Freud - Complete Works (41 page)

Studies On Hysteria

209

   As a comparable state in normal
people we would adduce, not concentration of attention, but
preoccupation
.(If someone is 'preoccupied’ by some
vivid idea, such as a worry, his mental capacity is similarly
reduced.

   Every observer is largely under
the influence of the subjects of his observation, and we are
inclined to believe that Janet’s views were mainly formed in
the course of a detailed study of the feeble-minded hysterical
patients who are to be found in hospitals or institutions because
they have not been able to hold their own in life on account of
their illness and the mental weakness caused by it. Our own
observations, carried out on educated hysterical patients, have
forced us to take an essentially different view of their minds. In
our opinion ‘among hysterics may be found people of the
clearest intellect, strongest will, greatest character and highest
critical power’. No amount of genuine, solid mental endowment
is excluded by hysteria, though actual achievements are often made
impossible by the illness. After all, the patron saint of hysteria,
St. Theresa, was a woman of genius with great practical
capacity.

   But on the other hand no degree
of silliness, incompetence and weakness of will is a protection
against hysteria. Even if we disregard what is merely a
result
of the illness, we must recognize the type of
feeble-minded hysteric as a common one. Yet even so, what we find
here is not torpid, phlegmatic stupidity but an excessive degree of
mental mobility which leads to inefficiency. I shall discuss later
the question of innate disposition. Here I merely propose to show
that Janet’s opinion that mental weakness is in any way at
the root of hysteria and splitting of the mind is untenable.

Studies On Hysteria

210

   In complete opposition to
Janet’s views, I believe that in a great many cases what
underlies dissociation is an excess of efficiency, the habitual
co-existence of two heterogeneous trains of ideas. It has
frequently been pointed out that we are often not merely
‘mechanically’ active while our conscious thought is
occupied by trains of ideas which have nothing in common with our
activity, but that we are also capable of what is undoubtedly
psychical functioning while our thoughts are ‘busy
elsewhere’ - as, for instance, when we read aloud correctly
and with the appropriate intonation, but afterwards have not the
slightest idea of what we have been reading.

   There are no doubt a whole number
of activities, from mechanical ones such as knitting or playing
scales, to some requiring at least a small degree of mental
functioning, all of which are performed by many people with only
half their mind on them. This is specially true of people who are
of a very lively disposition, to whom monotonous, simple and
uninteresting occupation is a torture, and who actually begin by
deliberately amusing themselves with thinking of something
different (cf. Anna O.’s ‘private theatre’).
Another situation, but a similar one, occurs when an interesting
set of ideas, derived for instance from books or plays, forces
itself upon the subject’s attention and intrudes into his
thoughts. This intrusion is still more vigorous if the extraneous
set of ideas is strongly coloured with affect (e.g. worry or the
longing of someone in love). We then have the state of
preoccupation that I have touched upon above, which, however, does
not prevent many people from performing fairly complicated actions.
Social circumstances often necessitate a duplication of this kind
even when the thoughts involved are of an exacting kind, as for
instance when a woman who is in the throes of extreme worry or of
passionate excitement carries out her social duties and the
functions of an affable hostess. We all of us manage minor
achievements of this kind in the course of our work; and
self-observation seems always to show that the affective group of
ideas are not merely aroused from time to time by association but
are present in the mind all the time and enter consciousness unless
it is taken up with some external impression or act of will.

Studies On Hysteria

211

   Even in people who do not
habitually allow day-dreams to pass through their minds alongside
their usual activity, some situations give rise during considerable
periods of time to this simultaneous existence of changing
impressions and reactions from external life on the one hand, and
an affectively-coloured group of ideas on the other.
Post
equitem sedet atra cura
[‘black care sits behind the
rider’]. Among these situations the most prominent are those
of looking after someone dear to us who is ill, and of being in
love. Experience shows that sick nursing and sexual affects also
play the principal part in the majority of the more closely
analysed case histories of hysterical patients.

   I suspect that the duplication of
psychical functioning, whether this is habitual or caused by
emotional situations in life, acts as a substantial
predisposition
to a genuine pathological splitting of the
mind. This duplication passes over into the latter state if the
content of the two co-existing sets of ideas is no longer of the
same kind, if one of them contains ideas which are inadmissible to
consciousness - which have been fended off, that is, or have arisen
from hypnoid states. When this is so, it is impossible for the two
temporarily divided streams to reunite, as is constantly happening
in healthy people, and a region of unconscious psychical activity
becomes permanently split off. This hysterical splitting of the
mind stands in the same relation to the ‘double ego’ of
a healthy person as does the hypnoid state to a normal reverie. In
this latter contrast what determines the pathological quality is
amnesia, and in the former what determines it is the
inadmissibility of the ideas to consciousness.

Studies On Hysteria

212

   Our first case history, that of
Anna O., to which I am obliged to keep on returning, affords a
clear insight into what happens. The girl was in the habit, while
she was in perfect health, of allowing trains of imaginative ideas
to pass through her mind during her ordinary occupations. While she
was in a situation that favoured auto-hypnosis, the affect of
anxiety entered into her reverie and created a hypnoid state for
which she had amnesia. This was repeated on different occasions and
its ideational content gradually became richer and richer; but it
continued to alternate with states of completely normal waking
thought. After four months the hypnoid state gained entire control
of the patient. The separate attacks ran into one another and thus
an
état de mal
arose, an acute hysteria of the most
severe type. This lasted for several months in various forms (the
period of somnambulism); it was then forcibly interrupted, and
thereafter alternated once again with normal psychical behaviour.
But even during her normal behaviour there was a persistence of
somatic and psychical phenomena (contractures, hemi-anaesthesia and
changes in speech) of which in this case we know as a fact that
they were based on ideas belonging to the hypnoid state. This
proves that even during her normal behaviour the ideational complex
belonging to the hypnoid state, the ‘subconsciousness’,
was in existence and that the split in her mind persisted.

