Freud - Complete Works (47 page)

Studies On Hysteria

241

   I will try to enumerate a few
instances of the excellent results brought about by this technical
procedure.

   I treated a girl suffering from
an intolerable
tussis nervosa
which had dragged on for six
years. It obviously drew nourishment from every common catarrh, but
must nevertheless have had strong psychical motives. All other
kinds of therapy had long proved impotent against it. I therefore
tried to remove the symptom by means of psychical analysis. All she
knew was that her nervous cough began when, at the age of fourteen,
she was boarding with an aunt. She maintained that she knew nothing
of any mental agitations at that time and did not believe that
there was any motive for her complaint. Under the pressure of my
hand she first of all remembered a big dog. She then recognized the
picture in her memory: it was a dog of her aunt’s which
became attached to her, followed her about everywhere, and so on.
And it now occurred to her, without further prompting, that this
dog died, that the children gave it a solemn burial and that her
cough started on the way back from the funeral. I asked why, but
had once more to call in the help of a pressure. The thought then
came to her: ‘Now I am quite alone in the world. No one here
loves me. This creature was my only friend, and now I have lost
him.’ She continued her story. ‘The cough disappeared
when I left my aunt’s, but it came on again eighteen months
later.’ ‘Why was that?’ ‘I don’t
know.’ I pressed again. She recalled the news of her
uncle’s death, when the cough started again, and also
recalled having a similar train of thought. Her uncle seems to have
been the only member of the family who had shown any feeling for
her, who had loved her. Here, then, was the pathogenic idea. No one
loved her, they preferred everyone else to her, she, did not
deserve to be loved, and so on. But there was something attaching
to the idea of ‘love’ which there was a strong
resistance to her telling me. The analysis broke off before this
was cleared up.

Studies On Hysteria

242

   Some time ago I was asked to
relieve an elderly lady of her attacks of anxiety, though judging
by her traits of character she was scarcely suitable for treatment
of this kind. Since her menopause she had become excessively pious,
and she used to receive me at each visit armed with a small ivory
crucifix concealed in her hand, as though I were the Evil One. Her
anxiety attacks, which were of a hysterical character, went back to
her early girlhood and, according to her, originated from the use
of a preparation of iodine intended to reduce a moderate swelling
of her thyroid gland. I naturally rejected this derivation and
tried to find another instead of it which would harmonize better
with my views on the aetiology of the neuroses. I asked her first
for an impression from her youth which stood in a causal relation
to her anxiety attacks, and, under the pressure of my hand, a
memory emerged of her reading what is known as an
‘edifying’ book, in which there occurred a mention, in
a sufficiently pious strain, of the sexual processes. The passage
in question made an impression on the girl which was quite the
reverse of the author’s intention: she burst into tears and
flung the book away. This was
before
her first anxiety
attack. A second pressure on the patient’s forehead conjured
up a further reminiscence - the recollection of a tutor of her
brothers who had manifested a great admiration for her and towards
whom she herself had had feelings of some warmth. This recollection
culminated in the reproduction of an evening in her parents’
house when they had all sat round the table with the young man and
had enjoyed themselves immensely in an entertaining conversation.
During the night following that evening she was woken up by her
first anxiety attack which, it is safe to say, had more to do with
a repudiation of a sensual impulse than with any contemporary doses
of iodine. - What prospect should I have had by any other method of
revealing such a connection, against her own views and assertions,
in this recalcitrant patient who was so prejudiced against me and
every form of mundane therapy?

Studies On Hysteria

243

   Another example concerns a young,
happily-married woman. As long ago as in her early girlhood she
used for some time to be found every morning in a stuporose
condition, with her limbs rigid, her mouth open and her tongue
protruding; and now once again she was suffering, on waking, from
attacks which were similar though not so severe. Since deep
hypnosis turned out not to be obtainable, I began to investigate
while she was in a state of concentration. At my first pressure I
assured her that she would see something that was directly related
to the causes of her condition in her childhood. She was quiet and
co-operative. She saw once more the house in which she had spent
her early girlhood, her own room, the position of her bed, her
grandmother, who had lived with them at that time, and one of her
governesses of whom she had been very fond. A number of small
scenes, all of them unimportant, which took place in these rooms
and between these people followed one after the other; they were
concluded by the departure of the governess, who left in order to
get married. I could make nothing at all of these reminiscences; I
could not establish any relation between them and the aetiology of
the attacks. Various circumstances showed, however, that they
belonged to the same period at which the attacks first appeared.
But before I was able to proceed with the analysis I had occasion
to talk to a colleague who in former years had been the family
doctor of my patient’s parents. He gave me the following
information. At the time at which he was treating the girl, who was
approaching maturity and very well developed physically, for her
first attacks, he was struck by the excessive affectionateness of
the relation between her and the governess who was at that time in
the house. He became suspicious and induced the grandmother to keep
an eye on this relationship. After a short time the old lady was
able to report to him that the governess was in the habit of
visiting the child in bed at night and that after such nights the
child was invariably found next morning in an attack. They did not
hesitate after this to arrange for the silent removal of this
corrupter of youth. The children and even the mother were
encouraged to believe that the governess had left in order to get
married. - My therapy, which was immediately successful, consisted
in giving the young woman the information I had received.

