Freud - Complete Works (432 page)

   (5)
Education
can be
described without more ado as an incitement to the conquest of the
pleasure principle, and to its replacement by the reality
principle; it seeks, that is, to lend its help to the developmental
process which affects the ego. To this end it makes use of an offer
of love as a reward from the educators; and it therefore fails if a
spoilt child thinks that it possesses that love in any case and
cannot lose it whatever happens.

   (6)
Art
brings about a
reconciliation between the two principles in a peculiar way. An
artist is originally a man who turns away from reality because he
cannot come to terms with the renunciation of instinctual
satisfaction which it at first demands, and who allows his erotic
and ambitious wishes full play in the life of phantasy. He finds
the way back to reality, however, from this world of phantasy by
making use of special gifts to mould his phantasies into truths of
a new kind, which are valued by men as precious reflections of
reality. Thus in a certain fashion he actually becomes the hero,
the king, the creator, or the favourite he desired to be, without
following the one roundabout path of making real alterations in the
external world. But he can only achieve this because other men feel
the same dissatisfaction as he does with the renunciation demanded
by reality, and because that dissatisfaction, which results from
the replacement of the pleasure principle by the reality principle,
is itself a part of reality.²

   (7) While the ego goes through
its transformation from a
pleasure-ego
into a
reality-ego
, the sexual instincts undergo the changes that
lead them from their original auto-erotism through various
intermediate phases to object-love in the service of procreation.
If we are right in thinking that each step in these two courses of
development may become the site of a disposition to later neurotic
illness, it is plausible to suppose that the form taken by the
subsequent illness (the
choice of neurosis
) will depend on
the particular phase of the development of the ego and of the
libido in which the dispositional inhibition of development has
occurred. Thus unexpected significance attaches to the
chronological features of the two developments (which have not yet
been studied), and to possible variations in their
synchronization.

  
¹
The superiority of the reality-ego over the
pleasure-ego has been aptly expressed by Bernard Shaw in these
words: ‘To be able to choose the line of greatest advantage
instead of yielding in the direction of least resistance.’
(
Man and Superman
.)

  
²
Cf. the similar position taken by Otto Rank
(1907).

Formulations On The Two Principles Of Mental Functioning

2557

   (8) The strangest characteristic
of unconscious (repressed) processes, to which no investigator can
become accustomed without the exercise of great self-discipline, is
due to their entire disregard of reality-testing; they equate
reality of thought with external actuality, and wishes with their
fulfilment - with the event - just as happens automatically under
the dominance of the ancient pleasure principle. Hence also the
difficulty of distinguishing unconscious phantasies from memories
which have become unconscious. But one must never allow oneself to
be misled into applying the standards of reality to repressed
psychical structures, and on that account, perhaps, into
undervaluing the importance of phantasies in the formation of
symptoms on the ground that they are not actualities, or into
tracing a neurotic sense of guilt back to some other source because
there is no evidence that any actual crime has been committed. One
is bound to employ the currency that is in use in the country one
is exploring - in our case a neurotic currency. Suppose, for
instance, that one is trying to solve a dream such as this. A man
who had once nursed his father through a long and painful mortal
illness, told me that in the months following his father’s
death he had repeatedly dreamt that
his father was alive once
more and that he was talking to him in his usual way. But he felt
it exceedingly painful that his father had really died, only
without knowing it
. The only way of understanding this
apparently nonsensical dream is by adding ‘as the dreamer
wished’ or ‘in consequence of his wish’ after the
words ‘that his father had really died’, and by further
adding ‘that he wished it’ to the last words. The
dream-thought then runs: it was a painful memory for him that he
had been obliged to wish for his father’s death (as a
release) while he was still alive, and how terrible it would have
been if his father had had any suspicion of it! What we have here
is thus the familiar case of self-reproaches after the loss of
someone loved, and in this instance the self-reproach went back to
the infantile significance of death-wishes against the father.

   The deficiencies of this short
paper, which is preparatory rather than expository, will perhaps be
excused only in small part if I plead that they are unavoidable. In
these few remarks on the psychical consequences of adaptation to
the reality principle I have been obliged to adumbrate views which
I should have preferred for the present to withhold and whose
justification will certainly require no small effort. But I hope it
will not escape the notice of the benevolent reader how in these
pages too the dominance of the reality principle is beginning.

2558

TYPES OF ONSET OF NEUROSIS

(1912)

2559

Intentionally left blank

2560

TYPES OF ONSET OF NEUROSIS

In the pages which follow, I shall describe,
on the basis of impressions arrived at empirically, the changes
which conditions must undergo in order to bring about the outbreak
of a neurotic illness in a person with a disposition to it. I shall
thus be dealing with the question of the precipitating factors of
illnesses and shall have little to say about their forms. The
present discussion of the precipitating causes will differ from
others in that the changes to be enumerated will relate exclusively
to the subject’s libido. For psycho-analysis has taught us
that the vicissitudes of the libido are what decide in favour of
nervous health or sickness. Nor are words to be wasted in this
connection on the concept of disposition. It is precisely
psycho-analytic research which has enabled us to show that neurotic
disposition lies in the history of the development of the libido,
and to trace back the operative factors in that development to
innate varieties of sexual constitution and to influences of the
external world experienced in early childhood.

