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Boris Sidis, Ph.D., M.D.
Psychopathic or neurotic maladies do not depend on the abnormal action of some one organ or function, but on a general condition common to all bodily and mental functions,―the fundamental primitive fear instinct which relates to life in general.
The deranged functions, cardiac, respiratory, or sexual,―fatigue, conflict, shock, repression and others are only the occasion. To regard any of these occasions as the sources of psychopathic maladies is like regarding the weather-cock as the cause of the wind. Self-preservation and the fear instinct alone form the source of all psychopathic maladies.
I adduce here a few cases which may be taken as typical:
Mrs. M. C., aged thirty-two years. Family history good; well developed physically and mentally. A year before the present trouble set in, patient suffered from a severe attack of grippe. Menstruation, which was before painless and normal in amount, became painful and scanty, accompanied by headaches, indisposition, irritability, crying spells and backache which lasted long after the menstrual period was over. The family physician ascribed the symptoms to endometritis, mainly cervical and treated her with absolute rest, fomentations, injections, scarification and dilatation of the cervix, and finally curetted the uterus. As the patient grew worse under the treatment, she was taken to a gynecologist, who after an examination suggested an operation. The operation was duly performed, with the result that the nervous symptoms became intensified, and the attacks increased in violence and duration. The turn of the nerve specialist came next. Hysteria, neurasthenia, and the more fashionable "psychasthenia" have been diagnosed by various neurologists. A year of psychoanalysis made of the patient a complete wreck, with depression, introspection and morbid self-analysis. Patient was put by neurologist under Weir Mitchell's treatment.
When the patient came under my care, she was in mental agonies, a complete wreck. I gave up the Weir Mitchell rest treatment, sent away the nurse, released the patient from solitary bed confinement, told her to leave the sick room, to give up dieting and medicines, and to return to a normal, active life. I kept on treating her by the hypnoidal state. The patient began to improve rapidly, and finally all her physical and mental symptoms disappeared appeared; she has continued for over six years in excellent condition of health.
A study of the case traced the fear instinct to experiences of early childhood, fears accentuated and developed into morbid states by the deleterious tendencies of the treatment, giving rise to a somatopsychosis, the physical symptoms mainly predominating.
A lady, aged fifty-nine years, suffered from kynophobia. When about the age of twenty-nine years she was bitten by a dog; since then she was afraid of hydrophobia. She kept on reading in the papers about cases of hydrophobia until the fear became developed to an extraordinary degree and became fixed and uncontrollable. According to the principles of evolution of psychopathic states, the fear kept on extending. The fear psychosis included all objects that might possibly carry the germ of hydrophobia. The neurosis became a mysophobia.
As in all other cases of psychopathic states the psychosis was traced to the fear instinct, the germ of which was laid in the patient's early history. The patient was a timid child, and was afraid of strange animals. In the village where she lived there were a few cases of hydrophobia which impressed her when a child. This germ was in later life developed by thirty years' cultivation.
Psychopathic or neurotic symptom complexes I observed in children whose early training was favorable to the awakening and development of the fear instinct. In children affected with fear of animals I traced the fear psychosis to the parents who were afraid of animals, on account of actual traumas in their life history, the child being influenced by imitation, by suggestion, often subconscious, by the behavior of the parents in the presence of animals. Such children are predisposed to recurrent psychopathic states.
In all such cases the etiology is easy to find, if the patient is carefully examined. In many cases the fear instinct with its symptom complex is associated with external objects, giving rise to the so-called phobias. Instead, however, of being associated with external objects, the fear instinct is frequently associated with somatic functions (pathophobia), or with mental activities (phrenophobia).
Man, aged forty-seven years; actor; family neurotic. Patient suffered from anorexia, indigestion, choking, vomiting, gagging, eructation, gastralgia, and occasional pains in the limbs. He led a rather gay and irregular life up to the age of thirty-two years, when he had syphilis, for which he was under treatment for two years. This scared him because he had the opportunity to see the consequences of syphilis in many of his friends. He had been under continual fear of the possibility of development of parasyphilitic diseases.
