In psychopathic or neurotic2 diseases one should take into consideration the fact that the patients are characterized by the tendency of formation of habits which are hard to break. The patients are apt to ask that the same thing be done again and again for the simple reason that it has been done several times before. In other words, psychopathic neurosis is characterized by automatism and routine. This tendency to recurrence3 is characteristic of all forms of primitive4 life as well as of mental activities which are on the decline,—it is the easiest way to get along.
Effort is abhorrent5 to the patient. He is afraid of change in the same way as the savage6 is afraid[359] of any novelty or of any change in custom. Tradition is holy, and in a double sense, because it has been handed down by former generations, regarded as divine and superior, and because the new is strange and, therefore, may prove dangerous and of evil consequence. What has not been tried may prove harmful, pernicious, and even deadly. The old has been tried and approved by generations and the consequences are known, while the new may be in alliance with evil powers. This holds true in all cases obsessed7 by the impulse of self-preservation and the fear instinct. What the patients have tried several times and what has proved good and pleasant is demanded by the patient to be repeated; the new is not known and may be risky8, dangerous. I have great difficulty in making changes in the life of advanced psychopathic cases, because of the fear of the new, neophobia. Once the change is made, and the patient becomes adapted to the new way, then the old way is shunned9. In short, neophobia is an essential trait of psychopathic patients.
The physician must take this trait of neophobia into account, and as the patient begins to improve, he must gradually and slowly wean the patient of this phobia, inherent in the very nature of the malady10. The patient must learn to do new things, and not simply follow mechanically a régime, laid out by the physician.
The patient’s life must become personal. The[360] patient should be made to change many of his ways, and above all he should learn to follow reason, rather than habit and routine. Everything, as much as possible, should be reasoned out,—he should be able to give a rational account of his habits and actions. Whatever appears to be a matter of routine, irrational11 and unaccountable habit, simply a matter of recurrence, of repetition of action, should be discarded, should be changed to actions and adaptations for which the patient could give a rational account.
We must remember that the patient lives in the condition of recurrent mental states, that his mental activity, as I have pointed12 out, follows the laws of recurrence, characteristic of the type of recurrent moment consciousness.[18] It is, therefore, the physician’s object to lift the patient out of this low form of mental activity to the higher types of rational, personal life in which the patient can rise above the perturbations of life, above the pettiness of existence with its worries and fears. This procedure is essential.
We can realize how pernicious are those schemes which physicians and many people in sanitariums lay out for the patients just to keep them busy for the time of their stay under special care. As soon as the patients leave, they are in the same predicament[361] as before. The patients wish to have their lives conducted in the same mechanical, automatic routine. In this way they are really on the same low plane of mental life, on the plane of recurrent moment consciousness, a type which forms the pathological web and woof of the patient’s life.
Unless the patient is lifted out of this low, mean, and animal form of conscious activity, he cannot be regarded as cured. Instead of having the patient’s life saturated13 and controlled by the recurrent automatisms of the fear instinct, he should learn to be controlled by the light of reason. “A free man is he,” says Spinoza, “who lives under the guidance of reason, who is not led by fear.” Epicurus and the ancient Epicureans laid special stress on the necessity of getting rid of fear through reason, enlightenment, and education. Thus the great poet Lucretius:
“The whole of life is a struggle in the dark. For even as children are flurried and dread14 all things in the thick darkness, thus we in the daylight fear things not a whit15 more to be dreaded16 than those which the children shudder17 at in the dark and fancy future evils. This terror, therefore, and darkness of mind must be dispelled18 not by the rays of the sun and glittering shafts19 of day, but by knowledge of the aspect and law of nature.”
As Carlyle tersely20 puts it: “The first duty of a man is still that of subduing21 Fear. We must get[362] rid of Fear; we cannot act at all till then. A man’s acts are slavish, not true but specious22 (we may add psychopathic); his very thoughts are false, he thinks too as a slave and coward, till he has got Fear under feet.... Now and always, the completeness of his victory over Fear will determine how much of a man he is.”
