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CHAPTER V

THE FEAR INSTINCT AND PSYCHOPATHIC STATES

            THE fear instinct is the soil on which grow luxuriantly the infinite varieties of psychopathic affections. The body, sense, intellect, and will are all profoundly affected by the irresistible sweep of the fear instinct as manifested in the overwhelming feeling of anxiety. The fear instinct and its offspring-anxiety—weaken, dissociate, and paralyze the functions of the body and mind, giving rise to the various symptoms of psychopathic diseases. The fear instinct keeps on gnawing at the very vitals of the psychopathic patient. Even at his best the psychopathic patient is not free from the workings of the fear instinct, from the feeling of anxiety which, as the patients themselves put it, “hangs like a cloud on the margin or fringe of consciousness.” From time to time he can hear the distant, threatening rumbling of the fear instinct. Even when the latter is apparently stilled the pangs of anxiety torment the patient like a dull toothache.

            Montaigne, the great anatomist of human passions, in writing of fear, says, “I am not so good a naturalist (as they call it) as to discern by what secret springs fear has its motion in us; but be this as it may, it is a strange passion, and such a one as the physicians say there is no other whatever that sooner dethrones our judgment from its proper seat; which is so true, that I myself have seen very many become frantic through fear; and even in those of the best settled temper, it is most certain that it begets a terrible astonishment and confusion during the fit. I omit the vulgar sort, to whom it one while represents their great-grandsires risen out of their graves in their shrouds, another while hobgoblins, specters, and chimeras; but even among soldiers, a sort of men over whom, of all others, it ought to have the least power, how often has it converted flocks of sheep into armed squadrons, reeds and bull-rushes into pikes and lances, and friends into enemies. . . . adeo pavor etiam auxilia formidat. . . . The thing in the world I am most afraid of is fear, that passion alone, in the trouble of it, exceeding all other accidents . . . . . Tum pavor sapientiam omnem mihi ex animo expectorat. Such as have been well banged in some skirmish, may yet, all wounded and bloody as they are, be brought on again the next day to the charge; but such as have once conceived a good sound fear of the enemy will never be made so much as to look the enemy in the face. Such as are in immediate fear of losing their estates, of banishment or of slavery, live in perpetual anguish, and lose all appetite and repose; whereas such as are actually poor, slaves or exiles, ofttimes live as merrily as other folks. And the many people who, impatient of perpetual alarms of fear, have hanged or drowned themselves, or dashed themselves to pieces, give us sufficiently to understand that fear is more importunate and insupportable than death itself.”

            In the present fearful war of European nations against the pressure of invasion by Teutons and their allies, a war unparalleled in the history of humanity for its extensive, brutal destructiveness, a war in which all the inventions of ages are made subservient to the passions of greed, hatred, and ferocity, having one purpose, the extermination of man, a war surpassing all battles ever waged by man or beast, in such a calamitous clash and slaughter of nations, the fear instinct comes to the foreground, claiming its victims, working havoc among the frenzied, struggling armed masses and terrified, stricken populations.

            That fear is a fundamentally important element in neuroses and psychoses has been fully acknowledged by many a neurologist and psychiatrist. Thus, Oppenheim says, “Fear is a common symptom in the neuroses. It may be an indefinite feeling of anxiety not awakened by any particular cause, or it may be definite concepts and external influences which call the fear into action. The sensation is variously described. It has its seat, as a rule, in the cardiac region, at other times in the head. The patient feels as if his heart were standing still; he thinks that he must fall or that he will get a stroke. Some explain the condition thus: ‘It seems to me that I have done something wrong, as if something terrible is going to happen.’ The expression of the face reveals a condition of anxiety, the fear often producing vasomotor, secretory, and motor disturbances; the face reddens or becomes pallid, perspiration breaks out, the saliva ceases to flow, the lips and tongue become dry, the pulse and respiration become accelerated.”

            “A materially different picture,” says Kirchoff, “is presented when the feeling of fear enters the symptom group (of melancholia). This feeling is referred to the cardiac region (precordial fear), and is one of the most important and frequent accompaniments of severe melancholia. The external quiet of severe simple melancholia becomes converted into anxious restlessness. From the start sleep is almost always disturbed because the patient is tormented by the pressure in the cardiac region. Other disagreeable sensations soon follow, such as constriction of the neck or a dull feeling in the head; bad dreams and anxious thoughts become more numerous. The daily work may make the condition endurable during the day for a time, but in the stillness of the night it is rapidly intensified, and if sleep does not refresh the excited brain, the days likewise are filled more and more with disheartening fears. The implication of the organs of the body is much more distinct in anxious than in simple melancholia. The appetite is lost, the nutrition is rapidly impaired. Respiration is superficial, the heart's action is accelerated and often irregular, the pulse is small, the skin is cool. When the terror shows variations or occurs in paroxysms, its increase is shown by suppression of the urine and perspiration, its subsidence by increase in these secretions. The more chronic the precordial fear the more indistinct do these symptoms become. . . . Religious notions are often awakened and are then explained as the dread of being possessed by evil spirits. . . . In more severe cases the internal life becomes a real dreamy condition in which external expressions are received in a confused, shadowy and inimical manner. A terrible, baseless, but paralyzing fear takes possession of consciousness.” The anxiety states of neurosis and psychosis are essentially due to the awakening of the fear instinct normally present in every living being. The fear instinct is a fundamental one; it is only inhibited by the whole course of civilization and by the training and education of social life. Like the jinn of the “Arabian Nights,” it slumbers in the breast of every normal individual, and comes fully to life in the various neuroses and psychoses.

