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CHAPTER VI

MANIFESTATIONS OF FEAR INSTINCT AND SYMPTOMS OF PSYCHOPATHIC DISEASES

            IF we examine closely the symptoms of fear, we invariably find the symptoms of functional psychosis. Fear affects the muscular and sensory systems, the vasomotor system, the respiratory system, the sudorific glands, the viscera, the heart, the intestines, etc. Bain, in describing the emotions of fear or terror, says “The appearances may be distributed. Terror on the physical side shows both a loss and a transfer of nervous energy. The appearances may be distributed between the effects of relaxation and effects of tension. The relaxation is seen, as regards the muscles, in the dropping of the jaw, in the collapse overtaking all organs not specially excited, in trembling of the lips and other parts, and in the loosening of the sphincters. Next, as regards the organic processes and viscera. The digestion is everywhere weakened; the flow of saliva is checked, the gastric secretion arrested (appetite failing), the bowels deranged; the expiration is enfeebled. The heart and circulation are disturbed; there is either a flushing of the face or a deadly pallor. The skin shows symptoms—the cold sweat, the altered odor of the perspiration, the creeping action that lifts the hair. The kidneys are directly or indirectly affected. The sexual organs feel the depressing influence. The secretion of milk in the mother’s breast is vitiated.”

            Darwin gives the following description of fear: “The frightened man at first stands like a statue motionless and breathless, or crouches down as if to escape observation. The heart beats quickly and violently; but it is very doubtful if it then works more efficiently than usual so as to send a greater supply of blood to the body; for the skin instantly becomes pale, as during incipient faintness. The paleness of the surface, however, is probably in large part or is exclusively due to the vasomotor center being affected in such a manner as to cause the contraction of the small arteries of the skin. That the skin is much affected under the sense of great fear we see in the marvelous manner in which the perspiration immediately exudes from it. This exudation is all the more remarkable as the surface is then cold, and hence the term, a cold sweat; whereas the sudorific glands are properly excited into action when the surface is heated. The hairs also on the skin stand erect, and the superficial muscles shiver. In connection with the disturbed action of the heart the breathing is hurried. The salivary glands act imperfectly; the mouth becomes dry and is often opened and shut. I have also noticed that under slight fear there is a slight tendency to yawn. One of the best symptoms is the trembling of all the muscles of the body. From this cause and from the dryness of the mouth, the voice becomes husky or indistinct, or may altogether fail.”

            If we turn now to the manifestations of psychopathic maladies, we meet with the same symptoms:—

            (a) The attacks may be muscular, involving symptoms such as trembling, shaking, paresis, paralysis, or rigidity; there may be affection of locomotion or of muscular co-ordination.

            (b) There may be sensory disturbances,—anaesthesia, paraesthesia, analgesia, or hyperalgesia, as well as affection of muscular sense and kinaesthesis.

            (c) There may be skin disturbances, such as arrest of perspiration or profuse perspiration, especially under the influence of emotions, worry, and fatigue; such perspiration may also occur at night, and in some cases the fear of tuberculosis may be associated with such conditions.

            (d) The lungs may become affected functionally, and there may occur respiratory disturbances; coughing, hawking, apnea, dyspnea, and asthmatic troubles may result.

            (e) The heart becomes affected, bringing about precordial pain; palpitation of the heart, bradycardia, tachycardia, and cardiac arrhythmia may result.

            (f) The stomach and intestines become affected; indigestion, vague fugitive soreness and pain may be experienced all over or in special regions of the abdomen; constipation or diarrhea may ensue.

            (g) The renal apparatus may become affected and its activity arrested, or, as is more often the case in the milder forms of psychopathic troubles, there may be present an alteration in the amount or frequency of micturition, such as is found in the conditions of anuria and polyuria.

            (h) Menstruation becomes disturbed, and we may meet with conditions of dysmenorrhea, amenorrhea, menorrhagia, and other disturbances of the tubes, ovaries, and uterus.

            (i) There are disturbances of the nervous system, such as headache, and a general dull sensation of fatigue and paresis of all mental functions, with dizziness and vertigo.

            On the mental side we find in the psychopathies the following disturbances:—

            (a) Affections of perceptual activity,—illusions and hallucinations.

            (b) Affections of intellectual activity,—argumenta-tiveness in regard to insignificant things, metaphysical and theological disputations.

           (c) Affections of the moral sense,—scrupulousness, overconscientiousness, not living up to ideal states.

           (d) Affections of religious life,—commission of sins and fear of punishment.

           (e) Affections of social life,—timidity, blushing, etc.

           (f) Affections in regard to objects, such as astrophobia, acmephobia, agoraphobia, claustrophobia, etc.

           (g) Affections of conceptual life,—insistent ideas.

           (h) Affections of the attention,—aprosexia.

           (i) Affections of the will,—states of aboulia and uncontrollable impulses.

            (j) Affections of the memory,—amnesic and paramnesic states.

            (k) General mental fatigue.

            (l) Affections of sexual life,—perversion and inversion.

            (m) Affections in regard to marital relations.

