Freud - Complete Works (570 page)

Introductory Lectures On Psycho-Analysis

3441

   A noteworthy relation between the
symptoms of the ‘actual’ neuroses and of the
psychoneuroses makes a further important contribution to our
knowledge of the formation of symptoms in the latter. For a symptom
of an ‘actual’ neurosis is often the nucleus and first
stage of a psychoneurotic symptom. A relation of this kind can be
most clearly observed between neurasthenia and the transference
neurosis known as ‘conversion hysteria’, between
anxiety neurosis and anxiety hysteria, but also between
hypochondria and the forms of disorder which will be mentioned
later under the name of paraphrenia (dementia praecox and
paranoia). Let us take as an example a case of hysterical headache
or lumbar pain. Analysis shows us that, by condensation and
displacement, it has become a substitutive satisfaction for a whole
number of libidinal phantasies or memories. But this pain was also
at one time a real one and it was then a direct sexual-toxic
symptom, the somatic expression of a libidinal excitation. We are
far from asserting that
all
hysterical symptoms contain a
nucleus of this kind. But it remains a fact that this is especially
often the case and that whatever somatic influences (whether normal
or pathological) are brought about by libidinal excitation are
preferred for the construction of hysterical symptoms. In such
cases they play the part of the grain of sand which a mollusc coats
with layers of mother-of-pearl. In the same way, the passing
indications of sexual excitement which accompany the sexual act are
employed by the psychoneurosis as the most convenient and
appropriate material for the construction of symptoms.

   A similar course of events
affords peculiar diagnostic and therapeutic interest. It not at all
infrequently happens in the case of a person who is disposed to a
neurosis without actually suffering from a manifest one, that a
pathological somatic change (through inflammation or injury
perhaps) sets the activity of symptom-formation going; so that this
activity hastily turns the symptom which has been presented to it
by reality into the representative of all the unconscious
phantasies which have only been lying in wait to seize hold of some
means of expression. In such a case the physician will adopt
sometimes one and sometimes another line of treatment. He will
either endeavour to remove the organic basis, without bothering
about its noisy neurotic elaboration; or he will attack the
neurosis which has taken this favourable opportunity for arising
and will pay little attention to its organic precipitating cause.
The outcome will prove the one or the other line of approach right
or wrong; it is impossible to make general recommendations to meet
such mixed cases.

Introductory Lectures On Psycho-Analysis

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LECTURE XXV

ANXIETY

LADIES AND
GENTLEMEN
, - What I said to you in my last lecture about the
general neurotic state will no doubt have struck you as the most
incomplete and inadequate of all my pronouncements. I know that is
true, and nothing will have surprised you more, I expect, than that
there was nothing in it about anxiety, of which most neurotics
complain, which they themselves describe as their worst suffering
and which does in fact attain enormous intensity in them and may
result in their adopting the craziest measures. But there at least
I had no intention of giving you short measure. On the contrary, it
was my intention to attack the problem of anxiety in neurotics
particularly keenly and to discuss it at length with you.

   I have no need to introduce
anxiety itself to you. Every one of us has experienced that
sensation, or, to speak more correctly, that affective state, at
one time or other on our own account. But I think the question has
never been seriously enough raised of why neurotics in particular
suffer from anxiety so much more and so much more strongly than
other people. Perhaps it has been regarded as something
self-evident: the words ‘
nervös
’ and
‘
ängstlich
’ are commonly used
interchangeably, as though they meant the same thing. But we have
no right to do so: there are ‘
ängstlich
’
people who are otherwise not at all
‘
nervös
’ and, moreover,
‘
nervös
’ people who suffer from many
symptoms, among which a tendency to ‘
Angst
’ is
not included.

