Freud - Complete Works (405 page)

2381

CONTRIBUTIONS TO A DISCUSSION ON SUICIDE

I. INTRODUCTORY REMARKS

   Gentlemen, - You have all
listened with much satisfaction to the plea put forward by an
educationalist who will not allow an unjustified charge to be
levelled against the institution that is so dear to him. But I know
that in any case you were not inclined to give easy credence to the
accusation that schools drive their pupils to suicide. Do not let
us be carried too far, however, by our sympathy with the party
which has been unjustly treated in this instance. Not all the
arguments put forward by the opener of the discussion seem to me to
hold water. If it is the case that youthful suicide occurs not only
among pupils in secondary schools but also among apprentices and
others, this fact does not acquit the secondary schools; it must
perhaps be interpreted as meaning that as regards its pupils the
secondary school takes the place of the traumas with which other
adolescents meet in other walks of life. But a secondary school
should achieve more than not driving its pupils to suicide. It
should give them a desire to live and should offer them support and
backing at a time of life at which the conditions of their
development compel them to relax their ties with their parental
home and their family. It seems to me indisputable that schools
fail in this, and in many respects fall short of their duty of
providing a substitute for the family and of arousing interest in
life in the world outside. This is not a suitable occasion for a
criticism of secondary schools in their present shape; but perhaps
I may emphasize a single point. The school must never forget that
it has to deal with immature individuals who cannot be denied a
right to linger at certain stages of development and even at
certain disagreeable ones. The school must not take on itself the
inexorable character of life: it must not seek to be more than a
game
of life.

II. CONCLUDING REMARKS

   Gentlemen, - I have an impression
that, in spite of all the valuable material that has been brought
before us in this discussion, we have not reached a decision on the
problem that interests us. We were anxious above all to know how it
becomes possible for the extraordinarily powerful life instinct to
be overcome: whether this can only come about with the help of a
disappointed libido or whether the ego can renounce its
self-preservation for its own egoistic motives. It may be that we
have failed to answer this psychological question because we have
no adequate means of approaching it. We can, I think, only take as
our starting-point the condition of melancholia, which is so
familiar to us clinically, and a comparison between it and the
affect of mourning. The affective processes in melancholia,
however, and the vicissitudes undergone by the libido in that
condition, are totally unknown to us. Nor have we arrived at a
psycho-analytic understanding of the chronic affect of mourning.
Let us suspend our judgement till experience has solved this
problem.

2382

LETTER TO DR. FRIEDRICH S. KRAUS ON
ANTHROPOPHYTEIA

My Dear Dr. Krauss,

   You have asked me what scientific
value can in my opinion be claimed by collections of erotic jokes,
witticisms, funny stories, etc. I know you have not felt any doubt
of being able to justify the making of such collections. You merely
wanted me to bear witness from the standpoint of a psychologist to
the fact that material of this kind is not only useful but
indispensable.

    There are two points upon
which I should principally like to insist. When all is said and
done, the erotic quips and comic anecdotes that you have collected
and published in
Anthropophyteia
have only been produced and
repeated because they gave pleasure both to their narrators and
their hearers. It is not difficult to guess which components of the
sexual instinct (compounded as it is from so many elements) find
satisfaction in this manner. These tales give us direct information
as to which of the component instincts of sexuality are retained in
a given group of people as particularly efficient in producing
pleasure; and in this way they give the neatest confirmation of the
findings reached by the psycho-analytic examination of neurotics.
Allow me to indicate the most important example of this kind.
Psycho-analysis has led us to assert that the anal region -
normally and not only in perverse individuals - is the site of an
erotogenic sensitivity, and that in certain ways it behaves exactly
like a genital organ. Doctors and psychologists, when told of there
being an anal erotism and an anal character derived from it, have
been highly indignant. At this point
Anthropophyteia
comes
to the help of psycho-analysis by showing how universally people
dwell with pleasure upon this part of the body, its performances
and indeed the product of its function. If this were not so, all
these anecdotes would be bound to give rise to disgust in their
hearers or else the whole mass of the population would have to be
‘perverse’ in the sense in which the word is used in
works dealing with ‘psychopathia sexualis’ in a
moralizing tone. It would not be hard to give other instances of
how the material collected by the authors of
Anthropophyteia
has been of value for the researches of sexual psychology. Its
value may even be increased, perhaps, by the circumstance (not in
itself an advantage) that the collectors know nothing of the
theoretical findings of psycho-analysis and have brought together
the material without any guiding principles.

