Psychopathy

“ 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 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. ”

“ And, still more, can the persistence of a mere association of the affect with the object independently of a subconscious process explain the psychosis? Either of these two last propositions is absurd on its face as being opposed to the experience of the great mass of mankind. The vast majority of people have undergone disturbing, sorrowful or fear-inspiring experiences at some time during the course of their lives and they do not find that they cannot for years afterwards face some object or idea belonging to that experience without being overwhelmed with the same emotion. ”

“ Anything which arouses the fear instinct in the inhibitory or paralyzing stages will necessarily give rise to psychopathic functional psychosis or neurosis. The fear instinct and the impulse of self-preservation, inherent in all life, are the alpha and omega of psychopathic maladies. ”

“ They develop in an emotional soil definitely related to the hopes and fears of the healthy individual and are to be looked upon as a morbid transformation of perfectly normal mechanisms. In addition to this he speaks of an increased self-consciousness, a natural tendency to resistiveness, an undeveloped type of thinking, psychological compensations for the disappointments of life, evidences of developmental inhibitions, improper habits of thought leading to morbid conceptions, etc. He refers to exaggerated self-consciousness as the fundamental basis of paranoia. ”

“ The moral faculties become more or less affected, and the patient‘s social and domestic relations are greatly altered. At one time he is subject to violent fits of immoderate laughter, at another he is gloomy and taciturn; sometimes quiet and tractable, at others wild and excited, necessitating close confinement. He is haunted by wild delusions, which at times take entire possession of him, and under the influence of which he acts in the most extraordinary manner. In the latter—melancholia, or mania with depression—delusion may be absent, or, rather, for a time undetectable. ”

“ And when we say that emotion does these things, we merely mean that something or other has stimulated the brain into producing these phenomena, and that along with the stimulus the feeling of grief or shame or anger coexists.
If all this be true, it may perchance throw some light upon many of the phenomena of disordered mind and brain: it may help us to understand why, with almost the same delusion, e.g., that the newspapers are writing about him, one man will be exultant, another angry, another depressed; it may explain why the same man is at one time maniacal, at another melancholic. ”

“ The dominating emotion is early reinforced by the awakening of its ally, the fear instinct, with all its physiological manifestations. Then tremor, palpitation, perspiration, and vasomotor disturbances break out. Shame may be added to the emotional state.
5201. This reaction becomes intelligible if we regard it as one of conflict resulting in painful bashfulness and shame, inhibition of thought; the excitation of painful ideas, amnesia, and limitation of the field of consciousness. The self-regarding sentiment is awakened and dominates the content of consciousness. ”

“ We have seen the mental disorder affecting modern society manifesting itself chiefly in the following forms: Mysticism, which is the expression of the inaptitude for attention, for clear thought and control of the emotions, and has for its cause the weakness of the higher cerebral centres; Ego-mania, which is an effect of faulty transmission by the sensory nerves, of obtuseness in the centres of perception, of aberration of instincts from a craving for sufficiently strong impressions, and of the great predominance of organic sensations over representative consciousness ”

“ The older psychiatry regarded such a complete breakdown, which it labelled acute mania, as the expression of a mere disorderly jumble of disintegrated mental process, but if we look on the whole situation as a means of reacting to the conflict between suppressed instinctive tendencies and controlling forces, it becomes a question whether the acute psychosis, with all its apparent disorder, is not merely the expression of a victory of the instinctive forces running riot after their escape from a lifelong period of suppression and control. ”

“ Psychopathic 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 the Trinity: ‘I am the Trinity.’” As a matter of fact every psychopathic patient is an egomaniac. ”

“ But it is not essentially a disease of the understanding: the intellectual element is secondary; this perpetual doubt, these endless questionings are merely the effects; the cause lies in a weakening of the emotional life and the will, rendering them incapable of arriving at a belief—i.e., an affirmation—and, more deeply still, in a disturbance of the organic life, as demonstrated by sensory perversions, motor enfeeblement, and the melancholic state of the patient with its physiological accompaniments, and lowering of the vital functions. ”

“ It may suffice to state, that with the exception of those cases of insanity which arise from injuries, blood poisons, sympathetic irritations, and other sources of an unquestionably physical nature, the common causes of insanity are such as produce emotional changes, either in the form of violent agitation of the passions, or that of a chronic state of abnormal emotion, which pronounces itself in the habitually exaggerated force of some one passion or desire, whereby the healthy balance of the mind is at length destroyed. ”

“ The next group, emotionally unstable, includes individuals who have average intelligence or better, but who show in their conduct and in their careers the predominating influence of the emotions. They are moody, changeable, impulsive, and in general it may be said that their conduct itself does not correspond to their beliefs, or intentions. The third group, the paranoid, includes individuals of average , intelligence or better in whose careers the 'emotional influences are of secondary importance, but whose main difficulties are a result of mistakes in logical thought processes. ”

“ Though there is no unanimity about this among health care professionals, we will distinguish between these two kinds of problems by calling a psychosis a mental illness, as opposed to an emotional disorder. It is a matter not only of degree but of kind. A person who is severely depressed or extremely anxious is usually still able to communicate rationally, and distinguish what is real from what is fantasy or delusion. ”

