Freud - Complete Works (80 page)

Sexuality In The Aetiology Of The Neuroses

473

   I can do no more in these brief
hints than mention the chief factors on which the theory of the
psychoneuroses is based: the deferred nature of the effect and the
infantile state of the sexual apparatus and of the mental
instrument. To reach a true understanding of the mechanism by which
the psychoneuroses come about, a more extended exposition would be
necessary. Above all, it would be indispensable to put forward as
worthy of belief certain hypotheses, which seem to me to be new,
about the composition and mode of operation of the psychical
apparatus. In a book on the interpretation of dreams on which I am
now engaged I shall find occasion to touch upon those fundamental
elements of a psychology of the neuroses. For dreams belong to the
same set of psychopathological structures as hysterical
idées fixes
, obsessions, and delusions.

   Since the manifestations of the
psychoneuroses arise from the deferred action of unconscious
psychical traces, they are accessible to psychotherapy. But in this
case the therapy must pursue paths other than the only one so far
followed of suggestion with or without hypnosis. Basing myself on
the ‘cathartic’ method introduced by Josef Breuer, I
have in recent years almost completely worked out a therapeutic
procedure which I propose to describe as
‘
psycho-analytic
’. I owe a great number of
successes to it, and I hope I may be able further to increase it
effectiveness considerably. The first accounts of the technique and
scope of this method were given in
Studies on Hysteria
,
written jointly with Breuer and published in 1895. Since then a
good deal, as I think I may say, has been altered for the better.
Whereas at that time we modestly declared that we could undertake
to only to remove the symptoms of hysteria, not to cure hysteria
itself, this distinction has since come to seem to me without
substance, so that there is a prospect of a genuine cure of
hysteria and obsessions. It is therefore with very lively interest
that I have read in the publications of colleagues that ‘in
this case the ingenious procedure devised by Breuer and Freud has
failed’, or that ‘the method has not performed what it
seemed to promise’. This gave me something of the feelings of
a man who reads his own obituary in the paper, but who is able to
reassure himself by his better knowledge of the facts. For the
method is so difficult that it has quite definitely to be learned;
and I cannot recall that a single one of my critics has expressed a
wish to learn it from me. Nor do I believe that, like me, they have
occupied themselves with it intensely enough to have been able to
discover it for themselves. The remarks in the
Studies on
Hysteria
are totally inadequate to enable a reader to master
the technique, nor are they in any way intended to give any such
complete instruction.

   Psycho-analytic therapy is not at
present applicable to all cases. It has, to my knowledge, the
following limitations. It demands a certain degree of maturity and
understanding in the patient and is therefore not suited for the
young or for adults who are feeble-minded or uneducated. It also
fails with people who are very advanced in years, because, owing to
the accumulation of material in them, it would take up so much time
that by the end of the treatment they would have reached a period
of life in which value is no longer attached to nervous health.
Finally, the treatment is only possible if the patient has a normal
psychical state from which the pathological material can be
mastered from which to work i.e. a relatively normal ego. During a
condition of hysterical confusion, or an interpolated mania or
melancholia, nothing can be effected by psycho-analytic means. Such
cases can nevertheless be treated by analysis after the violent
manifestations have been quieted by the usual measures. In actual
practice, chronic cases of psychoneurosis are altogether more
amenable to the method than cases with acute crises, in which the
greatest stress is naturally laid on the speed with which the
crises can be dealt with. For this reason, the most favourable
field of work for this new therapy is offered by hysterical phobias
and the various forms of obsessional neurosis.

Sexuality In The Aetiology Of The Neuroses

474

   That the method is confined
within these limits is to a large extent explained by the
circumstances in which I had to work it out. My material does in
fact consist of chronic nervous cases derived from the more
educated classes. I think it very probable that supplementary
methods may be devised for treating children and the public who go
for assistance to hospitals. I ought also to say that up to the
present I have tried my treatment exclusively on
severe
cases of hysteria and obsessional neurosis; I cannot tell how it
would turn out with those mild cases which, to all appearance at
least, are cured by some unspecific kind of treatment lasting for a
few months. It will readily be understood that a new therapy which
calls for many sacrifices can only reckon on obtaining patients who
have already tried the generally accepted methods without success,
or whose condition has justified the inference that they could
expect nothing from these supposedly more convenient and shorter
therapeutic procedures. Thus it happened that I was obliged to
tackle the hardest tasks straightaway with an imperfect instrument.
The test has proved all the more convincing.

