Freud - Complete Works (66 page)

   What, then are the specific
causes of neuroses? Is there a single one or are there several? And
is it possible to establish a constant aetiological relation
between a particular cause and a particular neurotic effect, in
such a way that each of the major neuroses can be attributed to a
special aetiology?

   On the basis of a laborious
examination of the facts, I shall maintain that this last
supposition is quite in agreement with reality, that each of the
major neuroses which I have enumerated has as its immediate cause
one particular disturbance of the economics of the nervous system,
and that these functional pathological modifications
have as
their common source the subject’s sexual life, whether they
lie in a disorder of his contemporary sexual life or in important
events in his past life
.

   This, to tell the truth, is no
new, unheard-of proposition. Sexual disorders have always been
admitted among the causes of nervous illness, but they have been
subordinated to heredity - and co-ordinated with the other
agents provocateurs
; their aetiological influence has been
restricted to a limited number of observed cases. Physicians had
even fallen into the habit of not investigating them unless the
patient brought them up himself. What gives its distinctive
character to my line of approach is that I elevate these sexual
influences to the rank of specific causes, that I recognize their
action in every case of neurosis, and finally that I trace a
regular parallelism, a proof of a special aetiological relation
between the nature of the sexual influence and the pathological
species of the neurosis.

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   I am quite sure that this theory
will call up a storm of contradictions from contemporary
physicians. But this is not the place in which to present the
documents and the experiences which have forced me to my
convictions, nor to explain the true meaning of the rather vague
expression ‘disorders of the economics of the nervous
system’. This will be done, most fully, I hope, in a work on
the subject which I have in preparation. In the present paper I
limit myself to reporting my findings.

   Neurasthenia proper, if we detach
anxiety neurosis from it, has a very monotonous clinical
appearance: fatigue, intracranial pressure, flatulent dyspepsia,
constipation, spinal paraesthesias, sexual weakness, etc. The only
specific aetiology it allows of is (immoderate) masturbation or
spontaneous emissions.

   It is the prolonged and intense
action of this pernicious sexual satisfaction which is enough on
its own account to provoke a neurasthenic neurosis or which imposes
on the subject the special neurasthenic stamp that is manifested
later under the influence of an incidental accessory cause. I have
also come across people presenting the indications of a
neurasthenic constitution in whom I have not succeeded in bringing
to light the aetiology I have mentioned; but I have at least shown
that the sexual function has never developed to its normal level in
these patients; they seemed to have been endowed by heredity with a
sexual constitution analogous to what is brought about in a
neurasthenic as a result of masturbation.

   The anxiety neurosis exhibits a
much richer clinical picture: irritability, states of anxious
expectation, phobias, anxiety attacks, complete or rudimentary,
attacks of fear and of vertigo, tremors, sweating, congestion,
dyspnoea, tachycardia, etc., chronic diarrhoea, chronic locomotor
vertigo, hyperaesthesia, insomnia, etc.¹ It is easily revealed
as being the specific effect of various disorders of sexual life
which possess a characteristic common to all of them. Enforced
abstinence, unconsummated genital excitation (excitation which is
not relieved by a sexual act ), coition which is imperfect or
interrupted (which does not end in gratification), sexual efforts
which exceed the subject’s psychical capacity, etc. - all
these agents, which occur only too frequently in modern life, seem
to agree in the fact that they disturb the equilibrium of the
psychical and somatic functions in sexual acts, and that they
prevent the psychical participation necessary in order to free the
nervous economy from sexual tension.

  
¹
For the symptomatology as well as for the
aetiology of anxiety neurosis, see my paper referred to
above.

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375

   These remarks, which perhaps
contain the germ of a theoretical explanation of the functional
mechanism of the neurosis in question, give rise already to a
suspicion that a complete and truly scientific exposition of the
subject is not possible at the present time, and that it would be
necessary to start off by approaching the physiological problem of
sexual life from a fresh angle.

   I will say finally that the
pathogenesis of neurasthenia and anxiety neurosis can easily do
without the co-operation of a hereditary disposition. That is the
outcome of daily observation. But if heredity is present, the
development of the neurosis will be affected by its powerful
influence.

   As regards the second class of
major neuroses, hysteria and obsessional neurosis, the solution of
the aetiological problem is of surprising simplicity and
uniformity. I owe my results to a new method of psycho-analysis,
Josef Breuer’s exploratory procedure; it is a little
intricate, but it is irreplaceable, so fertile has it shown itself
to be in throwing light upon the obscure paths of unconscious
ideation. By means of that procedure - this is not the place in
which to describe it ¹ - hysterical symptoms are traced back
to their origin, which is always found in some event of the
subject’s sexual life appropriate for the production of a
distressing emotion. Travelling backwards into the patient’s
past, step by step, and always guided by the organic train of
symptoms and of memories and thoughts aroused, I finally reached
the starting-point of the pathological process; and I was obliged
to see that at bottom the same thing was present in all the cases
submitted to analysis - the action of an agent which must be
accepted as the specific cause of hysteria.

  
¹
See
Studies on Hysteria
, by Breuer
and Freud, 1895.

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376

   This agent is indeed a memory
relating to sexual life; but it is one which presents two
characteristics of the first importance. The event of which the
subject has retained an unconscious memory is
a precocious
experience of sexual relations with actual excitement of the
genitals, resulting from sexual abuse committed by another
person
; and
the period of life
at which this fatal event
takes place is
earliest youth
- the years up to the age of
eight to ten, before the child has reached sexual maturity.

