( Originally Published 1908 )
WE now pass on to speak of abnormal fears. These are evidences or symptoms of an unhealthy psychical state. They are especially associated with neurasthenia and psychasthenia. Neurasthenic differ from psychasthenic fears in being milder, not so deeply rooted in the mental organism and more amenable, therefore, to psychical treatment. When these fears assume a precise and systematized form, they are technically called "phobias." To enumerate them were impossible; for a phobia may attach itself to almost any object or idea. Among the more common are "monophobia," fear of being alone; "claustrophobia," fear of narrow places; "agoraphobia," fear of broad or open places; "ereutophobia," fear of blushing; "triskaidekaphobia," fear of the number 13; "mysophobia," fear of dirt or microbes; "nosophobia," fear of disease. Janet classifies all phobias or systematized dreads under four heads: —
1. The phobias of the body, — which arise in connection with psychic pain felt on the movement of any of the limbs. The body is in every respect healthy, yet the sufferer is conscious of intense agony: it may be in the teeth or in the skin, ear, eyes — in brief, in any part of the organism. One sufferer is afraid to walk; an-other is afraid to sit down because he has the feeling that on doing so he is elevated in the air; a third is afraid to eat because he conceives it to be painful. Janet tells of a woman who from remorse refused nourishment and had a horror of eating. This trouble was cured, recurred, and once more was cured. On the third attack the trouble assumed an opposite form: the patient eats well, but has a fear that her sickness is coming back; that she is prevented from eating by this fear, and that thus she is on the way to death from starvation. The result is that she eats with anxiety from the fear of having the fear of eating.
2. The phobias of objects. These are produced by the perception of certain objects. As the emotion is dreaded by the patient, there results a fear of the object which is the occasion of it. One trembles at the sight of a dog; another fears to look at the stars; a third is terrified at the thought of being polluted with microbes. Dr. Weir Mitchell tells of a sufferer on whom an experiment was tried. A cat was secretly imprisoned in a cup-board. The patient came into the room a little later. The cat was neither heard nor seen, nor did the patient know that there was such an animal in the house. Nevertheless, after a few minutes, he showed the greatest fear, was conscious that a cat was near at hand, and as a result could not be persuaded to remain in the room. Dr. Weir Mitchell admits that he has found no satisfactory explanation of this incident. Readers of John Bunyan's "Grace Abounding" will remember that in his unconverted days he took great pleasure in ringing the bells of the parish church at Elstow. Then, under the goad of a morbid conscience, he felt it to be wrong. The result was that he contracted a phobia, a terrible fear of seeing or hearing bells.
3. Phobias of situation. These may develop in connection with the patient's perception of a physical or moral situation in which he happens to find himself. For example, in a broad or open space the patient feels himself isolated; he has a sense of vacancy all around him. The fear amounts to a terror such as would be produced by toppling over a precipice. A classical ex-ample of this type of fear is the case of Pascal who was obsessed throughout his life by the feeling that an abyss stretched on his left hand beneath him.' What gives rise in the sufferer to overpowering anxiety is the feeling of being alone without any moral or physical support. The opposite to agoraphobia is claustrophobia, fear of narrow spaces. Under this head would come fear of entering a carriage or a railroad car, fear of being in a church, a fear by the way which appears to be very wide-spread, or fear of entering a tunnel. The sensation is most painful; it is as though one were traveling along a corridor which was becoming more and more narrow. Or again there is monophobia, the fear of being alone and separated from people. Perhaps the fear arises from the perception not of a physical but of a moral situation. Here we have a typical example in the fear of blushing, ereutophobia. This very fear is itself the cause of blushing. So painful is this misery at times that the sufferer will avoid society, give up his professional work and become a misanthrope. Another example is " dysmorphobia" or fear of bodily disfigurement. A woman, for example, is afraid that her hair is falling out, or that she is losing her teeth, though both hair and teeth are quite as sound as they ought to be.
4. Phobias of ideas. These arise in consequence of an abstract idea which presents itself to the mind of the patient. For example, a psychasthenic imagines that he has outraged religion by, it may be, bringing the thought of the Deity into connection with something trivial or debasing. There follows upon this obsession a phobia of blasphemy or he may have a hypochondriacal idea out of which spring all sorts of morbid imaginings about death, especially the fear of being buried alive.
Many of these and allied fears are so absurd, so fantastically whimsical, the product, one might suppose, of a sort of inverted genius, that only one accustomed to deal with such sufferers can bear their condition with patience. It cannot be too forcibly impressed upon the minds of friends and relatives that the unhappy victims of these psychical miseries ought to be pitied and helped, not scolded or blamed.