   The main difficulties which still
stand in the way of the psycho-analytic method of cure. It is no
more than a necessary corollary to this complete ignorance that
doctors consider themselves justified in using the most unfounded
assurances for the consolation of their patients or in order to
induce them to adopt therapeutic measures. ‘Come to my
sanatorium for six weeks’, they will say, ‘and you will
get rid of your symptoms’ (travel anxiety, obsessions, and so
on).Sanatoria are, it is true, indispensable for calming acute
attacks that may arise in the course of a psychoneurosis by
diverting the patient’s attention, nursing him and taking
care of him. But towards removing chronic conditions they achieve
precisely nothing: and the superior sanatoria, which are supposed
to be conducted on scientific lines, do no more than the ordinary
hydropathic establishments.

Sexuality In The Aetiology Of The Neuroses

475

   It would be more dignified as
well as more helpful to the patient - who, after all, has to come
to terms with his ailments - for the doctor to tell the truth, as
he knows it from his daily practice. The psychoneuroses as a genus
are by no means mild illnesses. When hysteria sets in, no one can
foretell when it will come to an end. We mostly comfort ourselves
with the vain prophecy that ‘one day it will suddenly
disappear’. Recovery often enough turns out to be merely an
agreement to mutual toleration between the sick part of the patient
and the healthy part; or it is the result of the transformation of
a symptom into a phobia. A girl’s hysteria, calmed down with
difficulty, revives in her as a wife after the short interruption
of young married happiness. The only difference is that another
person, the husband, is now driven by his own interests to keep
silence about her condition. Even if an illness of this kind leads
to no manifest incapacity on the patients’ part to carry on
their life, it nearly always prevents free unfolding of their
mental powers. Obsessions recur throughout their lives; and phobias
and other restrictions upon the will have hitherto been unamenable
to treatment of any kind. All this is kept from the knowledge of
the layman. The father of a hysterical girl is consequently
horrified if, for instance, he is asked to agree to her being given
a year’s treatment, when she has perhaps only been ill for a
few months. The layman is, as it were, deeply convinced in himself
that all these psychoneuroses are unnecessary; so he has no
patience with the processes of the illness and no readiness to make
sacrifices for its treatment. If, in face of a case of typhus which
lasts three weeks, or of a broken leg which takes six months to
mend, he adopts a more understanding attitude, and if, as soon as
his child shows the first signs of a curvature of the spine, he
finds it reasonable that orthopaedic treatment should be carried on
over several years, the difference in his behaviour is due to the
better knowledge on the part of the physicians who pass on their
knowledge honestly to the layman. Honesty on the part of the
physician and willing acquiescence on the part of the layman will
be established for the neuroses too, as soon as an insight into the
nature of those affections becomes common property in the medical
world. Radical treatment of these disorders will no doubt always
require special training and will be incompatible with other kinds
of medical activity. On the other hand, this class of physicians,
which will, I believe, be a large one in the future, has the
prospect of achieving noteworthy results and of obtaining a
satisfying insight into the mental life of mankind.

476

THE PSYCHICAL MECHANISM OF FORGETFULNESS

(1898)

477

Intentionally left blank

478

THE PSYCHICAL MECHANISM OF FORGETFULNESS

The phenomenon of forgetfulness, which I
should like to describe and then go on to explain in this paper,
has doubtless been experienced by everyone in himself or been
observed by him in others. It affects in particular the use of
proper names -
nomen propria
- and it manifests itself in
the following manner. In the middle of carrying on a conversation
we find ourselves obliged to confess to the person we are talking
to that we cannot hit on a name we wanted to mention at that
moment, and we are forced to ask for his - usually ineffectual -
help. ‘What is his name? I know it so well. It’s on the
tip of my tongue. Just this minute it’s escaped me.’ An
unmistakable feeling of irritation, similar to that which
accompanies motor aphasia, now attends our further efforts to find
the name, which we feel we had in our head only a moment before. In
appropriate instances two accompanying features deserve our notice.
First, an energetic deliberate concentration of the function which
we call attention proves powerless, however long it is continued,
to find the lost name. Secondly, in place of the name we are
looking for, another name promptly appears, which we recognize as
incorrect and reject, but which persists in coming back. Or else,
instead of a substituted name, we find in our memory a single
letter or syllable, which we. We say, for instance: ‘It
begins with a "B".’ If we finally succeed, in one
way or another, in discovering what the name is, we find in the
great majority of cases that it does not begin with a
‘B’ and does not in fact contain the letter
‘B’ at all.

