Freud - Complete Works (551 page)

   Obsessional neurosis is shown in
the patient’s being occupied with thoughts in which he is in
fact not interested, in his being aware of impulses in himself
which appear very strange to him and in his being led to actions
the performance of which give him no enjoyment, but which it is
quite impossible for him to omit. The thoughts (obsessions) may be
senseless in themselves, or merely a matter of indifference to the
subject; often they are completely silly, and invariably they are
the starting-point of a strenuous mental activity, which exhausts
the patient and to which he only surrenders himself most
unwillingly. He is obliged against his will to brood and speculate
as though it were a question of his most important vital problems.
The impulses which the patient is aware of in himself may also make
a childish and senseless impression; but as a rule they have a
content of the most frightful kind, tempting him, for instance, to
commit serious crimes, so that he not merely disavows them as alien
to himself, but flies from them in horror and protects him. self
from carrying them out by prohibitions, renunciations and
restrictions upon his freedom. At the same time, these impulse
never - literally never - force their way through to performance;
the outcome lies always in victory for the flight and the
precautions. What the patient actually carries out - his so called
obsessional actions - are very harmless and certainly trivial
things, for the most part repetitions or ceremonial elaborations of
the activities of ordinary life. But these necessary activities
(such as going to bed, washing, dressing or going for a walk)
become extremely tedious and almost insoluble tasks. In different
forms and cases of obsessional neurosis the pathological ideas,
impulses and actions are not combined in equal proportions; it is
the rule, rather, that one or other of these factors dominates the
picture and gives its name to the illness, but the common element
in all these forms is sufficiently unmistakable.

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   Certainly this is a crazy
illness. The most extravagant psychiatric imagination would not, I
think, have succeeded in constructing anything like it; and if one
did not see it before one every day one would never bring oneself
to believe in it. Do not suppose, however, that you will help the
patient in the least by calling on him to take a new line, to cease
to occupy himself with such foolish thoughts and to do something
sensible instead of his childish pranks. He would like to do so
himself, for he is completely clear in his head, shares your
opinion of his obsessional symptoms and even puts it forward to you
spontaneously. Only he cannot help himself. What is carried into
action in an obsessional neurosis is sustained by an energy to
which we probably know nothing comparable in normal mental life.
There is only one thing he can do: he can make displacements, and
ex changes, he can replace one foolish idea by another somewhat
milder, he can proceed from one precaution or prohibition to
another, instead of one ceremonial he can perform another. He can
displace the obsession but not remove it. The ability to displace
any symptom into something far removed from its original
conformation is a main characteristic of his illness. Moreover it
is a striking fact that in his condition the contradictions
(polarities) with which mental life is interlaced emerge especially
sharply differentiated. Alongside of obsessions with a positive and
negative content,
doubt
makes itself felt in the
intellectual field and little by little it begins to gnaw even at
what is usually most certain. The whole position ends up in an
ever-increasing degree of indecision, loss of energy and
restriction of freedom. At the same time, the obsessional neurotic
starts off with a very energetic disposition, he is often
extraordinarily self-willed and as a rule he has intellectual gifts
above the average. He has usually reached a satisfactorily high
level of ethical development; he exhibits over-conscientiousness,
and is more than ordinarily correct in his behaviour. You can
imagine that no small amount of work is needed before one can make
one’s way any distance into this contradictory hotch-potch of
character-traits and symptoms. And to begin with we aim at nothing
whatever else than understanding a few of the symptoms and being
able to interpret them.

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   Perhaps you would like to know in
advance, having in mind our earlier talks, what attitude
contemporary psychiatry adopts towards the problems of obsessional
neurosis. But it is a meagre chapter. Psychiatry gives names to the
different obsessions but says nothing further about them. On the
other hand it insists that those who suffer from these symptoms are
‘degenerates’. This gives small satisfaction; in fact
it is a judgement of value a condemnation instead of an
explanation. We are supposed to think that every possible sort of
eccentricity may arise in de generates. Well, it is true that we
must regard those who develop such symptoms as somewhat different
in their nature from other people. But we may ask: are they more
‘degenerate’ than other neurotics-than hysterical
patients, for instance, or those who fall ill of psychoses? Once
again, the characterization is evidently too general. Indeed, we
may doubt whether there is any justification for it at all, when we
learn that such symptoms occur too in distinguished people of
particularly high capacities, capacities important for the world at
large. It is true that, thanks to their own discretion and to the
untruthfulness of their biographers, we learn little that is
intimate about the great men who are our models; but it may
nevertheless happen that one of them, like Émile Zola, may
be a fanatic for the truth, and we then learn from him of the many
strange obsessional habits to which he was a life-long
victim.¹

  
¹
E. Toulouse,
Émile Zola,
enquête médico-psychologique
, Paris,
1896.

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   Psychiatry has found a way out by
speaking of ‘
dégénérés
supérieurs
’. Very nice. But we have found from
psycho-analysis that it is possible to get permanently rid of these
strange obsessional symptoms, just as of other complaints and just
as in people who are not degenerate. I myself have succeeded
repeatedly in this.

   I shall give you only two
examples of the analysis of an obsessional symptom: one an old
observation which I cannot find a better one to replace, and
another recently met with. I limit myself to this small number,
because it is impossible in such reports to avoid being very
diffuse and entering into every detail.