           (n) Affections in regard to personal life,—diffidence, self-condemnation, self-depreciation.

            (o) Affections of apparent loss feeling of self gone.

            (p) Formation of multiple personality.

            In connection with all such psychoneurotic affections we find invariably present a feeling of unrest, of uneasiness, a feeling of anxiety, conscious or subconscious, an anxious feeling of some impending evil. In all such affections we find the brooding spirit of the most powerful of all animal instincts,—the fear instinct.

            All those affections in psychopathic cases are manifestations of fear. They are the symptoms of the fear instinct. Fear, with its consequent feeling of anxiety of some impending evil is the cause of all the symptoms of functional psychosis in general and of somopsychosis in particular. Remove the fear and the symptoms will disappear.

            The fear instinct, revealed by examination of psychogenesis in the case of somopsychosis, becomes still more evident in the case of psychoneurosis. In psychoneurosis the fear protrudes into the upper consciousness. The patient clearly indicates his fears in his account, and one has to be misled with abstruse theoretical considerations not to notice clearly that the whole matter is one of the fear instinct. The patient lays stress on his state of fear by every gesture, attitude, speech, and by his account of his trouble. He comes to the physician with some kind of fear of something, and finally shows fear in general, and asks the physician to assure him that his mind is not giving way, as he is mortally afraid of insanity. Some of the psychoneurotics work themselves up into such a state of excitement that they make arrangements with their relatives and friends to take care of them and stand by them when their mind will succumb. The whole state is one of fear, of intense fear, of frenzy and panic.

            Functional psychosis, both somopsychosis and psychoneurosis, can be reduced to one source,—the fear instinct. The anxiety present in the various forms of psychopathic maladies is the pang of dissolution, the foreshadowing of death-agonies, the agonising fear of dissolution such as is present in cases of angina pectoris. In fact, the fear-paroxysm of functional psychosis is even worse than the death-agony itself. Anxiety is conscious or subconscious fear of pain and suffering, vague as to extent and intensity. In anxiety there is an element of uncertainty. Fears which have their roots deep down in the subconscious are, therefore, specially apt to become feelings of anxiety. Neither inattention, nor disappointments, nor fatigue, physical or mental, nor exhaustion of disease, nor suppression of wishes and desires, nor suppressed and unsatisfied sexual life, nor conflicts, nor shocks of themselves, can ever give rise to psychopathic states. It is only in so far as they become associated with the fear instinct that psychopathic states can arise. The fear instinct is the sole cause of psychopathic affections.

            It may be well to point out here that in neuropsychosis the fear is conscious, or, at any rate, sufficiently clear for the physician to find it out and reveal it to the patient, while in somopsychosis the fear is entirely submerged and subconscious, the somatic symptoms alone constituting the patient's conscious complaint. In psychoneurosis the patient has an inkling of fear in his dread of objects, states of mind, moral scruples, lack of confidence, blushing, religious or social expectations, of some coming misfortune and some mysterious evil, but he is not aware of the fear instinct developed in him by the events and training of early childhood. The fears of early childhood are all subconscious. At any rate, the patient does not connect them with his present mental affection. In somopsychosis the patient is entirely innocent of the whole situation, he is entirely engrossed by the somatic symptoms which he regards as the sum and substance of his trouble, the fear is entirely subconscious.

            The fear instinct fostered by frights, scares, dread of sickness, by religious instruction with its fear of the Lord, moral and religious injunctions, with fear of punishment for failure in the moral standard and duties, the enforcement of social taboos with the consequent dread of failure and degradation, all go to the cultivation of the fear instinct which in later life becomes manifested as somopsychosis or psychoneurosis. All functional psychosis, whether somopsychosis or psychoneurosis, is nothing else but an obsession of the fear instinct, conscious and subconscious.

            The deleterious influence of fear-instinct on the nervous system is well stated by Dr. Crile:

            “It has been shown that the various cases of the discharge of nervous energy produce alterations in the nervous system and probably in the thyroid gland. This is especially true of the fear stimulus, and has been clearly demonstrated in the brains of rabbits which had been subjected to fear alone. Of special interest was the effect of daily fright. In this case the brain-cells showed a distinct change, although the animal had been subjected to no fear for twenty-four hours before it was killed. Now, a great distinction between man and the lower animals is the greater control man has acquired over his actions. This quality of control, having been phylogenetically most recently acquired, is the most vulnerable to various nocuous influences. The result of a constant noci-integration may be a wearing-out of the control cells of the brain. In a typical case of Graves’ disease a marked morphologic change in the brain-cells has been demonstrated. As has been previously stated, the origin of many cases of Graves’ disease is associated with some noci-influence. If this influence causes stimulation of both the brain and the thyroid, its excessive action may cause impairment of the brain and also hyperplasia of the thyroid. As self-control is impaired, fear obtains an ascendency, and, pari passu, stimulates the thyroid gland still more actively. Finally, the fear of the disease itself becomes a noci-stimulus. As the thyroid secretion causes an increase in the facility with which nervous energy is discharged, a pathologic reciprocal interaction is established between the brain and the thyroid. The effect of the constantly recurring stimulus of the noci-influence is heightened by summation. This reciprocal goading may continue until either the brain or the thyroid is destroyed. If the original noci-stimulus is withdrawn before the fear of the disease becomes too strong, and before too much injury to the brain and thyroid has been inflicted, a spontaneous cure may result. Recovery may be greatly facilitated by complete therapeutic rest. A cure implies the return of the brain-cells to their normal state, with the re-establishment of the normal self-control and the restoration of the thyroid to its normal state, when the impulses of daily life will once more have possession of the final common path and the noci-influence will be dispossessed. The discovery of the real cause of a given case of Graves’ disease is frequently difficult because it may be of a painful personal nature. Of extreme interest is the fact that, in the acute stage, the patient may be unable to refer to the exciting cause without exhibiting an exacerbation of the symptoms of the disease. I presume no case should be regarded as cured until reference can be made to its cause without an abnormal reaction. It has been established that in Graves’ disease injury to any part of the body, even under inhalation anesthesia, causes an exacerbation of the disease. Fear alone may cause an acute exacerbation. These acute exacerbations are frequently designated ‘hyperthyroidism,’ and are the special hazard of operation.

