Origin and Nature of Emotions Part 2

In an experimental research, we found evidence that the physiologic phenomena of fear have a physical basis. This evidence is found in the morphologic alterations in the brain-cells, which are similar to those observed in certain stages of surgical shock and in fatigue from muscular exertion (Figs. 2, 4, 5, and 13). For the present, we shall a.s.sume that fear is a REPRESENTATION of trauma.

Because fear was created by trauma, fear causes a discharge of the energy of the nervous system by the law of phylogenetic a.s.sociation.

The almost universal fear of snakes, of blood, and of death and dead bodies may have such a phylogenetic origin.

It was previously stated that under the stimulus of fear animals show preternatural strength. An a.n.a.lysis of the phenomena of fear shows that, as far as can be determined, all the functions of the body requiring the expenditure of energy, and which are of no direct a.s.sistance in the effort toward self-preservation, are suspended.

In the voluntary expenditure of muscular energy, as in the chase, the suspension of other functions is by no means so complete.

Fear and trauma may drain to the last dreg the dischargeable nervous energy, and, therefore, the greatest possible exhaustion may be produced by fear and trauma.

Summation

In the discharge of energy, summation plays an important role.

Summation is attained by the repet.i.tion of stimuli at such a rate that each succeeding stimulus is applied before the nerve-cells have returned to the resting stage from the preceding stimulus.

If drops of water fall upon the skin from a sufficient height to cause the slightest unpleasant sensation, and at such a rate that before the effect of the stimulus of one drop has pa.s.sed another drop falls in precisely the same spot, there will be felt a gradually increasing painful sensation which finally becomes unbearable.

This is summation of stimuli. When, for a long time, a patient requires frequent painful wound dressings, there is a gradual increase in the acuteness of the pain of the receptors.

This is caused by summation. In a larger sense, the entire behavior of the individual gives considerable evidence of summation, _e.

g_., in the training of athletes, the rhythmic discharge of muscular energy at such intervals that the resting stage is not reached before a new exercise is given results in a gradual ascent in efficiency until the maximum is reached. This is summation, and summation plays a large role in the development of both normal and pathologic phenomena.

We have now pointed out the manner in which at least a part of the nervous energy of man may be discharged.

The integrative action of the nervous system and the discharge of nervous energy by phylogenetic a.s.sociation may be ill.u.s.trated by their a.n.a.logy to the action of an electric automobile.

The electric automobile is composed of four princ.i.p.al parts: The motor and the wheels (the muscular system and the skeleton); the cells of the battery containing stored electricity (brain-cells, nervous energy); the controller, which is connected with the cells by wiring (the receptors and the nerve-fibers); and an accelerator for increasing the electric discharge (thyroid gland?). The machine is so constructed that it acts as a whole for the accomplishment of a single purpose.

When the controller is adjusted for going ahead (adequate stimulus of a receptor), then the conducting paths (the final common path) for the accomplishment of that purpose are all open to the flow of the current from the battery, and the vehicle is integrated to go ahead.

It spends its energy to that end and is closed to all other impulses.

When the controller is set for reverse, by this adequate stimulus the machine is integrated to back, and the battery is closed to all other impulses. Whether integrated for going forward or backward, if the battery be discharged at a proper rate until exhausted, the cells, though possessing no more power (fatigue), have sustained no further impairment of their elements than that of normal wear and tear. Furthermore, they may be restored to normal activity by recharging (rest). If the vehicle be placed against a stone wall, and the controller be placed at high-speed (trauma and fear), and if the accelerator be used as well (thyroid secretion?), though the machine will not move, not only will the battery soon be exhausted, but the battery elements themselves will be seriously damaged (exhaustion--surgical shock).

We have now presented some evidence that nervous energy is discharged by the adequate stimulation of one or more of the various receptors that have been developed in the course of evolution.

In response to an adequate stimulus, the nervous system is integrated for a specific purpose by the stimulated receptor, and but one stimulus at a time has possession of the final common path-- the nerve mechanisms for action. The most numerous receptors are those for harmful contact; these are the nociceptors.

