Causation and Treatment of Psychopathic Diseases

THE CAUSATION AND TREATMENT OF PSYCHOPATHIC DISEASES

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

I have formulated the following fundamental principles of psychopathic diseases:

Psychopathic maladies, like sarcomatous and carcinomatous growths, are of an embryonic type, having their genesis in the psychic stroma of early childhood. The genesis of psychopathic diseases can be traced to a pathological germ focus, to a phobo-experience as germinal nucleus round which the fear instinct becomes organized. This pathological focus keeps up the fermentation, development, and growth of the slowly forming psychopathic symptom complex. Psychopathic states are primarily embryonic. The pathogenic germs of the primitive fear instinct are planted in the embryonic mental tissues of early child life. The psychogenesis of neurosis is an embryonic fear instinct.

II. The Principle of Recurrence¹. In the simple life of the child, under the influence of slowly changing environment, the psychopathological system of the aroused fear instinct, formed in early childhood, tends to recur, both in the waking and sleeping states, especially in the intermediate hypnoidal states to which the child is subject, as demonstrated by my observations and experiments.

III. The Principle of Proliferation and Complication. With the gradual change of the environment and with the growth of the child, each recurrence of the fear system tends to an increased proliferation of fear associations. There is a tendency to formation of a complex psychopathic system which grows more complicated with the proliferation of conscious and subconscious associations, and with the ever increasing assimilation of new masses of fear and anxiety experiences, further induced and kept up by worries of a depressing and unfavorable environment. The pathological focus with its organizing fear instinct as substratum brings about an ever greater proliferation and complication with the growing assimilation of psychic contents, forming the psychopathic matrix of the symptom complex.

IV. The Principle of Fusion or of Synthesis. The newly assimilated psychic contents, entering into the slowly forming complex fear system, are at first in a state of confused, incoherent disaggregation and disorganization. With the repetition of the processes of recurrence, proliferation, and complication, the psychic contents become firmly associated, synthesized, and organized into an integral psychic compound with the fear instinct as the main, inner, controlling focus. The psychic contents become fused, synthesized into one complex network of fear obsessions.

V. The Principle of Contrast. Feelings and emotions follow the law of alternation by association of contrast. After an intense, prolonged, and exhausting activity of a complex system with one set of feelings and reactions, another system with a contrasting set of emotions and reactions is brought into function. Thus excitement and passion of emotional pleasure-tone may pass into its opposite of contrasting, disagreeable, painful feeling. Feelings of excitement, passion, and exhilaration may be followed by disgust, nausea, and even vomiting. Such emotional alternation is by some medical men ascribed to fanciful, speculative, anatomical and embryological connections. The principle is essentially central in nature. The particular form of its expression is a matter of central associations formed by experience. The fear instinct becomes attached to the opposed contrast emotions of self-regard, such as love and desire. Fear, though positive and primary, assumes a negative and secondary aspect as non-fulfillment of desire or fear of loss of the object of love.

Psychomotor reactions with contrast feeling tone may be formed by means of voluntary association for the relief or rather for the inhibition of too great tension of unpleasant overexcitement. The law of contrast is characteristic of the mental life of primitive man and of the undeveloped consciousness of the child, as well as of the degenerative, atavistic states of psychopathic diseases. Psychopathic fear compounds with feelings of depression alternate with systems, having as their feeling-tone states of mental exhilaration. This condition gives rise to that mental alternation so typical of psychopathic diseases, closely simulating manic-depressive psychoses.

VI. The Principle of Recession. Child experiences tend to lapse from conscious memory. This tendency is further reinforced by the process of recession, developed in detail in my works. Cognitive states recede from the focus to the periphery of consciousness, but emotional fear reactions to particular, conditional stimuli keep on recurring reflexly, automatically. The receding mental states become marginal and subconscious. Such states, to use a Mendelian term, are recessive. Recessive states recede and fade away from consciousness with each recurrence or reproduction of the symptom complex.

