Whenever dynamic energy is exhausted and the levels of reserve energy are reached, the individual affected begins to feel restless, and if there is no access to the levels of reserve energy, the individual gets scared. The fear instinct becomes awakened, giving rise, after repeated unavailing attempts, to the states of psychopathic neurosis. In states of depression, such as hypochondria and more especially in the states of melancholia, the fear instinct is potent. The fear instinct is brought about in the darkness of the night, when the individual is fatigued from his day's labor, when the external stimuli are at a minimum, and reserve energy is not available. The fear instinct rises from the subconscious regions to the surface of conscious activities.

        Convalescent states as well as exhaustion from pain and disease, such as fever or a shock from some accident, war-shock, shell-shock, surgical shock predispose to the manifestation of the fear instinct. Hence the caution of surgeons in the preparation of the patient for a serious operation. For the result may be a shock to the system due to subconscious activities of the fear instinct present in subconscious mental life, no longer protected by the guardianship of the upper consciousness. And it may also be shown, both my experiment and observation, that during the subconscious states when the lower strata of dynamic energy are reached, such as hypnoidal, hypnoid states, and sleep, that the individual is more subject to fear than during the waking states. We know how a sudden noise, a flash of light during drowsy states or sleep startles one, and the same holds true of any stimulus. I have observed the same condition of fright during hypnoidal states.

        We must agree with the French psychologist, Ribot, when he comes to the conclusion that "every lowering of vitality, whether permanent or temporary, predisposes to fear; the physiological conditions which engender or accompany it, are all ready; in a weakened organism fear is always in a nascent condition."

        The fear instinct becomes morbid when the individual has to draw on his reserve energy, and finds he is unable to do it. The cure consists in the release of the reserve energy which has become inaccessible. This can be done by various methods, but the best is the method of induction of the hypnoidal state under the control of a competent psychopathologist. The whole process consists in the restitution of the levels of dynamic energy and the building up of the patient's active personality.

        From our point of view, fear is not necessarily due to pain previously experienced, it may be purely instinctive. The fear instinct may be aroused directly, such for instance is the fear of young children who have never before experienced a fall. In fact we claim that the fear instinct and the restlessness which expresses it antedate and precede pain. The fear of pain is but one of the forms under which the fear instinct is manifested. The fear instinct appears long before pain and pleasure come into existence. This holds true not only of the lower animal life, but also of the vague fear found in many a case of neurathenia and functional neurosis and psychosis. Ribot also calls attention to pantophobia. "This is a state in which the patient fears everything, where anxiety instead of being riveted on one object, floats as a dream, and only becomes fixed an instant at a time, passing from one object to another, as circumstances may determine."

        It is probably best to classify fears as antecedent and subsequent to experience, or fears as undifferentiated and differentiated.

        When the dynamic energy is used up in the course of life adaptations, and reserve energy is drawn upon, there may be danger that the energy may be used up until the static energy is reached, and neuropathic conditions are manifested. These conditions are preceded by psychopathic disturbances. Associative life becomes disturbed, and emotional reactions become morbid. There is a degeneration or reversion to earlier and lower forms of mental activity, and to lower instinctive life. The primitive instincts, the impulse of self-preservation and the fear instinct, come to the foreground, giving rise to the various forms of psychopathic affections.

        This process of degeneration and simplification is characteristic of all forms of psychopathic conditions, though it may be more prominent in some cases than in others. The type of mental life becomes lowered and there is a reversion, a sort of atavism, to simpler and more childish experiences, memories, reactions of earlier and less complex forms of mental life. I have laid special stress on this feature of psychopathic reactions in all my works on the subject. What I emphasize in my present work is the fact that psychopathic reactions are dominated by self and fear, which are laid bare by the process of degeneration.

        The patient in psychopathic states is tortured by his fears, he is obsessed by wishes which are entirely due to his fears, he obsessed by wishes which are entirely due to his fear and deranged impulse of self-preservation.

