RECURRENT FEAR STATES,--PSYCHOLEPSY
There are cases in which the nature of the psychopathic states
stands out more clearly and distinctly than in others. They occur
periodically, appearing like epileptic states, in a sort of an
explosive form, so that some authorities have mistaken them for
epilepsy, and termed them psychic epilepsy. My researches have
shown them to be recurrent explosions of subconscious states,
which I termed _psycholepsy_. They really do not differ from
general psychopathic states, but they may be regarded as classic
_pseudo-epileptic_, or _psycholeptic_ states; they are classic
_fear-states_--_states of panic_.
M. L. is nineteen years of age, of a rather limited intelligence.
He works as a shopboy amidst surroundings of poverty, and leads
a hard life, full of privations. He is undersized and underfed,
and looks as if he has never had enough to eat. Born in New York,
of parents belonging to the lowest social stratum, he was treated
with severity and even brutality. The patient has never been to any
elementary school and can neither read nor write. His mathematical
knowledge did not extend beyond hundreds; he can hardly accomplish
a simple addition and subtraction, and has no idea of the
multiplication table. The names of the President and a few Tammany
politicians constitute all his knowledge of the history of the
United States.
Family history is not known; his parents died when the patient was
very young, and he was left without kith and kin, so that no data
could be obtained.
Physical examination is negative. Field of vision is normal. There
are no sensory disturbances. The process of perception is normal,
and so also is recognition. Memory for past and present events is
good. His power of reasoning is quite limited, and the whole of his
mental life is undeveloped, embryonic. His sleep is sound; dreams
little. Digestion is excellent; he can digest anything in the way
of eatables. He is of an easy-going, gay disposition, a New York
“street-Arab.”
The patient complains of “shaking spells.” The attack sets in
with tremor of all the extremities, and then spreads to the whole
body. The tremor becomes general, and the patient is seized by
a convulsion of shivering, trembling, and chattering of teeth.
Sometimes he falls down, shivering, trembling, and shaking all
over, in an intense state of fear, a state of panic. The seizure
seems to be epileptiform, only it lasts sometimes for more than
three hours. The attack may come any time during the day, but is
more frequent at night.
During the attack the patient does not lose consciousness; he knows
everything that is taking place around him, can feel everything
pretty well; his teeth chatter violently, he trembles and shivers
all over, and is unable to do anything.
The fear instinct has complete possession of him. He is in agony
of terror. There is also a feeling of chilliness, as if he is
possessed by an attack of “fear ague.” The seizure does not start
with any numbness of the extremities, nor is there any anaesthesia
or paraesthesia during the whole course of the attack. With the
exception of the shivers and chills the patient claims he feels
“all right.”
The patient was put into a condition close to the hypnotic
state. There was some catalepsy of a transient character, but no
suggestibility of the hypnotic type. In this state it came to light
that the patient “many years ago” was forced to sleep in a dark,
damp cellar where it was bitter cold. The few nights passed in that
dark, cold cellar he had to leave his bed, and shaking, trembling,
and shivering with cold and fear he had to go about his work in
expectation of a severe punishment in case of non-performance of
his duties.
While in the intermediary, subwaking, hypnoidal state, the patient
was told to think of that dark, damp, cold cellar. Suddenly the
attack set in,--the patient began to shake, shiver, and tremble
all over, his teeth chattering as if suffering from intense fear.
The attack was thus reproduced in the hypnoidal state. “This is
the way I have been,” he said. During this attack no numbness, no
sensory disturbance, was present. The patient was quieted, and
after a little while the attack of shivering and fear disappeared.
The room in which the patient was put into the subconscious
state was quite dark, and accidentally the remark was dropped
that the room was too dark to see anything; immediately the
attack reappeared in all its violence. It was found later that it
was sufficient to mention the words, “dark, damp, and cold” to
bring on an attack even in the fully waking state. We could thus
reproduce the attacks at will,--those magic words had the power
to release the pent-up subconscious forces and throw the patient
into convulsions of shakings and shiverings, with chattering of the
teeth and intense fear.
