The profound influence of the central nervous system, more especially of the cortex with its mental processes, on bodily activities, on glandular, circulatory, and visceral functions is now firmly established by psychophysiological and psycho-pathological research work. As Darwin puts it: "The manner in which the secretions of the alimentary canal and of certain glands, as the liver, kidneys, or mammæ are affected by strong emotions, is an excellent instance of the direct action of the sensorium on these organs." The heart is extremely sensitive to sensory and ideosensory stimulations. Claude Bernard has shown how the least excitement of sensory nerve reacts through the pneumogastric nerve on the heart. The vasomotor system is directly acted on by the sensorium.
Early investigators (Bidder, Schmidt, Richet) observed the fact that the sight of food causes the secretion of gastric juice. Pavloff in his experiments has shown that the central nervous system acts on the secretions of the stomach through the vagi nerves that innervate its glandular activity. Pavloff made a gastric fistula in the dog, then exposed the esophagus, opened it, and sewed the cut end to the edges of the wound. Food taken by the mouth fell out through the opening, but an abundant secretion of gastric juice was observed. There are two moments in the process of secretion: (1) The psychic moment, the perception of food, and (2) the chemical moment. According to Pavloff, the psychic moment is the more important.
By the term "unconditional reflex" Pavloff means to indicate the response which the animal with a fistula in the secretory glands reacts by secretion to abnormal stimulus, such as bread, meat, and other food. By "conditional reflex" Pavloff indicates the reaction made by the operated animal to a stimulus artificially associated with the unconditional reflex. Thus during the time the animal is fed, a light is flashed or a whistle is sounded or various figures are shown to the animal, as Doctor Orbeli has done. After a series of repetition, twenty, thirty, or a hundred. the animal reacts with secretion to that artificially associated stimulus. When another stimulus is in its turn associated with that of the conditional reflex, the result is not an increase, but total inhibition of the conditional reflex.
Savadsky modified the conclusions of the previous investigators, but he affirms the fact that an intense stimulus completely annihilates the secretion of the conditional reflex such as is due to scratch stimulus, for instance, while a weak stimulus produces a lesser effect. He finds that the external stimulus inhibits the condition of the nerve centres. In summarizing the work of previous investigators in Pavloff's laboratory, Orbeli says: "Vasiliev and Mishtovt have shown that any phenomenon indifferent in itself may not only become a source of a new conditional reflex, but may become a special inhibitory agent in relation to the existing conditional reflexes, This quality of the nervous system to work out special cases of inhibition makes the conditional reflexes a delicate index of reactions of the organism to its external environment."
On the strength of experiments performed on the visual reactions of the dog, Orbeli comes to the same conclusion with Vasiliev, Mishovt, Babkin, and Savadski. Similarly in the experiments carried on in my laboratory on the galvanic reflex, I find that the results coincide with Pavloff's experiments on inhibition. In a letter to me Pavloff writes that he is at work on the higher activities of the brain of the dog, studying mental reactions by the methods of conditional reflexes. According to Pavloff, mental life, however, complex, can be studied successfully by the reactions of glandular secretions.
An intimate relation exists between the functions of the central nervous system on the one hand and the sensory, motor, glandular, and visceral functions on the other. This vital relation, though unobtrusive to the casual observer. stands out clear and distinct in the domain of certain nervous and mental disturbances, such as hysteria, hysteroepilepsy, larval epilepsy, neurasthenia, psychasthenia. All such conditions are mental disturbances, conscious or subconscious, and are termed by me psychopathies or recurrent mental states. Recurrence of the symptom complex is pathognomonic of psychopathies, or briefly, of neurosis. This essential trait of recurrence, found in neurosis, is a reversion to a low type of mental life. I refer all those who are interested in the subject to my work on the moment consciousness studied from a psychobiological standpoint in my recent volume, Foundations of Normal and Abnormal Psychology.