Perhaps the story of one who has suffered from these strange and painful emotions will be more helpful and instructive than any abstract discussion. Some twelve years ago, alone in his office one Saturday afternoon, the patient had been taking account of his financial situation. He had weathered the panic of '93, but he was still "playing a losing game," and he "must keep up the smile," as he says; for pride forbade letting go and starting anew. Sitting thus at his long office table, the table slowly rose in the air, he with it, and both began to revolve to the right, increasing in speed. He clung to the edge of the table and the mental cyclone continued for some minutes. Finally, the man and table came to rest, and shaking with fear, he made his way to the office of a physician friend; from there he went home in a carriage. Following upon this came eye trouble, throat trouble, stomach trouble, insomnia, one vanishing as another appeared, like moving pictures, but the one abiding thing was fear, culminating in panics, or what the patient terms "Bull Runs." This began with hesitation to go out of town alone; then to go to his office alone; then to stay at his office alone; and finally to be alone anywhere at any time. Indeed, sometimes he was conscious of a panic if his wife went out for an hour, notwithstanding the presence of a servant in the house, a telephone in the hall, and the family physician only two blocks away. We will now let the patient describe his phobias in his own words, and we do so with all the greater readiness as his account is singularly intelligent and shows incidentally that these abnormal feelings are possible to men otherwise of more than ordinary mental power. "I think to begin with the pride that kept me going was after all fear of criticism. As I lost faith in my own powers, my fear of the eyes, thoughts, and words of others increased proportionately. For example, the fear in taking a street-car was not primarily fear that anything serious would happen to me, but that something would happen which would result in a scene — fear that I should make a spectacle of myself. I think the beginning of every panic was either some slight physical disturbance, a pain, a dizziness, or some-thing of that sort; or else a matter of environment or association would suggest a panic. To illustrate this: in going to a specific place which could be reached by two equidistant routes, if I had had a panic going by one route, I might go with ease by the other path at another time; but a retracing of the path in which a panic had overtaken me would result in a second panic at almost the identical point in the road where the first panic had occurred. I have found I can go further and more easily when the means of locomotion are under my own control, that is, walking or riding a bicycle, or driving in a carriage under my direction as contrasted with a railway-car, a trolley, or even a carriage under the control of an-other. I resolve to go to my office on my wheel — an easy, delightful ride. At the end of three or four blocks I begin to get scared; another block, I am breathing hard and my heart is pounding, but I pedal on; another block, and I am shaking. I call myself a fool and a coward. I ransack the vocabulary of abuse wherewith to rouse some sense of manhood, and I keep on pedaling; another block, and things get hazy, but I grit my teeth and I vow I will go on if I drop. dead on the street. Then comes the `Bull Run.' The next thing of which I am conscious is the fact that I am riding back towards home as though a demon were at my heels. It is much the same in a street-car or in an elevator. I have often walked up eight flights because I was unable to take any one of the four high-speed elevators at my command, but I think I could have run any one of those elevators myself all day with perfect composure. The chief permanent effect of these panics is a deepening of my self-distrust. The immediate but passing effect is utter exhaustion and incapacity for work." It is pleasant to be able to say that this gifted but unhappy man is on the road to recovery.
Let us now ask by what methods can this type of suffering be relieved and cured. Space will permit only the briefest outline. (1) Hypnotic suggestion. According to some French investigators, it is possible to produce the hypnotic state only in patients who are suffering from hysteria. Basing his idea on such a theory, Janet states in the work on which we have so largely drawn, as well as in his later Harvard lectures on "The Major Symptoms of Hysteria," that it is impossible to hypnotize the psychasthenic. If hypnosis, as Janet affirms, is an artificially produced hysteric state and therefore can only be induced in those suffering from hysteria, this remark is quite true, but if we take the more probable view that the hypnotic state is merely an artificially produced mental condition allied to the absent-mindedness of everyday life, then we must take exception to his statement. Any one who has had any experience in psychotherapeutic work can easily recall case after case of psychasthenia without any hysterical manifestations and conforming in every detail to Janet's conception of the disorder in which hypnosis was produced as a therapeutic measure. (2) Still more important than hypnotic suggestion is re-education. The function of the real must be restored, and this is done by creating a happy emotion. A happy emotion increases our vitality. The more vitality we have, the more conscious are we of our reality. The happy emotions can be produced by demonstrating the true character of the disorder to the sufferer and by showing how curable it is. The result is, the psychological tension is relieved. (3) Work is a valuable therapeutic agent. Physical exercise, especially such exercise as requires great attention, exerts a most beneficial influence on the disorder. Cataloguing, clay-modeling, gymnastic exercises are of the greatest value. (4) Finally, the religious instinct should be appealed to. A sense of the ideal presence of God should be aroused. The sufferer's faith that, though apparently alone, he is really not alone, that about him is an Unseen Presence, will often avail to ward off an emotional crisis.