Thus the apparent epileptiform seizures, the insistent psychomotor
states of seemingly unaccountable origin, were traced to
subconscious fear obsessions.
The following case is of similar nature. The study clearly shows
the subconscious nature of such psycholeptic attacks:[10]
Mr. M., aged twenty-one years, was born in Russia, and came to this
country four years previously. His family history, as far as can be
ascertained, is good. There is no nervous trouble of any sort in
the immediate or remote members of his family.
The patient himself has always enjoyed good health. He is a young
man of good habits.
He was referred to me for epileptiform attacks and anaesthesia
of the right half of his body. The attack is preceded by an aura
consisting of headache and a general feeling of malaise. The aura
lasts a few days and terminates in the attack which sets in about
midnight, _when the patient is fully awake_. The attack consists of
a series of spasms, rhythmic in character, and lasting about one or
two minutes. After an interval of not more than thirty seconds the
spasms set in again.
This condition continues uninterruptedly for a period of five or
six days (a sort of status epilepticus), persisting during the time
the patient is awake, and ceasing only during the short intervals,
or rather moments, of sleep. Throughout the whole period of the
attacks the patient is troubled with insomnia. He sleeps restlessly
for only ten or fifteen minutes at a time. On one occasion he was
observed to be in a state of delirium as found in post-epileptic
insanity and the so-called Dämmerzustände of epilepsy. This
delirium was observed but once in the course of five years.
The regular attack is not accompanied by any delirious states or
Dämmerzustände. On the contrary, during the whole course of the
attack the patient’s _mind remains perfectly clear_.
During the period of the attack the whole right side becomes
anaesthetic to all forms of sensations, kinaesthesis included, so
that he is not even aware of the spasms unless he actually observes
the affected limbs.
The affected limbs, previously normal, also become paretic. After
the attack has subsided, the paresis and anaesthesia persist (as
sometimes happens in true idiopathic epilepsy) for a few days,
after which the patient’s condition remains normal until the next
attack. After his last attack, however, the anaesthesia and paresis
continued for about three weeks.
He has had every year one attack which, curiously, sets in about
the same time, namely, about the month of January or February.
The attacks have of late increased in frequency, so that the
patient has had four, at intervals of about three or four months.
On different occasions he was in the Boston City Hospital for the
attacks.
There was a profound right hemianaesthesia including the right half
of the tongue, with a marked hypoaesthesia of the right side of the
pharynx. All the senses of the right side were involved. The field
of vision of the right eye was much limited. The ticking of a watch
could not be heard more than three inches away from the right
ear. Taste and smell were likewise involved on the right side. The
muscular and kinaesthetic sensations on the right side were much
impaired.
The patient’s mental condition was good. He states that he has few
dreams and these are insignificant, concerned as they are with the
ordinary matters of daily life. Occasionally he dreams that he is
falling, but there is no definite content to the dream.
These findings were indicative of functional rather than organic
disease. The _previous history_ of the case was significant. The
first attack came on after peculiar circumstances, when the patient
was sixteen years of age and living in Russia. After returning from
a ball one night, he was sent back to look for a ring which the
lady, whom he escorted, had lost on the way. It was after midnight,
and his way lay on a lonely road which led by a cemetery. When near
the cemetery he was suddenly overcome by a great fright, thinking
that somebody was running after him. He fell, _struck his right
side_, and lost consciousness. The patient did not remember this
last event. It was told by him when in a hypnotic state.
The patient was a Polish Jew, densely ignorant, terrorized by
superstitious fears of evil powers working in the dead of night.
By the time he was brought home he regained consciousness, but
there existed a spasmodic shaking of the right side, involving the
arm, leg, and head. The spasm persisted for one week. During this
time he could not voluntarily move his right arm or leg, and the
right half of his body felt numb. There was also apparently a loss
of muscular sense, for he stated that he was unaware of the shaking
of his arm or leg, unless he looked and saw the movements. In other
words, there was right hemiplegia, anaesthesia, and spasms.
