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Introductory Lectures On Psycho-Analysis

3437

   In your contact as doctors with
neurotics, Gentlemen, you will soon give up expecting that the ones
who raise the most lamentations and complaints about their illness
will be the most eager to co-operate and will offer you the least
resistance. It is rather the opposite. But of course you will
easily realize that everything that contributes to the gain from
illness will intensify the resistance due to repression and will
increase the therapeutic difficulties. But to the portion of gain
from illness which is, so to say, born with the illness we have to
add another portion which arises later. When a psychical
organization like an illness has lasted for some time, it behaves
eventually like an independent organism; it manifests something
like a self-preservative instinct; it establishes a kind of
modus vivendi
between itself and other parts of the mind,
even with those which are at bottom hostile to it; and there can
scarcely fail to be occasions when it proves once again useful and
expedient and acquires, as it were, a
secondary function
which strengthens its stability afresh. Instead of an example from
pathology, let us take a glaring instance from daily life. A
capable working-man, who earns his living, is crippled by an
accident in the course of his occupation. The injured man can no
longer work, but eventually he obtains a small disablement pension,
and he learns how to exploit his mutilation by begging. His new,
though worsened, means of livelihood is based precisely on the very
thing that deprived him of his former means of livelihood. If you
could put an end to his injury you would make him, to begin with,
without means of subsistence; the question would arise of whether
he was still capable of taking up his earlier work again. What
corresponds in the case of neuroses to a secondary exploitation
like this of an illness may be described as the
secondary
gain from illness in contrast to the primary one.

   In general, however, I should
like to recommend that, while not under-estimating the
practical
importance of the gain from illness, you should
not let yourselves be impressed by it theoretically. After all,
apart from the exceptions recognized earlier, it always calls to
mind the examples of ‘animal intelligence’ illustrated
by Oberländer in
Fliegende Blätter
. An Arab was
riding his camel along a narrow path cut in the steep face of a
mountain. At a turn in the path he suddenly found himself face to
face with a lion, which prepared to make a spring. He saw no way
out: on one side a perpendicular cliff and on the other a
precipice; retreat and flight were impossible. He gave himself up
for lost. But the animal thought otherwise. He took one leap with
his rider into the abyss - and the lion was left in the lurch. The
help provided by a neurosis has as a rule no better success with
the patient. This may be because dealing with a conflict by forming
symptoms is after all an automatic process which cannot prove
adequate to meeting the demands of life, and in which the subject
has abandoned the use of his best and highest powers. If there were
a choice, it would be preferable to go down in an honourable
struggle with fate.

Introductory Lectures On Psycho-Analysis

3438

   But I still owe you further
enlightenment, Gentlemen, on my reasons for not starting my account
of the theory of the neuroses with the common neurotic state. You
may perhaps suppose that it was because in that case I should have
had greater difficulty in proving the sexual causation of the
neuroses. But you would be wrong there. In the case of the
transference neuroses one must work one’s way through the
interpretation of symptoms before one can arrive at that discovery.
In the common forms of what are known as the ‘actual
neuroses’ the aetiological significance of sexual life is a
crude fact that springs to the observer’s eyes. I came upon
it more than twenty years ago when one day I asked myself the
question of why in the examination of neurotics their sexual
activities were so regularly excluded from consideration. At that
time I sacrificed my popularity with my patients for the sake of
these enquiries; but after only a brief effort I was able to
declare that ‘if the
vita sexualis
is normal, there
can be no neurosis’ - and by this I meant no ‘actual
neurosis’. No doubt this statement passes too lightly over
people’s individual differences; it suffers, too, from the
indefiniteness inseparable from the judgement of what is
‘normal’. But as a rough guide it retains its value to
this day. I had by then reached the point of establishing specific
relations between particular forms of neurosis and particular
sexual noxae; and I have no doubt that I could repeat the same
observations to-day if similar pathological material were still at
my disposal. I found often enough that a man who indulged in a
certain kind of incomplete sexual satisfaction (for instance,
manual masturbation) had fallen ill of a particular form of
‘actual neurosis’, and that this neurosis promptly gave
place to another if he replaced this sexual
régime
by
another equally far from being irreproachable. I was then in a
position to infer the change in a patient’s sexual mode of
life from an alteration in his condition. I also learnt then to
stand obstinately by my suspicions till I had overcome the
patients’ disingenuousness and compelled them to confirm my
views. It is true that thereafter they preferred to go to other
doctors who did not make such keen enquiries about their sexual
life.

