Freud - Complete Works (67 page)

   The obsessional neurosis
(
Zwangsneurose
) arises from a specific cause very analogous
to that of hysteria. Here too we find a precocious sexual event,
occurring before puberty, the memory of which becomes active during
or after that period; and the same remarks and arguments which I
put forward in connection with hysteria will apply to my
observations of the other neurosis (six cases, three of which were
pure ones). There is only one difference which seems capital. At
the basis of the aetiology of hysteria we found an event of passive
sexuality, an experience submitted to with indifference or with a
small degree of annoyance or fright. In obsessional neurosis it is
a question on the other hand, of an event which has given
pleasure
, of an act of aggression inspired by desire (in the
case of a boy) or of a participation in sexual relations
accompanied by enjoyment (in the case of a little girl). The
obsessional ideas, when their intimate meaning has been recognized
by analysis, when they have been reduced, as it were, to their
simplest expression, are nothing other than
reproaches addressed
by the subject himself on account of this anticipated sexual
enjoyment
, but reproaches distorted by an unconscious psychical
work of transformation and substitution.

   The very fact of sexual
aggressions of this kind taking place at such a tender age seems to
reveal the influence of a previous seduction of which the precocity
of sexual desire would be the consequence. In the cases analysed by
me analysis confirms this suspicion. In this way an interesting
fact is explained which is always found in these cases of
obsessions: the regular complication of the framework of symptoms
by a certain number of symptoms which are simply hysterical.

Heredity And The Aetiology Of The Neuroses

380

   The importance of the active
element in sexual life as a cause of obsessions, and of sexual
passivity for the pathogenesis of hysteria, even seems to unveil
the reason for the more intimate connection of hysteria with the
female sex and the preference of men for obsessional neurosis. One
sometimes comes across a pair of neurotic patients who were a pair
of little lovers in their earliest childhood - the man suffering
from obsessions and the woman from hysteria. If they are a brother
and sister, one might mistake for a result of nervous heredity what
is in fact the consequence of precocious sexual experiences.

   There are no doubt pure and
isolated cases of hysteria or obsessions, independent of
neurasthenia or anxiety neurosis; but this is not the rule. A
psychoneurosis appears more often as an accessory to a neurasthenic
neurosis, provoked by it and following its decline. This is because
the specific causes of the latter, the contemporary disorders of
sexual life, operate at the same time as auxiliary causes of the
psychoneuroses, whose specific cause, the memory of the precocious
sexual experience, they awaken and revive.

   As regards nervous heredity, I am
far from being able to estimate correctly its influence in the
aetiology of the psychoneuroses. I admit that its presence is
indispensable for severe cases; I doubt if it is necessary for
slight ones; but I am convinced that nervous heredity by itself is
unable to produce psychoneuroses if their specific aetiology,
precocious sexual excitation, is missing. I even believe that the
decision as to which of the neuroses, hysteria or obsessions, will
develop in a given case, is not decided by heredity but a special
characteristic of the sexual event in earliest childhood.

381

FURTHER REMARKS ON THE NEURO-PSYCHOSES OF DEFENCE

(1896)

382

Intentionally left blank

383

FURTHER REMARKS ON THE NEURO-PSYCHOSES OF DEFENCE

In a short paper published in 1894, I grouped
together hysteria, obsessions and certain cases of acute
hallucinatory confusion under the name of ‘neuro-psychoses of
defence’, because those affections turned out to have one
aspect in common. This was that their symptoms arose through the
psychical mechanism of (unconscious)
defence
- that is, in
an attempt to repress an incompatible idea which had come into
distressing opposition to the patient’s ego. In some passages
in a book which has since appeared by Dr. J. Breuer and myself
(
Studies on Hysteria
) I have been able to elucidate, and to
illustrate from clinical observations, the sense in which this
psychical process of ‘defence’ or
‘repression’ is to be understood. There, too, some
information is to be found about the laborious but completely
reliable method of psycho-analysis used by me in making those
investigations - investigations which also constitute a therapeutic
procedure.

   My observations during my last
two years of work have strengthened me in the inclination to look
on defence as the nuclear point in the psychical mechanism of the
neuroses in question; and they have also enabled me to give this
psychological theory a clinical foundation. To my own surprise, I
have come upon a few simple, though narrowly circumscribed,
solutions of the problems of neurosis, and in the following pages I
shall give a preliminary and brief account of them. In this kind of
communication it is not possible to bring forward the evidence
needful to support my assertions, but I hope to be able to fulfil
this obligation later in a detailed presentation.

