A General Introduction to Psychoanalysis

On the other hand, you must not think for a moment that what I present to you as the psychoanalytic conception is a purely speculative system. Indeed, it is a sum total of experiences and observations, either their direct expression or their elaboration. Whether this elaboration is done adequately and whether the method is justifiable will be tested in the further progress of the science. After two and a half decades, now that I am fairly advanced in years, I may say that it was particularly difficult, intensive and all-absorbing work which yielded these observations. I have often had the impression that our opponents were unwilling to take into consideration this objective origin of our statements, as if they thought it were only a question of subjective ideas arising haphazard, ideas to which another may oppose his every passing whim. This antagonistic behavior is not entirely comprehensible to me. Perhaps the physician's habit of steering clear of his neurotic patients and listening so very casually to what they have to say allows him to lose sight of the possibility of deriving anything valuable from his patients' communications, and therefore, of making penetrating observations on them. I take this opportunity of promising you that I shall carry on little controversy in the course of my lectures, least of all with individual controversialists. I have never been able to convince myself of the truth of the saying that controversy is the father of all things. I believe that it comes down to us from the Greek sophist philosophy and errs as does the latter through the overvaluation of dialectics. To me, on the contrary, it seems as if the so-called scientific criticism were on the whole unfruitful, quite apart from the fact that it is almost always carried on in a most personal spirit. For my part, up to a few years ago, I could even boast that I had entered into a regular scientific dispute with only one scholar (Lowenfeld, of Munich). The end of this was that we became friends and have remained friends to this day. But I did not repeat this attempt for a long time, because I was not certain that the outcome would be the same.

Now you will surely judge that so to reject the discussion of literature must evidence stubborness, a very special obtuseness against objections, or, as the kindly colloquialisms of science have it, "a complete personal bias." In answer, I would say that should you attain to a conviction by such hard labor, you would thereby derive a certain right to sustain it with some tenacity. Furthermore, I should like to emphasize the fact that I have modified my views on certain important points in the course of my researches, changed them and replaced them by new ones, and that I naturally made a public statement of that fact each time. What has been the result of this frankness? Some paid no attention at all to my self-corrections and even to-day criticize me for assertions which have long since ceased to have the same meaning for me. Others reproach me for just this deviation, and on account of it declare me unreliable. For is anyone who has changed his opinions several times still trustworthy; is not his latest assertion, as well, open to error? At the same time he who holds unswervingly to what he has once said, or cannot be made to give it up quickly enough, is called stubborn and biased. In the face of these contradictory criticisms, what else can one do but be himself and act according to his own dictates? That is what I have decided to do, and I will not allow myself to be restrained from modifying and adapting my theories as the progress of my experience demands. In the basic ideas I have hitherto found nothing to change, and I hope that such will continue to be the case.

Now I shall present to you the psychoanalytic conception of neurotic manifestations. The natural thing for me to do is to connect them to the phenomena we have previously treated, for the sake of their analogy as well as their contrast. I will select as symptomatic an act of frequent occurrence in my office hour. Of course, the analyst cannot do much for those who seek him in his medical capacity, and lay the woes of a lifetime before him in fifteen minutes. His deeper knowledge makes it difficult for him to deliver a snap decision as do other physicians – "There is nothing wrong with you" – and to give the advice, "Go to a watering-place for a while." One of our colleagues, in answer to the question as to what he did with his office patients, said, shrugging his shoulders, that he simply "fines them so many kronen for their mischief-making." So it will not surprise you to hear that even in the case of very busy analysts, the hours for consultation are not very crowded. I have had the ordinary door between my waiting room and my office doubled and strengthened by a covering of felt. The purpose of this little arrangement cannot be doubted. Now it happens over and over again that people who are admitted from my waiting room omit to close the door behind them; in fact, they almost always leave both doors open. As soon as I have noticed this I insist rather gruffly that he or she go back in order to rectify the omission, even though it be an elegant gentleman or a lady in all her finery. This gives an impression of misapplied pedantry. I have, in fact, occasionally discredited myself by such a demand, since the individual concerned was one of those who cannot touch even a door knob, and prefer as well to have their attendants spared this contact. But most frequently I was right, for he who conducts himself in this way, and leaves the door from the waiting room into the physician's consultation room open, belongs to the rabble and deserves to be received inhospitably. Do not, I beg you, defend him until you have heard what follows. For the fact is that this negligence of the patient's only occurs when he has been alone in the waiting room and so leaves an empty room behind him, never when others, strangers, have been waiting with him. If that latter is the case, he knows very well that it is in his interest not to be listened to while he is talking to the physician, and never omits to close both the doors with care.

