The following discussion in the form of questions and answers may prove of interest to the physician and to the intelligent layman. The discussion occurred in the course of correspondence. A friend of mine thought the subject of sufficient importance to have it brought to the attention of the medical profession.
The questions are as follows:
"Are not all neuropathic conditions the results of a morbid, unstable nervous organism, the basis of which lies in a faulty heredity?
"Are not weak nerves the cause of hysterical, neurasthenic and neuropathic affections in general?
"Is not all neurosis due to defective parent stock?
"If the occasions for fear, as some psychopathologists claim, were more frequent in primitive times than now, then the cave men must have had more psychopathic affections than civilized man.
"Are religious sectarians justified in their claim that all diseases are nothing but imaginary fears of disease, mere "errors of the mortal mind"?
To these questions the following answers are given:
Psychopathic diseases are not hereditary―they are acquired characteristics, having their origin in the abnormal hypertrophied growth of the fear instinct which is at the root of the primal impulse of self preservation. This is proven by psychopathological studies of clinical cases; and it can be further demonstrated by experimental work in the laboratory even in the case of animals.1 "Weak nerves," "a run down, exhausted nervous system,"' whatever the terms may mean, may overlap psychopathic conditions, but the two are by no means equivalent, much less identical. Psychopathic states are not "weak nerves" or "fatigued nerves." Above all, there is no need to obscure the matter and resort to the much abused, mystical and mystifying factor of heredity. It is easy to shift all blames on former generations, where in most cases the fault is close at hand, namely, a debased environment, a defective training, and a vicious education.
Under the rigorous conditions of primitive life individuals who have been unfortunate and have become affected with mental troubles and emotional afflictions of the fear instinct are mercilessly exterminated by the process of tribal and social selection. Each generation weeds out the individuals who have been unfortunate enough to fall under unfavorable circumstances and have become mentally sick, suffering from acquired psychopathic disturbances. In primitive life the crippled, the maimed, the wounded, the sick fall by the way, and are left to perish a miserable death. In fact, the less fortunate, the wounded and the stricken in the battle of life, are attacked by their own companions―they are destroyed by the ruthless social brute. The gregarious brute has no sympathy with the pains and sufferings of the injured and the wounded. The faint and the ailing are destroyed by the herd.
Civilization, on the other hand, tends more and more towards the preservation of psychopathic individuals. We no longer kill our sick and our weak, nor do we abandon them to a miserable, painful death―we take care of them, and cure them. Moreover, we prevent pathogenic factors from exercising a harmful, malign social selection of the "fit." We do our best to free ourselves from the blind, merciless, purposeless selection, produced by pathogenic microorganisms and by other noxious agencies. "We learn to improve the external environment.
We do not condemn people to death because they are infected with smallpox, typhus, typhoid bacilli, or because of an infected appendix. We no longer regard them as sinful, unclean, accursed and tabooed. We vaccinate, inoculate, operate, and attempt to cure them. By sanitary and prophylactic measures we attempt to prevent the very occurrence of epidemics. Our valuation of individuals is along lines widely different from those of the stone age and the cave man. We value a Pascal, a Galileo, a Newton, a Darwin, a Pasteur, and a Helmholtz far above a Milo of Croton or an African Johnson.
Civilization is in need of refined, delicate and sensitive organizations, just as it is in need of galvanometers, chronometers, telephones, wireless apparatuses, sensitive plates, and various chemical re-agents of a highly delicate character. We are beginning to appreciate delicate mechanisms and sensitive organizations. We shall also learn to train and guard our sensitive natures until they are strong and resistant the incident forces of an unfavorable environment. The recognition, the diagnosis, and the preservation of psychopathic individual account for the apparent increase of neurotics in civilized communities.
It may be well to add that, although the occasions for sudden, intense, overwhelming fears are not so prevalent in organized societies as they are in primitive savage communities, the worries the anxieties, the various forms of slow grinding fears of a vague, marginal subconscious character, present in commercial and industrial nations, are even more effective in the production of psychopathic states than are the isolated occasions of intense frights in the primitive man of the paleolithic or neolithic periods.
A brief outline of the classification of nervous and mental diseases, made by me in my various works, may be of help towards a clear understanding of the etiology and differential diagnosis of the neurotic affections under discussion.
The different forms of nervous and mental diseases may be classified into Organic and Functional.
By organic affections we mean to indicate pathological modifications of the neuron and its processes taking place in the very structure (probably the cytoreticulum) of the nerve cell. Under this category come such maladies as general paresis, dementia pręcox, all mental and nervous affections of a degenerative and involutionary character. Such diseases are termed by me Organopathies, or Necropathies.
