Freud - Complete Works (71 page)

  
¹
I purposely leave out of this discussion
the question of what the category is to which the association
between the two memories belong, (whether it is an association by
simultaneity, or by causal connections or by similarity of
content), and of what psychological character is to be attributed
to the various ‘memories’ (conscious or
unconscious).

The Aetiology Of Hysteria

412

   But we must not fail to lay
special emphasis on one conclusion to which analytic work along
these chains of memory has unexpectedly led. We have learned that
no hysterical experience can arise from a real experience alone,
but that in every case the memory of earlier experiences awakened
in association to it plays a part in causing the symptom
. If -
as I believe - this proposition holds good
without
exception
, it furthermore shows us the basis on which a
psychological theory of hysteria must be built.

   You might suppose that the rare
instances in which analysis is able to trace the symptom back
direct to a traumatic scene that is thoroughly suitable as a
determinant and possesses traumatic force, and is able, by thus
tracing it back, at the same time to remove it (in the way
described in Breuer’s case history of Anna O.) - you might
suppose that such instances must, after all, constitute powerful
objections to the general validity of the proposition I have just
put forward. It certainly looks so. But I must assure you that I
have the best grounds for assuming that even in such instances
there exists a chain of operative memories which stretches far back
behind the first traumatic scene,
even though
the
reproduction of the latter alone may have the result of removing
the symptom.

   It seems to me really astonishing
that hysterical symptoms can only arise with the co-operation of
memories, especially when we reflect that, according to the
unanimous accounts of the patients themselves, these memories did
not come into their consciousness at the moment when the symptom
first made its appearance. Here is much food for thought; but these
problems must not distract us at this point from our discussion of
the aetiology of hysteria. We must rather ask ourselves: where
shall we get to if we follow the chains of associated memories
which the analysis has uncovered? How far do they extend!  Do
they come anywhere to a natural end? Do they perhaps lead to
experiences which are in some way alike, either in their content or
the time of life at which they occur, so that we may discern in
these universally similar factors the aetiology of hysteria of
which we are in search?

The Aetiology Of Hysteria

413

   The knowledge I have so far
gained already enables me to answer these questions. If we take a
case which presents several symptoms, we arrive by means of the
analysis, starting from each symptom, at a series of experiences
the memories of which are linked together in association. To begin
with, the chains of memories lead backwards separately from one
another; but, as I have said, they ramify. From a single scene two
or more memories are reached at the same time, and from these again
side-chains proceed whose individual links may once more be
associatively connected with links belonging to the main chain.
Indeed, a comparison with the genealogical tree of a family whose
members have also intermarried, is not at all a bad one. Other
complications in the linkage of the chains arise from the
circumstance that a single scene may be called up several times in
the same chain, so that it has multiple relationships to a later
scene, and exhibits both a direct connection with it and a
connection established through intermediate links. In short, the
concatenation is far from being a simple one; and the fact that the
scenes are uncovered in a reversed chronological order (a fact
which justifies our comparison of the work with the excavation of a
stratified ruined site) certainly contributes nothing to a more
rapid understanding of what has taken place.

   If the analysis is carried
further, new complications arise. The associative chains belonging
to the different symptoms begin to enter into relation with one
another; the genealogical trees become intertwined. Thus a
particular symptom in, for instance, the chain of memories relating
to the symptom of vomiting, calls up not only the earlier links in
its own chain but also a memory from another chain, relating to
another symptom, such as a headache. This experience accordingly
belongs to both series, and in this way it constitutes a
nodal
point
. Several such nodal points are to be found in every
analysis. Their correlate in the clinical picture may perhaps be
that from a certain time onwards both symptoms have appeared
together, symbiotically, without in fact having any internal
dependence on each other. Going still further back, we come upon
nodal points of a different kind. Here the separate associative
chains converge. We find experiences from which two or more
symptoms have proceeded; one chain has attached itself to one
detail of the scene, the second chain to another detail.

The Aetiology Of Hysteria

414

   But the most important finding
that is arrived at if an analysis is thus consistently pursued is
this. Whatever case and whatever symptom we take as our point of
departure,
in the end we infallibly come to the field of sexual
experience
. So here for the first time we seem to have
discovered an aetiological precondition.

   From previous experience I can
foresee that it is precisely against this assertion or against its
universal validity that your contradiction, Gentlemen, will be
directed. Perhaps it would be better to say, your
inclination
to contradict; for none of you, no doubt, have
as yet any investigations at your disposal which, based upon the
same procedure, might have yielded a different result. As regards
the controversial matter itself, I will only remark that the
singling out of the sexual factor in the aetiology of hysteria
springs at least from no preconceived opinion of my part. The two
investigators as whose pupil I began my studies of hysteria,
Charcot and Breuer, were far from having any such presupposition;
in fact they had a personal disinclination to it which I originally
shared. Only the most laborious and detailed investigations have
converted me, and that slowly enough, to the view I hold to-day. If
you submit my assertion that the aetiology of hysteria lies in
sexual life to the strictest examination, you will find that it is
supported by the fact that in some eighteen cases of hysteria I
have been able to discover this connection in every single symptom,
and, where the circumstances allowed, to confirm it by therapeutic
success. No doubt you may raise the objection that the nineteenth
or the twentieth analysis will perhaps show that hysterical
symptoms are derived from other sources as well, and thus reduce
the universal validity of the sexual aetiology to one of eighty
percent. By all means let us wait and see; but, since these
eighteen cases are at the same time
all
the cases on which I
have been able to carry out the work of analysis and since they
were not picked out by anyone for my convenience, you will find it
understandable that I do not share such an expectation but am
prepared to let my belief run ahead of the evidential force of the
observations I have so far made. Besides, I am influenced by
another motive as well, which for the moment is of merely
subjective value. In the sole attempt to explain the physiological
and psychical mechanism of hysteria which I have been able to make
in order to correlate my observations, I have come to regard the
participation of sexual motive forces as an indispensable
premiss.

