A General Introduction to Psychoanalysis

This analogy tempts us to classify 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 passed 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 class 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 analysis, 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 assumption of unconscious psychological processes. Until then, however, we shall continue to use this assumption, and when anyone wants to bring forward the objection that the unconscious can have no reality for science and is a mere makeshift, (une façon 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 analysis, the associations 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 analysis.

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 analysis 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 psychoanalysis 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 analyzed, never interpreted dreams, or never translated neurotic symptoms into meaning and purpose, are most ill-suited to pass 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 analytic interpretation is an irrefutable indication of the existence of unconscious psychological processes – or, if you prefer, an irrefutable proof of the necessity for their assumption.

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 coöperation 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 substitution 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, psychoanalytic therapy solves the problem of the neurotic symptom.

Accordingly, Breuer's discovery still remains the foundation of psychoanalytic therapy. The assertion 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 analyst 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 fagots et fagots,"[39 - There are fagots and fagots.] as Molière 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 analysis 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 assertion 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.

I do not wish to go any further to-day, but since our time is not yet up I intend to call your attention to another characteristic of our two analyses, namely, the memory gaps or amnesias, whose full appreciation will be possible later. You have heard that it is possible to express the object of psychoanalytic treatment in a formula: all pathogenic unconscious experience must be transposed into consciousness. You will perhaps be surprised to learn that this formula can be replaced by another: all the memory gaps of the patient must be filled out, his amnesias must be abolished. Practically this amounts to the same thing. Therefore an important role in the development of his symptoms must be accredited to the amnesias of the neurotic. The analysis of our first case, however, will hardly justify this valuation of the amnesia. The patient has not forgotten the scene from which the compulsion act derives – on the contrary, she remembers it vividly, nor is there any other forgotten factor which comes into play in the development of these symptoms. Less clear, but entirely analogous, is the situation in the case of our second patient, the girl with the compulsive ritual. She, too, has not really forgotten the behavior of her early years, the fact that she insisted that the door between her bedroom and that of her parents be kept open, and that she banished her mother out of her place in her parents' bed. She recalls all this very clearly, although hesitatingly and unwillingly. Only one factor stands out strikingly in our first case, that though the patient carries out her compulsive act innumerable times, she is not once reminded of its similarity with the experience after the bridal-night; nor was this memory even suggested when by direct questions she was asked to search for its motivation. The same is true of the girl, for in her case not only her ritual, but the situation which provoked it, is repeated identically night after night. In neither case is there any actual amnesia, no lapse of memory, but an association is broken off which should have called out a reproduction, a revival in the memory. Such a disturbance is enough to bring on a compulsion neurosis. Hysteria, however, shows a different picture, for it is usually characterized by most grandiose amnesias. As a rule, in the analysis of each hysterical symptom, one is led back to a whole chain of impressions which, upon their recovery, are expressly designated as forgotten up to the moment. On the one hand this chain extends back to the earliest years of life, so that the hysterical amnesias may be regarded as the direct continuation of the infantile amnesias, which hides the beginnings of our psychic life from those of us who are normal. On the other hand, we discover with surprise that the most recent experiences of the patient are blurred by these losses of memory – that especially the provocations which favored or brought on the illness are, if not entirely wiped out by the amnesia, at least partially obliterated. Without fail important details have disappeared from the general picture of such a recent memory, or are placed by false memories. Indeed it happens almost regularly that just before the completion of an analysis, certain memories of recent experiences suddenly come to light. They had been held back all this time, and had left noticeable gaps in the context.

We have pointed out that such a crippling of the ability to recall is characteristic of hysteria. In hysteria symptomatic conditions also arise (hysterical attacks) which need leave no trace in the memory. If these things do not occur in compulsion-neuroses, you are justified in concluding that these amnesias exhibit psychological characteristics of the hysterical change, and not a general trait of the neuroses. The significance of this difference will be more closely limited by the following observations. We have combined two things as the meaning of a symptom, its "whence," on the one hand, and its "whither" or "why," on the other. By these we mean to indicate the impressions and experiences whence the symptom arises, and the purpose the symptom serves. The "whence" of a symptom is traced back to impressions which have come from without, which have therefore necessarily been conscious at some time, but which may have sunk into the unconscious – that is, have been forgotten. The "why" of the symptom, its tendency, is in every case an endopsychic process, developed from within, which may or may not have become conscious at first, but could just as readily never have entered consciousness at all and have been unconscious from its inception. It is, after all, not so very significant that, as happens in the hysterias, amnesia has covered over the "whence" of the symptom, the experience upon which it is based; for it is the "why," the tendency of the symptom, which establishes its dependence on the unconscious, and indeed no less so in the compulsion neuroses than in hysteria. In both cases the "why" may have been unconscious from the very first.

