Freud - Complete Works (39 page)

Studies On Hysteria

197

   In view of the fact that states
of mind which are so different though they agree with one another
in the most important respect can be classed with auto-hypnosis, it
seems desirable to adopt the expression ‘hypnoid’,
which lays stress on this internal similarity. It sums up the view
put forward by Moebius in the passage quoted above. Most of all,
however, it points to auto-hypnosis itself, the importance of which
in the genesis of hysterical phenomena rests on the fact that it
makes conversion easier and protects (by amnesia) the converted
ideas from wearing-away - a protection which leads, ultimately, to
an increase in the psychical splitting.

   If a somatic symptom is caused by
an idea and is repeatedly set going by it, we should expect that
intelligent patients capable of self-observation would be conscious
of the connection; they would know by experience that the somatic
phenomenon appeared at the same time as the memory of a particular
event. The underlying causal nexus is, it is true, unknown to them;
but all of us always know what the idea is which makes us cry or
laugh or blush, even though we have not the slightest understanding
of the nervous mechanism of these ideogenic phenomena. Sometimes
patients do really observe the connection and are conscious of it.
For instance, a woman may say that her mild hysterical attack
(trembling and palpitations, perhaps) comes from some great
emotional disturbance and is repeated when, and only when, some
event reminds her of it. But this is not the case with very many or
indeed the majority of hysterical symptoms. Even intelligent
patients are unaware that their symptoms arise as the result of an
idea and regard them as physical phenomena on their own account. If
it were otherwise the psychical theory of hysteria must already
have reached a respectable age.

   It would be plausible to believe
that, though the symptoms in question were ideogenic in the first
instance, the repetition of them has, to use Romberg’s
phrase, ‘imprinted’ them into the body, and they would
now no longer be based on a psychical process but on modifications
in the nervous system which have occurred in the meantime: they
would have become self-sufficient, genuinely somatic symptoms.

Studies On Hysteria

198

   This view is in itself neither
untenable nor improbable. But I believe that the new light which
our observations have thrown on the theory of hysteria lies
precisely in its having shown that this view is inadequate to meet
the facts, at any rate in many instances. We have seen that
hysterical symptoms of the most various kinds which have lasted for
many years ‘immediately and permanently disappeared when we
had succeeded in bringing clearly to light the memory of the event
by which they were provoked and in arousing their accompanying
affect, and when the patient had described that event in the
greatest possible detail and had put the affect into words’.
The case histories which have been reported in these pages provide
some pieces of evidence in support of these assertions. ‘We
may reverse the dictum "
cessante causa cessat
effectus
" ["when the cause ceases the effect
ceases"], and conclude from these observations that the
determining process’ (that is, the recollection of it)
‘continues to operate for years - not indirectly, through a
chain of intermediate causal links, but as a
directly
releasing cause - just as a psychical pain that is remembered in
waking consciousness still provokes a lachrymal secretion long
after the event. Hysterics suffer mainly from reminiscences.’
But if this is so - if the memory of the psychical trauma must be
regarded as operating as a contemporary agent, like a foreign body,
long after its forcible entrance, and if nevertheless the patient
has no consciousness of such memories or their emergence - then we
must admit that
unconscious ideas exist and are
operative
.

   Moreover, when we come to analyse
hysterical phenomena we do not only find such unconscious ideas
in isolation
. We must recognize the fact that in reality, as
has been shown by the valuable work carried out by French
investigators, large complexes of ideas and involved psychical
processes with important consequences remain completely unconscious
in a number of patients and co-exist with conscious mental life; we
must recognize that there is such a thing as a splitting of
psychical activity, and that this is of fundamental value for our
understanding of complicated hysterias.

Studies On Hysteria

199

   I may perhaps be allowed to
explore this difficult and obscure region rather more fully. The
need to establish the meaning of the terminology that has been used
may to some extent excuse the theoretical discussion which
follows.

(5)  UNCONSCIOUS IDEAS AND IDEAS
INADMISSIBLE TO CONSCIOUSNESS -

SPLITTING OF THE MIND

   We call those ideas conscious
which we are aware of. There exists in human beings the strange
fact of self-consciousness. We are able to view and observe, as
though they were objects, ideas that emerge in us and succeed one
another. This does not happen always, since occasions for
self-observation are rare, But the capacity for it is present in
everyone, for everyone can say: ‘I thought this or
that.’ We describe as conscious those ideas which we observe
as active in us, or which we should so observe if we attended to
them. At any given moment of time there are very few of them; and
if others, apart from those, should be current at the time, we
should have to call them
unconscious
ideas.

   It hardly seems necessary any
longer to argue in favour of the existence of current ideas that
are unconscious or subconscious. They are among the commonest facts
of everyday life. If I have forgotten to make one of my medical
visits, I have feelings of lively unrest. I know from experience
what this feeling means: that I have forgotten something. I search
my memories in vain; I fail to discover the cause, till suddenly,
hours later perhaps, it enters my consciousness. But I have been
uneasy the whole time. Accordingly, the idea of the visit has been
all the time operative, that is to say present, but not in my
consciousness. Or again, a busy man may have been annoyed by
something one morning. He is entirely absorbed by his office work;
while he is doing it his conscious thoughts are fully occupied, and
he gives no thought to his annoyance. But his decisions are
influenced by it and he may well say ‘no’ where he
would otherwise have said ‘yes’. So in spite of
everything this memory is operative, that is to say present. A
great deal of what we describe as ‘mood’ comes from
sources of this kind, from ideas that exist and are operative
beneath the threshold of consciousness. Indeed, the whole conduct
of our life is constantly influenced by subconscious ideas. We can
see every day how, where there is mental degeneration, as for
instance in the initial stages of general paralysis, the
inhibitions which normally restrain certain actions become weaker
and disappear. But the patient who now makes indecent jokes in the
presence of women was not, in his healthy days, prevented from
doing so by conscious memories and reflections; he avoided it
‘instinctively’ and ‘automatically’ - that
is to say, he was restrained by ideas which were called up by the
impulse to behave in this way, but which remained beneath the
threshold of consciousness, though they nevertheless inhibited the
impulse. All intuitive activity is directed by ideas which are to a
large extent subconscious. For only the clearest and most intense
ideas are perceived by self-consciousness, whilst the great mass of
current but weaker ideas remains unconscious.

