Chapter L: E. W., forty-nine years of age, farmer and lawyer by occupation, a (5)

Another example of this idea and of the way it induced a psychosis is
the following: She had an intense dislike to hearing the sound of
running water. This sound induced an intense feeling of _unhappiness
and loneliness_. This feeling was so intense that whenever she heard
the sound of running water she endeavored to get away from it. The
sound of a fountain or rainwater running from a roof, for example,
would cause such unpleasant feelings that she would change her
sleeping room to avoid them. Likewise drawing water to fill the
bathtub was so unpleasant that she would insist upon the door being
closed to exclude the sound. She could give no explanation of this
psychosis. It was discovered in the following way: She had been
desirous of finding out the cause, and we had discussed the subject. I
had promised that I would unravel the matter in due time, after the
other phobia had been cured. I then hypnotized her and, while she was
in hypnosis and just after we had completed the other problem, she
remarked that a memory of the running water association was on the
verge of emerging into her mind. She could not get it for some time,
and then, after some effort, it suddenly emerged. She described it as
follows: “It was at Bar Harbor. She was about eight years of age.
There was a brook there called Duck Brook. The older girls used to go
up there on Sundays for a walk with the boys. I went with them one
Sunday, accompanied by the governess, and was standing by the brook
with a boy. It was a very noisy brook, the water running down from the
hillside. While I was standing by the brook, watching the running
water, the boy left me to join the other girls, who had gone off. I
thought that was the way it would always be in life; that I was ugly,
and that they would never stay with me. I felt lonely and unhappy.
During that summer I would not join parties of the same kind, fearing
or feeling that the same thing would happen. I stayed at home by
myself, and when I refused to go it was attributed to sullenness. They
did not know my real reasons. Ever since I have been unable to bear
the sound of running water, which produces the feeling of unhappiness
and loneliness, the same feeling that I had at that time. I thought
then that it was all my fault, because I was ugly.” It was then
tentatively pointed out at some length to the subject that as she now
knew all the facts which had been brought to the “full light of day,”
etc., she, of course, would no longer have her former unpleasant
emotions from the sound of running water. Hereupon, to put the
question to the test, I reached out my hand and poured some water from
a caraffe, by chance standing by, into a tumbler, letting the water
fall from a height to make a sound. At once she manifested discomfort,
and sought to restrain me with her hand. Plainly the setting had to be
changed. This was easily done by leading her to see that her
childhood’s ideas had been proven by life’s experiences to be false.
When this became apparent she laughed at herself, and the psychosis
ceased at once.

Footnote 187:

Social Psychology.

Footnote 188:

This was done in hypnosis, the dream being forgotten when awake.

Footnote 189:

For instance, when I came to the therapeutics I found in abstraction
that the patient did not want to give up her point of view “because,”
as she said, “it forms an excuse so that when I feel lonely, if there
is nothing else to be lonely about, I have that memory and point of
view to fall back upon as something to justify my crying and feeling
lonely and blue.”

When she now feels blue and cries, as happens occasionally, and she
asks herself Why? then she drifts back in her mind to childhood and
remembers she was lonely and then cries the harder. Then she vaguely
thinks of her mother’s death being her fault. She likes therefore to
hold on to this as a peg on which to hang any present feeling of
blueness and loneliness.

Footnote 190:

Some, I have no doubt, will insist upon seeing in towers with bells a
sexual symbol, and in the self-reproach a reaction to a repressed
infantile or other sexual wish. But I cannot accede to this view
first, because a tower was not only not the real object of the phobia,
but not even the alleged object, which was the ringing of bells;
secondly, because it is an unnecessary postulate unsupported by
evidence, and, thirdly, because in fact, the associative memories of
early life were conspicuously free from sex knowledge, wishes,
curiosity, episodes and imaginings, nor was there any evidence of the
so-called “mother complex” or “father-complex,” or any other sexual
complex that I could find after a most exhaustive probing. The
impulses of instincts other than sexual are sufficient to induce
psychical trauma, insistent ideas, and emotion. To hold otherwise is
to substitute dogma for the evidence of experience.

Footnote 191:

It is worth noting that between the bringing to the “full light of
day” the facts furnished by the analysis and the cure a full year and
a half elapsed, during which the phobia continued. The “cure” was
effected at one sitting. The original study was undertaken on purely
psychological grounds; the cure for the purpose of completing the
study.

Footnote 192:

This account will be clearer if read in connection with the full
analysis (“A Clinical Study of a Case of Phobia”), published in the
_Jour, of Abn. Psychol._, October-November, 1912.

Footnote 193:

She was apprehensive of having inherited Bright’s disease from her
father, who had convulsions.

Footnote 194:

It is quite possible that this subconscious process induced the
unreality syndrome in which struggling for air was the salient
symptom.

Footnote 195:

I am excluding conditions like split personalities, automatic writing,
etc., and refer rather to normal mental processes.

LECTURE XIV
THE PHYSIOLOGICAL MANIFESTATIONS OF EMOTION

Emotion,[196] more particularly fear, plays so large a part in the psychogenesis and symptomatology of the psychoses that it is desirable to have a clear realization of its physiological and psychological manifestations and of the disturbances of the organism which it can induce. It is not necessary for our purpose to discuss the various theories of the nature of emotion that have been propounded; we need deal only with the _manifestations_ of emotion and its effect upon the organism.[197] We will consider the physiological manifestations first.

When a strong emotion is awakened in consciousness there are a large number of physiological reactions, for the most part visceral, which can be noted. Some of these may be graphically recorded and measured by means of instruments of precision. These physiological reactions are numerous and have been extensively described by Féré[198] among others. The earlier work of Mosso upon the disturbances of the respiration and vasomotor apparatus induced by sensory stimulation is well known.

