The great psychologist Ribot classifies fear 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 include all manifestations, implying in any degree whatever the fear of pain, from that of a fall or the prick of a needles, 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 protections 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 probably 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 of 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 objets 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 ear disgust. In such cases the fear instinct, the 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 state 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 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 various 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:

        The fear of the etherized of 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 by 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 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 articles 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 may 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 of 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, 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 systematic diseases, especially cardiac and tubercular troubles.
        (VI) In a large family of children the first, or last child, or sickly child of psychopatic 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.

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