By thus bringing into prominence the unconscious in psychic life, we have raised the most evil spirits of criticism against psychoanalysis. Do not be surprised at this, and do not believe that the opposition is directed only against the difficulties offered by the conception of the unconscious or against the relative inaccessibility of the experiences which represent it. I believe it comes from another source. Humanity, in the course of time, has had to endure from the hands of science two great outrages against its naive self-love. The first was when humanity discovered that our earth was not the center of the universe, but only a tiny speck in a world-system hardly conceivable in its magnitude. This is associated in our minds with the name "Copernicus," although Alexandrian science had taught much the same thing. The second occurred when biological research robbed man of his apparent superiority under special creation, and rebuked him with his descent from the animal kingdom, and his ineradicable animal nature. This re-valuation, under the influence of Charles Darwin, Wallace and their predecessors, was not accomplished without the most violent opposition of their contemporaries. But the third and most irritating insult is flung at the human mania of greatness by present-day psychological research, which wants to prove to the "I" that it is not even master in its own home, but is dependent upon the most scanty information concerning all that goes on unconsciously in its psychic life. We psychoanalysts were neither the first, nor the only ones to announce this admonition to look within ourselves. It appears that we are fated to represent it most insistently and to confirm it by means of empirical data which are of importance to every single person. This is the reason for the widespread revolt against our science, the omission of all considerations of academic urbanity, and emancipation of the opposition from all restraints of impartial logic. We were compelled to disturb the peace of the world, in addition, in another manner, of which you will soon come to know.

NINETEENTH LECTURE

GENERAL THEORY OF THE NEUROSES

Resistance and Suppression

IN order to progress in our understanding of the neuroses, we need new experiences and we are about to obtain two. Both are very remarkable and were at the time of their discovery, very surprising. You are, of course, prepared for both from our discussions of the past semester.

In the first place: When we undertake to cure a patient, to free him from the symptoms of his malady, he confronts us with a vigorous, tenacious resistance that lasts during the whole time of the treatment. That is so peculiar a fact that we cannot expect much credence for it. The best thing is not to mention this fact to the patient's relatives, for they never think of it otherwise than as a subterfuge on our part in order to excuse the length or the failure of our treatment. The patient, moreover, produces all the phenomena of this resistance without even recognizing it as such; it is always a great advance to have brought him to the point of understanding this conception and reckoning with it. Just consider, this patient suffers from his symptoms and causes those about him to suffer with him. He is willing, moreover, to take upon himself so many sacrifices of time, money, effort and self-denial in order to be freed. And yet he struggles, in the very interests of his malady, against one who would help him. How improbable this assertion must sound! And yet it is so, and if we are reproached with its improbability, we need only answer that this fact is not without its analogies. Whoever goes to a dentist with an unbearable toothache may very well find himself thrusting away the dentist's arm when the man makes for his sick tooth with a pair of pincers.

The resistance which the patient shows is highly varied, exceedingly subtle, often difficult to recognize, Protean-like in its manifold changes of form. It means that the doctor must become suspicious and be constantly on his guard against the patient. In psychoanalytic therapy we make use, as you know, of that technique which is already familiar to you from the interpretation of dreams. We tell the patient that without further reflection he should put himself into a condition of calm self-observation and that he must then communicate whatever results this introspection gives him – feelings, thoughts, reminiscences, in the order in which they appear to his mind. At the same time, we warn him expressly against yielding to any motive which would induce him to choose or exclude any of his thoughts as they arise, in whatever way the motive may be couched and however it may excuse him from telling us the thought: "that is too unpleasant," or "too indiscreet" for him to tell; or "it is too unimportant," or "it does not belong here," "it is nonsensical." We impress upon him the fact that he must skim only across the surface of his consciousness and must drop the last vestige of a critical attitude toward that which he finds. We finally inform him that the result of the treatment and above all its length is dependent on the conscientiousness with which he follows this basic rule of the analytic technique. We know, in fact, from the technique of interpreting dreams, that of all the random notions which may occur, those against which such doubts are raised are invariably the ones to yield the material which leads to the uncovering of the unconscious.