More recently considerable experimental work has been done, particularly by German investigators, to determine the influence of affective states upon the circulation and respiration.

Modifications of the _peripheral circulation_, manifested through pallor or turgescence of the skin and measured by changes recorded by the plethismograph in the volume of the limbs; modifications of the volume of the _heart_ and of the rhythm and force of the beats recorded by the sphygmograph, and of arterial tension measured by the sphygmomonometer are common phenomena. (Fear is more particularly accompanied by pallor, and shame by turgescence—blushing. Anger in some is manifested by pallor and in others by turgescence, and so on.) Changes in rate of the heart-beats belong to popular knowledge. It is not so well known, even to physiologists that the volume of the heart may be affected by emotion. In several series of observations made under conditions of emotional excitement upon a large number of healthy men, candidates for civil service appointments, I recorded in a high percentage not only alterations in the rate and rhythm and force of the heart-beat, but temporary dilatation of the heart lasting during the period of excitement.[199] This dilatation in some cases was sufficient to lead to insufficiency of the mitral valve and to give rise to murmurs. The examination was purposely conducted so as to induce a high degree of emotional excitement, at least in many men. In another series of observations (not published) the arterial tension was measured, and it was found, as would be expected, that an increase of tension accompanied the cardiac excitation under emotion.[200]

Fig. 2. J., acute katatonic stupor. b is a wave selected from the
series in which 6 is sudden call by name. The galvanometer curve (a)
is slight, but the change in the pneumograph curve is notable.
(Peterson and Jung.[201])
]

As to the _respiratory apparatus_ the effect of emotion in altering the rate and depth of respiration may be shown by the pneumograph; by this method the effects of slight emotion that otherwise would escape observation may be detected. Such a disturbance of respiration is shown in the tracing, Fig. 2.

That emotion will profoundly affect the respiration has of course been common knowledge from time immemorial, and has been made use of by writers of fiction and actors for dramatic effect. The same may be said of modifications of the functioning of the whole respiratory apparatus, including the nostrils and the mouth; and likewise of the decrease or increase of secretions (dryness of the mouth from fear, and “foaming” from anger). These are among the well known physiological effects of emotions.

Increase of _sweat_ sometimes amounting to an outpour, and alterations in the amount of the various _glandular secretions_ (_salivary_, _gastric_, etc.), and _rigor_ are important phenomena.

The remarkable researches of Pawlow[202] and his co-workers in Russia on the _work of the digestive glands_, and those of Cannon[203] in America on the _movements of the stomach and intestines_ have revealed that these functions are influenced in an astonishing degree by psychical factors.

Although it has long been known that the sight of food under certain conditions would call forth a secretion of gastric juice in a hungry dog (Bidder and Smith, 1852), and common observation has told us that emotion strongly affects the gastrointestinal functions, increasing or diminishing the secretions of saliva and gastric juice, and even producing dyspeptic disturbances and diarrhœa, it has remained for Pawlow and his co-workers to demonstrate the important part which the “appetite,” as a psychical state, plays in the process of digestion. In hungry dogs a large quantity of gastric juice, rich in ferment, is poured out when food is swallowed, and even at the sight of food, and it was proved that this outpouring was due to psychical influences. Simply teasing and tempting the animal with food cause secretions, and food associations in the environment may have the same effect. “If the dog has not eaten for a long time every movement, the going out of the room, the appearance of the attendant who ordinarily feeds the animal—in a word, every triviality—may give rise to excitation of the gastric glands.” (Pawlow, p. 73.) This first secreted juice is called “appetite juice,” and is an important factor in the complicated process of digestion. “The appetite is the first and mightiest exciter of the secretory nerves of the stomach.” (Pawlow, p. 75.) Pawlow’s results have been confirmed in man by Hornborg, Umber, Bickel, and Cade and Latarjet. The mere chewing of appetizing food, for instance, is followed by a copious discharge of gastric juice, while chewing of rubber and distasteful substances has a negative result. Depressing emotions inhibit the secretion of juice (Bickel). More than this, Cannon,[204] in his very remarkable experiments on the movements of the stomach and intestines, found that in animals (cat, rabbit, dog, etc.), gastric peristalsis is stopped whenever the animal manifests signs of rage, distress, or even anxiety. “Any signs of emotional disturbance, even the restlessness and continual mewing which may be taken to indicate uneasiness and discomfort, were accompanied in the cat by total cessation of the segmentation movements of the small intestines, and of antiperistalsis in the proximal colon.” Bickel and Sasaki have confirmed in dogs these emotional effects obtained by Pawlow and Cannon.

The effect of the emotions on the digestive processes is so important from the standpoint of clinical medicine that I quote the following summary of published observations from Cannon: "Hornborg found that when the boy whom he studied chewed agreeable food a more or less active secretion of the gastric juice was started, whereas the chewing of indifferent material was without influence.

"Not only is it true that normal secretion is favored by pleasurable sensations during mastication, but also that unpleasant feelings, such as vexation and some of the major emotions, are accompanied by a failure of secretion. Thus Hornborg was unable to confirm in his patient the observation of Pawlow that mere sight of food to a hungry subject causes the flow of gastric juice. Hornborg explains the difference between his and Pawlow’s results by the difference in the reaction of the subjects to the situation. When food was shown, but withheld, Pawlow’s hungry dogs were all eagerness to secure it, and the juice at once began to flow. Hornborg’s little boy, on the contrary, became vexed when he could not eat at once, and began to cry; then no secretion appeared. Bogen also reports that his patient, a child, aged three and a half years, sometimes fell into such a passion in consequence of vain hoping for food, that the giving of the food, after calming the child, was not followed by any secretion of the gastric juice.

