Freud - Complete Works (30 page)

   We also occasionally come across
this same fact of the traumas accumulated during sick-nursing being
dealt with subsequently, where we get no general impression of
illness but where the mechanism of hysteria is nevertheless
retained. Thus I am acquainted with a highly-gifted lady who
suffers from slight nervous states and whose whole character bears
evidence of hysteria, though she has never had to seek medical help
or been unable to carry on her duties. She has already nursed to
the end three or four of those whom she loved. Each time she
reached a state of complete exhaustion; but she did not fall ill
after these tragic efforts. Shortly after her patient’s
death, however, there would begin in her a work of reproduction
which once more brought up before her eyes the scenes of the
illness and death. Every day she would go through each impression
once more, would weep over it and console herself - at her leisure,
one might say. This process of dealing with her impressions was
dovetailed into her everyday tasks without the two activities
interfering with each other. The whole thing would pass through her
mind in chronological sequence. I cannot say whether the work of
recollection corresponded day by day with the past. I suspect that
this depended on the amount of leisure which her current household
duties allowed.

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   In addition to these outbursts of
weeping with which she made up arrears and which followed close
upon the fatal termination of the illness, this lady celebrated
annual festivals of remembrance at the period of her various
catastrophes, and on these occasions her vivid visual reproduction
and expression of feeling kept to the date precisely. For instance,
on one occasion I found her in tears and asked her sympathetically
what had happened that day. She brushed aside my question
half-angrily: ‘Oh no,’ she said, ‘it is only that
the specialist was here again to-day and gave us to understand that
there was no hope. I had no time to cry about it then.’ She
was referring to the last illness of her husband, who had died
three years earlier. I should be very much interested to know
whether the scenes which she celebrated at these annual festivals
of remembrance were always the same ones or whether different
details presented themselves for abreaction each time, as I suspect
in view of my theory.¹ But I cannot discover with certainty.
The lady, who had no less strength of character than intelligence,
was ashamed of the violent effect produced in her by these
reminiscences.

   I must emphasize once more: this
woman is not ill; her postponed abreaction was not a hysterical
process, however much it resembled one. We may ask why it should be
that one instance of sick-nursing should be followed by a hysteria
and another not. It cannot be a matter of individual
predisposition, for this was present to an ample degree in the lady
I have in mind.

  
¹
I once learnt to my surprise that an
‘abreaction of arrears’ of this kind - though the
impressions concerned were not derived from sick nursing - can form
the subject-matter of an otherwise puzzling neurosis. This was so
in the case of Fräulein Mathilde H., a good-looking,
nineteen-year-old girl. When I first saw her she was suffering from
a partial paralysis of the legs. Some months later, however, she
came to me for treatment on account of a change in her character.
She had become depressed to the point of a
taedium vitae
,
utterly inconsiderate to her mother, irritable and inaccessible.
The patient’s picture as a whole forbad my assuming that this
was a common melancholia. She was very easily put into a state of
deep somnambulism, and I availed myself of this peculiarity of hers
in order to give her commands and suggestions at every visit. She
listened to these in deep sleep, to the accompaniment of floods of
tears; but, apart from this, they caused very little change in her
condition. One day she became talkative in her hypnosis and told me
that the cause of her depression was the breaking off of her
engagement, which had occurred several months earlier. Closer
acquaintance with her fiancé had brought out more and more
things that were unwelcome to her and her mother. On the other
hand, the material advantages of the connection had been too
obvious for it to be easy to decide to break it off. So for a long
time they had both wavered and she herself had fallen into a state
of indecision in which she regarded all that happened to her with
apathy. In the end her mother uttered the decisive negative on her
behalf. A little later she had woken up as though from a dream and
begun to occupy her thoughts busily with the decision that had
already been made and to weigh the pros and cons. This process, she
told me, was still going on: she was living in the period of
doubt, and every day she was possessed by the mood and thoughts
which were appropriate to the day in the past with which she was
occupied. Her irritability with her mother, too, had its basis only
in the circumstances which prevailed at that time.: In comparison
with these activities of her thoughts, her present life seemed like
a mere appearance of reality, like something in a dream. -I did not
succeed in inducing the girl to talk again. I continued to address
her while she was in deep somnambulism and saw her burst into tears
each time without ever answering me; and one day, round about the
anniversary of her engagement, her whole state of depression passed
off - an event which brought me the credit of a great therapeutic
success by hypnotism.

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149

   But I must now return to
Fräulein Elisabeth von R. While she was nursing her father, as
we have seen, she for the first time developed a hysterical symptom
- a pain in a particular area of her right thigh. It was possible
by means of analysis to find an adequate elucidation of the
mechanism of the symptom. It happened at a moment when the circle
of ideas embracing her duties to her sick father came into conflict
with the content of the erotic desire she was feeling at the time.
Under the pressure of lively self-reproaches she decided in favour
of the former, and in doing so brought about her hysterical
pain.

   According to the view suggested
by the conversion theory of hysteria what happened may be described
as follows. She repressed her erotic idea from consciousness and
transformed the amount of its affect into physical sensations of
pain. It did not become clear whether she was presented with this
first conflict on one occasion only or on several; the latter
alternative is the more likely. An exactly similar conflict -
though of higher ethical significance and even more clearly
established by the analysis - developed once more some years later
and led to an intensification of the same pains and to an extension
beyond their original limits. Once again it was a circle of ideas
of an erotic kind that came into conflict with all her moral ideas;
for her inclinations centred upon her brother-in-law, and, both
during her sister’s lifetime and after her death, the thought
of being attracted by precisely this man was totally unacceptable
to her. The analysis provided detailed information about this
conflict, which constituted the central point in the history of the
illness. The germs of the patient’s feeling for her
brother-in-law may have been present for a long time; its
development was favoured by physical exhaustion owing to more
sick-nursing and by moral exhaustion owing to disappointments
extending over many years. The coldness of her nature began to
yield and she admitted to herself her need for a man’s love.
During the several weeks which she passed in his company at the
health resort her erotic feelings as well as her pains reached
their full height.

