Freud - Complete Works (31 page)

  
¹
It is otherwise in hypnoid hysteria, where
the content of the separate psychical group would never have been
in the ego-consciousness.

Studies On Hysteria

153

   I must now turn to a point which
I have described as offering a difficulty to the understanding of
this case history. On the evidence of the analysis, I assumed that
a first conversion took place while the patient was nursing her
father, at the time when her duties as a nurse came into conflict
with her erotic desires, and that what happened then was the
prototype of the later events in the Alpine health resort which led
to the outbreak of the illness. But it appeared from the
patient’s account that while she was nursing her father and
during the time that followed - what I have described as the
‘first period’ -
she had no pains whatever and no
locomotor weakness
. It is true that once during her
father’s illness she was laid up for a few days with pains in
her legs, but it remained a question whether this attack was
already to be ascribed to hysteria. No causal connection between
these first pains and any psychical impression could be traced in
the analysis. It is possible, and indeed probable, that what she
was suffering from at that time were common rheumatic muscular
pains. Moreover, even if we were inclined to suppose that this
first attack of pains was the effect of a hysterical conversion as
a result of the repudiation of her erotic thoughts at the time, the
fact remains that the pains disappeared after only a few days, so
that the patient had behaved differently in reality from what she
seemed to indicate in the analysis. During her reproduction of what
I have called the first period she accompanied all her stories
about her father’s illness and death, about her impressions
of her dealings with her first brother-in-law, and so on, with
manifestations of pain, whereas at the time of actually
experiencing these impressions she had felt none. Is not this a
contradiction which is calculated to reduce very considerably our
belief in the explanatory value of an analysis such as this?

   I believe I can solve this
contradiction by assuming that the pains - the products of
conversion - did not occur while the patient was experiencing the
impressions of the first period, but only after the event, that is,
in the second period, while she was reproducing those impressions
in her thoughts. That is to say, the conversion did not take place
in connection with her impressions when they were fresh, but in
connection with her memories of them. I even believe that such a
course of events is nothing unusual in hysteria and indeed plays a
regular part in the genesis of hysterical symptoms. But since an
assertion like this is not self-evident, I will try to make it more
plausible by bringing forward some other instances.

   It once happened to me that a new
hysterical symptom developed in a patient during the actual course
of an analytic treatment of this kind so that I was able to set
about getting rid of it on the day after its appearance. I will
interpolate the main features of the case at this point. It was a
fairly simple one, yet not without interest.

Studies On Hysteria

154

   Fräulein Rosalia H., aged
twenty-three, had for some years been undergoing training as a
singer. She had a good voice, but she complained that in certain
parts of its compass it was not under her control. She had a
feeling of choking and constriction in her throat so that her voice
sounded tight. For this reason her teacher had not yet been able to
consent to her appearing as a singer in public. Although this
imperfection affected only her middle register, it could not be
attributed to a defect in the organ itself. At times the
disturbance was completely absent and her teacher expressed great
satisfaction; at other times, if she was in the least agitated, and
sometimes without any apparent cause, the constricted feeling would
reappear and the production of her voice was impeded. It was not
difficult to recognize a hysterical conversion in this very
troublesome feeling. I did not take steps to discover whether there
was in fact a contracture of some of the muscles of the vocal
cords.¹ In the course of the hypnotic analysis which I carried
out with the girl, I learned the following facts about her history
and consequently about the cause of her trouble. She lost her
parents early in life and was taken to live with an aunt who
herself had numerous children. In consequence of this she became
involved in a most unhappy family life. Her aunt’s husband,
who was a manifestly pathological person, brutally ill-treated his
wife and children. He wounded their feelings more particularly by
the way in which he showed an open sexual preference for the
servants and nursemaids in the house; and the more the children
grew up the more offensive this became. After her aunt’s
death Rosalia became the protector of the multitude of children who
were now orphaned and oppressed by their father. She took her
duties seriously and fought through all the conflicts into which
her position led her, though it required a great effort to suppress
the hatred and contempt which she felt for her uncle.² It was
at this time that the feeling of constriction in her throat
started. Every time she had to keep back a reply, or forced herself
to remain quiet in the face of some outrageous accusation, she felt
a scratching in her throat, a sense of constriction, a loss of
voice - all the sensations localized in her larynx and pharynx
which now interfered with her singing. It was not to be wondered at
that she sought an opportunity of making herself independent and
escaping the agitations and distressing experiences which were of
daily occurrence in her uncle’s house. A highly competent
teacher of singing came to her assistance disinterestedly and
assured her that her voice justified her in choosing the profession
of singer. She now began to take lessons with him in secret. But
she used often to hurry off to her singing lesson while she still
had the constriction in her throat that used to be left over after
violent scenes at home. Consequently a connection was firmly
established between her singing and her hysterical paraesthesia - a
connection for which the way was prepared by the organic sensations
set up by singing. The apparatus over which she ought to have had
full control when she was singing turned out to be cathected with
residues of innervations left over from the numerous scenes of
suppressed emotion. Since then, she had left her uncle’s
house and had moved to another town in order to be away from her
family. But this did not get over her difficulty.

  
¹ I had another
case of a singer under my observation in which a contracture of the
masseters made it impossible for her to practise her art. This
young woman had been obliged to go on the stage by unfortunate
events in her family. She was singing at a rehearsal in Rome at a
time when she was in a state of great emotional excitement, and
suddenly had a feeling that she could not close her open mouth and
fell to the floor in a faint. The doctor who was called in brought
her jaws together forcibly. But thenceforward the patient was
unable to open her jaws by more than a finger’s breadth and
had to give up her new profession. When, several years later, she
came to me for treatment, the causes of her emotional excitement
had obviously long since disappeared, for some massage while she
was in a state of light hypnosis sufficed to enable her mouth to
open wide. Since then the lady has sung in public.

