horror and disgust at the touch, at the mere sight of a woman. He must be on the look out not to be in one line with a woman, even if the woman be two or three blocks away. Nothing must be picked up on the street, not even the most valuable object, perchance it might have been dropped by a woman. A woman once happened to visit his wife, who could not help herself and had to admit her female guest. The visitor was sent off by some excuse or other. Unfortunately, the woman before leaving stopped on the threshold of the house for a few moments. The house was at once washed, cleaned, scrubbed, and purified as after a pest. The husband was not permitted to enter that door for a week, until the threshold was ripped up, another new one made, and the position of the door changed. Patient has unaccountable fears; she does not know what it is she is afraid of; she is only conscious that, when she remains alone, especially in the evening, a fear suddenly seizes her.

The hypnoidal state brought out the fact that the patient, who was educated in a convent, was easily frightened and was specially afraid of the dead and of the devil. While in convent she used to have frightful dreams in which the devil played the chief part. Thus once she dreamed that the devil pinched her ear; she cried out and woke up in great fear. The nun upbraided her, because the devil could not possibly visit such a holy institution as a convent. Once the devil threw her out of bed and threw the mattress after her. The people in the convent became frightened, and the girls screamed and prayed. The priest was called for, and he asked the patient whether she had been praying for the lost souls in purgatory. On being answered in the affirmative the priest advised her not to pray any longer, because the-souls from purgatory troubled her. She stopped praying for the-lost souls and the trouble completely disappeared. It is the fear of evil agencies that keeps on persisting in the subconscious life of our patient and is now and then giving rise to indefinite fears of the unknown, panophobia. The foundation of this panophobia was laid in the patient’s tender childhood, and, although she no longer believed in evil, impure agencies, in fact even ridiculed them, still the fear did not fully lapse,—it became dissociated and subconscious.

The patient’s motor automatisms and imitativeness can be readily traced to her childhood. As a young child patient was very impressible, highly suggestible, more so than any other child of her age—she suffered then from habit-tics and from choreic-like movements and twitchings. The suggestibility of the patient's waking state is now greatly reduced, but the subconscious suggestibility is as strong as ever. She can, however, easily free herself from such subconscious motor suggestions and imitations, so that they do not trouble her much. They are but transient and soon tend to disappear.

Some twelve years ago the patient had a bad fall and hurt her spine. It is to that fall that the subjective paraesthesia in the extremities, the tingling sensations—numbness, paresis and pains in the back can be traced,—the patient passes at each attack through the original experiences of the accident of the fall.

When about the age of eighteen the patient suffered a great shock,—one of her near relatives attempted to assault her at night. This accident threw her into a series of attacks which she characterized as “hysterical attacks.” She really never got fully over it, and the incident, though apparently but faintly present in her conscious memory, has remained active in her subconscious life.

The patient’s gynophobia or hatred of women may be traced to her training received in the convent. While there she was impressed with the belief that woman is a vessel of vice and impurity. This seemed to have been impressed on her by one of the nuns who was holy and practiced self-mortification. With the onset of her periods, and with the observation of the same in the other girls, this doctrine of female impurity was all the stronger impressed on her sensitive mind. This, however, lapsed from her conscious memory and did not come to the foreground of consciousness until later in life when she was fatigued and exhausted by the strain of office work, toiling many days at a stretch. Still this dissociated, subconsciously buried prejudice of youth might have never come to the surface had not another factor favored its forthcoming and resurrected an experience that had apparently long gone from her active life. Three years ago the patient married a man somewhat younger than herself. Being of a highly sensitive mind and of a suspicious disposition, she developed an intense feeling of jealousy in regard to her husband. It was under these conditions of jealousy that the long-buried and dissociated belief in the impurity of woman came to life again.

Instead of applying it to herself, the feeling of gynophobia was applied to others. This is due to the jealousy which called forth that subconscious atavistic belief of the patient's religious youth. The magic formulae and superstitions full of fear belong to the same subconscious stratum.

Patient is a woman of forty-four, married at the age of twenty-four; nineteen years ago had salpingitis and pelvic cellulitis, for which she had all forms of treatments and operations. All these treatments did not alter her condition. She finally fell into the hands of a gynecologist who, after treating her by all kinds of gynecological methods, became tired of her, and referred her to a neurologist who tried his neurological powers and gave her up in his turn. By this time the patient was frantic with the fixed idea of operations. She was in terror of her trouble, and she raged at her invalidism. The patient became obsessed with faith in surgical operations as a cure of her terrible state from which she must be delivered at any cost. One operation after another was performed on her for the relief of her “fearful suffering.” She had an operation of ventral suspension, another operation for pelvic adhesions, another for rectal stricture, and a number of other ones just in order to humor her.

