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SYMPTOMATOLOGY, PSYCHOGNOSIS, AND DIAGNOSIS OF PSYCHOPATHIC DISEASES
Boris Sidis, Ph.D., M.D.
Boston: R. Badger, 1914
FIXED IDEAS, MORBID IMPULSES, AND EMOTIONS
HERE is a form of mental derangement to which the term imperative concepts or insistent ideas is applied. From some subconscious source, unknown to the patient, an idea rises into consciousness with a persistency which the patient cannot overcome. Thus a number or a sentence may repeatedly and at various times force itself into the mind of the subject. The person may be engaged in some entirely different thought when suddenly this idea or concept forces itself into the mind and crowds out all others. This is usually a source of great discomfort and inconvenience to the patient, as it interferes greatly with his mental activity.
These forms of mental disturbances may in otherwise mentally normal persons, but especially in those of neurotic predisposition. pathology consists in the dissociation of a persistent well organized system, present in the subconscious and then coming into consciousness in the form of a state more or less hypnoid or hypnoidal in character.
Morbid impulses are uncontrollable manifestations of affective, ideo-motor states. An unaccountable impulse to do a certain thing suddenly takes possession of the patientís mind, an impulse which may be so overwhelming that restraint is almost impossible. The impulse as soon as it appears in consciousness may immediately pass into action. It is a form of emotional automatism. Thus a patient confined in an asylum met an attendant with whom he was on pleasant relations. The patient at once and without reason or warning suddenly struck the attendant a blow, felling him to the ground. The patient immediately after expressed great regret and sorrow at his deed. The impulse to strike was simply irresistible.
Morbid impulses are of the nature of hypnonergic states, or of post-hypnotic suggestion. Like the latter, they consist in a dissociation of ideo-motor systems from the upper consciousness, but present to the subconscious. They may emerge at regular or irregular intervals and work themselves out automatically. Morbid impulses differ from hypnonergic or post-hypnotic states, manifested in the hypnotic subject and in different forms of psychopathies, in that they are better organized, more persistent, and usually of a character harmful to the patient or his social environment.
To this class also belong the phenomena of automatism sometimes termed imperative movements. The movements are often automatic, the consciousness accompanying them is disconnected from the general stream of consciousness. The patient may be conscious of what he is doing, but continues the same movement over and over. Thus some will move in a certain direction, as in a circle or in a certain figure; others will repeatedly walk to and fro, others move their lips, etc. Similar movements are sometimes found in idiots and imbeciles. Imperative, automatic, subconscious movements occur in hypnonergic states and also in the different forms of psychopathic states.
Under morbid emotional states may be classed all those states in which an apparently unaccountable emotion appears, not adapted to the particular, external environment. Some of these states may be revivals of primitive emotions, adapted to a former environment. Most of such morbid emotional states, however, are due to experiences, often traced to early childhood, experiences which have become dissociated from the upper consciousness and formed into a stable, well organized system, emerging from the subconscious under certain conditions. Such states usually occur in those of neurotic predisposition and under circumstances which favor such a dissociation.
In agoraphobia there is an intense and apparently unaccountable anxiety when remaining in an open space, or in an open square. The anxiety may become so great that the patient becomes almost paralyzed and unable to move. This state some consider as an atavistic, racial, subconscious manifestation, dating to the time when anthropoid ape was living in a forest and for safety avoiding open places. A similar condition we find in wild animals and even in the domesticated cat. The cat always avoids open spaces, seeks to remain near a hedge or fence when she goes about. It can, however, be shown that the phobia is due to some association formed in early childhood.
Claustrophobia consists in a morbid anxiety of remaining in closed places, such as a small room or closed vehicle. This state some consider as being atavistic in its nature, and going back to the time when primitive man or animals lived in caves having many exits for their escape. It can, however, be proven that claustrophobia, like agoraphobia, is due to subconscious experiences of early childhood.
We not infrequently find in the lower classes of European or Asiatic populations a fear of entering into dark, deserted places, or uninhabited houses or passing through a graveyard at night, on account of associations formed in childhood about ghosts and spirits. This is true not only of superstitious persons, but also of the highly educated who in daylight ridicule the superstition, but when in darkness are unable to overcome their intense emotion.
Various terms have been applied to these morbid fears, and the number of phobias may be endless, pertaining to all sorts of ideas. Among the most common beside those above mentioned, are phobia or fear of heights, monophobia, fear of solitude, misophobia or fear of contamination, or defilement, aichmophobia or fear of sharp objects, crystallophobia or fear of glass, metallophobia or fear of metals, anthropophobia or fear of men, and so on.
Morbid propensities are morbid impulses, associated with intense morbid emotional states. The patient has an impulse to do a certain act, but the act is not automatic; he is fully conscious of the impulse and has intense satisfaction and sometimes great pleasure in the fulfillment of it. Morbid propensities may be of great variety, relating almost to any acts or objects. They may be of a harmless nature, or they may be dangerous to life and property.
Desires and emotions play an important part in life, and may give rise to morbid propensities. An example of the harmless variety may be the desire to collect all forms of newspapers, or old shoes, clothes, etc. Morbid propensities may take the form of desire to set fire to buildings (pyromania), or to steal (kleptomania), or to kill (homicidal mania), morphomania, alcoholism, onanism and many other forms.
The sexual propensities, on account of their sensational character, have of late attracted undue attention. Freud and his school have made an unsuccessful attempt to identify all psychopathic states with sexual propensities. The Freudian school forces the facts by means of a mediaeval or Chaldean symbolism, by means of a revival of the superstitious symbolism characteristic of astrology, alchemy, chiromanthy, or palmistry, and onieromancy. Oneiromancy is specially the stronghold of this school of occultism.
All those various states, impulses, emotional conditions and morbid propensities can be traced by psychognosis to subconscious experiences, originated in early child life.
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