Freud - Complete Works (76 page)

   The special characteristics of
cortical paralysis are determined by the peculiarities of cerebral
structure, and allow us to infer back to the anatomy of the brain.
Hysterical paralysis on the contrary behaves as though there were
no such thing as cerebral anatomy. Hysteria knows nothing of the
anatomy of the brain. The alteration which underlies hysterical
paralysis can have no resemblance to organic lesions but must be
looked for in the conditions governing the accessibility of some
particular circle of ideas.

Abstracts Of The Scientific Writings Of Dr. Sigm. Freud 1877-1897

446

XXIX

   ‘The neuro-psychoses of
defence: an attempt at a psychological theory of acquired hysteria,
of many phobias and obsessions and of certain hallucinatory
psychoses.’

   The first of a series of short
papers which now follow and which are directed to the task of
preparing a general exposition of the neuroses on a new basis which
is now in hand.

   The splitting of consciousness in
hysteria is not a primary characteristic of this neurosis, based on
degenerative weakness, as Janet insists. It is the consequence of a
peculiar psychical process known as ‘defence’ which is
shown by some short reports of analyses to be present not only in
hysteria but in numerous other neuroses and psychoses. Defence
comes into operation when an instance of incompatibility arises in
ideational life between a particular idea and the
‘ego’. The process of may be figuratively represented
as though the quota of excitation were torn away from the idea that
is to be repressed and put to some other use. This can occur in a
variety of ways: in hysteria the liberated sum of excitation is
transformed into somatic innervation (
conversion hysteria
);
in obsessional neurosis it remains in the psychical field and
attaches itself to other ideas which are not incompatible in
themselves and which are thus
substitutes
for the repressed
idea. The source of the incompatible ideas which are subjected to
defence is solely and exclusively sexual life. An analysis of a
case of hallucinatory psychosis shows that this psychosis too
represents a method of achieving defence.

XXX

   ‘Obsessions and phobias:
their psychical mechanism and aetiology.’

   Obsessions and phobias are to be
distinguished from neurasthenia as independent neurotic affections.
In both it is a question of the linkage between an idea and an
affective state. In phobias the latter is always the same, namely
anxiety; in true obsessions it can be of various kinds
(self-reproach, sense of guilt, doubt, etc.). The affective state
emerges as the essential element of the obsession, since it remains
unaltered in the individual case, whereas the idea attached to it
is changed. Psychical analysis shows that the affect of the
obsession is justified in every instance, but that the idea
attached to it represents a substitute for an idea derived from
sexual life which is more appropriate to the affect and which has
succumbed to repression. This state of affairs is illustrated by
numerous short analyses of cases of
folie du doute
, washing
mania, arithmomania, etc., in which the reinstatement of the
repressed idea was successful and accompanied by useful therapeutic
effects. The phobias in the strict sense are reserved for the paper
on anxiety neurosis (No. XXXII).

Abstracts Of The Scientific Writings Of Dr. Sigm. Freud 1877-1897

447

XXXI

  
Studies on Hysteria
.

   (In collaboration with Dr. J.
Breuer.)

   This volume contains the
carrying-through of the subject raised in the ‘Preliminary
Communication’ (No. XXIV) dealing with the psychical
mechanism of hysterical phenomena. Although it proceeds from the
joint work of the two authors, it is divided into separate
sections, of which four detailed case histories together with
discussions and an attempt at a ‘Psychotherapy of
Hysteria’ represent my share. The aetiological part played by
the sexual factor is stressed with greater emphasis in this book
than in the ‘Preliminary Communication’, and the
concept of ‘conversion’ is used to throw light on the
formation of hysterical symptoms. The essay on psychotherapy seeks
to give some insight into the technique of the psycho-analytic
procedure, which is alone able to lead to the investigation of the
unconscious content of the mind, and the employment of which may
also be expected to lead to important psychological
discoveries.

XXXII

  ‘On the grounds for detaching a
particular syndrome from neurasthenia under the description
"anxiety neurosis".’

   The concurrence of a constant
grouping of symptoms with a particular aetiological determinant
makes it possible to pick out from the composite province of
‘neurasthenia’ a syndrome which deserves the name of
‘anxiety neurosis’, because all of its constituents
arise from the symptoms of anxiety. These are either to be regarded
as immediate manifestations of anxiety or as rudiments and
equivalents of them (E. Hecker), and they are often in complete
opposition to the symptoms which constitute neurasthenia proper.
The aetiology of the two neuroses also points to an opposition of
this kind. Whereas true neurasthenia arises from spontaneous
emissions or is acquired through masturbation, the factors
belonging to the aetiology of anxiety neurosis are such as
correspond to a holding back of sexual excitation - such as
abstinence when libido is present, unconsummated excitation and,
above all, coitus interruptus. In actual life the neuroses here
distinguished usually appear in combination, though pure cases can
also be demonstrated. When a mixed neurosis of this kind is
subjected to analysis, it is possible to indicate a mixture of
several specific aetiologies.

   An attempt to arrive at a theory
of anxiety neurosis leads to a formula to the effect that its
mechanism lies in
the deflection of somatic sexual excitation
from the psychical field
and a consequent abnormal employment
of that excitation.
Neurotic anxiety is transformed sexual
libido
.

Abstracts Of The Scientific Writings Of Dr. Sigm. Freud 1877-1897

448

XXXIII

   ‘A reply to criticisms of
my paper on anxiety neurosis.’