"The observations of Bickel and Sasaki confirm and define more precisely the inhibitory effects of violent emotion on _gastric secretion_. They studied these effects on a dog with an œsophageal fistula, and with a side pouch of the stomach which, according to Pawlow’s method, opened only to the exterior. If the animal was permitted to eat while the œsophageal fistula was open the food passed out through the fistula and did not go to the stomach. Bickel and Sasaki confirmed the observation of Pawlow that this sham feeding is attended by a copious flow of gastric juice, a true ‘psychic secretion,’ resulting from the pleasurable taste of the food. In a typical instance the sham feeding lasted five minutes, and the secretion continued for twenty minutes, during which time 66.7 c. c. of pure gastric juice was produced.

"On another day a cat was brought into the presence of the dog, whereupon the dog flew into a great fury. The cat was soon removed, and the dog pacified. Now the dog was again given the sham feeding for five minutes. In spite of the fact that the animal was hungry and ate eagerly, there was no secretion worthy of mention. During a period of twenty minutes, corresponding to the previous observation, only 9 c. c. of acid fluid was produced, and this was rich in mucus. It is evident that in the dog, as in the boy observed by Bogen, strong emotions can so profoundly disarrange the mechanisms of secretion that the natural nervous excitation accompanying the taking of food cannot cause the normal flow.

"On another occasion Bickel and Sasaki started gastric secretion in the dog by sham feeding, and when the flow of gastric juice had reached a certain height the dog was infuriated for five minutes by the presence of the cat. During the next fifteen minutes there appeared only a few drops of a very mucous secretion. Evidently in this instance a physiological process, started as an accompaniment of a psychic state quietly pleasurable in character, was almost entirely stopped by another psychic state violent in character.

"It is noteworthy that in both the positive and negative results of the emotional excitement illustrated in Bickel and Sasaki’s dog the effects persisted long after the removal of the exciting condition. This fact Bickel was able to confirm in a girl with œsophageal and gastric fistulas; the gastric secretion long outlasted the period of eating, although no food entered the stomach. The importance of these observations to personal economics is too obvious to require elaboration.

“Not only are the secretory activities of the stomach unfavorably affected by strong emotions; the movements of the stomach as well, and, indeed, the movements of almost the entire alimentary canal, are wholly stopped during excitement.”[205]

So you see that the proverb, “Better a dinner of herbs where love is than a stalled ox and hatred therewith,” has a physiological as well as a moral basis.

Nearly any sensory or psychical stimulus can be artificially made to excite the _secretion of saliva_ as determined by experimentation on animals by Pawlow.

It is probable that all the _ductless glands_ (thyroid, suprarenal, etc.), are likewise under the influence of the emotions. The suprarenal glands secrete a substance which in almost infinitesimal doses has a powerful effect upon the heart and blood vessels, increasing the force of the former and contracting the peripheral arterioles. The recent observations of Cannon and de la Paz have demonstrated in the cat that under the influence of fear or anger an increase of this substance is poured into the circulation.[206] Cannon, Shohl and Wright have also demonstrated that the glycosuria which was known to occur in animals experimented upon in the laboratory is due (in cats) to the influence of the emotions, very probably discharging through the sympathetic system on the adrenal glands and increasing their secretion.[207] The glycosuria is undoubtedly due to an increase of sugar in the blood. It is interesting to note, in this connection, that there is considerable clinical evidence that indicates that some cases of diabetes and glycosuria have an emotional origin. The same is true of disease of the thyroid gland (exophthalmic goiter).

Most of the viscera are innervated by the sympathetic system, and the visceral manifestations of emotion indicate the dominance of sympathetic impulses. “When, for example, a cat becomes frightened, the pupils dilate, the stomach and intestines are inhibited, the heart beats rapidly, the hairs of the back and tail stand erect—all signs of nervous discharge along sympathetic paths” (Cannon). Cannon and his co-workers have further made the acute suggestion that, as adrenalin itself is capable of working the effects evoked by sympathetic stimulation, “the persistence of the emotional state, after the exciting object has disappeared, can be explained” by the persistence of the adrenalin in the blood. There is reason to believe that some of the adrenal secretion set free by nervous stimulation returning in the blood stream to the glands stimulates them to further activity, and this would tend to continue the emotional effect after the emotion has subsided. “Indeed it was the lasting effect of excitement in digestive processes which suggested” to Cannon his investigations.[208]

According to Féré[209] the _pupils_ may dilate under the influence of asthenic emotions and contract with sthenic emotions. However that may be, the dilatation of the pupils during states of fear may be demonstrated in animals.

exert force of which he is ordinarily incapable. Or this energy, instead of being discharged into the channels being made use of by the will, and so augmenting its effects, may be so discharged as to inhibit the will, and produce paralysis of the will and muscular action.

These muscular vasomotor and secretory changes need not surprise us, as indeed they have a biological meaning. As Sherrington[210] has pointed out, “there is a strong bond between emotion and muscular action. Emotion ‘moves’ us, hence the word itself. If developed in intensity, it impels toward vigorous movement. Every vigorous movement of the body ... involves also the less noticeable co-operation of the viscera, especially of the circulatory and respiratory [and, I would add, the secretory glands of the skin]. The extra demand made upon the muscles that move the frame involves a heightened action of the nutrient organs which supply to the muscles the material for their energy”; and also involves a heightened action of the sweat glands to maintain the thermic equilibrium. “We should expect,” Sherrington remarks, “visceral action to occur along with the muscular expression of emotion,” and we should expect, it may be added, that through this mechanism emotion should become integrated with vasomotor, secretory, and other visceral functions.