Seven years ago, at the age of forty years, he had to watch at the bedside of an intimate friend, who had been suffering from severe gastric crises of tabes dorsalis. After one specially exhausting night of vigil, worry and fear, 'he went to bed for a short nap and woke up with the idea of general r paresis and intense fear. From that time he began to suffer from symptoms of tabes with fear of general paresis.
The patient had been an imaginative child; he had his fear instinct cultivated from early childhood by stories of frights, scares, and horrible accidents. When ten years old, his grandfather gave Faust to him to read. Since then the patient was troubled with the fear of selling his soul to Satan. The patient was religious in his childhood, prayed much, and was possessed by the fear of committing sins. "It has now all come back," he complained. A great number of fears could be traced to his early childhood. The somatic symptoms were the manifestations of association of experiences of parasyphilitic diseases, based on the pathological state of the fear instinct, a case of pathophobia, a somatopsychosis.
A few hypnoidal treatments effected a cure. The patient returned to his occupation, free from any distressing symptoms.
H. M. aged twenty-seven years, male, Canadian. Family history good; looked pale, anemic, and frail; very intelligent, sensitive, restless, and had a tendency to worry. About a year ago, he began to feel depressed, to worry about his health; thought he suffered from tuberculosis. His physician assured him that nothing was the matter, but he had an uncontrollable fear of consumption; and the idea kept on recurring. Up to the age of nineteen years he was perfectly well. He was then laid up with a sore knee for a few weeks. He had time enough to brood over the knee, and read some literature on the subject. He thought it was tuberculosis and worried much. The knee, however, got well, and gradually he forgot all about it, although the idea of tuberculosis often made him feel uncomfortable, and the idea of "water in the knee" used to flash through his mind, to pass away the next moment.
A year ago, however, he happened to lose his work, became despondent, began to worry and to brood over his financial troubles, slept restlessly, suffered from anorexia, and began to lose flesh. The idea of the knee and the fear of tuberculosis got possession of him. He could not rid himself of the idea of tuberculosis. If in the clinic the physician assured him that he was all right, he felt better for a couple of hours; but often it did not last even as long as that. The least pain, cough, heart beat, a feeling of chill or heat, and the like, brought the idea and fear of tuberculosis back to his mind with renewed energy. He was obsessed by the fear of tuberculosis and felt he was doomed to certain death, a psychosomatic pathophobia.
Hypnoidal states did good service. The patient's mental condition began to improve rapidly. He was no longer troubled with depression, insomnia, and fears; began to gain in weight, appetite improved, felt energy flowing in; began to look for work in real earnest, finally found it, and kept at it.
Man, aged forty-three years, suffered from palpitation of the heart, fainted easily, especially on physical examination by physician, or at the beginning of medical treatment. He suffered from indigestion for which he had been under treatment for a number of years by physicians who gave him medicine for his bowels and also from time to time kept on washing his stomach. He had a great fear of becoming a victim of cardiac troubles, especially of some unknown, terrible, valvular affection. When under my care he kept on asking to be taken to heart and stomach specialists, to be examined, and have some radical operation performed. Frequently under the influence of the fear states and obsession of heart and stomach trouble, especially the heart, he would collapse suddenly, be unable to walk, and be afraid that he suffered from some paralysis.
On examination the patient revealed a history full of various traumas which, from his very childhood until he came under my care, helped to bring about his psychopathic condition, and developed the fear instinct to an extraordinary degree.
Physicians had the lion's share in this special case by their rearing of the fear instinct, and by their favoring the patient's phobias by their examinations, by their prescriptions, and by the diet and treatment. The patient was in such a panic that he kept on taking his pulse on the least occasion, was feeling his heart, stomach, and intestines at every opportunity. The hypertrophied growth of his morbid self and fear instinct had invaded and dominated the patient's whole personality, developed a typical psychosomatic, pathophobia with its recurrent states. The patient was cured by hypnoidal states.
