Freud - Complete Works (245 page)

Fragment Of An Analysis Of A Case Of Hysteria

1384

   An opportunity very soon occurred
for interpreting Dora’s nervous cough in this way by means of
an imagined sexual situation. She had once again been insisting
that Frau K. only loved her father because he was ‘
ein
vermögender Mann
[‘a man of means’]. Certain
details of the way in which she expressed herself (which I pass
over here, like most other purely technical parts of the analysis)
led me to see that behind this phrase its opposite lay concealed,
namely, that her father was ‘
ein unvermögender
Mann
’ [‘a man without means’]. This could
only be meant in a sexual sense - that her father, as a man, was
without means, was impotent.¹ Dora confirmed this
interpretation from her conscious knowledge; whereupon I pointed
out the contradiction she was involved in if on the one hand she
continued to insist that her father’s relation with Frau K.
was a common love-affair, and on the other hand maintained that her
father was impotent, or in other words incapable of carrying on an
affair of such a kind. Her answer showed that she had no need to
admit the contradiction. She knew very well, she said, that there
was more than one way of obtaining sexual gratification. (The
source of this piece of knowledge, however, was once more
untraceable.) I questioned her further, whether she referred to the
use of organs other than the genitals for the purpose of sexual
intercourse, and she replied in the affirmative. I could then go on
to say that in that case she must be thinking of precisely those
parts of the body which in her case were in a state of irritation,
- the throat and the oral cavity. To be sure, she would not hear of
going so far as this in recognizing her own thoughts; and indeed,
if the occurrence of the symptom was to be made possible at all, it
was essential that she should not be completely clear on the
subject. But the conclusion was inevitable that with her spasmodic
cough, which, as is usual, was referred for its exciting stimulus
to a tickling in her throat, she pictured to herself a scene of
sexual gratification
per os
between the two people whose
love-affair occupied her mind so incessantly. A very short time
after she had tacitly accepted this explanation her cough vanished
- which fitted in very well with my view; but I do not wish to lay
too much stress upon this development, since her cough had so often
before disappeared spontaneously.

  
¹
[‘
Unvermögend
’
means literally ‘unable’, and is commonly used in the
sense of both ‘not rich’ and
‘impotent’.]

Fragment Of An Analysis Of A Case Of Hysteria

1385

   This short piece of the analysis
may perhaps have excited in the medical reader - apart from the
scepticism to which he is entitled - feelings of astonishment and
horror; and I am prepared at this point to look into these two
reactions so as to discover whether they are justifiable. The
astonishment is probably caused by my daring to talk about such
delicate and unpleasant subjects to a young girl - or, for that
matter, to any woman who is sexually active. The horror is aroused,
no doubt, by the possibility that an inexperienced girl could know
about practices of such a kind and could occupy her imagination
with them. I would advise recourse to moderation and reasonableness
upon both points. There is no cause for indignation either in the
one case or in the other. It is possible for a man to talk to girls
and women upon sexual matters of every kind without doing them harm
and without bringing suspicion upon himself, so long as, in the
first place, he adopts a particular way of doing it, and, in the
second place, can make them feel convinced that it is unavoidable.
A gynaecologist, after all, under the same conditions, does not
hesitate to make them submit to uncovering every possible part of
their body. The best way of speaking about such things is to be dry
and direct; and that is at the same time the method furthest
removed from the prurience with which the same subjects are handled
in ‘society’, and to which girls and women alike are so
thoroughly accustomed. I call bodily organs and processes by their
technical names, and I tell these to the patient if they - the
names, I mean - happen to be unknown to her.
J’appelle un
chat un chat
. I have certainly heard of some people - doctors
and laymen - who are scandalized by a therapeutic method in which
conversations of this sort occur, and who appear to envy either me
or my patients the titillation which, according to their notions,
such a method must afford. But I am too well acquainted with the
respectability of these gentry to excite myself over them. I shall
avoid the temptation of writing a satire upon them. But there is
one thing that I will mention: often, after I have for some time
treated a patient who had not at first found it easy to be open
about sexual matters, I have had the satisfaction of hearing her
exclaim: ‘Why, after all, your treatment is far more
respectable than Mr. X.’s conversation!’

Fragment Of An Analysis Of A Case Of Hysteria

1386

   No one can undertake the
treatment of a case of hysteria until he is convinced of the
impossibility of avoiding the mention of sexual subjects, or unless
he is prepared to allow himself to be convinced by experience. The
right attitude is: ‘
pour faire une omlette il faut casser
des oeufs
.’ The patients themselves are easy to convince;
and there are only too many opportunities of doing so in the course
of the treatment. There is no necessity for feeling any compunction
at discussing the facts of normal or abnormal sexual life with
them. With the exercise of a little caution all that is done is to
translate into conscious ideas what was already known in the
unconscious; and, after all, the whole effectiveness of the
treatment is based upon our knowledge that the affect attached to
an unconscious idea operates more strongly and, since it cannot be
inhibited, more injuriously than the affect attached to a conscious
one. There is never any danger of corrupting an inexperienced girl.
For where there is no knowledge of sexual processes even in the
unconscious, no hysterical symptom will arise; and where hysteria
is found there can no longer be any question of ‘innocence of
mind’ in the sense in which parents and educators use the
phrase. With children of ten, of twelve, or of fourteen, with boys
and girls alike, I have satisfied myself that the truth of this
statement can invariably be relied upon.

