A General Introduction to Psychoanalysis Part 15

I will give you two examples only of the a.n.a.lysis of compulsion symptoms, one, an old observation, which cannot be replaced by anything more complete, and one a recent study. I am limiting myself to such a small number because in an account of this nature it is necessary to be very explicit and to enter into every detail.

A lady about thirty years old suffered from the most severe compulsions.

I might indeed have helped her if caprice of fortune had not destroyed my work--perhaps I will yet have occasion to tell you about it. In the course of each day the patient often executed, among others, the following strange compulsive act. She ran from her room into an adjoining one, placed herself in a definite spot beside a table which stood in the middle of the room, rang for her maid, gave her a trivial errand to do, or dismissed her without more ado, and then ran back again. This was certainly not a severe symptom of disease, but it still deserved to arouse curiosity. Its explanation was found, absolutely without any a.s.sistance on the part of the physician, in the very simplest way, a way to which no one can take exception. I hardly know how I alone could have guessed the meaning of this compulsive act, or have found any suggestion toward its interpretation. As often as I had asked the patient: "Why do you do this? Of what use is it?" she had answered, "I don't know." But one day after I had succeeded in surmounting a grave ethical doubt of hers she suddenly saw the light and related the history of the compulsive act. More than ten years prior she had married a man far older than herself, who had proved impotent on the bridal night. Countless times during the night he had run from his room to hers to repeat the attempt, but each time without success. In the morning he said angrily: "It is enough to make one ashamed before the maid who does the beds," and took a bottle of red ink that happened to be in the room, and poured its contents on the sheet, but not on the place where such a stain would have been justifiable. At first I did not understand the connection between this reminiscence and the compulsive act in question, for the only agreement I could find between them was in the running from one room into another,--possibly also in the appearance of the maid. Then the patient led me to the table in the second room and let me discover a large spot on the cover. She explained also that she placed herself at the table in such a way that the maid could not miss seeing the stain. Now it was no longer possible to doubt the intimate relation of the scene after her bridal night and her present compulsive act, but there were still a number of things to be learned about it.

In the first place, it is obvious that the patient identifies herself with her husband, she is acting his part in her imitation of his running from one room into the other. We must then admit--if she holds to this role--that she replaces the bed and sheet by table and cover. This may seem arbitrary, but we have not studied dream symbolism in vain. In dreams also a table which must be interpreted as a bed, is frequently seen. "Bed and board" together represent married life, one may therefore easily be used to represent the other.

The evidence that the compulsive act carries meaning would thus be plain; it appears as a representation, a repet.i.tion of the original significant scene. However, we are not forced to stop at this semblance of a solution; when we examine more closely the relation between these two people, we shall probably be enlightened concerning something of wider importance, namely, the purpose of the compulsive act. The nucleus of this purpose is evidently the summoning of the maid; to her she wishes to show the stain and refute her husband's remark: "It is enough to shame one before the maid." He--whose part she is playing--therefore feels no shame before the maid, hence the stain must be in the right place. So we see that she has not merely repeated the scene, rather she has amplified it, corrected it and "turned it to the good." Thereby, however, she also corrects something else,--the thing which was so embarra.s.sing that night and necessitated the use of the red ink--impotence. The compulsive act then says: "No, it is not true, he did not have to be ashamed before the maid, he was not impotent." After the manner of a dream she represents the fulfillment of this wish in an overt action, she is ruled by the desire to help her husband over that unfortunate incident.

Everything else that I could tell you about this case supports this clue more specifically; all that we otherwise know about her tends to strengthen this interpretation of a compulsive act incomprehensible in itself. For years the woman has lived separated from her husband and is struggling with the intention to obtain a legal divorce. But she is by no means free from him; she forces herself to remain faithful to him, she retires from the world to avoid temptation; in her imagination she excuses and idealizes him. The deepest secret of her malady is that by means of it she shields her husband from malicious gossip, justifies her separation from him, and renders possible for him a comfortable separate life. Thus the a.n.a.lysis of a harmless compulsive act leads to the very heart of this case and at the same time reveals no inconsiderable portion of the secret of the compulsion neurosis in general. I shall be glad to have you dwell upon this instance, as it combines conditions that one can scarcely demand in other cases. The interpretation of the symptoms was discovered by the patient herself in one flash, without the suggestion or interference of the a.n.a.lyst. It came about by the reference to an experience, which did not, as is usually the case, belong to the half-forgotten period of childhood, but to the mature life of the patient, in whose memory it had remained un.o.bliterated. All the objections which critics ordinarily offer to our interpretation of symptoms fail in this case. Of course, we are not always so fortunate.