   However that may be, there is no
question that the problem of anxiety is a nodal point at which the
most various and important questions converge, a riddle whose
solution would be found to throw a flood of light on our whole
mental existence. I will not assert that I can give you this
complete solution; but you will certainly expect psycho-analysis to
approach this subject too in quite a different way from academic
medicine. Interest there seems mainly to be centred on tracing the
anatomical paths along which the state of anxiety is brought about.
We are told that the medulla oblongata is stimulated, and the
patient learns that he is suffering from a neurosis of the vagus
nerve. The medulla oblongata is a very serious and lovely object. I
remember quite clearly how much time and trouble I devoted to its
study many years ago. To-day, however, I must remark that I know
nothing that could be of less interest to me for the psychological
understanding of anxiety than knowledge of the path of the nerves
along which its excitations pass.

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   It is possible at the start to
work upon the subject of anxiety for quite a time without thinking
at all of neurotic states. You will understand me at once when I
describe this kind of anxiety as ‘realistic’ anxiety in
contrast to ‘neurotic’ anxiety. Realistic anxiety
strikes us as something very rational and intelligible. We may say
of it that it is a reaction to the perception of an external danger
- that is, of an injury which is expected and foreseen. It is
connected with the flight reflex and it may be regarded as a
manifestation of the self-preservative instinct. On what occasions
anxiety appears - that is to say, in the face of what objects and
in what situations - will of course depend to a large extent on the
state of a person’s knowledge and on his sense of power
vis-à-vis
the external world. We can quite understand
how a savage is afraid of a cannon and frightened by an eclipse of
the sun, while a white man, who knows how to handle the instrument
and can foretell the eclipse, remains without anxiety in these
circumstances. On other occasions it is actually superior knowledge
that promotes anxiety, because it makes an early recognition of the
danger possible. Thus the savage will be terrified at a trail in
the jungle that tells an uninformed person nothing, because it
warns him of the proximity of a wild animal; and an experienced
sailor will look with terror at a small cloud in the sky that seems
trivial to a passenger, because it tells him of an approaching
hurricane.

   On further consideration we must
tell ourselves that our judgement that realistic anxiety is
rational and expedient calls for drastic revision. For the only
expedient behaviour when a danger threatens would be a cool
estimate of one’s own strength in comparison with the
magnitude of the threat and, on the basis of that, a decision as to
whether flight or defence, or possibly even attack, offers the best
prospect of a successful issue. But in this situation there is no
place at all for anxiety; everything that happens would be achieved
just as well and probably better if no anxiety were generated. And
you can see, indeed, that if the anxiety is excessively great it
proves in the highest degree inexpedient; it paralyses all action,
including even flight. Usually the reaction to danger consists n a
mixture of the affect of anxiety and defensive action. A terrified
animal is afraid and flees; but the expedient part of this is the
‘flight’ and not the ‘being afraid’.

Introductory Lectures On Psycho-Analysis

3444

   Thus one feels tempted to assert
that the generation of anxiety is never an expedient thing. It may
perhaps help us to see more clearly if we dissect the situation of
anxiety more carefully. The first thing about it is
preparedness
for the danger, which manifests itself in
increased sensory attention and motor tension. This expectant
preparedness can be unhesitatingly recognized as an advantage;
indeed, its absence may be made responsible for serious
consequences. From it there then proceeds on the one hand motor
action - flight in the first instance and at a higher level active
defence - and on the other hand what we feel as a state of anxiety.
The more the generation of anxiety is limited to a mere abortive
beginning - to a signal - the more will the preparedness for
anxiety transform itself without disturbance into action and the
more expedient will be the shape taken by the whole course of
events. Accordingly, the
preparedness
for anxiety seems to
me to be the expedient element in what we call anxiety, and the
generation
of anxiety the inexpedient one.