This omission of the patient's is so predetermined that it becomes neither accidental nor meaningless, indeed, not even unimportant, for, as we shall see, it throws light upon the relation of this patient to the physician. He is one of the great number of those who seek authority, who want to be dazzled, intimidated. Perhaps he had inquired by telephone as to what time he had best call, he had prepared himself to come on a crowd of suppliants somewhat like those in front of a branch milk station. He now enters an empty waiting room which is, moreover, most modestly furnished, and he is disappointed. He must demand reparation from the physician for the wasted respect that he had tendered him, and so he omits to close the door between the reception room and the office. By this, he means to say to the physician: "Oh, well, there is no one here anyway, and probably no one will come as long as I am here." He would also be quite unmannerly and supercilious during the consultation if his presumption were not at once restrained by a sharp reminder.

You will find nothing in the analysis of this little symptomatic act which was not previously known to you. That is to say, it asserts that this act is not accidental, but has a motive, a meaning, a purpose, that it has its assignable connections psychologically, and that it serves as a small indication of a more important psychological process. But above all it implies that the process thus intimated is not known to the consciousness of the individual in whom it takes place, for none of the patients who left the two doors open would have admitted that they meant by this omission to show me their contempt. Some could probably recall a slight sense of disappointment at entering an empty waiting room, but the connection between this impression and the symptomatic act which followed – of these, his consciousness was surely not aware.

Now let us place, side by side with this small analysis of a symptomatic act, an observation on a pathological case. I choose one which is fresh in my mind and which can also be described with relative brevity. A certain measure of minuteness of detail is unavoidable in any such account.

A young officer, home on a short leave of absence, asked me to see his mother-in-law who, in spite of the happiest circumstances, was embittering her own and her people's existence by a senseless idea. I am introduced to a well preserved lady of fifty-three with pleasant, simple manners, who gives the following account without any hesitation: She is most happily married and lives in the country with her husband, who operates a large factory. She cannot say enough for the kind thoughtfulness of her husband. They had married for love thirty years ago, and since then there had never been a shadow, a quarrel or cause for jealousy. Now, even though her two children are well married, the husband and father does not yet want to retire, from a feeling of duty. A year ago there happened the incredible thing, incomprehensible to herself as well. She gave complete credence to an anonymous letter which accused her excellent husband of having an affair with a young girl – and since then her happiness is destroyed. The more detailed circumstances were somewhat as follows: She had a chambermaid with whom she had perhaps too often discussed intimate matters. This girl pursued another young woman with positively malicious enmity because the latter had progressed so much further in life, despite the fact that she was of no better origin. Instead of going into domestic service, the girl had obtained a business training, had entered the factory and in consequence of the short-handedness due to the drafting of the clerks into the army had advanced to a good position. She now lives in the factory itself, meets all the gentlemen socially, and is even addressed as "Miss." The girl who had remained behind in life was of course ready to speak all possible evil of her one-time schoolmate. One day our patient and her chambermaid were talking of an old gentleman who had been visiting at the house, and of whom it was known that he did not live with his wife, but kept another woman as his mistress. She does not know how it happened that she suddenly remarked, "That would be the most awful thing that could happen to me, if I should ever hear that my good husband also had a mistress." The next day she received an anonymous letter through the mail which, in a disguised handwriting, carried this very communication which she had conjured up. She concluded – it seems justifiably – that the letter was the handiwork of her malignant chambermaid, for the letter named as the husband's mistress the self-same woman whom the maid persecuted with her hatred. Our patient, in spite of the fact that she immediately saw through the intrigue and had seen enough in her town to know how little credence such cowardly denunciations deserve, was nevertheless at once prostrated by the letter. She became dreadfully excited and promptly sent for her husband in order to heap the bitterest reproaches upon him. Her husband laughingly denied the accusation and did the best that could be done. He called in the family physician, who was as well the doctor in attendance at the factory, and the latter added his efforts to quiet the unhappy woman. Their further procedure was also entirely reasonable. The chambermaid was dismissed, but the pretended rival was not. Since then, the patient claims she has repeatedly so far calmed herself as no longer to believe the contents of the anonymous letter, but this relief was neither thoroughgoing nor lasting. It was enough to hear the name of the young lady spoken or to meet her on the street in order to precipitate a new attack of suspicion, pain and reproach.