In psychopathic affections the disturbance consists in the formation of nonadaptive associations of central neuron-systems with receptors which normally do not have as their terminal response the particular motor and glandular reactions.
In Pavloff's experiments the flow of saliva or of gastric juice in the dog with the fistula could be brought about by association with blue light, with the sound of a whistle, by a tickle, a scratch, or by various diagrams, squares, circles, as in the experiments of Orbeli. What holds true in the case of conditional reflexes in regard to saliva and gastric juice, also holds true of other conditional reflexes formed by psychopathies. The mechanism in psychopathies is the same which Pavloff and his disciples employ in the formation of various conditional reflexes in the case of the dogs. All kinds of abnormal reactions of a morbid character ma thus be formed in response to ordinary stimuli of life.
Emotions arc specially subject to associations of a morbid or psychopathological character. The physiological effects of emotions may be linked by associative processes with ideas, percepts, and sensations which are ordinarily either indifferent or give rise to reactions and physiological effects of a type opposite to that of the normal. Milk may excite nausea, a rose induce disgust, red paint produce fainting, while the croak of a crow, Limburger cheese, overripened game, the smell of garlic and asaftida may be enjoyed with delight.
The reactions of muscle and gland are like so many electric bells which by various connections and combinations may be made to ring from any sensory button or receptor, as Sherrington would put it. An object, however harmless, may become associated with reactions of anguish and distress. This holds true, not only of man, out also of the life of the lower animals.
Associations and reactions, motor, circulatory, glandular, however abnormal, formed by young animals, persist through life. This holds specially true in the case of the higher and more sensitive animal organisms, such as the mammals. All training and the formation of peculiar reactions, such as various tricks, habits, scare habits, scare-pain reflexes depend entirely on this plasticity of the nervous system to form new associations or as Pavloff and his school put it, to form conditional reflexes and inhibitions in regard to glandular secretions as well as to other psychophysiological reactions.
Psychopathies are essentially pathological affections of associative life. Psychopathic maladies are the formation of abnormal, morbid "conditional reflexes" and of inhibitions of reactions of associative normal life activity.
The psychopathies may be classified into: Somatopsychoses and psychoneuroses.
The psychopathies may present chiefly somatic symptoms, such as paralysis, contractures, convulsions, or anesthesia, hypesthesia, hyperesthesia of the various organs, glands, and tissues. Such mental diseases may be termed somatic psychoses, somatopsychoses. The somatic psychoses or neuroses would comprise the various manifestations of what is at present described as hysteria and neurasthenia as well as the milder forms of hypochondriasis. In all such diseases the psychical symptoms are the prominent elements of the mental malady. The patient remains unaware of the underlying mental grounds. So much is this the case that the patient is offended, if his trouble is regarded as purely mental in character. The mental side of the diseases is then said to be submerged subconsciously.
In the psychoneuroses or neuropsychoses the physical symptoms are, on the contrary, few or none at all, while the predominating symptoms are entirely of a mental character. The patient ignores his physical condition, even if any exists, and his whole mind is occupied with mental troubles. Such conditions are to be found in all obsessions, fixed ideas, imperative impulses, and other allied morbid mental states. Thus one patient is in agony over the unrighteousness of his conduct, another is obsessed by a terror of some mysterious agency, or by religious and moral scruples.
The two clinical forms of psychopathies are in strong contrast. In the somatic psychopathies or somatopsychoses, the patient brings before the physician physical symptoms―stomach derangements, intestinal pains, contractures of limbs, menstrual disturbances, affections of the sexual organs and functions, paresis, paralysis, anesthesia, headaches, and similar bodily troubles. It is for the physician to discover the underlying mental states. In the mental forms, the psychoneuroses, the patient omits reference to his physical condition. He usually states that he has always been physically well, and some patients assert that they are sure that they will always be physically well, that the whole trouble is purely mental. "I have no physical trouble," he tells the physician, "all my troubles are mental. If you could cure me of my mental suffering, I should be perfectly happy."