The first reaction we call out by laying down this basic technical rule is that the patient directs his entire resistance against it. The patient tries in every way to escape its requirements. First he will declare that he cannot think of anything, then, that so much comes to his mind that it is impossible to seize on anything definite. Then we discover with no slight displeasure that he has yielded to this or that critical objection, for he betrays himself by the long pauses which he allows to occur in his speaking. He then confesses that he really cannot bring himself to this, that he is ashamed to; he prefers to let this motive get the upper hand over his promise. He may say that he did think of something but that it concerns someone else and is for that reason exempt. Or he says that what he just thought of is really too trivial, too stupid and too foolish. I surely could not have meant that he should take such thoughts into account. Thus it goes on, with untold variations, in the face of which we continually reiterate that "telling everything" really means telling everything.

One can scarcely find a patient who does not make the attempt to reserve some province for himself against the intrusion of the analysis. One patient, whom I must reckon among the most highly intelligent, thus concealed an intimate love relation for weeks; and when he was asked to explain this infringement of our inviolable rule, he defended his action with the argument that he considered this one thing was his private affair. Naturally, analytic treatment cannot countenance such right of sanctuary. One might as well try in a city like Vienna to allow an exception to be made of great public squares like the Hohe Markt or the Stephans Platz and say that no one should be arrested in those places – and then attempt to round up some particular wrong-doer. He will be found nowhere but in those sanctuaries. I once brought myself around to permit such an exception in the case of a man on whose capacity for work a great deal depended, and who was bound by his oath of service, which forbade him to tell anyone of certain things. To be sure, he was satisfied with the results – but not I; I resolved never to repeat such an attempt under these conditions.

Compulsion neurotics are exceedingly adept at making this technical rule almost useless by bringing to bear all their over-conscientiousness and their doubts upon it. Patients suffering from anxiety-hysteria sometimes succeed in reducing it to absurdity by producing only notions so remote from the thing sought for that analysis is quite unprofitable. But it is not my intention to go into the way in which these technical difficulties may be met. It is enough to know that finally, by means of resolution and perseverance, we do succeed in wresting a certain amount of obedience from the patient toward this basic rule of the technique; the resistance then makes itself felt in other ways. It appears in the form of an intellectual resistance, battles by means of arguments, and makes use of all difficulties and improbabilities which a normal yet uninstructed thinking is bound to find in the theory of analysis. Then we hear from one voice alone the same criticisms and objections which thunder about us in mighty chorus in the scientific literature. Therefore the critics who shout to us from outside cannot tell us anything new. It is a veritable tempest in a teapot. Still the patient can be argued with, he is anxious to persuade us to instruct him, to teach him, to lead him to the literature, so that he may continue working things out for himself. He is very ready to become an adherent of psychoanalysis on condition that analysis spare him personally. But we recognize this curiosity as a resistance, as a diversion from our special objects, and we meet it accordingly. In those patients who suffer from compulsion neuroses, we must expect the resistance to display special tactics. They frequently allow the analysis to take its way, so that it may succeed in throwing more and more light on the problems of the case, but we finally begin to wonder how it is that this clearing up brings with it no practical progress, no diminution of the symptom. Then we may discover that the resistance has entrenched itself in the doubts of the compulsion neurosis itself and in this position is able successfully to resist our efforts. The patient has said something like this to himself: "This is all very nice and interesting. And I would be glad to continue it. It would affect my malady considerably if it were true. But I don't believe that it is true and as long as I don't believe it, it has nothing to do with my sickness." And so it may go on for a long time until one finally has shaken this position itself; it is then that the decisive battle takes place.

The intellectual resistances are not the worst, one can always get ahead of them. But the patient can also put up resistances, within the limits of the analysis, whose conquest belongs to the most difficult tasks of our technique. Instead of recalling, he actually goes again through the attitudes and emotions of his previous life which, by means of the so-called "transference," can be utilized as resistances to the physician and the treatment. If the patient is a man, he takes this material as a rule from his relations to his father, in whose place he now puts the physician, and in so doing constructs a resistance out of his struggle for independence of person and opinion; out of his ambition to equal or to excel his father; out of his unwillingness to assume the burden of gratitude a second time in his life. For long times at a stretch one receives the impression that the patient desires to put the physician in the wrong and to let him feel his helplessness by triumphing over him, and that this desire has completely replaced his better intention of making an end to his sickness. Women are adepts at exploiting, for the purposes of the resistance, a tender, erotically tinged transference to the physician. When this leaning attains a certain intensity, all interest for the actual situation of the treatment is lost, together with every sense of the responsibility which was assumed by undertaking it. The never-failing jealousy as well as the embitterment over the inevitable repudiation, however gently effected, all must serve to spoil the personal understanding between patient and physician and thus to throw out one of the most powerful propelling forces of the analysis.

