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CHAPTER XVI

PSYCHOPATHIC FEARS

            I give here a series of quotations from my patients’ accounts. (Each patient’s account is indicated separately by a Roman numeral.)

I

            “I cannot quite remember when I commenced to be apprehensive; possibly it was seven or eight years ago. Whenever I would feel tired or nervous, then any little pain I might have or thought I had would be very much magnified in my mind and would only be forgotten after a visit to a doctor who would, as a rule, tell me there was nothing the matter and I would come out entirely well.

            “I remember, a little longer than eight years ago, I went to see a doctor whom I had not seen before. He examined me, or at least pretended to, and pronounced it diabetes.

            “My regular physician was away at the time and would not return for two months, during this period I lost a great deal of weight, did not sleep, and had to pass urine every half hour or so as I remember. When my own physician returned, I went to see him, and told him the story. He said ‘nonsense, there is nothing the matter with you, except nervousness’ and advised me to get off my special diet and live a normal life, which I did; and all the previous symptoms disappeared.

            “Three or four years ago, I was troubled with more or less sore throat and, in the morning, would find that the saliva would contain some blood. I immediately had tubercular trouble, until I went to a specialist and was told that indigestion caused the throat trouble, and that bleeding gums produced the blood.

            “I have had headaches usually directly over the nasal tract in the middle of the forehead. I had heard of one who was similarly affected and had to be operated upon. I went and had an X-ray taken and found nothing, did a little more exercising, and got my headaches over.

            “Last spring, just previous to my going away, and at the height of my nervous state, I woke up suddenly one night and found that my stomach was very much distended, was pressing my heart, and that the latter was beating most rapidly. I thought immediately that I had had a shock, but later when the physician called, he said ‘no.’ The experience of that night however, has always remained with me, and I never go to bed without some fear that I may have a recurrence. I did have a similar attack about three weeks ago, without the vomiting, and it was only after taking some whiskey that I was able to get the wind out of my stomach.

            “I have had cancer, appendicitis and maybe one or two other things, the fear of which has at various times been dispelled by physicians.

            “I thought once, some years ago, that a burglar was in the house at a time when I was alone. I went and investigated at the time and found none, but for the rest of the summer, during which I lived alone at the house obtaining my meals elsewhere, I always made an effort to arrive home before dark, to get the lights lit and never went to bed during that period without more or less of a ‘creepy feeling.’

            “This last summer in July I started to play tennis one day and found that my heart immediately commenced to palpitate, but saved myself as well as I could.

            “After the match, I laid down, and my heart did not return to normal for a couple of hours. As I had always played much tennis in the previous summers, this worried me a great deal. Later in the summer I found that in playing golf, my heart action would increase a great deal in the course of the game. I had never given particular attention to the heart before. This worried me. I tried dancing one night, and I thought my heart never would get down, and had to go out on the piazza to calm it and myself.

            “The result was that when I returned to the office in September, I felt tired, nervous, and discouraged.”

II

            “When a child I always had an intense fear of burglars. I used to dream about them night after night for several years. I also had a fear that my life was in danger all the time. I was always suspicious of persons, because I believed that at any moment they might kill me—in fact I am always suspicious of people to-day, although I have no fear about being killed. I am always afraid that I am being imposed upon and that people take advantage of me. I was always bashful from a mere child.

            “However, when I got into high school I began to lose that characteristic. I always was unusually afraid of girls until I began to go to dances and parties, and then my bashfulness wore off somewhat. I had appeared before rather large audiences on the stage and that didn’t seem to trouble me much. It was always when I came in close contact with people that I felt uneasy. I always felt at a loss as to what to say to strangers.

            “Whenever I was with a crowd of boys, I was rather backward. As regard injuries I only remember a couple. I was hit in the forehead by a base-ball when playing catcher on a team. I was only in grammar school at this particular time; I was knocked down unconscious. Another time I was injured while playing hockey on the ice; I tripped and fell on the back of my head; I was semi-conscious, and remained so for about eighteen hours. Somehow I happened to board a car and went home. I had to change cars to get home and I did all this in an automatic manner. The following morning I awoke with a terrible pain in the back of my head.

            “When I was between sixteen and seventeen, I began masturbation, I used to do it anywhere from one to three or four times a week. It was very seldom that I ever masturbated more than once in the same day. I made a final attempt to stop masturbating. I succeeded, and have never done it since.

            “I was always more or less sensitive about my looks, because I knew I was unusually homely. My reason for being sensitive was because my relatives on both sides of my family are considered extremely good looking and I was unfortunate enough to be born with such a physiognomy as I possessed. Thus I overheard some one remark about me, it hurt my feelings a good deal. When I went out on the street cars, I was always the center of attraction. I feel that peculiar feeling in my face. My eyes feel as if they were trying to get out of my head. I also feel a peculiar irritation in them. All this takes place only when anyone is around. My face begins to heat up, I am conscious every minute while anyone is around.

            “Sometimes I try to throw the feeling off. When I am outdoors the sensation seems more intense. When I go to town I feel that the eyes of all the people are on me.

            “While in the public library one day last summer, I accidentally came across a book which had sexual hygiene. I have forgotten the title of the book and the name of the author as well, however, I believe I could find the book again, if I went to the library. In this book I happened to read about the eyes being affected, if masturbation was indulged in to excess. I have forgotten what it said how the eyes were affected. It also said that after masturbation had stopped, the eyes would be relieved anywhere from six months to two or three years depending on how much the person indulged in masturbation. I believe it said in some cases the eyes were never cured. After reading this and having my peculiar feeling in the eyes I stopped masturbation, because I feared to be afflicted with this disease all my life.”

            “I had the usual fear of the dark common to all children. When put to bed at night and the light taken away, the darkness of the room seemed peopled with dreadful, mysterious shapes, ready to spring out upon me, if I relaxed my watch in the least. So I would keep myself awake, as it were by main force, though my eyes would get so heavy with sleep that it was almost painful to keep them open.

            “There were two fears that stood out prominently in my mind for years, even past the time of childhood. One was the fear of mad dogs.

            “I have no conscious recollection of ever being greatly frightened by a dog, though my mother says I was once attacked by a dog, and she thought that affected me. At all events I had a perfect terror and great fear that some time I should be bitten by a mad dog and die in that awful agony.

            “If there was anything in the papers about mad dogs, I was sure to see it and remember it. I had nightmares in my younger days, and one of the forms the nightmares took was that of a dream that I was being pursued by a mad dog, and then often being bitten by him. I can recall perfectly well, the overwhelming sense of relief in waking up and finding it was all a dream. As years went on, however, all this fear gradually left me, and there is only an echo left of it in my mind. I don’t like to have dogs touch my hands with their mouths or teeth, I always give a wide berth to strange dogs out in the street.

            “The other fear, distinct in my mind, was that of blindness. If I would wake up in the night and find the room absolutely dark without a ray of light, I would be horrified and think I was surely gone blind. I used always to take pains and do to this day, to have the curtain or shade drawn in such a way that there was always at least a little chink left for the light to come into the bedroom.

            “When I was about eighteen, I studied Greek one summer vacation to make up work I had lost by sickness the previous winter. Shortly after I began to have black specks before my eyes. I went to our family physician after a time, for one didn’t think so much about consulting an oculist in those days, and he at once pronounced it ‘amaurosis,’ or disease of the optic nerve. I stopped my school at once. I was in the high school preparing for college, and after a few months my father sent me over to spend a year with his relatives, hoping the change would strengthen my health and my eyes. But this undercurrent of fear that I was going blind was with me for several years, though not enough to mar seriously my enjoyment of life. My mother says that my father, who had been over-straining his eyes, thought he was going blind, and she was planning and turning over in her mind what they could do to save my father’s eyesight.

IV

            One patient writes:

           “Apropos of my fear of the darkness which mostly passed away with childhood and youth; at another period of my life, when I was past thirty, similar fears reappeared. I had been for some time in a very weak and nervous condition, and was sleeping downstairs alone. Every night those horrible nervous fears would seize me, and though I knew they were foolish, I did not seem able to rid myself of them. It did not seem to be so much a fear of the darkness, per se, as a haunting impression that something was climbing in at the windows of the next rooms, and I had to keep awake and on guard, with every nerve tense. To quiet myself, I used to repeat over and over, the 91^st Psalm, which I knew by heart, dwelling especially on that verse, ‘thou shalt not be afraid for the terror by night.” Suddenly and unexpectedly one night, though the condition remained just the same, the burden of fear was entirely lifted, and has never returned.