   Another advantage of a wider
character is presented in particular by erotic
jokes
, in the
strict sense, just as it is by jokes in general. I have shown in my
study of jokes that the revelation of what is normally the
repressed unconscious element in the mind can, under certain
provisions, become a source of pleasure and thus a technique for
the construction of jokes. In psycho-analysis to-day we describe a
congeries of ideas and its associated affect as a
‘complex’; and we are prepared to assert that many of
the most admired jokes are ‘complexive jokes’ and that
they owe their exhilarating and cheerful effect to the ingenious
uncovering of what are as a rule repressed complexes. It would
carry me too far afield if I were to bring forward instances here
in proof of this thesis, but I can assert that the outcome of such
an examination of the evidence is that the jokes, both erotic and
of other sorts, which are in popular circulation provide an
excellent auxiliary means of investigating the unconscious human
mind - in the same way as do dreams, myths and legends, with the
exploitation of which psycho-analysis is already actively

engaged.

   It is therefore safe to hope that
the psychological importance of folklore will be more and more
clearly recognized, and that the relations between that branch of
study and psycho-analysis will soon become more intimate.

   I remain, dear Dr. Krauss, yours
very sincerely,

FREUD

June
26,1910

2383

TWO INSTANCES OF PATHOGENIC PHANTASIES

REVEALED BY THE PATIENTS THEMSELVES

A

A short while ago I saw a patient, about
twenty years of age, who gave an unmistakable picture (confirmed by
other opinions) of a dementia praecox (hebephrenia). During the
initial stages of his illness he had exhibited periodic changes of
mood and had made a considerable improvement. While he was in this
favourable condition he was removed from the institution by his
parents and for about a week he was regaled with entertainments of
every kind to celebrate his supposed recovery. His relapse followed
immediately upon this week of festivities. When he was brought back
to the institution, he said that the consulting physician had
advised him ‘to flirt with his mother a little’. There
can be no doubt that in this delusory paramnesia he was giving
expression to the excitement which had been provoked in him by
being in his mother’s company and which had been the
immediate provocation of his relapse.

B

   More than ten years ago, at a
time when the findings and hypotheses of psycho-analysis were known
to only a few people, the following events were reported to me from
a trustworthy source. A girl, who was the daughter of a medical
man, fell ill of hysteria with local symptoms. Her father denied
that it was hysteria and arranged for various somatic treatments to
be initiated, which brought little improvement. One day a woman
friend of the patient’s said to her: ‘Have you never
thought of consulting Dr. F.?’ To which the patient replied:
‘What good would that be? I know he’d say to me:
"Have you ever had the idea of having sexual intercourse with
your father?"' - It seems unnecessary for me to say
explicitly that it has never been my practice and is not my
practice to-day to ask such questions. But it is worth remarking
that much of what patients report of the words and actions of their
physicians may be understood as revelations of their own pathogenic
phantasies.

2384

REVIEW OF WILHELM NEUTRA’S
LETTERS TO NEUROTIC WOMEN

It should be taken as an encouraging sign of
the awakening interest in psychotherapy that a second edition of
this book has been called for so quickly. Unluckily we cannot hail
the book itself as an encouraging phenomenon. The author, who is an
assistant physician in the Gainfarn hydropathic institute near
Vienna, has borrowed the form of Oppenheim’s
Psychotherapeutische Briefe
and has given that form a
psycho-analytic content. This is in a sense ill-judged, since
psycho-analysis cannot be satisfactorily combined with
Oppenheim’s (or, if that is preferred, Dubois’)
technique of ‘persuasion’; it looks for it therapeutic
results along quite other paths. What is more important, however,
is the fact that the author fails to attain the merits of his model
- tact and moral seriousness - and that in his presentation of
psycho-analytic theory he often drops into empty rhetoric and is
also guilty of some misstatements. Nevertheless much of what he
writes is neatly and aptly expressed; and the book may pass muster
as a work for popular consumption. In a more serious, scientific
exposition of the subject the author would have had to indicate the
sources of his views and assertions with greater
conscientiousness.

