FEAR VARIETIES
The great psychologist Ribot classifies fears into pain fears,
and disgust fears. To quote from Ribot: “I propose to reduce them
(fears) to two groups. The first is directly connected with fear
and includes all manifestations, implying in any degree whatever
the fear of pain, from that of a fall or the prick of a needle, to
that of illness or death. The second is directly connected with
disgust, and seems to me to include the forms which have sometimes
been called pseudophobia (Gelineau). Such are the fear of contact,
the horror of blood and of innocuous animals, and many strange
and causeless aversions. Let us remark furthermore that fear and
disgust have a common basis, being both instruments of protection
or defense. The first is the defensive-conservative instinct of
relative life, the second the defensive-conservative instinct of
organic life. As both have a common basis of aversion, they show
themselves in equivalent ways: fear of withdrawal, departure,
flight, disgust by vomiting and nausea: The reflexes of disgust are
the succedanea of flight; the organism cannot escape by movement
in space from the repugnant object which it has taken into itself,
and goes through a movement of expulsion instead.”
I hesitate to accept Ribot’s classification, inasmuch as we have
pointed out that fear is prior to pain. In most lower animals
it is hardly probable that not having representations that
there is present a fear of pain in advance of the pain itself.
Fear under such conditions can only be awakened by an actual
sensory experience whether it be painful or not. In fact Ribot
himself agrees to the fact that “There is a primary, instinctive,
unreasoning fear preceding all individual experience, a hereditary
fear.”
Perhaps a word may be said in regard to the factor of disgust
as having a common basis with fear. It is only by a stretch of
imagination, if not by a stretch of words, that fear and disgust
can be identified. There may be fear where there is no disgust,
and there may be disgust where there is no fear. The two are
independent variables, and can hardly be referred to as one and
the same fundamental reaction, such as withdrawal and flight. The
object of disgust does not preclude approach. The avoidance or
aversion, the nausea and vomiting are all subsequent phenomena.
Disgust may even follow after an abuse of food, of pleasant or
necessary objects of nutrition, such as satiety.
The reactions of the fear instinct run the contrary way, approach
is precluded from the very start. Fear is not associated with
useful objects or events, unless it be in morbid states of fear.
And still fear and disgust may become intimately associated when
disgust and its objects awaken the fear instinct, and the fear
becomes the fear of disgust or of the disgusting object. Disgust is
more of a specialized character, and is associated with particular
events or specific objects, while fear, in its primitive form at
least, is more of a generalized character.
In the higher forms of life disgust may be so intimately related to
fear that the two become synthesized, so to say, and are felt like
one emotional state, the state becoming one of fear disgust. In
such cases the fear instinct, fear disgust, is a determining factor
of the morbid state. This is confirmed by clinical experience of
the various cases of psychopathic functional neurosis and psychosis.
In the various morbid states of the depressive types fear is
awakened long before any pain is actually suffered, or any
particular cause is found by the patient to account for the terror
that dominates his mental life. The fear comes first while the
representative cause is assigned by the sufferer as the cause of
the fear.
Similarly in the functional psychosis and neurosis the object,
experience, event, may be quite ordinary without any suggestion of
pain or distress in it. In fact, the experience may be indifferent
or even pleasant, but when associated with the fear instinct may
become the nucleus of a very distressing pathological state. The
experience is the _occasion_, while the fear instinct, the intimate
companion of the impulse of self-preservation, is the only cause of
functional psychopathic maladies.
The fear instinct in its primitive state is anterior to all
experiences of danger, pain, and suffering, as is the case in
most of the lower animals. In the higher animals where memory
is developed, the fear instinct is associated with some form of
representation, however vague, and then fear becomes posterior to
experience. In man both forms of fear are present. The anterior
form is specially found in children, while in adults the posterior
form is, under normal conditions, predominating. The primitive
anterior type of the fear instinct is by no means absent, in fact,
it is more overpowering, its effects are overwhelming when it comes
forth from the subconscious regions to which it is confined, and is
manifested under conditions of lowered vitality.
When the strata of dynamic energies are passed and the strata
of reserve energies are reached, the reserve energy not being
accessible, the fear instinct is elemental, fundamental, while the
fear of pain and of some definite representation of danger, or of
suffering is a secondary consequence. People may suffer from pain,
disease, and even danger, and still have no fear, while others may
have never experienced the pain or disease, and still be obsessed
by intense pangs of fear. Fear is _sui generis_, it is at the
foundation of animal life.
The fear instinct may be awakened directly by a sensory stimulus,
when, for instance, one finds himself in darkness and feels some
creeping, slimy thing, or when attacked suddenly with a club or a
knife. The fear instinct may again be aroused by an expectation, by
something to which his dynamic energies cannot respond adequately,
while the reserve energies are in abeyance, such for instance
as the expectation of some threatening event either to himself
or to the objects bound up with his life existence. When one is
threatened with some misfortune, with torture, death, or with a
mortal disease, or with a serious operation, or when confronted
with great danger against which his energies prove inadequate, in
such cases the fear is ideational. These types of fear may in turn
be either conscious or subconscious.
We may thus classify the fears as follows:
{ Conscious
I. Sensory {
{ Subconscious
{ Conscious
II. Ideational {
{ Subconscious
The fear of the etherized or chloroformed patient is entirely
of the subconscious type. It is the arousing of subconscious
fear which, from the nature of the case, cannot be reached and
alleviated that gives rise to functional psychosis and neurosis.
From this standpoint it may be said that _psychopathic diseases
are subconscious fear states, in other words functional psychosis
or neurosis is essentially a disease of subconscious activities_.
This is, in fact, confirmed by my clinical experience and by my
psychopathological research work.
