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 disorders3. 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 essentially4 egotistic.
[116]
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 diabolical5 in his selfishness.
The constant sympathy which the patients crave6 from others, and which they demand, if it is not given to them immediately, is but an expression of their extreme obsession7 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 often expressed in a frank, brutal9 way. Even in the best of patients one can find glimpses into the depths of the psychopathic soul which is nothing but the immense egotism of the beast, worsted in the struggle for existence, tortured by the agonizing10 pangs11 of the fear instinct.
In the vanity, conceit12, arrogance13, and overbearing attitude towards others, friend or stranger, as well as in the total indifference14 to the suffering of his intimate friends and acquaintances, we once more find the expression of that terrible selfishness which obsesses15 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[117] 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 fully16 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 altruistic18 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 delicacy19 and extraordinary sensitivity. This trait he is specially17 anxious to impress on his friends, on his family, and even on those whom he apparently20 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[118] 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 whims22, and especially his fears, which underlie23 all his wishes and desires. There is nothing so tyrannical and merciless as the autocratic, fear-obsessed24 “weak” will of a psychopathic or neurotic25 patient.
The patient’s whole attention is concentrated on himself, or more specially on the symptoms of his psychopathic malady26, symptoms which obsess8 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 exacting27 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 sufferings 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[119] to their health and happiness. Everything is absorbed by the worship of Moloch Health to whom the patients sacrifice everything. Pain, suffering, and distress28 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 others 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 frankly29 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 insomnia30 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, nausea31, eructation, and vomiting32. The patients then turn round, abuse the person who helps them, telling him disagreeable[120] 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.
Psychopathic patients do not hesitate, for the alleviation33 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 the Trinity: ‘I am the Trinity.’” As a matter of fact every psychopathic patient is an egomaniac.
Bacon’s aphorisms34 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 noted35 is, that those which are sui amantes sine rivali, are many times unfortunate.”
Driven by the impulse of self-preservation and by the anguish36 of extreme fear, the psychopathic patient may be pitied as a most unfortunate, miserable37 wretch38.
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[121] with its instinctive39 emotion of fear can always be found in the background of consciousness or in the subconsciousness40.
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 primitive41 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 stereotyped42 character. The stimuli43 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 formerly44 used to take an interest lose their attraction for him. The life he is 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 humanitarian45 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[122] the overwhelming fatigue46 due to ill health, and in spite of the fearful ideas and impulses that have beset47 him day and night he still has succeeded in fighting his way through.
The patient hankers for notoriety, for praise, for appreciation48 by other people. He is apt to complain that the family, neighbors, acquaintances, friends cannot appreciate his good points, 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.
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 puny49 being of mediocre50 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.”
[123]
Psychopathic patients subscribe51 to the “cheerful” effusions of “New Thought,” and plaster the walls of their rooms with elevating “Rules for Health and Happiness.” Psychoanalysis and Christian52 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 minutiae53 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, autobiographies54, all telling the same old story of “blighted lives” due to ill health, drugs, and treatment, all describing with the over-scrupulous exactness of microscopic55 anatomy56 the different symptoms that plague them by night and by day. The patients tell of their talents and remarkable57 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,[124] 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 partially58 covered this ground in my autobiography59. I should be glad to have my general outlook on life considered, and to receive suggestions relative to vocations60 and avocations62, 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 modification63. First, there was the religious motive64 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 meditate65 upon ethical66 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 liking67 for one calling or another.... My lines of thought have gradually drifted into the philosophical68 (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[125] 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 ethics69, 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 supreme70 importance. The question is,—Is my position in regard to general truths so peculiar71 that I should regard it my mission to give those subjects more attention in study and expression than do other men?
“The question I 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[126] medicine, law, business, or politics, caring little for the relation of his vocation61 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 disposition72 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 confessions73 can be easily elicited74 from psychopathic patients even in their best states of apparent diffidence, humility75. 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 attentively76. It is the expression of an intensified77 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 hysterical78 symptoms. I was treated[127] for general neurasthenia.” ... Psychopathic, philosophical and ethical speculations79 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 conscientious80 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 motives81 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 exalted82 and more rigid83 one of his own making which, unsupported by habit, and institutions, requires a greater loyalty84, 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 maker85 and money lover, and not the opportunity to substitute and supplement the usual motives by and[128] 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 inhibited86 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 sluggishness87, quick fatigue, inability for deep thought, general state of irritability88.”
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 humbled89.
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[129] 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 hesitation90 took advantage of others in order to satisfy the least whim21 that might have crossed her mind, especially those whims that relate to health. She had all kinds of directions, prescriptions91, exercises, requisite92 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.
[130]
For the sake of his “health” the patient will not stop at anything. Neurotics93 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.
