Popular Science Monthly/Volume 56/March 1900/The Morbid Sense of Injury
|THE MORBID "SENSE OF INJURY."|
By W. F. BECKER, M. D.
AS a fog about a ship removes it from exact relations to surroundings, so, from the standpoint of morbid psychology, we may fancy the mind peering through a more or less misty envelope to the true adjustment to things—the "glass" through which we see "darkly." Were all action and reaction of the mind to surroundings perfectly adapted, there could be such a thing as absolute sanity. So long, however, as evolution with continuous readaptation and the processes of dissolution with attempted adaptations continue, so long can there be but groping, imperfect relations to surroundings, so long must there be defective or morbid mental action, and sanity and insanity therefore but relative terms. Thus many symptoms of the insane appear to be but varying degrees of the morbid mental manifestations of health, and we may assume a priori that they have a common genesis and can be identified for study. If we take, for example, one of the commonest of these—viz., the idea of persecution among the insane—we may safely identify it with the "sense of injury" equally common among the sane.
By this "sense of injury" is meant that vague sense which afflicts many of us at times of being the object of hostile feelings on the part of others. No doubt we often are, for, in the stress of necessary rivalry and conflict upon which progress depends, we give and take injuries. But there remains a large excess of this "injured" feeling which can not be so explained, or which is disproportionate to its cause or entirely gratuitous, and is thus shifted into the field of morbid psychology. This only is here treated—the morbid sense of injury.
It seems to find an easy entrance to the mind from a mere feeling of being ill used or stinted in sympathy to the entertainment of serious grievances or persecutory ideas. In certain temperaments it is marked. On so-called "blue" days we are constantly moved to a "sense of injury" from fancied aloofness of our friends. Madam Lofty slights us, and our jaundiced imagination has it that she has heard something detrimental and dislikes us. But lo! to-day, when the liver is released, madam smiles sweetly, and never heard a thing.
So in suspicious people. They entertain a chronic state of mind, by which the acts of others are given an invidious construction. They anticipate ill will, carrying the chip on the shoulder. Of two constructions of a given situation, they leap to the more offending. Some take on the vindictive attitude as a result, approaching that type of insanity known as paranoia, of which Guiteau and Prendergast were conspicuous examples; others are humiliated, as a consequence approaching the melancholia type of insanity, each illustrating again how the sane and insane states are paralleled. Many come to bear the outward marks—the stigmata of this mental attitude, approaching sometimes the "asylum" face, like that of the insanely suspicious Rousseau. We all know such faces, with their hard, set expressions, as if forever sealed against any tender of good will.
By a curious fact, those who invite ill will seem often to get it. Society, based on a reciprocity of faith, seems to have no smiles to bestow upon the misanthrope. It bids him, "Laugh, and the world laughs with you." It so comes to pass that many of them acquire some real ground for their "sense of injury," and in the long run that real quarrels are precipitated from this atmosphere of suspiciousness. Indeed, this is the psychology of most quarrels. The effect of imaginary grievances comes in turn to be the cause of real ones. Thus into an incident between two persons, one of them mistakenly reads an affront to himself. He retaliates, and the other person, unconscious of having done anything to evoke any hostility, finds himself affronted, and in his turn retaliates. By this time real grievances have come, and the quarrel is on. Balzac, that master analyst, in alluding to friendship, in one of his stories, says: "It died" (the friendship) "like other great passions—by a misunderstanding. Both sides imagine treachery, pride prevents an understanding, and the rupture comes." Just as the malevolent feelings may arise de novo, so it is with the benevolent ones. Nordau shows how the nondescript state of being "in love" often arises. Some incident between John and Mary leads one of them—we will say John—to think mistakenly that Mary has been attracted to him. Pleased with the fact, he reciprocates. Mary, altogether unconscious of the reciprocal nature of John's attention, finds pleasure in it, and in her turn reciprocates. Mutual reciprocity then follows.