The psychosomatic patient lays stress on his physical symptoms and is offended when they are declared to be mental: the psychoneurotic, on the contrary, insists on his mental symptoms, and becomes impatient when the physician pays attention to physical symptoms or to bodily functions. The psychosomatic patient believes he is afflicted with some awful, incurable, physical malady, such as cardiac trouble, tuberculosis, or some other fatal bodily disease. The psychoneurotic, on the contrary, ignores all physical troubles, but he thinks he is on the verge of insanity. The psychosomatic seeks to he assured that he is not an incurable invalid. The psychoneurotic wants to be certain that he is not crazy. The psychosomatic wishes to know whether or no he is really and truly free from some malignant diseases, some horrible infection, or some fatal physical malady. The psychoneurotic is anxious to be convinced that he is not insane, and that he is not to end the rest of the days of his life in some retreat or asylum for the insane. The clinical difference between the somatopsychoses and neuropsychoses is a fundamental one, and is of the utmost consequence in prognosis and treatment.
The main source of psychopathic diseases is the fundamental instinct of fear with its manifestations the feeling of anxiety, anguish, and worry. Fear is one of the most primitive instincts of animal life. "Fear," says Darwin, "is the most depressing of all the emotions, and it soon induces utter, helpless prostration." Our life is so well guarded by the protective agencies of civilization that we hardly realize the extent, depth, and overwhelming effect of the fear instinct. Fear is rooted deep down in the very organization of animal existence; it takes its root in the very essence of life,―the instinct of self preservation. Primus in orbe Deus fecit timor.
"The progress from brute to man," says James, is characterized by nothing so much as the decrease in frequency of the proper occasion for fear. In civilized life in particular it has at last become possible for large numbers of people to pass from the cradle to the grave without ever having had a pang of genuine fear. Many of us need an attack of mental disease to teach us the meaning of the word. Hence the possibility of so much blindly optimistic philosophy and religion. Fear is a genuine instinct, and one of the earliest shown by the human child."
The fear of coming evil, especially if it is unknown and mysterious, gives rise to the feeling of anxiety. "If we expect to suffer," says Darwin, "we are anxious." Similarly, James regards anxiety, especially the precordial anxiety, as morbid fear. "The anxious condition of mind," says Bain, "is a sort of diffused terror." Fear often expresses itself through cardiac and circulatory affections, giving rise to the feeling of anxiety. Anxiety is nothing else but the working of the instinct of fear.
In most men the instinct of fear is controlled, regulated, and inhibited from very childhood by education and by the whole organization of civilized social life. There are cases, however, when the instinct of fear is not moderated by education and civilization, when the instinct of fear is aroused by some particular incidents or by particular objects and states. In such cases, fear becomes associated with definite situations, giving rise to morbid fear and anxiety, resulting in the mental diseases known as psychopathies or recurrent mental states, psychoneuroses, and somatopsychoses.
In all such cases we can find the cultivation of the instinct of fear in early childhood. "Superstitions, and especially the early cultivation of religion, with its "fear of the Lord" and of unknown mysterious agencies, are especially potent in the development of the instinct of fear. Even the early cultivation of morality and conscientiousness, with their fears of right and wrong, often cause psychoneurotic states in later life. Religious, social, and moral taboos and superstitions associated with apprehension of threatening impending evil, based on the fear instinct, form the germs of psychopathic affections.
What we find on examination of the psychogenesis of psychopathic cases, is the presence of the fear instinct which becomes associated with some interest of life. The interest may be physical in regard to bodily functions, or the interest may be sexual, social; it may be one of ambition in life, or it may be of a general character, referring to the loss of personality, or even to the loss of mind. The fear instinct may become by cultivation highly specialized and associated with indifferent objects, giving rise to the various phobias, such as astrophobia, agoraphobia, claustrophobia, erythrophobia, aichmophobia, and other phobias, according to the objects with which the fear instinct becomes associated. Objects, otherwise indifferent and even pleasant, may by association arouse the fear instinct and give rise to morbid states, like the "conditional reflexes" of Pavloff's animals.