VII. The Principle of Dissociation. Recessive elements and states, becoming marginal and submerged subconsciously, lapse from voluntary control and from recall of conscious memory; they fall outside the dominant conscious life of the individual. The lapsed states are present subconsciously, and can be reproduced in various subconscious conditions, such as hypnotic, hypnoid, hypnoidal, and hypnoidic, a description of which I give in The Symptomatology. Recessive elements and states fall outside the domain of voluntary associations, and as such, they are regarded as dissociated from the patient's personal life activity. Dissociated systems become parasitic, and, like malignant growths, suck the life energy of the affected individual. Under unfavorable conditions and appropriate stimulations these dissociated, parasitic, recessive systems become manifested in later life, giving rise to fully developed symptom complexes of psychopathic states.

VIII. The Principle of Irradiation or of Diffusion. The various factors of recurrence, complication, fusion, contrast, recession, and dissociation tend to neutralization of various characters of life experiences, entering into synthesis of the pathological complex system. The fear emotion becomes devoid of much, if not of all, of the cognitive content of experience. During this stage of the growth of the psychopathic symptom complex the affected individual may for a time appear normal. The pathological condition, however, is subconsciously dormant. Meanwhile, the fear instinct, acting like a fermenting enzyme, keeps on affecting more and more psychic material. Like a malignant tumor, growing by infiltration, the latent, subconscious fear instinct becomes gradually infiltrated, diffused, irradiated throughout the psychic life of the individual, finally giving rise to a general diffused state of apprehension, anxiety, and anguish.

IX. The Principle of Differentiation. With the growth of the child’s personal life and with the further development of cognitive activity the general diffused emotion of the fear instinct with its feeling of anxiety and anguish, either through a series of traumas or through the intensity of a shock, becomes associated with some special object or event in the patient’s present life experience, forming the apparent nucleus of the neurosis, constituting the ultimate fear state. This apparently central nucleus could not possibly of itself evoke all the extensity and intensity of the fear reactions of the psychopathic states, were it not for the great mass of fear systems which lend the last trauma its overwhelming force. The last trauma, however, is but the exciting cause, simply revealing the latent psychosis or neurosis which becomes differentiated along definite lines of mental life.

X. The Principle of Dominance. Ultimate fear states persist in consciousness, becoming amplified and intensified with the unfolding of mental life. Such mental states, normal and abnormal, to use another Mendelian term, are dominant. In many cases, under unfavorable conditions of life and education, the fear experiences of early childhood become reinforced by a series of further traumas, which help the formation and keep up the recurrence of ultimate fear states. The fear instinct, like a malignant growth, expands along lines of least resistance. The dominant systems persist throughout the vicissitudes of life, giving rise to a fully developed somatopsychosis or psychoneurosis.

XI. The Principle of Dynamogenesis. This factor is important in the domain of psychopathology and psychotherapy. It is intimately related to the more general and more fundamental principle of reserve energy, developed independently by Professor James and by myself. A dissociated system of recessive elements, latent and inactive, gathers force, manifesting itself in subconscious eruptions, convulsing the patient’s general life activity. Subconscious systems of recessive states, when called into function, respond to appropriate stimulations with intense psychomotor reactions. The mass of associated systems exercises control on each one of its constituent systems. When a system is dissociated, the control is removed,—it is like a mechanism without its controlling, governing gear, manifesting all its latent energy, giving rise to increased dynamogenesis. The emotion of the fear instinct becomes abnormally intense and uncontrollable.

XII. The Principle of Inhibition. According to the principle of irradiation and fusion, the fear instinct tends to spread and gets diffused throughout the patient’s personality. The fear instinct keeps on oscillating, spreading, changing with age, education, sex, and fluctuations of personal interests, spreading to states farther and farther removed from the original pathological focus with which, however, the states remain firmly associated. The neurosis may thus pass through many stages of metamorphosis with new determinations, but the fear nucleus remains ever the same, gathering more and more energy with each transforming interest. When the fear instinct becomes intense and diffused, it begins to exercise an inhibitive influence on nervous and mental functions. This inhibition by the hypertrophied fear instinct is specially strong on all those functions and systems that enter into the synthesis of the psychopathic aggregate.

