Freud - Complete Works (57 page)

   I will now indicate which of the
various elements put forward in this theory can be directly
demonstrated and which have been filled in by me. What can be
directly demonstrated, apart from the end-product of the process -
the obsession - is in the first place the source of the affect
which is now in a false connection. In all the cases I have
analysed it was the subject’s
sexual life
that had
given rise to a distressing affect of precisely the same quality as
that attaching to his obsession. Theoretically, it is not
impossible that this affect should sometimes arise in other fields;
I can only report that so far I have not come across any other
origin. Moreover, it is easy to see that it is precisely sexual
life which brings with it the most copious occasions for the
emergence of incompatible ideas.

   Furthermore, the most unambiguous
statements by the patients give proof of the effort of will, the
attempt at defence, upon which the theory lays emphasis; and at
least in a number of cases the patients themselves inform us that
their phobia or obsession made its first appearance after the
effort of will had apparently succeeded in its aim.
‘Something very disagreeable happened to me once and I tried
very hard to put it away from me and not to think about it any
more. I succeeded at last; but then I got this other thing, which I
have not been able to get rid of since.’ It was with these
words that a woman patient confirmed the chief points of the theory
I have developed here.

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   Not everyone who suffers from
obsessions is as clear as this about their origin. As a rule, when
one draws a patient’s attention to the original idea of a
sexual kind, the answer is: ’It can’t come from that. I
didn’t think at all much about that. For a moment I was
frightened, but I turned my mind away from it and I haven’t
been troubled by it since.’ In this frequent objection we
have evidence that the obsession represents a substitute or
surrogate for the incompatible sexual idea and has taken its place
in consciousness.

   Between the patient’s
effort of will, which succeeds in repressing the unacceptable
sexual idea, and the emergence of the obsessional idea, which,
though having little intensity in itself, is now supplied with an
incomprehensibly strong affect, yawns the gap which the theory here
developed seeks to fill. The separation of the sexual idea from its
affect and the attachment of the latter to another, suitable but
not incompatible idea-these are processes which occur without
consciousness. Their existence can only be presumed, but can not be
proved by any clinico-psychological analysis. Perhaps it would be
more correct to say that these processes are not of a psychical
nature at all, that they are physical processes whose psychical
consequences present themselves as if what is expressed by the
terms ‘separation of the idea from its affect’ and
‘false connection’ of the latter had really taken
place.

   Alongside of the cases which show
a sequence between an incompatible sexual idea and an obsessional
idea, we find a number of other cases in which obsessional ideas
and sexual ideas of a distressing character are present
simultaneously. To call the latter ‘sexual obsessional
ideas’ will not do very well, for they lack one essential
feature of obsessional ideas: they turn out to be fully justified,
whereas the distressing character of ordinary obsessional ideas is
a problem for both doctor and patient. So far as I have been able
to see my way in cases of this kind, what is happening is that a
perpetual defence is going on against sexual ideas that are
continually coming up afresh - a piece of work, that is to say,
which has not yet come to completion.

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   So long as the patients are aware
of the sexual origin of their obsessions, they often keep them
secret. If they do complain about them, they usually express their
astonishment that they should be subject to the affect in question
- that they should feel anxiety, or have certain impulses, and so
on. To the experienced physician, on the contrary, the affect seems
justified and comprehensible; what
he
finds noticeable is
only that an affect of that kind should be linked with an idea
which does not merit it. The affect of the obsession appears to
him, in other words, as being
dislodged
or
transposed
; and if he has accepted what has been said in
these pages, he will be able, in a number of cases of obsessions,
to attempt to
re-translate them into sexual terms
.

   To provide this secondary
connection for the liberated affect, any idea can be made use of
which is either able, from its nature, to be united with an affect
of the
quality
in question, or which has certain relations
to the incompatible idea which make it seem as though it could
serve as a surrogate for it. Thus, for example, liberated anxiety,
whose sexual origin must not be remembered by the patient, will
seize upon the common primary phobias of mankind about animals,
thunderstorms, darkness and so on, or upon things which are
unmistakably associated in one way or another with what is
sexual-such as micturition, defaecation, or dirtying and contagion
generally.

   The ego gains much less advantage
from choosing
transposition
of affect as a method of defence
than from choosing the hysterical
conversion
of psychical
excitation into somatic innervation. The affect from which the ego
has suffered remains as it was before, unaltered and undiminished,
the only difference being that the incompatible idea is kept down
and shut out from recollection. The repressed ideas, as in the
other case, form the nucleus of a second psychical group, which, I
believe, is accessible even without the help of hypnosis. If
phobias and obsessions are unaccompanied by the striking symptoms
which characterize the formation of an independent psychical group
in hysteria, this is doubtless because in their case the whole
alteration has remained in the psychical sphere and the
relationship between psychical excitation and somatic innervation
has undergone no change.

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   To illustrate what has been said
about obsessions, I will give a few examples which are, I imagine,
of a typical kind:

   (1) A girl suffered from
obsessional self-reproaches. If she read something in the papers
about coiners, the thought would occur to her that she, too, had
made counterfeit money; if a murder had been committed by an
unknown person, she would ask herself anxiously whether it was not
she who had done the deed. At the same time she was perfectly
conscious of the absurdity of these obsessional reproaches. For a
time, this sense of guilt gained such an ascendancy over her that
her powers of criticism were stifled and she accused herself to her
relatives and her doctor of having really committed all these
crimes. (This was an example of a psychosis through simple
intensification - an
‘
Überwältigungspsychose
’.) Close
questioning then revealed the source from which her sense of guilt
arose. Stimulated by a chance voluptuous sensation, she had allowed
herself to be led astray by a woman friend into masturbating, and
had practised it for years, fully conscious of her wrong-doing and
to the accompaniment of the most violent, but, as usual,
ineffective self-reproaches. An excessive indulgence after going to
a ball had produced the intensification that led to the psychosis.
After a few months of treatment and the strictest surveillance, the
girl recovered.