            “I had a great shrinking from death, a fear of it, not because I did not believe in God and a future life, and knew that I was quite safe in my Father’s hands, but more because I shrank from going out into something unknown and untried, and especially a sort of feeling that I should lose my personal identity. I was apt to be quite apprehensive when I had little attacks of illness, and fear I was going to die, or ponder over certain symptoms, which I had read were indications of this or that disease, and fear I had it.”

V

            One of my patients gives the following account: “The nervous trouble (feeling of lassitude, fear of vague evil, fear of shadows fading into darkness, intense depression, loss of appetite and flesh, insomnia, headaches, and visceral disturbances) began in a rudimentary way about a year and a half ago, although I had already been nervous, and was gradually getting more so. At first it would be just what I call ‘a painful thought,’ that is, if I read something that was a story of misfortune or suffering of any kind, or heard of a real case of similar nature, I could feel how the person must have suffered, felt it as if it were myself. What if that had been me? I shuddered and was afraid. I would go through the most painful of all the sorrowful things I had ever read or known of. It would seem that I was going through the whole experience myself, and then I would hear myself tell the story of suffering, and it was I who had suffered all these experiences. I would begin to believe the story. When the end would come I would go off into a shivering horror that would end in a chill, which would sometimes last for three hours.

            “When the horror would come on I would go out and walk until I was tired and come home and go to bed without any dinner and sleep, the sleep of reaction and complete exhaustion. I slept apparently a dreamless sleep, which sometimes lasted about nine hours. Then I seemed to get better in the daytime, but would begin to dream the whole thing at night, and wake up in a blind, shivering terror.” The dreams terrorized the patient, who, finally, sank into a deep physical and mental depression. As in many other cases, the patient presents a sensitive organization, subject to a series of shocks dating back to early childhood. The terrorizing dreams are hallucinations formed by the play of associations out of fragments of actual experiences gone through during the periods of trauma.

VI

            “During the year 1907,” a patient writes, “I took up the study of astronomy and was much engrossed in same, when suddenly an obsession of the mind occurred and which for the time being, and in fact ever since, put a stop to my study of this science. As near as I can recollect I was not in bad health at the time, but was nervous and somewhat worried over business conditions. I had been reading a chapter in Flammarion’s Popular Astronomy about the earth's motion and its fall through space, instantly the thought came into my mind that the world was falling. The thought of the fall was so impressed on my mind that try as I could, I failed to throw off the thought. My fear was in the falling. I conceived the idea that the world would bring up somewhere. I could about imagine that I was falling with the world and, when this fear was particularly bad, I worked myself into such a nervous condition that a couple of nights I thought my chance of continued life was most slim. I shook off this condition, and it left me about as quickly as it came. I lost a few pounds in weight during the illness. During the summer of 1911 I had a run of headaches that lasted about six weeks, and which were of almost daily occurrence. At this time the thought of self-destruction was conceived in my mind, making me somewhat nervous, yet was not strong enough to make any great impression. I threw that thought off quickly when the headache subsided. This thought was not in any way active, but merely the thought that I might commit such an act.

            “At M., the first two weeks I was much depressed but gained confidence the third and fourth weeks. In the five weeks there, all the time I spent in my room was in sleeping and the few minutes once or twice a day to make a change of clothing. A fear which I could not appear to control kept me out of the room. I awoke late each morning with a most depressed view of things, and I must admit that the vigorous exercise in the gymnasium served to reduce the blue feeling. The sharp knife at my plate at every meal had many terrors for me, but in a few weeks I rather gained confidence, and for a few days the knife had almost lost its horrors to me. One day, becoming very tired after a very long walk, the fear of the knife returned and remained with me.

            After about two weeks’ stay at this place, I was sent to walk with a man, this being the first time that but two of us walked together. About half way around there suddenly came into my mind the thought that I might hurt my companion and that fear of the walk for me was a strenuous attempt to combat the idea, in which I failed, as that fear hung to me during the rest of my stay. While walking with several people, the fear would be with me just the same, and for a time I suffered greatly, because of this most unreasonable idea. This fear was greatly lessened in the fourth week of my stay, but in the fifth week, a week wherein every effort appeared to be a tiresome one, the fear returned with the same previous vigor. A day or two before I left M. I was sent on a walk with a young man, a walk of some miles and it was a miserable, weary walk for me. The entire walk, my mind held that loathsome fear that I might hurt the young man, and strive as I could I was unable to refute the fear. That one walk had undone the good work that I accomplished the previous week in subduing that particular fear. The thought of self-injury was with me during the first three weeks’ stay there, and at times I worked myself into a miserable condition, and I longed to take my misery to some one so that a little consolation could be given in return. But knowing full well that consolation or cheer could not be had from anyone, I suffered alone in my misery and that such suffering was of benefit to me is extremely doubtful.

            “In my room there was a safety razor, my thoughts often reverted to this, and the act of shaving had many fears for me. I slept but little while at this place. I had horrible dreams during the little sleep I did get, and such dreams did not make my mind the easier to be sure.”

VII

            “The earliest recollection of my fear that I have goes back, to early childhood. I heard from some source that wicked people would be judged after death and irrevocably sentenced to eternal torture in fire, and this idea raised a feeling of the most intense horror in my mind, lest I should not come up to the necessary standard in that dread day of judgment. I used to resolve to be good, particularly on reflection after going to bed, that I would be better so as to escape. However, the fear was vague and only came to me occasionally.

            “When I got to be about eleven or twelve years old the fear got to be concrete and more constant. Then I feared that some remark I had previously made about God might have been blasphemy against the Holy Ghost which the Bible says is not pardonable in this or the next world.

            “This idea persisted indefinitely, but others came too. I feared I had been instrumental in the death of a playmate, so a possible murderer, and the Bible said no murderer could be saved. There were, besides, many other ideas came in turn, each leading to the fear of hell punishment. For instance I got a great fear of poisons and imagined that my clothes and hands were infected with poison, and I feared I might be damned for not warning people that I was a source of danger to their lives, not having the moral courage to tell them I might be covered with poison. In this connection I feared my discharge might be poisonous and dangerous to others, therefore, dangerous to my soul. At a later time I feared I had not enough faith for salvation from hell.

            “By the time I was sixteen years old I had become very much demoralized, afraid of facing my fear, and particularly afraid of being away for any considerable time or distance from my family. In other words, so far as running up against my particular fear was concerned, I had become an abject coward. I have not by any means enumerated all my early fears up to this time, but the first definite one and some of the following leading ones.

            “At this time, the age of about sixteen, I became imbued with a new and permanent fear. As I have said I had become a great coward on account of my fear, and I began to wonder what would happen if for some great reason I was called upon to exercise courage and fortitude along the line I was most afraid. I could think of plenty of things that I was so much afraid to do that it took my breath away to consider them even, such for instance as living away from family and friends while under the influence of my fear and still more impossible things. Then the thought occurred to me, suppose it became supremely necessary for me to make such a sacrifice, and the particular form it took was, suppose it was necessary to save somebody else from hell, from an eternity of suffering against merely a temporary bit of pain on my part. Then I went all to pieces with fear and it seemed to me that in the very nature of the case justice must doom me for even having the slightest doubt about such a thing.”

VIII

            “As a child, I was much afraid of the dark, not a rational fear, e.g. of burglars, but when alone in a dark room, I had a fear of some mysterious sort, as though something might pounce upon me. Even now, if I am all alone in a house after nightfall, I feel it to some extent. I remember in my early days waking up at night when I was in bed alone, the terror growing steadily upon me.

            “During all my later life, the fears that trouble me most aside from the fears of blushing already spoken of to you, are fears of inefficiency, of not coming up to the necessary standard (painful self-disparagement). While I was first in rank in my class in my seminary course and received marked recognition at Harvard, where I studied also in graduate work, yet the unsocial self-absorption of my life left me so out of touch with the world and society that each point of contact impressed me anew with a fear of maladjustment and unfitness.

            “While during the present years I have become much more familiar with people and life, and especially the last year and a half have gained new courage in meeting life, yet the fear of falling below the established standard of efficiency, is a thing I have constantly to fight against. Again and again have dreamed of forgetting to come to school in time or forgetting about a whole series of classes I was to meet. In waking life there is a fear that I will not meet people socially in an acceptable way, fear of blushing, fear I will fail to recognize people I ought to know. (I am distinctly deficient in this matter). If I read a school or college catalogue, it seems as though the standard of the courses set, condemned me. If I read a book on pedagogy, I feel myself condemned as a poor teacher, etc. Against this at the present time, is the growing confidence that I am moving forward to steady mastery of life, yet fears of that character make a background that gives a tone of burden and strenuousness and struggle to all my work, making the free, joyous, frictionless working a difficult thing for me to attain.