Under osteopathic treatment she developed the fixed idea that she had a Lane’s kink. Recent skiagrams, of which I received a great number, developed in her the fear of some trouble in her “sigmoid flexure.” This “sigmoid flexure” keeps on moving up and down in the body, keeps on pounding until it makes her feel nauseated, sick, in constant agony of headache, full of pains in the left side, unable to walk, even to make a step, unable to see or to read, unable to do any work, on account of the constant agonies; incapable of eating, incapable of thinking, and generally being in a state of “living death.”

The patient was in terror of her “sigmoid flexure” which actually incapacitated her from doing anything. She was, to all intents and purposes, paralyzed by the fear of “sigmoid flexure” of which she kept on thinking day and night, and of which she was in a panic, lest it became paralyzed, “relaxed, dead,” and then begin to pound. The pounding and the paralysis of the sigmoid flexure were to her the Scylla and Charybdis between which she had to steer in order to avoid “the horrors of her sufferings.”

For some time she was in fear of taking any food, because this excited the sigmoid flexure to activity and pounding with consequent paralysis of the lower intestinal tract. In such a state she was frantic with fear. She ran around and asked for the thumping to begin; sometimes when the thumping was too much for her, she asked to be taken out in an automobile, in order to paralyze and “deaden” the overactive sigmoid flexure. She fell back on liquid food and that only in spare quantities, took to her bed, did not want to see anybody, did not walk on account of her “extreme feebleness,” could not do anything, and became emaciated and an invalid for years.

The fear of indigestion and the sigmoid horror poisoned her life and extended to all her activities finally reducing her to a living skeleton, to “a machine, to an automaton.” She was afraid to walk a few yards for fear of the sigmoid flexure. The “sigmoid flexure system” extended and finally invaded the whole of her life; she became nothing but a sigmoid flexure.

The patient had intervals when the condition somewhat improved or rather when it was not so intense. About every two weeks, at rather irregular periods, she had attacks or “spells,” when the fear of the sigmoid flexure and “the deadening of her life” reached a climax, and she was in a state of panic. In her effort to escape from the “terror and horror” of the sigmoid flexure, the patient was ready to do anything. She behaved like a hunted animal frantic with fear.

The patient’s whole mind was set on herself, on getting well, on her health. One could clearly study in her the underlying factors of the impulse of self-preservation with its fear instinct as well as the factor of the low fund of neuron energy by the constant complaints of exhaustion and fatigue at the least effort, mental or physical. Anything that in any way disturbed her brought about all the symptoms of the disease, the headache, the nausea, the constipation, the eye-ache, and above all the thumping and pounding of the “sigmoid flexure” with the consequent paralysis of the lower tract and the evil effect of “deadness,” accompanied by a state of intense terror, almost uncontrollable, wild fear.

Everything was sacrificed on the altar of that merciless, psychopathic Moloch, the self-impulse and fear.

“My earliest recollection of any illness was a good deal of sore throat, not excessively severe, not enough to keep me much from school. When about seven I had a long, severe attack of typhoid fever accompanied by erysipelas from my knees down. It was only on account of the greatest care that I survived.

“During my childhood I acquired most of the children’s diseases: scarlet fever, measles, chicken pox, etc. I usually spent a good portion of the winter months indoors with childish trouble. There was one thing that never failed to accompany my illnesses. That was aching ankles. It exceeded any other suffering I had. I was troubled with them for two years; Mr. F. says even after we were married.

“When I was between ten and eleven years I contracted a fever which was called malaria, only I think it must have been something more serious. It began with a severe chill and after that I was ill in bed for a long time. When I was better my mother and I went abroad, and in eight months I gained about twenty-five pounds, weighing, at the age of twelve, ninety ounds.

“After my return from Europe I steadily increased in weight and would say that during my girlhood days I weighed from one hundred and fifteen to one hundred and twenty-five pounds.

“I matured at thirteen years, six months, and was always normal. During my periods I lived my everyday life, going to school, dancing, and doing anything that I did at other times.

“At about thirteen years of age my eyes were tested and glasses prescribed for distant use. I was both near-sighted and astigmatic. While I could see clearly for near work I always seemed to be under a nervous strain. To apply myself closely to study and to concentrate my mind and eyesight in any work always left me nervous, and I skimmed over the surface of everything I did, never going deeply into anything, not memorizing much of my recitations which sufficed for the day’s work. This strain grew more marked as I grew older and always have I labored under it. I went to numerous oculists, but with no satisfactory results.

“At this time I suffered from constipation and sick headaches. A marked characteristic of my headaches has always been a full feeling in the head, pressure against the back of my eyes. I know now that a large part of my discomfort and nervousness was due to my constipation and from the gas in the bowels. My mother was dead, I was not in the habit of discussing my physical troubles, so I kept them to myself and stood them as best I could. I thought it was necessary for some people to suffer from troubles, and that it was my weakness. I do not remember of doing anything for my constipation until I was a young woman.

“My headaches were never relieved by lying down or sleeping, so I kept on with my life under trying conditions many times. I went to school and lived my life as best I could. While I walked an ordinary amount, I was not a good walker and, as I remember, was often conscious of a dragging weight in the rectum.

