Freud - Complete Works (74 page)

   Sometimes it is the accidental
circumstances of these infantile sexual scenes which in later years
acquire a determining power over the symptoms of the neurosis.
Thus, in one of my cases the circumstance that the child was
required to stimulate the genitals of a grown-up woman with his
foot was enough to fixate his neurotic attention for years on to
his legs and to their function, and finally to produce a hysterical
paraplegia. In another case, a woman patient suffering from anxiety
attacks which tended to come on at certain hours of the day could
not be calmed unless a particular one of her many sisters stayed by
her side all the time. Why this was so would have remained a riddle
if analysis had not shown that the man who had committed the
assaults on her used to enquire at every visit whether this sister,
who he was afraid might interrupt him, was at home.

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429

   It may happen that the
determining power of the infantile scenes is so much concealed
that, in a superficial analysis, it is bound to be overlooked. In
such instances we imagine that we have found the explanation of
some particular symptom in the content of one of the later scenes -
until, in the course of our work, we come upon the same content in
one of the
infantile
scenes, so that in the end we are
obliged to recognize that, after all, the later scene only owes its
power of determining symptoms to its agreement with the earlier
one. I do not wish because of this to represent the later scenes
being unimportant; if it was my task to put before you the rules
that govern the formation of hysterical symptoms, I should have to
include as one of them that the idea which is selected for the
production of a symptom is one which has been called up by a
combination of several factors and which has been aroused from
various directions simultaneously. I have elsewhere tried to
express this in the formula:
hysterical symptoms are
overdetermined
.

   One thing more, Gentlemen. It is
true that earlier I put the relation between recent and infantile
aetiology aside as a separate theme. Nevertheless, I cannot leave
the subject without overstepping this resolution at least with one
remark. You will agree with me that there is
one
fact above
all which leads us astray in the psychological understanding of
hysterical phenomena, and which seems to warn us against measuring
psychical acts in hysterics and in normal people with the same
yardstick. That fact is the discrepancy between psychically
exciting stimuli and psychical reactions which we come upon in
hysterical subjects. We try to account for it by assuming the
presence in them of a general abnormal sensitivity to stimuli, and
we often endeavour to explain it on a physiological basis, as if in
such patients certain organs of the brain which serve to transmit
stimuli were in a peculiar chemical state (like the spinal centres
of a frog, perhaps, which has been injected with strychnine) or as
if these cerebral organs had withdrawn from the influence of higher
inhibiting centres (as in animals being experimented on under
vivisection). Occasionally one or other of these concepts may be
perfectly valid as an explanation of hysterical phenomena; I do not
dispute this. But the main part of the phenomenon - of the
abnormal, exaggerated, hysterical reaction to psychical stimuli -
admits of another explanation, an explanation which is supported by
countless examples from the analyses of patients. And this is as
follows:
The reaction of hysterics is only apparently
exaggerated; it is bound to appear exaggerated to us because we
only know a small part of the motives from which it arises
.

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430

   In reality, this reaction is
proportionate to the exciting stimulus; thus it is normal and
psychologically understandable. We see this at once when the
analysis has added to the manifest motives, of which the patient is
conscious, those other motives, which have been operative without
his knowing about them, so that he could not tell us of them.

   I could spend hours demonstrating
the validity of this important assertion for the whole range of
psychical activity in hysteria, but I must confine myself here to a
few examples. You will remember the mental
‘sensitiveness’ which is so frequent among hysterical
patients and which leads them to react to the least sign of being
depreciated as though they had received a deadly insult. What would
you think, now, if you were to observe this high degree of
readiness to feel hurt on the slightest occasion, if you came
across it between two normal people, a husband and wife, perhaps?
You would certainly infer that the conjugal scene you had witnessed
was not solely the result of this latest trifling occasion, but
that inflammable material had been piling up for a long time and
that the whole heap of it bad been set alight by the final
provocation.

