Freud - Complete Works (72 page)

   I therefore put forward the
thesis that at the bottom of every case of hysteria there are
one or more occurrences of premature sexual experience
,
occurrences which belong to the earliest years of childhood but
which can be reproduced through the work of psycho-analysis in
spite of the intervening decades. I believe that this is an
important finding, the discovery of a
caput Nili
in
neuropathology; but I hardly know what to take as a starting-point
for a continuation of my discussion of this subject. Shall I put
before you the actual material I have obtained from my analyses? Or
shall I rather try first to meet the mass of objections and doubts
which, as I am surely correct in supposing, have now taken
possession of your attention? I shall choose the latter course;
perhaps we shall then be able to go over the facts more calmly.

   (
a
) No one who is
altogether opposed to a psychological view of hysteria, who is
unwilling to give up the hope that some day it will be possible to
trace back its symptoms to ‘finer anatomical
changes’  and who has rejected the view that the
material foundations of hysterical changes are bound to be of the
same kind as those of our normal mental processes - no one who
adopts this attitude will, of course, put any faith in the results
of our analyses; however, the difference in principle between his
premisses and ours absolves us from the obligation of convincing
him on individual points.

The Aetiology Of Hysteria

418

   But other people, too, although
they may be less averse to psychological theories of hysteria, will
be tempted, when considering our analytic findings, to ask what
degree of certainty the application of psycho-analysis offers. Is
it not very possible either that the physician forces such scenes
upon his docile patients, alleging that they are memories, or else
that the patients tell the physician things which they have
deliberately invented or have imagined and that he accepts those
things as true?  Well, my answer to this is that the general
doubt about the reliability of the psycho-analytic method can be
appraised and removed only when a complete presentation of its
technique and results is available. Doubts about the genuineness of
the infantile sexual scenes can, however, be deprived of their
force here and now by more than one argument. In the first place,
the behaviour of patients while they are reproducing these
infantile experiences is in every respect incompatible with the
assumption that the scenes are anything else than a reality which
is being felt with distress and reproduced with the greatest
reluctance. Before they come for analysis the patients know nothing
about these scenes. They are indignant as a rule if we warn them
that such scenes are going to emerge. Only the strongest compulsion
of the treatment can induce them to embark on a reproduction of
them. While they are recalling these infantile experiences to
consciousness, they suffer under the most violent sensations, of
which they are ashamed and which they try to conceal; and, even
after they have gone through them once more in such a convincing
manner, they still attempt to withhold belief from them, by
emphasizing the fact that, unlike what happens in the case of other
forgotten material, they have no feeling of remembering the
scenes.¹

   This latter piece of behaviour
seems to provide conclusive proof. Why should patients assure me so
emphatically of their unbelief, if what they want to discredit is
something which - from whatever motive - they themselves have
invented?

   It is less easy to refute the
idea that the doctor forces reminiscences of this sort on the
patient, that he influences him by suggestion to imagine and
reproduce them. Nevertheless it appears to me equally untenable. I
have never yet succeeded in forcing on a patient a scene I was
expecting to find, in such a way that he seemed to be living
through it with all the appropriate feelings. Perhaps others may be
more successful in this.

  
¹
(
Footnote added
1924:) All this is
true; but it must be remembered that at the time I wrote it I had
not yet freed myself from my
overvaluation
of reality and my
low valuation
of phantasy.

The Aetiology Of Hysteria

419

   There are, however, a whole
number of other things that vouch for the reality of infantile
sexual scenes. In the first place there is the uniformity which
they exhibit in certain details, which is a necessary consequence
if the preconditions of these experiences are always of the same
kind, but which would otherwise lead us to believe that there were
secret understandings between the various patients. In the second
place, patients sometimes describe as harmless events whose
significance they obviously do not understand, since they would be
bound otherwise to be horrified by them. Or again, they mention
details, without laying any stress on them, which only someone of
experience in life can understand and appreciate as subtle traits
of reality.

   Events of this sort strengthen
our impression that the patients must really have experienced what
they reproduce under the compulsion of analysis as scenes from
their childhood. But another and stronger proof of this is
furnished by the relationship of the infantile scenes to the
content of the whole of the rest of the case history. It is exactly
like putting together a child’s picture-puzzle: after many
attempts, we become absolutely certain in the end which piece
belongs in the empty gap; for only that one piece fills out the
picture and at the same time allows its irregular edges to be
fitted into the edges of the other pieces in such a manner as to
leave no free space and to entail no overlapping. In the same way,
the contents of the infantile scenes turn out to be indispensable
supplements to the associative and logical framework of the
neurosis, whose insertion makes its course of development for the
first time evident, or even, as we might often say,
self-evident.

The Aetiology Of Hysteria

420

   Without wishing to lay special
stress on the point, I will add that in a number of cases
therapeutic evidence of the genuineness of the infantile scenes can
also be brought forward. There are cases in which a complete or
partial cure can be obtained without our having to go as deep as
the infantile experiences. And there are others in which no success
at all is obtained until the analysis has come to its natural end
with the uncovering of the earliest traumas. In the former cases we
are not, I believe, secure against relapses; and my expectation is
that a complete psycho-analysis implies a radical cure of the
hysteria. We must not, however, be led into forestalling the
lessons of observation.

