It is easy to understand how, during the active phase, one symptom leads to another, this being nothing more than the result of the progression of unstable control towards permanent insufficiency. There is, in addition, an added phenomenon, one which differenti ates the first phase from the second, which is that patients become more and more aware of their mental state; the feeling, which is often hard to define, causes patients to exhibit very characteristic signs of fear and anxiety. This phenomenon is also a symptom which, while tolerable during the first phase, becomes unbearably frightening in the second.
This explains how even insignificant facts or events take on enormous importance, and often result in a crisis of severe depression or despair - patients lose sight of their real, objective point of view, and are only concerned with their insufficiency of control.
When considered from this angle, all the symptoms exhibited by psychasthenics can be explained and easily understood. These are no imaginary symptoms: they are quite "real" and are the result of an abnormal functioning of the brain.
We can therefore say that all symptoms which occur during the active phase of psychasthenia are partly the result of unstable control, and partly the result of how the patient feels about his/her instability.
Now let's take a look at what aggravates symptoms during the latent phase.
Take patients in the dream state, who live in a kind of semi-consciousness. There's nothing harmful about this in itself, since everyone drifts off into a daydream from time to time - it's the brain's way of relaxing. But in normal persons the state is voluntary - they can choose whether to dream or not to dream. At the beginning of the latent phase, this is also true of psychasthenics, but little by little, because of mental laziness, they get into the habit, they seek out the dream state, and are soon unable to get out of it, reluctant even to try since the effort becomes so difficult. They start living more and more inside themselves, distancing themselves from the outside world; and this results in a kind of unhealthy, self-centered egoism, which affects their entire behavior, and makes them such a burden on other people. They lose all contact with the people and things around them, they cannot see farther than the thick veil which clouds their minds; they have no sense of "self," and often end up hating themselves, without being able to escape from their own mental prison.
We have said that they will suffer as they attempt to break out of this negative state, and their suffering is very real; the return to normalcy can only be achieved after a kind of painful rupture has taken place, and patients are fearful of the process. On the other hand, they are also aware that this dream state cannot go on indefinitely, and that it leads inevitably to despair, depression and anxiety; they are torn between the two alternatives, lacking willpower, lacking strength, lacking courage.
The inability to concentrate their thoughts, which we have called mental wandering, does not represent a major inconvenience at the outset of the disorder, except as far as work is concerned. But as the state persists and eventually becomes permanent, things soon change. The incessant effort of trying to concentrate tires patients out; the multitude of thoughts going round and round in their head obsesses them day and night, and results in terrible anxiety.
They no longer feel in control, they are like a boat being tossed around in a storm without a rudder. Because they are so numerous, and also because of fatigue, thoughts lose any value and clarity; confusion sets in, and is soon followed by panic.
The mental excitation which we found in the first phase also become proportionally worse, and produces fits of anger or bouts of despair, with no apparent cause. These are usually followed by periods of sadness, hopelessness and depression.
Being aware of this uncontrolled state produces a series of diverse sensations which we will now quickly review.
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