Freud - Complete Works (38 page)

   Our observations show two ways in
which affective ideas can be excluded from association.

   The first is
‘defence’, the deliberate suppression of distressing
ideas which seem to the subject to threaten his happiness or his
self-esteem. In his paper on ‘The Neuro-Psychoses of
Defence’ (1894
a
) and in his case histories in the
present volume, Freud has discussed this process, which undoubtedly
possesses very high pathological significance. We cannot, it is
true, understand how an idea can be deliberately repressed from
consciousness. But we are perfectly familiar with the corresponding
positive process, that of concentrating attention on an idea, and
we are just as unable to say how we effect
that
. Ideas,
then, from which consciousness is diverted, which are not thought
about, are also withdrawn from the wearing-away process and retain
their quota of affect undiminished.

   We have further found that there
is another kind of idea that remains exempt from being worn away by
thought. This may happen, not because one does not
want
to
remember the idea, but because one
cannot
remember it:
because it originally emerged and was endowed with affect in states
in respect of which there is amnesia in waking consciousness - that
is, in hypnosis or in states similar to it. The latter seem to be
of the highest importance for the theory of hysteria, and
accordingly deserve a somewhat fuller examination.¹

  
¹
When, here and later on, we speak of ideas
that are currently present and operative but yet unconscious, we
are seldom concerned with
single
ideas (such as the big
snake hallucinated by Anna O. which started her contracture). It is
almost always a question of
complexes
of ideas, of
recollections of external events and trains of thought of the
subject’s own. It may sometimes happen that every one of the
individual ideas comprised in such a complex of ideas is thought of
consciously, and that what is exiled from consciousness is only the
particular combination of them.

Studies On Hysteria

192

(4)  HYPNOID STATES

   When, in our ‘Preliminary
Communication’ we put forward the thesis that the basis and
sine qua non
of hysteria is the existence of hypnoid states,
we were overlooking the fact that Moebius had already said exactly
the same thing in 1890. ‘The necessary condition for the
(pathogenic) operation of ideas is, on the one hand, an innate -
that is, hysterical - disposition and, on the other, a special
frame of mind. We can only form an imprecise idea of this frame of
mind. It must resemble a state of hypnosis; it must correspond to
some kind of vacancy of consciousness in which an emerging idea
meets with no resistance from any other - in which, so to speak,
the field is clear for the first comer. We know that a state of
this kind can be brought about not only by hypnotism but by
emotional shock (fright, anger, etc.) and by exhausting factors
(sleeplessness, hunger, and so on).’

   The problem to whose solution
Moebius was here making a tentative approach is that of the
generating of somatic phenomena by ideas. He here recalls the ease
with which this can occur under hypnosis, and regards the operation
of affects as analogous. Our own, somewhat different, view on the
operation of the affects has been fully explained above. I need
not, therefore, enter further into the difficulty involved in
Moebius’s assumption that in anger there is a ‘vacancy
of consciousness’¹ (which admittedly exists in fright
and prolonged anxiety) or into the more general difficulty of
drawing an analogy between the state of excitation in an affect and
the quiescent state in hypnosis. We shall come back later, however,
to these remarks by Moebius, which in my opinion embody an
important truth.

  
¹
It is possible that by this description
Moebius means nothing else than the inhibition of the current of
ideas - an inhibition which certainly occurs in the case of
affects, though owing to entirely different causes from those
operating in hypnosis.

Studies On Hysteria

193

   For us, the importance of these
states which resemble hypnosis - ‘hypnoid’ states -
lies, in addition and most especially, in the amnesia that
accompanies them and in their power to bring about the splitting of
the mind which we shall discuss presently and which is of
fundamental significance for ‘major hysteria’. We still
attribute this importance to hypnoid states. But I must add a
substantial qualification to our thesis. Conversion - the ideogenic
production of somatic phenomena - can also come about apart from
hypnoid states. Freud his found in the deliberate amnesia of
defence a second source, independent of hypnoid states, for the
construction of ideational complexes which are excluded from
associative contact. But, accepting this qualification, I am still
of opinion that hypnoid states are the cause and necessary
condition of many, indeed of most, major and complex hysterias.