   I would ask you to carry this
line of thought over on to hysterical patients. It is not the
latest slight - which, in itself, is minimal - that produces the
fit of crying, the outburst of despair or the attempt at suicide,
in disregard of the axiom that an effect must be proportionate to
its cause; the small slight of the present moment has aroused and
set working the memories of very many, more intense, earlier
slights, behind all of which there lies in addition the memory of a
serious slight in childhood which has never been overcome. Or
again, let us take the instance of a young girl who blames herself
most frightfully for having allowed a boy to stroke her hand in
secret, and who from that time on has been overtaken by a neurosis.
You can, of course, answer the puzzle by pronouncing her an
abnormal, eccentrically disposed and over-sensitive person; but you
will think differently when analysis shows you that the touching of
her hand reminded her of another, similar touching, which had
happened very early in her childhood and which formed part of a
less innocent whole, so that her self-reproaches were actually
reproaches about that old occasion. Finally, the problem of the
hysterogenic points is of the same kind. If you touch a particular
spot, you do something you did not intend: you awaken a memory
which may start off a convulsive attack, and since you know nothing
of this psychical intermediate link you refer the attack directly
to the operation of your touch. The patients are in the same state
of ignorance and therefore fall into similar errors. ie they too
are unaware of the re-awakening of the unconscious memory They
constantly establish ‘false connections’ between the
most recent cause, which they are conscious of, and the effect,
which depends on so many intermediate links. If, however, the
physician has been able to bring together the conscious and
unconscious motives for the purpose of explaining a hysterical
reaction, he is almost always obliged to recognize that the
seemingly exaggerated reaction is appropriate and is abnormal only
in its form.

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431

   You may, however, rightly object
to this justification of the hysterical reaction to psychical
stimuli and say that nevertheless the reaction is not a normal one.
For why do healthy people behave differently?  Why do not all
their
excitations of long ago come into operation once more
when a new, present-day, excitation takes place? One has an
impression, indeed, that with hysterical patients it is as if all
their old experiences - to which they have already reacted so often
and, moreover, so violently - had retained their effective power;
as if such people were incapable of disposing of their psychical
stimuli. Quite true, Gentlemen, something of the sort must really
be assumed. You must not forget that in hysterical people when
there is a present-day precipitating cause, the old experiences
come into operation in the form of
unconscious memories
. It
looks as though the difficulty of disposing of a present
impression, the impossibility of transforming it into a powerless
memory, is attached precisely to the character of the psychical
unconscious. You see that the remainder of the problem lies once
more in the field of psychology - and, what is more, a psychology
of a kind for which philosophers have done little to prepare the
way for us.

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432

   To this psychology, which has yet
to be created to meet our needs - to this future
psychology of
the neuroses
- I must also refer you when, in conclusion, I
tell you something which will at first make you afraid that it may
disturb our dawning comprehension of the aetiology of hysteria. For
I must affirm that the aetiological role of infantile sexual
experience is not confined to hysteria but holds good equally for
the remarkable neurosis of obsessions, and perhaps also, indeed,
for the various forms of chronic paranoia and other functional
psychoses. I express myself on this with less definiteness, because
I have as yet analysed far fewer cases of obsessional neurosis than
of hysteria; and as regards paranoia, I have at my disposal only a
single full analysis and a few fragmentary ones. But what I
discovered in these cases seemed to be reliable and filled me with
confident expectations for other cases. You will perhaps remember
that already, at an earlier date, I recommended that hysteria and
obsessions should be grouped together under the name of
‘
neuroses of defence
’, even before I had come to
know of their common infantile aetiology. I must now add that
although this need not be expected to happen in general - every one
of my cases of obsessions revealed a substratum of hysterical
symptoms, mostly sensations and pains, which went back precisely to
the earliest childhood experiences. What, then, determines whether
the infantile sexual scenes which have remained unconscious will
later on, when the other pathogenic factors are super-added, give
rise to hysterical or to obsessional neurosis or even to paranoia?
This increase in our knowledge seems, as you see, to prejudice the
aetiological value of these scenes, since it removes the
specificity of the aetiological relation.

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433

   I am not yet in a position,
Gentlemen, to give a reliable answer to this question. The number
of cases I have analysed is not large enough nor have the
determining factors in them been sufficiently various. So far, I
have observed that obsessions can be regularly shown by analysis to
be disguised and transformed
self-reproaches about acts of
sexual aggression in childhood
, and are therefore more often
met with in men than in women, and that men develop obsessions more
often than hysteria. From this I might conclude that the character
of the infantile scenes - whether they were experienced with
pleasure or only passively - has a determining influence on the
choice of the later neurosis; but I do not want to underestimate
the significance of the age at which these childhood actions occur,
and other factors as well. Only a discussion of further analyses
can throw light on these points. But when it becomes clear which
are the decisive factors in the choice between the possible forms
of the neuro-psychoses of defence, the question of what the
mechanism is in virtue of which that particular form takes shape
will once again be a purely psychological problem.