The effect of the adequate stimulus of a nociceptor is like that of pressing an electric b.u.t.ton that sets great machinery in motion.

With this conception, the human body may be likened to a musical instrument--an organ--the keyboard of which is composed of the various receptors, upon which environment plays the many tunes of life; and written within ourselves in symbolic language is the history of our evolution. The skin may be the "Rosetta Stone"

which furnishes the key.

Anoci-a.s.sociation

By the law of phylogenetic a.s.sociation, we are now prepared to make a practical application of the principles of the discharge of nervous energy. In the case of a surgical operation, if fear be excluded and if the nerve-paths between the field of operation and the brain be blocked with cocain,[*] no discharge of energy will be caused by the operation; hence no shock, no exhaustion, can result.

Under such conditions the nervous system is protected against noci-a.s.sociation, resulting from noci-perception or from an adequate stimulation of nociceptors. The state of the patient in whom all noci-a.s.sociations are excluded can be described only by coining a new word. That word is "anoci-a.s.sociation" (Fig. 14).

[*] See footnote, page 4.@@@

The difference between anesthesia and anoci-a.s.sociation is that, although _inhalation anesthesia_ confers the beneficent loss of consciousness and freedom from pain, it does not prevent the nerve impulses from reaching and influencing the brain, and therefore does not prevent surgical shock nor the train of later nervous impairments so well described by Mumford. _Anoci-a.s.sociation_ excludes fear, pain, shock, and postoperative neuroses. _Anoci-a.s.sociation_ is accomplished by combining the special management of patients (applied psychology), morphin, inhalation anesthesia, and local anesthesia.

We have now presented in summary much of the ma.s.s of experimental and clinical evidence we have acc.u.mulated in support of our princ.i.p.al theme, which is that the discharge of nervous energy is accomplished in accordance with the law of phylogenetic a.s.sociation.

If this point seems to have been emphasized unduly, it is because we expect to rear upon this foundation a clinical structure.

How does this hypothesis apply to surgical operations?

Prevention of Shock by the Application of the Principle of Anoci-a.s.sociation

Upon this hypothesis a new principle in operative surgery is founded, _i.

e_., operation during the state of _anoci-a.s.sociation_. a.s.suming that no unfavorable effect is produced by the anesthetic and that there is no hemorrhage, the cells of the brain cannot be exhausted in the course of a surgical operation except by fear or by trauma, or by both.

Fear may be excluded by narcotics and special management until the patient is rendered unconscious by inhalation anesthesia.

Then if, in addition to inhalation anesthesia, the nerve-paths between the brain and the field of operation are blocked with cocain,[*] the patient will be placed in the beneficent state of _anoci-a.s.sociation_, and at the completion of the operation will be as free from shock as at the beginning. In so-called "fair risks"

such precautions may not be necessary, but in cases handicapped by infections, by anemia, by previous shock, and by Graves'

disease, etc., anoci-a.s.sociation may become vitally important.

[*] See footnote, page 4.@@@

Graves' Disease

By applying the principle of the discharge of nervous energy by phylogenetic a.s.sociation, and by making the additional hypothesis that in the discharge of nervous energy the thyroid gland is stimulated through the nervous system, we can explain many of the phenomena of Graves' disease and may possibly discover some of the factors which explain both its genesis and its cure.

In the wild state of animal life in which only the fittest survive in the struggle for existence, every point of advantage has its value. An animal engaged in battle or in a desperate effort to escape will be able to give a better account of itself if it have some means of accelerating the discharge of energy-- some influence like that of pouring oil upon the kindling fire.

There is evidence, though perhaps it is not conclusive, that such an influence is exerted by the thyroid gland.

In myxedema, a condition characterized by a lack of thyroid secretion, there is dulness of the reflexes and of the intellect, a lowered muscular power, and generally a sluggish discharge of energy.

In Graves' disease there is an excessive production of thyroid secretion.

In this disease the reflexes are increased, the discharge of energy is greatly facilitated, and metabolism is at a maximum.

