Psychasthenia is characterized by obsessions, morbid fears and doubts.
We have already studied imperative ideas and learned that they constitute a form of mental automatism.
We have also studied the principal characteristics of anxiety. Its relations to imperative ideas have been much discussed. Westphal, who was one of the first to make a thorough study of obsessions, is of the opinion that the anxiety is always secondary to the imperative idea. This opinion is certainly too absolute, for anxiety may precede the imperative idea and even appear independently of it.
1 Arnaud. Su lar theorie de Vobsession. Arch, de neurol., 1902, No. 76. - Roubinowitch. Etude cliniqiie des obsessions et des impulsions morbides. Ann. med. psych., Sept.-Oct., 1899. - P. Janet. Les obsessions et Vanasthenie, 1902, Paris, F. Alcan.
Ribot, Freud, Pitres, and Regis have insisted upon those cases of diffuse anxiety, or panophobia, in which the emotion exists independently of any fixed idea.1
This question seems to be analogous to that which we have considered in connection with allopsychic disorientation and hallucinations. We are inclined in this case to view with favor a similar solution, namely, that imperative ideas and anxiety are two manifestations of the same fundamental psychic disorder.
Intact consciousness and judgment are, as we have just pointed out, the rule in obsessions; the patient is therefore able to realize the pathological nature of the phenomenon. There are, however, some exceptions to this. The subject has sometimes, when his anxiety reaches its height, a sense of reduplication or of transformation of the personality. One such patient of Seglas' entered a shop "to speak to the clerks, to ask for something and thus to find new proof that she was her real self."
Obsessions are occasionally accompanied by hallucinations, chiefly motor hallucinations, which in a manner exteriorize the imperative idea.
Obsessions are of various forms. First of all, three great classes are to be distinguished, depending upon the influence which the imperative idea exercises upon the patient: (1) intellectual obsessions, which are unaccompanied by any voluntary activity; (2) impulsive obsessions, in which the idea tends to be transformed into an act; (3) inhibiting obsessions, the action of which tends to paralyze certain voluntary acts.
The consciousness of the patient is occupied either by some concrete idea - a word, an object, an image of some person or of some scene - or by some abstract idea, often of a metaphysical nature. To the latter category belong the obsessions in which the subject has a feeling that he does not exist, that the external world is formed of nothing but phantoms, etc. The imperative idea is then said to have a negative form. In other instances, without going as far as complete negation, it is expressed by doubt, thus constituting a transitional form between intellectual and inhibiting obsessions.
1 Freud. Obsessions et phobies. Rev. neurol., 1895. - Manaud.
La nevrose d'angoisse. Troubles nerveux d'origine sexuelle. These de Lyon, 1900. - P. Londe. De I'angoisse. Rev. de med., 1902, A.ug.-Oct.