Another physiological effect of emotion ought to be mentioned, as of recent years it has been the object of much and intensive study by numerous students and has been frequently made use of in the clinical study of mental derangements and in the study of subconscious phenomena. I refer to the so-called “_psycho-galvanic reflex_.” As an outcome of all the investigations which have been made by numerous students into this phenomenon, it now seems clear that there are two types of galvanic reactions, distinct from each other, which can be recognized. The one type first described by Féré[211] consists in an increase, brought about by emotion, of a galvanic current made to pass through the body from a galvanic cell. If a very sensitive galvanometer is put in circuit with the body and such a cell, a certain deviation of the needle of course may be noted varying in amplitude according to the resistance of the body. Now, if an idea associated with emotion—i.e., possessing a sufficient amount of affective tone—is made to enter the consciousness of the person experimented upon, there is observed an increased deflection of the needle, showing an increase of current under the influence of the emotion. The generally accepted interpretation of this increase is that it is due to diminished resistance of the skin (with which the electrodes are in contact) caused by an increase of the secretions of the sweat glands. A similar increase of current follows various sensory stimulations, such as the pricking of a pin, loud noises, etc. It may be interesting for historical reasons to quote here Féré’s statement of his observations, as they seem to be generally overlooked. In his volume, “La Pathologie des Emotions,” in 1892, he thus sums up his earlier and later observations: "I then produce various sensory stimulations—visual (colored glasses), auditory (tuning fork), gustatory, olfactory, etc. Whereupon there results a sudden deviation of the needle of the galvanometer which, for the strongest stimulations, may travel fifteen divisions (milliampères). The same deviation may also be produced under the influence of sthenic emotions, that is to say, it is produced under all the conditions where I have previously noticed an augmentation of the size of the limbs, made evident through the plethysmograph. Absence of stimulation, on the contrary, increases the resistance; in one subject the deviation was reduced by simply closing the eyes.

“Since these facts were first described at the Biological Society I have been enabled to make more exact observations by using the process recommended by A. Vigouroux (De la résistance électrique chez les mélancoliques, Th. 1890, p. 17), and I have ascertained that under the influence of painful emotions or tonic emotions the electrical resistance may, in hystericals, instantaneously vary from 4,000 to 60,000 ohms.”

It will be noticed that Féré attributed the variations of the current to variations of resistance of the body induced by sensations and emotions.

The method of obtaining the psycho-galvanic reaction may be varied in many ways, the underlying principle being the same, namely, the arousing of an emotion of some kind. This may be simply through imagined ideas, or by expectant attention, sensory stimulation, suggested thoughts, verbal stimuli, etc. According to Peterson and Jung,[212] “excluding the effect of attention, we find that every stimulus accompanied by an emotion causes a rise in the electric curve, and directly in proportion to the liveliness and actuality of the emotion aroused. The galvanometer is therefore a measurer of the amount of emotional tone, and becomes a new instrument of precision in psychological research.” This last statement can hardly be said to be justified, as we have no means of measuring the “liveliness and actuality” of an emotion and, therefore, of co-relating it with a galvanic current, nor have we any grounds for assuming that the secretion of sweat (upon which the diminished resistance of the body presumably depends) is proportionate to the liveliness of the emotion, or, indeed, even that it always occurs. It is enough to say that the galvanic current is in general a means of detecting the presence of emotion.

The second type of galvanic reaction, as shown by Sidis and Kalmus,[213] does not depend upon the diminished resistance of the body to a galvanic current passing from without through the body, but is a current originating within the body under the influence of emotion. Sidis and Kalmus concluded that “active psycho-physiological processes, sensory and emotional processes, with the exception of purely ideational ones, initiated in a living organism, bring about electromotive forces with consequent galvanometric deflections.” In a later series of experiments Sidis and Nelson[214] came to the conclusion that the origin of the electromotive force causing the galvanic deflection was in the muscles.[215] Wells and Forbes,[216] on the other hand, conclude from their own investigation that the origin of the galvanic current is to be found in the sweat gland activity and believe the muscular origin improbable. From a clinical standpoint the question is unimportant.

_Sensory disturbances._ On the sensory side the effect of emotions, particularly unpleasant ones, in awakening “thrills” and all sorts of sensations in different parts of the body is a matter of everyday observation. _Nausea_, _dizziness_, _headache_, _pains_ of different kinds are common accompaniments. Such reactions, however, largely vary as idiosyncrasies of the individual, and are obviously not open to experimentation or measurement. Whether they should be spoken of as physiological or aberrant reactions is a matter of terminology. They are, however, of common occurrence. In pathological conditions disagreeable sensations accompanying fear, grief, disgust, and other distressing forms of emotion often play a prominent part, and as symptoms contribute to the syndromes of the psychosis. The following quaintly described case quoted by Cannon from Burton’s Anatomy of Melancholy is as good as a more modern illustration: “A gentlewoman of the same city saw a fat hog cut up; when the entrails were opened, and a noisome savour offended her nose, she much disliked, and would not longer abide; a physician in presence told her, as that hog, so was she full of filthy excrements, and aggravated the matter by some other loathsome instances, insomuch this nice gentlewoman apprehended it so deeply that she fell forthwith a vomiting; was so mightily distempered in mind and body that, with all his art and persuasion, for some months after, he could not restore her to herself again; she could not forget or remove the object out of her sight.” Cannon remarks: “Truly, here was a moving circle of causation, in which the physician himself probably played the part of a recurrent augmenter of the trouble. The first disgust disturbed the stomach, and the disturbance of the stomach, in turn, aroused in the mind greater disgust, and thus between them the influences continued to and fro until digestion was impaired and serious functional derangement supervened. The stomach is ‘king of the belly,’ quotes Burton, ‘for if he is affected all the rest suffer with him.’”

