Freud - Complete Works (40 page)

  
¹
This expression
[‘
Bewusstseinsunfähig
’] is not unambiguous
and for that reason leaves much to be desired. It is, however,
constructed on the analogy of ‘
Hoffähig
’
[‘admissible to Court’, ‘having the
entrée
’] and may in the meantime be used for
lack of a better term.

Studies On Hysteria

203

   Perhaps I may be allowed to quote
another example. A young married woman was for some time very much
worried about her younger sister’s future. As a result of
this her period, normally regular, lasted for two weeks; she was
tender in the left hypogastrium, and twice she found herself lying
stiff on the floor, coming out of a ‘faint’. There
followed an ovarian neuralgia on the left side, with signs of a
severe peritonitis. The absence of fever, and a contracture of the
left leg (and of her back), showed that the illness was a
pseudo
-peritonitis; and when, a few years later, the patient
died and an autopsy was performed, all that was found was a
‘microcystic degeneration’ of
both
ovaries
without any traces of an old peritonitis. The severe symptoms
disappeared by degrees and left behind an ovarian neuralgia, a
contracture of the muscles of the back, so that her trunk was as
stiff as a board, and a contracture of the left leg. The latter was
got rid of under hypnosis by direct suggestion. The contracture of
her back was unaffected by this. Meanwhile her younger
sister’s difficulties had been completely smoothed out and
all her fears on that score had vanished. But the hysterical
phenomena, which could only have been derived from them, persisted
unaltered. It was tempting to suppose that what we were faced by
were changes in innervation, which had assumed an independent
status and were no longer attached to the idea that had caused
them. But after the patient had been compelled under hypnosis to
tell the whole story up to the time when she had fallen ill of
‘peritonitis’ - which she did most unwillingly - she
immediately sat up in bed without assistance, and the contracture
of her back disappeared for ever. (Her ovarian neuralgia, which was
undoubtedly much older in its origin, remained unaffected.) Thus we
see that her pathogenic anxious idea had persisted in active
operation for months on end, and that it had been completely
inaccessible to any correction by actual events.

   If we are obliged to recognize
the existence of ideational complexes that never enter
consciousness and are not influenced by conscious thought, we shall
have admitted that, even in such simple cases of hysteria as the
one I have just described, there is a splitting of the mind into
two relatively independent portions. I do not assert that
everything that we call hysterical has a splitting of this kind as
its basis and necessary condition; but I
do
assert that
‘the splitting of psychical activity which is so striking in
the well-known cases in the form of "
double
conscience
" is present to a rudimentary degree in every
major hysteria’, and that ‘the liability and tendency
to such a dissociation is the basic phenomenon of this
neurosis’.

Studies On Hysteria

204

   But before entering into a
discussion of this subject, I must add a comment with regard to the
unconscious ideas which produce somatic effects. Many hysterical
phenomena last continuously for a long time, like the contracture
in the case described above. Should we and may we suppose that
during all this time the causative idea is perpetually active and
currently present? I think so. It is true that in healthy people we
see their psychical activity going forward to the accompaniment of
a rapid change of ideas. But we find sufferers from severe
melancholia immersed continuously for long periods in the same
distressing idea which is perpetually active and present. Indeed,
we may well believe that even when a healthy person has a great
care on his mind it is present all the time, since it governs his
facial expression even when his consciousness is filled with other
thoughts. But the portion of psychical activity which is separated
off in hysterical subjects and which we think of as filled with
unconscious ideas contains as a rule such a meagre store of them
and is so inaccessible to interchange with external impressions
that it is easy to believe that a single idea can be permanently
active in it.

   If it seems to us, as it does to
Binet and Janet, that what lies at the centre of hysteria is a
splitting off of a portion of psychical activity, it is our duty to
be as clear as possible on this subject. It is only too easy to
fall into a habit of thought which assumes that every substantive
has a substance behind it - which gradually comes to regard
‘consciousness’ as standing for some actual thing; and
when we have become accustomed to make use metaphorically of
spatial relations, as in the term ‘sub-consciousness’,
we find as time goes on that we have actually formed an idea which
has lost its metaphorical nature and which we can manipulate easily
as though it was real. Our mythology is then complete.