By functional affections we mean to indicate all neuron changes in which the functions of the neuron and its reactions to external and internal stimulations are involved in the pathological process without, however, affecting the anatomical structure of the nerve cell. The psychological changes are not permanent recovery of normal function is possible with the restitution of favorable conditions of nutrition and elimination.
Functional nervous and mental diseases are in turn subdivided into Neuropathies and Psychopathies.
Neuropathic diseases are disturbances of functioning activity, due to defective neuron metabolism, brought about by external stimuli, and more specially by harmful internal stimuli-glandular secretions, hormones, toxic and autotoxic agencies. The pathological, neuropathic process produces few, if any, anatomical changes in the structure of the neuron. The pathology of neuropathic diseases (probably of the cytoplasm) is essentially chemico-physiological in nature.
Neuropathic diseases include maladies in which the neuron undergoes degenerative changes which at first may bring about an apparent increase, then an inhibition, and finally a complete suspension of neuron function, not terminating in the destruction of the neuron. Neuron restitution is possible. Such affections are produced by poisons, organic or inorganic, by auto toxic products, by hyposecretion or hypersecretion, or total absence of hormones in the economy of the organism. Here belong all the temporary, or recurrent maniacal, melancholic, and delusional states, puerperal mania, epileptic insanity, the mental aberrations of adolescent and climacteric periods, periodic insanity, alternating insanities, and in general all the mental affections at present known under the description of manic-depressive insanity.
Where the disease depends not so much on the neuron itself as on the interrelation or neurons in a complex system, on association of systems of neurons, the condition is psychopathic in nature. In psychopathic troubles the neuron itself may remain unaffected, may be perfectly normal and healthy. The disorder is due to associations with systems of neurons which are usually not called into action by the function of that particular neuron or neuron system.
By Organopathies or Necropathies we indicate a group or psychophysiological symptoms accompanied by structural, necrotic changes of the neuron, terminating in the ultimate death of the neuron systems involved in the pathological process.
By Neuropathies we indicate a group of psychophysiological manifestation due to pathological functional neuron modifications, capable of restitution thru a more perfect, more normal metabolism.
By Psychopathies we designate pathological phenomena of psychophysiological dissociation and disaggregation of neuron systems and their functions in clusters, the neuron itself and its special function remaining undamaged and untouched.
The psychopathies are further subdivided into: Somopsychoses (Somatopsychoses) and Psychoneuroses or Neuropsychoses.
The Somopsychoses are characterized by somatic symptoms, by disturbances of bodily functions, such as paralysis, contractures, convulsions, anesthesia, analgesia, hyperalgesia, and other sensory disturbances, as well as by intestinal, cardiac, respiratory and genito-urinary affections.
The Psychoneuroses or Neuropsychoses are characterized by mental symptoms. The patient's whole mind is occupied with mental troubles. Such conditions are found in all obsessions, fixed ideas, imperative impulses, emotional compulsions, and other allied mental and ncryous maladies.
The somopsychoses simulate physical and organic nervous troubles. Thus, many "hysterical" forms simulate tabes, or paralysis agitans, hemiplegia, paraplegia, or epilepsy, while many of the neurasthenic, hypochondriacal, and their allied states simulate tumor or cancer of the stomach, intestinal obstructions and glandular derangements; cardiac, laryngeal, pneumonic, hepatic, splanchnic, ovarian, tubal, uterine, renal, and hundreds of other bodily afflictions.
The neuropsychoses or psychoneuroses simulate all forms of mental disease, beginning with melancholia and mania and en1ingwith general paresis and dementia.
Psychoneurosis and Somopsychosis are diseases of the subconsciousness, in the one the mental, in the other the physical symptoms predominate.
Psychopathic states should be rigidly differentiated from all other neuroscs and psychoses, such as ncuropathies and organopathies or necropathics. (See my Symptomatology, Ch. XI.)
The classification of nervous and mental diseases may be represented by the following diagram:
In my works I lay special stress on the fact that the psychopathic individual has a predisposition to dissociative states. Early experiences and training in childhood enter largely into the formation of such a predisposition. Still, there is no doubt that a sensitive nervous system is required―a brain susceptible to special stimuli of the external environment. This, of course, does not mean that the individual must suffer from stigmata of degeneration. On the contrary, it is quite possible, and in many patients we actually find it to be so, that the psychopathic individual may be even of a superior organization. It is the sensitivity and the delicacy of nervous organization that make the system susceptible to injurious stimulations to which a lower form of organization could be subjected with impunity. An ordinary clock can he handled roughly without disturbance of its internal workings, but the delicate and complicated mechanism of a chronometer requires careful handling and special, favorable conditions for its normal functioning. Unfavorable conditions are more apt to affect a highly complex mechanism than a roughly made instrument. It is quite probable that it is the superior minds and more highly complex mental and nervous organizations that are subject to psychopathic states or to states of dissociation. Of course, unstable minds are also subject to dissociative states, but we must never forget the fact that highly organized brains, on account of their very complexity, are apt to become unstable under unfavorable conditions. A predisposition to dissociation may occur either in degenerative minds or in minds superior to the average. Functional psychosis requires a long history of dissociated, subconscious shocks given to a highly or lowly organized nervous system dating back to early childhood.