In the Trudi for 1913 of the University of Moscow, Russia, Doctor Ribakov made an extensive study of a series of cases of psychopathic or psychoneurotic asthma, and arrived at a conclusion similar to my own, although he was no doubt unaware of my work and publications on the same subject. He came to the same conclusion as I that the etiology of neurosis is to be found in fear, which alone forms the basis of psychopathic neurosis. All other factors, social, professional, sexual, religious, repressions, conflicts are only occasions of the disease. It is fear, and fear alone that forms the pathology of the psychopathic neurotic symptom complex.
A young lady was afflicted with ornithophobia, fear of birds, fear of chickens. The sight of a chicken set her into a panic. The patient is very timid, and this timidity can be traced to her early childhood. When at the age of six, a playmate threw a live chicken at her in the dark. The child was terribly frightened, screamed, and fainted. The mother used to tell her fairy stories full of adventure, of ghosts, of dragons, and of monsters. This prepared the patient to react so violently to the sudden attack made by the flight, struggling, and feel of the chicken in the dark. Since that time, patient has formed an uncontrollable fear of live birds.
Another patient of mine, a lady of forty-nine years, single, suffered from potamophobia, a fear of going into rivers, or into the ocean. When about seven years old she was thrown into water by one of her elder sisters. She was nearly drowned and was half dead with fear when rescued. Since then she has been in terror of water, or rather of rivers and oceans. Several times she made conscious efforts to get rid of the fear, but the attempts were unsuccessful. In fact, the more she was forced or forced herself consciously to get into the water, the greater was the fear. This fear became all the more intensified, when some of her intimate friends were drowned in a boat. This fixed the fear which became uncontrollable.
A patient of mine, a man of thirty-five years, was afraid of going out in the dark. This was traced to early associations of fears of the dark, to superstitious beliefs in ghosts and spirits cultivated in the patient's early childhood. He was afraid to remain alone in the dark or to go down at night into cellars or other secluded places. This fear was unfortunately still more intensified by an accident. At the age of twenty-seven, one night when returning late from a visit, he was assaulted from behind by foot-pads. This accident fixed the fear of darkness.
A lady of sixty-seven years, with pronounced arteriosclerosis, had an attack of hemiplegia of the left side. She suffered from motor aphasia, but did not lose consciousness. The paralysis cleared up in a few days, but the sudden attack demoralized her. Since that time she is in terror of another attack. She watches for symptoms, and the least sensation of faintness throws her into a panic. The patient is the wife of a general and was in China during the Boxer riots, in the Spanish American war, in the Philippines, and other military engagements. The fear instinct was cultivated in her by all such conditions.
In her early childhood there were fears and frights of child character, enough to arouse the fear instinct, which was gradually developed and cultivated by the circumstances of life and by worries in the course of the various wars, of which she was a witness. Finally the fear culminated by the stroke of paralysis.
Similarly, I had patients who suffered from tuberculosis, from asthma, from heart trouble, and from all kinds of intestinal affections which specially abound in psychopathic cases. All such cases can be clearly traced to various somatic symptoms based on the fear instinct. The etiology is fear, the arousal and development of the fear instinct in respect to the special symptom complex.
A patient, aged twenty-six years, suffered from agoraphobia at various intervals. As a child of nine years, he was attacked by rough boys. He freed himself and ran in great terror. The boys threatened him with another "licking" when he appeared again on the street. He was afraid to go out for several weeks. The parents forced him to go and buy some things. Living in a rough neighborhood, on account of his fatherís circumstances, he had been many times subjected to knocks, blows, and assaults by rough boys, until the fear of the open street became fixed into the well known form of agoraphobia.
Another case, that of a lady of thirty-eight years, married, suffers from ailurophobia, or fear of cats. This can be traced to the patient's early childhood. When she was a child her brothers and sisters went through attacks of diphtheria, which was ascribed to infection caused or transmitted by cats. The patient was specially impressed with the danger from cats. Under such training and suggestion given in early childhood, the patient gradually formed a fear of cats. This fear was still more intensified and became a panic when she was put into a dark room and a cat was let loose on the poor victim by her mischievous companions, who knew of the patient's fear. When the patient had children of her own, she was still more affected by the fear of cats, on account of the subconscious and conscious fear of the possibility or infection transmitted by cats to her children.