2385

PSYCHO-ANALYTIC NOTES ON AN
AUTOBIOGRAPHICAL ACCOUNT

OF A CASE OF PARANOIA

(DEMENTIA PARANOIDES)

(1911)

2386

Intentionally left blank

 
2387

PSYCHO-ANALYTIC NOTES ON AN
AUTOBIOGRAPHICAL ACCOUNT

OF A CASE OF PARANOIA

(DEMENTIA PARANOIDES)

The analytic investigation of paranoia
presents difficulties of a peculiar nature to physicians who, like
myself, are not attached to public institutions. We cannot accept
patients suffering from this complaint, or, at all events, we
cannot keep them for long, since we cannot offer treatment unless
there is some prospect of therapeutic success. It is only in
exceptional circumstances, therefore, that I succeed in getting
more than a superficial view of the structure of paranoia - when,
for instance, the diagnosis (which is not always an easy matter) is
uncertain enough to justify an attempt at influencing the patient,
or when, in spite of an assured diagnosis, I yield to the
entreaties of the patient’s relatives and undertake to treat
him for a time. Apart from this, of course, I see plenty of cases
of paranoia and of dementia praecox, and I learn as much about them
as other psychiatrists do about their cases; but that is not
enough, as a rule, to lead to any analytic conclusions.

   The psycho-analytic investigation
of paranoia would be altogether impossible if the patients
themselves did not possess the peculiarity of betraying (in a
distorted form, it is true) precisely those things which other
neurotics keep hidden as a secret. Since paranoics cannot be
compelled to overcome their internal resistances, and since in any
case they only say what they choose to say, it follows that this is
precisely a disorder in which a written report or a printed case
history can take the place of personal acquaintance with the
patient. For this reason I think it is legitimate to base analytic
interpretations upon the case history of a patient suffering from
paranoia (or, more precisely, from dementia paranoides) whom I have
never seen, but who has written his own case history and brought it
before the public in print.

Psycho-Analytic Notes On An Autobiographical Account Of A Case Of Paranoia

2388

   I refer to Dr. jur. Daniel Paul
Schreber, formerly Senatspräsident in Dresden, whose book,
Denkwürdigkeiten eines Nervenkranken
[
Memoirs of a
Nerve Patient
], was published in 1903, and, if I am rightly
informed, aroused considerable interest among psychiatrists. It is
possible that Dr. Schreber may still be living to-day and that he
may have dissociated himself so far from the delusional system
which he put forward in 1903 as to be pained by these notes upon
his book. In so far, however, as he still retains his identity with
his former personality, I can rely upon the arguments with which he
himself - ‘a man of superior mental gifts and endowed with an
unusual keenness alike of intellect and of observation’¹
- countered the efforts that were made to restrain him from
publishing his memoirs: ‘I have been at no pains’, he
writes, ‘to close my eyes to the difficulties that would
appear to lie in the path of publication, and in particular to the
problem of paying due regard to the susceptibilities of certain
persons still living. On the other hand, I am of opinion that it
might well be to the advantage both of science and of the
recognition of religious truths if, during my life-time, qualified
authorities were enabled to undertake some examination of my body
and to hold some enquiry into my personal experiences. To this
consideration all feelings of a personal character must
yield.’² He declares in another passage that he has
decided to keep to his intention of publishing the book, even if
the consequence were to be that his physician, Geheimrat Dr.
Flechsig of Leipzig, brought an action against him. He urges upon
Dr. Flechsig, however, the same considerations that I am now urging
upon him himself: ‘I trust’, he says, ‘that even
in the case of Geheimrat Prof. Dr. Flechsig any personal
susceptibilities that he may feel will be outweighed by a
scientific interest in the subject-matter of my memoirs.’
(446.)³

   Though all the passages from the
Denkwürdigkeiten
upon which my interpretations are
based will be quoted verbatim in the following pages, I would ask
my readers to make themselves acquainted with the book by reading
it through at least once beforehand.

  
¹
This piece of self-portraiture, which is
certainly not unjustified, will be found on page 35 of his
book.

