Freud - Complete Works (23 page)

   And now, under the pressure of my
hand, the memory of a third and still earlier scene emerged, which
was the really operative trauma and which had given the scene with
the chief accountant its traumatic effectiveness. It had happened a
few months earlier still that a lady who was an acquaintance of her
employer’s came to visit them, and on her departure kissed
the two children on the mouth. Their father, who was present,
managed to restrain himself from saying anything to the lady, but
after she had gone, his fury burst upon the head of the unlucky
governess. He said he held her responsible if anyone kissed the
children on the mouth, that it was her duty not to permit it and
that she was guilty of a dereliction of duty if she allowed it; if
it ever happened again he would entrust his children’s
upbringing to other hands. This had happened at a time when she
still thought he loved her, and was expecting a repetition of their
first friendly talk. The scene had crushed her hopes. She had said
to herself: ‘If he can fly out at me like, this and make such
threats over such a trivial matter, and one for which, moreover, I
am not in the least responsible, I must have made a mistake. He can
never have had any warm feelings for me, or they would have taught
him to treat me with more consideration.’ - It was obviously
the recollection of this distressing scene which had come to her
when the chief accountant had tried to kiss the children and had
been reprimanded by their father.

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   After this last analysis, when,
two days later, Miss Lucy visited me once more, I could not help
asking her what had happened to make her so happy. She was as
though transfigured. She was smiling and carried her head high. I
thought for a moment that after all I had been wrong about the
situation, and that the children’s governess had become the
Director’s fiancée. But she dispelled my notion.
‘Nothing has happened. It’s just that you don’t
know me. You have only seen me ill and depressed. I’m always
cheerful as a rule. When I woke yesterday morning the weight was no
longer on my mind, and since then I have felt well.’ -
‘And what do you think of your prospects in the house?’
- ‘I am quite clear on the subject. I know I have none, and I
shan’t make myself unhappy over it.’ - ‘And will
you get on all right with the servants now?’ - ‘I think
my own oversensitiveness was responsible for most of that.’ -
‘And are you still in love with your employer?’ -
‘Yes, I certainly am, but that makes no difference. After
all, I can have thoughts and feelings to myself.’

   I then examined her nose and
found that its sensitivity to pain and reflex excitability had been
almost completely restored. She was also able to distinguish
between smells, though with uncertainty and only if they were
strong. I must leave it an open question, however, how far her
nasal disorder may have played a part in the impairment of her
sense of smell.

   This treatment lasted in all for
nine weeks. Four months later I met the patient by chance in one of
our summer resorts. She was in good spirits and assured me that her
recovery had been maintained.

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DISCUSSION

   I am not inclined to
under-estimate the importance of the case that I have here
described, even though the patient was suffering only from a slight
and mild hysteria and though only a few symptoms were involved. On
the contrary it seems to me in instructive fact that even an
illness such as this, so unproductive when regarded as a neurosis,
called for so many psychical determinants. Indeed, when I consider
this case history more closely, I am tempted to regard it as a
model instance of one particular type of hysteria, namely the form
of this illness which can be acquired even by a person of sound
heredity, as a result of appropriate experiences. It should be
understood that I do not mean by this a hysteria which is
independent of
any
pre-existing disposition. It is probable
that no such hysteria exists. But we do not recognize a disposition
of this sort in a subject until he has actually become a hysteric;
for previously there was no evidence of its existence. A
neuropathic disposition, as generally understood, is something
different. It is already marked out before the onset of the illness
by the amount of the subject’s hereditary taint or the sum of
his individual psychical abnormalities. So far as my information
goes, there was no trace in Miss Lucy R. of either of these
factors. Her hysteria can therefore be described as an acquired
one, and it presupposed nothing more than the possession of what is
probably a very widespread proclivity - the proclivity to acquire
hysteria. We have as yet scarcely a notion of what the features of
this proclivity may be. In cases of this kind, however, the main
emphasis falls upon the nature of the trauma, though taken in
conjunction, of course, with the subject’s reaction to it. It
turns out to be a
sine qua non
for the acquisition of
hysteria that an incompatibility should develop between the ego and
some idea presented to it. I hope to be able to show elsewhere how
different neurotic disturbances arise from the different methods
adopted by the ‘ego’ in order to escape from this
incompatibility. The hysterical method of defence - for which, as
we have seen, the possession of a particular proclivity is
necessary - lies in the conversion of the excitation into a somatic
innervation; and the advantage of this is that the incompatible
idea is repressed from the ego’s consciousness. In exchange,
that consciousness now contains the physical reminiscence which has
arisen through conversion (in our case, the patient’s
subjective sensations of smell) and suffers from the affect which
is more or less clearly attached to precisely that reminiscence.
The situation which has thus been brought about is now not
susceptible to further change; for the incompatibility which would
have called for a removal of the affect no longer exists, thanks to
the repression and conversion. Thus the mechanism which produces
hysteria represents on the one hand an act of moral cowardice and
on the other a defensive measure which is at the disposal of the
ego. Often enough we have to admit that fending off increasing
excitations by the generation of hysteria is, in the circumstances,
the most expedient thing to do; more frequently, of course, we
shall conclude that a greater amount of moral courage would have
been of advantage to the person concerned.