   (
a
) The most obvious, the
most easily discoverable and the most intelligible precipitating
cause of an onset of neurosis is to be seen in the external factor
which may be described in general terms as
frustration
. The
subject was healthy so long at his need for love was satisfied by a
real object in the external world; he becomes neurotic as soon as
this object is withdrawn from him without a substitute taking its
place. Here happiness coincides with health and unhappiness with
neurosis. It is easier for fate to bring about a cure than for the
physician; for it can offer the patient a substitute for the
possibility of satisfaction which he has lost.

   Thus with this type, to which, no
doubt, the majority of human beings on the whole belong, the
possibility of falling ill arises only when there is abstinence.
And it may be judged from this what an important part in the
causation of neuroses may be played by the limitation imposed by
civilization on the field of accessible satisfactions. Frustration
has a pathogenic effect because it dams up libido, and so submits
the subject to a test as to how long he can tolerate this increase
in psychical tension and as to what methods he will adopt for
dealing with it. There are only two possibilities for remaining
healthy when there is a persistent frustration of satisfaction in
the real world. The first is by transforming the psychical tension
into active energy which remains directed towards the external
world and eventually extorts a real satisfaction of the libido from
it. The second is by renouncing libidinal satisfaction, sublimating
the dammed-up libido and turning it to the attainment of aims which
are no longer erotic and which escape frustration. That these two
possibilities are realized in men’s lives proves that
unhappiness does not coincide with neurosis and that frustration
does not alone decide whether its victim remains healthy or falls
ill. The immediate effect of frustration lies in its bringing into
play the dispositional factors which have hitherto been
inoperative.

   Where these are present and
sufficiently strongly developed, there is a risk of the libido
becoming ‘introverted’.¹ It turns away from
reality, which, owing to the obstinate frustration, has lost its
value for the subject, and turns towards the life of phantasy, in
which it creates new wishful structures and revives the traces of
earlier, forgotten ones. In consequence of the intimate connection
between the activity of phantasy and material present in everyone
which is infantile and repressed and has become unconscious, and
thanks to the exceptional position enjoyed by the life of phantasy
in regard to reality-testing,² the libido may thenceforward
move on a backward course; it may follow the path of
regression
along infantile lines, and strive after aims that
correspond with them. If these strivings, which are incompatible
with the subject’s present-day individuality, acquire enough
intensity, a conflict must result between them and the other
portion of his personality, which has maintained its relation to
reality. This conflict is resolved by the formation of symptoms,
and is followed by the onset of manifest illness. The fact that the
whole process originated from frustration in the real world is
reflected in the resulting event that the symptoms, in which the
ground of reality is reached once more, represent substitutive
satisfactions.

  
¹
To use a term introduced by C. G.
Jung.

  
²
See my ‘Formulations on the Two
Principles of Mental Functioning’ (1911
b
).

Types Of Onset Of Neurosis

2561

   (
b
) The second type of
precipitating cause of falling ill is by no means so obvious as the
first; and it was in fact only possible to discover it through
searching analytic investigations following on the Zurich
school’s theory of complexes.¹ Here the subject does not
fall ill as a result of a change in the external world which has
replaced satisfaction by frustration, but as a result of an
internal effort to obtain the satisfaction which is accessible to
him in reality. He falls ill of his attempt to adapt himself to
reality and to fulfil
the demands of reality
- an attempt in
the course of which he comes up against insurmountable internal
difficulties.

   It is advisable to draw a sharp
distinction between the two types of onset of illness - a sharper
distinction than observation as a rule permits. In the first type
what is prominent is a change in the external world; in the second
type the accent falls on an internal change. In the first type the
subject falls ill from an experience; in the second type it is from
a developmental process. In the first case he is faced by the task
of renouncing satisfaction, and he falls ill from his incapacity
for resistance; in the second case his task is to exchange one kind
of satisfaction for another, and he breaks down from his
inflexibility. In the second case the conflict, which is between
the subject’s effort to remain as he is and the effort to
change himself in order to meet fresh purposes and fresh demands
from reality, is present from the first. In the former case the
conflict only arises after the dammed-up libido has chosen other,
and incompatible, possibilities of satisfaction. The part played by
the conflict and the previous fixation of the libido is
incomparably more obvious in the second type than in the first, in
which such unserviceable fixations may perhaps only emerge as a
result of the external frustration.

  
¹
Cf. Jung (1909).