Such cases could be multiplied many fold from the records of every psychopathologist. I happen by chance to be interrupted while writing this page by a patient who presents herself suffering from a phobia of fainting. When this fear (possibly with other emotions) is awakened she is attacked by nausea and eructation of the gastric contents, and, if she takes food, by vomiting of the meal. (Owing to a misunderstanding of the true pathology by her physician, her stomach was washed out constantly for a period of two years without relief!)

=General psychopathology.=—In the light of all these well-known physiological effects of emotion it is apparent that when an idea possessing a strong emotional tone, such as fear or its variants, enters consciousness, it is accompanied by a complex of physiological reactions. In other words, fear, _as a biological reaction_ of the organism to a stimulus, does not consist of the psychical element alone, but includes a large syndrome of physiological processes. We can, indeed, theoretically construct a schema which would represent the emotional reaction. This schema would undoubtedly vary in detail in particular cases, according to the excitability of the different visceral functions involved in different individuals and to the mixture of the emotions taking part (fear, disgust, shame, anger, etc.). As one type, for instance, of a schema, taking only the most obtrusive phenomena which do not require special technique for their detection, we would have:

Fear (or one of its variants, anxiety, apprehension, etc., or a compound emotion that includes fear).

Inhibition of thought (confusion).

Pallor of the skin.

Increased perspiration.

Cardiac palpitation.

Respiratory disturbances.

Tremor.

Muscular weakness.

Gastric and intestinal disturbances.

(Blushing or congestion of the skin would replace pallor if the fear was represented or accompanied by shame or bashfulness, etc. (self-debasement and self-consciousness),[217] or if the affective state was anger.)

On the sensory side we would have various paresthesiæ varying with the idiosyncrasies of the individual, and apparently dependent upon the paths through which the emotional energy is discharged:

“Thrills.”

Feeling of oppression in the chest.

Headache.

Nausea (with or without vomiting).

Pains, fatigue, etc.

It is of practical importance to note that attacks of powerful emotions, according to common experience, are apt to be followed by exhaustion; consequently in morbid fears fatigue is a frequent sequela.

Physiological Mimicry of Disease.

Now, theoretically, one or more of these physiological disturbances might be so obtrusive as to be the predominant feature of the syndrome and to mask the psychical element which might then be overlooked. Gastric and intestinal disturbances, for instance, or cardiac distress, might be so marked as not to be recognized as simply manifestations of an emotion, but be mistaken for true gastric, intestinal, or heart disease. Going one step further, if a person had a frequently recurring fear, as is so common, and the physiological symptoms were obtrusively predominant, these latter would necessarily recur in attacks and, overshadowing the psychical element, might well have all the appearance (both to the subject and the observer) of true disease of the viscera.

Now, as a fact this theoretical possibility is just what happens. It is one of the commonest of occurrences, although it is too frequently misunderstood.[218] A person, we will say, has acquired—owing to no matter what psychogenetic factor—a recurrent fear. This fear, or, in less obtrusive form, anxiety, or apprehension, is, we will say, of disease—heart disease or insanity or fainting or cancer or epilepsy or what not. It recurs from time to time when awakened by some thought or stimulus from the environment. At once there is an outburst of physiological, i.e., functional disturbances, in the form of an “attack.” There may be violent cardiac and respiratory disease, tremor, flushing, perspiration, diarrhœa, sensory disturbances, etc., followed by more or less lasting exhaustion. On the principle of complex building, which we have discussed in a previous lecture, the various physiological reactions embraced in such a scheme as I have outlined tend to become welded into a complex (or association psycho-neurosis), and this complex of reactions in consequence recurs as a syndrome every time the fear is reëxcited. On every occasion when the anxiety recurs, a group of symptoms recurs which is made up of these physical manifestations of emotion which are peculiar to the individual case. The symptoms, unless a searching inquiry is made into their mode of onset, sequence, and associative relations, will appear a chaotic mass of unrelated phenomena; or only certain obtrusive ones, which in the mind of the patient point to disease of a particular organ, are described by him. The remainder have to be specifically sought for by the investigator. The latter, if experienced in such psycho-neuroses, can often from his knowledge of the phenomena of emotion anticipate the facts and in a large degree foretell to the patient the list of symptoms from which he suffers. By those who lack familiarity with these functional disturbances mistakes in diagnosis are frequently made. Disease of the heart, or of the stomach, or of the nervous system is frequently diagnosed when the symptoms are simply the product of emotion. Quite commonly, when the symptoms are less related to particular organs, but more conspicuously embrace vasomotor, sensory, digestive disturbances (inhibition of function), and fatigue, the syndrome is mistaken for so-called _neurasthenia_.[219] Thus it happens that in recurrent morbid fears—known as the phobias or obsessions—a group of symptoms are met with which at first sight appear to be unrelated bodily disturbances, but which when analyzed are seen to be only a certain number of physiological manifestations of emotion welded into a complex. On every occasion that the fear recurs this complex is reproduced.

It now remains to study the effect of the emotions on the psychical side. This we shall do in the next lecture.

-----

Footnote 196:

I use the word, not in the strict but in the popular and general
sense, to include feeling, indeed all affective states, excepting
where the context gives the strict meaning.

Footnote 197:

The James-Lange theory is disregarded here as untenable.

Footnote 198:

La Pathologie des Emotions, 1892.