The same phenomena occur also after the administration of thyroid extract in large doses to normal subjects. In the course of s.e.xual activities there is an increased action of the thyroid, which is indicated by an increase in its size and vascularity.

That in fear and in injury the thyroid, in cases of Graves'

disease, is probably stimulated to increased activity is indicated by the increased activity of the thyroid circulation, by an increase in the size of the gland, by the histologic appearance of activity in the nuclei of the cells, and by an increase of the toxic symptoms.

Finally, Asher has stated that electric stimulation of the nerve supply of the thyroid causes an increased secretion. The origin of many cases of Graves' disease is closely a.s.sociated with some of the causes of the discharge of nervous energy, depressive influences especially, such as nervous shocks, worry and nervous strain, disappointment in love, business reverses, illness and death of relatives and friends.

The a.s.sociation of thyroid activity with procreation is well known, hence the coincidence of a strain of overwork or of fear with the s.e.xual development of maturing girls is obviously favorable to the incidence of Graves' disease. The presence of a colloid goiter is a suitable soil for the development of Graves' disease, and I fully recognize also the evidence that infection or auto-intoxication may be contributing factors and must be a.s.signed their role.

I have never known a case of Graves' disease to be caused by success or happiness alone, or by hard physical labor unattended by psychic strain, or to be the result of energy voluntarily discharged.

Some cases seem to have had their origin in overdosage with thyroid extract in too vigorous an attempt to cure a colloid goiter.

One of the most striking characteristics of Graves' disease is the patient's loss of control and his increased susceptibility to stimuli, especially to trauma and to fear and to the administration of thyroid extract. It has been shown that the various causes of the discharge of nervous energy produce alterations in the nervous system and probably in the thyroid gland. This is especially true of the fear stimulus, and has been clearly demonstrated in the brains of rabbits which had been subjected to fear alone (Fig. 13). Of special interest was the effect of daily fright.

In this case the brain-cells showed a distinct change, although the animal had been subjected to no fear for twenty-four hours before it was killed (Fig. 13 C. Now, a great distinction between man and the lower animals is the greater control man has acquired over his actions.

This quality of control, having been phylogenetically most recently acquired, is the most vulnerable to various NOCUOUS influences.

The result of a constant noci-integration may be a wearing-out of the control cells of the brain. In a typical case of Graves'

disease a marked morphologic change in the brain-cells has been demonstrated (Fig. 15). As has been previously stated, the origin of many cases of Graves' disease is a.s.sociated with some noci-influence. If this influence causes stimulation of both the brain and the thyroid, its excessive action may cause impairment of the brain and also hyperplasia of the thyroid.

As self-control is impaired, fear obtains an ascendency and, _pari pa.s.su_, stimulates the thyroid still more actively (Fig. 16).

Finally, the fear of the disease itself becomes a noci-stimulus.

As the thyroid secretion causes an increase in the facility with which nervous energy is discharged, a pathologic reciprocal interaction is established between the brain and the thyroid.

The effect of the constantly recurring stimulus of the noci-influence is heightened by summation. This reciprocal goading may continue until either the brain or the thyroid is destroyed.

If the original noci-stimulus is withdrawn before the fear of the disease becomes too strong, and before too much injury to the brain and the thyroid has been inflicted, a spontaneous cure may result.

Recovery may be greatly facilitated by complete therapeutic rest.

A cure implies the return of the brain-cells to their normal state, with the reestablishment of the normal self-control and the restoration of the thyroid to its normal state, when the impulses of daily life will once more have possession of the final common path and the noci-influence will be dispossessed.

The discovery of the real cause of a given case of Graves' disease is frequently difficult because it may be of a painful personal nature.

Of extreme interest is the fact that, in the acute stage, the patient may be unable to refer to the exciting cause without exhibiting an exacerbation of the symptoms of the disease.

I presume no case should be regarded as cured until reference can be made to its cause without an abnormal reaction.

It has been established that in Graves' disease injury to any part of the body, even under inhalation anesthesia, causes an exacerbation of the disease. Fear alone may cause an acute exacerbation.

These acute exacerbations are frequently designated "hyperthyroidism"

and are the special hazard of operation.