Types Of Onset Of Neurosis

2562

    A young man who has
hitherto satisfied his libido by means of phantasies ending in
masturbation, and who now seeks to replace a régime
approximating to auto-erotism by the choice of a real object - or a
girl who has given her whole affection to her father or brother and
who must now, for the sake of a man who is courting her, allow her
hitherto unconscious incestuous libidinal wishes to become
conscious - or a married woman who would like to renounce her
polygamous inclinations and phantasies of prostitution so as to
become a faithful consort to her husband and a perfect mother to
her child - all of these fall ill from the most laudable efforts,
if the earlier fixations of their libido are powerful enough to
resist a displacement; and this point will be decided, once again,
by the factors of disposition, constitution and infantile
experience. All of them, it might be said, meet with the fate of
the little tree in the Grimms’ fairy tale, which wished it
had different leaves. From the hygienic point of view - which, to
be sure, is not the only one to be taken into account - one could
only wish for them that they had continued to be as undeveloped, as
inferior and as useless as they were before they fell ill. The
change which the patients strive after, but bring about only
imperfectly or not at all, invariably has the value of a step
forward from the point of view of real life. It is otherwise if we
apply ethical standards: we see people falling ill just as often
when they discard an ideal as when they seek to attain it.

   In spite of the very clear
differences between the two types of onset of illness that we have
described, they nevertheless coincide in essentials and can without
difficulty be brought together into a unity. Falling ill from
frustration may also be regarded as incapacity for adaptation to
reality - in the particular case, that is, in which reality
frustrates satisfaction of libido. Falling ill under the conditions
of the second type leads directly to a special case of frustration.
It is true that reality does not here frustrate
every
kind
of satisfaction; but it frustrates the one kind which the subject
declares is the only possible one. Nor does the frustration come
immediately from the external world, but primarily from certain
trends in the subject’s ego. Nevertheless, frustration
remains the common factor and the more inclusive one. In
consequence of the conflict which immediately sets in in the second
type, both kinds of satisfaction - the habitual one as well as the
one aimed at - are equally inhibited; a damming-up of libido, with
all its consequences, comes about just as it does in the first
case. The psychical events leading to the formation of symptoms are
if anything easier to follow in the second type than in the first;
for in the second type the pathogenic fixations of the libido do
not need to be freshly established, but have already been in force
while the subject was healthy. A certain amount of introversion of
libido is, as a rule, already present; and there is a saving of
some part of the subject’s regression to the infantile stage,
owing to the fact that his forward development has not yet
completed its course.

Types Of Onset Of Neurosis

2563

   (
c
) The next type, which I
shall describe as falling ill from
an inhibition in
development
, looks like an exaggeration of the second one -
falling ill from the demands of reality. There is no theoretical
reason for distinguishing it, but only a practical one; for those
we are here concerned with are people who fall ill as soon as they
get beyond the irresponsible age of childhood, and who have thus
never reached a phase of health - a phase, that is, of capacity for
achievement and enjoyment which is on the whole unrestricted. The
essential feature of the dispositional process is in these cases
quite plain. Their libido has never left its infantile
fixations;  the demands of reality are not suddenly made upon
a wholly or partly mature person, but arise from the very fact of
growing older, since it is obvious that they constantly alter with
the subject’s increasing age. Thus conflict falls into the
background in comparison with insufficiency. But here, too, all our
other experience leads us to postulate an effort at overcoming the
fixations of childhood; for otherwise the outcome of the process
could never be neurosis but only a stationary infantilism.

   (
d
) Just as the third type
has brought the dispositional determinant before us almost in
isolation, so the fourth type, which now follows, draws our
attention to another factor, which comes into consideration in
every single case and might easily for that very reason be
overlooked in a theoretical discussion. We see people fall ill who
have hitherto been healthy, who have met with no fresh experience
and whose relation to the external world has undergone no change,
so that the onset of their illness inevitably gives an impression
of spontaneity. A closer consideration of such cases, however,
shows us that none the less a change
has
taken place in them
whose importance we must rate very highly as a cause of illness. As
a result of their having reached a particular period of life, and
in conformity with regular biological processes, the
quantity
of libido in their mental economy has experienced
an increase which is in itself enough to upset the equilibrium of
their health and to set up the necessary conditions for a neurosis.
It is well known that more or less sudden increases of libido of
this kind are habitually associated with puberty and the menopause
- with the attainment of a certain age in women; in some people
they may in addition be manifested in periodicities that are still
unknown. Here the damming-up of libido is the primary factor; it
becomes pathogenic as a consequence of a
relative
frustration on the part of the external world, which would still
have granted satisfaction to a smaller claim by the libido. The
unsatisfied and dammed-up libido can once again open up paths to
regression and kindle the same conflicts which we have demonstrated
in the case of absolute external frustration. We are reminded in
this way that the quantitative factor should not be left out of
account in any consideration of the precipitating causes of
illness. All the other factors - frustration, fixation,
developmental inhibition - remain ineffective unless they affect a
certain amount of libido and bring about a damming-up of libido of
a certain height. It is true that we are unable to measure this
amount of libido which seems to us indispensable for a pathogenic
effect; we can only postulate it after the resulting illness has
started. There is only one direction in which we can determine it
more precisely. We may assume that it is not a question of an
absolute
quantity, but of the relation between the quota of
libido in operation and the quantity of libido which the individual
ego is able to deal with - that is, to hold under tension, to
sublimate or to employ directly. For this reason a
relative
increase in the quantity of libido may have the same effects as an
absolute one. An enfeeblement of the ego owing to organic illness
or owing to some special demand upon its energy will be able to
cause the emergence of neuroses which would otherwise have remained
latent in spite of any disposition that might be present.