Freud - Complete Works (58 page)

The Neuro-Psychoses Of Defence

314

   The fact to which I now wish to
call attention is that the content of a hallucinatory psychosis of
this sort
consists precisely in the accentuation of the idea
which was threatened by the precipitating cause of the onset of the
illness. One is therefore justified in saying that the ego has
fended off the incompatible idea through a flight into psychosis.
The process by which this has been achieved once more eludes the
subject’s self perception, as it eludes psychologico-clinical
analysis. It must be regarded as the expression of a pathological
disposition of a fairly high degree and it may be described more or
less as follows. The ego breaks away from the incompatible idea;
but the latter is inseparably connected with a piece of reality, so
that, in so far as the ego achieves this result, it, too, has
detached itself wholly or in part from reality. In my opinion this
latter event is the condition under which the subject’s ideas
receive the vividness of hallucinations; and thus when the defence
has been successfully carried out he finds himself in a state of
hallucinatory confusion.

   I have only very few analyses of
psychoses of this sort at my disposal. But I think we have to do
here with a type of psychical illness which is very frequently
employed. For no insane asylum is without what must be regarded as
analogous examples - the mother who has fallen ill from the loss of
her baby, and now rocks a piece of wood unceasingly in her arms, or
the jilted bride who, arrayed in her wedding-dress, has for years
been waiting for her bridegroom.

   It is perhaps not superfluous to
point out that the three methods of defence here described and,
along with them, the three forms of illness to which those methods
lead, may be combined in the same person. The simultaneous
appearance of phobias and hysterical symptoms which is so often
observed in practice is one of the factors which render it
difficult to separate hysteria clearly from other neuroses and
which make it necessary to set up the category of ‘mixed
neuroses’. It is true that hallucinatory confusion is not
often compatible with a persistence of hysteria, nor, as a rule, of
obsessions. On the other hand, it is not rare for a psychosis of
defence episodically to break through the course of a hysterical or
mixed neurosis.

   I should like, finally, to dwell
for a moment on the working hypothesis which I have made use of in
this exposition of the neuroses of defence. I refer to the concept
that in mental functions something is to be distinguished - a quota
of affect or sum of excitation - which possesses all the
characteristics of a quantity (though we have no means of measuring
it), which is capable of increase, diminution, displacement and
discharge, and which is spread over the memory-traces of ideas
somewhat as an electric charge is spread over the surface of a
body.

   This hypothesis which,
incidentally, already underlies our theory of
‘abreaction’ in our ‘Preliminary
Communication’ (1893
a
), can be applied in the same
sense as physicists apply the hypothesis of a flow of electric
fluid. It is provisionally justified by its utility in
co-ordinating and explaining a great variety of psychical
states.

VIENNA
,
end of January
1894.

315

OBSESSIONS AND PHOBIAS

THEIR
PSYCHICAL MECHANISM AND THEIR AETIOLOGY

(1895)

316

Intentionally left blank

317

OBSESSIONS AND PHOBIAS

THEIR
PSYCHICAL MECHANISM AND THEIR AETIOLOGY

I shall begin by challenging two assertions
which are often found repeated in regard to the syndromes
‘obsessions’ and ‘phobias’. It must be
said, first, that they cannot be included under neurasthenia
proper, since the patients afflicted with these symptoms are no
more often neurasthenics than not; and secondly, that we are not
justified in regarding them as the effect of mental degeneracy,
because they are found in persons no more degenerate than the
majority of neurotics in general, because they sometimes improve,
and sometimes, indeed, we even succeed in curing them.¹

   Obsessions and phobias are
separate neuroses, with a special mechanism and aetiology which I
have succeeded in demonstrating in a certain number of cases, and
which, I hope, will prove similar in a good number of fresh
cases.

   As regards classification of the
subject, I propose in the first place to exclude a group of intense
obsessions which are nothing but memories, unaltered images of
important events. As an example, I may cite Pascal’s
obsession: he always thought he saw an abyss on his left hand
‘after he had nearly been thrown into the Seine in his
coach’. Such obsessions and phobias, which might be called
traumatic
, are allied to the symptoms of hysteria.

   Apart from this group we must
distinguish: (
a
) true obsessions (
b
) phobias. The
essential difference between them is the following:

   Two constituents are found in
every obsession: (1) an idea that forces itself upon the patient
(2) an associated emotional state. Now in the group of phobias this
emotional state is always one of ‘anxiety’, while in
true obsessions other emotional states, such as doubt, remorse, or
anger, may occur just as well as anxiety. I will first attempt to
explain the really remarkable psychological mechanism of true
obsessions, a mechanism quite different from that of the
phobias.