This, now, is the case history of this good woman. It does not need much psychiatric experience to understand that her portrayal of her own case was, if anything, rather too mild in contrast to other nervous patients. The picture, we say, was dissimulated; in reality she had never overcome her belief in the accusation of the anonymous letter.

Now what position does a psychiatrist take toward such a case? We already know what he would do in the case of the symptomatic act of the patient who does not close the doors to the waiting room. He declares it an accident without psychological interest, with which he need not concern himself. But this attitude cannot be maintained toward the pathological case of the jealous woman. The symptomatic act seems no great matter, but the symptom itself claims attention by reason of its gravity. It is bound up with intense subjective suffering while objectively it threatens to break up a home; therefore its claim to psychiatric interest cannot be put aside. The first endeavor of the psychiatrist is to characterize the symptom by some distinctive feature. The idea with which this woman torments herself cannot in itself be called nonsensical, for it does happen that elderly married men have affairs with young girls. But there is something else about it that is nonsensical and incredible. The patient has no reason beyond the declaration in the anonymous letter to believe that her tender and faithful husband belongs to this sort of married men, otherwise not uncommon. She knows that this letter in itself carries no proof; she can satisfactorily explain its origin; therefore she ought to be able to persuade herself that she has no reason to be jealous. Indeed she does this, but in spite of it she suffers every bit as much as she would if she acknowledged this jealousy as fully justified. We are agreed to call ideas of this sort, which are inaccessible to arguments based on logic or on facts, "obsessions." Thus the good lady suffers from an "obsession of jealousy" that is surely a distinctive characterization for this pathological case.

Having reached this first certainty, our psychiatric interest will have become aroused. If we cannot do away with a delusion by taking reality into account, it can hardly have arisen from reality. But the delusion, what is its origin? There are delusions of the most widely varied content. Why is it that in our case the content should be jealousy? In what types of persons are obsessions liable to occur, and, in particular, obsessions of jealousy? We would like to turn to the psychiatrist with such questions, but here he leaves us in the lurch. There is only one of our queries which he heeds. He will examine the family history of this woman and perhaps will give us the answer: "The people who develop obsessions are those in whose families similar and other psychic disturbances have repeatedly occurred." In other words, if this lady develops an obsession she does so because she was predisposed to it by reason of her heredity. That is certainly something, but is it all that we want to know? Is it all that was effective in causing this breakdown? Shall we be content to assume that it is immaterial, accidental and inexplicable why the obsession of jealousy develops rather than any other? And may we also accept this sentence about the dominance of the influence of heredity in its negative meaning, that is, that no matter what experiences came to this human being she was predestined to develop some kind of obsession? You will want to know why scientific psychiatry will give no further explanation. And I reply, "He is a rascal who gives more than he owns." The psychiatrist does not know of any path that leads him further in the explanation of such a case. He must content himself with the diagnosis and a prognosis which, despite a wealth of experience, is uncertain.