Resistances of this sort must not be narrow-mindedly condemned. They contain so much of the most important material of the patient's past and reproduce it in such a convincing manner, that they become of the greatest aid to the analysis, if a skillful technique is able to turn them in the right direction. It is only remarkable that this material is at first always in the service of the resistance, for which it serves as a barrier against the treatment. One can also say that here are traits of character, adjustments of the ego which were mobilized in order to defeat the attempted change. We are thus able to learn how these traits arose under the conditions of the neurosis, as a reaction to its demands, and to see features more clearly in this character which could otherwise not have shown up so clearly or at least not to this extent, and which one may therefore designate as latent. You must also not get the impression that we see an unforeseen endangering of the analytic influence in the appearance of these resistances. On the contrary, we know that these resistances must come to light; we are dissatisfied only when we do not provoke them in their full strength and so make them plain to the patient Indeed, we at last understand that overcoming these resistances is the essential achievement of analysis and is that portion of the work which alone assures us that we have accomplished something with the patient.

You must also take into account the fact that any accidental occurrences which arise during the treatment will be made use of by the patient as a disturbance – every diverting incident, every statement about analysis from an inimical authority in his circle, any chance illness or any organic affection which complicates the neurosis; indeed, he even uses every improvement of his condition as a motive for abating his efforts. You will then have gained an approximate, though still an incomplete picture of the forms and devices of the resistance which must be met and overcome in the course of every analysis. I have given this point such detailed consideration because I am about to inform you that our dynamic conception of the neurosis is based on this experience with the resistance of neurotic patients against the banishment of their symptoms. Breuer and I both originally practiced psycho-therapy by means of hypnosis. Breuer's first patient was treated throughout under a condition of hypnotic suggestibility, and I at first followed his example. I admit that my work at that time progressed easily and agreeably and also took much less time. But the results were capricious and not permanent; therefore I finally gave up hypnotism. Then only did I realize that no insight into the forces which produce these diseases was possible as long as one used hypnotism. The condition of hypnosis could prevent the physician from realizing the existence of a resistance. Hypnosis drives back the resistance and frees a certain field for the work of analysis, but similarly to the doubt in the compulsion neurosis, in so doing it clogs the boundaries of this field till they become impenetrable. That is why I can say that true psychoanalysis began when the help of hypnotism was renounced.

But if the establishment of the resistance thus becomes a matter of such importance, then surely we must give our caution full rein, and follow up any doubts as to whether we are not all too ready in our assumption of their existence. Perhaps there really are neurotic cases in which associations appear for other reasons, perhaps the arguments against our hypothesis really deserve more consideration and we are unjustified in conveniently rejecting all intellectual criticisms of analysis as a resistance. Indeed, ladies and gentlemen, but our judgment was by no means readily arrived at. We had opportunity to observe every critical patient from the first sign of the resistance till after its disappearance. In the course of the treatment, the resistance is moreover constantly changing in intensity. It is always on the increase as we approach a new theme, is strongest at the height of its elaboration, and dies down again when this theme has been abandoned. Furthermore, unless we have made some unusual and awkward technical error, we never have to deal with the full measure of resistance of which the patient is capable. We could therefore convince ourselves that the same man took up and discarded his critical attitude innumerable times in the course of the analysis. Whenever we are on the point of bringing before his consciousness some piece of unconscious material which is especially painful to him, then he is critical in the extreme. Even though he had previously understood and accepted a great deal, nevertheless all record of these gains seems now to have been wiped out. He may, in his desire to resist at any cost, present a picture of veritable emotional feeblemindedness. If one succeeds in helping him to overcome this new resistance, then he regains his insight and his understanding. Thus his criticism is not an independent function to be respected as such; it plays the role of handy-man to his emotional attitude and is guided by his resistance. If something displeases him, he can defend himself against it very ingeniously and appear most critical. But if something strikes his fancy, then he may show himself easily convinced. Perhaps none of us are very different, and the patient under analysis shows this dependence of the intellect on the emotional life so plainly only because, under the analysis, he is so hard pressed.