  
¹
I am very glad to find that the authors of
the most recent work on this subject express opinions very similar
to mine. Cf. Gélineau (1894), and Hack Tuke
(1894).

Obsessions And Phobias

318

I

   In many true obsessions it is
quite plain that the emotional state is the principal thing, since
that state persists unchanged while the idea associated with it
varies. The girl in Case 1 quoted below, for example, felt remorse
in some degree for all sorts of reasons - for having stolen, for
having ill-treated her sisters, for having made counterfeit money,
etc. People who doubt have many doubts at the same time or in
succession. It is the emotional state which remains constant in
them; the idea changes. In other cases the idea, too, seems
fixated, as in Case 4, of the girl who pursued the servants in the
house with an incomprehensible hatred, though constantly changing
the individual object.

   Now a careful psychological
analysis of these cases shows that
the emotional state, as such,
is always justified
. The girl in Case 1, who suffered from
remorse, had good reasons for it; the women in Case 3 who doubted
their powers of resistance to temptation knew very well why. The
girl in Case 4, who detested servants, had good reasons for
complaining, etc. Only, and it is in these two characteristics that
the pathological mark lies, (1)
the emotional state persists
indefinitely
, and, (2) the associated idea is
no longer the
appropriate original one, related to the aetiology of the
obsession, but is one which replaces it, a substitute for
it
.

   The proof of this is the fact
that we can always find in the previous history of the patient,
at the beginning of the obsession
, the original idea that
has been replaced. The replaced ideas all have common attributes;
they correspond to really distressing experiences in the
subject’s sexual life which he is striving to forget. He
succeeds merely in replacing the incompatible idea by another
ill-adapted for being associated with the emotional state, which
for its part remains unchanged. It is this
mésalliance
between the emotional state and the
associated idea that accounts for the absurdity so characteristic
of obsessions.

Obsessions And Phobias

319

   I will now bring forward my
observations and conclude with an attempt at a theoretical
explanation.

   Case 1. A girl reproached herself
for things which she knew were absurd: for having stolen, for
having made counterfeit money, for being involved in a conspiracy,
etc., according to what she happened to have been reading during
the day.

  
Reinstatement of the replaced
idea
: She reproached herself with the masturbation she had been
practising in secret without being able to renounce it. She was
cured by careful surveillance which prevented her from
masturbating.

   Case 2. A young man, a medical
student, suffered from an analogous obsession. He reproached
himself for all sorts of immoral acts: for having killed his
cousin, for having violated his sister, for having set fire to a
house, etc. He got to the point of having to turn round in the
street to see whether he had not killed the last passer-by.

  
Reinstatement
: He had been
much affected by reading in a quasi-medical book that masturbation,
to which he was addicted, destroyed one’s morale.

   Case 3. Several women complained
of an obsessional impulse to throw themselves out of the window, to
stab their children with knives, scissors, etc.

  
Reinstatement
: Obsessions
based on typical temptations. These were women who, not being at
all satisfied in marriage, had to struggle against the desires and
voluptuous ideas that constantly troubled them at the sight of
other men.

   Case 4. A girl who was perfectly
sane and very intelligent displayed an uncontrollable hatred
against the servants in the house. It had been started in
connection with an impertinent servant, and had been transferred
from servant to servant, to an extent that made housekeeping
impossible. The feeling was a mixture of hate and disgust. She gave
as a reason for it that the coarseness of these girls spoilt her
idea of love.

  
Reinstatement
: This girl
had been an involuntary witness of a love-scene in which her mother
had taken part. She had hidden her face, had stopped up her ears,
and had done her utmost to forget it, as it disgusted her and would
have made it impossible for her to remain with her mother, whom she
loved tenderly. She succeeded in her efforts, but her anger at her
idea of love having been defiled persisted within her, and this
emotional state soon linked itself to the idea of a person who
could take her mother’s place.

Obsessions And Phobias

320

   Case 5. A girl had become almost
completely isolated on account of an obsessional fear of
incontinence of urine. She could no longer leave her room or
receive visitors without having urinated a number of times. When
she was at home or entirely alone the fear did not trouble her.

  
Reinstatement
: It was an
obsession based on temptation or mistrust. She did not mistrust her
bladder, but her resistance to erotic impulses. The origin of the
obsession shows this clearly. Once, at the theatre, on seeing a man
who attracted her, she had felt an erotic desire, accompanied (as
spontaneous pollutions in women always are) by a desire to urinate.
She was obliged to leave the theatre, and from that moment on she
was a prey to the fear of having the same sensation, but the desire
to urinate had replaced the erotic one. She was completely
cured.