Yet, can psychoanalysis do more at this point? Indeed yes! I hope to show you that even in so inaccessible a case as this it can discover something which makes the further understanding possible. May I ask you first to note the apparently insignificant fact that the patient actually provoked the anonymous letter which now supports her delusion. The day before, she announces to the intriguing chambermaid that if her husband were to have an affair with a young girl it would be the worst misfortune that could befall her. By so doing she really gave the maid the idea of sending her the anonymous letter. The obsession thus attains a certain independence from the letter; it existed in the patient beforehand – perhaps as a dread; or was it a wish? Consider, moreover, these additional details yielded by an analysis of only two hours. The patient was indeed most helpful when, after telling her story, she was urged to communicate her further thoughts, ideas and recollections. She declared that nothing came to her mind, that she had already told everything. After two hours the undertaking had really to be given up because she announced that she already felt cured and was sure that the morbid idea would not return. Of course, she said this because of this resistance and her fear of continuing the analysis. In these two hours, however, she had let fall certain remarks which made possible definite interpretation, indeed made it incontestable; and this interpretation throws a clear light on the origin of her obsession of jealousy. Namely, she herself was very much infatuated with a certain young man, the very same son-in-law upon whose urging she had come to consult me professionally. She knew nothing of this infatuation, or at least only a very little. Because of the existing relationship, it was very easy for this infatuation to masquerade under the guise of harmless tenderness. With all our further experience it is not difficult to feel our way toward an understanding of the psychic life of this honest woman and good mother. Such an infatuation, a monstrous, impossible thing, could not be allowed to become conscious. But it continued to exist and unconsciously exerted a heavy pressure. Something had to happen, some sort of relief had to be found and the mechanism of displacement which so constantly takes part in the origin of obsessional jealousy offered the most immediate mitigation. If not only she, old woman that she was, was in love with a young man but if also her old husband had an affair with a young girl, then she would be freed from the voice of her conscience which accused her of infidelity. The phantasy of her husband's infidelity was thus like a cooling salve on her burning wound. Of her own love she never became conscious, but the reflection of it, which would bring her such advantages, now became compulsive, obsessional and conscious. Naturally all arguments directed against the obsession were of no avail since they were directed only to the reflection, and not to the original force to which it owed its strength and which, unimpeachable, lay buried in the unconscious.

Let us now piece together these fragments to see what a short and impeded psychoanalysis can nevertheless contribute to the understanding of this case. It is assumed of course that our inquiries were carefully conducted, a point which I cannot at this place submit to your judgment. In the first place, the obsession becomes no longer nonsensical nor incomprehensible, it is full of meaning, well motivated and an integral part of the patient's emotional experience. Secondly, it is a necessary reaction toward an unconscious psychological process, revealed in other ways, and it is to this very circumstance that it owes its obsessional nature, that is, its resistance to arguments based on logic or fact. In itself the obsession is something wished for, a kind of consolation. Finally, the experiences underlying the condition are such as unmistakably determine an obsession of jealousy and no other. You will also recognize the part played by the two important analogies in the analysis of the symptomatic act with reference to its meaning and intent and also to its relation to an unconscious factor in the situation.

Naturally, we have not yet answered all the questions which may be put on the basis of this case. Rather the case bristles with further problems of a kind which we have not yet been able to solve in any way, and of others which could not be solved because of the disadvantage of the circumstances under which we were working. For example: why is this happily married woman open to an infatuation for her son-in-law, and why does the relief which could have been obtained in other ways come to her by way of this mirror-image, this projection of her own condition upon her husband? I trust you will not think that it is idle and wanton to open such problems. Already we have much material at our disposal for their possible solution. This woman is in that critical age when her sexual needs undergo a sudden and unwelcome exaggeration. This might in itself be sufficient. In addition, her good and faithful mate may for many years have been lacking in that sufficient sexual capacity which the well-preserved woman needs for her satisfaction. We have learned by experience to know that those very men whose faithfulness is thus placed beyond a doubt are most gentle in their treatment of their wives and unusually forbearing toward their nervous complaints. Furthermore, the fact that it was just the young husband of a daughter who became the object of her abnormal infatuation is by no means insignificant. A strong erotic attachment to the daughter, which in the last analysis leads back to the mother's sexual constitution, will often find a way to live on under such a disguise. May I perhaps remind you in this connection that the relationship between mother and son-in-law has seemed particularly delicate since all time and is one which among primitive peoples gave rise to very powerful taboos and avoidances.[37 - Compare S. Freud, Totem and Taboo, 1913.] It often transgresses our cultural standards positively as well as negatively. I cannot tell you of course which of these three factors were at work in our case; whether two of them only, or whether all of them coöperated, for as you know I did not have the opportunity to continue the analysis beyond two hours.

