The psychopathic character appears to be full of contradictions, “a house divided against itself.” Neurotics are like “the troubled ocean which never rests.” Some of my patients complain of fatigue, physical and especially intellectual, inability of concentration of attention, and yet they hint at being undeveloped, unappreciated geniuses. The patient may be said to suffer from a paradoxical state of “humble superiority.”

A few of my cases may help one to form some faint idea of the intensity of the impulse of self-preservation and fear instinct which obsess the psychopathic sufferer.

M. A. Age 43, female, married; sister and brother died of tuberculosis. When young, she herself had an attack of tuberculosis from which, however, she entirely recovered. This made her, from her very childhood, think of herself and of the fear of death. She suffers from headaches, backaches, indigestion, and intestinal pains. Her mind is entirely engrossed with herself. The whole world is for her sake, and she does not scruple to utilize anyone who is willing to serve her. She takes advantage of everybody and does not care what the feeling of others might be about her extreme selfishness. If she were sure that no fine or punishment would follow, she would not hesitate to take anything that belongs to others, no matter whether it be a friend or enemy, provided it does her good, drives away some of her discomforts, fear of disease, or gives pleasure to her, even at the expense of other people’s agonies. If there were a prize for selfishness, she would be sure to get it. She is sure to take advantage of people who do not know her and who practice the ordinary activities and amenities of life in regard to her. She does not get offended when people refuse her demands. She goes to look for other victims who have as yet no knowledge of her temperament and “sickness.” Everything is legitimate to her in order to get well and healthy.

The patient talks of high ideals and of service to humanity, and yet she has not hesitated to lure away a man who had a wife and three children. She made him divorce his wife who was her bosom friend, and marry herself. She spends all his money on her “artistic dresses,” while his former wife and his little family are allowed just enough to keep them from starvation. The patient goes around travelling, visits physicians, cures herself, keeps on being sick in various health resorts, learning all kinds of fads, modes of “healthy living.”

The patient is in terror of disease and of old age. She fears even to think of such things. She carries around with her all kinds of prescriptions and directions as to how to preserve youth. I was especially instructed by her husband not to inquire for her age. Everything must be subservient to her impulse of self-preservation and instinct of fear. She has dwindled to a parasitic existence, obsessed with the lowest instincts of life. She avoids all responsibilities. She wants to get as much as she can in order to obtain for herself the highest possible benefit. When she meets people who do not know her, she is quick in taking advantage of them. Life to her has no duties but rights. Patient is a typical Nero, a Caligula. She would cheerfully sacrifice a nation to get out a mite of pleasure, comfort, and health.

V. S. Age 49, female. Married; no children. She has three sisters and two brothers who are all well. As a child she lived in great poverty. She was neglected and met with accidents and scares; suffered from sickness until her little body was emaciated from privation. She managed, however, to go through school and become a clerk in a small store; she was very careful of her appearance which meant to her a good marriage, comfortable life. She also took care of her health which was rather precarious, on account of the many colds accompanied by severe headaches. At the same time on account of the poor life led, she also suffered from some obscure troubles. After years of precarious health and quests for happiness, for marriage, she succeeded in capturing a well-to-do merchant in whose store she had worked as a clerk. Immediately after marriage she rigged up a beautiful home with “rich mahogany furniture” which the husband regarded with a gasp, settled down to a life of leisure, to complete idleness, and began to attend to her health....

The patient began to find more and more troubles with her organs, from the top of her head to the pelvis and intestines. Nothing was quite right. Things could be improved. The impulse of self-preservation gained more and more control over her. Along with this impulse the fear instinct gained in strength, became more and more extensive.

The patient became full of fear which, by the principle of proliferation and diffusion, kept on growing and diffusing in ever new directions, and spreading to ever new associations and systems. The central fear was poverty. The patient was afraid she might become poor. This was naturally a fear from her early childhood,—the fear of suffering in poverty, a fear which persisted throughout her life. The fear became accentuated and developed with time. She was afraid to spend money, especially sums above a five dollar bill. No matter how much she tried to reason with herself this fear persisted. She was afraid to buy new things which she regarded more or less expensive. She was afraid to put on new dresses, to buy new furniture, to spend money in any way. In fact, quite often the fear was so uncontrollable that even when she had no thought of threatening poverty she was in a panic of being confronted with expensive purchases.

The fears then began to spread to other things,—such as giving away small articles or loaning books, or presenting any things or objects that might be regarded as expensive and valuable. The fears spread to other objects of importance and value.

Along with it she had fears of indigestion and nutrition, nausea, vomiting, intestinal pains, discomfort, and especially an inordinate amount of distress when in a state of nervous excitement.

The patient was as obstinate as a mule, though claiming that she was doing her best and trying everything in her power to co-operate. She was doing everything in her power to frustrate the physician’s directions, claiming at the same time that she was doing her best to follow scrupulously the doctor’s orders. She claimed she was nice to people when she was nasty and offensive to everybody who in any way happened not to fall in with her whims and caprices. In fact, even those who went out of their way to please her and did everything in attending to her, and helping her in every way day and night, even those she treated with lack of consideration, even positive disdain and contempt. She was the incarnation of demoniacal obsession of psychopathic meanness and egotism.

