CHAPTER XXVII NEUROSIS AND HEREDITY

The following discussion in the form of questions and answers may prove of interest to the physician and to the intelligent layman. The discussion occurred in the course of correspondence. A friend of mine thought the subject of sufficient importance to have it brought to the attention of the cultured public.

The questions are as follows:

“Are not all neuropathic conditions the results of a morbid, unstable nervous organism, the basis of which lies in a faulty heredity?

“Are not weak nerves the cause of hysterical, neurasthenic and neuropathic affections in general?

“Is not all neurosis due to defective parent stock?

“If the occasions for fear, as some psychopathologists claim, were more frequent in primitive times than now, then the cave men must have had more psychopathic affections than civilized man.”

To these questions the following answers are given:

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Psychopathic diseases are not hereditary—they are acquired characteristics, having their origin in the abnormal, hypertrophied growth of the fear instinct which is at the root of the primal impulse of self-preservation. This is proved by psychopathological studies of clinical cases; and it can be further demonstrated by experimental work in the laboratory even in the case of animals. “Weak nerves,” “a run down, exhausted nervous system,” whatever the terms may mean, may overlap psychopathic conditions, but the two are by no means equivalent, much less identical. Psychopathic, psychoneurotic states are not “weak nerves” or “fatigued nerves.” Above all, there is no need to obscure the matter and resort to the much abused, mystical and mystifying factor of heredity. It is easy to shift all blame on former generations, when, in most cases, the fault is close at hand, namely, a debased environment, a defective training, and a vicious education.

There is good reason to believe that primitive man had a far greater tendency to dissociation, to subconscious psychopathic states than modern man. Even the Middle Ages teem with psychopathic mental epidemics of the most puerile type. In the course of evolution, social and individual, this neurotic, psychopathic tendency has gradually diminished, but has never been completely eliminated. Increase of knowledge, better education, the increase[273] of social safeguards, sanitary and hygienic conditions with consequent increase of safety from dangers, have all helped materially in decreasing the occasions for the cultivation of the fear instinct.

Under the rigorous conditions of primitive life individuals who have been unfortunate and have become affected with mental troubles and emotional afflictions of the fear instinct are mercilessly exterminated by the process of tribal and social selection. Each generation weeds out the individuals who have been unfortunate enough to fall under unfavorable circumstances and have become mentally sick, suffering from acquired psychopathic disturbances. In primitive life the crippled, the maimed, the wounded, the sick fall by the way, and are left to perish a miserable death. In fact, the less fortunate, the wounded and the stricken in the battle of life, are attacked by their own companions,—they are destroyed by the ruthless, social brute. The gregarious brute has no sympathy with the pains and sufferings of the injured and the wounded. The faint and the ailing are destroyed by the herd.

Civilization, on the other hand, tends more and more towards the preservation of psychopathic individuals. We no longer kill our sick and our weak, nor do we abandon them to a miserable, painful death,—we take care of them, and cure them. Moreover,[274] we prevent pathogenic factors from exercising a harmful, malign social selection of the “fit.” We do our best to free ourselves from the blind, merciless, purposeless selection, produced by pathogenic micro-organisms and by other noxious agencies. We learn to improve the external environment.

We do not condemn people to death because they are infected with smallpox, typhus, typhoid bacilli, or because of an infected appendix. We no longer regard them as sinful, unclean, accursed, and tabooed. We vaccinate, inoculate, operate, and attempt to cure them. By sanitary and prophylactic measures we attempt to prevent the very occurrence of epidemics. Our valuation of individuals is along lines widely different from those of the stone age and cave man. We value a Pascal, a Galileo, a Newton, a Darwin, a Pasteur, and a Helmholtz far above a Milo of Croton or an African Johnson.

Civilization is in need of refined, delicate and sensitive organizations, just as it is in need of galvanometers, chronometers, telephones, wireless apparatuses, and various chemical reagents of a highly delicate character. We are beginning to appreciate delicate mechanisms and sensitive organizations. We shall also learn to train and guard our sensitive natures until they are strong and resistant to the incident forces of an unfavorable[275] environment. The recognition, the diagnosis, and the preservation of psychopathic individuals account for the apparent increase of neurotics in civilized communities.

It may be well to add that, although occasions for sudden, intense, overwhelming fears are not so prevalent in civilized societies as they are in primitive savage communities, the worries, the anxieties, the various forms of slow grinding fears of a vague, marginal, subconscious character present in commercial and industrial nations, are even more effective in the production of psychopathic states than are the isolated occasions of intense frights in the primitive man of the paleolithic or neolithic periods.