The Aetiology Of Hysteria

415

   Eventually, then, after the
chains of memories have converged, we come to the field of
sexuality and to a small number of experiences which occur for the
most part at the same period of life - namely, at puberty. It is in
these experiences, it seems, that we are to look for the aetiology
of hysteria, and through them that we are to learn to understand
the origin of hysterical symptoms. But here we meet with a fresh
disappointment and a very serious one. It is true that these
experiences, which have been discovered with so much trouble and
extracted out of all the mnemic material, and which seemed to be
the ultimate traumatic experiences, have in common the two
characteristics of being sexual and of occurring at puberty; but in
every other respect they are very different from each other both in
kind
and in
importance
. In some cases, no doubt, we
are concerned with experiences which must be regarded as severe
traumas - an attempted rape, perhaps, which reveals to the immature
girl at a blow all the brutality of sexual desire, or the
involuntary witnessing of sexual acts between parents, which at one
and the same time uncovers unsuspected ugliness and wounds childish
and moral sensibilities alike, and so on. But in other cases the
experiences are astonishingly trivial. In one of my women patients
it turned out that her neurosis was based on the experience of a
boy of her acquaintance stroking her hand tenderly and, at another
time, pressing his knee against her dress as they sat side by side
at table, while his expression let her see that he was doing
something forbidden. For another young lady, simply hearing a
riddle which suggested an obscene answer had been enough to provoke
the first anxiety attack and with it to start the illness. Such
findings are clearly not favourable to an understanding of the
causation of hysterical symptoms. If serious and trifling events
alike, and if not only experiences affecting the subject’s
own body but visual impressions too and information received
through the ears are to be recognized as the ultimate traumas of
hysteria, then we may be tempted to hazard the explanation that
hysterics are peculiarly constituted creatures - probably on
account of some hereditary disposition or degenerative atrophy - in
whom a shrinking from sexuality, which normally plays some part at
puberty, is raised to a pathological pitch and is permanently
retained; that they are, as it were, people who are psychically
inadequate to meeting the demands of sexuality. This view, of
course, leaves hysteria in men out of account. But even without
blatant objections such as that, we should scarcely be tempted to
be satisfied with this solution. We are only too distinctly
conscious of an intellectual sense of something half-understood,
unclear and insufficient.

The Aetiology Of Hysteria

416

   Luckily for our explanation, some
of these sexual experiences at puberty exhibit a further
inadequacy, which is calculated to stimulate us into continuing our
analytic work. For it sometimes happens that they, too, lack
suitability as determinants although this is much more rarely so
than with the traumatic scenes belonging to later life. Thus, for
instance, let us take the two women patients whom I have just
spoken of as cases in which the experiences at puberty were
actually innocent ones. As a result of those experiences the
patients had become subject to peculiar painful sensations in the
genitals which had established themselves as the main symptoms of
the neurosis. I was unable to find indications that they had been
determined either by the scenes at puberty or by later scenes; but
they were certainly not normal organic sensations nor signs of
sexual excitement. It seemed an obvious thing, then, to say to
ourselves that we must look for the determinants of these symptoms
in yet other experiences, in experiences which went still further
back - and that we must, for the second time, follow the saving
notion which had earlier led us from the first traumatic scenes to
the chains of memories behind them. In doing so, to be sure, we
arrive at the period of earliest childhood, a period before the
development of sexual life; and this would seem to involve the
abandonment of a sexual aetiology. But have we not a right to
assume that even the age of childhood is not wanting in slight
sexual excitations, that later sexual development may perhaps be
decisively influenced by childhood experiences?  Injuries
sustained by an organ which is as yet immature, or by a function
which is in process of developing, often cause more severe and
lasting effects than they could do in maturer years. Perhaps the
abnormal reaction to sexual impressions which surprises us in
hysterical subjects at the age of puberty is quite generally based
on sexual experiences of this sort in childhood, in which case
those experiences must be of a similar nature to one another, and
must be of an important kind. If this is so, the prospect is opened
up that what has hitherto had to be laid at the door of a still
unexplained hereditary predisposition may be accounted for as
having been acquired at an early age. And since infantile
experiences with a sexual content could after all only exert a
psychical effect through their
memory-traces
, would not this
view be a welcome amplification of the finding of psycho-analysis
which tells us that
hysterical symptoms can only arise with the
co-operation of memories
?

The Aetiology Of Hysteria

417

II

   You will no doubt have guessed,
Gentlemen, that I should not have carried this last line of thought
so far if I had not wanted to prepare you for the idea that it is
this line alone which, after so many delays, will lead us to our
goal. For now we are really at the end of our wearisome and
laborious analytic work, and here we find the fulfilment of all the
claims and expectations upon which we have so far insisted. If we
have the perseverance to press on with the analysis into early
childhood, as far back as a human memory is capable of reaching, we
invariably bring the patient to reproduce experiences which, on
account both of their peculiar features and of their relations to
the symptoms of his later illness, must be regarded as the
aetiology of his neurosis for which we have been looking. These
infantile
experiences are once more
sexual
in
content, but they are of a far more uniform kind than the scenes at
puberty that had been discovered earlier. It is now no longer a
question of sexual topics having been aroused by some sense
impression or other, but of sexual experiences affecting the
subject’s own body - of
sexual intercourse
(in the
wider sense). You will admit that the
importance
of such
scenes needs no further proof; to this may now be added that, in
every instance, you will be able to discover in the details of the
scenes the
determining
factors which you may have found
lacking in the other scenes - the scenes which occurred later and
were reproduced earlier.