And one thing more! Have you not observed how this insignificant compulsive act initiated us into the intimate life of the invalid? A woman can scarcely relate anything more intimate than the story of her bridal night, and is it without further significance that we just happened to come on the intimacies of her s.e.xual life? It might of course be the result of the selection I have made in this instance. Let us not judge too quickly and turn our attention to the second instance, one of an entirely different kind, a sample of a frequently occurring variety, namely, the sleep ritual.

A nineteen-year old, well-developed, gifted girl, an only child, who was superior to her parents in education and intellectual activity, had been wild and mischievous in her childhood, but has become very nervous during the last years without any apparent outward cause. She is especially irritable with her mother, always discontented, depressed, has a tendency toward indecision and doubt, and is finally forced to confess that she can no longer walk alone on public squares or wide thoroughfares. We shall not consider at length her complicated condition, which requires at least two diagnoses--agoraphobia and compulsion neurosis. We will dwell only upon the fact that this girl has also developed a sleep ritual, under which she allows her parents to suffer much discomfort. In a certain sense, we may say that every normal person has a sleep ritual, in other words that he insists on certain conditions, the absence of which hinders him from falling asleep; he has created certain observances by which he bridges the transition from waking to sleeping and these he repeats every evening in the same manner. But everything that the healthy person demands in order to obtain sleep is easily understandable and, above all, when external conditions necessitate a change, he adapts himself easily and without loss of time. But the pathological ritual is rigid, it persists by virtue of the greatest sacrifices, it also masks itself with a reasonable justification and seems, in the light of superficial observation, to differ from the normal only by exaggerated pedantry. But under closer observation we notice that the mask is transparent, for the ritual covers intentions that go far beyond this reasonable justification, and other intentions as well that are in direct contradiction to this reasonable justification. Our patient cites as the motive of her nightly precautions that she must have quiet in order to sleep; therefore she excludes all sources of noise. To accomplish this, she does two things: the large clock in her room is stopped, all other clocks are removed; not even the wrist watch on her night-table is suffered to remain. Flowerpots and vases are placed on her desk so that they cannot fall down during the night, and in breaking disturb her sleep. She knows that these precautions are scarcely justifiable for the sake of quiet; the ticking of the small watch could not be heard even if it should remain on the night-table, and moreover we all know that the regular ticking of a clock is conducive to sleep rather than disturbing.

She does admit that there is not the least probability that flowerpots and vases left in place might of their own accord fall and break during the night. She drops the pretense of quiet for the other practice of this sleep ritual. She seems on the contrary to release a source of disturbing noises by the demand that the door between her own room and that of her parents remain half open, and she insures this condition by placing various objects in front of the open door. The most important observances concern the bed itself. The large pillow at the head of the bed may not touch the wooden back of the bed. The small pillow for her head must lie on the large pillow to form a rhomb; she then places her head exactly upon the diagonal of the rhomb. Before covering herself, the featherbed must be shaken so that its foot end becomes quite flat, but she never omits to press this down and redistribute the thickness.

Allow me to pa.s.s over the other trivial incidents of this ritual; they would teach us nothing new and cause too great digression from our purpose. Do not overlook, however, the fact that all this does not run its course quite smoothly. Everything is pervaded by the anxiety that things have not been done properly; they must be examined, repeated. Her doubts seize first on one, then on another precaution, and the result is that one or two hours elapse during which the girl cannot and the intimidated parents dare not sleep.

These torments were not so easily a.n.a.lyzed as the compulsive act of our former patient. In the working out of the interpretations I had to hint and suggest to the girl, and was met on her part either by positive denial or mocking doubt. This first reaction of denial, however, was followed by a time when she occupied herself of her own accord with the possibilities that had been suggested, noted the a.s.sociations they called out, produced reminiscences, and established connections, until through her own efforts she had reached and accepted all interpretations. In so far as she did this, she desisted as well from the performance of her compulsive rules, and even before the treatment had ended she had given up the entire ritual. You must also know that the nature of present-day a.n.a.lysis by no means enables us to follow out each individual symptom until its meaning becomes clear. Rather it is necessary to abandon a given theme again and again, yet with the certainty that we will be led back to it in some other connection. The interpretation of the symptoms in this case, which I am about to give you, is a synthesis of results, which, with the interruptions of other work, needed weeks and months for their compilation.