In what way shall we now account for the observation that the patient so energetically resists our attempts to rid him of his symptoms and to make his psychic processes function in a normal way? We tell ourselves that we have here come up against strong forces which oppose any change in the condition; furthermore, that these forces must be identical with those which originally brought about the condition. Some process must have been functional in the building up of these symptoms, a process which we can now reconstruct by means of our experiences in solving the meaning of the symptoms. We already know from Breuer's observations that the existence of a symptom presupposes that some psychic process was not carried to its normal conclusion, so that it could not become conscious. The symptom is the substitute for that which did not take place. Now we know where the forces whose existence we suspect must operate. Some violent antagonism must have been aroused to prevent the psychic process in question from reaching consciousness, and it therefore remained unconscious. As an unconscious thought it had the power to create a symptom. The same struggle during the analytic treatment opposes anew the efforts to carry this unconscious thought over into consciousness. This process we felt as a resistance. That pathogenic process which is made evident to us through the resistance, we will name repression.

We are now ready to obtain a more definite idea of this process of repression. It is the preliminary condition for the formation of symptoms; it is also a thing for which we have no parallel. If we take as prototype an impulse, a psychological process which is striving to convert itself into action, we know that it may succumb before a rejection, which we call "repudiation" or "condemnation." In the course of this struggle, the energy which the impulse had at its disposal was withdrawn from it, it becomes powerless; yet it may subsist in the form of a memory. The whole process of decision occurs with the full knowledge of the ego. The state of affairs is very different if we imagine that this same impulse has been subjected to repression. In that case, it would retain its energy and there would be no memory of it left; in addition, the process of repression would be carried out without the knowledge of the ego. Through this comparison, however, we have come no nearer understanding the nature of repression.

I now go into the theoretical ideas which alone have shown themselves useful in making the conception of repression more definite. It is above all necessary that we progress from a purely descriptive meaning of the word "unconscious" to its more systematic meaning; that is, we come to a point where we must call the consciousness or unconsciousness of a psychic process only one of its attributes, an attribute which is, moreover, not necessarily unequivocal. If such a process remained unconscious, then this separation from consciousness is perhaps only an indication of the fate to which it has submitted and not this fate itself. To bring this home to us more vividly, let us assume that every psychological process – with one exception, which I will go into later – first exists in an unconscious state or phase and only goes over from this into a conscious phase, much as a photographic picture is first a negative and then becomes a picture by being printed. But not every negative need become a positive, and just as little is it necessary that every unconscious psychological process should be changed into a conscious one. We find it advantageous to express ourselves as follows: Any particular process belongs in the first place to the psychological system of the unconscious; from this system it can under certain conditions go over into the system of the conscious. The crudest conception of these systems is the one which is most convenient for us, namely, a representation in space. We will compare the system of the unconscious to a large ante-chamber, in which the psychic impulses rub elbows with one another, as separate beings. There opens out of this ante-chamber another, a smaller room, a sort of parlor, which consciousness occupies. But on the threshold between the two rooms there stands a watchman; he passes on the individual psychic impulses, censors them, and will not let them into the parlor if they do not meet with his approval. You see at once that it makes little difference whether the watchman brushes a single impulse away from the threshold, or whether he drives it out again after it has already entered the parlor. It is a question here only of the extent of his watchfulness, and the timeliness of his judgment. Still working with this simile, we proceed to a further elaboration of our nomenclature. The impulses in the ante-chamber of the unconscious cannot be seen by the conscious, which is in the other room; therefore for the time being they must remain unconscious. When they have succeeded in pressing forward to the threshold, and have been sent back by the watchman, then they are unsuitable for consciousness and we call them suppressed. Those impulses, however, which the watchman has permitted to cross the threshold have not necessarily become conscious; for this can happen only if they have been successful in attracting to themselves the glance of the conscious. We therefore justifiably call this second room the system of the fore-conscious. In this way the process of becoming conscious retains its purely descriptive sense. Suppression then, for any individual impulse, consists in not being able to get past the watchman from the system of the unconscious to that of the fore-conscious. The watchman himself is long since known to us; we have met him as the resistance which opposed us when we attempted to release the suppression through analytic treatment.

Now I know you will say that these conceptions are as crude as they are fantastic, and not at all permissible in a scientific discussion. I know they are crude – indeed, we even know that they are incorrect, and if we are not very much mistaken we have a better substitute for them in readiness. Whether they will continue then to appear so fantastic to you I do not know. For the time being, they are useful conceptions, similar to the manikin Ampère who swims in the stream of the electric current. In so far as they are helpful in the understanding of our observation, they are by no means to be despised. I should like to assure you that these crude assumptions go far in approximating the actual situation – the two rooms, the watchman on the threshold between the two, and consciousness at the end of the second room in the role of an onlooker. I should also like to hear you admit that our designations —unconscious, fore-conscious, and conscious are much less likely to arouse prejudice, and are easier to justify than others that have been used or suggested – such as sub-conscious, inter-conscious, between-conscious, etc.