The patient complains of lack of confidence. This is a pathognomonic symptom of psychopathic states. At the same time there is confidence in the symptom complex which is often described by him with microscopic23 minuteness. The patient has no doubt about that. He is in search of some one who can overcome this symptom complex in a way which he specially24 approves. The patient matches his morbid25 self-will against the physician’s control. The physician is not to be subdued26 by the authority of the diseased personality, he should not let himself be controlled by the ruling symptoms of the patient’s life. Either the physician meets with opposition27, and after some time, must give up the treatment of the case, or he is victimized by the patient’s demands, and must comply with them. In the latter case the patient may stick to the physician for some time. In both cases the patient is not really cured. It is only when the diseased self becomes subdued and falls under the physician’s control, it is only then that a cure is really possible, it is only then that the normal healthy self may come to the foreground.
[363]
The first and foremost characteristic of psychopathic states is the narrowing down of the patient’s life interests. He begins to lose interest in abstract problems, then in that of his own profession or occupation, then he loses interest in the welfare of his party or his country, and finally, in his family, wife, and children. Even in the case of love, the psychopathic patient seeks to utilize28 the person he loves for his own, neurotic benefit, namely, his neurotic comfort and health. He loves the person as a glutton29 likes his meal, or as a drunkard his liquor. The self becomes narrowed down to health, the key to his supposed spiritual life. Self-preservation and fear permeate30 the patient’s life.
We notice that the patient’s life activity, especially his mental functions, becomes narrowed down. His attention becomes circumscribed31 to a few subjects and objects. This is the limitation of the extent of attention. There is afterward32 a limitation of the temporal span of attention. The patient cannot keep his attention on any subject for any length of time. This span of attention becomes more and more limited with the growth and severity of the psychopathic malady. If the patient is educated and has had an interest in various subjects, the latter become more and more limited in scope. Finally the patient becomes reduced to the least amount of effort of the attention, and that only for a brief period of time. When the trouble reaches its climax,[364] the patient loses all interest and capacity of reading and of studying. He cannot think, he becomes less and less original in his thoughts, he becomes even incapable33 of thinking. The patient’s whole mind becomes limited to himself and to the symptoms of his disease.
Along with it the fear instinct grows in power, inhibiting34 all other activities. There is a limitation of the patient’s personal self. The personality becomes reduced to the lowest levels of existence, caring for his own selfish pains and small pleasures, which are exaggerated and magnified to an extraordinary degree. In other words, the personal life of the patient becomes more and more limited as the pathological process goes on. It becomes harder and harder for the patient to take an active interest in life.
It is clear that under such conditions the tendency of the patient is to rest and brood about himself, and keep indulging his limited interests, which get still more narrowed as the pathological process becomes more extensive and intensive. Under such conditions it is suicidal to indulge the patient and suggest to him a rest cure, a cure which lies along the line of the disease process, thus tending to intensify35 the disease. What the patient needs is to change his environment, and be put under conditions in which his interests of life can be aroused. His life activities should be stimulated36 to functioning[365] on the right lines, laid out by physicians who understand the patient’s condition. Rest is harmful to the neurotic. What the patient needs is work, work, and work.
What we must remember in the treatment of psychopathic patients is the fact that we deal here with the aberrations37 of the impulse of self-preservation, the most powerful, the most fundamental, and the least controllable of animal impulses, accompanied with the fear instinct, which is the most primitive of all animal instincts. This morbid state of the impulse of self-preservation must be fully38 realized before any treatment is begun. The physician must also see and study closely the line on which the self-preservation impulse is tending, and comprehend the associations along which the impulse takes its course in the history of the patient and in the symptom complex.