            “In periods of depression (not so much the last year) it seems to me sometimes that there was nothing in the world I could do to make a living except teaching, and that I was so unfit to teach, it was a question whether I ought not to resign.

            “I talked once to a principal of our school about the trouble I had had about flushing, and said I felt doubtful whether I ought to keep my position, but he did not take the same view of it. My view of things would be sharply different in certain periods of depression and weakness.”

IX

            “I have always felt faint whenever I have had any kind of examination, for insurance, gymnasium, or by my own doctors. I never could listen to stories of operations without being obliged to get up and leave the room.

            “The sight of blood from a cut finger is apt to make me feel faint.

            “I had my tonsils taken out several years ago. On my way home I could feel that there was a slight bleeding going on in the back of my throat, I became panicky, had to stand by the door of the car where there was more air, and would have given a great deal to be at home.

            “Occasionally, on the street I have felt as though the blood was leaving my head, and that I might faint, and my inclination has been to lean against a building for a few moments until the feeling would be past. In all these panicky times my heart would beat more rapidly, and perspiration would come out on my body.

            “When playing bridge, during an important turn of the game my heart would commence to beat fast, I would get short of breath, and I would be obliged to get up and walk around some, or frequently I would take some sodium bicarbonate which would seem to help me collect myself.

            “These attacks at bridge have only been noticeable during the last five or six months and did not always occur when I was playing.

            “I have always figured that my nervousness had brought on indigestion, then would follow the increased heart beat and the resulting panicky feeling which was akin to fainting in my mind.

            “The only incident I can remember that might have a bearing on my being afraid in the dark was when I was in the West at sixteen or seventeen years of age. I lived alone in a home in the suburbs for a time, obtaining my meals at the hotel in town. I used to dread going to that home every night, but I had to, and did. It was during this time that a burglary occurred. I really do not remember being afraid of the dark before this period.

            “There is another weakness which has troubled me and that is that I am very apt to exaggerate, and not tell the exact truth even when no consequence could possibly follow the telling of the exact facts. This has troubled me very much.

            “Then there are some words that I cannot pronounce distinctly except with extreme care, and I have felt for some time that it indicated a gradual breaking up of my mental powers.

            “About a year ago an associate of mine in business had a complete nervous and physical breakdown. I had considerable to do for him at the time, and finally took him with his nurse out to a sanitarium in Framingham. His condition, action, and appearance during that ride are always recurring, and the fear that some day I may be in similar shape occasionally comes to me. He has since recovered as far as his mentality is concerned, although his physical condition is not good.

            “I frequently think out possible accidents to the children. If my boys ride to school on their bicycles in the morning, I worry, thinking that an automobile may run over them. If a child slides down a balustrade, I worry for fear he may do it some day and fall off and hurt himself. When my children have been sick, I have worried and have always wanted to send for the physician on the slightest pretense.

            “When our last child was born, my wife toward the end showed evidence of kidney trouble. The doctor would not let her know, but told me. I did not feel that he was giving the case proper attention and insisted on a specialist being called in. The latter arrived as my wife was going into a first convulsion. The baby was of course taken right away, but my wife had a very narrow escape. This experience was almost a nightmare for months after.

            “I could not seem to take a logical point of view. Instead of being thankful that my wife and baby had been saved, the predominating thought was rather, what if the specialist had not come, what if anything had happened to my wife, what would or could I have done for the other children in case the worst had happened.

            “Even now when I think of my wife and children, instead of the thought of them making me brace up and determine to get strong for their sake, my inclination is to weaken, get blue and down in the dumps.

            “I had a considerable shock about nine months ago. Lightning struck a house where my wife and I were staying, and from the shingles and plaster which I saw coming down I felt that the room we occupied was most struck.

            “I commenced to have palpitation, felt weak as a rag, and only with difficulty could I get upstairs. I found my wife had stopped on the way in the corridor to speak to some one and was not near her room, which we found was the one struck.

            “The memory of that incident constantly came back to me. Again, instead of the thread of thought running along thankful-it-is-over-and-no-one-hurt lines, I kept thinking of the consequences had the facts been different.”

X

            “The first fright I remember was at the age of three, when one of my brothers accidentally discharged a gun wounding a woman in the room where I was, since which time I have always experienced a great terror at the sight of a gun or pistol, even in a moving picture show. Also until recently the sight of blood has greatly terrified me, always causing a feeling of faintness.

            “Not long after, lightning entered the room where I was, breaking a window and giving us a shock.

            “At the age of four and a half my mother’s sister, who lived near us, died after a short, severe illness. I overheard the news of it, and, as I recall the full significance of it, it seemed to impress me and I cried for several hours until my parents returned with the little girl cousin who always afterward lived with us.

            “A little before I was nine we moved to the village of Adrian. I had began to stutter at this time and for the first time was teased about it by two or three of my playmates; this distressed me very much, though I never spoke of it to teacher or the family. It was rather a trying ordeal, to have names shouted after me even on the street, by children three or four years older than myself.

            “About the age of twelve, while out with a picnic party, we attempted to cross a long railroad bridge, and the train surprised us while crossing. Fortunately no one was injured, though several of us had to jump a considerable distance. I did not jump until the train almost reached me, when I fell, left my basket on the track, and barely escaped injury. I remember being too unnerved to walk for some time, and that a couple of hours later someone remarked that I was still trembling.

            “Perhaps a year or two later, or possible the winter following, while we were playing with our sleds at school, one of the big boys seized mine and ran with it across a deep narrow ditch, throwing me off so violently that for some little time, perhaps ten minutes, I was unable to move and they carried me into the school room. From this time on for several years I had considerable trouble with my back. It grew tired easily and would pain.”

XI

            “As you are desirous of knowing more about my life and environment, I will state concerning them, as follows:

            “You will remember that I told you that my step-father was a liquor dealer. Throughout all the time that he was in business we either lived over the barroom or else lived right in the place where the liquor was sold. My step-father was a heavy drinker, a man of violent nature, and decidedly pugnacious. As a child I have been scared to death by drunken brawls, and many nights have I been dragged out of bed by my mother who would flee with me to the house of a neighbor for safety.

            “I might say that until I was seventeen years old, I lived in continual terror of something going to happen. If he was arrested by the police, as often happened, our home would be the scene of turmoil until the case was settled.

            “I remember one incident very plainly, when he came home one night completely covered with blood as the result of being held up by thugs, and another time when he left the house to subdue some quarreling drunks with a pistol and returned after an exchange of shots with his hand shot through.

            “As a child, I was inclined to study, and associated very little with other children. My mother tells me that I talked early, but when about three years old I began to stammer. This trouble bothered me a great deal and I used to worry about it all the time, especially in school when I would try to recite. I might add that even now, when excited, I am troubled in the same way.

            “My step-father has been subject to nightmares nearly all his life; when asleep he would cry and moan and would be unable to move until someone would shake him out of it. He was terribly afraid of them, and I remember he used to say that he expected to die in one of them. I used to be left alone with him quite frequently, and I stood in constant fear of his dying; and if he fell asleep (as he frequently did in the daytime) I would either wake him or watch his respiration to see if he was alive. At other times, I have been awakened in the night by his cries and would assist my mother in bringing him to consciousness. It was during one of these times that I became aware of my heart palpitating, and whenever he had such a spell, I would be in a state of fear and excitement for some time after. He would have these nightmares nearly every night and sometimes four or five times in one night; and I might add that he has them even now.

            “I began to have attacks of dizziness in the streets, and finally one day, I had one, and all symptoms and fears of the attack in school came on, and from that time on I have watched my respiration and suffered from dizziness, and mental depression and sadness.

            “You have asked me to tell you more in detail about the attacks or nightmares to which my step-father was subject and which always frightened me greatly, especially when a child.

            “My step-father had the habit of falling asleep quite often, even in the daytime, and I have never known him to go to sleep without having an attack in some form. If one watched him asleep, as I often did, one could tell by his respiration when an attack was coming. His breathing would become slower and hardly perceptible, and finally he would begin to moan, and cry out; then, when shaken vigorously and spoken to, he would awaken in great fear and apparent suffering. If he had an attack, and we did not respond soon enough, he would be very angry and say that we cared not if he should die. We were so afraid of these attacks that we had trained ourselves to be ever on the look-out for his cries, even at night.

            “It really seemed as if his life rested in our hands. I might say that sometimes these attacks lasted several minutes before he could be awakened. He used to say that at such times he always dreamed someone was choking, beating, or otherwise torturing him. He had been told by some physician that he would ultimately die in such an attack.