She abused and dominated her husband by her sickness, trouble, fainting and crying spells, headaches, moans and weeping. She made him do everything she pleased. In fact, she tyrannized over her husband, and kept on claiming she loved him. She could not for a moment be without him, and complained that on account of her extreme devotion to him, “her will was broken.”

She was a regular termagant, a demon incarnate. She knew how to make a scene and put the blame on her “dear ones.” It was enough for her to suspect what her friends wanted her to do, she was sure out of sheer malice, to act the contrary. She was distrustful, spying on others, sneaky and lying without any scruples; and yet “no one was so mild, so ideal, so kind, so affectionate, so considerate, so calm as she was.” She went around reciting poetry about ideals, health, and happiness. She persuaded herself that she was highly educated, that she was the best business woman, the best critic, appreciative of poetry and of art in general. She was a veritable Nero, an “egomaniac” devoid of all love and human sympathy. She suffered so much, because she was so unusually altruistic. A coyote in her fear, a tigress in her rage, she claimed the gentleness of the dove and the innocence of the babe.

Not for a moment could she fix her attention on anything but herself, eating, drinking, sleeping, and feeling. Nothing interested her but herself. She avoided work, however short and easy. She could, however, talk of herself, of her achievements, of her moral, intellectual qualities by the hour and by the day. Even games did not interest her, nothing but herself, and self. This was so evident that one of the attendants noticed this characteristic psychopathic trait, and described her as “egomaniac.” She was the “Great I am.” “The Ego-person is the reflection of the Ego-god.” ...

Whenever one spoke of a great man, she was sure to have her opinion of him. She was at any rate superior to him. She could give her opinion on any conceivable subject in literature, economics, and politics.

She was as cunning as a savage, and as treacherous as a wild brute, and yet she was to all appearances a veritable saint, full of suffering for the sins of humanity, and for the faults of her husband who was “boyish and foolish, whom she had to manage,” and whom she did control and handle with an iron rod.

There is no doubt, however, that she herself was driven by her intense, uncontrollable impulse of self-preservation and by the instinct of fear. What especially terrorized her was the slow but sure extension of the fear instinct to more and more objects and acts. The fear instinct kept on creeping on her, slowly choking the life sources of her being. To call the patient “egocentric” is a mild descriptive term,—“tigress,” “satan,” “fiend,” would be more appropriate appellations. In her terror of self-preservation she tormented herself and others. She was a firebrand from hell, a firebrand fanned by the furies of self and fear.

F. W. Age 47; female, married; has no children. The patient claims to have been an invalid from childhood; that she was of extremely delicate health; she always had to take care of her health, and had to go through all kinds of diseases, especially gastro-intestinal troubles. At the age of eighteen she got married and then her family felicity began. She began to complain of all kinds of infirmities. The gynecologist humored her with operations and treatments. The fear disease became strengthened, and finally she cultivated a typical pathophobia; she was in terror of some fearful malady that might possibly take possession of her.

The patient always wanted to have someone near her. This fear of remaining alone dated from childhood, when at the least discomfort, she asked and screamed in terror for help. A companion, or nurse had to be with her day and night, so as to protect her from any impending evil.

Occasionally, to relieve her feelings, in the middle of a conversation, whether for the sake of impressing her family, her husband or her physicians with the gravity of her disease, or as a vent for the rising instinct of fear, she emitted a scream, wild and weird, reminding one of the howling of a timber wolf, or of a wild whoop of an Indian. This was a habit she kept up from childhood. It was a reaction of her fears, and a protection, it was a call for help which was sure to attract attention. The family could not refuse help at hearing such an unearthly call. Later on, it was consciously and unconsciously utilized by the patient as a rod to rule the family and especially her husband, when the latter happened to become refractory. The fear reaction was thus used as a protection and as a weapon of defense.

Things had to run according to her pleasure, or else she was put in a state of nervous excitement and fear with its awful yell of which the family and the husband were in perfect terror; they yielded unconditionally. The patient literally subjugated her husband by her spells of fear, especially by the fearful acoustic performance, the aura, the harbinger of a psychopathic attack.

The patient was always discontented and grumpy. Nothing could satisfy her, nothing was good enough for her. Everybody was criticized. No matter how one tried to please her, she always found fault with the person. In fact, the fault-finding was in proportion to the eagerness one tried to serve and oblige her. The nurses are not good, the servants intolerable, and people in general are bad, mean, stupid, and vulgar. She claims she comes from an “old New England family, from good stock.” Her grandfather was a fisherman, and her father a petty tradesman. The patient makes pretensions to education, poetry, art, and drawing. In reality, she is quite dull and ignorant.