In irritable persons we find the morbid sense of injury coupled with resentment. Quickly interpreting anything disagreeable to them as an affront by another, their first impulse is to resent it, which they do more or less violently, according to circumstances, their second thought often recognizing the irrational nature of the outbreak. This suggests the feral instinct. Examples are common in the lower animals, while in pain attacking those about them as if they were the cause of it. No doubt this resentment is a survival from evolutionary ancestry. It has probably served a necessary purpose in the conservation of animal life by causing the animal to attack what may, in the jealousy of self-preservation and its feeble discrimination, even be suspected of being inimical to its welfare. Blind and unjust, perhaps, but Nature hesitates at no apparent injustice to accomplish this. When we go higher, to the tribal relation of man, we find the same blind resentment. The Australian aborigines have no conception of death, except as vaguely associated with homicidal causes, and when a member of a tribe dies a most natural death a member of a hostile tribe is killed to avenge the supposed murder. The Africans, too, read homicidal forces into natural deaths. In civilized social relations it appears again in the very popular and usually irrational demand for a scapegoat when matters go wrong. The idea of religious sacrifice, too, is a practice by which the anthropomorphic God is credited with being aggrieved by human conduct and of wishing to be appeased therefor. Though the exercise of this indiscriminate resentment was probably greater and more necessary in the pre-social stage of human evolution, there is still ground for its activity to-day in the struggle for existence which has but changed its arena. Under a veneer of amity, laudable enough, there are till the suspicion and resentment of the tribal relation, as we may often see unveiled in a posse of boys, and that this resentment is yet of the blind kind, we still have proof if we have seen an enlightened man deliberately kick a harmless chair because he stumbled on it in the dark.
Phylogenetically, then, we see this morbid "sense of injury" to be reversional. This is in harmony with the atavic theory of insanity. In the individual it is a delusion, and, like other delusions, an attempt by the reason to explain a disordered feeling; in this case a painful feeling, having its origin broadly in some imperfect adaptation of the organism. This attempt to explain a feeling or sensation seems a human necessity. However wide of the truth such explanations usually are, we seem forced to attempt them. In the case of this painful feeling, with which we are here concerned, we are either unwilling or unable to explain it in its true way, and are prone to attribute it to malevolent agencies, often personal—perhaps the "bogy-man" remnant of the child and race. Such explanation is often an easy escape from truths unwelcome to our ego—truths which, if recognized, would wound pride or conscience beyond easy endurance. It requires a man of rare courage and mental clarity to recognize his particular pain from failure in adaptation as autogenetic, and to lay it to natural and unflattering causes. We prefer, of the two, to accuse the environment rather than the organism, especially when the organism happens to be our own. We take refuge in a grievance rather than impugn the supremacy of our ego. Indeed, it seems to be necessary for healthy subjective activity, so to speak, that a sort of imperialism of the ego, however circumscribed, be maintained. It is the condition sine qua non of the necessary measure of well-being of the individual. It is most reluctantly relinquished, and we constantly see the plainest truths immolated that it be retained. Only in the great self-effacement of melancholia and in those rare characters who recognize and bear complacently naked truths—the Weltschmerz of Goethe—is this well-being renounced. Even those who are willing to father their own wounded ego still seek the necessary approbation by reducing its future pretensions or claims so that they may not be again pained by their failure to achieve them. They unhitch their wagon from the star. Professor James has illustrated this by a fraction showing that our approbation is determined by our success divided by our pretensions. Thus, success = approbation (self-esteem). The quotient may be increased by diminishing the pretensions or by increasing the success. James's fraction is as applicable to the moral conduct as to the intellectual side.
When we look for the physical equivalent of the mental state which evokes the "sense of injury" we find it in dynamic and toxic states of the nervous system and their correlation. Certain conditions of the individual or environment bring these into special relief. Old age is one. The querulousness, the sense of abuse or persecution which afflict the aged and often lead them to take refuge in the martyr-spirit, are sad examples. The state of fatigue or exhaustion is another, and "neurasthenic" insanity is only an expression in greater degree of the morbid mental action found in fatigue and exhausted states.
The primary and secondary effects of alcohol or other narcotic indulgence is another soil in which the "sense of injury" easily grows. The habitué is notoriously suspicious and irritable, and full of fictitious grievances and unwarranted persecutory ideas. His attitude toward them is that of the paranoiac, vindictive, rather than that of the melancholiac, humiliated. They swell the army of so-called "borderland" cases of insanity, fretting their friends and puzzling the doctor with conduct alternately interpreted as "cussed" or "crazy."
Where there is bodily disease, acute or chronic, the morbid "sense of injury" is much in play. An intelligent patient, on recovery from a stomach disorder, admitted that whenever her stomach had ached she was taken with a violent hatred of her companion with whom she was in affectionate relation. An ignorant Southern colored woman, who had rheumatism in her ankle, believed that she had been "hoodooed," and explained the pain in her ankle by the presence of a snake, which she believed had been put there by a "hoodoo." She was not insane, the idea being consistent with her degree of intelligence, training, and early environment. Another patient, a sensible, cultivated woman, while suffering from a non-nervous illness, in which she had received all the consideration that love and money could furnish, believed herself to have been constantly and deliberately abused. After her recovery, now some years, she still maintains the belief. Instances could be multiplied, for doctors continually meet this atmosphere in the sick-room, from ugly little grievances to delusions of persecution. They are not surprised when a patient tells them in mingled confidence and complaint that he is hungry and neglected, that "they" will give him nothing to eat, etc., to find that his wife has been most attentive, has been pressing him to eat, and has stocked the pantry in anticipation. Dr. Johnson had plenty of ground for saying that a sick man is a rascal, though the modern doctor has reversed the formula.