            “These attacks were sufficient to precipitate a small panic in the house. I know not a single hour of day or night, but that I have either been called or awakened by my mother in her efforts to awaken him. With the attack over, I would be trembling all over, and my heart would be beating madly. I can remember these attacks from my earliest childhood and it seems to me that on one occasion, at your office, I was startled just as these attacks used to make me.”

            While in the hypnoidal state patient exclaimed: “I am afraid. . . All my life I lived under terrible fear”. . . . “This is just my disease—fear—.”

XII

            “I have a fear of going home, and I fear being away; I am not particularly afraid of anything, yet I always have a thought or a fear; whenever I undertake to do anything, there is a queer imagination about it. I think of childhood thoughts; if I see buildings, they look to me like sanitariums, which are very distasteful. There is nothing that seems the same to me, no matter what it is. I seem to have little sense and not much memory when I am doing anything; sounds startle me as if it was something else, and if it were something I see, a coat or any garment, it will sometimes startle me as if it were a person; or, looking at a beautiful piece of art work or picture, I can see nothing but the wrong part and a very distasteful thought with it, which I never had because we were lovers of art, as it was our line of business. I never had these thoughts, that is, I never noticed them when well. A few months after I was sick my brothers would accuse me of over-indulgence, also my mother, as she never liked her sons’ wives.

            “I know that ever since I was told of our stenographer I was afraid of hurting a baby; if I would be around my sister’s dear little one, I would get nervous and leave the room for fear I would hurt it.

            “All my nervousness seems to come from my fears. Even in seeing, hearing, smelling etc., there is nothing I am really afraid of, my fears seem to be imaginary.

            “Ever since I can remember I always had a fear, no matter where I went, but I learned to be brave. I often heard my father say that I was afraid to walk until I was four years old, but he said I was always good and pleasant.

            “There were seven of us; my mother was hard of hearing, and the children could learn and hear bad things without her knowledge. In school I was very bright, especially in arithmetic and history. I always had the first seat in school.

            “After getting through the intermediate school, I learned the granite trade which was very hard work, also tool dressing for stone cutters, which I learned rapidly; but always feared I could not do enough, or it was not well enough.

            “The men I served my apprenticeship to were vulgar and drinkers, as such men are as a rule. I was never very stout, rather small, but quick.

            “The reason for starting to work so early in life was, because we were poor and my father was dead and I was allowed to do as I pleased on account of mother’s condition, being deaf. All the brothers learned the same trade, after which four of us started a little shop, and it grew with our hard work; we aimed to do a high class of work, being practical. We soon established a nice respectable business, and then it was necessary for one of us to travel as salesman on the road, so the burden fell to me, which I stuck to for several years, and was thrown in with lots of good and bad company, and got to drinking, as I think now, too much.

            “There being four of us, when we did things, we were afraid to tell, for we were afraid of being scolded. I, being of tender heart and easily affected, would never tell anything and it was nothing, as men do every day, drink and have a little fun, but I never did anything wrong. If I went with a girl, my mother would always scold about it and also my brothers. This opposition always broke me down, but I still went with the girl for several years, and finally I married her five years ago; under great protest and fear. I loved her as she was noble and good, but mother could never forgive her sons for marrying and continually fussed about it, which I think kept me unhappy and I would drink.

            “Whenever I took the grip, I always thought I was going to die. In a few days I would be all right and would go and hustle, either doing hard work or selling goods.

            “Last January, we noticed some one had been using our autos and my brother let the police know, so one night at twelve o’clock, they caught them, four men, and took them to the jail. One of them was a young fellow, a driver of ours, and I felt very sorry for him, lying in jail and feared he would be sent to the penitentiary which I could not bear.

            “I had a fear, for just a few evenings before that I and another friend had taken his mother and sister out for a ride, for they had pleaded for an auto ride, all of which I told my wife, as there was nothing wrong.

            “I feared she would make up some slander against me, to save her brother, and I was very nervous, but still there ought not have been any worry on my part, there was nothing wrong. I felt sorry for the boy and was afraid of false slander. I would drink to rest my nerves, but did not think so at the time, for I did not know what nerves were.

            “On the 20th of February 1904, I took to bed thinking I had a cold or grip and was frightened to death, for I thought I had pneumonia one day, Bright’s disease the next, because I thought I drank too much, and the doctor assured me that there was nothing the matter with me, except a little fever, grip or bronchitis, and I imagined I had everything, for I had a terrific pain in my heart which made my arm straighten out. In a few days I got up and was nervous, but I thought it was from drink and I never told the doctor for fear of my parents and wife.

            “A few weeks after my nervousness our typewriter gave birth to a child and my brothers asked me if I was responsible, and I told them ‘No’, but I worried, thinking she may blame it on to me, for I was perfectly innocent, but could not help worrying as I was nervous. A few weeks after my illness I went to B. with my brother, and when the public found it out some one put it in a yellow sheet, saying that I had gone to a sanitarium over the condition of our stenographer. I think all this gave me a set-back, for I could not bear to hear a newsboy, and was afraid of women for a long time. All the old vulgar tales I heard and things I saw hurt me.

            “I can’t sleep nights unless I take medicine, and when I wake I have so many uncontrollable thoughts. My mind never stops, and now I begin to imagine things are alive and all sorts of illusions trouble me. I always thought I never would get well after fighting so hard for ten months, with all the best doctors to help me. Even when I work I fear I am doing something else.

            “At times I want to get well and be happy again. I went to a doctor and I overheard him tell my mother that my ‘sensory nerves were functionally affected.’

I always thought I drank too much. I had a bad sickness fifteen years ago of a sexual nature, but was never bothered with it since. I weighed two hundred pounds before I broke down. The doctor says that it was bloat a good deal. I may have been nervous a long time before I knew it, I would drink and probably that brought me to this fearful state.”

XIII

            “I was bred in fear from my childhood. My training and education were essentially religious, of an authoritative and terrorizing character. I was told all sorts of ghost stories, stories of murders, highway robberies, and other horrible tales by the ignorant and superstitious servants and people with whom I came in contact when a child. Many times when in the dark I fancied spirit folk haunting the place. I sometimes felt like screaming with terror. I often used to hear mysterious voices and sounds which I ascribed to spirits. At night, I would often in my fear cover my head with my blanket, bury my head in the pillow and shiver with fear. I was afraid of darkness, of secluded places, of the cellar, of the loft, of the lonely barn, of the church, of the church yard, and more especially of the cemetery. Had I been left alone in such places I would have fainted from terror. My mind was filled with superstitions of all the horrible accidents that may happen to one under such conditions.

            “There was a strong feeling of self in the fear, inasmuch as I was in terror of death, and of illness that may bring about death. I have witnessed in my childhood a great many deaths in the family. The agonies of the dying left a deep impression on me. I was afraid of death, and more still of the mystery of death. This fear is now as strong in me as ever,—it is a morbid fear, giving rise to intense agony and anxiety. The very mention of illness and death is enough to arouse the fear, and if the fear is left uncontrolled, the most excruciating anxiety and agony may be awakened, rising to a veritable frenzy of terror.

            “This fear of threatening illness and death, whether in myself or in my family, may rise to such an acute stage as to drive me to drink, so as to counteract the emotion by some form of reaction. Drink, however, does not agree with me. A few teaspoonfuls of brandy or of whiskey are enough to upset my stomach or my intestinal tract, and I may vomit, or I may just feel nauseated for a long time, and vomit, if I take a couple more teaspoonfuls. Sometimes the very smell of brandy is enough to make me feel nauseated. I have formed a fear of alcoholic drinks, even wine is apt to upset me. There is no way of overcoming my agonizing fears. Everything with me turns into fear.

            “Even the sexual side of my life is associated with fear. I was afraid to come near women for fear of infection. I used to be in agonies of fear of possible infection for days and weeks together. Marriage did not seem to improve matters. Intense headaches are associated with sexual functions so that I am afraid of ruining my brain, my nerves, my health, and getting paralysis, or sinking into imbecility and dementia, in spite of the assurance of my physicians to the contrary.

            “The fear of possible infection, bringing a fearful malady, ending in a miserable death specially haunts me of late. The least cut, the most insignificant scratch is apt to bring about an attack of fear. Shaking hands with strangers, especially drinking from a dish, touched by a strange person, is enough to set me in a paroxysm of terror. Sometimes it is enough to read in a paper, or to hear of sickness, or of an epidemic, to stir up my morbid fear of sickness and death.

