EGOTISM AND FEAR
As we have pointed out, the fear instinct is the arousal of
the impulse of self-preservation. Psychopathic conditions are
at bottom fear states interrelated with hypnoidal states and
with an abnormal, pathological condition of the impulse of
self-preservation. This is manifested in the fundamental trait of
extreme selfishness characteristic of psychopathic patients. The
patient is entirely absorbed in himself, and is ready to sacrifice
every one to his terrors.
For many years, day after day and night after night, I lived with
patients who were under my care, observation, and treatment. One
trait always revealed to me the predominant characteristic under
the constantly changing psychopathic symptom-complex and that is
_the extreme selfishness of the patients_. There is no greater
egotism to be found than in the typical cases of psychopathic
disorders. This egotism runs parallel to the condition of the
psychopathic state. This does not mean that every egotist is
necessarily psychopathic, but _every psychopathic case is
essentially egotistic_.
The psychopathic patient does not hesitate a moment to sacrifice
to his “affection” father, mother, brother, sister, husband, wife,
lover, friend, and children. In severe cases the patient stops at
nothing and only fear of suffering, sickness, evil consequences,
and punishments can restrain the patient. In some extreme cases the
patient is almost diabolical in his selfishness.
The constant sympathy which the patients crave from others, and
which they demand, if it is not given to them immediately, is
but an expression of their extreme obsession by the impulse of
self-preservation. In their struggle for self-preservation they
forget everything else, nothing is remembered but themselves. This
condition becomes the ground character which is often expressed
in a frank, brutal way. Even in the best of patients one can find
glimpses into the depths of the psychopathic soul which is nothing
but the immense egotism of the beast, worsted in the struggle for
existence, tortured by the agonizing pangs of the fear instinct.
In the vanity, conceit, arrogance, and overbearing attitude towards
others, friend or stranger, as well as in the total indifference
to the suffering of his intimate friends and acquaintances, we
once more find the expression of that terrible selfishness which
obsesses the psychopathic patient. In order to get rid of some
small inconvenience, or to obtain some slight pleasure, the patient
will put others as well as his “near and dear ones” not only to
inconvenience, but to permanent pain, and even torture.
The patient lacks confidence, at least that is what he complains
of, but he does not hesitate to demand of his best friends and even
of total strangers all the services possible, if they are given
to him, thinking that he is fully entitled to them. The patient
has the conceit and vanity of his great worth in comparison with
other people. The world and especially his family, physicians,
attendants, friends, acquaintances, lovers, should offer their
happiness and life for his comfort.
Even when the psychopathic patient does some altruistic act,
it is only in so far as he himself can benefit by that deed.
He is ready to drop it as soon as the work does not answer his
selfish purposes. Himself first and last, that is the essence of
psychopathic life.
The patient is convinced of his goodness and kindness, and of his
human affections which are far superior to those of the common
run. He adores himself and he is always ready to dwell in the
glory of his delicacy and extraordinary sensitivity. This trait
he is specially anxious to impress on his friends, on his family,
and even on those whom he apparently loves. “I am the delicate
being of whom you all, unappreciative, gross, insensible people
should take care.” That is the principle on which the psychopathic
patient lives. The patient will do anything to attract attention
to this side of his personality. He will emphasize his sickness,
exaggerate his symptoms, and even manufacture them for the benefit
of those who dare to ignore him or who pay little attention to
his condition, to his wants, needs, caprices, passing whims, and
especially his fears, which underlie all his wishes and desires.
_There is nothing so tyrannical and merciless as the autocratic,
fear-obsessed “weak” will of a psychopathic or neurotic patient._
The patient’s whole attention is concentrated on himself, or more
specially on the symptoms of his psychopathic malady, symptoms
which obsess him for the time being. Whatever the symptoms be,
permanent or changing, the patient’s demand is to have others
sympathize with the illness from which he suffers, to have them
realize the “fearful” agonies which he undergoes. The selfishness
of the patient is exacting and knows no bounds. The whole world is
to serve him, and be at his command. The psychopathic patient is
driven by the impulse of self-preservation and by the furies of the
fear instinct.