For one week after the cessation of the spasms his right arm and
leg remained weak, but he was soon able to resume his work, and he
felt as well as ever. Since then every year, as already stated,
about the same month the patient has an attack similar in every
respect to the original attack, with the only exception that there
is no loss of consciousness. Otherwise the subsequent yearly
attacks are _photographic pictures, close repetitions, recurrences
of the original attack_.
A series of experiments accordingly was undertaken. First,
as to the anaesthesia. If the anaesthesia were functional,
sensory impressions ought to be felt, even though the patient
was unconscious of them, and we ought to be able to get sensory
reactions.
Experiments made to determine the nature of the anaesthesia
produced interesting results. These experiments show that the
anaesthesia is not a true one, but that impressions from the
anaesthetic parts which seem not to be felt are really perceived
subconsciously.
Different tests showed that the subconscious reactions to
impressions from the anaesthetic hand were more delicately plastic
and responsive than the conscious reactions to impressions from
the normal hand. We have the so-called “psychopathic paradox” that
_functional anaesthesia is a subconscious hyperaesthesia_.
It is evident then that there could be no inhibition of the sensory
centres, or suppression of their activity, or whatever else it
may be called. In spite of the apparent, profound anaesthesia,
the pin pricks were felt and perceived. Stimulations gave rise to
perception, cognition, to a sort of pseudo-hallucinations that
showed the pin pricks were counted and localized in the hand. The
results of these tests demonstrate that in psychopathic patients
all sensory impressions received from anaesthetic parts, while
they do not reach the _personal_ consciousness are perceived
_subconsciously_.
Inasmuch as the sensations are perceived, the failure of the
subject to be conscious of them must be due to a _failure in
association_. The perception of the sensation is dissociated from
the personal consciousness. More than this, these _dissociated_
sensations are capable of a certain amount of independent
functioning; hence the pseudo-hallucinations, and hence the
failure of psychopathic patients to be incommoded by their
anaesthesia. This condition of dissociation underlies psychopathic
states.
For the purpose of studying the attacks, the patient was
hypnotized. He went into a deep somnambulic condition, in which,
however, the _anaesthesia still persisted_. This showed that the
dissociation of the sensory impressions was unchanged.
In hypnosis he related again the history of the onset of the
trouble. His memory became broader, and he was able to give the
additional information, which he could not do in his waking state,
that at the time he was badly frightened, he fell on his right
side. Moreover, he recalled what he did not remember when awake,
that throughout the period of his attacks when he fell asleep,
he had vivid dreams of an intense hallucinatory character, all
relating to terror and fall.
In these dreams he lived over and over again the experience which
was the beginning of his trouble. He again finds himself in his
little native town, on a lonely road; he thinks some one is running
after him; he becomes frightened, calls for help, falls, and then
wakes up with a start, and the whole dream is forgotten. After he
wakes he knows nothing of all this; there is no more fear or any
emotional disturbance; he is then simply distressed by the spasms.
While testing the anaesthesia during hypnosis, an attack
developed, his right arm and leg began to shake, first mildly
and then with increasing intensity and frequency. His head also
spasmodically turned to the right side. The movements soon became
rhythmic. Arm and leg were abducted and adducted in a slow rhythmic
way at the rate of about thirty-six times per minute. With the
same rate and rhythm, the head turned to the right side, with
chin pointing upward. The right side of the face was distorted
by spasm, as if in great pain. The left side of the face was
unaffected. Pressure over his right side (where he struck when
he fell) elicited evidences of great pain. Respiration became
deep and labored, and was synchronous with each spasm. The whole
symptom-complex simulated Jacksonian epilepsy.
Consciousness persisted unimpaired, but showed a curious and
unexpected alteration. When asked what was the matter, he replied
in his native dialect, “I do not understand what you say.” It was
found that he had lost all understanding of English, so that it was
necessary to speak to him in his native dialect. His answers to
our questions made it apparent that during the attack, as in his
dreams, he was living through the experience which had originally
excited his trouble.