Our patient gradually learns to understand that she has banished clocks and watches from her room during the night because the clock is the symbol of the female genital. The clock, which we have learned to interpret as a symbol for other things also, receives this role of the genital organ through its relation to periodic occurrences at equal intervals. A woman may for instance be found to boast that her menstruation is as regular as clockwork. The special fear of our patient, however, was that the ticking of the clock would disturb her in her sleep. The ticking of the clock may be compared to the throbbing of the c.l.i.toris during s.e.xual excitement. Frequently she had actually been awakened by this painful sensation and now this fear of an erection of the c.l.i.toris caused her to remove all ticking clocks during the night. Flowerpots and vases are, as are all vessels, also female symbols. The precaution, therefore, that they should not fall and break at night, was not without meaning. We know the widespread custom of breaking a plate or dish when an engagement is celebrated. The fragment of which each guest possesses himself symbolizes his renunciation of his claim to the bride, a renunciation which we may a.s.sume as based on the monogamous marriage law. Furthermore, to this part of her ceremonial our patient adds a reminiscence and several a.s.sociations. As a child she had slipped once and fallen with a bowl of gla.s.s or clay, had cut her finger, and bled violently. As she grew up and learned the facts of s.e.xual intercourse, she developed the fear that she might not bleed during her bridal night and so not prove to be a virgin. Her precaution against the breaking of vases was a rejection of the entire virginity complex, including the bleeding connected with the first cohabitation.

She rejected both the fear to bleed and the contradictory fear not to bleed. Indeed her precautions had very little to do with a prevention of noise.

One day she guessed the central idea of her ceremonial, when she suddenly understood her rule not to let the pillow come in contact with the bed. The pillows always had seemed a woman to her, the erect back of the bed a man. By means of magic, we may say, she wished to keep apart man and wife; it was her parents she wished to separate, so to prevent their marital intercourse. She had sought to attain the same end by more direct methods in earlier years, before the inst.i.tution of her ceremonial. She had simulated fear or exploited a genuine timidity in order to keep open the door between the parents' bedroom and the nursery. This demand had been retained in her present ceremonial. Thus she had gained the opportunity of overhearing her parents, a proceeding which at one time subjected her to months of sleeplessness. Not content with this disturbance to her parents, she was at that time occasionally able to gain her point and sleep between father and mother in their very bed. Then "pillow" and "wooden wall" could really not come in contact. Finally when she became so big that her presence between the parents could not longer be borne comfortably, she consciously simulated fear and actually succeeded in changing places with her mother and taking her place at her father's side. This situation was undoubtedly the starting point for the phantasies, whose after-effects made themselves felt in her ritual.

If a pillow represented a woman, then the shaking of the featherbed till all the feathers were lumped at one end, rounding it into a prominence, must have its meaning also. It meant the impregnation of the wife; the ceremonial, however, never failed to provide for the annulment, of this pregnancy by the flattening down of the feathers. Indeed, for years our patient had feared that the intercourse between her parents might result in another child which would be her rival. Now, where the large pillow represents a woman, the mother, then the small pillow could be nothing but the daughter. Why did this pillow have to be placed so as to form a rhomb; and why did the girl's head have to rest exactly upon the diagonal? It was easy to remind the patient that the rhomb on all walls is the rune used to represent the open female genital. She herself then played the part of the man, the father, and her head took the place of the male organ. (Cf. the symbol of beheading to represent castration.)

Wild ideas, you will say, to run riot in the head of a virgin girl. I admit it, but do not forget that I have not created these ideas but merely interpreted them. A sleep ritual of this kind is itself very strange, and you cannot deny the correspondence between the ritual and the phantasies that yielded us the interpretation. For my part I am most anxious that you observe in this connection that no single phantasy was projected in the ceremonial, but a number of them had to be integrated,--they must have their nodal points somewhere in s.p.a.ce.

Observe also that the observance of the ritual reproduce the s.e.xual desire now positively, now negatively, and serve in part as their rejection, again as their representation.