  
²
Preface, iii.

  
³
[Throughout this paper figures in brackets
with no preceding ‘p.’ are page references to the
original German edition of Schreber’s memoirs -
Denkwürdigkeiten eines Nervenkranken
, Leipzig, Oswald
Mutze.]

Psycho-Analytic Notes On An Autobiographical Account Of A Case Of Paranoia

2389

I

CASE
HISTORY

‘I have suffered twice from nervous
disorders’, writes Dr. Schreber, ‘and each time as a
result of mental overstrain. This was due on the first occasion to
my standing as a candidate for election to the Reichstag while I
was Landgerichtsdirektor at Chemnitz, and on the second occasion to
the very heavy burden of work that fell upon my shoulders when I
entered on my new duties as Senatspräsident in the
Oberlandesgericht in Dresden.’ (34.)

   Dr. Schreber’s first
illness began in the autumn of 1884, and by the end of 1885 he had
completely recovered. During this period he spent six months in
Flechsig’s clinic, and the latter, in a formal report which
he drew up at a later date, described the disorder as an attack of
severe hypochondria. Dr. Schreber assures us that this illness ran
its course ‘without the occurrence of any incidents bordering
upon the sphere of the supernatural’. (35.)

   Neither the patient’s own
account, nor the reports of the physicians which are reprinted at
the end of his book, tell us enough about his previous history or
his personal circumstances. I am not even in a position to give the
patient’s age at the time of his illness, though the high
judicial position which he had attained before his second illness
establishes some sort of lower limit. We learn that Dr. Schreber
had been married long before the time of his
‘hypochondria’. ‘The gratitude of my wife’,
he writes, ‘was perhaps even more heartfelt; for she revered
Professor Flechsig as the man who had restored her husband to her,
and hence it was that for years she kept his portrait standing upon
her writing-table.’ (36.) And in the same place: ‘After
my recovery from my first illness I spent eight years with my wife
- years, upon the whole, of great happiness, rich in outward
honours, and only clouded from time to time by the oft repeated
disappointment of our hope that we might be blessed with
children.’

Psycho-Analytic Notes On An Autobiographical Account Of A Case Of Paranoia

2390

   In June, 1893, he was notified of
his prospective appointment as Senatspräsident, and he took up
his duties on the first of October of the same year. Between these
two dates¹ he had some dreams, though it was not until later
that he came to attach any importance to them. He dreamt two or
three times that his old nervous disorder had come back; and this
made him as miserable in the dream as the discovery that it was
only a dream made him happy when he woke up. Once, in the early
hours of the morning, moreover, while he was in a state between
sleeping and waking, the idea occurred to him ‘that after all
it really must be very nice to be a woman submitting to the act of
copulation’. (36.) This idea was one which he would have
rejected with the greatest indignation if he had been fully
conscious.

   The second illness set in at the
end of October 1893 with a torturing bout of sleeplessness. This
forced him to return to the Flechsig clinic, where, however, his
condition grew rapidly worse. The further course of the illness is
described in a Report drawn up subsequently by the director of the
Sonnenstein Asylum: ‘At the commencement of his residence
there² he expressed more hypochondriacal ideas, complained
that he had softening of the brain, that he would soon be dead,
etc. But ideas of persecution were already finding their way into
the clinical picture, based upon sensory illusions which, however,
seemed only to appear sporadically at first; while simultaneously a
high degree of hyperaesthesia was observable - great sensitiveness
to light and noise. - Later, the visual and auditory illusions
became much more frequent, and, in conjunction with coenaesthetic
disturbances, dominated the whole of his feeling and thought. He
believed that he was dead and decomposing, that he was suffering
from the plague; he asserted that his body was being handled in all
kinds of revolting ways; and, as he himself declares to this day,
he went through worse horrors than any one could have imagined, and
all on behalf of a holy purpose. The patient was so much
pre-occupied with these pathological experiences that he was
inaccessible to any other impression and would sit perfectly rigid
and motionless for hours (hallucinatory stupor). On the other hand,
they tortured him to such a degree that he longed for death. He
made repeated attempts at drowning himself in his bath, and asked
to be given the "cyanide that was intended for him". His
delusional ideas gradually assumed a mystical and religious
character; he was in direct communication with God, he was the
plaything of devils, he saw "miraculous apparitions", he
heard "holy music", and in the end he even came to
believe that he was living in another world.’ (380.)

