Freud - Complete Works (50 page)

Studies On Hysteria

256

   (I am making use here of a number
of similes, all of which have only a very limited resemblance to my
subject and which, moreover, are incompatible with one another. I
am aware that this is so, and I am in no danger of over-estimating
their value. But my purpose in using them is to throw light from
different directions on a highly complicated topic which has never
yet been represented. I shall therefore venture to continue in the
following pages to introduce similes in the same manner, though I
know this is not free from objection.)

   If it were possible, after the
case had been completely cleared up, to demonstrate the pathogenic
material to a third person in what we now know is its complicated
and multi-dimensional organization, we should rightly be asked how
a camel like this got through the eye of the needle. For there is
some justification for speaking of the ‘defile’ of
consciousness. The term gains meaning and liveliness for a
physician who carries out an analysis like this. Only a single
memory at a time can enter ego-consciousness. A patient who is
occupied in working through such a memory sees nothing of what is
pushing after it and forgets what has already pushed its way
through. If there are difficulties in the way of mastering this
single pathogenic memory - as, for instance, if the patient does
not relax his resistance against it, if he tries to repress or
mutilate it - then the defile is, so to speak, blocked. The work is
at a standstill, nothing more can appear, and the single memory
which is in process of breaking through remains in front of the
patient until he has taken it up into the breadth of his ego. The
whole spatially-extended mass of psychogenic material is in this
way drawn through a narrow cleft and thus arrives in consciousness
cut up, as it were, into pieces or strips. It is the
psychotherapist’s business to put these together once more
into the organization which he presumes to have existed. Anyone who
has a craving for further similes may think at this point of a
Chinese puzzle.

   If we are faced with starting
such an analysis, in which we have reason to expect an organization
of pathogenic material like this, we shall be assisted by what
experience has taught us, namely that
it is quite hopeless to
try to penetrate directly to the nucleus of the pathogenic
organization
. Even if we ourselves could guess it, the patient
would not know what to do with the explanation offered to him and
would not be psychologically changed by it.

Studies On Hysteria

257

   There is nothing for it but to
keep at first to the periphery of the psychical structure. We begin
by getting the patient to tell us what he knows and remembers,
while we are at the same time already directing his attention and
overcoming his slighter resistances by the use of the pressure
procedure. Whenever we have opened a new path by thus pressing on
his forehead, we may expect him to advance some distance without
fresh resistance.

   After we have worked in this way
for some time, the patient begins as a rule to co-operate with us.
A great number of reminiscences now occur to him, without our
having to question him or set him tasks. What we have done is to
make a path to an inner stratum within which the patient now has
spontaneously at his disposal material that has an equal degree of
resistance attaching to it. It is best to allow him for a time to
reproduce such material without being influenced. It is true that
he himself is not in a position to uncover important connections,
but he may be left to clear up material lying within the same
stratum. The things that he brings up in this way often seem
disconnected, but they offer material which will be given point
when a connection is discovered later on.

   Here we have in general to guard
against two things. If we interfere with the patient in his
reproduction of the ideas that pour in on him, we may
‘bury’ things that have to be freed later with a great
deal of trouble. On the other hand we must not over-estimate the
patient’s unconscious ‘intelligence’ and leave
the direction of the whole work to it. If I wanted to give a
diagrammatic picture of our mode of operation, I might perhaps say
that we ourselves undertake the opening up of inner strata,
advancing
radially
, whereas the patient looks after the
peripheral
extension of the work.

   Advances are brought about, as we
know, by overcoming resistance in the manner already indicated. But
before this, we have as a rule another task to perform. We must get
hold of a piece of the logical thread, by whose guidance alone we
may hope to penetrate to the interior. We cannot expect that the
free communications made by the patient, the material from the most
superficial strata, will make it easy for the analyst to recognize
at what points the path leads into the depths or where he is to
find the starting-points of the connections of thought of which he
is in search. On the contrary, this is precisely what is carefully
concealed; the account given by the patient sounds as if it were
complete and self-contained. It is at first as though we were
standing before a wall which shut out every prospect and prevents
us from having any idea whether there is anything behind it, and if
so, what.

Studies On Hysteria

258

   But if we examine with a critical
eye the account that the patient has given us without much trouble
or resistance, we shall quite infallibly discover gaps and
imperfections in it. At one point the train of thought will be
visibly interrupted and patched up by the patient as best he may,
with a turn of speech or an inadequate explanation; at another
point we come upon a motive which would have to be described as a
feeble one in a normal person. The patient will not recognize these
deficiencies when his attention is drawn to them. But the physician
will be right in looking behind the weak spots for an approach to
the material in the deeper layers and in hoping that he will
discover precisely there the connecting threads for which he is
seeking with the pressure procedure. Accordingly, we say to the
patient: ‘You are mistaken; what you are putting forward can
have nothing to do with the present subject. We must expect to come
upon something else here, and this will occur to you under the
pressure of my hand.’

   For we may make the same demands
for logical connection and sufficient motivation in a train of
thought, even if it extends into the unconscious, from a hysterical
patient as we should from a normal individual. It is not within the
power of a neurosis to relax these relations. If the chains of
ideas in neurotic and particularly in hysterical patients produce a
different impression, if in them the relative intensity of
different ideas seems inexplicable by psychological determinants
alone, we have already found out the reason for this and can
attribute it to
the existence of hidden unconscious motives
.
We may thus suspect the presence of such secret motives wherever a
breach of this kind in a train of thought is apparent or when the
force ascribed by the patient to his motives goes far beyond the
normal.