The attack was _hypnoidic, a fear attack_, hallucinatory in
character. He said that he was sixteen years old, that he was
in Rovno (Russia), that he had just fallen, because he was
_frightened_, that he was lying on the roadside near the cemetery,
which in the popular superstitious fear is inhabited by ghosts. At
that hour of the night the dead arise from their graves and attack
the living who happen to be near.
The hypnoidic state developed further, the patient living through,
as in a dream, the whole experience that had taken place at that
period. He was in a carriage, though he did not know who put him
there. Then in a few moments he was again home, in his house,
with his parents attending on him as in the onset of his first
epileptiform seizures.
The attack terminated at this point, and thereupon he became
perfectly passive, and when spoken to answered again in English.
Now he was again twenty-one years old, was conscious of where he
was, and was in absolute ignorance of what had just taken place.
It was found that an attack could regularly and artificially be
induced, if the patient in hypnosis was taken back by suggestion to
the period when the accident happened.
The experiment was now tried of taking him back to a period
antedating the first attack. He was told that he was fifteen years
old, that is, a year before the accident occurred. He could no
longer speak or understand English, he was again in Rovno, engaged
as a salesman in a little store, had never been in America, and
did not know who we were. Testing sensation, it was found that it
had spontaneously returned to the hand. _There was not a trace of
the anaesthesia left._ The hands which did not feel deep pin pricks
before now reacted to the slightest stimulation. _Spontaneous
synthesis of the dissociated sensory impressions had occurred._
Just as formerly before the accident, sensation was in normal
association with the rest of his mental processes, so now this
association was re-established with the memories of that period to
which the patient was artificially reduced.
The patient was now (while still believing himself to be fifteen
years old) taken a year forward to the day on which the accident
occurred. He says he is going to the ball tonight. He is now at the
ball; he returned home; he is sent back to look for a ring. Like
a magic formula, it calls forth an attack in which again he lives
through the accident,--the terror and the spasms.
It was thus possible to reproduce an attack at any time with
clock-like precision by taking him back to the period of the
accident, and reproducing all its details in a hypnoidic state.
Each time the fear and the physical manifestations of the attack
(spasms, paresis, and anaesthesia) developed. These induced attacks
were identical with the spontaneous attacks, one of which we had
occasion to observe later.
At periodic intervals, as under the stress of fear, the
dormant activity is awakened and, though still unknown to the
patient, gives rise to the same sensori-motor disturbances
which characterized the original experience. These subconscious
dissociated states are so much more intense in their manifestations
by the very fact of their dissociaton from the inhibitory
influences of the normal mental life.
The psychognosis of such cases reveals on the one hand a
dissociation of mental processes, and on the other hand an
independent and automatic activity of subconscious psychic states,
under the disaggregating, paralyzing influence of the fear instinct.
A patient under my treatment for four months during the year of
1922 presents interesting traits. I regard the case as classic as
far as the fundamental factors of neurosis are concerned.
Patient, male, age 32, married, has two children. He lives in an
atmosphere of fear and apprehension about himself. He comes from
a large, but healthy family. The patient is of a rather cowardly
disposition especially in regard to his health. He worked hard in a
store during the day, and led a life of dissipation at night. One
day, after a night of unusual dissipation, or orgy, when on his
way to his work, he felt weak, he was dizzy, he became frightened
about himself; he thought he had an attack of apoplexy, and that
he was going to die. His heart was affected, it began to beat
violently, and he trembled and shivered in an “ague” of intense
fear. The palpitation of the heart was so great, the trembling was
so violent, and the terror was so overwhelming that he collapsed in
a heap. He was taken to his father’s store in a state of “fainting
spell.” A physician was called in who treated the patient for an
attack of acute indigestion.