   Even at that time I could not
fail to notice that the causation of the illness did not always
point to sexual life. One person, it was true, fell ill directly
from a sexual noxa; but another did so because he had lost his
fortune or had been through an exhausting organic illness. The
explanation of these varieties came later, when we gained an
insight into the suspected interrelations between the ego and the
libido, and the explanation became the more satisfactory the deeper
that insight extended. A person only falls ill of a neurosis if his
ego has lost the capacity to allocate his libido in some way. The
stronger is his ego, the easier will it be for it to carry out that
task. Any weakening of his ego from whatever cause must have the
same effect as an excessive increase in the claims of the libido
and will thus make it possible for him to fall ill of a neurosis.
There are other and more intimate relations between the ego and the
libido; but these have not yet come within our scope, so I will not
bring them up as part of my present explanation. What remains
essential and makes things clear to us is that, in every case and
no matter how the illness is set going, the symptoms of the
neurosis are sustained by the libido and are consequently evidence
that it is being employed abnormally.

Introductory Lectures On Psycho-Analysis

3439

   Now, however, I must draw your
attention to the decisive difference between the symptoms of the
‘actual’ neuroses and those of the psychoneuroses, the
first group of which, the transference neuroses, have occupied us
so much hitherto. In both cases the symptoms originate from the
libido, and are thus abnormal employments of it, substitutive
satisfactions. But the symptoms of the ‘actual’
neuroses - intracranial pressure, sensations of pain, a state of
irritation in an organ, weakening or inhibition of a function -
have no ‘sense’, no psychical meaning. They are not
only manifested predominantly in the body (as are hysterical
symptoms, for instance, as well), but they are also themselves
entirely somatic processes, in the generating of which all the
complicated mental mechanisms we have come to know are absent. Thus
they really are what psychoneurotic symptoms were so long believed
to be. But if so, how can they correspond to employments of the
libido, which we have recognized as a force operating in the
mind
? Well, Gentlemen, that is a very simple matter. Let me
remind you of one of the very first objections that were brought up
against psycho-analysis. It was said then that it was occupied in
finding a purely psychological theory of neurotic phenomena and
this was quite hopeless, since psychological theories could never
explain an illness. People had chosen to forget that the sexual
function is not a purely psychical thing any more than it is a
purely somatic one. It influences bodily and mental life alike. If
in the symptoms of the psychoneuroses we have become acquainted
with manifestations of disturbances in the
psychical
operation of the sexual function, we shall not be surprised to find
in the ‘actual’ neuroses the direct
somatic
consequences of sexual disturbances.