   First and foremost, of course,
among hypnoid states are to be numbered true auto-hypnoses, which
are distinguished from artificial hypnoses only by the fact of
their originating spontaneously. We find them in a number of
fully-developed hysterias, occurring with varying frequency and
duration, and often alternating rapidly with normal waking states
(cf. Case Histories 1 and 2). On account of the dream-like nature
of their content, they often deserve the name of ‘
delirium
hystericum
’. What happens during auto-hypnotic states is
subject to more or less total amnesia in waking life (whereas it is
completely remembered in artificial hypnosis). The amnesia
withdraws the psychical products of these states, the associations
that have been formed in them, from any correction during waking
thought; and since in auto-hypnosis criticism and supervision by
reference to other ideas is diminished, and, as a rule, disappears
almost completely, the wildest delusions may arise from it and
remain untouched for long periods. Thus it is almost only in these
states that there arises a somewhat complicated irrational
‘symbolic relation between the precipitating cause and the
pathological phenomenon’, which, indeed, is often based on
the most absurd similarities of sound and verbal associations. The
absence of criticism in auto-hypnotic states is the reason why
auto-suggestions so frequently arise from them as, for instance,
when a paralysis remains behind after a hysterical attack. But, and
this may be merely by chance, we have scarcely ever in our analyses
come across an instance of a hysterical phenomenon originating in
this manner. We have always found it happen, in auto-hypnosis no
less than outside it, as a result of the same process - namely,
conversion of an affective excitation.

Studies On Hysteria

194

   In any case, this
‘hysterical conversion’ takes place more easily in
auto-hypnosis than in the waking state, just as suggested ideas are
realized physically as hallucinations and movements so much more
easily in artificial hypnosis. Nevertheless the process of
conversion of excitation is essentially the same as has been
described above. When once it has taken place, the somatic
phenomenon is repeated if the affect and the auto-hypnosis occur
simultaneously. And in that case it seems as though the hypnotic
state has been called up by the affect itself. Accordingly, so long
as there is a clear-cut alternation between hypnosis and full
waking life, the hysterical symptom remains restricted to the
hypnotic state and is strengthened there by repetition; moreover,
the idea that gave rise to it is exempt from correction by waking
thoughts and their criticism precisely because it never emerges in
clear waking life.

   Thus with Anna O. (Case History
1) the contracture of her right arm, which was associated in her
auto-hypnosis with the affect of anxiety and the idea of the snake,
remained for four months restricted to the moments during which she
was in a hypnotic state (or, if we consider this term inappropriate
for
absences
of very short duration, a hypnoid one), though
it recurred frequently. The same thing happened with other
conversions that were carried out in her hypnoid state; and in this
way the great complex of hysterical phenomena grew up in a
condition of complete latency and came into the open when her
hypnoid state became permanent.

   The phenomena which have arisen
in this way emerge into clear consciousness only when the split in
the mind, which shall discuss later, has been completed, and when
the alternation between waking and hypnoid states has been replaced
by co-existence between the normal and the hypnoid complexes of
ideas.

   Are hypnoid states of this kind
in existence before the patient falls ill, and how do they come
about? I can say very little about this, for apart from the case of
Anna O. we have no observations at our disposal which might throw
light on the point. It seems certain that with her the
auto-hypnosis had the way paved for it by habitual reveries and
that it was fully established by an affect of protracted anxiety,
which, indeed, would itself be the basis for a hypnoid state. It
seems not improbable that this process holds good fairly
generally.

