Freud - Complete Works (18 page)

Studies On Hysteria

84

   Neurotics, in whose self-feeling
we seldom fail to find a strain of depression or anxious
expectation, form greater numbers of these antithetic ideas than
normal people, or perceive them more easily; and they regard them
as of more importance. In our patient’s state of exhaustion
the antithetic idea, which was normally rejected, proved itself the
stronger. It is this idea which put itself into effect and which,
to the patient’s horror, actually produced the noise she
dreaded. In order to explain the whole process it may further be
assumed that her exhaustion was only a partial one; it affected, to
use the terminology of Janet and his followers, only her
‘primary ego’ and did not result in a weakening of the
antithetic idea as well.

   It may further be assumed that it
was her horror at the noise produced against her will that made the
moment a traumatic one, and fixed the noise itself as a somatic
mnemic symptom of the whole scene. I believe, indeed, that the
character of the
tic
itself, consisting as it did of a
succession of sounds which were convulsively emitted and separated
by pauses and which could be best likened to clackings, reveals
traces of the process to which it owed its origin. It appears that
a conflict had occurred between her intention and the antithetic
idea (the counter-will) and that this gave the
tic
its
discontinuous character and confined the antithetic idea to paths
other than the habitual ones for innervating the muscular apparatus
of speech.

Studies On Hysteria

85

   The patient’s spastic
inhibition of speech, her peculiar stammer, was the residue of an
essentially similar exciting cause. Here, however, it was not the
outcome
of the final innervation - the exclamation - but the
process of innervation itself - the attempted convulsive inhibition
of the organs of speech - which was made into a symbol of the event
for her memory.

   These two symptoms, the clacking
and the stammering, which were thus closely related through the
history of their origin, continued to be associated and were turned
into chronic symptoms after being repeated on a similar occasion.
Thereafter they were put to a further use. Having originated at a
moment of violent fright, they were thenceforward joined to any
fright (in accordance with the mechanism of monosymptomatic
hysteria which will be described in Case 5), even when the fright
could not lead to an antithetic idea being put into effect.

   The two symptoms were eventually
linked up with so many traumas, had so much reason for being
reproduced in memory, that they perpetually interrupted the
patient’s speech for no particular cause, in the manner of a
meaningless
tic
. Hypnotic analysis, however, was able to
demonstrate how much meaning lay concealed behind this apparent
tic
; and if the Breuer procedure did not succeed in this
case in getting rid of the two symptoms completely at a single
blow, that was because the catharsis had extended only to the three
principal traumas and not to the secondarily associated
ones.¹