Further Remarks On The Neuro-Psychoses Of Defence

384

I

THE ‘SPECIFIC’ AETIOLOGY OF
HYSTERIA

   In earlier publications, Breuer
and I have already expressed the opinion that the symptoms of
hysteria can only be understood if traced back to experiences which
have a ‘traumatic’ effect, and that these psychical
traumas refer to the patient’s sexual life. What I have to
add here, as a uniform outcome of the analyses carried out by me on
thirteen cases of hysteria, concerns on the one hand the
nature
of those sexual traumas, and, on the other, the
period of life in which they occur. In order to cause hysteria, it
is not enough that there should occur at some period of the
subject’s life an event which touches his sexual existence
and becomes pathogenic through the release and suppression of a
distressing affect. On the contrary,
these sexual traumas must
have occurred in early childhood (before puberty), and their
content must consist of an actual irritation of the genitals (of
processes resembling copulation)
.

   I have found this specific
determinant of hysteria -
sexual passivity during the pre-sexual
period
- in every case of hysteria (including two male cases)
which I have analysed. How greatly the claims of hereditary
disposition are diminished by the establishment in this way of
accidental aetiological factors as a determinant needs no more than
a mention. Furthermore, a path is laid open to an understanding of
why hysteria is far and away more frequent in members of the female
sex; for even in childhood they are more liable to provoke sexual
attacks.

Further Remarks On The Neuro-Psychoses Of Defence

385

   The most immediate objections to
this conclusion will probably be that sexual assaults on small
children happen too often for them to have any aetiological
importance, or that these sorts of experiences are bound to be
without effect precisely because they happen to a person who is
sexually undeveloped; and further, that one must beware of forcing
on patients supposed reminiscences of this kind by questioning
them, or of believing in the romances which they themselves invent.
In reply to the latter objections we may ask that no one should
form too certain judgements in this obscure field until he has made
use of the only method which can throw light on it - of
psycho-analysis for the purpose of making conscious what has so far
been unconscious.¹ What is essential in the first objections
can be disposed of by pointing out that it is not the experiences
themselves which act traumatically their revival as a
memory
after the subject has entered on sexual maturity.

   My thirteen cases were without
exception of a severe kind; in all of them the illness was of many
years’ duration, and a few came to me after lengthy and
unsuccessful institutional treatment. The childhood traumas which
analysis uncovered in these severe cases had all to be classed as
grave sexual injuries; some of them were positively revolting.
Foremost among those guilty of abuses like these, with their
momentous consequences, are nursemaids, governesses and domestic
servants, to whose care children are only too thoughtlessly
entrusted; teachers, moreover, figure with regrettable frequency.
In seven out of these thirteen cases, however, it turned out that
blameless children were the assailants; these were mostly brothers
who for years on end had carried on sexual relations with sisters a
little younger than themselves. No doubt the course of events was
in every instance similar to what it was possible to trace with
certainty in a few individual cases: the boy, that is to say, had
been abused by someone of the female sex, so that his libido was
prematurely aroused, and then, a few years later, he had committed
an act of sexual aggression against his sister, in which he
repeated precisely the same procedures to which he himself had been
subjected.

  
¹
I myself am inclined to think that the
stories of being assaulted which hysterics so frequently invent may
be obsessional fictions which arise from the memory-trace of a
childhood trauma.

Further Remarks On The Neuro-Psychoses Of Defence

386

   Active masturbation must be
excluded from my list of the sexual noxae in early childhood which
are pathogenic for hysteria. Although it is found so very often
side by side with hysteria, this is due to the circumstance that
masturbation itself is a much more frequent consequence of abuse or
seduction than is supposed.

   It is not at all rare for both of
the two children to fall ill later on of a defence neurosis - the
brother with obsessions and the sister with hysteria. This
naturally gives the appearance of a familial neurotic disposition.
Occasionally, however, this pseudo-heredity is resolved in a
surprising fashion. In one of my cases a brother, a sister, and a
somewhat older male cousin were all of them ill. From the analysis
which I carried out on the brother, I learnt that he was suffering
from self-reproaches for being the cause of his sister’s
illness. He himself had been seduced by his cousin, and the latter,
it was known in the family, had been the victim of his
nursemaid.

   I cannot say for certain what the
upper age-limit is below which sexual injury plays a part in the
aetiology of hysteria; but I doubt whether sexual passivity can
bring on repression later than between the eighth and tenth years,
unless it is enabled to do so by previous experiences. The lower
limit extends as far back as memory itself - that is, therefore, to
the tender age of one and a half or two years! (I have had two
cases of this.) In a number of my cases the sexual trauma (or
series of traumas) occurred in the third and fourth years of life.
I should not lend credence to these extraordinary findings myself
if their complete reliability were not proved by the development of
the subsequent neurosis. In every case a number of pathological
symptoms, habits and phobias are only to be accounted for by going
back to these experiences in childhood, and the logical structure
of the neurotic manifestations makes it impossible to reject these
faithfully preserved memories which emerge from childhood life.
True, it would be useless to try to elicit these childhood traumas
from a hysteric by questioning him outside psycho-analysis; their
traces are never present in conscious memory, only in the symptoms
of the illness.