Many of my psychopathic patients tell me that they feel sensitive
as long as they witness the sufferings of other people, otherwise
they do not care to know anything about them. They are anxious
to have such things away from them as a nuisance. They insist on
being surrounded only with pleasant things or with persons and
objects that contribute to their health and happiness. Everything
is absorbed by the worship of Moloch Health to whom the patients
sacrifice everything. Pain, suffering, and distress of other people
are looked at only from the standpoint of the possible effect they
may have on the patient’s “precarious health.” Like Nero, who
was probably a psychopathic character, the psychopathic patient
is ready to burn others for his health; if necessary, to torture
“health and happiness” out of his best friends.
One of my patients, who is highly intelligent, tells me frankly
that he uses others to squeeze out of them strength for himself.
As soon as he can no longer get it, or has obtained all he can,
he is anxious to part with them, gets tired of them, and even
begins to be resentful because they are in the way of his health.
Another of my patients was ready to burn parks, stables, and
destroy everything, if he knew that it was good for his health.
Other patients of mine do not hesitate to wake up the whole house
to help them in insomnia or indigestion. Many of my patients take
pleasure in forming acquaintances and even friendship with people,
ask for their sympathy, require their help and assistance, come to
them early in the morning and late at night, disturb their sleep
in the small hours of the morning, display all their symptoms
of indigestion, nausea, eructation, and vomiting. The patients
then turn round, abuse the person who helps them, telling him
disagreeable things, because he is no longer useful. A few hours
later the patients may turn again for help to the same person,
because they find that they could still make use of him.
Psychopathic patients do not hesitate, for the alleviation of their
pains, of depression, of insomnia, to take a bath in the early
morning and wake up all the other patients. They are entirely
absorbed in themselves. Self is the only object of their regard.
A clever lawyer, aptly characterized one of my most severe and
typical psychopathic cases as “egomaniac.” “When you talk of
gravity, ‘I am gravity,’ she claims. Talk of the Trinity: ‘I am the
Trinity.’” As a matter of fact every psychopathic patient is an
egomaniac.
Bacon’s aphorisms about self-lovers may well apply to psychopathic
patients: “And certainly it is in the nature of extreme
self-lovers, as they will set a house on fire, and it were but
to roast their eggs.... That which is specially to be noted is,
that those which are _sui amantes sine rivali_, are many times
unfortunate.”
Driven by the impulse of self-preservation and by the anguish of
extreme fear, the psychopathic patient may be pitied as a most
unfortunate, miserable wretch.
In the psychognosis of the particular condition, mental or nervous,
be it object, idea, or action from which the patient suffers, the
impulse of self-preservation with its instinctive emotion of fear
can always be found in the background of consciousness or in the
subconsciousness.
An insight into a series of cases will help best to understand the
fundamental psychopathological processes that give rise to the
different forms of psychoneuroses and somatopsychoses.
The inhibition of the patient’s activities, produced by the most
primitive impulse of self-preservation with its instinct of fear,
limits the patient’s life to such an extent that the interests and
the activities are reduced to automatic repetition of reactions of
a stereotyped character. The stimuli must be the same, otherwise
the patient does not care to respond. He loses interest in his
business, in reading, in his work, and games. The attention keeps
on wandering. Games, pleasures, and hobbies in which he formerly
used to take an interest lose their attraction for him. The life
he is disposed to lead is of a vegetative existence. He is afraid
of anything new. Things are done in an automatic way. _Routine and
automatisms are characteristic of his activities._
The psychopathic or neurotic patient talks about his humanitarian
ideals, about his great abilities superior to the common run of
humanity, and how with his talents he is willing and has been
willing to confer benefits on poor suffering humanity in spite of
the fact that he has to struggle with his poor health, physical,
nervous and mental. In spite of the overwhelming fatigue due to
ill health, and in spite of the fearful ideas and impulses that
have beset him day and night he still has succeeded in fighting his
way through.
The patient hankers for notoriety, for praise, for appreciation by
other people. He is apt to complain that the family, neighbors,
acquaintances, friends cannot appreciate his good points, his good
will, and his high ideals to which he conforms his life, tortured
as it is with pains and suffering of poor health. The _egocentric_
character of the psychopathic patient is bound up in his abnormally
developed impulse of self-preservation and in his pathological
state of the fear instinct.