It would be possible to make a better a.n.a.lysis of this ritual by relating it to other symptoms of the patient. But we cannot digress in that direction. Let the suggestion suffice that the girl is subject to an erotic attachment to her father, the beginning of which goes back to her earliest childhood. That perhaps is the reason for her unfriendly att.i.tude toward her mother. Also we cannot escape the fact that the a.n.a.lysis of this symptom again points to the s.e.xual life of the patient.

The more we penetrate to the meaning and purpose of neurotic symptoms, the less surprising will this seem to us.

By means of two selected ill.u.s.trations I have demonstrated to you that neurotic symptoms carry just as much meaning as do errors and the dream, and that they are intimately connected with the experience of the patient. Can I expect you to believe this vitally significant statement on the strength of two examples? No. But can you expect me to cite further ill.u.s.trations until you declare yourself convinced? That too is impossible, since considering the explicitness with which I treat each individual case, I would require a five-hour full semester course for the explanation of this one point in the theory of the neuroses. I must content myself then with having given you one proof for my a.s.sertion and refer you for the rest to the literature of the subject, above all to the cla.s.sical interpretation of symptoms in Breuer's first case (hysteria) as well as to the striking clarification of obscure symptoms in the so-called dementia praec.o.x by C. G. Jung, dating from the time when this scholar was still content to be a mere psychoa.n.a.lyst--and did not yet want to be a prophet; and to all the articles that have subsequently appeared in our periodicals. It is precisely investigations of this sort which are plentiful. Psychoa.n.a.lysts have felt themselves so much attracted by the a.n.a.lysis, interpretation and translation of neurotic symptoms, that by contrast they seem temporarily to have neglected other problems of neurosis.

Whoever among you takes the trouble to look into the matter will undoubtedly be deeply impressed by the wealth of evidential material.

But he will also encounter difficulties. We have learned that the meaning of a symptom is found in its relation to the experience of the patient. The more highly individualized the symptom is, the sooner we may hope to establish these relations. Therefore the task resolves itself specifically into the discovery for every nonsensical idea and useless action of a past situation wherein the idea had been justified and the action purposeful. A perfect example for this kind of symptom is the compulsive act of our patient who ran to the table and rang for the maid. But there are symptoms of a very different nature which are by no means rare. They must be called typical symptoms of the disease, for they are approximately alike in all cases, in which the individual differences disappear or shrivel to such an extent that it is difficult to connect them with the specific experiences of the patient and to relate them to the particular situations of his past. Let us again direct our attention to the compulsion neurosis. The sleep ritual of our second patient is already quite typical, but bears enough individual features to render possible what may be called an _historic_ interpretation. But all compulsive patients tend to repeat, to isolate their actions from others and to subject them to a rhythmic sequence.

Most of them wash too much. Agoraphobia (topophobia, fear of s.p.a.ces), a malady which is no longer grouped with the compulsion neurosis, but is now called anxiety hysteria, invariably shows the same pathological picture; it repeats with exhausting monotony the same feature, the patient's fear of closed s.p.a.ces, of large open squares, of long stretched streets and parkways, and their feeling of safety when acquaintances accompany them, when a carriage drives after them, etc. On this identical groundwork, however, the individual differences between the patients are superimposed--moods one might almost call them, which are sharply contrasted in the various cases. The one fears only narrow streets, the other only wide ones, the one can go out walking only when there are few people abroad, the other when there are many. Hysteria also, aside from its wealth of individual features, has a superfluity of common typical symptoms that appear to resist any facile historical methods of tracing them. But do not let us forget that it is by these typical symptoms that we get our bearings in reaching a diagnosis. When, in one case of hysteria we have finally traced back a typical symptom to an experience or a series of similar experiences, for instance followed back an hysterical vomiting to its origin in a succession of disgust impressions, another case of vomiting will confuse us by revealing an entirely different chain of experiences, seemingly just as effective. It seems almost as though hysterical patients must vomit for some reason as yet unknown, and that the historic factors, revealed by a.n.a.lysis, are chance pretexts, seized on as opportunity best offered to serve the purposes of a deeper need.