   Clinical medicine has given us a
valuable pointer towards an interpretation of these disturbances,
and one that has been taken into account by various enquirers. The
‘actual’ neuroses, in the details of their symptoms and
also in their characteristic of influencing every organic system
and every function, exhibit an unmistakable resemblance to the
pathological states which arise from the chronic influence of
external toxic substances and from a sudden withdrawal of them - to
intoxications and conditions of abstinence. The two groups of
disorders are brought together still more closely by intermediate
conditions such as Grave’s disease which we have learnt to
recognize as equally due to the operation of toxic substances, but
of toxins which are not introduced into the body from outside but
originate in the subject’s own metabolism. In view of these
analogies, we cannot, I think, avoid regarding the neuroses as
results of disturbances in the sexual metabolism, whether because
more of these sexual toxins is produced than the subject can deal
with, or whether because internal and even psychical conditions
restrict the proper employment of these substances. The popular
mind has from time immemorial paid homage to hypotheses of this
kind on the nature of sexual desire, speaking of love as an
‘intoxication’ and believing that falling in love is
brought about by love philtres - though here the operative agent is
to some extent externalized. And for us this would be an occasion
for recalling the erotogenic zones and our assertion that sexual
excitation can be generated in the most various organs. But for the
rest the phrase ‘sexual metabolism’ or ‘chemistry
of sexuality’ is a term without content; we know nothing
about it and cannot even decide whether we are to assume two sexual
substances, which would then be named ‘male’ and
‘female’, or whether we could be satisfied with
one
sexual toxin which we should have to recognize as the
vehicle of all the stimulant effects of the libido. The theoretical
structure of psycho-analysis that we have created is in truth a
superstructure, which will one day have to be set upon its organic
foundation. But we are still ignorant of this.

Introductory Lectures On Psycho-Analysis

3440

   What characterizes
psycho-analysis as a science is not the material which it handles
but the technique with which it works. It can be applied to the
history of civilization, to the science of religion and to
mythology, no less than to the theory of the neuroses, without
doing violence to its essential nature. What it aims at and
achieves is nothing other than the uncovering of what is
unconscious in mental life. The problems of the
‘actual’ neuroses, whose symptoms are probably
generated by direct toxic damage, offer psycho-analysis no points
of attack. It can do little towards throwing light on them and must
leave the task to biologico-medical research.

   And now perhaps you understand
better why I did not choose to arrange my material differently. If
I had promised you an ‘Introduction to the Theory of the
Neuroses’ the correct path would certainly have led from the
simple forms of the ‘actual’ neuroses to the more
complicated psychical illnesses due to disturbance of the libido.
As regards the former I should have had to collect from various
sources what we have learnt or believe we know, and in connection
with the psychoneuroses psycho-analysis would have come up for
discussion as the most important technical aid in throwing light on
those conditions. But what I intended to give and what I announced
was an ‘Introduction to Psycho-Analysis’. It was more
important for me that you should gain an idea of psycho-analysis
than that you should obtain some pieces of knowledge about the
neuroses; and for that reason the ‘actual’ neuroses,
unproductive so far as psycho-analysis is concerned, could no
longer have a place in the foreground. I believe, too, that I have
made the better choice for you. For, on account of the profundity
of its hypotheses and the comprehensiveness of its connections,
psycho-analysis deserves a place in the interest of every educated
person, while the theory of the neuroses is a chapter in medicine
like any other.

   Nevertheless you will rightly
expect that we should devote some interest to the
‘actual’ neuroses as well. Their intimate clinical
connection with the psychoneuroses would alone compel us to do so.
I may inform you, then, that we distinguish three pure forms of
‘actual’ neuroses: neurasthenia, anxiety neurosis and
hypochondria. Even this assertion is not uncontradicted. All the
names are in use, it is true, but their content is indefinite and
fluctuating. There are even doctors who oppose any dividing lines
in the chaotic world of neurotic phenomena, any segregation of
clinical entities or individual diseases, and who do not even
recognize the distinction between the ‘actual’ neuroses
and the psychoneuroses. I think they are going too far and have not
chosen the path which leads to progress. The forms of neurosis
which I have mentioned occur occasionally in their pure form; more
often, however, they are intermixed with each other and with a
psychoneurotic disorder. This need not lead us to abandon the
distinction between them. Consider the difference between the study
of minerals and of rocks in mineralogy. The minerals are described
as individuals, no doubt on the basis of the fact that they often
occur as crystals, sharply separated from their environment. Rocks
consist of aggregations of minerals, which, we may be sure, have
not come together by chance but as a result of what determined
their origin. In the theory of the neuroses we still know too
little of the course of their development to produce anything
resembling petrology. But we are certainly doing the right thing if
we start by isolating from the mass the individual clinical
entities which we recognize and which are comparable to the
minerals.