Freud - Complete Works (56 page)

   You must not suppose, then, that
very much has been gained by this for the therapeutics of hysteria.
Hysteria, like the neuroses, has its deeper causes; and it is those
deeper causes that set limits, which are often very appreciable, to
the success of our treatment.

299

THE NEURO-PSYCHOSES OF DEFENCE

(1894)

300

Intentionally left blank

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THE NEURO-PSYCHOSES OF DEFENCE

(AN
ATTEMPT AT A PSYCHOLOGICAL THEORY OF ACQUIRED HYSTERIA, OF MANY

PHOBIAS, AND OBSESSIONS AND OF CERTAIN HALLUCINATORY PSYCHOSES)

   After making a detailed study of
a number of nervous patients suffering from phobias and obsessions,
I was led to attempt an explanation of those symptoms; and this
enabled me afterwards to arrive successfully at the origin of
pathological ideas of this sort in new and different cases. My
explanation therefore seems to me to deserve publication and
further examination. Simultaneously with this ‘psychological
theory of phobias and obsessions’ my observation of patients
resulted in a contribution to the theory of hysteria, or rather to
a change in it, which appears to take into account an important
characteristic that is common both to hysteria and to the neuroses
I have just mentioned. Furthermore, I had occasion to gain insight
into what is undoubtedly a form of mental disease, and I found at
the same time that the point of view which I had tentatively
adopted established an intelligible connection between these
psychoses and the two neuroses under discussion. At the end of this
paper I shall bring forward a working hypothesis which I have made
use of in all three instances.

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302

I

   Let me begin with the change
which seems to me to be called for in the theory of the hysterical
neurosis.

   Since the fine work done by
Pierre Janet, Josef Breuer and others, it may be taken as generally
recognized that the syndrome of hysteria, so far as it is as yet
intelligible, justifies the assumption of there being a splitting
of consciousness, accompanied by the formation of separate
psychical groups. Opinions are less settled, however, about the
origin of this splitting of consciousness and about the part played
by this characteristic in the structure of the hysterical
neurosis.

   According to the theory of Janet
(1892-4 and 1893), the splitting of consciousness is a primary
feature of the mental change in hysteria. It is based on an innate
weakness of the capacity for psychical synthesis, on the narrowness
of the ‘field of consciousness (
champ de la
conscience
)' which, in the form of a psychical stigma, is
evidence of the degeneracy of hysterical individuals.

   In contradistinction to
Janet’s view, which seems to me to admit of a great variety
of objections, there is the view put forward by Breuer in our joint
communication (Breuer and Freud, 1893). According to him,
‘the basis and
sine qua non
of hysteria’ is the
occurrence of peculiar dream-like states of consciousness with a
restricted capacity for association, for which he proposes the name
‘hypnoid states’. In that case, the splitting of
consciousness is secondary and acquired; it comes about because the
ideas which emerge in hypnoid states are cut off from associative
communication with the rest of the content of consciousness.

   I am now in a position to bring
forward evidence of two other extreme forms of hysteria in which it
is impossible to regard the splitting of consciousness as primary
in Janet’s sense. In the first of these forms I was
repeatedly able to show that
the splitting in the content of
consciousness is the result of an act of will on the part of the
patient
; that is to say, it is initiated by an effort of will
whose motive can be specified. By this I do not, of course, mean
that the patient intends to bring about a splitting of his
consciousness. His intention is a different one; but, instead of
attaining its aim, it produces a splitting of consciousness.

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303

   In the third form of hysteria,
which we have demonstrated by means of a psychical analysis of
intelligent patients, the splitting of consciousness plays an
insignificant part, or perhaps none at all. They are those cases in
which what has happened is only that the reaction to traumatic
stimuli has failed to occur, and which can also, accordingly, be
resolved and cured by ‘abreaction’.¹ These are the
pure ‘retention hysterias’.

   As regards the connection with
phobias and obsessions, I am only concerned with the second form of
hysteria. For reasons which will soon be evident, I shall call this
form ‘
defence
hysteria’, using the name to
distinguish it from
hypnoid
hysteria and
retention
hysteria. I may also provisionally present my cases of defence
hysteria as ‘acquired’ hysteria, since in them there
was no question either of a grave hereditary taint or of an
individual degenerative atrophy.

   For these patients whom I
analysed had enjoyed good mental health up to the moment at which
an occurrence of incompatibility took place in their ideational
life
- that is to say, until their ego was faced with an
experience, an idea or a feeling which aroused such a distressing
affect that the subject decided to forget about it because he had
no confidence in his power to resolve the contradiction between
that incompatible idea and his ego by means of
thought-activity.

   In females incompatible ideas of
this sort arise chiefly on the soil of sexual experience and
sensation; and the patients can recollect as precisely as could be
desired their efforts at defence, their intention of ‘pushing
the thing away’, of not thinking of it, of suppressing it. I
will give some examples, which I could easily multiply, from my own
observation: the case of a girl, who blamed herself because, while
she was nursing her sick father, she had thought about a young man
who had made a slight erotic impression on her; the case of a
governess who had fallen in love with her employer and had resolved
to drive this inclination out of her mind because it seemed to her
incompatible with her pride; and so on.²

  
¹
Cf. our joint communication, ibid., 2,
8-9.

  
²
These examples are taken from a volume by
Breuer and myself which is still in preparation and which deals in
detail with the psychical mechanism of hysteria.