This becomes all the more important to me if you should warn me that this arrangement of the psychic apparatus, such as I have assumed in the explanation of neurotic symptoms, must be generally applicable and must hold for normal functioning as well. In that, of course, you are right. We cannot follow this up at present, but our interest in the psychology of the development of the symptom must be enormously increased if through the study of pathological conditions we have the prospect of finding a key to the normal psychic occurrences which have been so well concealed.

You will probably recognize what it is that supports our assumptions concerning these two systems and their relation to consciousness. The watchman between the unconscious and the fore-conscious is none other than the censor under whose control we found the manifest dream to obtain its form. The residue of the day's experiences, which we found were the stimuli which set off the dream, are fore-conscious materials which at night, during sleep, had come under the influence of unconscious and suppressed wishes. Borne along by the energy of the wish, these stimuli were able to build the latent dream. Under the control of the unconscious system this material was worked over, went through an elaboration and displacement such as the normal psychic life or, better said, the fore-conscious system, either does not know at all or tolerates only exceptionally. In our eyes the characteristics of each of the two systems were betrayed by this difference in their functioning. The dependent relation between the fore-conscious and the conscious was to us only an indication that it must belong to one of the two systems. The dream is by no means a pathological phenomenon; it may appear in every healthy person under the conditions of sleep. Any assumption as to the structure of the psychic apparatus which covers the development of both the dream and the neurotic symptom has also an undeniable claim to be taken into consideration in any theory of normal psychic life.

So much, then, for suppression. It is, however, only a prerequisite for the evolution of the symptom. We know that the symptom serves as a substitute for a process kept back by suppression. Yet it is no simple matter to bridge this gap between the suppression and the evolution of the substitute. We have first to answer several questions on other aspects of the problem concerning the suppression and its substantiation: What kind of psychological stimuli are at the basis of the suppression; by what forces is it achieved; for what motives? On these matters we have only one insight that we can go by. We learned in the investigation of resistance that it grows out of the forces of the "I," in other words from obvious and latent traits of character. It must be from the same traits also that suppression derived support; at least they played a part in its development. All further knowledge is still withheld from us.

A second observation, for which I have already prepared, will help us further at this point. By means of analysis we can assign one very general purpose to the neurotic symptom. This is of course nothing new to you. I have already shown it to you in the two cases of neuroses. But, to be sure, what is the significance of two cases! You have the right to demand that it be shown to you innumerable times. But I am unable to do this. Here again your own experience must step in, or your belief, which may in this matter rely upon the unanimous account of all psychoanalysts.

You will remember that in these two cases, whose symptoms we subjected to searching investigation, the analysis introduced us to the most intimate sexual life of these patients. In the first case, moreover, we could identify with unusual clearness the purpose or tendency of the symptoms under investigation. Perhaps in the second case it was slightly covered by another factor – one we will consider later. Now, the same thing that we saw in these two examples we would see in all other cases that we subjected to analysis. Each time, through analysis, we would be introduced to the sexual wishes and experiences of the patient, and every time we would have to conclude that their symptoms served the same purpose. This purpose shows itself to be the satisfaction of sexual wishes; the symptoms serve as a sexual satisfaction for the patient, they are a substitute for such satisfactions as they miss in reality.

Recall the compulsive act of our first patient. The woman longs for her intensely beloved husband, with whom she cannot share her life because of his shortcoming and weaknesses. She feels she must remain true to him, she can give his place to no one else. Her compulsive symptom affords her that for which she pines, ennobles her husband, denies and corrects his weaknesses, – above all, his impotence. This symptom is fundamentally a wish-fulfillment, exactly as is a dream; moreover, it is what a dream not always is, an erotic wish-fulfillment. In the case of our second patient you can see that one of the component purposes of her ceremonial was the prevention of the intercourse of her parents or the hindrance of the creation of a new child thereby. You have perhaps also guessed that essentially she strove to put herself in the place of her mother. Here again we find the removal of disturbances to sexual satisfaction and the fulfillment of personal sexual wishes. We shall soon turn to the complications of whose existence we have given you several indications.