“As I grew to womanhood I began the use of enemas, laxative waters, and latterly various drugs. These gave me temporary relief only, clearing my head and helping my nervousness; but the reaction came quickly. I changed from one remedy to another, but was never satisfied that I was getting anything more than temporary relief. It did not take but a small quantity of any medicine to move the bowels. I think the movement was low down in the bowel.

“All this time I was stout, had good color, and was the picture of health. I was married at about twenty-four years of age.

“The year after I was married I weighed almost one hundred and fifty pounds. I was happy, but my intestinal trouble continued. There was much gas in the bowels and pressure in my head. Part of the time I tried to ignore it and part of the time attempted to relieve myself with enemas, etc.

“When I had been married about one and one-half years I had a severe attack of cellulitis. My husband had some catarrhal trouble. At different times he had been treated for it, it was at one of these attacks that I became infected.

“I was very ill and was left with many adhesions. I did not know why I did not recover, but remember there was a feeling of weight and the tissues were not as free as formerly. This added greatly to my nervousness.

“After operation my nerves felt the strain of it all, and I realized I was breaking down. I went to a sanitarium and was given, in addition to the baths, etc., pelvic massage.

“I kept the bowels free and was able to do quite a little walking. My weight was much reduced and when I left I weighed about one hundred and fifteen pounds.

“For a few years I got on a little better. At times I would find a way of taking enemas or some medicine that would relieve me, and then I would feel better and gain in weight. At one time I weighed about one hundred and thirty-five pounds and remember how relieved I was from the feeling of weight in the lower part of my body.

“About eight years ago I became very much frightened over my nervous condition: The medicine I had been taking for my bowels ceased to be effective; the movements were loose and there was so much tightening of the lower bowels and much gas.

“I came to New York, and almost immediately upon my arrival, it seemed as if something gave way in the lower part of my body. I think it must have been a weakening and lowering of the pelvic floor. I went to a gynecologist whom I had previously consulted, and who at one time had curetted my uterus.

“I was beside myself nervously, and thought the bowel trouble had been aggravated by the uterine condition and, if something could only be done for that, I could get along with the intestinal trouble. I knew nothing of strictures, did not know what they were. I blame myself now that I made light of the intestinal trouble.

“The doctor said he did not see why I was in such a nervous condition, but suggested fastening the uterus to the abdominal wall. This he did, but he also attempted to break up the ovarine adhesions which he found, and he removed the appendix.

“After the operation I had more adhesions than I had ever dreamed of before, but so sure was I of my surgeon’s ability that I believed that they would all be absorbed and I would get well. I was full of hope, and, though under a terrible nervous strain, gained in weight.

“If I had gone to some quiet place with my nurse, I might have avoided trouble for a time at least, but I was induced to go back home where I saw too many people, and kept up beyond my strength. It took but a short time to complete my breakdown. I lost all feeling in the lower part of my body and all sensation was centered around the right side of my body. I have always had more or less of it, due, I think, to the weakness of the nerves and the pressure of the gas in the colon.

“I went to a sanitarium. I did everything to keep up all the time with the pounding going on in my intestines; I was so distressed and frightened that I did not know which way to turn. The uterus finally came down and I had to get off my feet altogether, the congestion in the pelvis was so great.

I was terribly distressed in the lower part of my body. My physician had discovered a great deal of eye strain and had both the horizontal and the vertical muscles cut. Finally he sent me to a gynecologist, and from him I got some relief and a little of my confidence restored. He had me take various positions four times a day at periods of fifteen minutes each, and breathe against a ‘shot apron’ placed across my abdomen. This stretched the adhesions, strengthened the abdominal wall, and raised the pelvic floor. The movements of the bowels were better formed. Since then I have been operated several times. I am convinced that the sigmoid flexure is at the bottom of all my troubles.”

It may be of interest to learn the fact that as a child, up to the age of five, patient lived with her parents who settled as pioneers in a woodland country, infested with poisonous serpents or snakes. One day, about the age of three, she entered the house with a dead, poisonous snake in her hands. The child was covered with blood. The parents were greatly scared. The child herself was not afraid, but the intense fear of the parents was communicated to the child, and this fear was strongly impressed on her. Since then the child was in terror of poisonous serpents, in fact, of all kinds of snakes. Even now she is in terror of anything that in the least resembles a serpent, a snake, such as worms, or caterpillars.

Soon after, the patient began to have nightmares of serpents attacking her; she kills them, like the infant Hercules; she wakes in a horrible state of panic. These dreams have survived into her adult life and manifest themselves from time to time, though not with such severity of terror. It is quite probable that the fear of the sigmoid flexure is a survival of this fear of her early childhood, manifested under different conditions. In other words, the fear of disease has gradually extended by the principle of metathesis, proliferation, irradiation, and fusion, involving the ancient fear of childhood on which the patient finally settled unconsciously or rather subconsciously, as the fons et origo of her malady.

¹ All these are evil omens, tests and charms, formed by the patient on the principle of metathesis, contrast, and others.