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304

   I cannot, of course, maintain
that an effort of will to thrust things of this kind out of
one’s thoughts a pathological act; nor do I know whether and
in what way intentional forgetting succeeds in those people who,
under the same psychical influences, remain healthy. I only know
that this kind of ‘forgetting’ did not succeed
with the patients I analysed, but led to various pathological
reactions which produced either hysteria or an obsession or a
hallucinatory psychosis. The ability to bring about one of these
states - which are all of them bound up with a splitting of
consciousness -by means of an effort of will of this sort, is to be
regarded as the manifestation of a pathological disposition,
although such a disposition is not necessarily identical with
individual or hereditary ‘degeneracy’.

   As regards the path which leads
from the patient’s effort of will to the onset of the
neurotic symptom, I have formed an opinion which may be expressed,
in current psychological abstractions, somewhat as follows. The
task which the ego, in its defensive attitude, sets itself of
treating the incompatible idea as ‘
non
arivée
’ simply cannot be fulfilled by it. Both the
memory-trace and the affect which is attached to the idea are there
once and for all and cannot be eradicated. But it amounts to an
approximate fulfilment of the task if the ego succeeds in
turning this powerful idea into a weak one
, in robbing it of
the affect - the sum of excitation - with which it is loaded. The
weak idea will then have virtually no demands to make on the work
of association.
But the sum of excitation which has been
detached from it must be put to another use
.

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305

   Up to this point the processes in
hysteria, and in phobias and obsessions are the same; from now on
their paths diverge. In hysteria, the incompatible idea is rendered
innocuous by its
sum of excitation
being
transformed into
something somatic
. For this I should like to propose the name
of
conversion
.

   The conversion may be either
total or partial. It proceeds along the line of the motor or
sensory innervation which is related - whether intimately or more
loosely - to the traumatic experience. By this means the ego
succeeds in freeing itself from the contradiction; but instead, it
has burdened itself with a mnemic symbol which finds a lodgement in
consciousness, like a sort of parasite, either in the form of an
unresolvable motor innervation or as a constantly recurring
hallucinatory sensation, and which persists until a conversion in
the opposite direction takes place. Consequently the memory-trace
of the repressed idea has, after all, not been dissolved; from now
on, it forms the nucleus of a second psychical group.

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306

   I will only add a few more words
to this view of the psycho-physical processes in hysteria. When
once such a nucleus for a hysterical splitting-off has been formed
at a ‘traumatic moment’, it will be increased at other
moments (which might be called ‘auxiliary moments’)
whenever the arrival of a fresh impression of the same sort
succeeds in breaking through the barrier erected by the will, in
furnishing the weakened idea with fresh affect and in
re-establishing for a time the associative link between the two
psychical groups, until a further conversion sets up a defence. The
distribution of excitation thus brought about in hysteria usually
turns out to be an unstable one. The excitation which is forced
into a wrong channel (ie which has been channelled into a somatic
innervation) now and then finds its way back to the idea from which
it has been detached, and it then compels the subject either to
work over the idea associatively or to get rid of it in hysterical
attacks - as we see in the familiar contrast between attacks and
chronic symptoms. The operation of Breuer’s cathartic method
lies in leading back the excitation in this way from the somatic to
the psychical sphere deliberately, and in then forcibly bringing
about a settlement of the contradiction by means of
thought-activity and a discharge of the excitation by talking.

   If the splitting of consciousness
which occurs in acquired hysteria is based upon an act of will,
then we have a surprisingly simple explanation of the remarkable
fact that hypnosis regularly widens the restricted consciousness of
a hysteric and allows access to the psychical group that has been
split off. Indeed, we know it as a peculiarity of all states
resembling sleep that they suspend the distribution of excitation
on which the ‘will’  of the conscious personality
is based.

   Thus we see that the
characteristic factor in hysteria is not the splitting of
consciousness but
the capacity for conversion
, and we may
adduce as an important part of the disposition to hysteria - a
disposition which in other respects is still unknown - a
psycho-physical aptitude for transposing very large sums of
excitation into the somatic innervation.

   This aptitude does not, in
itself, exclude psychical health; and it only leads to hysteria in
the event of there being a psychical incompatibility or an
accumulation of excitation. In taking this view, Breuer and I are
coming closer to Oppenheim’s¹ and
Strümpell’s² well-known definitions of hysteria,
and are diverging from Janet, who assigns too great an importance
to the splitting of consciousness in his characterization of
hysteria.³ The presentation given here may claim to have made
intelligible the connection between conversion and the hysterical
splitting of consciousness.

  
¹
According to Oppenheim, hysteria is an
intensified expression of motion. The ‘expression of
emotion’, however, represents the amount of psychical
excitation which normally undergoes conversion.

  
²
Strümpell maintains that in hysteria
the disturbance lies psycho-physical sphere - in the region where
the somatic and the mental are linked together.

  
³
In the second section of his acute paper
‘Quelques définitions . . .’
Janet has himself dealt with the objection which argues that
splitting of consciousness occurs in psychoses and in so-called
‘psychasthenia’ as well as in hysteria, but in my
judgement he has not met it satisfactorily. It is in the main this
objection which obliges him to describe hysteria as a form of
degeneracy. But he has failed to produce any characteristic which
sufficiently distinguishes the splitting of consciousness in
hysteria from that in psychoses and similar states.

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307

II

   If someone with a disposition
lacks the aptitude for conversion, but if, nevertheless, in order
to fend off an incompatible idea, he sets about separating it from
its affect, then
that affect is obliged to remain in the
psychical sphere
. The idea, now weakened, is still left in
consciousness, separated from all association.
But its affect,
which has become free, attaches itself to other ideas which are not
in themselves incompatible; and, thanks to this ‘false
connection’, those ideas turn into obessional ideas
.
This, in a few words, is the psychological theory of obsessions and
phobias mentioned at the beginning of this paper.