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311

   (2) Another girl suffered from
the dread of being overcome by the need to urinate, and of being
unable to avoid wetting herself, ever since a need of this kind had
in fact once obliged her to leave a concert hall during the
performance. By degrees this phobia had made her completely
incapable of enjoying herself or of going into society. She only
felt well if she knew that there was a W. C. near at hand which she
could reach unobtrusively. There was no question of any organic
complaint which might justify this mistrust in her power to control
her bladder; when she was at home, in quiet conditions, or at
night, the need to urinate did not arise. A detailed examination
showed that the need had occurred first in the following
circumstances. In the concert hall a gentleman to whom she was not
indifferent had taken a seat not far from her. She began to think
about him and to imagine herself sitting beside him as his wife.
During this erotic reverie she had the bodily sensation which is to
be compared with an erection in a man, and which in her case - I do
not know if this is always so - ended with a slight need to
urinate. She now became greatly frightened by the sexual sensation
(to which she was normally accustomed) because she had resolved
within herself to combat this particular liking, as well as any
other she might feel; and next moment the affect had become
transferred on to the accompanying need to urinate and compelled
her after an agonizing struggle to leave the hall. In her ordinary
life she was so prudish that she had an intense horror of
everything to do with sex and could not contemplate the thought of
ever marrying. On the other hand, she was so hyperaesthetic
sexually that during every erotic reverie, in which she readily
indulged, the same voluptuous sensation appeared. The erection was
each time accompanied by the need to urinate, though without its
making any impression on her until the scene in the concert hall.
The treatment led to an almost complete control over her
phobia.

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   (3) A young married woman who, in
five years of marriage, had had only one child, complained to me of
an obsessional impulse to throw herself out of the window or from
the balcony, and also of a fear which seized her when she saw a
sharp knife, of stabbing her child with it. She admitted that
marital intercourse seldom occurred, and only subject to
precautions against conception, but she did not miss it, she said,
as hers was not a sensual nature. At this point I ventured to tell
her that at the sight of a man she had erotic ideas and that she
had therefore lost confidence in herself and regarded herself as a
depraved person, capable of anything. The translation back of the
obsessional idea into sexual terms was successful. In tears, she at
once confessed the long-concealed poverty of her marriage; and
later she told me also of distressing ideas of an unmodified sexual
character such as the often-recurring sensation of something
forcing itself under her skirt.

   I have turned observations of
this kind to account in my therapeutic work by leading back the
attention of patients with phobias and obsessions to the repressed
sexual ideas in spite of all their protestations, and, wherever
possible, by stopping up the sources from which those ideas sprang.
I cannot, of course, assert that
all
phobias and obsessions
arise in the manner I have shown here. In the first place, my
experience of them includes only a limited number compared with the
frequency of these neuroses; and in the second place, I myself am
aware that such ‘psychasthenic’ symptoms, as Janet
terms them, are not all equivalent.¹ There are, for instance,
purely hysterical phobias. Nevertheless, I think that it will be
possible to show the presence of the mechanism of transposition of
affect in the great majority of phobias and obsessions, and I would
therefore urge that these neuroses, which are found in an isolated
state as often as in combination with hysteria or neurasthenia,
should not be thrown into a heap along with common neurasthenia,
for the basic symptoms of which there is no ground at all to assume
a
psychical
mechanism.

  
¹
The group of typical phobias, of which
agoraphobia is a typical model, cannot be traced back to the
psychical mechanism described above; on the contrary, the mechanism
of agoraphobia differs from that of obsessions proper, and of the
phobias that are reducible to them, in one decisive point. There is
no repressed idea from which the anxiety affect might have been
separated off. The anxiety of these phobias has another
origin.

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313

III

   In both the instances considered
so far, defence against the incompatible idea was effected by
separating it from its affect; the idea itself remained in
consciousness, even though weakened and isolated. There is,
however, a much more energetic and successful kind of defence.
Here, the ego rejects the incompatible idea together with its
affect and behaves as if the idea had never occurred to the ego at
all.
But from the moment at which this has been successfully
done the subject is in a psychosis, which can only be classified as
‘hallucinatory confusion
. A single example may serve to
illustrate this statement:

   A girl had given her first
impulsive affection to a man, and firmly believed that he returned
her love. In fact, she was wrong; the young man had a different
motive for visiting the house. Disappointments were not wanting. At
first she defended herself against them by effecting a hysterical
conversion of the experiences in question and thus preserved her
belief that one day he would come and ask her hand. But at the same
time she felt unhappy and ill, because the conversion was
incomplete and because she was continually being met by fresh
painful impressions. Finally, in a state of great tension, she
awaited his arrival on a particular day, the day of a family
celebration. But the day wore on and he did not appear. When all
the trains by which he could arrive had come and gone, she passed
into a state of hallucinatory confusion: he had arrived, she heard
his voice in the garden, she hurried down in her night-dress to
receive him. From that time on she lived for two months in a happy
dream, whose content was that he was there, always at her side, and
that everything was as it had been before (before the time of the
disappointments which she had so laboriously fended off). Her
hysteria and her depression of spirits were overcome. During her
illness she was silent about the whole latter period of doubt and
suffering; she was happy so long as she was left undisturbed, and
she broke out in fury only when some rule of conduct insisted on by
those around her hindered her in something which seemed to her to
follow quite logically from her blissful dream. This psychosis,
which had been unintelligible at the time, was explained ten years
later with the help of a hypnotic analysis.