   ²
[
Footnote added
1924:] In this
instance, too, it was in fact the girl’s father, not her
uncle.

Studies On Hysteria

155

   This good-looking and unusually
intelligent girl exhibited no other hysterical symptoms.

   I did my best to get rid of this
‘retention hysteria’ by getting her to reproduce
all her agitating experiences and to abreact them after the event.
I made her abuse her uncle, lecture him, tell him the unvarnished
truth, and so on, and this treatment did her good. Unfortunately,
however, she was living in Vienna under very unfavourable
conditions. She had no luck with her relatives. She was being put
up by another uncle, who treated her in a friendly way; but for
that very reason her aunt took a dislike to her. This woman
suspected that her husband had a deeper interest in his niece, and
therefore chose to make her stay in Vienna as disagreeable as
possible. The aunt herself in her youth had been obliged to give up
a desire for an artistic career and envied her niece for being able
to cultivate her talent, though in the girl’s case it was not
her desire but her need for independence that had determined her
decision. Rosalie felt so constrained in the house that she did not
venture, for instance, to sing or play the piano while her aunt was
within earshot and carefully avoided singing or playing to her
uncle (who, incidentally, was an old man, her mother’s
brother) when there was a possibility of her aunt coming in. While
I was trying to wipe out the traces of old agitations, new ones
arose out of these relations with her host and hostess, which
eventually interfered with the success of my treatment as well as
bringing it to a premature end.

Studies On Hysteria

156

   One day the patient came for her
session with a new symptom, scarcely twenty-four hours old. She
complained of a disagreeable pricking sensation in the tips of her
fingers, which, she said, had been coming on every few hours since
the day before and compelled her to make a peculiar kind of
twitching movement with her fingers. I was not able to observe an
attack; otherwise I should no doubt have been able to guess from
the nature of the movements what it was that had occasioned them.
But I immediately tried to get on the track of the explanation of
the symptom (it was in fact a minor hysterical attack) by hypnotic
analysis. Since the whole thing had only been in existence such a
short time I hoped that I should quickly be able to explain and get
rid of the symptom. To my astonishment the patient produced a whole
number of scenes, without hesitation and in chronological order,
beginning with her early childhood. They seemed to have in common
her having had some injury done to her, against which she had not
been able to defend herself, and which might have made her fingers
jerk. They were such scenes, for instance, as of having had to hold
out her hand at school and being struck on it with a ruler by her
teacher. But they were quite ordinary occasions and I should have
been prepared to deny that they could play a part in the aetiology
of a hysterical symptom. But it was otherwise with one scene from
her girlhood which followed. Her bad uncle, who was suffering from
rheumatism, had asked her to massage his back and she did not dare
to refuse. He was lying in bed at the time, and suddenly threw off
the bed-clothes, sprang up and tried to catch hold of her and throw
her down. Massage, of course, was at an end, and a moment later she
had escaped and locked herself in her room. She was clearly loth to
remember this and was unwilling to say whether she had seen
anything when he suddenly uncovered himself. The sensations in her
fingers might be explained in this case by a suppressed impulse to
punish him, or simply by her having been engaged in massaging him
at the time. It was only after relating this scene that she came to
the one of the day before, after which the sensations and jerking
in her fingers had set in as a recurrent mnemic symbol. The uncle
with whom she was now living had asked her to play him something.
She sat down to the piano and accompanied herself in a song,
thinking that her aunt had gone out; but suddenly she appeared in
the door. Rosalie jumped up, slammed the lid of the piano and threw
the music away. We can guess what the memory was that rose in her
mind and what the train of thought was that she was fending off at
that moment: it was a feeling of violent resentment at the unjust
suspicion to which she was subjected and which should have made her
leave the house, while in fact she was obliged to stay in Vienna on
account of the treatment and had nowhere else where she could be
put up. The movement of her fingers which I saw her make while she
was reproducing this scene was one of twitching something away, in
the way in which one literally and figuratively brushes something
aside - tosses away a piece of paper or rejects a suggestion.

Studies On Hysteria

157

   She was quite definite in her
insistence that she had not noticed this symptom previously - that
it had not been occasioned by the scenes she had first described.
We could only suppose, therefore, that the event of the previous
day had in the first instance aroused the memory of earlier events
with a similar subject-matter and that thereupon a mnemic symbol
had been formed which applied to the whole group of memories. The
energy for the conversion had been supplied, on the one hand, by
freshly experienced affect and, on the other hand, by recollected
affect.

   When we consider the question
more closely we must recognize that a process of this kind is the
rule rather than the exception in the genesis of hysterical
symptoms. Almost invariably when I have investigated the
determinants of such conditions what I have come upon has not been
a
single
traumatic cause but a group of similar ones. (This
is well exemplified in the case of Frau Emmy - Case History 2.) In
some of these instances it could be established that the symptom in
question had already appeared for a short time after the first
trauma and had then passed off, till it was brought on again and
stabilized by a succeeding trauma. There is, however, in principle
no difference between the symptom appearing in this temporary way
after its first provoking cause and its being latent from the
first. Indeed, in the great majority of instances we find that a
first trauma has left no symptom behind, while a later trauma of
the same kind produces a symptom, and yet that the latter could not
have come into existence without the co-operation of the earlier
provoking cause; nor can it be cleared up without taking all the
provoking causes into account.