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   The analysis, moreover, gave
evidence that during the same period the patient was in a special
psychical state. The connection of this state with her erotic
feelings and her pains seems to make it possible to understand what
happened on the lines of the conversion theory. It is, I think,
safe to say that at that time the patient did not become clearly
conscious of her feelings for her brother-in-law, powerful though
they were, except on a few occasions, and then only momentarily. If
it had been otherwise, she would also inevitably have become
conscious of the contradiction between those feelings and her moral
ideas and would have experienced mental torments like those I saw
her go through after our analysis. She had no recollection of any
such sufferings; she had avoided them. It followed that her
feelings themselves did not become clear to her. At that time, as
well as during the analysis, her love for her brother-in-law was
present in her consciousness like a foreign body, without having
entered into relationship with the rest of her ideational life.
With regard to these feelings she was in the peculiar situation of
knowing and at the same time not knowing - a situation, that is, in
which a psychical group was cut off. But this and nothing else is
what we mean when we say that these feelings were not clear to her.
We do not mean that their consciousness was of a lower quality or
of a lesser degree, but that they were cut off from any free
associative connection of thought with the rest of the ideational
content of her mind.

   But how could it have come about
that an ideational group with so much emotional emphasis on it was
kept so isolated? In general, after all, the part played in
association by an idea increases in proportion to the amount of its
affect.

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   We can answer this question if we
take into account two facts which we can make use of as being
established with certainty. (1) Simultaneously with the formation
of this separate psychical group the patient developed her
hysterical pains. (2) The patient offered strong resistance to the
attempt to bring about an association between the separate
psychical group and the rest of the content of her consciousness;
and when, in spite of this, the connection was accomplished she
felt great psychical pain. Our view of hysteria brings these two
facts into relation with the splitting of her consciousness by
asserting that the second of them indicates the
motive
for
the splitting of consciousness, while the first indicates its
mechanism
. The motive was that of defence, the refusal on
the part of the patient’s whole ego to come to terms with
this ideational group. The mechanism was that of conversion: i.e.
in place of the mental pains which she avoided, physical pains made
their appearance. In this way a transformation was effected which
had the advantage that the patient escaped from an intolerable
mental condition; though, it is true, this was at the cost of a
psychical abnormality - the splitting of consciousness that came
about - and of a physical illness - her pains, on which an
astasia-abasia was built up.

   I cannot, I must confess, give
any hint of how a conversion of this kind is brought about. It is
obviously not carried out in the same way as an intentional and
voluntary action. It is a process which occurs under the pressure
of the motive of defence in someone whose organization - or a
temporary modification of it - has a proclivity in that
direction.

   This theory calls for closer
examination. We may ask: what is it that turns into physical pain
here? A cautious reply would be: something that might have become,
and should have become,
mental
pain. If we venture a little
further and try to represent the ideational mechanism in a kind of
algebraical picture, we may attribute a certain quota of affect to
the ideational complex of these erotic feelings which remained
unconscious, and say that this quantity (the quota of affect) is
what was converted. It would follow directly from this description
that the ‘unconscious love’ would have lost so much of
its intensity through a conversion of this kind that it would have
been reduced to no more than a weak idea. This reduction of
strength would then have been the only thing which made possible
the existence of these unconscious feelings as a separate psychical
group. The present case, however, is not well fitted to give a
clear picture of such a delicate matter. For in this case there was
probably only partial conversion; in others it can be shown with
likelihood that complete conversion also occurs, and that in it the
incompatible idea has in fact been ‘repressed’, as only
an idea of very slight intensity can be. The patients concerned
declare, after associative connection with the incompatible idea
has been established, that their thoughts had not been concerned
with it since the appearance of the hysterical symptoms.

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   I have asserted that on certain
occasions, though only for the moment, the patient recognized her
love for her brother-in-Iaw consciously. As an example of this we
may recall the moment when she was standing by her sister’s
bed and the thought flashed through her mind: ‘Now he is free
and you can be his wife’. I must now consider the
significance of these moments in their bearing on our view of the
whole neurosis. It seems to me that the concept of a ‘defence
hysteria’ in itself implies that at least
one
moment
of this kind must have occurred. Consciousness, plainly, does not
know in advance when an incompatible idea is going to crop up. The
incompatible idea, which, together with its concomitants, is later
excluded and forms a separate psychical group, must originally have
been in communication with the main stream of thought. Otherwise
the conflict which led to their exclusion could not have taken
place.¹ It is these moments, then, that are to be described as
‘traumatic’: it is at these moments that conversion
takes place, of which the results are the splitting of
consciousness and the hysterical symptom. In the case of
Fräulein Elisabeth von R. everything points to there having
been several such moments - the scenes of the walk, the morning
reverie, the bath, and at her sister’s bedside. It is even
possible that new moments of the same kind happened during the
treatment. What makes it possible for there to be
several
of
these traumatic moments is that an experience similar to the one
which originally introduced the incompatible idea adds fresh
excitation to the separated psychical group and so puts a temporary
stop to the success of the conversion. The ego is obliged to attend
to this sudden flare-up of the idea and to restore the former state
of affairs by a further conversion. Fräulein Elisabeth, who
was much in her brother-in-law’s company, must have been
particularly liable to the occurrence of fresh traumas. From the
point of view of my present exposition, I should have preferred a
case in which the traumatic history lay wholly in the past.