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pointed
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| adj.尖的，直截了当的 | |
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entirely
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| ad.全部地，完整地；完全地，彻底地 | |
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disorders
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| n.混乱( disorder的名词复数 )；凌乱；骚乱；（身心、机能）失调 | |
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essentially
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diabolical
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| adj.恶魔似的，凶暴的 | |
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crave
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| vt.渴望得到，迫切需要，恳求，请求 | |
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obsession
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| n.困扰，无法摆脱的思想(或情感) | |
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obsess
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| vt.使着迷，使心神不定，（恶魔）困扰 | |
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brutal
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agonizing
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| adj.痛苦难忍的；使人苦恼的v.使极度痛苦；折磨(agonize的ing形式) | |
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pangs
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| 突然的剧痛( pang的名词复数 )； 悲痛 | |
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conceit
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arrogance
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indifference
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| n.不感兴趣，不关心，冷淡，不在乎 | |
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obsesses
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| v.时刻困扰( obsess的第三人称单数 )；缠住；使痴迷；使迷恋 | |
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fully
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specially
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altruistic
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delicacy
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| n.精致，细微，微妙，精良；美味，佳肴 | |
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apparently
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whim
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WHIMS
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| 虚妄，禅病 | |
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underlie
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obsessed
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neurotic
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malady
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exacting
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distress
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frankly
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insomnia
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nausea
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vomiting
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alleviation
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aphorisms
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noted
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anguish
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| n.(尤指心灵上的)极度痛苦，烦恼 | |
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miserable
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wretch
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| n.可怜的人，不幸的人；卑鄙的人 | |
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instinctive
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| adj.(出于)本能的；直觉的；(出于)天性的 | |
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subconsciousness
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| 潜意识；下意识 | |
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primitive
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| adj.原始的；简单的；n.原(始)人，原始事物 | |
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stereotyped
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stimuli
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formerly
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humanitarian
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| n.人道主义者，博爱者，基督凡人论者 | |
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fatigue
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| n.疲劳，劳累 | |
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beset
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| v.镶嵌；困扰，包围 | |
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appreciation
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| n.评价；欣赏；感谢；领会，理解；价格上涨 | |
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puny
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mediocre
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| adj.平常的，普通的 | |
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subscribe
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| vi.(to)订阅，订购；同意；vt.捐助，赞助 | |
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Christian
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| adj.基督教徒的；n.基督教徒 | |
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minutiae
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| n.微小的细节，细枝末节；（常复数）细节，小事( minutia的名词复数 ) | |
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autobiographies
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| n.自传( autobiography的名词复数 )；自传文学 | |
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microscopic
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| adj.微小的，细微的，极小的，显微的 | |
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anatomy
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| n.解剖学，解剖；功能，结构，组织 | |
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remarkable
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| adj.显著的，异常的，非凡的，值得注意的 | |
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partially
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| adv.部分地，从某些方面讲 | |
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autobiography
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vocations
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| n.（认为特别适合自己的）职业( vocation的名词复数 )；使命；神召；（认为某种工作或生活方式特别适合自己的）信心 | |
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vocation
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avocations
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| n.业余爱好，嗜好( avocation的名词复数 )；职业 | |
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modification
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| n.修改，改进，缓和，减轻 | |
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motive
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| n.动机，目的；adv.发动的，运动的 | |
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meditate
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| v.想，考虑，（尤指宗教上的）沉思，冥想 | |
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ethical
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| adj.伦理的，道德的，合乎道德的 | |
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liking
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| n.爱好；嗜好；喜欢 | |
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philosophical
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| adj.哲学家的，哲学上的，达观的 | |
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ethics
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| n.伦理学；伦理观，道德标准 | |
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supreme
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| adj.极度的，最重要的；至高的，最高的 | |
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peculiar
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| adj.古怪的，异常的；特殊的，特有的 | |
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disposition
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| n.性情，性格；意向，倾向；排列，部署 | |
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confessions
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| n.承认( confession的名词复数 )；自首；声明；（向神父的）忏悔 | |
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elicited
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| 引出，探出( elicit的过去式和过去分词 ) | |
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humility
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| n.谦逊，谦恭 | |
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attentively
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| adv.聚精会神地；周到地；谛；凝神 | |
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intensified
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| v.（使）增强， （使）加剧( intensify的过去式和过去分词 ) | |
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hysterical
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| adj.情绪异常激动的，歇斯底里般的 | |
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speculations
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| n.投机买卖( speculation的名词复数 )；思考；投机活动；推断 | |
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conscientious
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| adj.审慎正直的，认真的，本着良心的 | |
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motives
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| n.动机，目的( motive的名词复数 ) | |
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exalted
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| adj.(地位等)高的，崇高的；尊贵的，高尚的 | |
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rigid
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| adj.严格的，死板的；刚硬的，僵硬的 | |
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loyalty
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| n.忠诚，忠心 | |
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maker
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| n.制造者，制造商 | |
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inhibited
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| a.拘谨的，拘束的 | |
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sluggishness
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| 不振，萧条，呆滞；惰性；滞性；惯性 | |
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irritability
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| n.易怒 | |
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humbled
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| adj. 卑下的，谦逊的，粗陋的 vt. 使 ... 卑下，贬低 | |
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hesitation
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| n.犹豫，踌躇 | |
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prescriptions
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| 药( prescription的名词复数 )； 处方； 开处方； 计划 | |
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requisite
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| adj.需要的，必不可少的；n.必需品 | |
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neurotics
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| n.神经官能症的( neurotic的名词复数 )；神经质的；神经过敏的；极为焦虑的 | |
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