            “When I look down from some high place, I feel a sort of sinking in my stomach. I am in agony of fear. The fear becomes sometimes so intense, that I feel dizzied, stagger, feel like throwing myself down, and put an end to the misery of my fear.

            “I am afraid to board a car or a train.    I am afraid I may fall out and get killed, in fact this has actually happened to me. I was nearly killed in accidents, once in my childhood, and another time in my youth.

            “In attempting to induce a state of intoxication I have often felt severe nausea and vomiting. Recently somebody told of cancer of the stomach giving rise to vomiting. I examined my vomitus and I found some red specks,—they were really something of the food taken—I became so terrified that I felt like one benumbed with fear, I was paralyzed with fear. All I knew and heard of cancer, of the suffering and death came clearly before my mind and overwhelmed me with a flood of blind fear.

            “While I write this account for you a mosquito hovers round me. I am afraid of this mosquito, having heard and read of the terrible diseases these insects communicate to people. When I kill a fly I have to keep on washing my hands endlessly,—I am afraid perhaps the fly carried some terrible infection.

            “The sight of blood is apt to make me faint. I think of sickness and death. Blood is to me the shedding of blood, it is death. Sometimes this feeling is quite strong with me, and sometimes I just feel apprehensive or a short time until some other fear takes its place.

            “What makes me specially apprehensive is the fact that the fear tends to spread to more and more objects and interests of life. My fears grow and become more extensive involving more parts of my being. I am afraid that the fears will finally end by paralyzing all my vital activities. What then? To escape my obsessions I employ all kinds of subterfuges. I get nowhere. I avoid one fear only to get into another. I become more and more entangled in the mesh of fears, like a fly in a spider's cobweb. My life is h-ll.”

XIV

            “I had a fear of a peculiar steamboat whistle; I had fears, during a certain period, of the end of the world; and I was afraid of harshness or unkindness. I have been more fearful than other people, I have been anxious about many things. I may say that I think my fears have always been along the line of my ideals, as soon as I began to have any. Thus, in early childhood I thought nothing of the future, and my fears were consequently limited to my present personal comfort. I may not have heretofore mentioned that I was always, at least after nine or ten years of age, rather timid before strangers. I shrank from harshness and abruptness in tone and manner.

            “With the onset of malaria, between the ages of nine and twelve, I naturally thought more of the subject of disease, but even then my fears were directed principally, if not wholly, to the particular trouble which was present. I worried, because the chills could not be broken. I also had fear of kidney trouble about that time, and a little later, I had a fear of seminal emissions.

            “A general sense of self-distrust began to show itself when I first realized that I was being raised differently from other boys and was being criticized in consequence, and, furthermore, that I could not feel at home in their company, due to my ignorance of their life and their ignorance of mine. Since then, many causes have conspired to make me timid, among which had been my sexual life.

            “All through my later life, whenever the importance of health has been emphasized in my thinking, my anxieties have run in that direction, and I have feared that I would not be physically strong enough for the battles of life. Whenever, as between the ages of fourteen and twenty especially, I have dwelt much in thought upon the importance of living in accord with religious precepts, I have feared that I should deviate therefrom—especially as there appeared to be looming up in my life a very powerful temptation. When, later on, I lost faith in the supernatural element in religion, there still remained the intense fear.”

XV

            “During my boyhood I was more or less persecuted by a conviction that if I did not go downstairs in a certain way I should be hung, or that if I did not touch every post in a certain fence I was passing, something alarming would happen to me, and I have been interested to learn since that others have had similar delusions, notably Samuel Johnson, the English writer.

            “After graduating from the medical school, I talked with men who were going to various parts of the country to practice, and it was a matter of astonishment to me that these men could contemplate going far away from home and friends, especially to engage in such a profession which I personally felt about as competent to engage in as a ten-year-old boy. I could not even induce myself to take a position in the hospital in Boston, although I felt that it would be an excellent thing for me. I was afraid of the unclean, ugly diseases, the maimed bodies, the contact with the patients and the internes and physicians who understood and enjoyed those things which simply terrified me—so I went home.

            “I had much time on my hands and had periods of great despondency and fear, when I would take long walks in the country where I learned much about bird-life which has been a great comfort and help to me, though in later years, as I have had more to do, I have lost much of my knowledge, my interest in it. I felt that I should employ my leisure or a portion of it, in the study of my profession, but the thought of it was so repugnant that I actually accomplished very little.

            “On the several occasions when my father went away and left his practice on my hands, I suffered horribly, but I accepted the situation, because it seemed to be unavoidable. It was my fate. The thought of revolt never seemed to have occurred to me.

            “When I was a student in the medical school, I woke one night with some abdominal pain, not particularly severe, but soon I began to shake violently so that the whole bed moved. I have been subject to such nervous chills ever since. Sometimes they come at rather frequent intervals, and then I may go perhaps a year without one. Of late years, I am often ill for a day or two after them, with loss of appetite, general malaise, etc.

            “After the death of my wife and after I had resumed work I had a most striking psychological experience, I was in a state of spiritual exaltation.

            “I had the kindest feeling for everyone, and everyone seemed to feel the same way toward me, but here is the remarkable thing about it; I seemed to be living two distinct lives at the same time. One was the ordinary everyday life of walking, working, eating, and drinking, and the other a higher, serene spiritual life which the small occurrences of the other life did not affect in the least. In the higher spiritual life I seemed to be very near my dead wife. I wrote a letter to friends at the time describing this experience and afterwards tried to recover the letter, but it had unfortunately been destroyed. I am not in the least in doubt about the two states in which I lived for the experience was as vivid as any I ever had in the material world, but the thing seemed to me rather unusual, and I thought the letter might throw some further light upon it. How long this state of exaltation lasted I do not know.

            “I gradually built up a little practice, confined to the eye and ear. I belonged to numberless local organizations which occupied my evenings.

            “All this time I was much depressed and worried. In 1908 I felt that everything that I did in a business way was wrong, that I never was able to satisfy a patient, and that I was losing what little practice I had. I remember sitting alone in my office one afternoon, putting my head down in my arms and saying aloud, ‘I don’t deserve it, I don’t deserve it.’ About this time I was haunted by the suicide idea. In my terrible mental distress this one idea seemed to give me relief—to offer a solution. When I went to bed at night at this time I would hear a persistent, rhythmical squeak in my chest which kept me awake. On examination by a specialist this proved to be a functional sound. I was advised to stop smoking which I did, and the squeak disappeared. The mental condition also improved.

            “I took up my work, although feeling that it was impossible for me to do it.

            “Each morning, with the exception of one, I woke very early and suffered mental tortures. Sometimes when I first became conscious after waking, I would be comfortable, but sooner or later the distress would come. It seemed to me that I had a terrible problem to solve, but I could not reach a satisfactory conclusion. The problem concerned my success in life, and earning a livelihood, and failure to solve it meant insanity. I felt that I must do something radical, start out in some new line of work, like public welfare work or possibly some form of agriculture, but always in these early morning agonies I was forced back upon my own special work as the only practical thing and a horrible fear seized me, I realized that there was no escape from it.

            “At these times I would shake violently with fear, and once I seemed to have descended into the very abyss of despair where it would be impossible to live for many moments. I am sure that I should have rushed from my room screaming, if the fear had lasted. Once, years before, after great emotional excitement, I had had a similar sensation, but not as pronounced. I rose each morning with paralyzing fear gripping me, and mechanically performed my duties as school physician.

            “After a time I told my father of my condition, but I felt that I could not make him understand the situation in which I found myself. One morning I found relief in assuring myself that I would keep on with my work, but would not take any of the cases which I dreaded; the relief was only temporary.

            “At another time, after a talk with my father in which he talked encouragingly about going into apple raising, I had a more comfortable night.

            “I took a course of treatment, dieting, drinking Vichy and taking exercise without any appreciable effect. My father offered to stay with me, on account of my terrible loneliness and fears; at first I declined, but later accepted, and found some comfort in feeling that he was near.

            “With the idea that I must do something to save myself from losing my grip, I forced myself to prepare for operation, but perhaps fortunately for the patient, although I got everything in readiness, he did not appear.

            “Often, especially if I had some exercise in the morning followed by a bath, I would feel quite normal in the afternoon and in the evening.

            “For a time during the early morning distress it seemed as though there was some solution to my problem, but after a time I could not tell what was the cause of my great mental distress which would not allow me to rest, but tortured me until I writhed and groaned. Then the fear of failure, poverty, destitution, and disgrace, seemed to take possession of me, and I remember one morning, before my father was sleeping with me, that I woke him and got him to assure me that he thought I was able to earn my own living.