   I have no second example to offer
of a similar course of development. I think, however, that the case
throws some light also on the growth of
traumatic
neuroses.
During the first few days after the traumatic event, the state of
hypnoid fright is repeated every time the event is recalled. While
this state recurs more and more often, its intensity so far
diminishes that it no longer
alternates
with waking thought
but only exists side by side with it. It now becomes continuous,
and the somatic symptoms, which earlier were only present during
the attack of fright, acquire a permanent existence. I can,
however, only
suspect
that this is what happens, as I have
never analysed a case of this kind.

   Freud’s observations and
analyses show that the splitting of the mind can also be caused by
‘defence’, by the deliberate deflection of
consciousness from distressing ideas: only, however, in some
people, to whom we must therefore ascribe a mental idiosyncracy. In
normal people, such ideas are either successfully suppressed, in
which case they vanish completely, or they are not, in which case
they keep on emerging in consciousness. I cannot tell what the
nature of this idiosyncracy is. I only venture to suggest that the
assistance of the hypnoid state is necessary if defence is to
result not merely in single converted ideas being made into
unconscious ones, but in a genuine splitting of the mind.
Auto-hypnosis has, so to speak, created the space or region of
unconscious psychical activity into which the ideas which are
fended off are driven. But, however this may be, the fact of the
pathogenic significance of 'defence’ is one that we must
recognize.

Studies On Hysteria

213

   I do not think, however, that the
genesis of splitting of the mind is anything like covered by the
half-understood processes that we have discussed. Thus, in their
initial stages hysterias of a severe degree usually exhibit for a
time a syndrome that may be described as acute hysteria. (In the
anamnesis of male cases of hysteria we generally come across this
form of illness represented as being ‘encephalitis’; in
female cases ovarian neuralgia leads to a diagnosis of
‘peritonitis’.) In this acute stage of hysteria
psychotic traits are very distinct, such as manic and angry states
of excitement, rapidly changing hysterical phenomena,
hallucinations, and so on. In states of this kind the splitting of
the mind may perhaps take place in a different manner from that
which we have tried to describe above. Perhaps the whole of this
stage is to be regarded as a long hypnoid state, the residues of
which provide the nucleus of the unconscious ideational complex,
while waking thought is amnesic for it. Since we are for the most
part ignorant of the causes that lead to an acute hysteria of this
kind (for I do not venture to regard the course of events with Anna
O. as having general application), there would seem to be another
sort of psychical splitting which, in contrast to those discussed
above, might be termed irrational.¹ And no doubt yet other
forms of this process exist, which are still concealed from our
young psychological science; for it is certain that we have only
taken the first steps in this region of knowledge, and our present
views will be substantially altered by further observations.

  
¹
I must, however, point out that precisely
in the best-known and clearest example of major hysteria with
manifest ‘
double conscience
’ - precisely in the
case of Anna O. - no residue of the acute stage was carried over
into the chronic one, and all the phenomena of the latter had
already been produced during the ‘incubation period’ in
hypnoid and affective states.

Studies On Hysteria

214

   Let us now enquire what the
knowledge of splitting of the mind that has been gained during the
last few years has achieved towards an understanding of hysteria.
It seems to have been great in amount and in importance.

   These discoveries have in the
first place made it possible for what are apparently purely somatic
symptoms to be traced back to ideas, which, however, are not
discoverable in the patients’ consciousness. (It is
unnecessary to enter into this again.) In the second place, they
have taught us to understand hysterical attacks, in part at least,
as being products of an unconscious ideational complex. (Cf.
Charcot.) But, besides this, they have also explained some of the
psychical characteristics of hysteria, and this point perhaps
deserves a more detailed discussion.

   It is true that
‘unconscious ideas’ never, or only rarely and with
difficulty, enter waking thought; but they influence it. They do
so, first, through their consequences - when, for instance, a
patient is tormented by a hallucination which is totally
unintelligible and senseless, but whose meaning and motivation
become clear under hypnosis. Further, they influence association by
making certain ideas more vivid than they would have been if they
had not been thus reinforced from the unconscious. So particular
groups of ideas constantly force themselves on the patient with a
certain amount of compulsion and he is obliged to think of them.
(The case is similar with Janet’s hemi-anaesthetic patients.
When their anaesthetic hand is repeatedly touched they feel
nothing; but when they are told to name any number they like, they
always choose the one corresponding to the number of times they
have been touched,) Again, unconscious ideas govern the
patient’s emotional tone, his state of feeling. When, in the
course of unrolling her memories, Anna O. approached an event which
had originally been bound up with a lively affect, the
corresponding feeling made its appearance several days in advance
and before the recollection appeared clearly even in her hypnotic
consciousness.

   This makes the patients’
‘moods’ intelligible - their inexplicable, unreasonable
changes of feeling which seem to waking thought without motive. The
impressionability of hysterical patients is indeed to a large
extent determined simply by their innate excitability; but the
lively affects into which they are thrown by relatively trivial
causes become more intelligible if we reflect that the
‘split-off mind’ acts like a sounding-board to the note
of a tuning-fork. Any event that provokes unconscious memories
liberates the whole affective force of these ideas that have not
undergone a wearing-away, and the affect that is called up is then
quite out of proportion to any that would have arisen in the
conscious mind alone.