I do not want to make reservations as to the universal applicability of these declarations later on, and therefore I wish to call to your attention the fact that everything that I say here about suppression, symptom-development and symptom-interpretation has been learned from three types of neuroses – anxiety-hysteria, conversion-hysteria, and compulsion-neuroses – and for the time being is relevant to these forms only. These three conditions, which we are in the habit of combining into one group under the name of "transference neuroses," also limit the field open to psychoanalytic therapy. The other neuroses have not been nearly so well studied by psychoanalysis, – in one group, in fact, the impossibility of therapeutic influence has been the reason for the neglect. But you must not forget that psychoanalysis is still a very young science, that it demands much time and care in preparation for it, that not long ago it was still in the cradle, so to speak. Yet at all points we are about to penetrate into the understanding of those other conditions which are not transference neuroses. I hope I shall still be able to speak to you of the developments that our assumptions and results have undergone by being correlated with this new material, and to show you that these further studies have not led to contradictions but rather to the production of still greater uniformity. Granted that everything, then, that has been said here, holds good for the three transference neuroses, allow me to add a new bit of information to the evaluation of its symptoms. A comparative investigation into the causes of the disease discloses a result that may be confined into the formula: in some way or other these patients fell ill through self-denial when reality withheld from them the satisfaction of their sexual wishes. You recognize how excellently well these two results are found to agree. The symptoms must be understood, then, as a substitute satisfaction for that which is missed in life.

To be sure, there are all kinds of objections possible to the declaration that neurotic symptoms are substitutes for sexual satisfaction. I shall still go into two of them today. If you yourself have analytically examined a fairly large number of neurotics you will perhaps gravely inform me that in one class of cases this is not at all applicable, the symptoms appear rather to have the opposite purpose, to exclude sexual satisfaction, or discontinue it. I shall not deny the correctness of your interpretation. The psychoanalytic content has a habit of being more complicated than we should like to have it. Had it been so simple, perhaps we should have had no need for psychoanalysis to bring it to light. As a matter of fact, some of the traits of the ceremonial of our second patient may be recognized as of this ascetic nature, inimical to sexual satisfaction; for example, the fact that she removes the clocks, which have the magic qualities of preventing nightly erections, or that she tries to prevent the falling and breaking of vessels, which symbolizes a protection of her virginity. In other cases of bed-ceremonials which I was able to analyze, this negative character was far more evident; the ceremonial might consist throughout of protective regulations against sexual recollections and temptations. On the other hand, we have often discovered in psychoanalysis that opposites do not mean contradictions. We might extend our assertion and say the symptoms purpose either a sexual satisfaction or a guard against it; that in hysteria the positive wish-fulfillment takes precedence, while in the compulsion neuroses the negative, ascetic characteristics have the ascendancy. We have not yet been able to speak of that aspect of the mechanism of the symptoms, their two-sidedness, or polarity, which enables them to serve this double purpose, both the sexual satisfaction and its opposite. The symptoms are, as we shall see, compromise results, arising from the integration of two opposed tendencies; they represent not only the suppressed force but also the suppressing factor, which was originally potent in bringing about the negation. The result may then favor either one side or the other, but seldom is one of the influences entirely lacking. In cases of hysteria, the meeting of the two purposes in the same symptom is most often achieved. In compulsion-neuroses, the two parts often become distinct; the symptom then has a double meaning, it consists of two actions, one following the other, one releasing the other. It will not be so easy to put aside a further misgiving. If you should look over a large number of symptom-interpretations, you would probably judge offhand that the conception of a sexual substitute-satisfaction has been stretched to its utmost limits in these cases. You will not hesitate to emphasize that these symptoms offer nothing in the way of actual satisfaction, that often enough they are limited to giving fresh life to sensations or phantasies from some sexual complex. Further, you will declare that the apparent sexual satisfaction so often shows a childish and unworthy character, perhaps approximates an act of onanism, or is reminiscent of filthy naughtiness, habits that are already forbidden and broken in childhood. Finally, you will express your surprise that one should designate as a sexual satisfaction appetites which can only be described as horrible or ghastly, even unnatural. As to these last points, we shall come to no agreement until we have submitted man's sexual life to a thorough investigation, and thus ascertained what one is justified in calling sexual.

TWENTIETH LECTURE

GENERAL THEORY OF THE NEUROSES

The Sexual Life of Man

ONE might think we could take for granted what we are to understand by the term "sexual." Of course, the sexual is the indecent, which we must not talk about. I have been told that the pupils of a famous psychiatrist once took the trouble to convince their teacher that the symptoms of hysteria very frequently represent sexual matters. With this intention they took him to the bedside of a woman suffering from hysteria, whose attacks were unmistakable imitations of the act of delivery. He, however, threw aside their suggestion with the remark, "a delivery is nothing sexual." Assuredly, a delivery need not under all circumstances be indecent.