I realize at this point, ladies and gentlemen, that I have been speaking entirely of things for which your understanding was not prepared. I did this in order to carry through the comparison of psychiatry and psychoanalysis. May I now ask one thing of you? Have you noticed any contradiction between them? Psychiatry does not apply the technical methods of psychoanalysis, and neglects to look for any significance in the content of the obsession. Instead of first seeking out more specific and immediate causes, psychiatry refers us to the very general and remote source – heredity. But does this imply a contradiction, a conflict between them? Do they not rather supplement one another? For does the hereditary factor deny the significance of the experience, is it not rather true that both operate together in the most effective way? You must admit that there is nothing in the nature of psychiatric work which must repudiate psychoanalytic research. Therefore, it is the psychiatrists who oppose psychoanalysis, not psychiatry itself. Psychoanalysis stands in about the same relation to psychiatry as does histology to anatomy. The one studies the outer forms of organs, the other the closer structure of tissues and cells. A contradiction between two types of study, where one simplifies the other, is not easily conceivable. You know that anatomy to-day forms the basis of scientific medicine, but there was a time when the dissection of human corpses to learn the inner structure of the body was as much frowned upon as the practice of psychoanalysis, which seeks to ascertain the inner workings of the human soul, seems proscribed to-day. And presumably a not too distant time will bring us to the realization that a psychiatry which aspires to scientific depth is not possible without a real knowledge of the deeper unconscious processes in the psychic life.

Perhaps this much-attacked psychoanalysis has now found some friends among you who are anxious to see it justify itself as well from another aspect, namely, the therapeutic side. You know that the therapy of psychiatry has hitherto not been able to influence obsessions. Can psychoanalysis perhaps do so, thanks to its insight into the mechanism of these symptoms? No, ladies and gentlemen, it cannot; for the present at least it is just as powerless in the face of these maladies as every other therapy. We can understand what it was that happened within the patient, but we have no means of making the patient himself understand this. In fact, I told you that I could not extend the analysis of the obsession beyond the first steps. Would you therefore assert that analysis is objectionable in such cases because it remains without result? I think not. We have the right, indeed we have the duty to pursue scientific research without regard to an immediate practical effect. Some day, though we do not know when or where, every little scrap of knowledge will have been translated into skill, even into therapeutic skill. If psychoanalysis were as unsuccessful in all other forms of nervous and psychological disease as it is in the case of the obsession, it would nevertheless remain fully justified as an irreplaceable method of scientific research. It is true that we would then not be in a position to practice it, for the human subjects from which we must learn, live and will in their own right; they must have motives of their own in order to assist in the work, but they would deny themselves to us. Therefore let me conclude this session by telling you that there are comprehensive groups of nervous diseases concerning which our better understanding has actually been translated into therapeutic power; moreover, that in disturbances which are most difficult to reach we can under certain conditions secure results which are second to none in the field of internal therapeutics.

