Freud - Complete Works (379 page)
¹
Studies on Hysteria
.
Five Lectures On Psycho-Analysis
2204
No doubt you will now ask me for
some further instances of the causation of hysterical symptoms
besides the one I have already given you of a fear of water
produced by disgust at a dog drinking out of a glass. But if I am
to keep to my programme I shall have to restrict myself to very few
examples. In regard to the patient’s disturbances of vision,
for instance, Breuer describes how they were traced back to
occasions such as one on which, ‘when she was sitting by her
father’s bedside with tears in her eyes, he suddenly asked
her what time it was. She could not see clearly; she made a great
effort, and brought her watch near to her eyes. The face of the
watch now seemed very big - thus accounting for her macropsia and
convergent squint. Or again, she tried hard to suppress her tears
so that the sick man should not see them.’¹ Moreover,
all of the pathogenic impressions came from the period during which
she was helping to nurse her sick father. ‘She once woke up
during the night in great anxiety about the patient, who was in a
high fever; and she was under the strain of expecting the arrival
of a surgeon from Vienna who was to operate. Her mother had gone
away for a short time and Anna was sitting at the bedside with her
right arm over the back of her chair. She fell into a waking dream
and saw a black snake coming towards the sick man from the wall to
bite him. (It is most likely that there were in fact snakes in the
field behind the house and that these had previously given the girl
a fright; they would thus have provided the material for her
hallucination.) She tried to keep the snake off, but it was as
though she was paralysed. Her right arm, over the back of the
chair, had gone to sleep, and had become anaesthetic and paretic;
and when she looked at it the fingers turned into little snakes
with death’s heads (the nails). (It seems probable that she
had tried to use her paralysed right hand to drive off the snake
and that its anaesthesia and paralysis has consequently become
associated with the hallucination of the snake.) When the snake
vanished, in her terror she tried to pray. But language failed her:
she could find no tongue in which to speak, till at last she
thought of some children’s verses in English and then found
herself able to think and pray in that language.’¹ When
the patient had recollected this scene in hypnosis, the rigid
paralysis of her left arm, which had persisted since the beginning
of her illness, disappeared, and the treatment was brought to an
end.
¹
Studies on Hysteria
.
Five Lectures On Psycho-Analysis
2205
When, some years later, I began
to employ Breuer’s method of examination and treatment on
patients of my own, my experiences agreed entirely with his. A
lady, aged about forty, suffered from a
tic
consisting of a
peculiar ‘clacking’ sound which she produced whenever
she was excited, or sometimes for no visible reason. It had its
origin in two experiences, whose common element lay in the fact
that at the moment of their occurrence she had formed a
determination not to make any noise, and in the fact that on both
these occasions a kind of counter-will led her to break the silence
with this same sound. On the first of these occasions one of her
children had been ill, and, when she had at last with great
difficulty succeeded in getting it off to sleep, she had said to
herself that she must keep absolutely still so as not to wake it.
On the other occasion, while she was driving with her two children
in a thunderstorm, the horses had bolted and she had carefully
tried to avoid making any noise for fear of frightening them even
more.¹ I give you this one example out of a number of others
which are reported in the
Studies on Hysteria
.²
¹
Studies on Hysteria
.
²
Extracts from that volume, together with
some later writings of mine on hysteria, are now to be had in an
English translation prepared by Dr. A. A. Brill of New
York.
Five Lectures On Psycho-Analysis
2206
Ladies and Gentlemen, if I may be
allowed to generalize - which is unavoidable in so condensed an
account as this - I should like to formulate what we have learned
so far as follows:
our hysterical patients suffer from
reminiscences
. Their symptoms are residues and mnemic symbols
of particular (traumatic) experiences. We may perhaps obtain a
deeper understanding of this kind of symbolism if we compare them
with other mnemic symbols in other fields. The monuments and
memorials with which large cities are adorned are also mnemic
symbols. If you take a walk through the streets of London, you will
find, in front of one of the great railway termini, a richly carved
Gothic column - Charing Cross. One of the old Plantagenet kings of
the thirteenth century ordered the body of his beloved Queen
Eleanor to be carried to Westminster; and at every stage at which
the coffin rested he erected a Gothic cross. Charing Cross is the
last of the monuments that commemorate the funeral
cortège.¹ At another point in the same town, not far
from London Bridge, you will find a towering, and more modern,
column, which is simply known as ‘The Monument’. It was
designed as a memorial of the Great Fire, which broke out in that
neighbourhood in 1666 and destroyed a large part of the city. These
monuments, then, resemble hysterical symptoms in being mnemic
symbols; up to that point the comparison seems justifiable. But
what should we think of a Londoner who paused to-day in deep
melancholy before the memorial of Queer Eleanor’s funeral
instead of going about his business in the hurry that modern
working conditions demand or instead of feeling joy over the
youthful queen of his own heart? Or again what should we think of a
Londoner who shed tears before the Monument that commemorates the
reduction of his beloved metropolis to ashes although it has long
since risen again in far greater brilliance? Yet every single
hysteric and neurotic behaves like these two unpractical Londoners.
Not only do they remember painful experiences of the remote past,
but they still cling to them emotionally; they cannot get free of
the past and for its sake they neglect what is real and immediate.
This fixation of mental life to pathogenic traumas is one of the
most significant and practically important characteristics of
neurosis.
I am quite ready to allow the
justice of an objection that you are probably raising at this
moment on the basis of the case history of Breuer’s patient.