All those cases were investigated and cured by hypnoidal states.
Mr. D., a young man of twenty-five years, was if born in Poland. As far as can be ascertained, the parents as well as the brothers and sisters are well. A physical examination of the patient reveals nothing abnormal. There are no sensory, no motor disturbances. He complains of severe headaches, preceded by a feeling of indisposition, depression, vertigo and distress. During the attack there is hyperesthesia to touch, pressure, temperature, and to visual and auditory stimulations. The patient shivers and looks pale. The cold experienced during the attack is so intense that the patient has to wrap himself in many blankets, as if' suffering from a malarial paroxysm.
Fears have strong possession of the patient's mind. He is afraid to remain in a closed place in the daytime and especially at night. When he has to remain alone at night, he is in an agony of fear, and cannot go to sleep. Every passerby is regarded as a robber or murderer, and he quakes at the least noise. When Walking in the house in the dark, he has the feeling as if someone were after him, and occasionally even experiences the hallucination of some one tugging at his coat. He is mortally afraid of the dead and shuns a funeral. The patient has also a fear of dogs, a kynophobia. The fear is irresistible, and is as involuntary as a reflex.
An investigation, by means of the hypnoidal states, brought out of the patient's subconscious life the following data: When a child of three years, the patient lived with his family in a small village near a large forest infested with wolves. In one of the intermediary states a faint memory, rather to say a vision, struggled up, a vision of wolves and dogs. Some one cried out: "Run, wolves are coming!" Crazed with fear, he ran into the hut and fell fainting on the floor. It turned out to be dogs instead of a pack of wolves. It is that fright in early childhood which has persisted in the subconscious mind, and, having become associated with subsequent experiences of attacks of dogs, has found expression in the patient's consciousness as an instinctive fear of dogs.
But why was the patient in such abject terror of dead people? This found its answer in the experiences and training of his early life. When a young child, the patient heard all kinds of ghost stories, and tales of wandering lost souls and of spirits of dead people hovering about the churchyard and burial grounds; he heard tales of ghouls and of evil spirits inhabiting deserted places, dwelling in the graves of sinners and the wicked. He listened to stories of haunted houses and of apparitions stalking about in the dark. His social and religious environment has been saturated with the belief in the supernatural, as is usually the case among the superstitious populations of Eastern Europe. We cannot wonder, then, that an impressionable child brought up under such conditions should stand in mortal fear of the supernatural, especially of the dead.
When the patient was about nine years old, his parents noticed some prominences on his right chest. It was suggested to them that the hand of a dead person possessed the property of blighting life and arresting all growth, and would, therefore, prove a "powerful medicine" for undesirable growths. It happened that an old woman in the neighborhood died. The little boy was taken into the room where the dead body was lying, and the cold hand of the corpse was put on the child's naked chest. The little fellow fainted away in terror. The fear of dead people became subconsciously fixed, and manifested itself as an insistent fear of the dead, and, in fact, of anything connected with the dead and the world of spirits.
The patient had hardly recovered from the shock of the "dead hand," when he had to pass through a still more severe experience. A party of drunken soldiers, stationed in the little town, invaded his house and beat his father unmercifully, almost crippled him; they knocked down his mother, killed a little brother of his, and he himself, in the very depth of a winter night, dressed in a little shirt and coat, made his escape to a deserted barn, where he passed the whole night. He was nearly frozen when found in the morning, crouching in a corner of the barn, shivering with fear and cold.
From that time on the headaches manifested themselves in full severity, with hyperesthesia and death-like paleness and intense cold of the body. The early cultivation of the fear instinct resulted in a neurosis with its recurrent states.