SEVENTEENTH LECTURE

GENERAL THEORY OF THE NEUROSES

The Meaning of the Symptoms

IN the last lecture I explained to you that clinical psychiatry concerns itself very little with the form under which the symptoms appear or with the burden they carry, but that it is precisely here that psychoanalysis steps in and shows that the symptom carries a meaning and is connected with the experience of the patient. The meaning of neurotic symptoms was first discovered by J. Breuer in the study and felicitous cure of a case of hysteria which has since become famous (1880-82). It is true that P. Janet independently reached the same result; literary priority must in fact be accorded to the French scholar, since Breuer published his observations more than a decade later (1893-95) during his period of collaboration with me. On the whole it may be of small importance to us who is responsible for this discovery, for you know that every discovery is made more than once, that none is made all at once, and that success is not meted out according to deserts. America is not named after Columbus. Before Breuer and Janet, the great psychiatrist Leuret expressed the opinion that even for the deliria of the insane, if we only understood how to interpret them, a meaning could be found. I confess that for a considerable period of time I was willing to estimate very highly the credit due to P. Janet in the explanation of neurotic symptoms, because he saw in them the expression of subconscious ideas (idées inconscientes) with which the patients were obsessed. But since then Janet has expressed himself most conservatively, as though he wanted to confess that the term "subconscious" had been for him nothing more than a mode of speech, a shift, "une façon de parler," by the use of which he had nothing definite in mind. I now no longer understand Janet's discussions, but I believe that he has needlessly deprived himself of high credit.

The neurotic symptoms then have their meaning just like errors and the dream, and like these they are related to the lives of the persons in whom they appear. The importance of this insight into the nature of the symptom can best be brought home to you by way of examples. That it is borne out always and in all cases, I can only assert, not prove. He who gathers his own experience will be convinced of it. For certain reasons, however, I shall draw my instances not from hysteria, but from another fundamentally related and very curious neurosis concerning which I wish to say a few introductory words to you. This so-called compulsion neurosis is not so popular as the widely known hysteria; it is, if I may use the expression, not so noisily ostentatious, behaves more as a private concern of the patient, renounces bodily manifestations almost entirely and creates all its symptoms psychologically. Compulsion neurosis and hysteria are those forms of neurotic disease by the study of which psychoanalysis has been built up, and in whose treatment as well the therapy celebrates its triumphs. Of these the compulsion neurosis, which does not take that mysterious leap from the psychic to the physical, has through psychoanalytic research become more intimately comprehensible and transparent to us than hysteria, and we have come to understand that it reveals far more vividly certain extreme characteristics of the neuroses.

The chief manifestations of compulsion neurosis are these: the patient is occupied by thoughts that in reality do not interest him, is moved by impulses that appear alien to him, and is impelled to actions which, to be sure, afford him no pleasure, but the performance of which he cannot possibly resist. The thoughts may be absurd in themselves or thoroughly indifferent to the individual, often they are absolutely childish and in all cases they are the result of strained thinking, which exhausts the patient, who surrenders himself to them most unwillingly. Against his will he is forced to brood and speculate as though it were a matter of life or death to him. The impulses, which the patient feels within himself, may also give a childish or ridiculous impression, but for the most part they bear the terrifying aspect of temptations to fearful crimes, so that the patient not only denies them, but flees from them in horror and protects himself from actual execution of his desires through inhibitory renunciations and restrictions upon his personal liberty. As a matter of fact he never, not a single time, carries any of these impulses into effect; the result is always that his evasion and precaution triumph. The patient really carries out only very harmless trivial acts, so-called compulsive acts, for the most part repetitions and ceremonious additions to the occupations of every-day life, through which its necessary performances – going to bed, washing, dressing, walking – become long-winded problems of almost insuperable difficulty. The abnormal ideas, impulses and actions are in nowise equally potent in individual forms and cases of compulsion neurosis; it is the rule, rather, that one or the other of these manifestations is the dominating factor and gives the name to the disease; that all these forms, however, have a great deal in common is quite undeniable.