 
¹
I may here be giving an
impression of laying too much emphasis on the details of the
symptoms and of becoming lost in an unnecessary maze of
sign-reading. But I have come to learn that the determination of
hysterical symptoms does in fact extend to their subtlest
manifestations and that it is difficult to attribute too much sense
to them. Let me give an example to justify this statement. Some
months ago I had under my treatment an eighteen-year-old girl
belonging to a family with a bad heredity. Hysteria played its full
part in her complex neurosis. The first thing I heard from her was
a complaint that she suffered from attacks of despair of two
varieties. In one variety she felt drawing and pricking sensations
in the lower part of her face, from her cheeks down towards her
mouth; in the other variety the toes of both her feet were
stretched out convulsively and kept on wriggling about.
To begin with I myself was unwilling to
attach much importance to these details, and there can be no doubt
that earlier students of hysteria would have been inclined to
regard these phenomena as evidence of the stimulation of cortical
centres during a hysterical attack. It is true that we are ignorant
of the locality of the centres for paraesthesias of this kind, but
it is well known that such paraesthesias usher in partial epilepsy
and constitute Charcot’s sensory epilepsy. Symmetrical
cortical areas in the immediate vicinity of the median fissure
might be held responsible for the movement of the toes. But the
explanation turned out to be a different one. When I had come to
know the girl better I put a straight question to her as to what
kind of thoughts came to her during these attacks. I told her not
to be embarrassed and said that she must be able to give an
explanation of the two phenomena. The patient turned red with
shame, but I was able to persuade her in the end, without using
hypnosis, to give the following account, the truth of which was
fully confirmed by her companion, who was present at the time. From
the time when her periods first set in she had suffered for years
from
cephalagia adolescentium
which had made any regular
occupation impossible and had interfered with her education. When
at last she was freed from this disability, this ambitious and
rather simple-minded child was determined to work extremely hard at
her own improvement, so as to catch up once more with her sisters
and contemporaries. In doing so she made quite unreasonable
efforts, and an effort of this kind usually ended in an outburst of
despair at having over-estimated her powers. She also, of course,
compared herself with other girls physically and felt unhappy when
she discovered some physical disadvantage in herself. Her teeth
projected noticeably, and she began to feel upset about this. She
got the idea of correcting the defect by practising for a quarter
of an hour at a time pulling down her upper lip over the projecting
teeth. The failure of these childish efforts once led to a fit of
despair; and thenceforward the drawing and pricking sensations from
the cheek downwards were established as the content of one of her
two varieties of attack. The origin of the other variety - with its
motor symptoms of stretching out and wriggling the toes - was no
less easily found. I was told that her first attack of this kind
followed after an excursion on the Schafberg near Ischl, and her
relatives were naturally inclined to set it down to over-exertion.
But the girl herself told me a different story. It seems that it
was a favourite habit of the sisters to tease one another about the
large size of their feet - an undeniable fact. The patient had long
felt unhappy over this blemish and tried to force her feet into the
tightest possible boots. Her observant father, however, would not
allow this and saw to it that she only wore comfortable-fitting
footgear. She was much dissatisfied with this regulation. She
thought about it all the time and acquired the habit of wriggling
her toes about in her shoes, as people do when they want to
discover whether a shoe is much too large, how much smaller a size
they could take, etc. During the excursion on the Schafberg (which
she was far from finding an exertion) there was once again, of
course, an opportunity for her attention to be drawn to the subject
of shoes, in view of the shortened skirts she wore. One of her
sisters said to her in the course of the walk: ‘You’ve
put extra big shoes on to-day.’ She experimented by wriggling
her toes and got the same impression. Thenceforward she could not
escape from her agitation about the unlucky size of her feet, and
when they got back from the walk her first attack came on; her toes
curled up and moved about involuntarily as a mnemic symbol of the
whole depressing train of thought.

   I
may point out that what we are dealing with here are attacks and
not chronic symptoms. I may also add that after the patient’s
confession her first variety of symptoms ceased, but the second
variety - her attacks of wriggling her toes - persisted. There must
therefore have been something left over, which she had not
confessed.

  
Postscript
. I learnt later that the reason why the foolish
girl worked so hard at beautifying herself was that she wanted to
attract a young cousin of hers. - [
Added
1924:] Some years
later her neurosis turned into a dementia praecox.

Studies On Hysteria

86

   In accordance with the rules
governing hysterical attacks, the exclamation of ‘Emmy’
during her attacks of confusion reproduced, it will be remembered,
her frequent states of helplessness during her daughter’s
treatment. This exclamation was linked to the content of the attack
by a complex train of thought and was in the nature of a protective
formula against the attack. The exclamation would probably, through
a more extended application of its meaning, have degenerated into a
tic
, as had in fact already happened in the case of the
complicated protective formula ‘Don’t touch me’,
etc. In both these instances hypnotic treatment prevented any
further development of the symptoms; but the exclamation
‘Emmy’ had only just come into existence, and I caught
it while it was still on it native soil, restricted to attacks of
confusion.