Footnote 199:

Physiological Dilatation and the Mitral Sphincter as Factors in
Functional and Organic Disturbances of the Heart, _The American
Journal of the Medical Sciences_, February, 1901; also, The Occurrence
and Mechanism of Physiological Heart Murmurs (Endocardial) in Healthy
Individuals, _The Medical Record_, April 20, 1889.

Footnote 200:

The emotional factor is a source of possible fallacy in all
observations on arterial tension and must be guarded against.

Footnote 201:

Frederick Peterson and C. G. Jung: Psycho-Physical Investigations with
the Galvanometer and Pneumograph, _Brain_, Vol. XXX, July, 1907, p.
153.

Footnote 202:

The Work of the Digestive Glands (English Translation), London, 02.

Footnote 203:

For a summary of Cannon’s work, see his article, Recent Advances in
the Physiology of the Digestive Organs Bearing on Medicine and
Surgery, _The Medical Journal of Medical Sciences_, 1906, New Series,
Vol. CXXXI, pp. 563-578.

Footnote 204:

_American Journal of Medical Sciences_, 1906, p. 566. See also “The
Influence of Emotional States on the Functions of the Alimentary
Canal,” by the same writer (_ibid._, April, 1909) for an interesting
résumé of the subject.

Footnote 205:

_American Journal of the Medical Sciences_, April, 1909.

Footnote 206:

Cannon and de la Paz: _American Journal of Physiology_, April 1, 1911.

Footnote 207:

Cannon, Shohl, and Wright, Ibid., December 1, 1911.

Footnote 208:

These effects of adrenalin suggest that the secretion may take some
part in pathological anxiety states.

Footnote 209:

Pathologie des Emotions, 1892.

The influence of emotion on the _muscular system_ need hardly be more
than referred to. Tremor, twitchings, particularly of the facial
muscles, and other involuntary movements, as well as modifications of
the tonus of the muscles, are common effects. All sorts of
disturbances occur, ranging from increase of excitability to
paralysis. Everyone knows that under the influence of powerful
emotion, whether of joy, anger, or fear, there is discharged an
increase of energy to the muscles, sometimes of an intensity which
enables an individual to

Footnote 210:

The Integrative Action of the Nervous System, p. 266.

Footnote 211:

Note sur les modifications de la résistance électrique sous
l’influence des excitations sensorielles et des émotions, _C. R. Soc.
de Biologie_, 1888, p. 217.

Footnote 212:

Psycho-Physical Investigations with the Galvanometer and Pneumograph
in Normal and Insane Individuals, _Brain_, Vol. XXX, July, 1907.

Footnote 213:

_Psychological Review_, November, 1908, and January, 1909.

Footnote 214:

The Nature and Causation of the Galvanic Phenomena, _Psychological
Review_, March, 1910, _Journal of Abnormal Psychology_, June-July,
1910.

Footnote 215:

Having demonstrated the development of electromotive force within the
body, these experimenters assumed that every psycho-galvanic reaction
was of this type. But plainly, their results do not contradict the
phenomenon of diminished resistance of the body to an electric current
brought about by emotion stimulating the sweat glands. The evidence
indicates, as I have said, two types of psycho-galvanic phenomena.

Footnote 216:

On Certain Electrical Processes in the Human Body and Their Relation
to Emotional Reactions, _Archives of Psychology_, March, 1911.

Footnote 217:

Morbid self-consciousness is commonly accompanied by fear and other
emotions. Nausea, although the specific manifestation of disgust, not
rarely is induced by fear.

Footnote 218:

A good example is that of an extreme “neurasthenic,” who had been
reduced to a condition of severe inanition from inability to take a
proper amount of food because of failure of digestion, nausea, and
vomiting. Examined by numerous and able physicians in this country and
Europe, none had been able to recognize any organic disease or the
true cause of the gastric difficulty which remained a puzzle. As a
therapeutic measure her stomach had been continuously and regularly
washed out. Yet it was not difficult to recognize, after analyzing the
symptoms and the conditions of their occurrence, that the disturbances
of the gastric functions were due to complex mental factors, the chief
of which, emotion, inhibited the gastric function, as in Cannon’s
experiments, and indirectly or directly, induced the nausea and
vomiting. The correctness of this diagnosis was recognized by the
attending physician and patient. Sometimes a phobia complicates a true
organic disease and produces symptoms which mimic the symptoms of the
latter—heart disease, for example. In this case it is often difficult
to recognize the purely phobic character of the symptoms. O. H. C. was
such a case. Though there was severe valvular disease of the heart,
compensation was good and there was little if any cardiac disability.
The attacks of dyspnœa and other symptoms were unmistakably the
physical manifestation of a phobia of the disease. The phobia had been
artificially created by overcautious physicians.

Footnote 219:

One has only to compare routine out-patient hospital records with the
actual state of patients to verify the truth of this statement. For
purposes of instruction I have frequently done this before the class.
The true nature of the psycho-neurosis and the irrelevancy of the
routine record and diagnosis have, I believe, been commonly made
manifest. Sometimes, however, of course, phobias complicate other
diseases, and we have a mixed symptomatology.