Fragment Of An Analysis Of A Case Of Hysteria

1387

   As regards the second kind of
emotional reaction, which is not directed against me this time, but
against my patient - supposing that my view of her is correct - and
which regards the perverse nature of her phantasies as horrible, I
should like to say emphatically that a medical man has no business
to indulge in such passionate condemnation. I may also remark in
passing that it seems to me superfluous for a physician who is
writing upon the aberrations of the sexual instincts to seize every
opportunity of inserting into the text expressions of his personal
repugnance at such revolting things. We are faced by a fact; and it
is to be hoped that we shall grow accustomed to it, when we have
put our own tastes on one side. We must learn to speak without
indignation of what we call the sexual perversions - instances in
which the sexual function has extended its limits in respect either
to the part of the body concerned or to the sexual object chosen.
The uncertainty in regard to the boundaries of what is to be called
normal sexual life, when we take different races and different
epochs into account, should in itself be enough to cool the
zealot’s ardour. We surely ought not to forget that the
perversion which is the most repellent to us, the sensual love of a
man for a man, was not only tolerated by a people so far our
superiors in cultivation as were the Greeks, but was actually
entrusted by them with important social functions. The sexual life
of each one of us extends to a slight degree - now in this
direction, now in that - beyond the narrow lines imposed as the
standard of normality. The perversions are neither bestial nor
degenerate in the emotional sense of the word. They are a
development of germs all of which are contained in the
undifferentiated sexual disposition of the child, and which, by
being suppressed or by being diverted to higher, asexual aims - by
being ‘sublimated’ - are destined to provide the energy
for a great number of our cultural achievements. When, therefore,
any one has
become
a gross and manifest pervert, it would be
more correct to say that he has
remained
one, for he
exhibits a certain stage of
inhibited development
. All
psychoneurotics are persons with strongly marked perverse
tendencies, which have been repressed in the course of their
development and have become unconscious. Consequently their
unconscious
phantasies
show precisely the same content as
the documentarily recorded
actions
of perverts - even though
they have not read Krafft-Ebing’s
Psychopathia
Sexualis
, to which simple-minded people attribute such a large
share of the responsibility for the production of perverse
tendencies. Psychoneuroses are, so to speak, the
negative
of
perversions. In neurotics their sexual constitution, under which
the effects of heredity are included, operates in combination with
any accidental influences in their life which may disturb the
development of normal sexuality. A stream of water which meets with
an obstacle in the river-bed is dammed up and flows back into old
channels which had formerly seemed fated to run dry. The motive
forces leading to the formation of hysterical symptoms draw their
strength not only from repressed
normal
sexuality but also
from unconscious perverse activities.¹

  
¹
These remarks upon the sexual perversions
had been written some years before the appearance of Bloch’s
excellent book (
Beiträge zur Äetiologie der
Psychopathia sexualis
, 1902 and 1903). See also my
Three
Essays on the Theory of Sexuality
, published this
year.

Fragment Of An Analysis Of A Case Of Hysteria

1388

   The less repellent of the
so-called sexual perversions are very widely diffused among the
whole population, as every one knows except medical writers upon
the subject. Or, I should rather say, they know it too; only they
take care to forget it at the moment when they take up their pens
to write about it. So it is not to be wondered at that this
hysterical girl of nearly nineteen, who had heard of the occurrence
of such a method of sexual intercourse ( sucking at the male
organ), should have developed an unconscious phantasy of this sort
and should have given it expression by an irritation in her throat
and by coughing. Nor would it have been very extraordinary if she
had arrived at such a phantasy even without having had any
enlightenment from external sources - an occurrence which I have
quite certainly observed in other patients. For in her case a
noteworthy fact afforded the necessary somatic prerequisite for
this independent creation of a phantasy which would coincide with
the practices of perverts. She remembered very well that in her
childhood she had been a thumb-sucker. Her father, too recollected
breaking her of the habit after it had persisted into her fourth or
fifth year. Dora herself had a clear picture of a scene from her
early childhood in which she was sitting on the floor in a corner
sucking her left thumb and at the same time tugging with her right
hand at the lobe of her brother’s ear as he sat quietly
beside her. Here we have an instance of the complete form of
self-gratification by sucking, as it has also been described to me
by other patients, who had subsequently become anaesthetic and
hysterical.

Fragment Of An Analysis Of A Case Of Hysteria

1389

   One of these patients gave me a
piece of information which sheds a clear light on the origin of
this curious habit. This young woman had never broken herself of
the habit of sucking. She retained a memory of her childhood,
dating back, according to her, to the first half of her second
year, in which she saw herself sucking at her nurse’s breast
and at the same time pulling rhythmically at the lobe of her
nurse’s ear. No one will feel inclined to dispute, I think,
that the mucous membrane of the lips and mouth is to be regarded as
a primary ‘erotogenic zone’, since it preserves this
earlier significance in the act of kissing, which is looked upon as
normal. An intense activity of this erotogenic zone at an early age
thus determines the subsequent presence of a somatic compliance on
the part of the tract of mucous membrane which begins at the lips.
Thus, at a time when the sexual object proper, that is, the male
organ, has already become known, circumstances may arise which once
more increase the excitation of the oral zone, whose erotogenic
character has, as we have seen, been retained. It then needs very
little creative power to substitute the sexual object of the moment
(the penis) for the original object (the nipple) or for the finger
which does duty for it, and to place the current sexual object in
the situation in which gratification was originally obtained. So we
see that this excessively repulsive and perverted phantasy of
sucking at a penis has the most innocent origin. It is a new
version of what may be described as a prehistoric impression of
sucking at the mother’s or nurse’s breast - an
impression which has usually been revived by contact with children
who are being nursed. In most instances a cow’s udder has
aptly played the part of an image intermediate between a nipple and
a penis.