The Psychical Mechanism Of Forgetfulness

479

   The best procedure for getting
hold of the missing name is, as is generally known, ‘not to
think of it’ - that is, to divert from the task that part of
the attention over which one has voluntary control. After a while,
the missing name ‘shoots’ into one’s mind; one
cannot prevent oneself from calling it out aloud - to the great
astonishment of one’s companion, who has already forgotten
the episode and who has in any case only taken very little interest
in the speaker’s efforts. ‘Really,’ he is apt to
say, ‘it makes no difference
what
the man is called;
only go on with your story.’ The whole of the time until the
matter is cleared up, and even after the intentional diversion, one
feels preoccupied to a degree which cannot in fact be explained by
the amount of interest possessed by the whole affair.¹

   In a few cases which I have
myself experienced of forgetting names in this way, I have
succeeded, by means of psychical analysis, in accounting to myself
for the chain of events; and I shall now describe in detail the
simplest and clearest case of this kind.

   During my summer holidays I once
went for a carriage drive from the lovely city of Ragusa to a town
nearby in Herzegovina. Conversation with my companion centred, as
was natural, round the condition of the two countries (Bosnia and
Herzegovina) and the character of their inhabitants. I talked about
the various peculiarities of the Turks living there, as I had heard
them described years before by a friend and colleague who had lived
among them as a doctor for many years. A little later, our
conversation turned to the subject of Italy and of pictures, and I
had occasion to recommend my companion strongly to visit Orvieto
some time, in order to see the frescoes there of the end of the
world and the Last Judgement, with which one of the chapels in the
cathedral had been decorated by a great artist. But the
artist’s name escaped me and I could not recall it. I exerted
my powers of recollection, made all the details of the day I spent
in Orvieto pass before my memory and convinced myself that not the
smallest part of it had been obliterated or become indistinct. On
the contrary, I was able to conjure up the pictures with greater
sensory vividness than is usual with me. I saw before my eyes with
especial sharpness the artist’s self-portrait - with a
serious face and folded hands - which he has put in a corner of one
of the pictures, next to the portrait of his predecessor in the
work, Fra Angelico da Fiesole; but the artist’s name,
ordinarily so familiar to me, remained obstinately in hiding, nor
could my travelling companion help me out. My continued efforts met
with no success beyond bringing up the names of two other artists,
who I knew could not be the right ones. These were
Botticelli
and, in the second place,
Boltraffio
.² The repetition of the sound
‘Bo’ in the two substitutive names might perhaps have
led a novice to suppose that it belonged to the missing name as
well, but I took good care to steer clear of that expectation.

  
¹
Nor by any feeling of unpleasure one may
have at being inhibited in a psychical act.

  
²
The first of these names was very familiar
to me; the second, on the other hand, I hardly knew.

The Psychical Mechanism Of Forgetfulness

480

   Since I had no access to any
reference books on my journey, I had for several days to put up
with this lapse of memory and with the inner torment associated
with it which recurred at frequent intervals each day, until I fell
in with a cultivated Italian who freed me from it by telling me the
name:
Signorelli
. I was myself able to add the
artist’s
first
name,
Luca.
Soon my ultra-clear
memory of the master’s features, as depicted in his portrait,
faded away.

   What influences had led me to
forget the name
Signorelli
which was so familiar to me and
which is so easily impressed on the memory? And what paths had led
to its replacement by the names
Botticelli
and
Boltraffio
? A short excursion back into the circumstances
in which the forgetting had taken place sufficed to throw a light
on both questions.

   Shortly before I had come to the
subject of the frescoes in the cathedral at Orvieto, I had been
telling my travelling-companion something I had heard from my
colleague years ago about the Turks in Bosnia. They treat doctors
with special respect and they show, in marked contrast to our own
people, an attitude of resignation towards the dispensations of
fate. If the doctor has to inform the father of a family that one
of his relatives is about to die, his reply is: ‘
Herr
,
what is there to be said? If he could be saved, I know you would
help him.’ Another recollection lay in my memory close to
this story. The same colleague had told me what overriding
importance these Bosnians attached to sexual enjoyments. One of his
patients said to him once: ‘
Herr
, you must know, that
if
that
comes to an end then life is of no value.’ At
the time, it seemed to the doctor and me that the two
character-traits of the Bosnian people illustrated by this could be
assumed to be intimately connected with each other. But when I
remembered these stories on my drive into Herzegovina, I suppressed
the second one, in which the subject of sexuality was touched on.
It was soon after this that the name
Signorelli
escaped me
and that the names
Botticelli
and
Boltraffio
appeared
as substitutes.