LECTURE XV
INSTINCTS, SENTIMENTS, AND CONFLICTS

It is generally agreed that emotions proper (as distinguished from other affective states) may be divided into those which are primary (anger, fear, disgust, etc.), and those (jealousy, admiration, hatred, etc.), which are compounded of two or more primary emotions. McDougall has made a great contribution to our knowledge in having made clear that a primary emotion is not only instinctive, but is the central or psychical element in a reflex process consisting, besides, of an ingoing stimulus and an outgoing impulse. The whole process is the instinct.[220] It is of course innate, and depends on congenital prearrangements of the nervous system. The central element, the emotion, provides the conative or impulse force which carries the instinct to fulfilment. It is the motive power, the dynamic agent that executes, that propels the response which follows the stimulus. Though we speak of anger and fear, for example, as instincts, McDougall is unquestionably right in insisting that more correctly speaking the activated instinct is a process in which the emotion is only one factor—the psychical. The instincts of anger and fear should more precisely be termed respectively “pugnacity with the emotion of anger” and “flight with the emotion of fear.” In the one case, the emotion, as the central reaction to a stimulus, by its conative force impels to pugnacity; in the other fear impels to flight; and so with the other instincts and their emotions which I would suggest may be termed arbitrarily the _emotion-instincts_, to distinguish them from the more general instincts and innate dispositions with which animal psychology chiefly deals, and in which the affective element is feebler or has less of the specific psychical quality. For brevity’s sake, however, we may speak of the instinct of anger, fear, tender feeling, etc. Of course they are biological in their nature.

This formulation, by McDougall, of emotion as one factor in an instinctive process must be regarded as one of the most important contributions to our knowledge of the mechanism of emotion. It can scarcely be traversed, as it is little more than a descriptive statement of observed facts. It is strange that this conception of the process should have been so long overlooked. Its value lies in replacing vagueness with a precise conception of one of the most important of psychological phenomena, and enables us to clearly understand the part played by emotion in mental processes. It also shows clearly the inadequacy of the objective methods of normal psychology when attempting to investigate emotion by measuring the discharge of its impulsive force in one direction only, namely, the disturbances of the functions of the viscera (vasomotor, glandular, etc.). It discharges also along lines of mental activity and conduct.

When studying the organization of complexes, and in other lectures, we saw, as everyone knows in a general way, that _affects may become linked with ideas_, and that the force derived from this association gives to the ideas intensity and conative influence. Further, it was developed that the linking of a strong affect tends to stronger registration and conservation of experiences. This linking of an affect to an idea is one of the foundation stones of the pathology of the psycho-neuroses. One might say that upon it “hangs all the law and the prophets.”

Inasmuch as a sentiment, even in the connotations of popular language, besides being an idea always involves an affective element, it is obvious that _a sentiment is an idea of an object with which one or more emotions are organized_. But, obvious as it is, it remained for Mr. Shand, as McDougall reminds us, to make this precise definition. It is hardly a discovery as the latter puts it, as the facts themselves have been long known; but it is a valuable definition and its value lies in helping us to think clearly. Nearly every idea, if not every idea, has an affective tone of some kind, or is one of a complex of ideas endowed with such tone. This tone may be weak so as to be hardly recognizable, or it may be strong. Now, if emotion is one factor in an instinctive process, it is evident that a sentiment more precisely is an idea of an object linked or organized with one or more “emotion-instincts.” As McDougall has precisely phrased it, “A sentiment is an organized system of emotional dispositions centered about the idea of some object.” The impulsive force of the emotional dispositions or linked instincts becomes the conative force of the idea, and it is this factor which carries the idea to fruition. This is one of the most important principles of functional psychology. Its value can scarcely be exaggerated. Without the impulse of a linked emotion ideas would be lifeless, dead, inert, incapable of determining conduct. But when we say that an emotion becomes linked to, i.e., organized with that composite called an idea, _we really mean (according to this theory of emotion) that it is the whole instinct, the emotional innate disposition of which the emotion is only a part that is so linked_. The instinct has also afferent and efferent activities. The latter is an impulsive or conative force discharged by the emotion. Thus the affective element of an instinctive process—a process which is a biological reaction—provides the driving force, makes the idea a dynamic factor, moves us to carry the idea to fulfilment. As McDougall has expressed it:

"We may say, then, that directly or indirectly the instincts are the
prime movers of all human activity; by the conative or impulsive force
of some instinct (or of some habit derived from some instinct), every
train of thought, however cold and passionless it may seem, is borne
along toward its end, and every bodily activity is initiated and
sustained. The instinctive impulses determine the ends of all
activities and supply the driving power by which all mental activities
are sustained; and all the complex intellectual apparatus of the most
highly developed mind is but a means toward these ends, is but the
instrument by which these impulses seek their satisfactions, while
pleasure and pain do but serve to guide them in their choice of the
means.

“Take away these instinctive dispositions with their powerful
impulses, and the organism would become incapable of activity of any
kind; it would lie inert and motionless like a wonderful clockwork
whose mainspring had been removed, or a steam engine whose fires had
been drawn. These impulses are the mental forces that maintain and
shape all the life of individuals and societies, and in them we are
confronted with the central mystery of life and mind and will.”[221]

Furthermore _the organization of the emotions with ideas to form sentiments is essential for self-control and regulation of conduct_, and becomes a safeguard against mental, physiological, and social chaos.

“The growth of the sentiments is of the utmost importance for the
character and conduct of individuals and of societies; it is the
organization of the affective and conative life. In the absence of
sentiments our emotional life would be a mere chaos, without order,
consistency, or continuity of any kind; and all our social relations
and conduct, being based on the emotions and their impulses, would be
correspondingly chaotic, unpredictable, and unstable. It is only
through the systematic organization of the emotional dispositions in
sentiments that the volitional control of the immediate promptings of
the emotions is rendered possible. Again, our judgments of value and
of merit are rooted in our sentiments; and our moral principles have
the same source, for they are formed by our judgments of moral
value.”[222]

Summing up, then, we may say _one of the chief functions of emotion_ is to provide the conative force which enables ideas to fulfill their aims, and one of the chief functions of sentiments to control and regulate the emotions.

Besides the instinctive dispositions proper there are other innate dispositions which similarly provide conative force and determine activities. For the practical purposes of the problems with which we are concerned, the conative or impulsive forces of all such innate dispositions and the sentiments which they help to form are here, it should be understood, considered together and included under instincts.