Studies On Hysteria

195

   A great variety of states lead to
‘absence of mind’ but only a few of them predispose to
auto-hypnosis or pass over immediately into it. An investigator who
is deep in a problem is also no doubt anaesthetic to a certain
degree, and he has large groups of sensations of which he forms no
conscious perception; and the same is true of anyone who is using
his creative imagination actively (cf. Anna O.’s
‘private theatre’). But in such states energetic mental
work is carried on, and the excitation of the nervous system which
is liberated is used up in this work. In states of abstraction and
dreaminess, on the other hand, intracerebral excitation sinks below
its clear waking level. These states border on sleepiness and pass
over into sleep. If during such a state of absorption, and while
the flow of ideas is inhibited, a group of affectively-coloured
ideas is active, it creates a high level of intracerebral
excitation which is not used up by mental work and is at the
disposal of abnormal functioning, such as conversion.

   Thus neither ‘absence of
mind’ during energetic work nor unemotional twilight states
are pathogenic; on the other hand, reveries that are filled with
emotion and states of fatigue arising from protracted affects
are
pathogenic. The broodings of a care-ridden man, the
anxiety of a person watching at the sick-bed of someone dear to
him, the day-dreams of a lover - these are states of this second
kind. Concentration on the affective group of ideas begins by
producing ‘absence of mind’. The flow of ideas grows
gradually slower and at last almost stagnates; but the affective
idea and its affect remain active, and so consequently does the
great quantity of excitation which is not being used up
functionally. The similarity between this situation and the
determinants of hypnosis seems unmistakable. The subject who is to
be hypnotized must not really go to sleep, that is to say, his
intracerebral excitation must not sink to the level of sleep; but
his flow of ideas must be inhibited. When this is so, the whole
mass of excitation is at the disposal of the suggested idea.

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196

   This is the way in which
pathogenic auto-hypnosis would seem to come about in some people -
by affect being introduced into a habitual reverie. This is perhaps
one of the reasons why in the anamnesis of hysteria we so often
come across the two great pathogenic factors of being in love and
sick-nursing. In the former, the subject’s longing thoughts
about his absent loved one create in him a ‘rapt’ state
of mind, cause his real environment to grow dim, and then bring his
thinking to a standstill charged with affect; while in sick-nursing
the quiet by which the subject is surrounded, his concentration on
an object, his attention fixed on the patient’s breathing -
all this sets up precisely the conditions demanded by many hypnotic
procedures and fills the twilight state produced in this way with
the affect of anxiety. It is possible that these states differ only
quantitatively from true auto-hypnoses and that they pass over into
them.

   Once this has happened, the
hypnosis-like state is repeated again and again when the same
circumstances arise; and the subject, instead of the normal
two
conditions of mind, has three: waking, sleeping and the
hypnoid state. We find the same thing happening when deep
artificial hypnosis has been frequently brought on.

   I cannot say whether spontaneous
hypnotic states may also be generated without an affect intervening
in this way, as a result of an innate disposition; but I consider
it very probable. When we see the difference in susceptibility to
artificial hypnosis both among healthy and sick people and how
easily it is brought on in some, it seems reasonable to suppose
that in such people it can also appear spontaneously. And a
disposition for this is perhaps necessary before a reverie can turn
into an auto-hypnosis. I am therefore far from attributing to all
hysterical patients the generating mechanism which we have been
taught by Anna O.

   I speak of hypnoid states rather
than of hypnosis itself because it is so difficult to make a clear
demarcation of these states, which play such an important part in
the genesis of hysteria. We do not know whether reveries, which
were described above as preliminary stages of auto-hypnosis, may
not themselves be able to produce the same pathological effect as
auto-hypnosis, and whether the same may not also be true of a
protracted affect of anxiety. It is certainly true of fright. Since
fright inhibits the flow of ideas at the same time at which an
affective idea (of danger) is very active, it offers a complete
parallel to a reverie charged with affect; and since the
recollection of the affective idea, which is constantly being
renewed, keeps on re-establishing this state of mind,
‘hypnoid fright’ comes into being, in which conversion
is either brought about or stabilized. Here we have the incubation
stage of ‘traumatic hysteria’ in the strict sense of
the words.