   The influence which had made the
name
Signorelli
inaccessible to memory, or, as I am
accustomed to say, had ‘repressed’ it, could only
proceed from the story I had suppressed about the value set on
death and sexual enjoyment. If that was so, we ought to be able to
discover the intermediate ideas which had served to connect the two
themes. The affinity between their
content
- in the one
case, the Last Judgement, ‘Doomsday’, and in the other,
death and sexuality- seems to be very slight; and since the matter
concerned the repression from memory of a
name
, it was on
the face of it probable that the connection was between one name
and another. Now, ‘
Signor
’ means
‘
Herr
, and the ‘
Herr
’ is also
present in the name ‘
Her
zegovina’. Moreover it
was certainly not without relevance that both the patients’
remarks which I was to recall contained a ‘
Herr
’
as a form of address to the doctor. The translation of
‘
Signor
’ into ‘
Herr
’ was
therefore the means by which the story that I had suppressed had
drawn after it into repression the name I was looking for. The
whole process was clearly made easier by the fact that during the
last few days in Ragusa I had been speaking Italian continually -
that is, that I had become accustomed to translating German into
Italian in my head.¹

  
When I tried to recover
the name of the artist, to bring it back out of repression, the
influence of the tie which the name had entered into in the
meantime inevitably made itself felt. I did find an artist’s
name, but not the right one. It was a displaced name, and the line
of displacement was laid down by the names that were contained in
the repressed topic. ‘Bottic
elli
’ contains the
same final syllables as ‘Signor
elli
’; the final
syllables - which, unlike the first part of the word,
‘
Signor
’, could not make a direct connection
with the name ‘Herzegovina’ - had therefore returned;
but the influence of the name ‘Bosnia’, which is
regularly associated with the name ‘Herzegovina’, had
shown itself by directing the substitution to two artists’
names which began with the same syllable ‘Bo’:
‘Botticelli’ and then ‘Boltraffio’. The
finding of the name ‘Signorelli’ is thus seen to have
been interfered with by the topic which lay behind it, in which the
names ‘Bosnia’ and ‘Herzegovina’
appear.

  
¹
‘A far-fetched, forced
explanation’, it will be said. This impression to establish a
connection with what is not suppressed; and for this purpose it
does not scorn even the path of external association. There is the
same ‘forced’ situation when rhymes have to be
made.

The Psychical Mechanism Of Forgetfulness

481

   For this topic to have been able
to produce such effects it is not enough that I should have
suppressed it once in conversation - an event brought about by
chance motives. We must assume rather that the topic itself was
also intimately bound up with trains of thought which were in a
state of repression in me - that is, with trains of thought which,
in spite of the intensity of the interest taken in them, were
meeting with a resistance that was keeping them from being worked
over by a particular psychical agency and thus from becoming
conscious. That this was really true at that time of the topic of
‘death and sexuality’ I have plenty of evidence, which
I need not bring up here, derived from my own self-investigation.
But I may draw attention to one consequence of these repressed
thoughts. Experience has taught me to require that every psychical
product shall be fully elucidated and even overdetermined.
Accordingly, it seemed to me that the second substitutive name,
‘Boltraffio’, called for a further determination; for
so far only its initial letters had been accounted for, by their
assonance with ‘Bosnia’. I now recollected that these
repressed thoughts had never engrossed me more than they had a few
weeks before after I had received a certain piece of news. The
place where the news reached me was called
‘
Trafoi
’ and this name is too much like the
second half of the name ‘Boltraffio’ not to have had a
determining effect on my choice of the latter. In the following
small schematic diagram, I have attempted to reproduce the
relations which have now been brought to light.

Fig. 1

The Psychical Mechanism Of Forgetfulness

482

   It is perhaps not without
interest for its own sake to be able to see into the history of a
psychical event of this kind, which is among the most trivial
disturbances that can affect the control of the psychical apparatus
and which is compatible with an otherwise untroubled state of
psychical health. But the example elucidated here receives an
immensely added interest when we learn that it may serve as nothing
more nor less than a model for the pathological processes to which
the psychical symptoms of the psychoneuroses - hysteria, obsessions
and paranoia - owe their origin. In both cases we find the same
elements and the same play of forces between those elements. In the
same manner as here and by means of similar superficial
associations, a repressed train of thought takes possession in
neuroses of an innocent recent impression and draws it down with
itself into repression. The same mechanism which causes the
substitute names ‘Botticelli’ and
‘Boltraffio’ to emerge from 
‘Signorelli’ (a substitution by means of intermediate
or compromise ideas) also governs the formation of obsessional
thoughts and paranoic paramnesias. Again, we have seen that such
cases of forgetfulness have the characteristic of liberating
continuous unpleasure till the moment the problem is solved - a
characteristic which is unintelligible apart from this, and
something which was in fact unintelligible to the person I was
talking to; but there is a complete analogy to it in the way in
which collections of repressed thoughts attach their capacity for
producing affect to some symptom whose psychical content seems to
our judgement totally unsuited to such a liberation of affect.
Finally, the resolution of the whole tension by a communication of
the correct name from an external quarter is itself a good example
of the efficacy of psycho-analytic therapy, which aims at
correcting the repressions and displacements and which removes the
symptoms by re-instating the genuine psychical object.