   A reply to objections made by
Löwenfeld to the content of No. XXXII. The problem of the
aetiology of the pathology of the neuroses is dealt with here, to
justify the division into three categories of the aetiological
factors that appear: (
a
) preconditions, (
b
) specific
causes and (
c
) concurrent or auxiliary causes. What are
called preconditions are the factors which, though they are
indispensable for producing the effect, cannot by themselves
produce it but need in addition the specific causes. The specific
causes are distinguished from the preconditions by the fact that
they figure in only a few aetiological formulas, while the
preconditions play the same part in numerous affections. Auxiliary
causes are such as neither need invariably be present nor are able
by themselves to produce the effect in question. - In the case of
neuroses it is possible that the precondition may be heredity; the
specific cause lies in sexual factors; everything else that is
brought up apart from these as forming the aetiology of the
neuroses (overwork, emotion, physical illness) is an auxiliary
cause and can never entirely take the place of the specific factor,
though it can no doubt serve as a substitute for it in the matter
of
quantity
. The form of a neurosis depends on the nature of
the specific sexual cause; whether there shall be a neurotic
illness
at all
is determined by factors operating
quantitatively; heredity works like a multiplier inserted in an
electric circuit.

XXXIV

   ‘On Bernhardt’s
disturbance of sensibility in the thigh.’

   A self-observation of this
harmless affection, which is probably traceable to local neuritis;
and a report of some other cases, including bilateral ones.

Abstracts Of The Scientific Writings Of Dr. Sigm. Freud 1877-1897

449

XXXV

   ‘Further remarks on the
neuro-psychoses of defence.’

   (1)
The specific aetiology of
hysteria
. A continuation of psycho-analytic work with
hysterical subjects has had the uniform result of showing that the
suspected traumatic events (as mnemic symbols of which hysterical
symptoms persist) occur in the patients’
earliest
childhood
and are to be described as sexual abuses in the
narrowest sense.

   (2)
The nature and mechanism
of obsessional neurosis
. Obsessional ideas are invariably
transformed self-reproaches which have re-emerged from repression
and which always relate to some sexual act that was performed with
pleasure in childhood. The course taken by this return of the
repressed is traced, as are the results of a primary and secondary
work of defence.

   (3)
Analysis of a case of
chronic paranoia
. This analysis, which is reported in detail,
indicates that the aetiology of paranoia is to be found in the same
sexual experiences of early childhood in which the aetiology of
hysteria and of obsessional neurosis has already been discovered.
The symptoms of this case of paranoia are traced in detail to the
activities of defence.

XXXVI

   ‘The aetiology of
hysteria.’

   More detailed reports of the
infantile sexual experiences which have been shown to constitute
the aetiology of the psychoneuroses. In their content these
experiences must be described as ‘perversions’, and
those responsible are as a rule to be looked for among the
patient’s nearest relatives. A discussion of the difficulties
which have to be surmounted in uncovering these repressed memories
and of the objections that may be raised against the results thus
arrived at. Hysterical symptoms are shown to be derivatives of
memories operating unconsciously; they appear only in collaboration
with such memories. The presence of infantile sexual experiences is
an indispensable condition if the efforts of defence (which occur
in normal people as well) are to result in producing pathogenic
effects - that is to say, neuroses.

Abstracts Of The Scientific Writings Of Dr. Sigm. Freud 1877-1897

450

XXXVII

   ‘Heredity and the aetiology
of the neuroses.’

   The findings hitherto arrived at
by psycho-analysis on the aetiology of the neuroses are here
employed to criticize the current theories of the omnipotence of
heredity in neuropathology. The part played by heredity has been
overestimated in several directions. Firstly, by including among
the inheritable neuropathic illnesses conditions such as headaches,
neuralgias, etc., which are very probably attributable as a rule to
organic affections of the cranial cavities (the nose). Secondly, by
regarding every discoverable nervous ailment among relatives as
evidence of hereditary taint and by thus from the first leaving no
room for
acquired
neuropathic illnesses which can possess no
similar evidential weight. Thirdly, the aetiological role of
syphilis has been misunderstood and the nervous ailments deriving
from it have been put down to the account of heredity. But in
addition, a general objection is permissible against a form of
heredity which is described as ‘dissimilar inheritance’
(or inheritance with a change in the form of the illness), and to
which a far more important part is allotted than to
‘similar’ inheritance. But when the fact of hereditary
taint in a family is demonstrated in its members being affected
alternatively by every sort of nervous complaint - chorea,
epilepsy, hysteria, apoplexy, etc. - without any more precise
determinants, then either we need a knowledge of the laws according
to which these complaints replace one another or else room is left
for the individual aetiologies which determine precisely the choice
of the neuropathic state which in fact results from them. If such
particular aetiologies exist, they are the specific causes, so much
sought after, of the various different clinical forms, and heredity
is pushed back into the role of a requirement or precondition.

Abstracts Of The Scientific Writings Of Dr. Sigm. Freud 1877-1897

451

XXXVIII

  
Infantile Cerebral
Palsies
.

   This is a summary of the two
works on the same theme published in 1891 and 1893, together with
the additions and alterations which have since become necessary.
These affect the chapter on
poliomyelitis acuta
, which has
meantime been recognized as a non-systematic disease, on
encephalitis as an initial process of spastic hemiplegia, and on
the interpretation of cases of paraplegic spasticity, the cerebral
nature of which affection may recently have been placed in doubt. A
special discussion is concerned with the attempts to split up the
content of the cerebral diplegias into several clearly divided
clinical entities, or at least to separate what is known as
‘Little’s disease’ as a clinical individual from
among the medley of forms of similar affections. The difficulties
which meet such attempts are pointed out, and it is maintained as
the only justifiable view that ‘infantile cerebral
palsy’ shall be retained at present as a collective clinical
concept for a whole number of similar affections with an exogenous
aetiology. The rapid increase in observations of familial and
hereditary nervous disorders of children, which resemble infantile
cerebral palsies clinically at many points, has made it a pressing
matter to collect these new forms and to attempt to draw a
fundamental distinction between them and infantile cerebral
palsies.