            Kraepelin and his school lay, with right, special stress on the fact that “Fear is by far the most important persistent emotion in morbid conditions. . . . Fear is manifested by anxious excitement and by anxious tension.” “Experience,” says Kraepelin, “shows an intimate relationship between insistent psychosis and the so-called ‘phobias,’ the anxiety states which in such patients become associated with definite impressions, actions, and views.” They are associated with the thought of some great unknown danger, although the patient may be aware that in reality nothing of the kind will befall him. Violent heart action, pallor, a feeling of anxiety, tremor, cold sweat, meteorismus, diarrhea, polyuria, weakness in the legs, attacks of fainting, so that the patient loses control of his limbs and occasionally simply collapses. “These states,” says Kraepelin, with his usual insight into abnormal mental life, “remind one of the feeling of anxiety which in the case of healthy people may in view of a painful situation or of a serious danger deprive one of the calmness of judgment and confidence in his movements.” Thus, we find from different standpoints that the feeling of anxiety with all its accompanying phenomena is one of the manifestations of the most fundamental, the most potent, of animal instincts, the fear instinct which is at the basis of all psychopathic maladies.

            The fear instinct, as the most subtle and most fundamental of all instincts, is well described by Kipling:—

            A well known author, a psychopathic sufferer, writes:

            “Carlyle laid his finger upon the truth, when he said that the reason why the pictures of the past were always so golden in tone, so delicate in outline, was because the quality of fear was taken from them. It is the fear of what may be and what must be that overshadows present happiness; and if fear is taken from us we are happy. The strange thing is that we cannot learn not to be afraid, even though all the darkest and saddest of our experiences have left us unscathed; and if we could but find a reason for the mingling of fear with our lives, we should have gone far towards solving the riddle of the world.”

            Dr. Crile lays special stress on the pathological aspect of the fear instinct:

            “That the brain is definitely influenced—damaged even—by fear has been proved by the following experiments: Rabbits were frightened by a dog but were neither injured nor chased. After various periods of time the animals were killed and their brain-cells compared with the brain-cells of normal animals—wide-spread changes were seen. The principal clinical phenomena expressed by the rabbit were rapid heart, accelerated respiration, prostration, tremors, and a rise in temperature. The dog showed similar phenomena, excepting that, instead of such muscular relaxation as was shown by the rabbit, it exhibited aggressive muscular action. Both the dog and the rabbit were exhausted but, although the dog exerted himself actively and the rabbit remained physically passive, the rabbit was much more exhausted.

            “Further observations were made upon the brain of a fox which had been chased for two hours by members of a hunt club, and had been finally overtaken by the hounds and killed. Most of the brain-cells of the fox, as compared with those of a normal fox, showed extensive physical changes.

            “The next line of evidence is offered with some reservation, but it has seemed to me to be more than mere idle speculation. It relates to the phenomena of one of the most interesting diseases in the entire category of human ailments―I refer to exophthalmic goiter, or Graves’ disease, a disease primarily involving the emotions. This disease is frequently the direct sequence of severe mental shock or of a long and intensely worrying strain. The following case is typical: A broker was in his usual health up to the panic of 1907; during this panic his fortune and that of others were for almost a year in jeopardy, failure finally occurring. During this heavy strain he became increasingly nervous and by imperceptible degrees there developed a pulsating enlargement of the thyroid gland, an increased prominence of the eyes, marked increase in perspiration—profuse sweating even—palpitation of the heart, increased respiration with frequent sighing, increase in blood-pressure; there were tremor of many muscles, rapid loss of weight and strength, frequent gastro-intestinal disturbances, loss of normal control of his emotions, and marked impairment of his mental faculties. He was as completely broken in health as in fortune. These phenomena resembled closely those of fear and followed in the wake of a strain which was due to fear.”

            Animals in which the fear instinct can be aroused to a high degree become paralyzed and perish. Under such conditions the fear instinct not only ceases to be of protective value, but is the very one that brings about the destruction of the animal obsessed by it. “One of the most terrible effects of fear,” says Mosso, “is the paralysis which allows neither of escape nor of defense.” The fear instinct is no doubt one of the most vital of animal instincts, but when it rises to a high degree of intensity, or when it is associated with familiar and useful objects instead of strange and harmless objects, then we may agree with the great physiologist, Haller, that the phenomena of fear are not aimed at the preservation, but at the destruction of the animal, or as Darwin puts it, are of “disservice to the animal.” This is just the condition found in psychopathic diseases. The fear instinct becomes aroused in early life and cultivated by training, education, and environment, becoming associated in later life with particular events, objects, and special states.