Another patient is a man of thirty years; his family history is good. He is physically well developed, a well known professor of physics in one of the foremost institutions in this country. He suffers from attacks of loss of personality. The attack is of a periodical character, coming on at intervals of two weeks, occasionally disappearing for a few months, then reasserting itself with renewed energy and vigor. During the attack the patient experiences a void, a panic, which is sudden in its onset, like petit mal. The trouble was diagnosed as larval or psychic epilepsy; the man was referred to me by Dr. Morton Prince as an extremely interesting, but puzzling neurological case.
Patient feels that his "self" is gone. He can carryon a conversation or a lecture during the attack, so that no outsider can notice any change in him, but his self is gone, and all that he does and says, even the demonstration of a highly complex problem in integral calculus is gone through in an automatic way. The fury of the attack lasts a few moments, but to him it appears of long duration. He is "beside himself," as he puts it. He seems to stand beside himself and watch his body, "the other fellow," as he describes it, carry on the conversation or the lecture. He is "knocked out of his body, which carries on all those complicated mental processes." For days after he must keep on thinking of the attack, feels scared and miserable, thinking insistently, in great agony, over his awful attack, a recurrent psychoneurotic phrenophobia.
At first the patient could trace this attack only as far back as his seventh year. Later on, earlier experiences of childhood came to light, and then it became clear that the attack developed out of the primitive instinctive fear of early childhood, fear of the unfamiliar, fear of the dark, of the unknown, of the mysterious, fears to which he had been subjected in his tender years.
This state was further reinforced by the early death of his parents, it was hammered in and fixed by hard conditions of life, full of apprehension and anxiety. Life became to the child one big mysterious fear of the unknown. The fear instinct formed the pathological focus of the attack. As the patient puts it: "It is the mystical fear of the attacks which overpowers me."
With the disintegration of the focus the symptom complex of the attacks disappeared. The patient is in excellent condition, he is doing brilliant work in physics and chemistry and is professor in one of the largest universities in Canada.
I present another case apparently "paranoidal," a case interesting from our standpoint. The patient is a man of twenty-seven years; his parents are neurotic, religious revivalists. As far back as the age of eight he suffered from agonizing fears of perdition and scares of tortures in hell, impressed on his sensitive, young mind during the revivals. He is very religious, obsessed with the fear of having committed an unpardonable sin. He thinks he is damned to suffer tortures in hell for all eternity. He keeps on testing any chance combinations, and if his guesses turn out correct, he is wrought up to a pitch of excitement and panic. For to him it means a communication coming from. an unseen world of unknown mysterious powers. With his condition diagnosed as "paranoidal dementia praecox," the patient was committed to an insane asylum, from which he was subsequently released.
The attack comes in pulses of brief duration, followed by long periods of brooding, depression, and worry. The primitive fear of pain, of danger and death, and the sense of the mysterious cultivated by his religious training, reached here an extraordinary degree of development. Among the earliest memories that have come up in the hypnoidal state was the memory of a Sunday school teacher, who cultivated in the patient, then but five years of age, those virulent germs which, grown on the soil of the primitive instinctive fear and the highly developed sense of the unknown and the mysterious, have brought forth poisonous fruits which now form the curse of his life. The case is a typical psychoneurotic phrenophobia with its characteristic recurrent states.
"It is difficult," the patient writes, "to place the beginning of my abnormal fear. It certainly originated from doctrines of hell which I heard in early childhood, particularly from a rather ignorant teacher who taught Sunday school. My early religious thought was chiefly concerned with the direful eternity of torture that might be awaiting me, if I was not good enough to be saved."
After a couple of years of persistent treatment by means of the hypnoidal state and by methods of association and disintegration of the active subconscious systems, the patient recovered. He entered a well known medical school and took the foremost rank among the medical students.1
In the investigation or psychognosis of psychopathic cases I invariably find the psychopathology to be a morbid condition of the fear instinct, rooted in the primordial impulse of self-preservation. The psychognosis of this underlying pathological state and disintegration of the latter are of the utmost consequence in the domain of psychopathology and psychotherapeutics.
1. A full account of the cases is published In my volume "The Causation and Treatment of Psychopathic Diseases."
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