Thus we soon reach the discouraging conclusion that although we can satisfactorily explain the individual neurotic symptom by relating it to an experience, our science fails us when it comes to the typical symptoms that occur far more frequently. In addition, remember that I am not going into all the detailed difficulties which come up in the course of resolutely hunting down an historic interpretation of the symptom. I have no intention of doing this, for though I want to keep nothing from you, and so paint everything in its true colors, I still do not wish to confuse and discourage you at the very outset of our studies. It is true that we have only begun to understand the interpretation of symptoms, but we wish to hold fast to the results we have achieved, and struggle forward step by step toward the mastery of the still unintelligible data. I therefore try to cheer you with the thought that a fundamental between the two kinds of symptoms can scarcely be a.s.sumed. Since the individual symptoms are so obviously dependent upon the experience of the patient, there is a possibility that the typical symptoms revert to an experience that is in itself typical and common to all humanity.

Other regularly recurring features of neurosis, such as the repet.i.tion and doubt of the compulsion neurosis, may be universal reactions which are forced upon the patient by the very nature of the abnormal change.

In short, we have no reason to be prematurely discouraged; we shall see what our further results will yield.

We meet a very similar difficulty in the theory of dreams, which in our previous discussion of the dream I could not go into. The manifest content of dreams is most profuse and individually varied, and I have shown very explicitly what a.n.a.lysis may glean from this content. But side by side with these dreams there are others which may also be termed "typical" and which occur similarly in all people. These are dreams of identical content which offer the same difficulties for their interpretation as the typical symptom. They are the dreams of falling, flying, floating, swimming, of being hemmed in, of nakedness, and various other anxiety dreams that yield first one and then another interpretation for the different patients, without resulting in an explanation of their monotonous and typical recurrence. In the matter of these dreams also, we see a fundamental groundwork enriched by individual additions. Probably they as well can be fitted into the theory of dream life, built up on the basis of other dreams,--not however by straining the point, but by the gradual broadening of our views.

EIGHTEENTH LECTURE

GENERAL THEORY OF THE NEUROSES

_Traumatic Fixation--The Unconscious_

I said last time that we would not continue our work from the standpoint of our doubts, but on the basis of our results. We have not even touched upon two of the most interesting conclusions, derived equally from the same two sample a.n.a.lyses.

In the first place, both patients give us the impression of being _fixated_ upon some very definite part of their past; they are unable to free themselves therefrom, and have therefore come to be completely estranged both from the present and the future. They are now isolated in their ailment, just as in earlier days people withdrew into monasteries there to carry along the burden of their unhappy fates. In the case of the first patient, it is her marriage with her husband, really abandoned, that has determined her lot. By means of her symptoms she continues to deal with her husband; we have learned to understand those voices which plead his case, which excuse him, exalt him, lament his loss. Although she is young and might be coveted by other men, she has seized upon all manner of real and imaginary (magic) precautions to safeguard her virtue for him. She will not appear before strangers, she neglects her personal appearance; furthermore, she cannot bring herself to get up readily from any chair on which she has been seated. She refuses to give her signature, and finally, since she is motivated by her desire not to let anyone have anything of hers, she is unable to give presents.

In the case of the second patient, the young girl, it is an erotic attachment for her father that had established itself in the years prior to p.u.b.erty, which plays the same role in her life. She also has arrived at the conclusion that she may not marry so long as she is sick. We may suspect she became ill in order that she need not marry, and that she might stay with her father.

It is impossible to evade the question of how, in what manner, and driven by what motives, an individual may come by such a remarkable and unprofitable att.i.tude toward life. Granted of course that this bearing is a general characteristic of neurosis, and not a special peculiarity of these two cases, it is nevertheless a general trait in every neurosis of very great importance in practice. Breuer's first hysterical patient was fixated in the same manner upon the time when she nursed her very sick father. In spite of her recuperation she has, in certain respects, since that time, been done with life; although she remained healthy and able, she did not enter on the normal life of women. In every one of our patients we may see, by the use of a.n.a.lysis, that in his disease-symptoms and their results he has gone back again into a definite period of his past. In the majority of cases he even chooses a very early phase of his life, sometime a childhood phase, indeed, laughable as it may appear, a phase of his very suckling existence.