G. A. Female, age 63; the patient was obsessed with pathophobia for over thirty-five years. She has been to a number of physicians, and to many sanitariums, looking for health everywhere, not finding it anywhere. The fears date to her early childhood. She was regarded as a delicate child, the fear of disease was strongly impressed on her. She went through a number of children’s diseases. Although she had several sisters and brothers, the child’s supposed delicate constitution was the fear and worry of the parents. This fear was communicated to the child, who for the rest of her life became a psychopathic patient with the characteristic developed impulse of self-preservation and intense fear of disease. She could not think of anybody but herself, everything had to be arranged for her,—for her food, for her sleep, and for her rest. She kept on complaining at the slightest change either in herself, in others, about the arrangements of the house, or about the weather. Everything had to be arranged just as she demanded, otherwise she was sick, or was going to become dangerously ill.

When about the age of thirty, she married a widower with two children. She trained the children to obey her commands implicitly, otherwise she resorted to the rod of sickness. The pathophobia, consciously or unconsciously, became a power which she wielded in the most tyrannical way. The children had to sacrifice themselves for the pleasure of the sick step-mother. They had to stay with her, and minister to all her whims and fears. The very individuality of the children became almost obliterated by the persistent, egotistic tyranny of the sick, old step-mother. She was like a regular vampire, sucking the life blood of her family.

It goes without saying that the same fear of disease tamed her husband over whom she ruled with an iron hand. The least opposition to her whims, or to her fears of possible disease made her so sick with all kinds of pains that the family and the husband were driven into submission.

The woman was obese as a hippopotamus, well nourished, with a florid complexion, and with an appetite that would shame a Gargantua. The rarest, the best, and the most appetizing dainties had to be on her table. She made of her meals a form of worship, requisite to propitiate the goddess of maladies. She did not hesitate to take the best morsels from the plates of her daughter and son in order to satisfy her appetite which was supposed to be “delicate and small.”

The patient was conscious of every square inch in her body; she was afraid that some form of malady may lurk there. She was a typical case of pathophobia. Fear of disease and quest of health were ever in her mind. She could not talk, or think of anything else, but herself and her symptoms. She made of her step-daughter a poor, colorless being, a day and night nurse, tyrannized over by pitiful, neurotic whimpering.

When the patient happened to wake during the night for ever so short a period of time, she did not hesitate to wake her step-daughter, tired as the latter was by constant attendance on this psychopathic shrew. The daughter had to wake up everybody who could in any way bring comfort to that “poor, old, suffering invalid.” After much groaning, moaning, and bewailing her bitter lot the invalid took some medicine to appease the fear of disease, partook of some nourishing food to keep up her strength and health, and went to sleep for the rest of the night.

Years ago, the patient was under the care of Weir Mitchell who sent her to me as a last resort. Dr. Weir Mitchell characterized the patient as an “American humbug.” As a matter of fact, the patient herself was convinced that she was on the verge of death, and was in terrible agony of her fears of disease, fears which made her quest for health a matter of life and death. The patient was obsessed by parasitic egotism, the quintessence of psychopathic affections.

Many times during the day she paced the room reciting elevating passages from the Bible, from “great poets,”—Emerson being her favorite writer.

I have heard neurotics with their “Mortal Mind,” “Sin and Error,” “Disease and Nothing,” recite edifying phrases such as: “The decaying flower, the blighted bud, the gnarled oak, the ferocious beast, like the discords of disease, sin, and death are unnatural” ... “Fear is inflammation, error” ... “Adam, a-dam, a-dam, dam, dam”....

A man, thirty-eight years old, married, highly sensitive, suffers from migraine; he is irritable and restless. When about eight years old, he wandered in the woods near his house. An Italian ran after him, flourishing a big knife. The boy ran away in terror. When he reached home he dropped from exhaustion and fear. Once or twice, on account of the fear of sharp objects, he actually hurt himself while handling knives. This increased his terror and fixed his fear. The instinct of fear was still further developed and stimulated by a series of events, such as falling into a river, from which he was saved. He does not like to take baths, he is afraid to enter a river, and he is in terror of sharp objects, such as knives and razors.

The patient is extremely selfish. He insists on playing games which he likes much, irrespective of the pleasure of his friends and acquaintances. All he cares for is to have a good time, to neglect his duties to his family. In his business he is exacting of others, although he himself is rather slovenly in his work, and slow in the performance of his obligations. He always insists on having his own way. Other people’s rights do not trouble him, provided his rights are carefully and scrupulously observed. He always demands services from others, especially from his friends.

The patient’s mind is occupied with his health, his fears, and his ailments. The interest he takes in his friends and acquaintances is how far they may serve his purposes of pleasure, game, health, and avoidance of fear of disease. His wife and child are regarded from a personal standpoint of his own good, otherwise they are totally ignored. When they interfere with him, or arouse his fears, he becomes impatient, angry, and furious. He claims to be the most considerate and kindest of men, brimful of humanitarian ideals. He thinks that he can accomplish more than anyone else in his circumstances. Nothing is too good for him, nobody is superior to him. As a rule things are badly conducted, he finds fault with everybody and with everything. He is driven by psychopathic furies,—discord, fear, and maddening egotism.