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   The actual traumatic moment,
then, is the one at which the incompatibility forces itself upon
the ego and at which the latter decides on the repudiation of the
incompatible idea. That idea is not annihilated by a repudiation of
this kind, but merely repressed into the unconscious. When this
process occurs for the first time there comes into being a nucleus
and centre of crystallization for the formation of a psychical
group divorced from the ego - a group around which everything which
would imply an acceptance of the incompatible idea subsequently
collects. The splitting of consciousness in these cases of acquired
hysteria is accordingly a deliberate and intentional one. At least
it is often
introduced
by an act of volition; for the actual
outcome is something different from what the subject intended. What
he wanted was to do away with an idea, as though it had never
appeared, but all he succeeds in doing is to isolate it
psychically.

   In the history of our present
patient the traumatic moment was the moment of her employer’s
outburst against her about his children being kissed by the lady.
For a time, however, that scene had no manifest effect. (It may be
that her oversensitiveness and low spirits began from it, but I
cannot say.) Her hysterical symptoms did not start until later, at
moments which may be described as ‘auxiliary’. The
characteristic feature of such an auxiliary moment is, I believe,
that the two divided psychical groups temporarily converge in it,
as they do in the extended consciousness which occurs in
somnambulism. In Miss Lucy R.’s case the first of the
auxiliary moments, at which conversion took place, was the scene at
table when the chief accountant tried to kiss the children. Here
the traumatic memory was playing a part: she did not behave as
though she had got rid of everything connected with her devotion to
her employer. (In the history of other cases these different
moments coincide; conversion occurs as an immediate effect of the
trauma.)

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   The second auxiliary moment
repeated the mechanism of the first one fairly exactly. A powerful
impression temporarily reunited the patient’s consciousness,
and conversion once more took the path which had been opened out on
the first occasion. It is interesting to notice that the second
symptom to develop masked the first, so that the first was not
clearly perceived until the second had been cleared out of the way.
It also seems to me worth while remarking upon the reversed course
which had to be followed by the analysis as well. I have had the
same experience in a whole number of cases; the symptoms that had
arisen later masked the earlier ones, and the key to the whole
situation lay only in the last symptom to be reached by the
analysis.

   The therapeutic process in this
case consisted in compelling the psychical group that had been
split off to unite once more with the ego-consciousness. Strangely
enough, success did not run
pari passu
with the amount of
work done. It was only when the last piece of work had been
completed that recovery suddenly took place.

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CASE
4

KATHARINA ----
  (Freud)

In the summer vacation of the year 189–
I made an excursion into the Hohe Tauern so that for a while I
might forget medicine and more particularly the neuroses. I had
almost succeeded in this when one day I turned aside from the main
road to climb a mountain which lay somewhat apart and which was
renowned for its views and for its well-run refuge hut. I reached
the top after a strenuous climb and, feeling refreshed and rested,
was sitting deep in contemplation of the charm of the distant
prospect. I was so lost in thought that at first I did not connect
it with myself when these words reached my ears: ‘Are you a
doctor, sir?’ But the question was addressed to me, and by
the rather sulky-looking girl of perhaps eighteen who had served my
meal and had been spoken to by the landlady, as
‘Katharina’. To judge by her dress and bearing, she
could not be a servant, but must no doubt be a daughter or relative
of the landlady’s.

   Coming to myself I replied:
‘Yes, I’m a doctor: but how did you know
that?’

   ‘You wrote your name in the
Visitors’ Book, sir. And I thought if you had a few moments
to spare . . . The truth is, sir, my nerves are bad.
I went to see a doctor in L-- about them and he gave me something
for them; but I’m not well yet.’

   So there I was with the neuroses
once again - for nothing else could very well be the matter with
this strong, well-built girl with her unhappy look. I was
interested to find that neuroses could flourish in this way at a
height of over 6,000 feet; I questioned her further therefore. I
report the conversation that followed between us just as it is
impressed on my memory and I have not altered the patient’s
dialect.

   ‘Well, what is it you
suffer from?’

   ‘I get so out of breath.
Not always. But sometimes it catches me so that I think I shall
suffocate.’

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   This did not, at first sight,
sound like a nervous symptom. But soon it occurred to me that
probably it was only a description that stood for an anxiety
attack: she was choosing shortness of breath out of the complex of
sensations arising from anxiety and laying undue stress on that
single factor.

   ‘Sit down here. What is it
like when you get "out of breath"?’

   ‘It comes over me all at
once. First of all it’s like something pressing on my eyes.
My head gets so heavy, there’s a dreadful buzzing, and I feel
so giddy that I almost fall over. Then there’s something
crushing my chest so that I can’t get my breath.’

   ‘And you don’t notice
anything in your throat?’

   ‘My throat’s squeezed
together as though I were going to choke.’

   ‘Does anything else happen
in your head?’

   ‘Yes, there’s a
hammering, enough to burst it.’

   ‘And don’t you feel
at all frightened while this is going on?’

   ‘I always think I’m
going to die. I’m brave as a rule and go about everywhere by
myself - into the cellar and all over the mountain. But on a day
when that happens I don’t dare to go anywhere; I think all
the time someone’s standing behind me and going to catch hold
of me all at once.’

   So it was in fact an anxiety
attack, and introduced by the signs of a hysterical
‘aura’ - or, more correctly, it was a hysterical attack
the content of which was anxiety. Might there not probably be some
other content as well?

   ‘When you have an attack do
you think of something and always the same thing? or do you see
something in front of you?’

   ‘Yes. I always see an awful
face that looks at me in a dreadful way, so that I 'm
frightened.’

   Perhaps this might offer a quick
means of getting to the heart of the matter.

   ‘Do you recognize the face?
I mean, is it a face that you’ve really seen some
time?’