It is quite true that all her traumas dated from the period when
she was nursing her sick father and that her symptoms can only be
regarded as mnemic signs of his illness and death. Thus they
correspond to a display of mourning, and there is certainly nothing
pathological in being fixated to the memory of a dead person so
short a time after his decease; on the contrary, it would be a
normal emotional process. I grant you that in the case of
Breuer’s patient there is nothing striking in her fixation to
her trauma. But in other cases - such as that of the
tic
that I treated myself, where the determinants dated back more than
fifteen and ten years - the feature of an abnormal attachment to
the past is very clear; and it seems likely that Breuer’s
patient would have developed a similar feature if she had not
received cathartic treatment so soon after experiencing the traumas
and developing the symptoms.
¹
Or rather, it is a modern copy of one of
these monuments. As Dr. Ernest Jones tells me, the name
‘Charing’ is believed to be derived from the words
‘
chère reine
’.
Five Lectures On Psycho-Analysis
2207
So far we have only been
discussing the relations between a patient’s hysterical
symptoms and the events of her life. There are, however, two
further factors in Breuer’s observation which enable up to
form some notion of how the processes of falling ill and of
recovering occur.
In the first place, it must be
emphasized that Breuer’s patient, in almost all her
pathogenic situations, was obliged to
suppress
a powerful
emotion instead of allowing its discharge in the appropriate signs
of emotion, words or actions. In the episode of her
lady-companion’s dog, she suppressed any manifestation of her
very intense disgust, out of consideration for the woman’s
feelings; while she watched at her father’s bedside she was
constantly on the alert to prevent the sick man from observing her
anxiety and her painful depression. When subsequently she
reproduced these scenes in her doctor’s presence the affect
which had been inhibited at the time emerged with peculiar
violence, as though it had been saved up for a long time. Indeed,
the symptom which was left over from one of these scenes would
reach its highest pitch of intensity at the time when its
determining cause was being approached, only to vanish when that
cause had been fully ventilated. On the other hand, it was found
that no result was produced by the recollection of a scene in the
doctor’s presence if for some reason the recollection took
place without any generation of affect. Thus it was what happened
to these affects, which might be regarded as displaceable
magnitudes, that was the decisive factor both for the onset of
illness and for recovery. One was driven to assume that the illness
occurred because the affects generated in the pathogenic situations
had their normal outlet blocked, and that the essence of the
illness lay in the fact that these ‘strangulated’
affects were then put to an abnormal use. In part they remained as
a permanent burden upon the patient’s mental life and a
source of constant excitation for it; and in part they underwent a
transformation into unusual somatic innervations and inhibitions,
which manifested themselves as the physical symptoms of the case.
For this latter process we coined the term ‘hysterical
conversion’. Quite apart from this, a certain portion of our
mental excitation is normally directed along the paths of somatic
innervation and produces what we know as an ‘expression
of the emotions’. Hysterical conversion exaggerates this
portion of the discharge of an emotionally cathected mental
process; it represents a far more intense expression of the
emotions, which has entered upon a new path. When the bed of a
stream is divided into two channels, then, if the current in one of
them is brought up against an obstacle, the other will at once be
overfilled. As you see, we are on the point of arriving at a purely
psychological theory of hysteria, with affective processes in the
front rank.
Five Lectures On Psycho-Analysis
2208
A second observation of
Breuer’s, again, compels us to attach great importance, among
the characteristics of the pathological chain of events, to states
of consciousness. Breuer’s patient exhibited, alongside of
her normal state, a number of mental peculiarities: conditions of
‘
absence
’, confusion, and alterations of
character. In her normal state she knew nothing of the pathogenic
scenes or their connection with her symptoms; she had forgotten the
scenes, or at all events had severed the pathogenic link. When she
was put under hypnosis, it was possible, at the expense of a
considerable amount of labour, to recall the scenes to her memory;
and, through this work of recollecting, the symptoms were removed.
The explanation of this fact would be a most awkward business, were
it not that the way is pointed by experiences and experiments in
hypnotism. The study of hypnotic phenomena has accustomed us to
what was at first a bewildering realization that in one and the
same individual there can be several mental groupings, which can
remain more or less independent of one another, which can
‘know nothing’ of one another and which can alternate
with one another in their hold upon consciousness. Cases of this
kind, too, occasionally appear spontaneously, and are then
described as examples of ‘
double
conscience
’.¹ If, where a splitting of the
personality such as this has occurred, consciousness remains
attached regularly to one of the two states, we call it the
conscious
mental state and the other, which is detached from
it, the
unconscious
one. In the familiar condition known as
‘post-hypnotic suggestion’, a command given under
hypnosis is slavishly carried out subsequently in the normal state.
This phenomenon affords an admirable example of the influences
which the unconscious state can exercise over the conscious one;
moreover, it provides a pattern upon which we can account for the
phenomena of hysteria. Breuer adopted a hypothesis that hysterical
symptoms arise in peculiar mental conditions to which he gave the
name of ‘hypnoid’. On this view, excitations occurring
during these hypnoid states can easily become pathogenic because
such states do not provide opportunities for the normal discharge
of the process of excitation. There consequently arises from the
process of excitation an unusual product - the symptom. This finds
its way, like a foreign body, into the normal state, which in turn
is in ignorance of the hypnoid pathogenic situation. Wherever there
is a symptom there is also an amnesia, a gap in the memory, and
filling up this gap implies the removal of the conditions which led
to the production of the symptom.