The fear of the unknown, of the unfamiliar, or the mysterious is quite common with children, with savages, and barbaric tribes. The fear of coming unknown unfamiliar evil is specially a source of anxiety to the young or untrained uncultivated minds.
All taboos of primitive societies, of savages, of barbarians, and also of civilized people take their origin, according to recent anthropological researches, in the "perils of the soul," or in the fear of impending evil. As the great anthropologist Frazer puts it: "Men are undoubtedly more influenced by what they fear than by what they love."
Animals in which the fear instinct can be aroused to a high degree become paralyzed and perish. Under such conditions the fear instinct not only ceases to be of protective value, but is the very one that brings about the destruction of the animal obsessed by it. "One of the most terrible effects of fear," says Mosso, "is the paralysis which allows neither of escape nor of defense." The fear instinct is no doubt one of the most vital of animal instincts, but when it rises to a high degree of intensity, or when it is associated with familiar and useful objects instead of strange and harmless objects, then we may agree with the great physiologist, Haller, that the phenomena of fear are not aimed at the preservation, but at the destruction of the animal, or as Darwin puts it, are of "disservice to the "animal." This is just the condition found in psychopathic diseases. The fear instinct becomes aroused in early life and cultivated by training, education, and environment, becoming associated in later life with particular events, objects, and special states.
When the instinct of fear is aroused in connection with some future impending misfortune, the feelings of expectation with all its psychologica changes, muscular, respiratory, cardiac, epigastric, and intestinal, go to form that complex state of anxiety and anguish, so highly characteristic of acute varieties of psychopathic disease. When fear reaches its acme, the heart is specially affected, the circulatory and respiratory changes become prominent, and give rise to oppression and depression which weigh like an incubus on the patient-the feeling known as, "precordial anxiety."
The fear instinct is the ultimate cause of the infinite varieties of psychopathic diseases.
Professor Stanley Hall accepts this view of the subject. In his recent paper on Fear, he writes: "If there be a vital principle, fear must be one of its close allies as one of the chief springs of the mind. . . ." In spite of his former "psychoanalytic" inclinations, Professor Hall now asserts that "Freud is wrong in interpreting this most generic form of fear as rooted in sex. . . . Sex anxieties are themselves rooted in the larger fundamental impulse of preservation of life with its concomitant instinct of fear." This is the etiology on which I laid stress in my papers and works on the subject of psychopathic diseases. So deeply convinced is Professor Stanley Hall of the primitive and fundamental character of the fear instinct, that he refers to the facts that "if the cerebrum is removed, animals, as Goltz and Bechterev have proved, manifest very intense symptoms of fear, and so do human monsters born without brains, or hemicephalic children, as Sternberg and Lotzko have demonstrated."
Oppenheim, Kirchoff, Kraepelin, and recently other psychologists and neurologists of note all concur that fear is a fundamental factor in the pathology of neurosis. As physicians, we must remember the importance of fear in cases of surgical shock.
So potent, all embracing, and all pervading is the fear instinct, that the physician must reckon with it in his private office, in the hospital, and in the surgical operating room. In a number of my cases, psychognosis clearly reveals the fact that even where the neurosis has not originated in a surgical trauma, surgical operations reinforced, developed, and fixed psychopathic conditions.