            “In applying the principle of anoci-association in operations on patients with Graves' disease there is scarcely a change in the pulse, in the respiration, or in the nervous state at the close of the operation. I know no remedy which can obviate the effect of the inflowing stimuli from the wound after the cocaine has worn off. It is necessary, therefore, not to venture too far in serious cases. Since the adoption of this new method (anoci-association) my operative results have been so vastly improved that now I rarely regard any case of Graves’ disease as inoperable, at least to the extent of contraindicating a double ligation:

            “Average 5 P. M. pulse-rate of ten patients during the first four days after operation:

            “Thus we can understand the variations in the gastric analyses in a timid patient alarmed over his condition and afraid of the hospital. He is integrated by fear and as fear takes precedence over all other impulses, no organ functionates normally. For the same reason, one sees animals in captivity pine away under the dominance of fear.”

            Neurosis may be represented as a fixed ideosensory nucleus, surrounded by a more or less variable network of associations the stability of which increases with the recession from the nucleus to the periphery or marginal fringe of consciousness.

            Fear of strangeness, of unfamiliarity, developed in early childhood, may remain unassociated and thus give rise to a state of vague fear. The instinct, however, may through experience, through some trauma, find for itself an object and become associated with it. “Anxiety, fear, horror,” says Mosso, “will twine themselves perpetually around the memory, like deadly ivy choking the light of reason.” It is the fear instinct, the fundamental instinct of self-preservation, that gives rise to all forms of recurrent mental states, with all their agony, anxiety, despair, and depression. The fear instinct is at the basis of psychopathic diseases. All the symptoms in their infinite variety are so many different manifestations of the one fundamental fear instinct.

            The inner conflict and introspection characteristic of psychopathic troubles, are pathological, solely because of their association with the fear instinct. Mental conflict and introspection never give rise to a mental malady; they are rather favorable to a speculative mind. When, however, introspection and mental conflict are associated with the fear instinct, the result is a psychopathic malady. In the same way a physical sickness in itself, or the thought of suffering, physical or mental, does not give rise to a psychopathic affection. It is only when the sickness, or the thought of disease, becomes associated with the fear instinct, only then does a psychopathic malady arise. The source of psychopathic affections is the fear instinct, a development of which in early childhood predisposes to all forms of psychopathic states.

            Functional psychosis or neurosis is an obsession of the fear instinct, conscious and subconscious. Thus one of my patients became obsessed with fear of tuberculosis, manifesting most of the symptoms of “consumption” after a visit of a tuberculous friend. Another patient became possessed with the fear of death after visiting a sick relative of his in one of the city hospitals. Another became obsessed with the fear of syphilis after having been in contact with a friend who had been under antiluetic treatment. In all these psychopathic fears there was a long history of a well developed subconscious fear instinct, often traced to experiences of early childhood. Take away the fear and the psychosis or neurosis disappears.

            As we have pointed out, according to the investigations of Pavloff, Vasiliev, Babkin, Savadsky, Mishtovt, Orbeli, Sherrington, and others, ideosensory changes initiated in the central nervous system and especially emotional disturbances, bring about extensive motor and circulatory reactions, accompanied by glandular secretions. Recently Schultze has found that glycosuria accompanies fear psychosis, and that the amount of glycosuria present varies with the degree and intensity of depression and fear, reaching its highest amount with the maximum of the fear psychosis. The clinical studies of Raimann, Arndt, and also my own go to confirm the same interrelation. The experiments of Cannon, Shohl, Wright, and de la Paz carried out on animals prove the intimate relation of emotion, and more especially of fear-anger emotions, and stimulation of adrenal secretion; the increased secretion of epinephrine gives rise to glycosuria. The extensive motor reactions, the circulatory disturbances, and especially the stimulations of glandular secretions and their consequent effects on the total systemic reactions of the organism under the influence of the fear instinct form a psychophysiological foundation for the psychopathology of functional psychosis or neurosis.

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