=The conative function of emotion.=—I shall take up in a later lecture[223] (in connection with the psychogenesis of multiple personality) the instincts and sentiments for discussion in more detail. The point to which I wish in this connection to call attention is that when a simple emotion-instinct, or an idea linked with an instinct (a sentiment) is awakened by any stimulus, _its impulsive force is discharged in three directions_: the _first_ is toward the excitation of those articulated movements and ideas which guide and carry the instinct to fruition—to fight in the case of anger, to flee in the case of fear, to cherish in the case of love, etc. _Second_ (accessory to the first) the excitation of many of the various visceral functions which we have reviewed reinforces the instinctive movements; e. g., for pugnacity or flight the increased respiration and activity of the heart increase the supply of oxygen and blood to the muscles; the secretion of sweat regulates the temperature during increased activity, the increased secretion of adrenalin and the increased secretion of sugar may, as Cannon suggests, respectively keep up the emotional state (after the cause of the fear or anger has subsided) and meet the demand of the muscles for an extra supply of food, etc.

Later experiments of Cannon seem to show that the adrenal secretion removes the fatigue of muscles; and, further, that stimulation of the splanchic nerves will largely recover fatigued muscles, increasing the efficiency as much as 100 per cent.[224] As emotion discharges its impulses along splanchic pathways to the adrenal glands, the inference as to the function of emotion in overcoming fatigue is obvious.

As to the _sensory accompaniments of emotion_, it is quite reasonable to suppose that their rôle is to supplement and reinforce in consciousness the affect, thereby aiding in arousing the individual to a full appreciation of the situation and to such voluntary effort (whether to guide and assist the instinct to its fulfillment or to repress it) as, in the light of past experiences, his judgment dictates. These sensory disturbances on this theory act as additional warnings in consciousness where the affect proper might be too weak.[225] Their function would be like that of pain in the case of organic disease. Pain is a biological reaction and a warning to the individual to rest the diseased part,[226] as well as a danger signal.

The _third_ direction which the discharge of the impulsive force of the emotion takes is toward the repression of the conflicting conative force of such other emotions as would act in an antagonistic direction.[227] The utility of the discharge in this direction is supplementary to that of the excitation of the visceral functions: _the former protects against the invasion of counteracting forces, the latter strengthens the force of the impulse in question_.

_Conflicts thus arise._ When an emotion is aroused a conflict necessarily occurs between its impulse and that of any other existing affective state, the impulse of which is antagonistic to the aim of the former. Consequently instincts and sentiments which, through the conative force of their emotion, tend to drive the conduct of the individual in a course in opposition to that of a newly aroused emotion (instinct) meet with resistance. Whichever instinct or sentiment, meaning whichever impulse, is the stronger necessarily downs the other; inhibits the central and efferent parts of the process—ideas, emotions and impulses—though the afferent part conveys the stimulus to the central factor. Thus processes of thought to which the inhibited sentiment or instinct would normally give rise, or with which it is systematized, are likewise inhibited and behavior correspondingly modified. These statements are only descriptive of what is common experience. If one recalls to mind the principal primary emotions (instincts) such as the sexual, anger, fear, tender feeling, hunger, self-abasement, self-assertion, curiosity, etc., this is seen to be an obvious biological truth.[228] Fear is suppressed by anger, tender feeling, or curiosity (wonder), and _vice versa_; hunger and the sexual instinct by disgust.

What is true of the primitive instincts and their primary emotions is also true of compound instincts (emotions) and of sentiments, i.e., ideas about which one or several emotions are systematized. We may, therefore, for brevity’s sake, speak of a conflict of ideas or sentiments or emotions or instincts indiscriminately. In other words, _any affective state may be suppressed by conflict with another and stronger affective state_. A timid mother, impelled by the parental instinct, has no fear of danger to herself when her child is threatened. The instinct of pugnacity (anger) in this case not being antagonistic (in conflict) is not only not suppressed but may be awakened as a reaction to aid in the expression of the parental instinct. _Per contra_, when anger would conflict with this instinct, as when the child does wrong, the anger is suppressed by the parental instinct. Conversely, the sentiment of love for a particular person may be completely suppressed by jealousy and anger. Hatred of a person may expel from consciousness previous sentiments of sympathy, justice, pity, respect, fear, etc. The animal under the influence of the parental instinct may be incapable of fear in defense of its young, particularly if anger is excited. Fear may be suppressed in an animal or human being if either is impelled by great curiosity over a strange object. Instead of taking to flight, the animal may stand still in wonder. Similarly in man, curiosity to examine, for example, an explosive—an unexploded shell or bomb—inhibits the fear of danger often, as we know, with disastrous results. The suppression of the sexual instinct by conflict is one of the most notorious of the experiences of this kind in everyday life. This instinct cannot be excited during an attack of fear and anger, and even during moments of its excitation, if there is an invasion of another strong emotion the sexual instinct at once is repressed. Under these conditions, as with other instincts, even habitual excitants can no longer initiate the instinctive process. Chloe would appeal in vain to her lover if he were suddenly seized with fright or she had inadvertently awakened in him an intense jealousy or anger. Similarly the instinct may be suppressed, particularly in men, as every psycho-pathologist has observed, by the awakening of the instinct of self-subjection with its emotion of self-abasement (McDougall) with fear, shown in the sentiments of incapacity, shame, etc. The authors of “_Vous n’avez rien à declarer_” makes this the principal theme in this laughable drama. Indeed the principle of the suppression of one instinct by conflict with another has been made use of by writers of fiction and drama in all times.