Studies On Hysteria

205

   All our thinking tends to be
accompanied and aided by spatial ideas, and we talk in spatial
metaphors. Thus when we speak of ideas which are found in the
region of clear consciousness and of unconscious ones which never
enter the full light of self-consciousness, we almost inevitably
form pictures of a tree with its trunk in daylight and its roots in
darkness, or of a building with its dark underground cellars. If,
however, we constantly bear in mind that all such spatial relations
are metaphorical and do not allow ourselves to be misled into
supposing that these relations are literally present in the brain,
we may nevertheless speak of a consciousness and a
subconsciousness. But only on this condition.

   We shall be safe from the danger
of allowing ourselves to be tricked by our own figures of speech if
we always remember that after all it is in the same brain, and most
probably in the same cerebral cortex, that conscious and
unconscious ideas alike have their origin. How this is possible we
cannot say. But then we know so little of the psychical activity of
the cerebral cortex that one puzzling complication the more
scarcely increases our limitless ignorance. We must take it as a
fact that in hysterical patients a part of their psychical activity
is inaccessible to perception by the self-consciousness of the
waking individual and that their mind is thus split.

   A universally known example of a
division of psychical activity like this is to be seen in
hysterical attacks in some of their forms and stages. At their
beginning, conscious thought is often extinguished; but afterwards
it gradually awakens. Many intelligent patients admit that their
conscious ego was quite lucid during the attack and looked on with
curiosity and surprise at all the mad things they did and said.
Such patients have, furthermore, the (erroneous) belief that with a
little goodwill they could have inhibited the attack, and they are
inclined to blame themselves for it. ‘They need not have
behaved like that.’ (Their self-reproaches of being guilty of
simulation are also to a great extent based on this feeling.) But
when the next attack comes on, the conscious ego is as little able
to control what happens as in earlier ones. - Here we have a
situation in which the thought and ideation of the conscious waking
ego stands alongside of the ideas which normally reside in the
darkness of the unconscious but which have now gained control over
the muscular apparatus and over speech, and indeed even over a
large part of ideational activity itself: the splitting of the mind
is manifest.

Studies On Hysteria

206

   It may be remarked that the
findings of Binet and Janet deserve to be described as a splitting
not merely of psychical activity but of consciousness. As we know,
these observers have succeeded in getting into contact with their
patients’ ‘subconsciousness’, with the portion of
psychical activity of which the conscious waking ego knows nothing;
and they have been able in some of their cases to demonstrate the
presence of all the psychical functions, including
self-consciousness, in that portion, since it has access to the
memory of earlier psychical events. This half of a mind is
therefore quite complete and conscious in itself. In our cases the
part of the mind which is split off is ‘thrust into
darkness’, as the Titans are imprisoned in the crater of
Etna, and can shake the earth but can never emerge into the light
of day. In Janet’s cases the division of the realm of the
mind has been a total one. Nevertheless, there is still inequality
in status. But this, too, disappears when the two halves of
consciousness alternate, as they do in the well known cases of
‘
double conscience
’, and when they do not differ
in their functional capability.

   But let us return to the ideas
which we have shown in our patients as the causes of their
hysterical phenomena. It is far from being possible for us simply
to describe them all as being ‘unconscious’ and
‘inadmissible to consciousness’. They form an almost
unbroken scale, passing through every gradation of vagueness and
obscurity, between perfectly conscious ideas which release an
unusual reflex and those which never enter consciousness in waking
life but only in hypnosis. In spite of this, we regard it as
established that a splitting of psychical activity occurs in the
more severe degrees of hysteria and that it alone seems to make a
psychical theory of the illness possible.

Studies On Hysteria

207

   What, then, can be asserted or
suspected with probability about the causes and origin of this
phenomenon?

   Janet, to whom the theory of
hysteria owes so very much and with whom we are in agreement in
most respects, has expressed a view on this point which we are
unable to accept.