            “These fears which came up in my business and even social life, would take possession of me in the early morning hours and torture me with terror and horror. I found some relief in talking these matters over with my father and step-mother and getting their advice.

            “Invariably, when I felt normal, it seemed to me that I ought to get away from everything and get some kind of work that would give me plenty of exercise out of doors and freedom from mental effort, but when the fear and depression gripped me again it all seemed hopeless.

            “If, when I returned from abroad last fall, I could only have found someone among those to whom I confided my troubles, who could see that I was incapable of doing anything for myself, and taking things on their own hands, have sent me where my mind could have been relieved of all unnecessary worries, my body supplied with plenty of wholesome exercise in the open air and abundance of good food, I might have been saved from months of hideous nightmares.”

XVI

            “In plain English I am ‘self-conscious.’ I have this self-consciousness in a most acute form. I would be classed as a monomaniac on the subject, and, silly as it may seem, it is ruining my whole life.

            “I don’t think that as a boy I was diffident or bashful to a marked degree. This self-consciousness was acquired and grew on me. Up to the age of fourteen I could ‘speak’ at school and do the other things that boys of that age do without embarrassment, but one day at about that age, I arose to recite. I got a little mixed up and a little ‘rattled,’ when I sat down the boy behind me commenced to ‘guy’ me, told me how red my face was, etc., and kept it up for some time and it seemed to prey on my mind. The next day when I arose to recite I commenced to fear lest my face would get red again and the first thing I knew my face was burning and my voice shaking. From that time on I was never able to get up in school and recite without fearing that the pupils were watching me to see how red my face would get and how embarrassed I would look, and that fear, ‘imagining,’ did the work. Finally out of pity the teachers excused me from speaking, or I should say attempting to speak before the school and reciting before the class.

            “After I left school I appeared to get better along that line. My father was cashier of a bank, and after taking a course of shorthand at a business college I went to work there. All this time I was always self-conscious and prone to blush, but the newer surroundings made it easier for me than with all of the scholars who knew my weakness.

            “During the last few; years the fear has been growing on me again and in some respects I am worse than I ever was before in my life. If I pass a friend on the street who knows my weakness, I at once proceed to get much embarrassed and ‘red’. I fear that he is watching me to see me do that very thing and so do not disappoint him. The horror, and it is a horror, with me, of getting red in the face is with me every minute that I am awake. The confidence that I should have to shake it off I do not seem able to get. If there is something that I am obliged to do that will bring me into a little prominence, such as attending a dinner (that I cannot get out of) I will worry for days for fear that I will make a ‘fool of myself,’ and of course, this previous worrying does not help to put me in good shape when the time comes.

            “I could go along writing several pages, but I think that I have said enough to enable you to see how this ‘fear hallucination’ has a hold of me. I am sure that I am not of a retiring disposition naturally, I enjoy the society of both sexes. I can go, say on a moonlight automobile trip and be just as natural and as much at ease as anyone, but to sit down to a dinner, commence to imagine that the people are glancing at me to see whether I am getting red in the face and then, as the boy says, ‘the stuff is off.’

            “There was one thing I could do, I always took an intense interest in baseball and played it for years. On the ball field I had absolute confidence in myself, and could get up before any number of people without the least bit of embarrassment or nervousness in the tightest places. In fact, once when our team was playing in another town, in writing up the game the next day, the editor of the paper stated that ‘Young G. has the nerve of a Von Moltke; he never gets excited or rattled.’ Now if I can get some of the confidence that I had on the ball field in my business and social relations it would mean a whole lot to me, otherwise I am more or less of a failure. Lately, I have been having periods of depression and at time I feel that I would almost welcome anything to end this foolish fear.

            “You probably think that I am lacking in will power and I surely am in this one respect at least, but I have been successful in a business way.

            “My father is state accountant and has been for the past five years. During this time I have been cashier in reality, although I wouldn't accept the office and name. The directors have voluntarily raised my salary at different times, and I know that my business judgment is respected; but this other matter, silly as it may seem, keeps gnawing at my nerves and I feel that some of these days, unless I am able to shake it off, that I will be a nervous wreck or go insane. It is a fear hallucination, pure and simple, but I must get rid of it soon.

XVII

            “From my earliest recollections I was an unusually brave child and proud of my bravery. Older brothers, on account of this, tried to frighten me in every manner possible. One appeared with a false face and frightened me so that I have ever since been afraid of everything else. Throwing chickens at me also resulted in my being afraid of all feathered animals since. Even a bunch of feathers gives me an unhappy, frightened feeling. Being bitten several times by dogs has made me fearful of dogs, and contributed to my general nervousness.

            “When about five years old (the year I received my first serious fright) I snapped a rubber in my left eye, turning the pupil in. Children teased and made fun of my eye, calling me ‘cross-eye,’ and thus made me nervous, sensitive, and uncomfortable in company. Also, perhaps, turned my thoughts in a morbid, self-conscious channel, to which other incidents have contributed since then.

            “I did not go to school until I was eleven years old, on account of my sensitiveness about my eye. My mother, also of my disposition as to sensitiveness, taught me at home. At eleven, I was operated on, the pupil coming back into its proper place. Since then, I cannot read with my left eye. My eyes water when out of doors, and I can with difficulty keep them open. When embarrassed or annoyed my eyes have a queer feeling over which I have no control. It makes me so uncomfortable to think I cannot keep my eyes from showing my inner feelings so readily. I believe it is due to their weakness. My right eye, with which I read constantly, has for the last few months felt blurred.

            “My grandmother came to live with us when I was about seven years old, and, I think, ruined all our dispositions by scolding, nagging, and slapping us almost constantly. We could not do the slightest thing, stand still, or sit down without a scolding. From being of a sunny, bright disposition, I became morose and sullen and am continually looking for affronts and brooding over them and have developed a disposition to worry over trifles and never to feel certain that I have taken the right course in anything, also to have a morbid sensitiveness to and fear of the opinion of others and never to feel happy or satisfied in any place. I am always looking forward to next year, or next month, or to going some other place, where things will be more pleasant.

            “When in company, I never seem to know what to say, and in my nervous fear, I say too much and afterwards feel an agony of mortification over remarks that I regard as absurd. From this fact, I think, I have very few friends. My peculiarities, due to my nervousness, all of which I am acutely conscious and worry on, cause me to be alone wherever I go. I try to please people and go out of my way to do favors for friends, but I am unpopular, because of the mannerisms and self-consciousness I possess.

            “I taught school six years, and worked faithfully early and late. Being accounted a good disciplinarian, I was given some hard rooms to teach and was kept in nervous tension all the time. My last year teaching was begun in my home town, and I was given a room of the worst children in town; and, being sensitive to the opinions of my home people, I felt hampered to carry out as strict measures of discipline as were necessary; but for the same reason I hated to give it up.

            “My mother’s health gave out and, my father’s work being in F. that year, I asked for leave of absence and we went to F. in January. While there I was continually worried over the thought of my return to school and in April I heard a friend remark that I was growing hard of hearing, and when I reached home in May, a noise in my ears started and has never ceased. Dr. Mayo of Rochester treated my ears and cut out my tonsils and cauterized my nose to help my hearing, but I have grown steadily worse. This was in 1906. The noise in my ears aggravates my nervousness. My voice seems affected so that people have difficulty hearing me. In company I sometimes dread to speak at all. I took up shorthand and typewriting, but lost two positions on account of my deafness. I nearly always feel tired and lacking in energy, due to my nervous fear and apprehensive thought. I have read so much that I seem to exist in a world of books quite apart from this world of reality, and am only contented when poring over a book.

            “As a child, I was timid, apprehensive, full of fears. As I grew older, I could be easily made angry and seemed to lose all control of myself when angry. I cannot answer anyone who affronts me, because I lose all control of my nerves, eyes, and voice. I feel paralyzed with fear and anger.”

XVIII

            “From childhood I have always been extremely timid. The illness and death of my youngest and favorite brother seven years ago was a particularly distressing one, which rendered him completely helpless for a year and a half, during which time I dreamed of his death or some scene connected with his illness would occur. For a year after his death I scarcely passed a night without dreaming of him nor a day without feeling the loss, so constantly had we been together and so deep were my love and admiration for this witty, clever brother who had always been so kind and considerate.

            ‘During the past four years I have experienced several peculiar dreams. The last of them was last August in M. when, for the first time since her death in January, I dreamed of my mother. She looked at me pityingly and embraced me, holding me for a long time as though to give comfort. The dream was very real. The following day a letter reached me from a friend at home; a real estate dealer saying that he thought he should probably be able to make a sale of our old house to the man he had had up to look at it the preceding day. Having the house pass into other hands and the prospect of my having to leave it all had been much on her mind during her last illness of which my brother’s family next door had knowledge.