I see that you take it amiss that I jest about such serious matters. But this is not altogether a jest. In all seriousness, it is not altogether easy to define the concept "sexual." Perhaps the only accurate definition would be everything that is connected with the difference between the two sexes; but this you may find too general and too colorless. If you emphasize the sexual act as the central factor, you might say that everything is sexual which seeks to obtain sensual excitement from the body and especially from the sexual organs of the opposite sex, and which aims toward the union of the genitals and the performance of the sexual act. But then you are really very close to the comparison of sexual and indecent, and the act of delivery is not sexual. But if you think of the function of reproduction as the nucleus of sexuality you are in danger of excluding a number of things that do not aim at reproduction but are certainly sexual, such as onanism or even kissing. But we are prepared to realize that attempts at definition always lead to difficulties; let us give up the attempt to achieve the unusual in our particular case. We may suspect that in the development of the concept "sexual" something occurred which resulted in a false disguise. On the whole, we are quite well oriented as to what people call sexual.

The inclusion of the following factors in our concept "sexual" amply suffices for all practical purposes in ordinary life: the contrast between the sexes, the attainment of sexual excitement, the function of reproduction, the characteristic of an indecency that must be kept concealed. But this is no longer satisfactory to science. For through careful examinations, rendered possible only by the sacrifices and the unselfishness of the subjects, we have come in contact with groups of human beings whose sexual life deviates strikingly from the average. One group among them, the "perverse," have, as it were, crossed off the difference between the sexes from their program. Only the same sex can arouse their sexual desires; the other sex, even the sexual parts, no longer serve as objects for their sexual desires, and in extreme cases, become a subject for disgust. They have to that extent, of course, foregone any participation in reproduction. We call such persons homosexual or inverted. Often, though not always, they are men and women of high physical, intellectual and ethical development, who are affected only with this one portentous abnormality. Through their scientific leaders they proclaim themselves to be a special species of mankind, "a third sex," which shares equal rights with the two other sexes. Perhaps we shall have occasion to examine their claims critically. Of course they are not, as they would like to claim, the "elect" of humanity, but comprise just as many worthless second-rate individuals as those who possess a different sexual organization.

At any rate, this type among the perverse seek to achieve the same ends with the object of their desires as do normal people. But in the same group there exists a long succession of abnormal individuals whose sexual activities are more and more alien to what seems desirable to the sensible person. In their manifold strangeness they seem comparable only to the grotesque freaks that P. Breughel painted as the temptation of Saint Anthony, or the forgotten gods and believers that G. Flaubert pictures in the long procession that passes before his pious penitent. This ill-assorted array fairly clamors for orderly classification if it is not to bewilder our senses. We first divide them, on the one hand, into those whose sexual object has changed, as is the case with homosexualists, and, on the other, those whose sexual aim has changed. Those of the first group have dispensed with the mutual union of the genital organs, and have, as one of the partners of the act, replaced the genitals by another organ or part of the body; they have thus overcome both the short-comings of organic structure and the usual disgust involved. There are others of this group who still retain the genitals as their object, but not by virtue of their sexual function; they participate for anatomic reasons or rather by reason of their proximity. By means of these individuals we realize that the functions of excretion, which in the education of the child are hushed away as indecent, still remain capable of drawing complete sexual interest on themselves. There are still others who have relinquished the genitals entirely as an objective, have raised another part of the body to serve as the goal of their desire; the woman's breast, the foot, the tress of hair. There are also the fetishists, to whom the body part means nothing, who are gratified by a garment, a piece of white linen, a shoe. And finally there are persons who seek the whole object but with certain peculiar or horrible demands: even those who covet a defenseless corpse for instance, which they themselves must criminally compel to satisfy their desire. But enough of these horrors.

Foremost in the second grouping are those perverted ones who have placed as the end of their sexual desire performances normally introductory or preparatory to it. They satisfy their desire by their eyes and hands. They watch or attempt to watch the other individual in his most intimate doings, or uncover those portions of their own bodies which they should conceal in the vague expectation of being rewarded by a similar procedure on the other person's part. Here also belong the enigmatic sadists, whose affectionate strivings know no other goal than to cause their object pain and agony, varying all the way from humiliating suggestions to the harshest physical ill-treatment. As if to balance the scale, we have on the other hand the masochists, whose sole satisfaction consists in suffering every variety of humiliation and torture, symbolic and real, at the hands of the beloved one. There are still others who combine and confuse a number of these abnormal conditions. Moreover, in both these groups there are those who seek sexual satisfaction in reality, and others who are content merely to imagine such gratification, who need no actual object at all, but can supplant it by their own fantastic creations.