As Mosso puts it: "The vivid impression of a strong emotion may produce the same effects as a blow on the head or some physical shock." We may, however, say that no functional psychosis, whether somopsychosis or psychoneurosis, can ever be produced simply by physical shocks. In all functional psychoses there must be a mental background, and it is the mental background alone that produces the psychosis and determines the character of the psychopathic state."
Fear is an important factor only in the etiology of psychopathic affections which include the somatopsychoses (or somopsychoses) and psychoneuroses.
To regard fear as "mortal error," as do some ignorant and deluded sectarians, is absurd, and is certainly unscientific. Abnormal fear, which is the basis of all functional nervous or psychopathic maladies, is essentially a pathological process affecting the organs in general and the nervous system in particular in as definite a way as the invasion and infection of the organism by various species of bacteria, bacilli, and other microorganisms which attack the individual during his lifetime.
Like infectious diseases, the deviations, abnormalities, and excesses of the fear instinct are acquired by the individual in the course of his relations with the external environment, and are as real and substantial as are syphilis, smallpox, diphtheria, cholera and the bubonic plague. To regard them as imaginary or to relegate them to the action of Providence or to heredity is theoretically a misconception, and practically a great danger to humanity.
There is nowadays a veritable craze for heredity and eugenics. Biology is misconceived, misinterpreted, and misapplied to social problems, and to individual needs and ailments. Everything is ascribed to heredity, from folly and crime to scratches and sneezes. The goddess Heredity is invoked at each flea-bite―in morsu pullicis Deum invocare. Even war is supposed to be due to the omnipotent deity of Heredity. Superior races by their patriotism and loyalty destroy the weak and the helpless, and relentlessly exterminate all peaceful tribes. Such warlike stock comes of superior clay. The dominant races have some miraculous germ-plasm (chromatin) with wonderful dominant Hunits" (chromosomes) which, like a precious heritage, these races transmit unsullied and untarnished to their descendants. Wars, carnage, butcheries make for progress, culture and evolution. Our boasted civilization with its "scientific" business thoroughness and its ideal of "efficiency" attempts to carry into effect this quasi-evolutionary doctrine―this apotheosis of brute force under the aegis of science. The eugenic belief is really a recrudescence of the ancient savage superstition of the magic virtues of noble blood and of divine king stock.
All nervous, mental, neuropathic, and psychopathic maladies are supposed to be a matter of heredity. If people are poor, ignorant, superstitious, stupid, degraded, brutal and sick, the eugenists unhesitatingly put it all up to poor stock. The eugenic remedy is as simple as it is believed to be efficacious: Introduce by legislation "efficient" laws favoring "eugenic" marriage, and teach the masses control of births. The select and chosen stock alone should multiply―the millennium is then bound to come. Such is the doctrine of our medico-biological sages.
"Scientific" farmers and breeders of vegetables, fruits, and cattle are regarded as competent judges of human "breeders." Agriculturists and horticulturists set themselves up as advisers in "the business of raising good crops of efficient children." Bachelors, spinsters, and the childless generally, are specially versed in eugenic wisdom and pedagogics. All social ills and individual complaints are referred to one main source―heredity. With the introduction of eugenic legislation, with the sterilization of the socially unfit, among whom the greatest men and women may be included, with the breeding of good "orthodox, common stock," and with the eugenic Malthusian control of births all evil and disease on earth will cease, while the Philistine "superman" will reign supreme for evermore.
In the Middle Ages all diseases and epidemics, all wars, all social and private misfortunes were considered as visitations of Divine wrath. In modern times our would-be eugenic science refers all ills of the flesh and woes of the mind to an outraged Heredity. The dark ages had resort to prayers, fasts, and penitence, while our age childishly pins its faith to the miraculous virtues and rejuvenating, regenerative powers of legislative eugenic measures, and to the eugenic Malthusian control of births.
Our scientists in eugenics gather hosts of facts showing by elaborate statistical figures that the family history of neurotics reveals stigmata of degeneration in the various members of the family. The eugenic inquirers do not stop for a moment to think over the fact that the same sort of evidence can be easily be brought the case of most people. In fact; the eugenists themselves, when inquiring into the pedigree of talent and genius, invariably find somewhere in the family some form of disease or degeneration. This sort of "scientific" evidence leads some eugenic speculators, without their noticing the reductio ad absurdum to the curious conclusion or generalization that degeneration is present in the family history of the best and the worst representatives of the human race.