            “The fall preceding mother's death I had been away from home several weeks in K., taking treatment for my stammering. Mother became aware that her condition was growing serious and though she did not write me at all differently from usual and, although she concealed her condition from my brothers who were near her, I seemed to know it and reluctantly went to spend a short time with my foster-sister, as my mother wrote to urge me to do, during the whole of which time I felt apprehensive about my mother, and I began to stammer severely.

            “My father’s illness was longer, and during it, upon our physician’s advice on the return of my foster-sister from school in the spring the family persuaded me to go away for awhile. For a couple of weeks I enjoyed my visit when all at once with so far as I could judge nothing in the letter to indicate much of a change in his condition, I became apprehensive and felt that I must return at once. But because my little nephew was to return with me and the journey was a long one and each day his pass was expected, I unwillingly waited and was not surprised when we received a telegram saying that my father was dead.

            “Last June, at the time of my operation at M., I had decided hastily and did not think it wise or necessary to inform any of the members of the family. I was ill with the shock afterward and wished very much for my foster-sister, but she was too far away to be sent for, and I improved so rapidly so I wrote her at the usual time in the usual way without mentioning the operation. Before even this could have reached her, I received a letter from her, saying ‘what is the matter,’ ‘I know you are ill.’

            “Why does it prove a strain to meet strangers and to be with people for long at a time? I believe one of the causes to be the great amount of criticism to which I was subjected in childhood both before guests and after their departure, and to be with people, which made a very deep and painful impression on my mind. My little girl cousin who lived with us was extremely exacting, and, while there was really a warm affection between us, there were constant differences and constant irritation, and unless my brothers interfered, if there was harmony it was only secured by my giving way to her. Of course, I was not blameless in the matter, being unduly sensitive, often teasing and disliking a fuss above all things and never being strong.

            “Until the last years of his life my father used to, at long intervals, indulge in fits of drinking in which he became violent, and I have often seen him take a knife and threaten to kill my brothers when they kept him from going out for more liquor, and they would have to hold him and soothe him. The fear of disgrace, the horror of it, and my mother’s grief, made a deep impression. We never spoke of it, of course, to outsiders, and seldom in the family except when we would become apprehensive that he was starting to drink.”

XIX

            “I am a married woman of fifty-two. All my life I have been imprisoned in the dungeon keep of fear. Fear paralyzes me in every effort. If I could once overcome my enemy, I would rejoice forever more.

            “In childhood everything cowered me. I was bred in fear. At five or six my mother died, and I feared and distrusted a God who would so intimidate me and bereave me. I heard tales of burglars, being discovered in hiding under beds, and a terrified child retired nightly for years. I was in agony of fear. My fears I never told. Later I heard of the doctrine of God’s foreknowledge, and, as a little rebel, I would place dishes on the pantry shelves, changing from place to place, and then giving up in despair, knowing that if fore-knowledge were true, God knew that I would go through with all that performance.

            “Through childhood I feared suicide. It was a world of escape that appealed to me and yet appalled me. I also heard of somnambulism, and I never saw a keen bladed knife, but I dreaded that in my sleep I might do damage to myself or to my friends in a state of unconsciousness.

            “In my twenties I did attempt suicide a number of times, but somehow they proved unsuccessful. I always aimed to have it appear an accident. I dreaded to have my death appear as a stain and disgrace to my family which I loved.

            “I always fear to walk at any height, on a trestle over running walls, or even to walk on a bridge without side railings.

            “As a child I was afraid of the dark, I was afraid of going out on the street in a dark night. In fact, even a moonlight night terrified me when I remained alone. I was afraid to go into dark places, such as cellars, or into lonely places even in the day time.

            “As a child I was always shy, fearful, timid and self-conscious to a painful degree. Even as a grown-up woman I am often a sufferer from the same cause, although I have sufficient self-control to conceal it.

            “I have to be careful of my state of health, as the latter is very delicate. I am a chronic sufferer from indigestion and constipation, although I somehow manage to regulate these troubles.

            “When I need my nerves in good control so frequently, they are in a state of utter collapse. My brain is in a state of confusion, in a state of whirl just when I need to think the clearest. My poor brain feels as if a tight band encircled and contracted it. It seems to me, as if the brain has shrunken from the temples.

            “My memory is unreliable. Often I read quite carefully, but I am unable to recall what I have read. Especially is this so, if called upon without previous warning. My brain goes into a panic of an extremely alarming kind.

            “I was told that I was a woman of a good brain and of great talent, that all I needed was to exercise my will and determination, and that I would succeed. I lack concentration and I lack confidence.

            “In my childhood hell fire was preached. Fire ordination and an arbitrary God were held up to my childish comprehension. I was bred in fear, and self-destruction resulted.”

XX

            The following valuable account given me by an eminent physician brings out well the main factors, laws, and principles of Psychopathology expounded in this volume:

            “You asked me to write about my fears. I give you a brief account.

            “As a child, as far as memory carries, I had a fear of darkness, fear of ghosts, of giants, of monsters, and of all kinds of mysterious and diabolical agencies and witchcraft of which I have heard a number of tales and stories in my early childhood. I was afraid of thieves, of robbers, and of all forms of evil agencies. The fears were strong at daytime, but more so at night. Strange noises, unexpected voices and sounds made a cold shiver run down my back.

            “I was afraid of remaining alone in a closed room, or in the dark, or in a strange place. It seemed to me as if I was left and abandoned by everybody, and that something awful was going to happen to me. When I happened to be left alone under such conditions I was often in a state of helplessness, paralyzing terror. Such states of fear sweep occasionally over me even at present. I find, however, that they are far more complicated with associations of a more developed personal life. I know that in some form or other the fears are present, but are inhibited by counteracting impulses and associations. I still may feel a cold shiver running down my back, when I happen to go into a dark cellar in the dead of night, or happen to remain alone in a dark, empty house. Such fears date back to my fourth year, and possibly to an earlier time of my childhood.

            “As a matter of contrast-inhibitions of such fears I may either brace myself and put myself in a state of courage and exaltation, or when this does not succeed, I let my mind dwell on other fears and troubles. I find that the last method is often by far the more effective in the inhibition of fear states which at the moment are present with me. All I need is to press the button, so to say, and awaken some other fears, the present fears diminish in intensity and fade away for the time being. I actually favor and welcome and even look for disagreeable and painful experience so as to overcome some of my present fears. The new fears are then treated in the same way.

            “As I became older, about the age of eight, I began to fear disease and death. This may be due to the infectious diseases that attacked many members of our family when I was about the age of eight. In fact, I have been present at the death bed of some of them, and the impression was one of terror, mysterious horror. I was afraid I might get diseases from which I might die. After my witnessing the last agonizing moments of death, my elders thought of removing me to a safer place; their fears and precautions still more impressed the fear of danger of disease and death. I may say that I really never freed myself from the fear of disease and death. The latter fears are always present with me in a vague, subconscious form, always ready to crop up at the least favorable opportunity. This fear, in so far as it is extending its tentacles in various directions, is often the bane of my life. Even at my best there is always a kind of vague fear of possible danger, lurking unknowingly to me in various objects which may be infected, or possibly poisonous.

            “This fear has been spreading and has become quite extensive, involving my family, my children, my friends, my acquaintances, and my patients. Usually I ignore these fears, or get control over them by an effort of will. When, however, I happen to be fatigued, or worried over small things by the course of my work, or happen to be in low spirits by petty reversals of life, these fears may become aroused, as if from slumber, and may come forth in their pristine vigor. Under such conditions I may become afraid, for instance, of drinking milk, because it may be tuberculous.

            “This fear may spread and involve fear for my children and my patients; or again I may be afraid of eating oysters and other shell fish, because they may be infected with typhoid fever germs. I may: refuse to eat mushrooms, because of the possibility that they are poisonous. The other day I was actually taken sick with nausea and with disposition to vomiting after eating of otherwise good mushrooms. The fear seized on me that they all might be poisonous ‘toadstools.’ Such fears may extend to ever new objects and persons. The spreading of the fears to ever new relations and to ever new associations is possibly the worst feature of the trouble.

            “I have a fear of coming in contact with strangers, lest I get infected by them, giving me tuberculosis, influenza, scarlet fever, and so on. This mysophobia involves my children and my friends, inasmuch that I am afraid that strangers may communicate some contagious diseases. A similar fear I have in regard to animals,—they may possibly be infected with rabies, or with glanders, or with some other deadly, pathogenic micro-organism. I am afraid of mosquito bites, lest they give malaria, or yellow fever. The fears, in the course of their extension, may become even more intense and more insidious than the original states.