   Although the cases I have
enumerated show varying degrees of complexity, they have this in
common: the original (incompatible) idea has been replaced by
another idea, the substituted idea. In the cases which I now
append, the original idea has been replaced, but not by another
idea; it has been replaced by acts or impulses which originally
served as measures of
relief
or as
protective
procedures, and are now grotesquely associated with an emotional
state which does not fit them, but which has persisted unchanged,
and which has remained as justifiable as it was at its origin.

   Case 6.
Obsessional
arithmomania
. - A woman found herself obliged to count the
boards in the floor, the steps in the stair case, etc. - acts which
she performed in a ridiculous state of anxiety.

  
Reinstatement
: She had
begun the counting in order to distract her mind from obsessional
ideas (of temptation). She had succeeded in doing so, but the
impulse to count had replaced the original obsession.

Obsessions And Phobias

321

   Case 7.
Obsessional brooding
and speculating
. - A woman suffered from attacks of this
obsession which ceased only when she was ill, and then gave place
to hypochondriacal fears. The theme of her worry was always a part
or function of her body; for example, respiration: ‘Why must
I breathe? Suppose I didn’t want to breathe?’ etc.

  
Reinstatement
: At the very
beginning she had suffered from the fear of becoming insane, a
hypochondriacal phobia common enough among women who are not
satisfied by their husbands, as she was not.
To assure herself
that she was not going mad
, that she was still in possession of
her mental faculties, she had begun to ask herself questions and
concern herself with serious problems. This calmed her at first,
but with time the habit of speculation replaced the phobia. For
more than fifteen years, periods of fear (pathophobia) and of
obsessive speculating had alternated in her.

   Case 8.
Folie du doute
. -
Several cases showed the typical symptoms of this obsession but
were explained very simply. These persons had suffered or were
still suffering from various obsessions, and the knowledge that the
obsessions had disturbed all their acts and had many times
interrupted their train of thought provoked a legitimate doubt
about the reliability of their memory. The confidence of each one
of us is shaken, and we all of us have to re-read a letter or
repeat a calculation if our attention has been distracted several
times during the performance of the act. Doubt is a quite logical
result when obsessions are present.

   Case 9.
Folie du doute
(Hesitation)
. - The girl in Case 4 had become extremely slow in
the performance of all her everyday actions, particularly in her
toilet. She took hours to tie her shoe laces or to clean her
finger-nails. By way of explanation she said she could not make her
toilet while the obsessional ideas were occupying her, nor
immediately afterwards. As a result, she had become accustomed to
wait a definite length of time after each return of the obsessional
idea.

Obsessions And Phobias

322

   Case 10.
Folie du doute
.
(
Fear of scraps of paper
.) - A young woman had suffered from
scruples after having written a letter; at the same time she
collected all the pieces of paper she saw. She explained this by
confessing to a love which she had formerly refused to admit. As a
result of constantly repeating her lover’s name, she was
seized with a fear that the name might have slipped off the end of
her pen, that she might have written it upon some scrap of paper in
a pensive moment.¹

   Case 11.
Mysophobia
. - A
woman kept washing her hands constantly and touched door-handles
only with her elbow.

  
Reinstatement
: It was the
case of Lady Macbeth. The washing was symbolic, designed to replace
by physical purity the moral purity which she regretted having
lost. She tormented herself with remorse for conjugal infidelity,
the memory of which she had resolved to banish from her mind. In
addition, she used to wash her genitals.

   As regards the theory of this
process of substitution, I will content myself with answering three
questions that arise here.

   (1) How can the substitution come
about?

   It seems to be the expression of
a special inherited mental disposition. At any rate, ‘similar
heredity’ is often enough found in obsessional cases, and in
hysteria. Thus the patient in Case 2 told me that his father had
suffered from similar symptoms. He once introduced me to a first
cousin who had obsessions and a
tic convulsif
; and to his
sister’s daughter, aged eleven, who already gave evidence of
obsessions (probably of remorse).

   (2) What is the motive for the
substitution?

   I think it may be regarded as an
act of defence (
Abwehr
) of the ego against the incompatible
idea. Among my patients there are some who remember a deliberate
effort to banish the distressing idea or recollection from the
field of consciousness. (See Cases 3, 4, 11.) In other cases the
expulsion of the incompatible idea is brought about which has left
no trace in the patient’s memory.

   (3) Why does the emotional state
that is associated with the obsessional idea persist indefinitely
instead of vanishing like other states of our ego?