   I have now come to the end of
what I have to say to-day. Prepared as I am to meet with
contradiction and disbelief, I should like to say one thing more in
support of my position. Whatever you may think about the
conclusions I have come to, I must ask you not to regard them as
the fruit of idle speculation. They are based on a laborious
individual examination of patients which has in most cases taken up
a hundred or more hours of work. What is even more important to me
than the value you put on my results is the attention you give to
the procedure I have employed. This procedure is new and difficult
to handle, but it is nevertheless irreplaceable for scientific and
therapeutic purposes. You will realize, I am sure, that one cannot
properly deny the findings which follow from this modification of
Breuer’s procedure so long as one puts it aside and uses only
the customary method of questioning patients. To do so would be
like trying to refute the findings of histological technique by
relying upon macroscopic examination. The new method of research
gives wide access to a new element in the psychical field of
events, namely, to processes of thought which have remained
unconscious - which, to use Breuer’s expression, are
‘inadmissible to consciousness’. Thus it inspires us
with the hope of a new and better understanding of all functional
psychical disturbances. I cannot believe that psychiatry will long
hold back from making use of this new pathway to knowledge.

434

ABSTRACTS OF THE SCIENTIFIC WRITINGS OF DR. SIGM. FREUD 1877-1897

(1897)

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ABSTRACTS OF THE SCIENTIFIC WRITINGS OF DR. SIGM. FREUD

1877-1897

A

BEFORE APPOINTMENT AS
PRIVATDOZENT

I

   ‘Observations on the
configuration and finer structure of the lobed organs in eels
described as testes.’

   Dr. Syrski had recently
recognized a paired, lobulated, grooved organ occurring in the
abdominal cavity of the eel as the animal’s male sexual organ
which had long been looked for. At Professor Claus’s
suggestion I investigated the occurrence and tissue components of
these lobed organs at the zoological station in Trieste.

II

   ‘On the origin of the
posterior nerve-roots in the spinal cord of Ammocoetes (Petromyzon
planeri).’

   (From the Institute of Physiology
of the University of Vienna. With one plate.)

   Investigation of the spinal cord
of Ammocoetes showed that the large nerve-cells described by
Reissner as occurring in the posterior grey matter (posterior
cells) give rise to the root fibres of the posterior roots.-The
anterior and posterior spinal roots of the Petromyzon, at all
events in the caudal region, are displaced relatively to each other
in their origins and remain distinct from each other in their
peripheral course.

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437

III

   ‘On the spinal ganglia and
spinal cord of Petromyzon.’

   (From the Institute of Physiology
of the University of Vienna. With four plates and two
woodcuts.)

   The spinal ganglion cells of fish
were long regarded as
bipolar
, and those of the higher
animals were considered to be
unipolar
. As regards the
latter elements Ranvier had shown that their single process
branched in a T-shape after a short course. - By the use of a gold
maceration technique it was possible to make a complete survey of
the spinal ganglia of Petromyzon; their nerve cells exhibit every
transition between bipolarity and unipolarity with T-shaped
branching of the fibres; the number of fibres of the posterior root
is regularly greater than the number of nerve cells in the
ganglion; thus there are ‘fibres of passage’ and
‘subsidiary’ nerve fibres, of which the latter merely
mingle with the elements of the roots. - A link between the spinal
ganglion cells and the posterior cells in the spinal cord which
have been described is provided in Petromyzon by cellular elements
which are exposed on the surface of the spinal cord between the
posterior root and ganglion. These scattered cells indicate the
path taken by the spinal ganglion cells in the course of evolution.
- In relation to the spinal cord of Petromyzon, the paper further
describes the branching of the fibres in the central pathway of the
posterior root fibres, and the forked ramification of the anterior
commissural fibres, the intercalation of nerve cells in the spinal
portions of the anterior roots, and a very fine nerve-net (which
can be stained by gold chloride) in the pia mater.

IV

   ‘Note upon a method for
anatomical preparations of the nervous system.’

   A modification of a method
recommended by Reichert. - A mixture of 1 part concentrated nitric
acid, 3 parts water, and 1 part concentrated glycerine, since it
destroys connective tissue and makes it easy to remove bones and
muscles, is useful for laying bare the central nervous system with
its peripheral branches, particularly in small mammals.