Thus one patient opens his account with the phrase: “From boyhood I
had a sensitive conscience.”
Another patient writes: “As a child I had a keener instinct as to
the real unexpressed attitude of those about me toward each other
than the average child.”
One of my patients, a puny being of mediocre intelligence, writes:
“I have always, from the earliest childhood, felt that I was
different from those about me; and I must acknowledge that it was
not alone a feeling of inferiority on account of poor control, but
a feeling that I understood more than they. I was, however, of a
delicate constitution and suffered from ill health.”
Psychopathic patients subscribe to the “cheerful” effusions of
“New Thought,” and plaster the walls of their rooms with elevating
“Rules for Health and Happiness.” Psychoanalysis and Christian
Science are the rage. The victims hide behind the veil of sickly,
psychopathic “Love.”
The writings and accounts of the patients are full of introspection
about health, and about the minutiae of their feelings in the
various parts of their body. Some of the patients with a literary
turn keep on writing volumes about the most minute symptoms of
their troubles to which they happen at any moment to be subject.
I have numbers of manuscripts, biographies, autobiographies, all
telling the same old story of “blighted lives” due to ill health,
drugs, and treatment, all describing with the over-scrupulous
exactness of microscopic anatomy the different symptoms that plague
them by night and by day. The patients tell of their talents and
remarkable abilities, superior to the average run, of their ill
luck and failures, due to their unfortunate state of ill health.
In quoting from some of the accounts given to me by the patients
themselves I wish to attract attention to this side of the
patient’s mental condition, the expression of the impulse of
self-preservation, manifested in the general panic of health, or
fear of disease, whether nervous or physical.
A patient of mine, a clerk of mediocre intelligence, with hardly
any ability, but with plenty of selfishness, introspection, and
immeasurable conceit, writes about his ideals in life:
“I would ask that this manuscript be considered in connection with
my other two writings. I have already partially covered this ground
in my autobiography. I should be glad to have my general outlook on
life considered, and to receive suggestions relative to vocations
and avocations, since my anxieties regarding these are inseparably
intermingled with my thoughts of physical and mental health.
“Of course since childhood my ideals have undergone a gradual
modification. First, there was the religious motive of life: I
wanted to be a soldier of the cross and assist in the regeneration
of souls and their preparation for the life beyond.... I began
to meditate upon ethical theories.... It appears that in doing
the world’s work the tendency is to specialize.... In the matter
of choosing my employment my own interest is identical with the
interest of society. At different times of my life I have fancied
I had a liking for one calling or another.... My lines of thought
have gradually drifted into the philosophical (patient means the
various occult scribblings about ‘health metaphysics’). I now
ask myself why I should be a lawyer, a physician, a minister,
a philanthropist or any other special thing? I conceive that a
man’s life is largely what circumstances make it, and it may be,
therefore, that I shall always be a clerk in an office, trying to
be useful in a small way; but now we are talking of influencing
such matters as far as we can by choice. I imagine that perhaps
my field is in the line of ethics, philosophy, or whatever words
may be used to signify the _general principles_ governing human
affairs. My reasons for thinking so are as follows: First, I feel a
strong interest in those principles comparing to no other interest
in my life. Second, I find very few people who seem to feel any
such interest in such matters. Third, I believe such principles
to be of supreme importance. The question is,--Is my position
in regard to general truths so peculiar that I should regard it
my mission to give those subjects more attention in study and
expression than do other men?
“The question I want to settle is,--Do other men feel this
same philosophical interest, realize the broad field of human
obligation, and come down to special occupations, not because
they are more interesting to them than the general field, but
because they realize they must specialize in order to properly
assist in carrying on the world’s work? If this be so then I am
mistaken in thinking I should give particular attention to general
principles. But my observations have gone to show that the average
physician, lawyer, merchant or politician is not interested in the
broad questions of life, but only in medicine, law, business,
or politics, caring little for the relation of his vocation to
other vocations except as he makes his bread by it. Why then if
the various departments of human activity must be correlated, and
if the individuals making up those respective departments have no
disposition to do the correlating,--should it not be done by those
who are interested in the general field?”
It means that such work could be and should be done by the patient,
by the philosophical clerk, interested in the general “metaphysics”
of health.