Dr. L. J. Pollock, professor of nervous diseases at Northwestern
University Medical School, made an extremely interesting “Analysis
of a Number of Cases of War Neurosis.” This analysis fully
conforms to the results obtained by me in my work on functional
psychosis and neurosis carried on for a great number of years.
It fully confirms the results of my studies, clinical and
psychopathological, that the causation, or etiology of functional
psychopathic states depends on fluctuations of the levels of neuron
energy, or physical exhaustion, fatigue, hunger and thirst, or
shock to the system, and more especially on the ravages of the fear
instinct, aroused during the dangers and horrors of war.
“Of several hundred cases which I observed in base hospitals in
France, copies of about 350 records were available. From these 200
of the more detailed ones were selected to determine the relative
frequency of some of the factors.... From the numerical group
has been excluded cases of emotional instability, timorousness,
hospital neuroses occurring as an aftermath of an illness or a
wound, the phobic reactions of gassed patients and constitutional
neuroses, and those not directly related to the war.
“Heredity as a factor plays but a small part, and the incidence of
neuropathic taint constituted little over 4 per cent.
“Of these 43 per cent followed shell fire, 36 per cent after
concussion as described by the soldier.... A definite history of
fatigue and hunger was obtained in 30.5 per cent. Both probably
occurred in a greater percentage, but were frequently masked by
other symptoms which occupied the patient’s attention to a greater
extent. Fatigue and hunger are important factors, not only because
they prepare the ground for an ensuing neurosis by breaking down
the defensive reactions, but also in that when the patient is more
sensitive and impressionable, the natural physical consequences of
fatigue are misinterpreted by him as an evidence of an illness, and
give rise to apprehension and fear.
“As frequently as fear is seen in some form or other in the
neuroses of civil life, so does it manifest itself in the war
neuroses. Fifty per cent of the cases admitted considerable fear
under shell fire. Concussion was the immediate precipitating cause
of the neuroses in 31 per cent of the cases. The symptoms of the
neuroses could be divided into those of the reactions of fear and
fatigue.”
These results corroborate my work on neurosis as due to exhaustion
of Neuron Energy and Self-Fear.
In fact, in one of my works written at the beginning of the war, I
predicted the wide occurrence of what is known as shell shock, war
shock or war neurosis. The prediction was fully corroborated by the
facts.
Fear, Self, Reserve Energy, and Fatigue are the main factors in
the formation of the psychopathic or neurotic condition. Janet,
in a recent article of his, lays stress on the fear states in
psychopathic affections and refers these conditions to the levels
of vital energy. There is no doubt that Janet lays his finger on
the very heart of the psychopathic diathesis.
In my work I come to a similar conclusion only I lay more stress on
the fear states, being referred to the fundamental instinct present
in all animal life as a primordial condition of existence. This
instinct is intensified and extended in the psychopathic diathesis.
The level of energy and the fear instinct are vitally
interdependent. A low level of energy, especially a dissociation
or inhibition of the store of reserve energy, arouses an excess
of reaction of the fear instinct, and _vice versa_ the excessive
reaction of the fear instinct locks up the stores of reserve
energy, thus intensifying and extending the psychopathic states
with their fear-fatigue conditions. Janet refers indirectly to the
impulse of self-preservation which is of the utmost consequence in
psychopathic affections. On the whole, I may say that my work and
clinical experience are in accord with that of the great French
psychopathologist.
Where the fear instinct, self, and inhibition of reserve energy are
present, then any emotion, even that of love, and devotion, will
give rise to psychopathic states. This psychopathic state is not
produced, because of the intensity or repression of the emotion,
but because of the underlying subconscious predisposition to
fear-instinct, self-preservation, and inhibition of reserve energy.
The feelings of inhibited reserve energy produced by fear and
self, make the individual hesitate in decision, in action, and
finally demoralize and terrorize him. These conditions take away
from him all assurance and security of life and action, and hold
him in a perpetual state of anxiety until he becomes completely
incapacitated for all kinds of action and reaction.
Events that threaten the impulse of self-preservation of the
individual, such as misfortunes, shocks, losses, tend to bring
about psychopathic states, on account of the aroused fear instinct,
on account of the impulse of self-preservation, and sudden
inhibition of the stores of reserve energy. Events that may lead
to dissolution of personality are, hence, attended with intense
anxiety.
As we have seen, an intense state of fear, conscious or
subconscious, produces a state of aboulia, a state of indecision,
a state of incompletion of action, a state of insufficiency, a
paralysis of will power, and a sense of unreality, all of which
are intimately interrelated. For the fear instinct, when intense,
inhibits and arrests the will and paralyzes action. _The patient
fears, not because he is inactive, but he is inactive, because he
fears._
The impulse of self-preservation, the fear instinct, and the
principle of subconscious reserve energy give an insight into the
multiform symptomatology of the psychopathic diathesis.
The following classes of people are subject to psychopathic
affections:
(I) Childless people.
(II) People who had been afflicted with various diseases in
childhood.
(III) Children of sickly, nervous, psychopathic parents who have
kept their progeny in a constant state of anxiety, full of terrors
and troubles of life.
(IV) People who had been affected by a series of shocks and fears
in childhood and youth.
(V) People whose parents suffered long from various systemic
diseases, especially cardiac and tubercular troubles.
(VI) In a large family of children the first, or last child, or
sickly child of psychopathic parents.
(VII) The only child, or sickly child, especially of a widowed
parent who is of a psychopathic diathesis.
_In all these cases the psychopathic state is due to early
cultivation of the fear instinct, self-impulse, and low level or
dissociated state of vital reserve energy._