The closest a.n.a.logies to these conditions of our neurotics are furnished by the types of sickness which the war has just now made so frequent--the so-called traumatic neuroses. Even before the war there were such cases after railroad collisions and other frightful occurrences which endangered life. The traumatic neuroses are, fundamentally, not the same as the spontaneous neuroses which we have been a.n.a.lysing and treating; moreover, we have not yet succeeded in bringing them within our hypotheses, and I hope to be able to make clear to you wherein this limitation lies. Yet on one point we may emphasize the existence of a complete agreement between the two forms. The traumatic neuroses show clear indications that they are grounded in a fixation upon the moment of the traumatic disaster. In their dreams these patients regularly live over the traumatic situation; where there are attacks of an hysterical type, which permit of an a.n.a.lysis, we learn that the attack approximates a complete transposition into this situation. It is as if these patients had not yet gotten through with the traumatic situation, as if it were actually before them as a task which was not yet mastered. We take this view of the matter in all seriousness; it shows the way to an _economic_ view of psychic occurrences. For the expression "traumatic" has no other than an economic meaning, and the disturbance permanently attacks the management of available energy. The traumatic experience is one which, in a very short s.p.a.ce of time, is able to increase the strength of a given stimulus so enormously that its a.s.similation, or rather its elaboration, can no longer be effected by normal means.

This a.n.a.logy tempts us to cla.s.sify as traumatic those experiences as well upon which our neurotics appear to be fixated. Thus the possibility is held out to us of having found a simple determining factor for the neurosis. It would then be comparable to a traumatic disease, and would arise from the inability to meet an overpowering emotional experience.

As a matter of fact this reads like the first formula, by which Breuer and I, in 1893-1895, accounted theoretically for our new observations. A case such as that of our first patient, the young woman separated from her husband, is very well explained by this conception. She was not able to get over the unfeasibility of her marriage, and has not been able to extricate herself from this trauma. But our very next, that of the girl attached to her father, shows us that the formula is not sufficiently comprehensive. On the one hand, such baby love of a little girl for her father is so usual, and so often outlived that the designation "traumatic" would carry no significance; on the other hand, the history of the patient teaches us that this first erotic fixation apparently pa.s.sed by harmlessly at the time, and did not again appear until many years later in the symptoms of the compulsion neurosis. We see complications before us, the existence of a greater wealth of determining factors in the disease, but we also suspect that the traumatic viewpoint will not have to be given up as wrong; rather it will have to subordinate itself when it is fitted into a different context.

Here again we must leave the road we have been traveling. For the time being, it leads us no further and we have many other things to find out before we can go on again. But before we leave this subject let us note that the fixation on some particular phase of the past has bearings which extend far beyond the neurosis. Every neurosis contains such a fixation, but every fixation does not lead to a neurosis, nor fall into the same cla.s.s with neuroses, nor even set the conditions for the development of a neurosis. Mourning is a type of emotional fixation on a theory of the past, which also brings with it the most complete alienation from the present and the future. But mourning is sharply distinguished from neuroses that may be designated as pathological forms of mourning.

It also happens that men are brought to complete deadlock by a traumatic experience that has so completely shaken the foundations on which they have built their lives that they give up all interest in the present and future, and become completely absorbed in their retrospections; but these unhappy persons are not necessarily neurotic. We must not overestimate this one feature as a diagnostic for a neurosis, no matter how invariable and potent it may be.

Now let us turn to the second conclusion of our a.n.a.lysis, which however we will hardly need to limit subsequently. We have spoken of the senseless compulsive activities of our first patient, and what intimate memories she disclosed as belonging to them; later we also investigated the connection between experience and symptom and thus discovered the purpose hidden behind the compulsive activity. But we have entirely omitted one factor that deserves our whole attention. As long as the patient kept repeating the compulsive activity she did not know that it was in any way related with the experience in question. The connection between the two was hidden from her, she truthfully answered that she did not know what compelled her to do this. Once, suddenly, under the influence of the cure, she hit upon the connection and was able to tell it to us. But still she did not know of the end in the service of which she performed the compulsive activities, the purpose to correct a painful part of the past and to place the husband, still loved by her, upon a higher level. It took quite a long time and a great deal of trouble for her to grasp and admit to me that such a motive alone could have been the motive force of the compulsive activity.