   As we have seen, these motor
symptoms originated in various ways: by putting an antithetic idea
into effect (as in the clacking), by a simple conversion of
psychical excitation into motor activity (as in the stammering), or
by a voluntary action during a hysterical paroxysm (as in the
protective measures exemplified by the exclamation
‘Emmy’ and the longer formula). But however these motor
symptoms may have originated, they all have this one thing in
common. They can be shown to have an original or long-standing
connection with traumas, and stand as symbols for them in the
activities of the memory.

Studies On Hysteria

87

   Others of the patient’s
somatic symptoms were not of a hysterical nature at all. This is
true, for example, of the neck-cramps, which I regard as a modified
form of migraine and which as such are not to be classed as a
neurosis but as an organic disorder. Hysterical symptoms, however,
regularly become attached to these. Frau von N.’s
neck-cramps, for instance, were employed for the purpose of
hysterical attacks, whereas she did not have the typical
symptomatology of hysterical attacks at her disposal.

   I will amplify this description
of Frau von N.’s psychical state by considering the
pathological changes of consciousness which could be observed in
her. Like her neck-cramps, distressing present-day events (cf. her
last delirium in the garden) or anything which powerfully recalled
any of her traumas brought her into a state of delirium. In such
states - and the few observations I made led me to no other
conclusion - there was a limitation of consciousness and a
compulsion to associate similar to that prevailing in dreams;
hallucinations and illusions were facilitated to the highest degree
and feeble-minded or even nonsensical inferences were made. This
state, which was comparable to one of hallucinatory alienation
probably represented an attack. It might be regarded as an acute
psychosis (serving as the equivalent of an attack) which would be
classified as a condition of ‘hallucinatory confusion’.
A further resemblance between such states of hers and a typical
hysterical attack was shown by the fact that a portion of the
old-established traumatic memories could usually be detected
underlying the delirium. The transition from a normal state to a
delirium often occurred quite imperceptibly. She would be talking
quite rationally at one moment about matters of small emotional
importance, and as her conversation passed on to ideas of a
distressing kind I would notice, from her exaggerated gestures or
the appearance of her regular formulas of speech, etc., that she
was in a state of delirium. At the beginning of the treatment the
delirium lasted all day long; so that it was difficult to decide
with certainty whether any given symptoms - like her gestures -
formed part of her psychical state merely as symptoms of an attack,
or whether - like the clacking and stammering - they had become
genuine chronic symptoms. It was often only possible
after the
event
to distinguish between what had happened in a delirium
and what had happened in her normal state. For the two states were
separated in her memory, and she would sometimes be highly
astonished to hear of the things which the delirium had introduced
piecemeal into her normal conversation. My very first interview
with her was the most remarkable instance of the way in which the
two states were interwoven without paying any attention to each
other. Only at one moment of this psychical see-sawing did it
happen that her normal consciousness, in touch with the present
day, was affected. This was when she gave me an answer which
originated from her delirium and said she was ‘a woman dating
from last century’.

Studies On Hysteria

88

   The analysis of these states of
delirium in Frau von N. was not exhaustively carried out. This was
mainly because her condition improved so rapidly that the deliria
became sharply differentiated from her normal life and were
restricted to the periods of her neck-cramps. On the other hand, I
gathered a great deal of information about the patient’s
behaviour in a third state, that of artificial somnambulism.
Whereas in her normal state she had no knowledge of the psychical
experiences during her deliria and during her somnambulism, she had
access during somnambulism to the memories of all three states. In
point of fact, therefore, she was at her most normal in the state
of somnambulism. Indeed, if I leave on one side the fact that in
somnambulism she was far less reserved with me than she was at her
best moments in ordinary life - that is, that in somnambulism she
gave me information about her family and such things, while at
other times she treated me as a stranger - and if, further, I
disregard the fact that she exhibited the full degree of
suggestibility characteristic of somnambulism, I am bound to say
that during her somnambulism she was in a completely normal state.
It was interesting to notice that on the other hand her
somnambulism showed no trace of being super-normal, but was subject
to all the mental failings that we are accustomed to associate with
a normal state of consciousness.