Persons who suffer from actual trouble or ill treatment easily develop a morbid sense of injury, just as under similar conditions they may become insane. Unable to estimate the precise amount of their real grievance, there is an easy mental overflow into the fictitious ones. It is for this reason that the narrative of a real trouble or quarrel is so fraught with calumnious arraignment of others that it is unreliable until we have heard the "other side of the story," and that when disputants meet and explanations follow they often find that they have no casus belli. In the examination of the alleged insane for commitment we have constantly to separate the real from the imaginary troubles. Mr. F—— was the subject of such examination. He was suffering from heart disease, and thereby compelled to remain at home idle. His wife was supporting the family by keeping boarders, and he began to develop a morbid jealousy of her. He annoyed her by a constant surveillance and suspicion of her every act, which amounted at times to the delusion that she was unfaithful to him, and which culminated one night in an outbreak in which the police figured. It was difficult to separate his real from his imaginary grievances, for his wife had ceased to have any affection for him, though his delusion in regard to her unfaithfulness was unfounded and had been grafted upon his real trouble. Sent to a general hospital, he improved, and was reported "not insane." Circumstances requiring a hard struggle for existence, disappointment without apparent cause, coupled with a certain sentimental cast of mind, often prevent the correct estimation of the wrongs suffered and the proper relation of undoubted misfortunes.
In the insane the sense of injury or its analogue—delusions of persecution—appears in numerous shapes. Thus patients are defrauded, or conspired against, or acted upon by witchcraft, magnetism, electricity, or poisoned, or preached against, or subjected to disagreeable odors. Sometimes the delusions are but ill-defined and vague. Often it is possible to trace them to their underlying disordered sense impression or the particular environment or to vestiges of outgrown beliefs. They appear in depressed states of melancholia as well as in the exalted states of mania and paranoia. In melancholia they accompany a feeling of worthlessness which is the patient's explanation of his persecution—i.e., he is unworthy of better treatment. In paranoia the patient believes the persecution to be prompted by fear or envy of him, and there is consequently a feeling of self-importance—a morbid egotism which is in direct proportion to the magnitude or complexity of the ideas of persecution. Indeed, it is probable that these ideas of persecution, acting on a potentially melancholic or a potentially paranoiac mind, whatever these may be, determine the type that these mental diseases take.
The difference between the "injured" sense in the sane and insane states we must from our view point, without essaying to bridge all the terra incognita which lies between sanity and insanity, regard as largely but one of degree. And so with the underlying mental and physical states. We find the morbid ideas more fixed in the sane than in the insane, frequent repetitions of the morbid impression tending to its final organization, so to speak. We also find that the morbid idea is usually more elaborated in the insane than in the sane state, although instances of the greatest elaboration are sometimes met with, especially where the element of some external foundation is large. It is probable, however, that the elements of fixity and elaboration of the persecutory idea are after all dependent upon and in proportion to the intensity of the underlying brain and mind states. In other words, that to increase a given intensity of these states is to increase the fixity and elaborateness of the "sense of injury," is to prevent the correction of the morbid idea, until finally exploited in conduct, which is the début of the insanity.
Thus the relativity of insanity which has all along been maintained is clear on the line here pursued. It would be equally so in following other lines of morbid psychology. It has, though, received but little general recognition, and writers still treat insanity as an entity apart from its bearings on the average mind and its evolutionary history. The word "insanity," or "lunatic," is no doubt largely responsible for this, suggesting popularly, as it does, a distinct class of persons—a type of being as unlike ourselves as a Martian might be fancied to be. Nature or science, however, has set no line between the morbid mental manifestations which constitute sanity and those which constitute insanity, that being an arbitrary, however practical, distinction which science has had rather to descend to meet. Nothing so stands in the way of the best welfare of the insane than this abysmal ignorance which still prevails in regard to them—an ignorance which still clings to the mediæval idea of insanity, the classical portraiture, as in the pictures of Hogarth, or on the stage, or in fiction; an ignorance which is ever hearkening for the maniac's shriek or the clanking of his fetters, which recognizes nothing short of "furious madness" as sufficient ground for committing a brain-sick man to the tender therapy of the hospital ward.
But those who know best tell us that the insane are very much like other people, that there is wonderfully little difference between them and ourselves; and sometimes but a slight circumstance, a mere accident of environment, determines which side of the hospital wall we shall be on.