The relation between the scene after the unhappy bridal night and the tender motive of the patient yield what we have called the meaning of the compulsive activity. But both the "whence" and the "why" remained hidden from her as long as she continued to carry out the compulsive act. Psychological processes had been going on within her for which the compulsive act found an expression. She could, in a normal frame of mind, observe their effect, but none of the psychological antecedents of her action had come to the knowledge of her consciousness. She had acted in just the same manner as a hypnotized person to whom Bernheim had given the injunction that five minutes after his awakening in the ward he was to open an umbrella, and he had carried out this order on awakening, but could give no motive for his so doing. We have exactly such facts in mind when we speak of the existence of _unconscious psychological processes_. Let anyone in the world account for these facts in a more correct scientific manner, and we will gladly withdraw completely our a.s.sumption of unconscious psychological processes. Until then, however, we shall continue to use this a.s.sumption, and when anyone wants to bring forward the objection that the unconscious can have no reality for science and is a mere makeshift, (_une facon de parler_), we must simply shrug our shoulders and reject his incomprehensible statement resignedly. A strange unreality which can call out such real and palpable effects as a compulsion symptom!

In our second patient we meet with fundamentally the same thing. She had created a decree which she must follow: the pillow must not touch the head of the bed; yet she does not know how it originated, what its meaning is, nor to what motive it owes the source of its power. It is immaterial whether she looks upon it with indifference or struggles against it, storms against it, determines to overcome it. She must nevertheless follow it and carry out its ordinance, though she asks herself, in vain, why. One must admit that these symptoms of compulsion neurosis offer the clearest evidence for a special sphere of psychological activity, cut off from the rest. What else could be back of these images and impulses, which appear from one knows not where, which have such great resistance to all the influences of an otherwise normal psychic life; which give the patient himself the impression that here are super-powerful guests from another world, immortals mixing in the affairs of mortals. Neurotic symptoms lead unmistakably to a conviction of the existence of an unconscious psychology, and for that very reason clinical psychiatry, which recognizes only a conscious psychology, has no explanation other than that they are present as indications of a particular kind of degeneration. To be sure, the compulsive images and impulses are not themselves unconscious--no more so than the carrying out of the compulsive-acts escapes conscious observation. They would not have been symptoms had they not penetrated through into consciousness. But their psychological antecedents as disclosed by the a.n.a.lysis, the a.s.sociations into which we place them by our interpretations, are unconscious, at least until we have made them known to the patient during the course of the a.n.a.lysis.

Consider now, in addition, that the facts established in our two cases are confirmed in all the symptoms of all neurotic diseases, that always and everywhere the meaning of the symptoms is unknown to the sufferer, that a.n.a.lysis shows without fail that these symptoms are derivatives of unconscious experiences which can, under various favorable conditions, become conscious. You will understand then that in psychoa.n.a.lysis we cannot do without this unconscious psyche, and are accustomed to deal with it as with something tangible. Perhaps you will also be able to understand how those who know the unconscious only as an idea, who have never a.n.a.lyzed, never interpreted dreams, or never translated neurotic symptoms into meaning and purpose, are most ill-suited to pa.s.s an opinion on this subject. Let us express our point of view once more. Our ability to give meaning to neurotic symptoms by means of a.n.a.lytic interpretation is an irrefutable indication of the existence of unconscious psychological processes--or, if you prefer, an irrefutable proof of the necessity for their a.s.sumption.

But that is not all. Thanks to a second discovery of Breuer's, for which he alone deserves credit and which appears to me to be even more far-reaching, we are able to learn still more concerning the relationship between the unconscious and the neurotic symptom. Not alone is the meaning of the symptoms invariably hidden in the unconscious; but the very existence of the symptom is conditioned by its relation to this unconscious. You will soon understand me. With Breuer I maintain the following: Every time we hit upon a symptom we may conclude that the patient cherishes definite unconscious experiences which withhold the meaning of the symptoms. Vice versa, in order that the symptoms may come into being, it is also essential that this meaning be unconscious.

Symptoms are not built up out of conscious experiences; as soon as the unconscious processes in question become conscious, the symptom disappears. You will at once recognize here the approach to our therapy, a way to make symptoms disappear. It was by these means that Breuer actually achieved the recovery of his patient, that is, freed her of her symptoms; he found a technique for bringing into her consciousness the unconscious experiences that carried the meaning of her symptoms, and the symptoms disappeared.

This discovery of Breuer's was not the result of a speculation, but of a felicitous observation made possible by the cooperation of the patient.

You should therefore not trouble yourself to find things you already know to which you can compare these occurrences, rather you should recognize herein a new fundamental fact which in itself is capable of much wider application. Toward this further end permit me to go over this ground again in a different way.