XIII. The Principle of Diminishing Resistance. In proportion as the psychopathic condition with its symptom complex keeps on recurring, the pathological system formed, is gaining not only in energy, but also in ease of manifestation. The psychopathic state is evoked at the least occasion. The psychopathological symptom complex emerges at an ever diminishing intensity of stimulation. The influence, the control, the resistance of associative systems, constituting the individuality of the patient, is more and more weakened. The resistance of healthy, normal associations is ever diminishing, until a point is reached when all power of opposition and control is lost. The psychopathological system with its symptom complex gets complete sway over the patient's life, and becomes an uncontrollable, psychopathic obsession.

XIV. The Principle of Metathesis and Control by Modification. In the psychognosis of psychopathic cases I find that in controlling the attack the patient may have recourse to a procedure which may help him in the inhibition of the psychopathic symptom aggregate. The patient is unable to control his psychopathic state by means of reasoning or exhortation, but he awakens another morbid state with accompanying symptoms of a psychopathic character. This awakened psychopathic state changes the trend of mental life with its psychomotor reactions. The old psychopathic state no longer occupies the mental field,—it must give room to another set of associations which may temporarily supplant the old psychopathic aggregate. The patient deliberately and voluntarily brings about various psychomotor conditions which help him to weaken the grip of the insistent psychopathic state. This is accomplished by stimulating a set of sensori-motor processes, accompanied by morbid emotional fear and anxiety states. If the patient worries about certain physical or mental symptoms from which he suffers, he calls forth some other symptoms of disease about which he will worry, or he may induce other sensori-motor reactions with similar feeling tone. The same result may be accomplished by voluntarily inducing ideo-motor states, fear of evil omens, signs, tests, and magic charms, bound up with similar feeling tone, mental states of the same or similar emotional and feeling quality. New fear states are thus formed which temporarily may inhibit or at least modify, for the time being, the old, recurrent, psychopathic state. If the original state be indicated by P, the awakened sensori-motor or ideational processes by S and I respectively, their accompanying psychopathic state by P₁, the resulting mental conditions by P₂, then we may represent the total process, sensory or ideational, by the following formulae: P+S+P₁=P₂ (1), and P+I+P₁=P₂ (2)

The principle of metathesis or of modification is important in the determination of the course of development taken by the psychopathic aggregate. This continuous modification which the patient is forced to take to free himself from the grip of the pathological mental state keeps on extending, enlarging, and changing the pathological aggregate in various directions on ever new lines, giving new fear determinations to the psychopathic manifestations. The symptoms keep on changing, although the fundamental state with its initial experiences remains as the central, controlling nucleus which can only be discovered by a careful psychognosis.

This progressive series of fear determinations of the original psychopathic state makes it impossible for the patient himself to understand the original experience; and to grasp the primitive trend of the psychopathic nucleus in the gradual progressive course of its formation to the time of the acme of its development. A comprehension can only be fully attained by a thorough psychognosis of the case, and by the tracing of the psychopathic state or aggregate to its primordial nucleus. The physician can thus realize the history of the formation of the ultimate fear states constituting the present psychopathic system complex. The revelation of the primitive, psychopathic nucleus unravels the complex skein of mental states, and makes it possible to differentiate the important from the unimportant, the essential from the inessential. This procedure is valuable from a psychotherapeutic standpoint, inasmuch as the finding of the nucleus makes possible its disintegration which in its turn helps the disorganization of the psychopathic aggregate.

This principle of metathesis or of modification may be regarded as a factor in the integration and disintegration of the psychopathic aggregate. The afferent, efferent; and central processes of the aggregate are modifiable². The modifiability, however, is not the same for all the processes. The motor elements are the easiest to change, the sensory, and the glandular reactions with the afferent elements they give rise to are more difficult to modify, while the central, affective, emotional synthesis, being the total product, is the last to be affected. This law of modifiability is of consequence in Psychotherapy. We shall take up the discussion of this subject further on in this work.

The evolution of psychopathic systems follows along these principles. A close psychognosis of psychopathic cases reveals the paramount importance of these psychopathological principles in the life history of the psychopathic aggregate from its germinal stage to its fully developed state of organization. Each case, when closely investigated, clearly reveals these fundamental, psychopathological principles.

¹ The principle of Recurrence is fundamental in Psychology and Psychopathology. Recurrence is a form of reproduction of various types of moments. See The Foundations, Part II.² The development of the psychopathic system on the principle of metathesis follows the evolution of the compound synthetic moment. See The Foundations, Part II.