Part 30

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