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Updated: June 5, 2025
Yet it is always wise to keep a psychasthenic interpretation in view as long as the insanity is not evident. I may mention such an extreme case. The patient, a man of middle age, highly educated, for years had heard voices calling his name.
Concerning the mental state characteristic of the ticquer it is generally agreed that there is a polymorphic psychic defect or disorder which shows itself particularly in a precocious or hyperemotional condition, in a lack of will power and of inhibitory control, leading to a state and feeling of doubt, indecision, incapacity, insufficiency and unreality, of inferiority and self-depreciation, with a tendency towards morbid self-absorption, egocentricity, self-observation, auto-and hetero-suggestion, with the consequent development in many instances of so-called neurasthenic, psychasthenic, hysteric and various psychotic reactions.
Psychotherapeutic influence may remove the phobia of a psychasthenic or the obsession of a neurasthenic or the emotion of a hysteric, and thus may bring not only momentary relief but a change which may be favorable for general improvement, but certainly the neurasthenia and psychasthenia and hysteria are not really removed by it.
The patient cannot choose as to his dress or his meals; cannot decide whether to stay in or go out, finds it difficult to choose to cross the street or to open a door; is thrown into a pendulum of yea and nay about speaking, etc. This psychasthenic state, the folie du doute of the French, is accompanied by fear, restlessness and an oppressive feeling of unreality.
At first but little more than purposive habit movements, they finally became irrepressible acts which sought for expression, which were but little under the control of the will, which occurred in attacks varying in frequency, duration and severity, which decreased under distraction and generally ceased during sleep, which were increased in frequency and duration and severity by fatigue, emotional upset, mental unrest, conflict and strain, while the lack of inhibition and will power, the lack of self-control was the dominant mental state, leading to feelings of insufficiency, doubt, indecision and incapacity, and making the ground work for the psychasthenic reactions in the form of morbid impulses and obsessions, and for the hysterical, so-called neurasthenic and other morbid psychic trends.
But the abnormal increase of suggestibility parallel to that of hypnotism for suggestions from without exists for suggestions from within, mainly in nervous diseases, especially in neurasthenic, hysteric, and psychasthenic states.
But it is entirely different with the mental states of the psychasthenic. The mere statement and objective proof that his obsession is based on an illusion would be ineffective. He knows that himself, but he may take the disturbance as the beginning of a brain disease, as a form of insanity, as a lasting damage which lies entirely beyond his control.
He was unwilling to believe that he had been in hypnosis at all. I told him that the effect would prove it and in his fully wakeful state I explained to him why there was not the slightest fear of insanity justified, that it was a psychasthenic state resulting from fatigue and shock and from a wrong attitude of his attention during the past months, and then I asked him to return the next day.
The psychologist will be more inclined to emphasize their relation to simple neurasthenia which itself imperceptibly shades over into our normal life. All neurasthenic and psychasthenic disabilities show a certain emotional continuity and uniformity. It is the emotional instability and the quick alternation of symptoms which characterize hysteria or rather the hysterias.
Of course, the abnormal impulse is psychophysically not different, whether it leads to a legally important result like the impulse to kill or leads to an indifferent result. The subjective suffering may be the same in both cases. The starting point of the impulse may be any chance experience. The psychasthenic may pick up such impulses from any model for imitation or from any haphazard report.
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