            “About the age of fourteen I began to be obsessed with sexual fears. Advice was given me again and again that all sexual acts and sexual errors make boys sick and finally result in a lingering, terrible death. Such advices often threw me into a panic, on account of the fears I already had. The fears grew in strength and complexity. I was often seized with terror over the least imaginable sexual trouble, thinking that I was to become a wreck, and that I was surely going to die a miserable death. Occasionally I was seized with the fear that my brain might give way, and that I would die in agonies, a miserable dement.

            “I have also a fear of dogs. As a child I had some bad experiences with dogs. I was attacked by dogs and was badly bitten. Although this fear is no longer so intense as it was in my childhood, still I know it is present. My heart sometimes comes to a sudden standstill, when I happen to come on a strange dog. When the strange dog growls and barks, all my courage is lost, and I beat an inglorious retreat. It is only in the presence of other people that I can rise to the effort to walk along and apparently pay no attention to the dog. This is because I fear the opinion of others more even than I fear growls of dogs. My social and moral fears are far greater than my purely physical fears. Fear has invaded my mental and physical organization.

            “When I became older, about the age of eighteen to twenty, a new form of fear appeared, like a new sprout added to the main trunk or possibly growing out of the main fear of disease and death, that is the fear of some vague, impending evil. The fear of some terrible accident to myself and more so to my family or to any of the people of whom I happen to take care is constantly present in the margin of my consciousness, or as you would put it, in my subconsciousness. Sometimes the fears leave me for awhile, sometimes they are very mild, and sometimes again they flare up with an intensity that is truly alarming and uncontrollable. The energy with which those fears become insistent in consciousness and the motor excitement to which they give rise is really extraordinary. The fears come like sudden floods. The energy with which those fears rise to consciousness is often overwhelming.

            “Fears get possession of me under circumstances in which my suspicions are, for some reason or other, aroused to activity, all the more so if the suspicions of possible impending evil are awakened suddenly. In other words, the fears arise with the stimulations of associations of threatening danger to myself and to my family. I am afraid that something may happen to my children; I fear that they may fall sick suddenly; I fear that some terrible accident may happen to them; I fear they may fall down from some high place and be maimed or be killed. I fear that my children and other members of my family may be poisoned by people who are not well disposed towards them. I am afraid that they may pick up food that was infected, or that they may be infected in school by children who happen to suffer from some infectious maladies. I am afraid that my children may be overrun by some vehicles, by automobiles, or that they may be killed in an accident, that they may be killed by the street car, or even that the house may collapse. This latter event has actually taken place when I was a child. In fact many, if not all of those fears have actually their origin in my experience.

            “As I write to you these lines many a memory of such events come crowding upon my mind. Are they the noxious seeds that have been planted on the soil of fear? I am afraid sometimes that even the food I and my children as well as other people eat may give rise to toxic products and thus produce disease. Often in the dead of night I may come to my child in order to convince myself that he has no fever and that he is not threatened by any terrible disease. The very words ‘sickness,’ ‘disease,’ ‘not feeling well,’ ‘death,’ arouse my fears and sometimes throw me into a panic. I am afraid to use such words in connection with any of my children. I am afraid the evil mentioned may actually happen.

            “As a child I learned about testing and omens. If such and such a test will come through in a certain way, it is an omen of good luck; otherwise it means bad luck. This superstitious testing and omens have remained with me, and that in spite of my liberal training and knowledge of such absurd superstitions. I may test by opening the Bible at any page, or I may test by anything that might occur according to my guesses. All of those fears I know have no meaning for me, they are senseless and absurd, but they are so rooted in my early childhood, they have been so often repeated, they have accumulated round them so much emotion of fear that they come to my mind with a force which is truly irresistible. Many of the fears have multiplied to such an extent that I cannot touch anything without arousing some slumbering fear. On the other hand, I am enabled to play one fear against another and some times obtain counteracting contrast effects.

            “To continue with my fears. I am often afraid that the doors are not well locked, and I must try them over and over again. I go away and come again, and try and try again, and once more. It is tiresome, but as the fear is constantly with me and is born again and again, I cannot be satisfied, and must repeat the whole process over and over until I get tired, and give up the whole affair in sheer despair. In such cases a contrary and different fear comes in handy. One devil banishes another. I am afraid that the gas jet is left open, and I must try it over and over, and test the jets with matches. This process of testing may go on endlessly without assurance,—the fear remains and the process must begin again until it is stopped by sheer effort of will as something meaningless, automatic, and absurd. The performance must be stopped and substituted by something else.

            “Colds or attacks of influenza of the mildest character have given rise to fears of pneumonia. Pains in the abdomen or a little intestinal distress have awakened fears of possible appendicitis, or of tumor, or of intestinal obstruction. The least suspicion of blood in the stools awakens the fear of possible cancer. Vomiting or even nausea brings fears of cancer of the stomach. There is no disease from which I have not suffered. The only diseases I have not feared were female diseases.

            “The same fears have naturally been extended to my children and to all those who are under my care. The least symptom is sufficient to arouse in me fears of possible terrible and horrible consequences.

            “I am afraid that suits may be brought against me, or that some of my own people, patients and even employees whom I discharge may bring legal action against me in court, or blackmail me. When I leave home, I am afraid that something terrible has happened. The fear of impending evil is always with me. The fears have invaded every part of my being. It seems as if there is no resistance in my mind to those terrible fear states.

            “Perhaps it may interest you to know that, although I am quite liberal and am even regarded as irreligious, still I am afraid to express any bad word against God, Christ, saints, martyrs of any church and denomination, be they Christian, Mohammedan, Buddhist and even pagan such as Apollo or Zeus or Jupiter or Ahriman and Ormuzd. I am afraid lest they may hear me and do me harm. I fear to say a bad word even about the devil and Satan. I am obsessed by fears. Fears pursue me as long as I am awake, and they do not leave me alone in my sleep and dreams. Fears are the curse of my life. And yet I have control of them, none but you has any suspicion of them. I go about my work in a seemingly cheerful and happy way. The fears, however, are the bane of my life, and torture me by their continued presence.

            “I tried to find whether or no those fears had any relations to my wishes or to my sexual experiences. I must say that I find that they bear no relation whatever to wish or sex. My mental states grow on fear, take their origin in fear, and feed on fear. Fear is the seed and the soil of all those infinite individual phobias that keep on torturing me without mercy, phobias which I must control by a supreme effort of will.

            “Truly the Biblical curse well applies to my life:

            “‘The Lord will make thy plagues wonderful, and the plagues of thy seed, even great plagues, and of long continuance, and sore sickness, and of long continuance. Moreover, he will bring upon thee all the diseases of Egypt, which thou wast afraid of; and they shall cleave unto thee. And every sickness, and every plague, which is not written in the book of this law, them will the Lord bring upon thee, until thou be destroyed. Thou shalt find no ease, neither shall the sole of thy foot have rest; but the Lord shall give thee a trembling heart, and failing of eyes, and sorrow of mind. And thy life shall hang in doubt before thee; and thou shalt fear day and night, and shalt have none assurance of thy life. In the morning thou shalt say, Would God it were even! and at even thou shalt say, Would God it were morning! for the fear of thine heart wherewith thou shalt fear. . . .’

            “I laid bare my soul before you. I permit you to do with this document whatever you may think fit.”

            In all these various cases and accounts we find the pathological background the impulse of self-preservation with the fear instinct highly intensified, invading more and more the life of the individual while the available fund of his dynamic energy keeps on falling. At the same time we can observe clearly the main psychopathological principles, formulated above, in the evolution of psychopathic mental aggregates.

            Most of these patients were cured by hypnoidal, twilight treatment, by disintegration of the fear systems, both in the waking, and hypnoidal states, also by a healthy life of work and by an improved condition of metabolism. About seventy-five per cent remained in good condition, and could be regarded as having been permanently cured. Out of the twenty-five per cent left about twenty per cent improved in their mental condition, and five per cent did not respond, on account of the short time of treatment.

            The course of treatment of psychopathic cases averages from half a year to a year and a half. In severe cases the course of treatment may take two to three years. Patience and perseverance are requisite in the treatment of each and every psychopathic case.

            On the whole, psychoneurotic cases are easier to handle than psychosomatic cases, but somatopsychosis yields more rapidly to treatment, especially in young persons, than do cases of psychoneurosis. As a rule men are easier to treat than women.

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