   There would be one other proof,
and a really unassailable one, of the genuineness of childhood
sexual experiences namely, if the statements of someone who is
being analysed were to be confirmed by someone else, whether under
treatment or not. These two people will have had to have taken part
in the same experience in their childhood - perhaps to have stood
in some sexual relationship to each other. Such relations between
children are, as you will hear in a moment, by no means rare.
Moreover, it quite often happens that both of those concerned
subsequently fall ill of neuroses; yet I regard it as a fortunate
accident that, out of eighteen cases, I have been able to obtain an
objective confirmation of this sort in two. In one instance, it was
the brother (who had remained well) who of his own accord confirmed
- not, it is true, his earliest sexual experiences with his sister
(who was the patient) - but at least scenes of that kind from later
childhood, and the fact that there had been sexual relations dating
further back. In the other instance, it happened that two women
whom I was treating had as children had sexual relations with the
same man, in the course of which certain scenes had taken place
à trois
. A particular symptom, which was derived from
these childhood events, had developed in both women, as evidence of
what they had experienced in common.

The Aetiology Of Hysteria

421

   (
b
)  Sexual
experiences in childhood consisting in stimulation of the genitals,
coitus-like acts, and so on, must therefore be recognized, in the
last analysis, as being the traumas which lead to a hysterical
reaction to events at puberty and to the development of hysterical
symptoms. This statement is certain to be met from different
directions by two mutually contradictory objections. Some people
will say that sexual abuses of this kind, whether practised upon
children or between them, happen too seldom for it to be possible
to regard them as the determinant of such a common neurosis as
hysteria. Others will perhaps argue that, on the contrary, such
experiences are very frequent-much too frequent for us to be able
to attribute an aetiological significance to the fact of their
occurrence. They will further maintain that it is easy, by making a
few enquiries, to find people who remember scenes of sexual
seduction and sexual abuse in their childhood years, and yet who
have never been hysterical. Finally we shall be told, as a weighty
argument, that in the lower strata of the population hysteria is
certainly no more common than in the highest ones, whereas
everything goes to show that the injunction for the sexual
safeguarding of childhood is far more frequently transgressed in
the case of the children of the proletariat.

   Let us begin our defence with the
easier part of the task. It seems to me certain that our children
are far more often exposed to sexual assaults than the few
precautions taken by parents in this connection would lead us to
expect. When I first made enquiries about what was known on the
subject, I learnt from colleagues that there are several
publications by paediatricians which stigmatize the frequency of
sexual practices by nurses and nursery maids, carried out even on
infants in arms; and in the last few weeks I have come across a
discussion of ‘Coitus in Childhood’ by Dr. Stekel
(1895) in Vienna. I have not had time to collect other published
evidence; but even if it were only scanty, it is to be expected
that increased attention to the subject will very soon confirm the
great frequency of sexual experiences and sexual activity in
childhood.

The Aetiology Of Hysteria

422

   Lastly, the findings of my
analysis are in a position to speak for themselves. In all eighteen
cases (cases of pure hysteria and of hysteria combined with
obsessions, and comprising six men and twelve women) I have, as I
have said, come to learn of sexual experiences of this kind in
childhood. I can divide my cases into three groups, according to
the origin of the sexual stimulation. In the first group it is a
question of assaults - of single, or at any rate isolated,
instances of abuse, mostly practised on female children, by adults
who were strangers, and who, incidentally, knew how to avoid
inflicting gross, mechanical injury. In these assaults there was no
question of the child’s consent, and the first effect of the
experience was preponderantly one of fright. The second group
consists of cases in which some adult looking after the child - a
nursery maid or governess or tutor, or, unhappily all too often, a
close relative - has initiated the child into sexual intercourse
and has maintained a regular love relationship with it - a love
relationship, moreover, with its mental side developed - which has
often lasted for years. The third group, finally, contains
child-relationships proper - sexual relations between two children
of different sexes, mostly a brother and sister, which are often
prolonged beyond puberty and which have the most far-reaching
consequences for the pair. In most of my cases I found that two or
more of these aetiologies were in operation together; in a few
instances the accumulation of sexual experiences coming from
different quarters was truly amazing. You will easily understand
this peculiar feature of my observations, however, when you
consider that the patients I was treating were all cases of severe
neurotic illness which threatened to make life impossible.

   Where there had been a relation
between two children I was sometimes able to prove that the
boy-who, here too, played the part of the aggressor - had
previously been seduced by an adult of the female sex, and that
afterwards, under the pressure of his prematurely awakened libido
and compelled by his memory, he tried to repeat with the little
girl exactly the same practices that he had learned from the adult
woman, without making any modification of his own in the character
of the sexual activity.

The Aetiology Of Hysteria

423

   In view of this, I am inclined to
suppose that children cannot find their way to acts of sexual
aggression unless they have been seduced previously. The foundation
for a neurosis would accordingly always be laid in childhood by
adults, the children themselves would transfer to one another the
disposition to fall ill of hysteria later. I will ask you to
consider a moment longer the special frequency with which sexual
relations in childhood occur precisely between brothers and sisters
and cousins, as a result of their opportunities for being together
so often; supposing, then, ten or fifteen years later several
members of the younger generation of the family are found to be
ill, might not this appearance of a family neurosis naturally lead
to the false supposition that a hereditary disposition is present
where there is only a
pseudo-heredity
and where in fact what
has taken place is a handing-on, an infection in childhood?