Further Remarks On The Neuro-Psychoses Of Defence

387

   All the experiences and
excitations which, in the period of life
after
puberty,
prepare the way for, or precipitate, the outbreak of hysteria,
demonstrably
have their effect only because they arouse the
memory-trace of these traumas in childhood, which do not thereupon
become conscious but lead to a release of affect and to repression.
This role of the later traumas tallies well with the fact that they
are not subject to the strict conditions which govern the traumas
in childhood but that they can vary in their intensity and nature,
from actual sexual violation to mere sexual overtures or the
witnessing of sexual acts in other people, or receiving information
about sexual processes.¹

   In my first paper on the neuroses
of defence there was no explanation of how the efforts of the
subject, who had hitherto been healthy, to forget a traumatic
experience of this sort could have the result of actually effecting
the intended repression and thus opening the door to the defence
neurosis. It could not lie in the nature of the experiences, since
other people remained healthy in spite of being exposed to the same
precipitating causes. Hysteria, therefore, could not be fully
explained from the effect of the trauma: it had to be acknowledged
that the susceptibility to a hysterical reaction had already
existed before the trauma.

   The place of this indefinite
hysterical disposition can now be taken, wholly or in part, by the
posthumous operation of a sexual trauma in childhood.
’Repression’ of the memory of a distressing sexual
experience which occurs in maturer years is only possible for those
in whom that experience can activate the memory-trace of a trauma
in childhood.

  
¹
In a paper on the anxiety neurosis, I
remarked that ‘anxiety neurosis can be produced in girls who
are approaching maturity by their first encounter with the problem
of sex. . . . Such an anxiety neurosis is combined with hysteria in
an almost typical fashion.’ I know now that the occasion on
which this ‘virginal anxiety’ breaks out in young girls
does not actually represent their
first
encounter with
sexuality, but that an experience of sexual passivity had
previously occurred in their childhood, the memory of which is
aroused by this ‘first encounter’.

  
²
A psychological theory of repression ought
also to throw light on the question of why it is only ideas with a
sexual
content that can be repressed. Such an explanation
might start out from the following indications. It is known that
having ideas with a sexual content produces excitatory processes in
the genitals which are similar to those produced by sexual
experience itself. We may assume that this somatic excitation
becomes transposed into the psychical sphere. As a rule the effect
in question is much stronger in the case of the experience than in
the case of the memory. But if the sexual experience occurs during
the period of sexual immaturity and the memory of it is aroused
during or after maturity, then the memory will have a far stronger
excitatory effect than the experience did at the time it happened;
and this is because in the meantime puberty has immensely increased
the capacity of the sexual apparatus for reaction. An inverted
relation of this sort between real experience and memory seems to
contain the psychological precondition for the occurrence of a
repression. Sexual life affords - through the retardation of
pubertal maturity as compared with the psychical functions - the
only possibility that occurs for this inversion of relative
effectiveness.
The traumas of childhood operate in a deferred
fashion as though they were fresh experiences; but they do so
unconsciously
. I must postpone entering into any more
far-reaching psychological discussion till another occasion. Let me
add, however, that the period of ‘sexual maturity’
which is in question here does not coincide with puberty but falls
earlier (from the eighth to the tenth year).

Further Remarks On The Neuro-Psychoses Of Defence

388

   Obsessions similarly presuppose a
sexual experience in childhood (though one of a different nature
from that found in hysteria). The aetiology of the two
neuro-psychoses of defence is related as follows to the aetiology
of the two simple neuroses, neurasthenia and anxiety neurosis. Both
the latter disorders are direct effects of the sexual noxae
themselves, as I have shown in my paper on anxiety neurosis
(1895
b
); both the defence neuroses are indirect consequences
of sexual noxae which have occurred before the advent of sexual
maturity - are consequences, that is, of the psychical
memory-traces of those noxae. The current causes which produce
neurasthenia and anxiety neurosis often at the same time play the
part of exciting causes of the neuroses of defence; on the other
hand, the specific causes of a defence-neurosis - the traumas of
childhood - can at the same time lay the foundations for a later
development of neurasthenia. Finally, it not infrequently happens,
too, that neurasthenia or anxiety neurosis is maintained, not by
current sexual noxae, but, instead, solely by the persisting effect
of a memory of childhood traumas.¹