   I shall avoid going more closely
into the question of whether our linguistic usage means the same
thing or something clearly different by ‘
Angst
[anxiety]’, ‘
Furcht
[fear]’ and
‘
Schreck
[fright]’. I will only say that I think
‘
Angst
’ relates to the state and disregards the
object, while ‘
Furcht
’ draws attention precisely
to the object. It seems that ‘
Schreck
’, on the
other hand, does have a special sense; it lays emphasis, that is,
on the effect produced by a danger which is not met by any
preparedness for anxiety. We might say, therefore, that a person
protects himself from fright by anxiety.

   A certain ambiguity and
indefiniteness in the use of the word ‘
Angst
’
will not have escaped you. By ‘anxiety’ we usually
understand the subjective state into which we are put by perceiving
the ‘generation of anxiety’ and we call this an affect.
And what is an affect in the dynamic sense? It is in any case
something highly composite. An affect includes in the first place
particular motor innervations or discharges and secondly certain
feelings; the latter are of two kinds - perceptions of the motor
actions that have occurred and the direct feelings of pleasure and
unpleasure which, as we say, give the affect its keynote. But I do
not think that with this enumeration we have arrived at the essence
of an affect. We seem to see deeper in the case of some affects and
to recognize that the core which holds the combination we have
described together is the repetition of some particular significant
experience. This experience could only be a very early impression
of a very general nature, placed in the prehistory not of the
individual but of the species. To make myself more intelligible -
an affective state would be constructed in the same way as a
hysterical attack; and, like it, would be the precipitate of a
reminiscence. A hysterical attack may thus be likened to a freshly
constructed individual affect, and a normal affect to the
expression of a general hysteria which has become a heritage.

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   Do not suppose that the things I
have said to you here about affects are the recognized
stock-in-trade of normal psychology. They are on the contrary views
that have grown up on the soil of psycho-analysis and are native
only to it. What you may gather about affects from psychology - the
James-Lange theory, for example - is quite beyond understanding or
discussion to us psycho-analysts. But we do not regard our
knowledge about affects as very assured either; it is a first
attempt at finding our bearings in this obscure region. I will
proceed, however. We believe that in the case of the affect of
anxiety we know what the early impression is which it repeats. We
believe that it is in the
act of birth
that there comes
about the combination of unpleasurable feelings, impulses of
discharge and bodily sensations which has become the prototype of
the effects of a mortal danger and has ever since been repeated by
us as the state of anxiety. The immense increase of stimulation
owing to the interruption of the renovation of the blood (internal
respiration) was at the time the cause of the experience of
anxiety; the first anxiety was thus a toxic one. The name
‘
Angst
- ‘
augustiae
’,
‘
Enge
’¹ - emphasizes the characteristic of
restriction in breathing which was then present as a consequence of
the real situation and is now almost invariably reinstated in the
affect. We shall also recognize it as highly relevant that this
first state of anxiety arose out of separation from the mother. It
is, of course, our conviction that the disposition to repeat the
first state of anxiety has been so thoroughly incorporated into the
organism through a countless series of generations that a single
individual cannot escape the affect of anxiety even if, like the
legendary Macduff, he ‘was from his mother’s womb
untimely ripped’ and has therefore not himself experienced
the act of birth. We cannot say what has become the prototype of
the state of anxiety in the case of creatures other than mammals.
And in the same way we do not know either what complex of feelings
is in such creatures the equivalent to our anxiety.

   It may perhaps interest you to
learn how anyone could have formed such an idea as that the act of
birth is the source and prototype of the affect of anxiety.
Speculation had a very small share in it; what I did, rather, was
to borrow from the
naïve
popular mind. Long years ago,
while I was sitting with a number of other young hospital doctors
at our mid-day meal in an inn, a house physician from the midwifery
department told us of a comic thing that had happened at the last
examination for midwives. A candidate was asked what it meant if
meconium (excreta) made its appearance at birth in the water coming
away, and she promptly replied: ‘it means the child’s
frightened.’ She was laughed at and failed in the
examination. But silently I took her side and began to suspect that
this poor woman from the humbler classes had laid an unerring
finger on an important correlation.