            When the instinct of fear is aroused in connection with some future impending misfortune, the feeling of expectation and all its psychological changes, muscular, respiratory, cardiac, epigastric, and intestinal, go to form that complex state of anxiety and anguish, so highly characteristic of acute varieties of psychopathic disease. When fear reaches its acme, the heart is specially affected, the circulatory and respiratory changes become prominent, and give rise to oppression and depression which weigh like an incubus on the patient—the feeling known as “precordial anxiety.”

            The fear instinct is the ultimate cause of the infinite varieties of psychopathic diseases.

            Stanley Hall seems to accept this view of the subject. In his recent paper on Fear, he writes: “If there be a vital principle, fear must be one of its close allies as one of the chief springs of the mind. . . ” In spite of his former “psychoanalytic” inclinations, Professor Hall now asserts that "Freud is wrong in interpreting this most generic form of fear as rooted in sex. . . Sex anxieties are themselves rooted in the larger fundamental impulse of preservation of life with its concomitant instinct of fear.” This is the etiology on which I laid stress in my papers and works on the subject of psychopathic diseases. So deeply convinced is Professor Stanley Hall of the primitive and fundamental character of the fear instinct, that he refers to the facts that “if the cerebrum is removed, animals, as Goltz and Bechterev have proved, manifest very intense symptoms of fear, and so do human monsters born without brains, or hemicephalic children, as Sternberg and Lotzko have demonstrated.”

            Oppenheim, Kirchoff, Kraepelin, and recently other psychologists and neurologists of note all concur that fear is a fundamental factor in the pathology of neurosis. As physicians, we must remember the importance of fear in cases of surgical shock.

            So potent, all embracing, and all pervading is the fear instinct, that the physician must reckon with it in his private office, in the hospital, and in the surgical operating room.

            “The acute fear of a surgical operation” Crile writes, “may be banished by the use of certain drugs that depress the associational power of the brain and so minimise the effect of the preparations that usually inspire fear. If, in addition, the entire field of operation is blocked by local anesthesia so that the associational centers are not awakened, the patient will pass through the operation unscathed.”

            In a number of my cases psychognosis clearly reveals the fact that even where the neurosis has not originated in a surgical trauma, surgical operations reinforced, developed, and fixed psychopathic conditions.

            The fear instinct arises from the impulse of self-preservation without which animal life cannot exist. The fear instinct is one of the most primitive and most fundamental of all instincts. Neither hunger, nor sex, nor maternal instinct, nor social instinct can compare with the potency of the fear instinct, rooted as it is in self preservation,—the condition of life primordial. When the instinct of fear is at its height, it sweeps before it all other instincts. Nothing can withstand a panic. Functional psychosis in its full development is essentially a panic. A psychogenetic examination of every case of functional psychosis brings one invariably to the fundamental fear instinct. Fear is the guardian instinct of life. The intensity of the struggle for existence, the preservation of life of the animal, is expressed in the instinct of fear. The fear instinct in its mild form, when connected with what is strange and unfamiliar, or with what is really dangerous to the animal, is of the utmost consequence to life.

            What is strange and unfamiliar may be a menace to life, and it is a protection, if under such conditions the fear instinct is aroused. It is again of the utmost importance in weak animals, to have the fear instinct easily aroused by the slightest strange stimulus; the animal is defenseless, and its refuge, its safety, is in running. The unfamiliar stimulus may be a signal of danger, and it is safer to get away from it; the animal cannot take chances. On the other hand, animals that are too timid, so that even the familiar becomes too suspicious, cannot get their food and cannot leave progeny,—they become eliminated by the process of natural selection. Even in weak animals an intensified state of the fear instinct becomes biologically abnormal, pathological.

            The fear instinct is abnormally developed in psychopathic disturbances. Harmful stimuli or expectation of danger to themselves, to their family, or to friends may arouse the feelings of anguish, anxiety, worry, manifestations of the fear instinct. Objects, thoughts, stimuli, situations, and events of expected danger may keep on changing, persisting for a longer or shorter time, but the underlying pathological state of the fear instinct remains, easily fusing with experiences of possible danger to all included within the circle of the patient's self-regard.

            Events or situations with fixed sensory stimuli, when repeated, fix the neurosis, very much in the same way as are the “conditional reflexes” in Pavloff’s experiments. Other sets of stimuli of an ideational character are transient in duration, while the general, apprehensive, subconscious condition persists unchanging to seize again and again on ever new objects and thoughts, forming psychic compounds of various degrees of stability.

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