The patient complains of lack of confidence. This is a
pathognomonic symptom of psychopathic states. At the same time
there is confidence in the symptom complex which is often described
by him with microscopic minuteness. The patient has no doubt about
that. He is in search of some one who can overcome this symptom
complex in a way which he specially approves. The patient matches
his morbid self-will against the physician’s control. The physician
is not to be subdued by the authority of the diseased personality,
he should not let himself be controlled by the ruling symptoms of
the patient’s life. Either the physician meets with _opposition_,
and after some time, must give up the treatment of the case, or
he is victimized by the patient’s demands, and must comply with
them. In the latter case the patient may stick to the physician
for some time. In both cases the patient is not really cured. It
is only when the _diseased self_ becomes subdued and falls under
the physician’s control, it is only then that a cure is really
possible, it is only then that the normal healthy self may come to
the foreground.
The first and foremost characteristic of psychopathic states is the
narrowing down of the patient’s life interests. He begins to lose
interest in abstract problems, then in that of his own profession
or occupation, then he loses interest in the welfare of his party
or his country, and finally, in his family, wife, and children.
Even in the case of love, the psychopathic patient seeks to utilize
the person he loves for his own, neurotic benefit, namely, his
neurotic comfort and health. He loves the person as a glutton
likes his meal, or as a drunkard his liquor. The self becomes
narrowed down to health, the key to his supposed spiritual life.
Self-preservation and fear permeate the patient’s life.
We notice that the patient’s life activity, especially his
mental functions, becomes narrowed down. His attention becomes
circumscribed to a few subjects and objects. This is the limitation
of the _extent_ of attention. There is afterward a limitation
of the _temporal span_ of attention. The patient cannot keep
his attention on any subject for any length of time. This span
of attention becomes more and more limited with the growth and
severity of the psychopathic malady. If the patient is educated and
has had an interest in various subjects, the latter become more and
more limited in scope. Finally the patient becomes reduced to the
least amount of effort of the attention, and that only for a brief
period of time. When the trouble reaches its climax, the patient
loses all interest and capacity of reading and of studying. He
cannot think, he becomes less and less original in his thoughts,
he becomes even incapable of thinking. The patient’s whole mind
becomes limited to himself and to the symptoms of his disease.
Public-domain text, read in full here on John Shaqi.
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