The fear instinct arises from the impulse of self preservation without which animal life cannot exist. The fear instinct is one of the most primitive and most fundamental of all instincts. Neither hunger, nor sex, nor maternal instinct nor social instinct can compare with the potency of the fear instinct, rooted as it is in self preservation―the condition of life, primordial. When the instinct of fear is at its height, it sweeps before it all other instincts. Nothing can withstand a panic. Functional psychosis in its full development is essentially a panic. A psychogenetic examination of every case of functional psychosis brings one invariably to the fundamental fear instinct. Fear is the guardian instinct of life. The, intensity of the struggle for existence, the preservation of life of the animal, is expressed in the instinct of fear. The fear instinct in its mild form, when connected with what is strange and unfamiliar, or with what is really dangerous to the animal, is of the utmost consequence to life.
What is strange and unfamiliar may be a menace to life, and it is a protection, if under such conditions the fear instinct is aroused. It is again of the utmost importance in weak animals, to have the fear instinct easily aroused by the slightest strange stimulus; the animal is defenseless, and its refuge, its safety, is in running. The unfamiliar stimulus may be a signal of danger, and it is safer to get away from it; the animal cannot take chances. On the, other hand, animals that are too timid, so that even the familiar becomes too suspicious, cannot get their food and cannot leave a progeny―they become eliminated by the process of natural selection. Even in weak animals an intensified state of the fear instinct becomes biologically abnormal, pathological.
The fear instinct is abnormally developed in psychopathic disturbances. Harmful stimuli or expectation of danger to themselves, to their family, or to friends may arouse the feelings of anguish, anxiety, worry, manifestations of the fear instinct. Objects, thoughts, stimuli, situations, and events of expected danger may keep on changing, persisting for a longer or shorter time, but the underlying pathological state of the fear instinct remains, easily fusing with experiences of possible danger to all included within the circle of the patient's self regard.
Events or situations with fixed sensory stimuli, when repeated, fix the neurosis, very much in the same way as are the "conditional reflexes" in Pavloff's experiments. Other sets of stimuli of an ideational character are transient in duration, while the general, apprehensive, subconscious condition persists unchanging to seize again and again on ever new objects and thoughts, forming psychic compounds of various degrees of stability.
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.
I have formulated the following fundamental principles of psychopathic diseases:
1. The principle of embryonic psychogenesis. 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 pathological germ focus, to a phoboexperience of 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.
2. The principle of recurrence. 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.
3. The principle of proliferation and complication. With the gradual change of the environment and with the growth of the child, each recurrence of reproduction of the fear system tends to an increased proliferation of fear associations. There is a tendency to a 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 experiences, of new increments of sensory, ideational, and feeling elements. 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.
4. 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 newly added psychic contents become fused, synthesized into one complex network, guided by the fear instinct.
5. 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 reaction is brought into function. Thus excitement and passion of emotional pleasure-tone may pass into its opposite and 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 given by experience. The fear instinct becomes attached to the opposed contrast emotions of self regard, such as love and desire. The fear, though positive and primary, assumes a negative and secondary aspect as nonfulfillment 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.
6. The principle of recession. Child experiences tend to lapse from conscious memory. This tendency is further reinforced by the mental process of recession, developed in detail in my works. Cognitive states tend to recede from the focus to the periphery of consciousness. The receding mental states become marginal and submerged subconsciously. Such states, to use a biological Mendelian term, are recessive. Recessive states recede and fade away from direct consciousness with each recurrence or reproduction of the symptom complex, organized and synthesized by the controlling fear instinct.
7. 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 voluntary 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 my 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.
8. 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.
9. 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 nucleus of the neurosis, a nucleus which appears central. 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.
10. The principle of dominance. Such mental states tend to persist in consciousness, becoming amplified and intensified with the unfolding of mental life. Such mental elements, normal and abnormal, to use a biological 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, often of the same character. The factor of recurrence predominates in the same symptom complex. 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.
11. 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.
12. The principle of inhibition. According to the principle of irradiation and fusion, the fear instinct tends to spread and get 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 of the hypertrophied fear instinct is specially strong on all those functions and systems that enter into the synthesis of the psychopathic aggregate.
13. 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 uncontrollable psychopathic obsession.
(To be continued.)