There is also a tendency to obsessive ideas and doubts; that is, ideas
and doubts that persist in coming against the will of the patient, such
as the obscene word or phrase that continually obtrudes itself on a
chaste woman, or the doubt whether one has shut the door or properly
turned off the gas. Of course, everybody has such obsessions and doubts
occasionally, but to be psychasthenic about it is to have them
continually and to have them obtrude themselves into every action. In
extreme psychasthenia the difficulty of "making up the mind", of
deciding, becomes so great that a person may suffer agonies of internal
debate about crossing the street, putting on his clothes, eating his
meals, doing his work, about every detail of his coming, going, doing,
and thinking. A restless anxiety results, a fear of insanity, an
inefficiency, and an incapacity for sustained effort that results in the
name that is often applied,--"anxiety neurosis."

Third, there is a group of impulsions and habits. Citing a few absurd
impulsions: a person feels compelled to step over every crack, to touch
the posts along his journey, to take the stairs three steps at a time.
The habits range from the queer desire to bite one's nails to the quick
that is so common in children and which persists in the psychasthenic
adult, to the odd grimaces and facial contortions, blinking eyes and
cracking joints of the inveterate _ticquer_. Against some of these habit
spasms, comparable to severe stammering, all measures are in vain, for
there seems to be a queer pleasure in these acts against which the will
of the patient is powerless.

Especially do the first two described types of trouble follow
exhaustion, acute illness, sudden fright, and long painful ordeal. The
ground is prepared for these conditions, _e.g._ by the strain of long