        As the static energy is reached, and with lack of functional energy of dynamic character, the energy habitually used in the ordinary relations of life, the patient experiences a monotony, a void in his life activity. He has a feeling of distress, as if something is haunting him, and possibly something terrible is going to happen to him or his family. He may have a feeling of some depression, and may suffer from a constant unquenchable craving for new stimulations, run after new impressions and excitements which pale in a short time on his fagged mind. He is restless, demanding new amusements and distractions. He is distracted with fear, conscious and more often subconscious,―which he is unable to dispel or shake off. He seems to stand over a fearful precipice, and he is often ready to do anything to avoid this terrible gap in his life. Life is empty, devoid of all social interest; he talks of ennui and even of suicide; he is of a pessimistic, gloomy disposition, his state of mind approaching a state of melancholia. He asks for new sensations, new pleasures, new enjoyments which soon tire him. He is in the condition of leaking a barrel which never can be filled.

        Psychopathic individuals are in a state of the wicked "who are like to ocean which never rests." This misery of ever forming wishes and attempting to assuage the inner suffering, this craving for new pleasures and excitements, in order to still uneasiness, distress, and the pangs of the fear instinct with its gnawing, agonizing anxieties, brings the patient to a state in which he is ready to drink and use narcotics. The patient seeks ways to relieve his misery. The patient has used up all his available dynamic energy, and being unable to reach the stores of reserve energy looks for a key or stimulant to release his locked up reserve energies. The patient is unable to respond to the stimuli of life, so he attempts then the use of his static energy. This can only result in producing psychopathic and neuropathic symptoms.

        The patient needs to be lifted out of the misery of monotony and ennui of life, he needs to be raised from his low level of vitality, to be saved from the listlessness into which he has fallen. The low level of energy makes him feel a physical, nervous, and mental bankrupt. This bankruptcy is unbearable to him. He is in a state of distraction, distracted with the agony of fear. Something must be done to free himself from the depression of low spirits and from the low level of energy which keeps him in a state devoid of all interest in life, accompanied by physical, mental and moral fatigue. He is like a prisoner doomed to a life long term.

        This constant craving for stimulation of energy, this reaction to the anxiety of the morbid fear instinct is the expression of exhaustion of available dynamic energy for the purpose of normal life activity. The patient attempts to draw on his latent reserve energy. Since this form of energy is not accessible to the stimulations of common life, he tries to release the energy by means of artificial stimulations, be it morphine, alcohol, mysticism, Freudism, sexual and religious "at-one-ments" or by other stimuli of exciting character. Unable to release energy by fair means the patient is driven to the employment of foul means for the stimulation of new sources of energy. The psychopathic patient is driven by fear, by fears of life and death.

        The morbid fear instinct in all cases is brought about by exhaustion of energy, whether sudden or gradual. Fear is due to exhaustion of lower levels of dynamic energy and to the inability of liberation of stored up reserve energy. The more intense this incapacity of utilization of reserve stores of energy be, the more intense is the fear. When this condition is prolonged the psychopathic symptoms become unendurable.

        The experienced, thinking surgeon has learned the danger of this condition in his operating room. Thus it is told of Porta, the great surgeon of Pavia, when his patients died under an operation, he used to throw his knife and instruments contemptuously to the ground, and shout in a tone of reproach to the corpse: "Cowards die of fear."

        The great physiologist Mosso gives a graphic description of the effects of fear in a pathetic case that has come under his personal observation: "As army surgeon, I had once to be present at the execution of some brigands. It was a summary judgment. A major of the besaglieri put a few questions to one or two, then turning to the captain said simply: 'Shoot them.' I remember one lad, of scarecly twenty years of age, who mumbled replies to a few questions, then remained silent, in the position of a man warding off a fatal blow, with lifted arms, extended palms, the neck drawn between the shoulders, the held head sideways, the body bent and drawn backwards. When he heard the dreadful words he emitted a shrill, heart-rendering cry of despair, look around him, as though eagerly seeking something, then turned to flee, and rushed with outspread arms against a wall of the court, writhing and scratching it as though trying to force an entrance between the stones, like a polyp clinging to a rock. After a few screams and contortions, he suddenly sank to the ground, powerless and helpless like a log. He was pale and trembled as I have never seen anyone tremble since. It seemed as though the muscles had been turned to a jelly which was shaken in all directions."

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