For a short time he felt better, but the attacks of terror,
trembling, shivering, weakness, pallor, fainting, palpitation of
the heart and general collapse kept on recurring. He then began
to suffer from insomnia, from fatigue, and is specially obsessed
by fear fatigue. He is in terror over the fact that his energy
is exhausted; physical, mental, nervous, sexual impotence. This
was largely developed by physicians who treated him for epilepsy,
putting him on a bromide treatment; others treated and diagnosed
the case as cardiac affection, kidney trouble, dementia praecox,
and one physician operated on the poor fellow for tonsillitis.
The patient was terrorized. He was on a diet for toxaemia, he was
starved. He took all sorts of medicine for his insomnia.
The patient became a chronic invalid for ten years. He was in
terror, scared with the horrors of sleepless nights. He has
been to neurologists, to psychoanalysts, and he tried Christian
Science, New Thought, Naturopathy, and Osteopathy, but of no avail.
The condition persisted. The attacks came on from time to time
like thunder storms. There were trembling, shivering, chattering
of teeth, palpitation of the heart, weakness, fainting, and
overwhelming, uncontrollable terror.
The first time I tried to put the patient into a hypnoidal state
was nine at night. I put out the electric light, lighted a candle,
and proceeded to put him into a hypnoidal condition. The patient
began to shiver, to tremble, to breathe fast and heavily, the pulse
rose to over 125, while the heart began to thump violently, as if
it were going to jump out. He was like one paralyzed, the muscles
of the chest labored hard, and under my pressure the muscle fibers
hardened, crackled, became rigid, and he could not reply when
spoken to. It took me some time to quieten him. He was clearly in a
state of great panic. I opened his eyelids and found the eye ball
turned up. The whole body was easily put in a state of catalepsy.
Clearly the patient was not in a hypnoidal state, he was in a state
of hypnosis. Night after night he fell into states of hypnosis
with all the symptoms of intense fear attacks. When the fear
attacks subsided the depths of the hypnotic state proportionately
diminished.
In my various clinical and laboratory experimental work, covering
a period of a quarter of a century, I have gradually come to the
conclusion that fear and hypnosis are interrelated. In fact I am
disposed to think that the hypnotic state is an ancient state,
a state of fear cataplexy, or rather trance obedience. While the
hypnoidal state is a primitive sleep state, the hypnotic condition
is a primitive, fear condition, still present in lowly formed
organisms.
After some time the general fear instinct becomes alleviated.
The patient goes by habit into a trance hypnotic state under the
influence of the hypnotizer in whom he gains more confidence. The
patient gets into a state of trance obedience to the hypnotizer of
whom he is in awe, and who can control the patient’s fear instinct.
Man obeys the commands, “the suggestions” of the hypnotizer, of the
master whom he subconsciously fears, and who inspires him with awe,
with “confidence-fear”. The crowd, the community, “public opinion,”
the mob, the leader, the priest, the magician, the medicine man,
are just such forces, such authorities to procure the slavish
obedience of the subconscious described as hypnosis. Soldiers and
slaves fall most easily into such states.
Man has been trained in fear for milleniums, in fear of society,
custom, fashion, belief, and the authority of crowd and mob. He
fears to stand alone, he must go with the crowd.
Man is a social being, a hypnotized, somnambulic creature. He walks
and acts like a hypnotized slave. Man is a social somnambulist
who believes, dreams, and acts at the order of the mob or of its
leader. Man belongs to those somnambulists who become artificial,
suggested, automatic personalities with their eyes fully open,
seeing and observing nothing but what is suggested to them.
The hypnoidic states, observed and described by me in the classical
Hanna case, belong to the same category. The hypnoidic states are
essentially fear cataleptic states of a vivid character, closely
related to hypnotic conditions of primitive life.[11]
FOOTNOTES:
[10] Dr. Morton Prince and Dr. H. Linenthal coöperated with me in
the study of the case published in full in the “Boston Medical and
Surgical Journal.”
[11] See my works, “The Psychology of Suggestion,” “Multiple
Personality,” and others.