V

‘On the structure of the nerve fibres
and nerve cells of the river crayfish.’

   The nerve fibres of the river
crayfish, when the tissues are examined live, exhibit without
exception a fibrillary structure. The nerve cells, whose survival
can be recognized from the granules in their nucleus, seem to be
composed of two substances. One of these is reticular and is
continued into the fibrils of the nerve fibres, and the other is
homogeneous and is continued in their ground substance.

VI

   ‘The structure of the
elements of the nervous system.’

   (Lecture delivered before the
Psychiatric Society, 1882.)

   Contents as in V.

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438

VII

 ‘A new method for the study of
nerve-tracts in the central nervous system.’

   If fine sections of the central
organ, hardened in chromate are treated with gold chloride, a
strong solution of soda and a 10 percent solution of calcium
iodide, a red to blue stain is obtained which affects either the
medullary sheaths or only the axis cylinders. The method is no more
reliable than other methods of gold staining.

VIIa

   ‘A new histological method
for the study of nerve-tracts in the brain and spinal
chord.’

   Contents as in VII.

VIII

   ‘A case of cerebral
haemorrhage with indirect basal focal symptoms in a patient
suffering from scurvy.’

   A report of a case of cerebral
haemorrhage in a patient suffering from scurvy, which ran a rapid
course under continuous observation. The symptoms are explained
with reference to Wernicke’s theory of the indirect effect of
focal lesions.

IX

   ‘On Coca.’

   The alkaloid of the coca plant
which was described by Niemann received little attention for
medical purposes at the time. My work included botanical and
historical notes on the coca plant based on statements in the
literature; it confirmed by experiments on normal subjects the
remarkable stimulating effects of cocaine and its action in
preventing hunger, thirst and sleep; and it endeavoured to lay down
indications for the therapeutic use of the drug.

   Among these indications the
reference to the possible employment of cocaine during withdrawal
of morphine became of importance later. The expectation voiced at
the end of the work that the property of cocaine for producing
local anaesthesia would find further applications was soon
afterwards fulfilled by K. Koller’s experiments in
anaesthetizing the cornea.

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439

X

   ‘Contribution to our
knowledge of the effects of coca.’

   Dynamometric demonstration of the
increase in motor strength during cocaine euphoria, motor strength
(measured by the strength of the grip) shows a regular daily
oscillation (similar to that of body temperature).

XI

   ‘A note upon the
inter-olivary tract.’

   Short notes on the connections of
the roots of the auditory nerve and the connection between the
inter-olivary tract and the crossed trapezoid body, based upon
incompletely myelinated human preparations.

XII

   ‘A case of muscular atrophy
with extensive disturbances of sensibility
(syringomyelia).’

   The combination of bilateral
muscular atrophy, of bilateral disturbance of sensibility in the
nature of a ‘partial’, dissociated paralysis of
sensation, and of trophic disturbances in the left hand (which also
exhibited the most intense anaesthesia), taken together with the
restriction of the pathological symptoms to the upper part of the
body, permitted a diagnosis
in vivo
in a 36-year-old man of
syringomyelia, an affection which at that time was regarded as rare
and hard to recognize.

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440

B

AFTER APPOINTMENT AS
PRIVATDOZENT

XIII

   ‘Acute multiple neuritis of
the spinal and cranial nerves.’

   An eighteen-year-old man fell ill
without fever but with general symptoms and dragging pains in his
chest and legs. At first he showed symptoms of endocarditis, but
later the pains increased and sensitiveness to pressure developed
in the vertebral column and regionally in the skin, muscles and
nerve trunks as the affection involved one extremity after the
other: heightening of the reflexes, outbreaks of sweating, local
wasting, and lastly diplopia, disturbances of swallowing, facial
paresis, and hoarseness. Finally fever, extreme acceleration of the
pulse and pulmonary affection. The diagnosis of acute multiple
neuritis made during the course of the illness was confirmed by the
post-mortem findings, which showed that all the spinal nerves in
their sheaths were injected, greyish-red, and, as it were, bunched
up. Similar changes in the cranial nerves. Endocarditis. -
According to the pathologist, this was the first post-mortem
finding of polyneuritis to be made in Vienna.

XIV

   ‘On the relation of the
restiform body to the posterior column and its nucleus with some
remarks on two fields of the medulla oblongata.’

   Jointly with Dr. L.
Darkschewitsch (Moscow).

