Freud - Complete Works (55 page)

On The Psychical Mechanism Of Hysterical Phenomena

293

   Sleeplessness or disturbed sleep
are also symptoms that are usually susceptible to the most precise
explanation. Thus, for years on end a woman could never get to
sleep till six in the morning. She had for a long time slept in the
room adjoining her sick husband, who used to rise at six
o’clock. After that hour she had been able to sleep in quiet;
and she behaved in the same way once more many years later during a
hysterical illness. Another case was that of a man. He was a
hysterical patient who had slept very badly for the last twelve
years. His sleeplessness, however, was of a quite special sort. In
the summer he slept excellently, but in the winter very badly; and
in November he slept quite particularly badly. He had no notion
what this was due to. Enquiry revealed that in November twelve
years earlier he had watched for many nights at the bedside of his
son, who was ill with diphtheria.

   Breuer’s patient, to whom I
have so often referred, offered an example of a disturbance of
speech. For a long period of her illness she spoke only English and
could neither speak nor understand German. This symptom was traced
back to an event which had happened before the outbreak of her
illness. While she was in a state of great anxiety, she had
attempted to pray but could find no words. At last a few words of a
child’s prayer in English occurred to her. When she fell ill
later on, only the English language was at her command.

On The Psychical Mechanism Of Hysterical Phenomena

294

   The determination of the symptom
by the psychical trauma is not so transparent in every instance.
There is often only what may be described as a
‘symbolic’ relation between the determining cause and
the hysterical symptom. This is especially true of pains. Thus one
patient suffered from piercing pains between her eyebrows. The
reason was that once when she was a child her grandmother had given
her an enquiring, ‘piercing’ look. The same patient
suffered for a time from violent pains in her right heel, for which
there was no explanation. These pains, it turned out, were
connected with an idea that occurred to the patient when she made
her first appearance in society. She was overcome with fear that
she might not ‘find herself on a right footing’.
Symbolizations of this kind were employed by many patients for a
whole number of so-called neuralgias and pains. It is as though
there were an intention to express the mental state by means of a
physical one; and linguistic usage affords a bridge by which this
can be effected. In the case, however, of what are after all the
typical symptoms of hysteria- such as hemi-anaesthesia, restriction
of the visual field, epileptiform convulsions, etc. - a psychical
mechanism of this sort cannot be demonstrated. On the other hand
this can often be done in respect to the hysterogenic zones.

   These examples, which I have
chosen out of a number of observations, seem to offer proof that
the phenomena of common hysteria can safely be regarded as being on
the same pattern as those of traumatic hysteria, with the
involvement of psychical, as vs. actual physical trauma and that
accordingly every hysteria can be looked upon as traumatic hysteria
in the sense of implying a psychical trauma and that every
hysterical phenomenon is determined by the nature of the
trauma.

On The Psychical Mechanism Of Hysterical Phenomena

295

   The further question which would
then have to be answered is as to the nature of the causal
connection between the determining factor which we have discovered
during hypnosis and the phenomenon which persists subsequently as a
chronic symptom. This connection might be of various kinds. It
might be of the type that we should describe as a
‘releasing’ factor. For instance, if someone with a
disposition to tuberculosis receives a blow on the knee as a result
of which he develops a tubercular inflammation of the joint, the
blow is a simple releasing cause. But this is not what happens in
hysteria. There is another kind of causation - namely,
direct
causation. We can elucidate this from the picture of
a foreign body, which continues to operate unceasingly as a
stimulating cause of illness until it is got rid of.
Cessante
causa cessat effectus
.¹ Breuer’s observation shows
us that there is a connection of this latter kind between the
psychical trauma and the hysterical phenomenon. For Breuer learnt
from his first patient that the attempt at discovering the
determining cause of a symptom was at the same time a therapeutic
manoeuvre. The moment at which the physician finds out the occasion
when the symptom first appeared and the reason for its appearance
is also the moment at which the symptom vanishes. When, for
instance, the symptom presented by the patient consists in pains,
and when we enquire from him under hypnosis as to their origin, he
will produce a series of memories in connection with them. If we
can succeed in eliciting a really vivid memory in him, and if he
sees things before him with all their original actuality, we shall
observe that he is completely dominated by some affect. And if we
then compel him to put this affect into words, we shall find that,
at the same time as he is producing this violent affect, the
phenomenon of his pains emerges very markedly once again and that
thenceforward the symptom, in its chronic character, disappears.
This is how events turned out in all the instances I have quoted.
And it was an interesting fact that the memory of this particular
event was to an extraordinary degree more vivid than the memory of
any others, and that the affect accompanying it was as great,
perhaps, as it had been when the event actually occurred. It could
only be supposed that the psychical trauma does in fact continue to
operate in the subject and maintains the hysterical phenomenon, and
that it comes to an end as soon as the patient has spoken about
it.

   As I have just said, if, in
accordance with our procedure, one arrives at the psychical trauma
by making enquiries from the patient under hypnosis, one discovers
that the memory concerned is quite unusually strong and has
retained the whole of its affect. The question now arises how it is
that an event which occurred so long ago - perhaps ten or twenty
years - can persist in exercising its power over the subject, how
it is that these memories have not been subject to the processes of
wearing away and forgetting.

