In my psychopathological and clinical work of the various manifestations and symptoms of psychopathic and functional diseases I come to the conclusion that the principal cause of all those morbid affections is the fear instinct, rooted in the very impulse of life, the impulse of self preservation. Fears are not secondary effects, they are due to one of the most fundamental of all instincts, the instinct of fear which is primary and elemental.
Anything which arouses the fear instinct in the inhibitory or paralyzing stages will necessarily give rise to psychopathic functional psychosis or neurosis. The fear instinct and the impulse of self-preservation, inherent in all life, are the alpha and omega of psychopathic maladies.
The fear instinct is usually cultivated by a long history of events of a fearsome character so that fear instinct and the impulse of self-preservation become easily aroused on various occasions of external stimulation, producing general fear, mental or emotional, and often accompanied by sensory,[325] motor, and intestinal derangements of various organs with their secretions and hormones, as well as with general morbid, functional changes of the central nervous system, sympathetic and parasympathetic systems. This in its turn gradually cultivates a disposition to formation of hypnoidal states, that is, the brief momentary formation of trance states, in which the subconscious becomes through dissociation exposed to fear suggestions or fear stimulations, which arouse in the morbidly cultivated subconscious morbid fear symptoms, motor, sensory, intestinal, emotional in their various combinations and associations.
The cultivated predisposition to lapses into hypnoidal states is a prerequisite of psychopathic disturbances. We may, therefore, say that the three factors, namely, Self-preservation, Fear instinct, Hypnoidal states form the triumvirate of psychopathic, functional neurosis.
Charcot with his sharp eye for observation as well as his long clinical experience observed, in what he termed hystericals, a brooding period which precedes the manifestations of the hysterical attacks and symptom complex of the hysterical manifestations. These brooding periods are of the utmost consequence, although Charcot and his disciples as well as the psychopathologists generally, hardly paid any attention to this important phenomenon.
These brooding periods preceding the onset of the[326] malady afterwards recur regularly before each attack of the malady, only the period is brief, and is hardly noticeable except by the one who looks searchingly. Psychopathologists pass this important stage without noticing its full significance. The period appears as a sort of a psychic aura, a sort of momentary attack of epileptic petit mal. This brooding state is a modification of the hypnoidal state.
It is during such hypnoidal states, when the conditions which I have shown to be requisite for the induction of trance or subconscious states, happen to be specially strong and the hypnoidal state is prolonged, that the unprotected subconscious becomes subject to fear suggestions or to stimuli arousing the fear instinct and the impulse of self-preservation.
“Many patients,” says the famous physiologist and physician, Mosso, “die in the hospital from fear and depression who would probably have recovered had they been tended in their own homes.... In their morning round the physicians find that the serious cases have grown worse, while those who are better beg to be dismissed.... The physician, who has the night watch must walk up and down the whole night, and is kept busy preventing convulsive attacks, or fainting fits.
“Fear attacks nullify every effort of the will.... Even Alexander of Macedon had to count with fear in his courageous army of select Macedonians.[327] In order to insure victory he offered sacrifices to Fear before he joined battle.”
Physical maladies become worse during the night, and especially during the early morning hours when the energy of the body is at its lowest level,—conscious and subconscious fears reaching their highest intensity. This holds specially true of nervous cases, and particularly of psychopathic patients, who are dominated by the impulse of self-preservation and the fear instinct. The fears and worries keep the patient awake, and the subconscious fears become emphasized by concentration of attention, monotony, limitation of field of consciousness, limitation of voluntary movements, and other factors favorable to dissociation and the induction of the hypnoidal state, in which the patient becomes sensitive to the awakening of the fear instinct, with all its horrible fear suggestions.
The symptoms of the disease which are more or less under his control during the day become often so intensified in the dark, that the patients become demoralized with fear, suffering as they do the anxiety and anguish induced by the terrors of the night. Even medical men, professors of medical colleges, who have come under my care, have confessed to me that, when in a state of insomnia, the terrors of the night are so intense that they had to resort to morphine to still the anguish of the fear instinct.
[328]
For years I lived in close relation with neurotic, psychopathic patients. I watched them day and night. I have been called by patients for medical aid in the late hours of the night, and more so during the vigil hours of the darkness of the night. I had to relieve and soothe the fears, the terrors of the night. It is in the night, when in a low state of neuron energy that patients feel the grip of horrors oppressing them with nightmares of the relentless and merciless instinct, the fear instinct. To be relieved of the night terrors many patients are willing to risk anything, even the consequence of deadly narcotics, the plagues of mental healers, and the sexual phantasms of Psychoanalysis.
The hypnoidal state is induced artificially, often brought about by intoxication, as in t............