   Janet’s view is the
following. He considers that the ‘splitting of a
personality’ rests on an innate psychological weakness
(‘
insuffisance psychologique
’). All normal
mental activity presupposes a certain capacity for
‘synthesis’, the ability to unite several ideas into a
complex. The combination of the various sense-perceptions into a
picture of the environment is already a synthetic activity of this
kind. This mental function is found to be far below the normal in
hysterical patients. If a normal person’s attention is
directed as fully as possible upon some point, e. g. upon a
perception by a single sense, it is true that he temporarily loses
the capacity to apperceive impressions from the other senses - that
is, to take them up into his conscious thought. But in hysterical
subjects this happens without any special concentration of the
attention. As soon as they perceive anything they are inaccessible
to other sense-perceptions. Indeed, they are not even in a position
to take in together a number of impressions coming from a
single
sense. They can, for instance, only apperceive
tactile sensations in one half of the body; those from the other
side reach the centre and are used for the co-ordination of
movement, but are not apperceived. A person like this is
hemi-anaesthetic. In normal people, an idea calls into
consciousness a great number of others by association; these may be
related to the first one, for instance, in a confirmatory or an
inhibiting manner, and only the most vivid ideas are so extremely
powerful that their associations remain below the threshold of
consciousness. In hysterical people this is always the case. Every
idea takes possession of the whole of their limited mental
activity, and this accounts for their excessive affectivity. This
characteristic of their mind is described by Janet as the
‘restriction of the field of consciousness’ of
hysterical patients, on the analogy of a ‘restriction of the
field of vision’. For the most part the sense-impressions
that are not apperceived and the ideas that are aroused but do not
enter consciousness cease without producing further consequences.
Sometimes, however, they accumulate and form complexes - mental
strata withdrawn from consciousness; they form a subconsciousness.
Hysteria, which is essentially based on this splitting of the mind,
is a ‘
maladie par faiblesse
’ [‘disease due
to weakness’], and that is why it develops most readily when
a mind which is innately weak is submitted to influences that
weaken it still further or is faced by heavy demands in relation to
which its weakness stands out still more.

Studies On Hysteria

208

   Janet’s opinions, as thus
summarized, already give his answer to the important question as to
the disposition to hysteria - as to the nature of the
typus
hystericus
(taking the term in the sense in which we speak of a
typus phthisicus
, by which we understand the long narrow
thorax, the small heart, etc.). Janet regards a particular form of
congenital mental weakness as the disposition to hysteria. In
reply, we should like to formulate our own view briefly as follows.
It is not the case that the splitting of consciousness occurs
because the patients are weak-minded; they appear to be weak-minded
because their mental activity is divided and only a part of its
capacity is at the disposal of their conscious thought. We cannot
regard mental weakness as the
typus hystericus
, as the
essence of the disposition to hysteria.

   An example makes plain what is
intended by the first of these two sentences. We were frequently
able to observe the following course of events with one of our
patients (Frau Cäcilie M.). While she was feeling
comparatively well a hysterical symptom would appear - a
tormenting, obsessive hallucination, a neuralgia, or something of
the kind - and would for some time increase in intensity.
Simultaneously the patient’s mental capacity would
continuously decrease, and after a few days any uninitiated
observer would have been bound to call her weak-minded. She would
then be relieved of the unconscious idea (the memory of a psychical
trauma, often belonging to the remote past), either by the
physician under hypnosis or by her suddenly describing the event in
a state of agitation and to the accompaniment of a lively emotion.
When this had happened she did not merely become quiet and cheerful
and free from the tormenting symptom; it was always astonishing to
observe the width and clarity of her intellect and the acuteness of
her understanding and judgement. Chess, which she played
excellently, was a favourite occupation of hers, and she enjoyed
playing two games at a time, which can scarcely be regarded as
indicating a lack of mental synthesis. It was impossible to escape
the impression that during a course of events such as we have just
described the unconscious idea drew to itself an ever-increasing
portion of her psychical activity and that the more this happened
the smaller became the part played by conscious thought, till it
was reduced to total imbecility; but that when, to use the
remarkably apt Viennese expression, she was
‘
beisammen
’ [literally ‘together’,
meaning ‘in one’s right mind’], she possessed
quite remarkable mental powers.