CHAPTER XV

EGOTISM AND FEAR

        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 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 suffering 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 other 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.

        Psycopathic 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 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 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 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, 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.

        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 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.