  
¹
And therefore before he could have been
affected by the overwork caused by his new post, to which he
attributes his illness.

  
²
In Professor Flechsig’s clinic at
Leipzig.

Psycho-Analytic Notes On An Autobiographical Account Of A Case Of Paranoia

2391

   It may be added that there were
certain people by whom he thought he was being persecuted and
injured, and upon whom he poured abuse. The most prominent of these
was his former physician, Flechsig, whom he called a
‘soul-murderer’; and he used to call out over and over
again: ‘
Little
Flechsig!’ putting a sharp stress
upon the first word (383). He was moved from Leipzig, and, after a
short interval spent in another institution, was brought in June
1894 to the Sonnenstein Asylum, near Pirna, where he remained until
his disorder assumed its final shape. In the course of the next few
years the clinical picture altered in a manner which can best be
described in the words of Dr. Weber, the director of the
asylum.

   ‘I need not enter any
further into the details of the course of the disease. I must,
however, draw attention to the manner in which, as time went on,
the initial comparatively acute psychosis, which had directly
involved the patient’s entire mental life and deserved the
name of "hallucinatory insanity", developed more and more
clearly (one might almost say crystallized out) into the paranoic
clinical picture that we have before us to-day.’ (385.) The
fact was that, on the one hand, he had developed an ingenious
delusional structure, in which we have every reason to be
interested, while, on the other hand, his personality had been
reconstructed and now showed itself, except for a few isolated
disturbances, capable of meeting the demands of everyday life.

Psycho-Analytic Notes On An Autobiographical Account Of A Case Of Paranoia

2392

   Dr. Weber, in his Report of 1899,
makes the following remarks: ‘It thus appears that at the
present time, apart from certain obvious psychomotor symptoms which
cannot fail to strike even the superficial observer as being
pathological, Herr Senatspräsident Dr. Schreber shows no signs
of confusion or of psychical inhibition, nor is his intelligence
noticeably impaired. His mind is collected, his memory is
excellent, he has at his disposal a very considerable store of
knowledge (not merely upon legal questions, but in many other
fields), and he is able to reproduce it in a connected train of
thought. He takes an interest in following events in the world of
politics, science and art, etc., and is constantly occupied with
such matters . . . and an observer who was
uninstructed upon his general condition would scarcely notice
anything peculiar in these directions. In spite of all this,
however, the patient is full of ideas of pathological origin, which
have formed themselves into a complete system; they are more or
less fixed, and seem to be inaccessible to correction by means of
any objective appreciation and judgement of the external
facts.’ (305-6.)

   Thus the patient’s
condition had undergone a great change, and he now considered
himself capable of carrying on an independent existence. He
accordingly took appropriate steps with a view to regaining control
over his own affairs and to securing his discharge from the asylum.
Dr. Weber set himself to prevent the fulfilment of these intentions
and drew up reports in opposition to them. Nevertheless, in his
Report dated 1900, he felt obliged to give this appreciative
account of the patient’s character and conduct: ‘Since
for the last nine months Herr Präsident Schreber has taken his
meals daily at my family board, I have had the most ample
opportunities of conversing with him upon every imaginable topic,
Whatever the subject was that came up for discussion (apart, of
course, from his delusional ideas), whether it concerned events in
the field of administration and law, of politics, art, literature
or social life - in short, whatever the topic, Dr. Schreber gave
evidence of a lively interest, a well-informed mind, a good memory,
and a sound judgement; his ethical outlook, moreover, was one which
it was impossible not to endorse. So, too, in his lighter talk with
the ladies of the party, he was both courteous and affable, and
when he touched upon matters in a more humorous vein he invariably
displayed tact and decorum. Never once, during these innocent talks
round the dining-table, did he introduce subjects which should more
properly have been raised at a medical consultation.’
(397-8.) Indeed, on one occasion during this period when a business
question arose which involved the interests of his whole family, he
entered into it in a manner which showed both his technical
knowledge and his common sense (401 and 510).