What one must especially look after is the elusive39 feeling of self-pity which manifests itself under various garbs40, and hides itself under all kinds of forms. As long as the patient is introspective and has the emotional side of self-pity present, so long is his condition psychopathic.
The extreme selfishness and the uniqueness with which psychopathic patients regard their own condition should be eradicated41 from their mind. It must be impressed on them that their case is quite common, and that there is nothing exceptional about[366] them. It must be made clear to them that the whole trouble is a matter of mal-adjustment, that they have developed inordinately42 the impulse of self-preservation and the fear instinct until their mental life has become morbid and twisted. The whole personality has to be readjusted. It is the special tendency of psychopathic patients to regard themselves as unique, privileged above all other patients, they are a kind of geniuses among the afflicted43, possibly on account of the special endowments possessed44 by them, gifts of quite exceptional and mysterious a character. “Have you ever met with a case like mine?” is the stereotyped45 phrase of the psychopathic, neurotic patient. As long as the patient entertains that conception of nobility, the impulse of self must still be regarded as morbid.
The neurotic must be made to understand clearly that there is no aristocracy in disease, and that there is no nobility of the specially elect in the world of morbid affections, any more than there is in the domain46 of physical maladies.
The egocentric character of the psychopathic patient puts him in the position of the savage who takes an animistic, a personal view of the world and of the objects that surround him. Natural forces are regarded as dealing47 with man and his fate, often conspiring48 against man. Magic is the remedy by which the savage tries to defend himself, and even to control the inimical or friendly natural[367] forces or objects, animate49 and inanimate, with which he comes in contact. This same attitude, animistic and personal, of the primitive man is present in the psychopathic patient. The patient is afraid that something fearful may happen to him. Against such accidents he takes measures often of a defensive50 character which differ but little from the magic of the savage and the barbarian51. That is why these patients are the victims of all kinds of fakes, schemes, panaceas52 of the wildest type, unscrupulous patent medicines, absurd régimes, mental and religious, whose silliness and absurdity53 are patent to the unprejudiced observer. The mental state of the psychopathic or neurotic patient is that of the savage with his anthropomorphic view of nature, with his fears based on the impulse of self-preservation. The psychopathic patient is in a state of primitive fear and of savage credulity with its faith in magic.
The emotional side of the impulse of self-preservation and of the fear instinct should always be kept in mind by the physician who undertakes the treatment of psychopathic cases. The physician must remember that the emotions in such cases are essentially54 of the instinctive55 type, that they therefore lie beyond the ken56 of the patient’s immediate57 control and action of the personal will. The physician should not, therefore, be impatient, but while protecting the invalid58 against the fears that assail59 the latter, he should gradually and slowly undermine the violence[368] of the impulse of self-preservation and the anxiety of the fear instinct. For in all psychopathic maladies the main factors are the impulse of self-preservation and the fear instinct.
FOOTNOTES:
[17] The discussion here is necessarily brief. The reader is referred for details to my work “The Causation and Treatment of Psychopathic Diseases,” Ch. XVII, General Psychotherapeutic Methods.
[18] See Sidis, “The Foundations,” Part II, Moment-Consciousness.