Studies On Hysteria

200

   The objections that are raised
against ‘unconscious ideas’ existing and being
operative seem for the most part to be juggling with words. No
doubt ‘idea’ is a word belonging to the terminology of
conscious thinking, and ‘unconscious idea’ is therefore
a self-contradictory expression. But the physical process which
underlies an idea is the same in content and form (though not in
quantity) whether the idea rises above the threshold of
consciousness or remains beneath it. It would only be necessary to
construct some such term as ‘ideational substratum’ in
order to avoid the contradiction and to counter the objection.

   Thus there seems to be no
theoretical difficulty in also recognizing unconscious ideas as
causes of pathological phenomena. But if we go into the matter more
closely we come upon other difficulties. As a rule, when the
intensity of an unconscious idea increases it enters consciousness
ipso facto
. Only when its intensity is slight does it remain
unconscious. What seems hard to understand is how an idea can be
sufficiently intense to provoke a lively motor act, for instance,
and at the same time not intense enough to become conscious.

   I have already mentioned a view
which should not, perhaps, be dismissed out of hand. On this view
the clarity of our ideas, and consequently their capacity for being
observed by our self-consciousness - that is, for being conscious -
is determined, among other things, by the feelings of pleasure or
unpleasure which they arouse, by their quota of affect. When an
idea immediately produces lively somatic consequences, this implies
that the excitation engendered by it flows off into the paths
concerned in these consequences, instead of, as would happen
otherwise, becoming diffused in the brain; and precisely
because
this idea has physical consequences, because its
sums of psychical stimuli have been ‘converted’ into
somatic ones, it loses the clarity which would otherwise have
marked it out in the stream of ideas. Instead of this it is lost
among the rest.

Studies On Hysteria

201

   Suppose, for instance, that
someone has had a violent affect during a meal and has not
‘abreacted’ it. When subsequently he attempts to eat he
is overtaken by choking and vomiting and these seem to him purely
somatic symptoms. His hysterical vomiting continues for some
considerable time. It disappears after the affect has been revived,
described and reacted to under hypnosis. There can be no doubt that
every attempt to eat called up the memory concerned. This memory
started the vomiting but did not appear clearly in consciousness,
because it was now without affect, whereas the vomiting absorbed
the attention completely.

   It is conceivable that the reason
which has just been given explains why
some
ideas that
release hysterical phenomena are not recognized as their causes.
But this reason - the fact that ideas that have lost their affect
because they have been converted are overlooked - cannot possibly
explain why, in other cases, ideational complexes that are anything
but devoid of affect do not enter consciousness. Numerous examples
of this are to be found in our case histories.

   In patients like these we found
that it was the rule for the emotional disturbance -
apprehensiveness, angry irritability, grief - to precede the
appearance of the somatic symptom or to follow it immediately, and
to increase, either until it was cleared up by being given
utterance in words or until the affect and the somatic phenomenon
gradually disappeared again. Where the former happened the quality
of the affect always became quite understandable, even though its
intensity could not fail to seem to a normal person (and to the
patient himself, after it had been cleared up) to be out of all
proportion. These, then, were ideas which were intense enough not
merely to cause powerful somatic phenomena but also to call out the
appropriate affect and to influence the course of association by
bringing allied ideas into prominence - but which, in spite of all
this, remained outside consciousness themselves. In order to bring
them into consciousness hypnosis was necessary (as in Case
Histories 1 and 2), or (as in Case Histories 4 and 5) a laborious
search had to be made with strenuous help from the physician.

Studies On Hysteria

202

   Ideas such as these which, though
current, are unconscious, not because of their relatively small
degree of liveliness, but in spite of their great intensity, may be
described as ideas that are ‘inadmissible to
consciousness’.¹

   The existence of ideas of this
kind that are inadmissible to consciousness is pathological. In
normal people all ideas that can become current at all enter
consciousness as well if they are sufficiently intense. In our
patients we find a large complex of ideas that are admissible to
consciousness existing side by side with a smaller complex of ideas
that are not. Thus in them the field of ideational psychical
activity does not coincide with potential consciousness. The latter
is more restricted than the former. Their psychical ideational
activity is divided into a conscious and an unconscious part, and
their ideas are divided into some that are admissible and some that
are inadmissible to consciousness. We cannot, therefore, speak of a
splitting of consciousness, though we can of a
splitting of the
mind
.

   Conversely, these subconscious
ideas cannot be influenced or corrected by conscious thought. They
are very often concerned with experiences which have in the
meantime lost their meaning - dread of events which did not occur,
fright that turned to laughter or joy after a rescue. Such
subsequent developments deprive the memory of all its affect so far
as consciousness is concerned; but they leave the subconscious
idea, which provokes somatic phenomena, completely untouched.