The symptom develops as a subst.i.tution for something else that has remained suppressed. Certain psychological experiences should normally have become so far elaborated that consciousness would have attained knowledge of them. This did not take place, however, but out of these interrupted and disturbed processes, imprisoned in the unconscious, the symptom arose. That is to say, something in the nature of an interchange had been effected; as often as therapeutic measures are successful in again reversing this transposition, psychoa.n.a.lytic therapy solves the problem of the neurotic symptom.

Accordingly, Breuer's discovery still remains the foundation of psychoa.n.a.lytic therapy. The a.s.sertion that the symptoms disappear when one has made their unconscious connections conscious, has been borne out by all subsequent research, although the most extraordinary and unexpected complications have been met with in its practical execution.

Our therapy does its work by means of changing the unconscious into the conscious, and is effective only in so far as it has the opportunity of bringing about this transformation.

Now we shall make a hasty digression so that you do not by any chance imagine that this therapeutic work is too easy. From all we have learned so far, the neurosis would appear as the result of a sort of ignorance, the incognizance of psychological processes that we should know of. We would thus very closely approximate the well-known Socratic teachings, according to which evil itself is the result of ignorance. Now the experienced physician will, as a rule, discover fairly readily what psychic impulses in his several patients have remained unconscious.

Accordingly it would seem easy for him to cure the patient by imparting this knowledge to him and freeing him of his ignorance. At least the part played by the unconscious meaning of the symptoms could easily be discovered in this manner, and it would only be in dealing with the relationship of the symptoms to the experiences of the patient that the physician would be handicapped. In the face of these experiences, of course, he is the ignorant one of the two, for he did not go through these experiences, and must wait until the patient remembers them and tells them to him. But in many cases this difficulty could be readily overcome. One can question the relatives of the patient concerning these experiences, and they will often be in a position to point out those that carry any traumatic significance; they may even be able to inform the a.n.a.lyst of experiences of which the patient knows nothing because they occurred in the very early years of his life. By a combination of such means it would seem that the pathogenic ignorance of the patient could be cleared up in a short time and without much trouble.

If only that were all! We have made discoveries for which we were at first unprepared. Knowing and knowing is not always the same thing; there are various kinds of knowing that are psychologically by no means comparable. "_Il y a f.a.gots et f.a.gots_,"[39] as Moliere says. The knowledge of the physician is not the same as that of the patient and cannot bring about the same results. The physician can gain no results by transferring his knowledge to the patient in so many words. This is perhaps putting it incorrectly, for though the transference does not result in dissolving the symptoms, it does set the a.n.a.lysis in motion, and calls out an energetic denial, the first sign usually that this has taken place. The patient has learned something that he did not know up to that time, the meaning of his symptoms, and yet he knows it as little as before. So we discover there is more than one kind of ignorance. It will require a deepening of our psychological insight to make clear to us wherein the difference lies. But our a.s.sertion nevertheless remains true that the symptoms disappear with the knowledge of their meaning.

For there is only one limiting condition; the knowledge must be founded on an inner change in the patient which can be attained only through psychic labors directed toward a definite end. We have here been confronted by problems which will soon lead us to the elaboration of a dynamics of symptom formation.

I must stop to ask you whether this is not all too vague and too complicated? Do I not confuse you by so often retracting my words and restricting them, spinning out trains of thought and then rejecting them? I should be sorry if this were the case. However, I strongly dislike simplification at the expense of truth, and am not averse to having you receive the full impression of how many-sided and complicated the subject is. I also think that there is no harm done if I say more on every point than you can at the moment make use of. I know that every hearer and reader arranges what is offered him in his own thoughts, shortens it, simplifies it and extracts what he wishes to retain. Within a given measure it is true that the more we begin with the more we have left. Let me hope that, despite all the by-play, you have clearly grasped the essential parts of my remarks, those about the meaning of symptoms, about the unconscious, and the relation between the two. You probably have also understood that our further efforts are to take two directions: first, the clinical problem--to discover how persons become sick, how they later on accomplish a neurotic adaptation toward life; secondly, a problem of psychic dynamics, the evolution of the neurotic symptoms themselves from the prerequisites of the neuroses. We will undoubtedly somewhere come on a point of contact for these two problems.