“ It is evident, that, theoretically, if antecedent conditions have prepared the emotional soil, and if an emotional complex, an intense sentiment, or instinct should be aroused by some stimulus, any one of a number of different possible psychopathic states might ensue, largely through the mechanism of conflict, according, on the one hand, to the degree and extent of the dissociation, inhibition, etc., established, and on the other to the character and systematization of the emotional complex or instinct. ”

“ Each psychosis repeats in itself, in tendency form at least, the essential stages in the evolution of consciousness. Every psychosis rises from the pure pleasure-pain as the lowest level of mentality like a wave, and like a wave falls back into it again. Every wave of consciousness, whether it rises slowly or rapidly, whether it subsides gradually or violently, rises from pure subjectivity and comes back to it again. ”

“ Emotional disturbances lead directly to the overthrow of the mental balance, which divides the normal man from the madman and the neurasthenic. Modern psychiatrists lay stress on the emotional character of the latter affection. The underlying features of "functional neurosis" reveal themselves in symptoms denoting the clash of emotional elements within, together with a corresponding lack of adaptability to outer environment, and are characterized by instability and exaggeration of emotion rather than impaired intellect. ”

“ For statistical purposes the differentiation of the psychopathic personalities has been described by the Association's committee as follows:—
"Under the designation of psychopathic personality is brought together a large group of pathological personalities whose abnormality of makeup is expressed mainly in the character and intensity of their emotional and volitional reactions. To meet the demands of current usage, the term for this group has been shortened from the older one "psychoses with constitutional psychopathic inferiority" with which it is synonymous. ”

“ In proportion as the neurotic attacks keep on recurring the formed pathological system is gaining in energy and in ease of manifestation. The psychopathic attacks with their symptoms emerge [148] at an ever diminishing intensity of stimulation. The resistance of healthy normal associations is ever on the decrease until a point is reached when all power of resistance is lost. The conscious and subconscious groups which enter into the psychopathic system, forming the neurosis, get control over the patient’s life, and become an uncontrollable, psychopathic obsession. ”

“ By this mental bondage morbid sympathy is clearly and definitely distinguished from all subordinate degrees of this instinct, however closely allied the imitation of a disorder may seem to be to that of a mere folly, of an absurd fashion, of an awkward habit in speech and manner, or even of a confusion of ideas. Even these latter imitations, however, directed as they are to foolish and pernicious objects, place the self-independence of the greater portion of mankind in a very doubtful light, and account for their union into a social whole. ”

“ This task is successfully solved in the case of the individual neurotic, and we are confident of finding a similar solution in the case of races.
In the second place we cannot help noticing that the sense of guilt contains much of the nature of anxiety; without hesitation it may be described as “conscience phobia.” But fear points to unconscious sources; The psychology of the neuroses taught us that when wish feelings undergo repression their libido becomes transformed into anxiety. ”

“ Individuals with such a disorder may manifest a disturbance of intrinsic personality patterns, exaggerated personality trends, or are persons ill primarily in terms of society and the prevailing culture. The latter or sociopathic reaction a re frequently symptomatic of a severe underlying neurosis of psychosis and frequently include those groups of individuals suffering from addiction or sexual deviation.' U.S.Code Cong. ”

“ The type of behavior disorder, the social reactions, the trends of interests, etc., which psychopathic personalities may show give special features to many cases, e.g., criminal traits, moral deficiency, tramp life, sexual perversions and various temperamental peculiarities. ”

“ Obsessed with the anxious fears of self-impulse, the patient avoids the terrors of life, and drags the grey, monotonous existence of a worm. Hence there is a tendency in the psychopathic patient to be on the lookout for ever new energetic personalities, lean on them, suck out all the energies he possibly can, then reject his new friends unhesitatingly and brutally, and be again in search for new personalities who can disperse, for ever so brief a time, the fearful monotony and dread of his miserable, psychopathic, neurotic existence. ”

“ This difference in type is the first great obstacle which stands in the way of an understanding concerning fundamental conceptions of our psychology. A second objection arises from the circumstance that the constructive method, faithful to itself, must adapt itself to the lines of the delusion. The direction along which the patient develops his morbid thoughts has to be accepted seriously, and followed out to its end; the investigator thus places himself at the standpoint of the psychosis. ”

“ The natural consequence is restlessness, agitation, anger, indecision, etc. The dissociation of personality, with the outcropping of the “b mood,” follows—a conflict due to the excitation of certain childhood complexes, conserved in the unconscious and embracing sentiments in which are incorporated the instinct of self-subjection or abasement. This “b mood” is a study in itself. ”

“ This is particularly true for sufferers from such forms of psychasthenia as bring down on them dreads and premonitions of evil in fears for the development of disease and in general a sense of instability with regard to the future, lest dreadful things should happen to them. At first patients object strenuously and seem to be deprived of a great satisfaction. After a time, however, they are invariably persuaded of the fact that the absence of mental contact with human misfortune, in this morbid way, is doing them good and that their dreads and premonitory feelings of evil drop from them. ”