Such confessions can be easily elicited from psychopathic patients
even in their best states of apparent diffidence, humility.
_This paranoidal aspect of self-aggrandizement is present in
all psychopathic cases._ In some this trait stands out more
clearly and distinctly than in others. It is, however, present
in all psychopathic patients, if one observes them closely and
attentively. It is the expression of an intensified state of the
impulse of self-preservation and fear instinct. In other words, it
is a state of an exaggerated, hypertrophied egotism.
“We must appeal to a law higher than the material law,” a patient
writes in his account. “I worried much over it. Since that time
the relation of mind and matter greatly interested me.... My
health at this time failed, I lost appetite and strength, had
hysterical symptoms. I was treated for general neurasthenia.” ...
Psychopathic, philosophical and ethical speculations and interests
have their sole source in fear of sickness and self-preservation.
“One of my anxieties,” another patient writes, “of my present life
is connected with my business and my relationship to my partners.
I am naturally conscientious and inclined to be not only earnest
and sincere, but serious. My nature, instincts, and desires are
not superficial. Yet my relation to the business is a superficial
one. I am neither fitted by natural tastes nor by training for the
indoor, rather mechanical, conventional, and routine processes upon
which business and commercial success depends....
“Without the common motives of an ordinary merchant (greed) I am
placed in the position of the one who lives not by the usual and
conventional standards of right and wrong, but rather by a more
exalted and more rigid one of his own making which, unsupported
by habit, and institutions, requires a greater loyalty, a higher
resolve, and a firmer will than is required of the conventional
and conforming citizen. Emerson says it demands something Godlike
in one who would essay such a task, not placing the same values
on money, trade, commerce, and profits as the natural money
maker and money lover, and not the opportunity to substitute and
supplement the usual motives by and with the larger, and to me
more compelling, of community betterment and employee welfare....”
This man had abandoned his wife and three children.
Another patient writes of himself, “The hypersensitive nervous
system with the initial shock has inhibited the development of my
highest potentialities and my highest endeavors.” He summarizes
his symptoms: “Dread and anxiety about being away from home and
friends, self-consciousness, mental sluggishness, quick fatigue,
inability for deep thought, general state of irritability.”
A neurotic patient tells me that he suffers from fatigue, insomnia,
dullness, inability of concentration of attention, failure in
studies, slowness of comprehension, and so on; and yet he gives
his opinion with papal infallibility on every conceivable subject,
and hints at being an undeveloped, unappreciated genius. The
psychopathic, neurotic patient rarely, if ever, suffers from a
complaint of inferiority. His real fear is that his superiority may
be humbled.
Obsessed by the impulse of self-preservation and fear instinct, and
with utter disregard of others, the patients are convinced of their
extraordinary kindness, gentleness, sympathy, martyrdom, and even
saintliness. It is from this class that neurotic philanthropists
are recruited. Psychopathic patients are always ready “to sacrifice
themselves for the good of humanity.” They talk endlessly about
goodness, and may even devote themselves to charity and instruction
of the “poor and degraded.” A patient of mine worked for three
years for the “good of the poor,” had “high ideals and a sensitive
conscience,” according to his accounts, but abandoned readily his
wife and children.
Another young woman, a typical psychopathic, full of high ideals,
ran away with a married man, had a child that died of exposure.
This patient was interested in modern education and improvement of
humanity. In reality she never cared to do anything for anybody,
and without any hesitation took advantage of others in order to
satisfy the least whim that might have crossed her mind, especially
those whims that relate to health. She had all kinds of directions,
prescriptions, exercises, requisite for the strength and health of
the body and the nerves.
One of my patients used to be anxious about my going and coming.
Was it love or devotion? I found out that he was afraid that I
might be killed. This fear was developed in him by an actual
accident in which his brother had died, but the same fear
associated with me was due to the fact that the patient was sure
that my treatment was requisite for his health and welfare. He
was in fear lest I might be killed, he would be unable to get his
treatments, and thus lose time in getting back his health.
For the sake of his “health” the patient will not stop at anything.
Neurotics may well name their troubles “Health and Science.” _The
psychopathic, neurotic patient makes of health his science and
religion, because self-preservation and fear are at the bottom of
the psychopathic, neurotic constitution._