Studies On Hysteria

259

   In carrying out this work we must
of course keep free from the theoretical prejudice that we are
dealing with the abnormal brains of
‘
dégénérés
’ and
‘
déséquilibrés
’,¹ who
are at liberty, owing to a stigma, to throw overboard the common
psychological laws that govern the connection of ideas and in whom
one chance idea may become exaggeratedly intense for no motive and
another may remain indestructible for no psychological reason.
Experience shows that the contrary is true of hysteria. Once we
have discovered the concealed motives, which have often remained
unconscious, and have taken them into account, nothing that is
puzzling or contrary to rule remains in hysterical connections of
thought, any more than in normal ones.

   In this way, then, by detecting
lacunas in the patient’s first description, lacunas which are
often covered by ‘false connections’, we get hold of a
piece of the logical thread at the periphery, and from this point
on we clear a further path by the pressure technique.

   In doing this, we very seldom
succeed in making our way right into the interior along one and the
same thread. As a rule it breaks off half-way: the pressure fails
and either produces no result or one that cannot be clarified or
carried further in spite of every effort. We soon learn, when this
happens, to avoid the mistakes into which we might fall. The
patient’s facial expression must decide whether we have
really come to an end, or whether this is an instance which
requires no psychical elucidation, or whether what has brought the
work to a standstill is excessive resistance. In the last case, if
we cannot promptly overcome the resistance we may assume that we
have followed the thread into a stratum which is for the time being
still impenetrable. We drop it and take up another thread, which we
may perhaps follow equally far. When we have arrived at this
stratum along all the threads and have discovered the entanglements
on account of which the separate threads could not be followed any
further in isolation, we can think of attacking the resistance
before us afresh.

  
¹
[‘Degenerate’ and
‘unbalanced’ persons.]

Studies On Hysteria

260

   It is easy to imagine how
complicated a work of this kind can become. We force our way into
the internal strata, overcoming resistances all the time; we get to
know the themes accumulated in one of these strata and the threads
running through it, and we experiment how far we can advance with
our present means and the knowledge we have acquired; we obtain
preliminary information about the contents of the next strata by
means of the pressure technique; we drop threads and pick them up
again; we follow them as far as nodal points; we are constantly
making up arrears; and every time that we pursue a file of memories
we are led to some side-path, which nevertheless eventually joins
up again. By this method we at last reach a point at which we can
stop working in strata and can penetrate by a main path straight to
the nucleus of the pathogenic organization. With this the struggle
is won, though not yet ended. We must go back and take up the other
threads and exhaust the material. But now the patient helps us
energetically. His resistance is for the most part broken.

   In these later stages of the work
it is of use if we can guess the way in which things are connected
up and tell the patient before we have uncovered it. If we have
guessed right, the course of the analysis will be accelerated; but
even a wrong hypothesis helps us on, by compelling the patient to
take sides and by enticing him into energetic denials which betray
his undoubted better knowledge.

   We learn with astonishment from
this that
we are not in a position to force anything on the
patient about the things of which he is ostensibly ignorant or to
influence the products of the analysis by arousing an
expectation
. I have never once succeeded, by foretelling
something, in altering or falsifying the reproduction of memories
or the connection of events; for if I had, it would inevitably have
been betrayed in the end by some contradiction in the material. If
something turned out as I had foretold, it was invariably proved by
a great number of unimpeachable reminiscences that I had done no
more than guess right. We need not be afraid, therefore, of telling
the patient what we think his next connection of thought is going
to be. It will do no harm.

   Another observation, which is
constantly repeated, relates to the patient’s spontaneous
reproductions. It may be asserted that every single reminiscence
which emerges during an analysis of this kind has significance. An
intrusion of
irrelevant
mnemic images (which happen in some
way or other to be associated with the important ones) in fact
never occurs. An exception which does not contradict this rule may
be postulated for memories which, unimportant in themselves, are
nevertheless indispensable as a bridge, in the sense that the
association between two important memories can only be made through
them.

Studies On Hysteria

261

   The length of time during which a
memory remains in the narrow defile in front of the patient’s
consciousness is, as has already been explained, in direct
proportion to its importance. A picture which refuses to disappear
is one which still calls for consideration, a thought which cannot
be dismissed is one that needs to be pursued further. Moreover, a
recollection never returns a second time once it has been dealt
with; an image that has been ‘talked away’ is not
seen again. If nevertheless this does happen we can confidently
assume that the second time the image will be accompanied by a new
set of thoughts, or the idea will have new implications. In other
words, they have not been completely dealt with. Again, it
frequently happens that an image or thought will re-appear in
different degrees of intensity, first as a hint and later with
complete clarity. This, however, does not contradict what I have
just asserted.

   Among the tasks presented by
analysis is that of getting rid of symptoms which are capable of
increasing in intensity or of returning: pains, symptoms (such as
vomiting) which are due to stimuli, sensations or contractures.
While we are working at one of these symptoms we come across the
interesting and not undesired phenomenon of ‘joining in the
conversation’. The problematical symptom re-appears, or
appears with greater intensity, as soon as we reach the region of
the pathogenic organization which contains the symptom’s
aetiology, and thenceforward it accompanies the work with
characteristic oscillations which are instructive to the physician.
The intensity of the symptom (let us take for instance a desire to
vomit) increases the deeper we penetrate into one of the relevant
pathogenic memories; it reaches its climax shortly before the
patient gives utterance to that memory; and when he has finished
doing so it suddenly diminishes or even vanishes completely for a
time. If, owing to resistance, the patient delays his telling for a
long time, the tension of the sensation - of the desire to vomit -
becomes unbearable, and if we cannot force him to speak he actually
begins to vomit. In this way we obtain a plastic impression of the
fact that ‘vomiting’ takes the place of a psychical act
(in this instance, the act of utterance ), exactly as the
conversion theory of hysteria maintains.