   By studying preparations with
incompletely myelinated medulla the restiform body can be divided
into two components: a ‘nucleus’ (primary restiform
body) and a ‘fringe’ (secondary restiform body). The
latter contains the olivary fibre system which becomes medullated
later. The primary restiform body, which is medullated earlier, is
divided into a ‘head portion’ and a ‘tail
portion’. The head of the primary restiform body arises from
the nucleus of the column of Burdach and thus represents a (for the
most part uncrossed) continuation to the cerebellum of the
centripetal tract from the extremities. The corresponding
continuation to the cerebrum is provided by means of the arcuate
fibres originating from this same nucleus. The tail portion of the
primary restiform body is a direct continuation of the spinal
lateral cerebellar tract. - The lateral field of the medulla
oblongata allows of a uniform interpretation of its components. It
contains four grey substances with the systems of fibres proceeding
from them, which are to be considered homologous to one another as
substances in which the sensory nerves from the extremities, and
the trigeminal, vagal, and auditory nerves have their origin.

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441

XV

   ‘On the origin of the
auditory nerve.’

   A description of the origin of
the auditory nerve, based on preparations of the human foetus,
illustrated by four drawings of cross-sections and a diagram. The
auditory nerve falls into three portions, of which the lowest (most
spinal) terminates in the auditory ganglion and has continuations
through the cornu trapezoides and the tracts of the superior
olivary body; the second can be traced as the
‘ascending’ auditory root of Roller into what is known
as Deiters’ nucleus; and the third runs into the inner
auditory field of the medulla oblongata, from which continuations
into the cerebellum arise. Details are given of the further course
of these tracts so far as it has been possible to follow them.

XVI

   ‘Observation of a severe
case of hemi-anaesthesia in a hysterical male.’

   (The organ of vision was examined
by Dr. Konigstein.)

   The case history of a 29-year-old
engraver with a bad family history, who fell ill after a dispute
with his brother. The case afforded a demonstration of the symptom
of sensible and sensorial hemi-anaesthesia in its classical form. -
The disturbance in the field of vision and in the sense of colour
is reported by Dr. Königstein.

XVII

   ‘Remarks on addiction to
cocaine and the fear of cocaine.’

   (With reference to a lecture by
W. A. Hammond.)

   The employment of cocaine for the
relief of abstinence from morphine resulted in the misuse of
cocaine and gave physicians an opportunity of observing the new
clinical picture of chronic cocaine addiction. My essay, supported
by a pronouncement from an American neuropathologist, seeks to show
that this addiction to cocaine comes about only in addicts to other
drugs (such as morphine) and that cocaine itself cannot be blamed
for it.

XVIII

   ‘On hemianopsia in earliest
childhood.’

   An observation of disturbance in
one half of the visual field in two children, aged 26 months and
three and a quarter years, an age at which the symptom had not
previously been medically recorded. A discussion on the lateral
inclination of the head and eyes which was to be observed in one of
the cases and on the localization of the suspected lesion. Both
cases are to be classed among the ‘unilateral cerebral
palsies of children’.

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XIX

  
On the Interpretation of the
Aphasias
, a critical study.

   After a firm basis for the
understanding of cerebral disturbances of speech had been
established by the discovery and definite localization of a motor
and a sensory aphasia (Broca and Wernicke), the authorities set
about tracing the more subtle symptoms of aphasia as well to
factors of localization. In this way they arrived at the hypothesis
of a
conduction
aphasia, with subcortical and transcortical,
and motor and sensory forms. This critical study is directed
against this view of speech disorders and it seeks to introduce for
their explanation functional factors in place of the topographical
ones. The forms described as subcortical and transcortical are not
to be explained by a particular localization of the lesion but by
conditions of reduced capacity for conduction in the apparatus of
speech. In fact there are no aphasias caused by subcortical lesion.
The justification for distinguishing a central aphasia from a
conduction aphasia is also disputed. The speech area of the cortex
is seen rather as a continuous region of the cortex inserted
between the motor fields of the cortex and those of the optic and
auditory nerves--a region within which all communication and
association subserving speech function takes place. The so-called
speech-centres revealed by the pathology of the brain correspond
merely to the corners of this field of speech; they are not
distinguished functionally from the interior regions; it is only on
account of their position in relation to the contiguous cortical
centres that they produce more obvious signs when they become
disordered.