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1
elimination
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| n.排除，消除，消灭 | |
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neurotic
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| adj.神经病的，神经过敏的；n.神经过敏者，神经病患者 | |
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recurrence
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| n.复发，反复，重现 | |
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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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abhorrent
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| adj.可恶的，可恨的，讨厌的 | |
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savage
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| adj.野蛮的；凶恶的，残暴的；n.未开化的人 | |
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obsessed
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| adj.心神不宁的,鬼迷心窍的,沉迷的 | |
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risky
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| adj.有风险的，冒险的 | |
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shunned
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| v.避开，回避，避免( shun的过去式和过去分词 ) | |
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malady
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| n.病，疾病(通常做比喻) | |
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irrational
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| adj.无理性的，失去理性的 | |
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pointed
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| adj.尖的，直截了当的 | |
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saturated
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| a.饱和的，充满的 | |
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14
dread
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| vt.担忧，忧虑；惧怕，不敢；n.担忧，畏惧 | |
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15
whit
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| n.一点，丝毫 | |
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dreaded
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| adj.令人畏惧的；害怕的v.害怕，恐惧，担心( dread的过去式和过去分词) | |
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17
shudder
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| v.战粟，震动，剧烈地摇晃；n.战粟，抖动 | |
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18
dispelled
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| v.驱散，赶跑( dispel的过去式和过去分词 ) | |
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19
shafts
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| n.轴( shaft的名词复数 )；（箭、高尔夫球棒等的）杆；通风井；一阵（疼痛、害怕等） | |
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20
tersely
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| adv. 简捷地, 简要地 | |
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21
subduing
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| 征服( subdue的现在分词 )； 克制； 制服； 色变暗 | |
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22
specious
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| adj.似是而非的；adv.似是而非地 | |
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23
microscopic
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| adj.微小的，细微的，极小的，显微的 | |
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specially
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| adv.特定地；特殊地；明确地 | |
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morbid
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| adj.病的；致病的；病态的；可怕的 | |
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subdued
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| adj. 屈服的，柔和的，减弱的 动词subdue的过去式和过去分词 | |
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opposition
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| n.反对，敌对 | |
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28
utilize
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| vt.使用，利用 | |
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29
glutton
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| n.贪食者，好食者 | |
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30
permeate
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| v.弥漫，遍布，散布；渗入，渗透 | |
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circumscribed
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| adj.[医]局限的：受限制或限于有限空间的v.在…周围划线( circumscribe的过去式和过去分词 )；划定…范围；限制；限定 | |
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32
afterward
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| adv.后来；以后 | |
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33
incapable
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| adj.无能力的，不能做某事的 | |
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inhibiting
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| 抑制作用的，约束的 | |
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35
intensify
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| vt.加强；变强；加剧 | |
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36
stimulated
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| a.刺激的 | |
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37
aberrations
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| n.偏差( aberration的名词复数 )；差错；脱离常规；心理失常 | |
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38
fully
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| adv.完全地，全部地，彻底地；充分地 | |
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39
elusive
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| adj.难以表达(捉摸)的；令人困惑的；逃避的 | |
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40
garbs
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| vt.装扮（garb的第三人称单数形式） | |
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41
eradicated
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| 画着根的 | |
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42
inordinately
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| adv.无度地，非常地 | |
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43
afflicted
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| 使受痛苦，折磨( afflict的过去式和过去分词 ) | |
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44
possessed
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| adj.疯狂的；拥有的，占有的 | |
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45
stereotyped
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| adj.(指形象、思想、人物等)模式化的 | |
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46
domain
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| n.(活动等)领域，范围；领地，势力范围 | |
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47
dealing
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| n.经商方法，待人态度 | |
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48
conspiring
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| 密谋( conspire的现在分词 )； 搞阴谋； （事件等）巧合； 共同导致 | |
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49
animate
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| v.赋于生命，鼓励；adj.有生命的，有生气的 | |
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50
defensive
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| adj.防御的；防卫的；防守的 | |
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51
barbarian
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| n.野蛮人；adj.野蛮(人)的；未开化的 | |
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52
panaceas
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| n.治百病的药，万灵药( panacea的名词复数 ) | |
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53
absurdity
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| n.荒谬，愚蠢；谬论 | |
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54
essentially
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| adv.本质上，实质上，基本上 | |
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55
instinctive
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| adj.(出于)本能的；直觉的；(出于)天性的 | |
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56
ken
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| n.视野，知识领域 | |
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57
immediate
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| adj.立即的；直接的，最接近的；紧靠的 | |
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58
invalid
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| n.病人，伤残人；adj.有病的，伤残的；无效的 | |
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59
assail
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| v.猛烈攻击，抨击，痛斥 | |
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