  
¹
[‘When the cause ceases the effect
ceases’]

On The Psychical Mechanism Of Hysterical Phenomena

296

   With a view to answering this
question, I should like to begin with a few remarks on the
conditions which govern the wearing-away of the contents of our
ideational life. We will start from a thesis that may be stated in
the following terms. If a person experiences a psychical
impression, something in his nervous system which we will for the
moment call the sum of excitation is increased. Now in every
individual there exists a tendency to diminish this sum of
excitation once more, in order to preserve his health. The increase
of the sum of excitation takes place along sensory paths, and its
diminution along motor ones. So we may say that if anything
impinges on someone he reacts in a motor fashion. We can now safely
assert that it depends on this reaction how much of the initial
psychical impression is left. Let us consider this in relation to a
particular example. Let us suppose that a man is insulted, is given
a blow or something of the kind. This psychical trauma is linked
with an increase in the sum of excitation of his nervous system.
There then instinctively arises an inclination to diminish this
increased excitation immediately. He hits back, and then feels
easier; he may perhaps have reacted adequately-that is, he may have
got rid of as much as had been introduced into him. Now this
reaction may take various forms. For quite slight increases in
excitation, alterations in his own body may perhaps be enough:
weeping, abusing, raging, and so on. The more intense the trauma,
the greater is the adequate reaction. The most adequate reaction,
however is always a deed. But, as an English writer has wittily
remarked, the man who first flung a word of abuse at his enemy
instead of a spear was the founder of civilization. Thus words are
substitutes for deeds, and in some circumstances (e. g. in
Confession) the only substitutes. Accordingly, alongside the
adequate reaction there is one that is less adequate. If, however,
there is no reaction
whatever
to a psychical trauma, the
memory of it retains the affect which it originally had. So that if
someone who has been insulted cannot avenge the insult either by a
retaliatory blow or by a word of abuse, the possibility arises that
the memory of the event may call up in him once more the affect
which was originally present. An insult that has been repaid, even
if only in words, is recollected quite differently from one that
has had to be accepted; and linguistic usage characteristically
describes an insult that has been suffered in silence as a
‘mortification’. Thus, if for any reason there can be
no reaction to a psychical trauma, it retains its original affect,
and when someone cannot get rid of the increase in stimulation by
‘abreacting’ it, we have the possibility of the event
in question remaining a psychical trauma. Incidentally, a healthy
psychical mechanism has other methods of dealing with the affect of
a psychical trauma even if motor reaction and reaction by words are
denied to it - namely by working it over associatively and by
producing contrasting ideas. Even if the person who has been
insulted neither hits back nor replies with abuse, he can
nevertheless reduce the affect attaching to the insult by calling
up such contrasting ideas as those of his own worthiness, of his
enemy’s worthlessness, and so on. Whether a healthy man deals
with an insult in one way or the other, he always succeeds in
achieving the result that the affect which was originally strong in
his memory eventually loses intensity and that finally the
recollection, having lost its affect, falls a victim to
forgetfulness and the process of wearing-away.

On The Psychical Mechanism Of Hysterical Phenomena

297

   Now we have found that in
hysterical patients there are nothing but impressions which have
not lost their affect and whose memory has remained vivid. It
follows, therefore, that these memories in hysterical
patients, which have become pathogenic, occupy an
exceptionalposition as regards the wearing-away process; and
observation shows that, in the case of all the events which have
become determinants of hysterical phenomena, we are dealing with
psychical traumas which have not been completely abreacted, or
completely dealt with. Thus we may assert that
hysterical
patients suffer from incompletely abreacted psychical
traumas
.

   We find two groups of conditions
under which memories become pathogenic. In the first group the
memories to which the hysterical phenomena can be traced back have
for their content ideas which involved a trauma so great that the
nervous system had not sufficient power to deal with it in any way,
or ideas to which reaction was impossible for social reasons (this
applies frequently to married life); or lastly the subject may
simply refuse to react, may not
want
to react to the
psychical trauma. In this last case the contents of the hysterical
deliria often turn out to be the very circle of ideas which the
patient in his normal state has rejected, inhibited and suppressed
with all his might.(For instance, blasphemies and erotic ideas
occur in the hysterical deliria of nuns.)  But in a second
group of cases the reason for the absence of a reaction lies not in
the content of the psychical trauma but in other circumstances. For
we very often find that the content and determinants of hysterical
phenomena are events which are in themselves quite trivial, but
which have acquired high significance from the fact that they
occurred at specially important moments when the patient’s
predisposition was pathologically increased. For instance, the
affect of fright may have arisen in the course of some other severe
affect and may on that account have attained such great importance.
States of this kind are of short duration and are, as one might
say, out of communication with the rest of the subject’s
mental life. While he is in a state of auto-hypnosis such as this,
he cannot get rid associatively of an idea that occurs to him, as
he can in a waking state. After considerable experience with these
phenomena, we think it probable that in every hysteria we are
dealing ‘with a rudiment of what is called 
‘
double conscience
’, dual consciousness, and
that a tendency to such a dissociation and with it the emergence of
abnormal states of consciousness, which we propose to call
‘hypnoid’, is the basic phenomenon of hysteria.

On The Psychical Mechanism Of Hysterical Phenomena

298

   Let us now consider the manner in
which our therapy operates. It falls in with one of the dearest
human wishes - the wish to be able to do something over again.
Someone has experienced a psychical trauma without reacting to it
sufficiently. We get him to experience it a second time, but under
hypnosis; and we now compel him to complete his reaction to it. He
can then get rid of the idea’s affect, which was so to say
‘strangulated’, and when this is done the operation of
the idea is brought to an end. Thus we cure - not hysteria but some
of its individual symptoms - by causing an unaccomplished reaction
to be completed.