  
A passive sexual experience
before puberty
: this, then, is the specific aetiology of
hysteria.

   I will without delay add some
factual details and some commentary to the result I have announced,
in order to combat the scepticism with which I expect to meet. I
have been able to carry out a complete psycho-analysis in thirteen
cases of hysteria, three of that number being true combinations of
hysteria and obsessional neurosis. (I do not speak of hysteria
with
obsessions.) In none of these cases was an event of the
kind defined above missing. It was represented either by a brutal
assault committed by an adult or by a seduction less rapid and less
repulsive, but reaching the same conclusion. In seven out of the
thirteen cases the intercourse was between children on both sides -
sexual relations between a little girl and a boy a little older
(most often her brother)  who had himself been the victim of
an earlier seduction. These relations sometimes continued for
years, until the little guilty parties reached puberty; the boy
would repeat the same practices with the little girl over and over
again and without alteration - practices to which he himself had
been subjected by some female servant or governess and which on
account of their origin were often of a disgusting sort. In a few
cases there was a combination of an assault and relations between
children or a repetition of a brutal abuse.

   The date of this precocious
experience varied. In two cases the series started in the little
creature’s second year (?); the commonest age in my
observations is the fourth or fifth year. It may be somewhat by
accident, but I have formed an impression from this that a passive
sexual experience occurring only after the age of from eight to ten
is no longer able to serve as the foundation of the neurosis.

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377

   How is it possible to remain
convinced of the reality of these analytic confessions which claim
to be memories preserved from the earliest childhood? and how is
one to arm oneself against the tendency to lies and the facility of
invention which are attributed to hysterical subjects? I should
accuse myself of blame-worthy credulity if I did not possess more
conclusive evidence. But the fact is that these patients never
repeat these stories spontaneously, nor do they ever in the course
of a treatment suddenly present the physician with the complete
recollection of a scene of this kind. One only succeeds in
awakening the psychical trace of a precocious sexual event under
the most energetic pressure of the analytic procedure, and against
an enormous resistance. Moreover, the memory must be extracted from
them piece by piece, and while it is being awakened in their
consciousness they become the prey to an emotion which it would be
hard to counterfeit.

   Conviction will follow in the
end, if one is not influenced by the patients’ behaviour,
provided that one can follow in detail the report of a
psycho-analysis of a case of hysteria.

   The precocious event has left an
indelible imprint on the history of the case; it is represented in
it by a host of symptoms and of special features which could be
accounted for in no other way; it is peremptorily called for
by the subtle but solid interconnections of the intrinsic structure
of the neurosis;  the therapeutic effect of the analysis lags
behind if one has not penetrated so far; and one is then left with
no choice but to reject or to believe the whole.

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   Is it understandable that a
precocious sexual experience of this kind, undergone by an
individual whose sex is barely differentiated, can become the
source of a persistent psychical abnormality like hysteria? 
And how would this supposition fit in with our present ideas on the
psychical mechanism of that neurosis? A satisfactory reply can be
given to the first of these questions. It is precisely because the
subject is in his infancy that the precocious sexual excitation
produces little or no effect at the time; but its psychical trace
is preserved. Later, when at puberty the reactions of the sexual
organs have developed to a level incommensurable with their
infantile condition, it comes about in one way or another that this
unconscious psychical trace is awakened. Thanks to the change due
to puberty, the memory will display a power which was completely
lacking from the event itself.
The memory will operate as though
it were a contemporary event
. What happens is, as it were,
a
posthumous action by a sexual trauma
.

   So far as I can see, this
awakening of a sexual memory after puberty, when the event itself
has happened at a time long before that period, forms the only
psychological instance of the effect of a
memory
surpassing
that of an actual event. But the constellation is an abnormal one,
which touches a weak side of the psychical mechanism and is bound
to produce a pathological psychical effect.

   I believe I can see that
this
inverse relation between the psychical effect of the memory and of
the event
contains the reason for
the memory remaining
unconscious
.

   In this way we arrive at a very
complex psychical problem, but one which, properly appreciated,
promises to throw a vivid light on the most delicate questions of
psychical life.

   The ideas put forward here, which
have as their starting point the finding of psycho-analysis to the
effect that a memory of a precocious sexual experience is always
found as the specific cause of hysteria, are not in harmony with
the psychological theory of neuroses held by M. Janet, nor with any
other; but they agree perfectly with my own speculations on the
‘
Abwehrneurosen
’, as I have developed them
elsewhere.

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379

   All the events subsequent to
puberty to which an influence must be attributed upon the
development of the hysterical neurosis and upon the formation of
its symptoms are in fact only concurrent causes - ‘
agents
provocateurs
’ as Charcot used to say, although for him
nervous heredity occupied the place which I claim for the
precocious sexual experience. These accessory agents are not
subject to the strict conditions imposed on the specific causes;
analysis demonstrates in an irrefutable fashion that they enjoy a
pathogenic influence for hysteria only owing to their faculty for
awakening the unconscious psychical trace of the childhood event.
It is also thanks to their connection with the primary pathogenic
impression, and inspired by it, that their memories will become
unconscious in their turn and will be able to assist in the growth
of a psychical activity withdrawn from the power of the conscious
functions.