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

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

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

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

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,

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.