   A lady, nearly thirty years of
age, who suffered from the most severe obsessional manifestations
and whom I might perhaps have helped if a malicious chance had not
brought my work to nothing - I may be able to tell you more about
this later on performed (among others) the following remarkable
obsessional action many times a day. She ran from her room into
another neighbouring one, took up a particular position there
beside a table that stood in the middle, rang the bell for her
housemaid, sent her on some indifferent errand or let her go
without one, and then ran back into her own room. This was
certainly not a very distressing symptom, but was nevertheless
calculated to excite curiosity. The explanation was reached in the
most unequivocal and unobjectionable manner, free from any possible
contribution on the doctor’s part. I cannot see how I could
possibly have formed any suspicion of the sense of this obsessional
action or could have offered any suggestion on how it was to be
interpreted. Whenever I asked the patient ‘Why do you do
that? What sense has it?’ she answered: ‘I don’t
know.’ But one day, after I had succeeded in defeating a
major, fundamental doubt of hers, she suddenly knew the answer and
told me what it was that was connected with the obsessional action.
More than ten years before, she had married a man very much older
than herself, and on the wedding-night he was impotent. Many times
during the night he had come running from his room into hers to try
once more, but every time without success. Next morning he had said
angrily: ‘I should feel ashamed in front of the housemaid
when she makes the bed,’ took up a bottle of red ink that
happened to be in the room and poured its contents over the sheet,
but not on the exact place where a stain would have been
appropriate. I could not understand at first what this recollection
had to do with the obsessional action in question; the only
resemblance I could find was in the repeated running from one room
into the other, and perhaps also in the entrance of the housemaid.
My patient then led me up to the table in the second room and
showed me a big stain on the tablecloth. She further explained that
she took up her position in relation to the table in such a way
that the maid who had been sent for could not fail to see the
stain. There could no longer be any doubt of the intimate
connection between the scene on her wedding-night and her present
obsessional action, though all kinds of other things remained to be
learnt.

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   It was clear, in the first place,
that the patient was identifying herself with her husband; she was
playing his part by imitating his running from one room into the
other. Further, to carry on the analogy, we must agree that the bed
and the sheet were re placed by the table and the tablecloth. This
might seem arbitrary, but surely we have not studied
dream-symbolism to no purpose. In dreams too we often find a table
which has to be interpreted as a bed. Table and bed together stand
for marriage, so that the one can easily take the place of the
other.

   It already seems proved that the
obsessional action had a sense; it appears to have been a
representation, a repetition, of the significant scene. But we are
not obliged to come to a halt here. If we examine the relation
between the two more closely, we shall probably obtain information
about something that goes further - about the intention of the
obsessional action. Its kernel was obviously the summoning of the
housemaid, before whose eyes the patient displayed the stain, in
contrast to her husband’s remark that he would feel ashamed
in front of the maid. Thus he, whose part she was playing, did not
feel ashamed in front of the maid; accordingly the stain was in the
right place. We see, therefore, that she was not simply repeating
the scene, she was continuing and at the same time correcting it;
she was putting it right. But by this she was also correcting the
other thing, which had been so distressing that night and had made
the expedient with the red ink necessary - his impotence. So the
obsessional action was saying: ‘No, it’s not true. He
had no need to feel ashamed in front of the housemaid; he was not
impotent.’ It represented this wish, in the manner of a
dream, as fulfilled in a present-day action; it served the purpose
of making her husband superior to his past mishap.

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   Everything I could tell you about
this woman fits in with this. Or, more correctly speaking,
everything else we know about her points the way to this
interpretation of what was in itself an unintelligible obsessional
action. The woman had been living apart from her husband for years
and was struggling with an intention to obtain a legal divorce. But
there was no question of her being free of him; she was forced to
remain faithful to him; she withdrew from the world so as not to be
tempted; she exculpated and magnified his nature in her
imagination. In deed, the deepest secret of her illness was that by
means of it she protected her husband from malicious gossip,
justified her separation from him and enabled him to lead a
comfortable separate life. Thus the analysis of a harmless
obsessional action led directly to the inmost core of an illness,
but at the same time betrayed to us no small part of the secret of
obsessional neurosis in general. I am glad to let you dwell a
little on this example because it combines conditions which we
could not fairly expect to find in every case. Here the
interpretation of the symptom was discovered by the patient herself
at a single blow, without any prompting or intervention on the
analyst’s part; and it resulted from a connection with an
event which did not (as is usually the case) belong to a forgotten
period of childhood, but which had happened in the patient’s
adult life and had remained undimmed in her memory. All the
objections which criticism is normally in the habit of raising
against our interpretation of symptoms fall to the ground in this
particular case. We cannot hope always to have such good luck.

   And one thing more. Were you not
struck by the way in which this unobtrusive obsessional action has
led us into the intimacies of the patient’s life? A woman
cannot have anything much more intimate to tell than the story of
her wedding-night. Is it a matter of chance and of no further
significance that we have arrived precisely at the intimacies of
sexual life? No doubt it might be the result of the choice I have
made on this occasion. Do not let us be too hasty in forming our
judgement, and let us turn to my second example, which is of quite
a different kind - a sample of a very common species, a
sleep-ceremonial.

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