Studies On Hysteria

244

   The revelations which one obtains
through the procedure of pressing occasionally appear in a very
remarkable form and in circumstances which make the assumption of
there being an unconscious intelligence even more tempting. Thus I
remember a lady who had suffered for many years from obsessions and
phobias and who referred me to her childhood for the genesis of her
illness but was also quite unable to say what might be to blame for
it. She was frank and intelligent and she put up only a remarkably
small conscious resistance. (I may remark in parenthesis that the
psychical mechanism of obsessions has a very great deal of internal
kinship with hysterical symptoms and that the technique of analysis
is the same for both of them.) When I asked this lady whether she
had seen anything or had any recollection under the pressure of my
hand, she replied: ‘Neither the one nor the other, but a word
has suddenly occurred to me.’ ‘A single word?’
‘Yes, but it sounds too silly.’ 'Say it all the
same.’ ‘Concierge.’ ‘Nothing else?’
‘No.’ I pressed a second time and once more an isolated
word shot through her mind: 'Night-gown.’ I saw now that
this was a new sort of method of answering, and by pressing
repeatedly I brought out what seemed to be a meaningless series of
words: ‘Concierge’ - 'night-gown’ -
’bed’ - ’town’ - ’farm-cart.’
‘What does all this mean?’ I asked. She reflected for a
moment and the following thought occurred to her: ‘It must be
the story that has just come into my head. When I was ten years old
and my next elder sister was twelve, she went raving mad one night
and had to be tied down and taken into the town on a farm-cart. I
remember perfectly that it was the concierge who overpowered her
and afterwards went with her to the asylum as well.’  We
pursued this method of investigation and our oracle produced
another series of words, which, though we were not able to
interpret all of them, made it possible to continue this story and
lead on from it to another one. Soon, moreover, the meaning of this
reminiscence became clear. Her sister’s illness had made such
a deep impression on her because the two of them shared a secret;
they slept in one room and on a particular night they had both been
subjected to sexual assaults by a certain man. The mention of this
sexual trauma in the patient’s childhood revealed not only
the origin of her first obsessions but also the trauma which
subsequently produced the pathogenic effects.

   The peculiarity of this case lay
only in the emergence of isolated key-words which we had to work
into sentences; for the appearance of disconnectedness and
irrelevance which characterized the words emitted in this oracular
fashion applies equally to the complete ideas and scenes which are
normally produced under my pressure. When these are followed up, it
invariably turns out that the apparently disconnected reminiscences
are closely linked in thought and that they lead quite straight to
the pathogenic factor we are looking for. For this reason I am glad
to recall a case of analysis in which my confidence in the products
of pressure were first put to a hard test but afterwards
brilliantly justified.

Studies On Hysteria

245

   A very intelligent and apparently
happy young married woman had consulted me about an obstinate pain
in her abdomen which was resistant to treatment. I recognized that
the pain was situated in the abdominal wall and must be referred to
palpable muscular indurations, and I ordered local treatment. Some
months later I saw the patient again and she said to me: ‘The
pain I had then passed off after the treatment you recommended, and
it stayed away for a long time; but now it has come back in a
nervous form. I know that is so, because I no longer have it, as I
used to, when I make certain movements, but only at particular
times - for instance, when I wake up in the morning and when I am
agitated in certain ways.’ The lady’s diagnosis was
quite correct. It was now a question of finding out the cause of
the pain, and she could not help me about this while she was in an
uninfluenced state. When I asked her, in concentration and under
the pressure of my hand, whether anything occurred to her or
whether she saw anything, she decided in favour of seeing and began
to describe her visual pictures. She saw something like a sun with
rays, which I naturally took to be a phosphene, produced by
pressure on the eyes. I expected that something more serviceable
would follow. But she went on: ‘Stars of a curious pale blue
light, like moon light’ and so on, all of which I took to be
no more than flickering, flashes and bright specks before her eyes.
I was already prepared to regard this experiment as a failure and I
was wondering how I could make an inconspicuous retreat from the
affair, when my attention was attracted by one of the phenomena
which she described. She saw a large black cross, leaning over,
which had round its edges the same shimmer of light with which all
her other pictures had shone, and on whose cross-beam a small flame
flickered. Clearly there could no longer be any question of a
phosphene here. I now listened carefully. Quantities of pictures
appeared bathed in the same light, curious signs looking rather
like Sanskrit; figures like triangles, among them a large triangle;
the cross once more. . . . This time I suspected an
allegorical meaning and asked what the cross could be. ‘It
probably means pain,’ she replied. I objected that by
‘cross’ one usually meant a moral burden. What lay
concealed behind the pain? She could not say, and went on with her
visions: a sun with golden rays. And this she was also able to
interpret. ‘It’s God, the primaeval force.’ Then
came a gigantic lizard which regarded her enquiringly but not
alarmingly. Then a heap of snakes. Then once more a sun, but with
mild, silver rays; and in front of her, between her and this source
of light, a grating which hid the centre of the sun from her. I had
known for some time that what I had to deal with were allegories
and at once asked the meaning of this last picture. She answered
without hesitation: ‘The sun is perfection, the ideal, and
the grating represents my weaknesses and faults which stand between
me and the ideal.’ ‘Are you reproaching yourself, then?
Are you dissatisfied with yourself: ‘Yes indeed.’
‘Since when?’ ‘Since I have been a member of the
Theosophical Society and have been reading its publications. I
always had a low opinion of myself.’ ‘What has made the
strongest impression on you recently?’ ‘A translation
from the Sanskrit which is just now coming out in
instalments.’ A minute later I was being initiated into her
mental struggles and her self-reproaches, and was hearing about a
small episode which gave rise to a self-reproach - an occasion on
which what had previously been an organic pain now for the first
time appeared as the consequence of the conversion of an
excitation. The pictures which I had first taken for phosphenes
were symbols of trains of thought influenced by the occult and were
perhaps actually emblems from the title-pages of occult books.