The so-called scientific method of the eugenists is radically faulty, in spite of the rich display of colored plates, stained tables, glittering biological speculations, brilliant mathematical formulae and complicated statistical calculations. The eugenists pile Ossa on Pelion of facts by the simple method of enumeration which Bacon and the thinkers coming after him have long ago condemned as puerile and futile. From the savage's belief in sympathetic, imitative magic with its consequent superstitions, omens, and taboos down to the articles of faith and dogmas of the eugenists we find the same faulty, primitive thought, guided by the puerile, imbecile method of simple enumeration, and controlled by the wisdom of the logical post hoc, ergo propter hoc. What would we say of the medical man who should claim that measles, mumps, cholera, typhoid fever, yellow fever, malaria, tetanus, and various other infectious diseases are hereditary by quoting learnedly long tables of statistics to the effect that for several generations members of the same family suffered from the same infectious diseases? What would we say of the medical advice forbidding marriage to individuals whose family history reveals the presence of exanthemata? We stamp out epidemics not by eugenic measures but by the cleansing of infectious filth and by the extermination of pathogenic microganisms.
Every human being has a predisposition to smallpox, cholera, smallpox, bubonic plague, typhus fever, malaria, and to like infectious diseases, but there is no inherent necessity for everyone to fall a victim to the action of pathogenic organisms, if the preventive and sanitary conditions are good and proper. No one is immune against the action of bullets, cannon balls, shells, and torpedoes, or to the action of various poisons, organic and inorganic, but one is not doomed to be killed by them, if one does not expose himself to their deadly action. Every living organism is by the very nature of its cellular tissues predisposed to the wounding by sharp instruments, or to the burning action of fire, but this does not mean an inherent organic weakness to which the organism must necessarily submit and perish. We are all of us predisposed to get injured and possibly killed, when we fall down from a high place, or when we are run over by an automobile or by a locomotive, but there is no fatalistic necessity about such accidents, if care is taken that they should not occur.
We may he predisposed to neurosis by the very nature of complexity, delicacy, and sensitivity inherent in the structure of a highly organized nervous system, and still we may remain healthy and strong all our life long, provided we know how to keep away from noxious agencies. The creed of the inevitable fatality of neurosis is as much of a superstition as the Oriental belief in the fatalism of infectious diseases, plagues, and accidents of all kinds. Such fatalistic superstitions are dangerous, fatal, because they distract the attention from the actual causes and from the requisite prophylactic measures.
We go far afield in search for the remote source of our troubles, when the cause is close at hand. We need only open our eyes to see the filth of our towns, the foul, loathsome slums of our cities, the miserable training, the wretched education given to our children, in order to realize at a glance the source of our ills and ailments. We should lay the guilt at the door of our social order. We starve our young. We starve our children physically and mentally. We piously sacrifice our tender children and the flower of our youth to the greedy, industrial Moloch of a military, despotic, rapacious plutocracy. Witness semi-civilized Europe with its lauded culture brutally shedding the blood of its youth and manhood on the altar of commercial patriotism! It is not heredity, it is the vicious conditions of life that stunt the physical, nervous, and mental growth at our young generation. When we are confronted with the miserable, degraded, crippled forms of our life, we fall back cheerfully on some remote grandparent and credulously take refuge in the magic panacea of eugenics.
The practical aspect is clear. Psychopathic neurosis in its two varieties, Somatopsychosis (Somopsychosis) and Psychoneurosis, is not hereditary, but acquired. We should not shift the blame on former generations and have resort to eugenics, but we must look to the improvement of mental hygienic conditions of early childhood, and to the proper education of the individual.
It is easy to put the blame on grandparents―they are dead and cannot defend themselves. Could they arise from their graves, they could tell some bitter truths to their degenerate descendents who are so ready to shift responsibility to other people's shoulders. It is about time to face the truth fairly and squarely a truth which is brought out by recent investigations in psychopathology, that no matter where the fons et origo of neurosis be, whether in self-preservation and its accompanying fear instinct, the condition of life primordial, or in other forms of self-preservation, the formation of psychopathic neurosis with all its characteristic protean symptoms, is not hereditary, but acquired. Neurosis arises within the life cycle of the individual, it is due to faulty training and harmful experience of early child life.
Future medicine will be largely prophylactic, preventive, sanitary, hygienic, dietetic. What holds true of medicine in general holds true of that particular branch of it that deals with neurosis. The treatment will become largely prophylactic, preventive, educational, or pedagogic. It is time that the medical and teaching professions should realize that functional neurosis is not congenital, not inborn, not hereditary, but is essentially the result of a defective education in early child life.
1. Sidis. The Causation and Treatment of Psychopathic Diseases.