Surely this means violent suffering. I believe that the wildest psychiatric phantasy could not have succeeded in deriving anything comparable, and if one did not actually see it every day, one could hardly bring oneself to believe it. Do not think, however, that you give the patient any help when you coax him to divert himself, to put aside these stupid ideas and to set himself to something useful in the place of his whimsical occupations. This is just what he would like of his own accord, for he possesses all his senses, shares your opinion of his compulsion symptoms, in fact volunteers it quite readily. But he cannot do otherwise; whatever activities actually are released under compulsion neurosis are carried along by a driving energy, such as is probably never met with in normal psychic life. He has only one remedy – to transfer and change. In place of one stupid idea he can think of a somewhat milder absurdity, he can proceed from one precaution and prohibition to another, or carry through another ceremonial. He may shift, but he cannot annul the compulsion. One of the chief characteristics of the sickness is the instability of the symptoms; they can be shifted very far from their original form. It is moreover striking that the contrasts present in all psychological experience are so very sharply drawn in this condition. In addition to the compulsion of positive and negative content, an intellectual doubt makes itself felt that gradually attacks the most ordinary and assured certainties. All these things merge into steadily increasing uncertainty, lack of energy, curtailment of personal liberty, despite the fact that the patient suffering from compulsion neurosis is originally a most energetic character, often of extraordinary obstinacy, as a rule intellectually gifted above the average. For the most part he has attained a desirable stage of ethical development, is overconscientious and more than usually correct. You can imagine that it takes no inconsiderable piece of work to find one's way through this maze of contradictory characteristics and symptoms. Indeed, for the present our only object is to understand and to interpret some symptoms of this disease.

Perhaps in reference to our previous discussions, you would like to know the position of present-day psychiatry to the problems of the compulsion neurosis. This is covered in a very slim chapter. Psychiatry gives names to the various forms of compulsion, but says nothing further concerning them. Instead it emphasizes the fact that those who show these symptoms are degenerates. That yields slight satisfaction, it is an ethical judgment, a condemnation rather than an explanation. We are led to suppose that it is in the unsound that all these peculiarities may be found. Now we do believe that persons who develop such symptoms must differ fundamentally from other people. But we would like to ask, are they more "degenerate" than other nervous patients, those suffering, for instance, from hysteria or other diseases of the mind? The characterization is obviously too general. One may even doubt whether it is at all justified, when one learns that such symptoms occur in excellent men and women of especially great and universally recognized ability. In general we glean very little intimate knowledge of the great men who serve us as models. This is due both to their own discretion and to the lying propensities of their biographers. Sometimes, however, a man is a fanatic disciple of truth, such as Emile Zola, and then we hear from him the strange compulsion habits from which he suffered all his life.[38 - E. Toulouse, Emile Zola —Enquête medico-psychologique, Paris, 1896.]

Psychiatry has resorted to the expedient of speaking of "superior degenerates." Very well – but through psychoanalysis we have learned that these peculiar compulsion symptoms may be permanently removed just like any other disease of normal persons. I myself have frequently succeeded in doing this.

I will give you two examples only of the analysis 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 assistance 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 repetition 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 embarrassing 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 analysis 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 analyst. 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 unobliterated. 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 sexual 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 pass 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 analyzed 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 associations 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 analysis 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 clitoris during sexual excitement. Frequently she had actually been awakened by this painful sensation and now this fear of an erection of the clitoris 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 assume as based on the monogamous marriage law. Furthermore, to this part of her ceremonial our patient adds a reminiscence and several associations. As a child she had slipped once and fallen with a bowl of glass or clay, had cut her finger, and bled violently. As she grew up and learned the facts of sexual 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 institution 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 space. Observe also that the observance of the ritual reproduce the sexual desire now positively, now negatively, and serve in part as their rejection, again as their representation.

It would be possible to make a better analysis 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 attitude toward her mother. Also we cannot escape the fact that the analysis of this symptom again points to the sexual 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 illustrations 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 illustrations 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 assertion and refer you for the rest to the literature of the subject, above all to the classical interpretation of symptoms in Breuer's first case (hysteria) as well as to the striking clarification of obscure symptoms in the so-called dementia praecox by C. G. Jung, dating from the time when this scholar was still content to be a mere psychoanalyst – 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. Psychoanalysts have felt themselves so much attracted by the analysis, 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 spaces), 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 spaces, 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 analysis, 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 assumed. 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 repetition 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 analysis 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 analyses.

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 puberty, 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 attitude 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 analysis, 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 analogies 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 analysing 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 analysis, 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 space of time, is able to increase the strength of a given stimulus so enormously that its assimilation, or rather its elaboration, can no longer be effected by normal means.