The Etiology of the Neuroses
With this conception of Freud’s we have to return to the question of the
etiology of the neuroses. We have seen that the psychoanalytic theory
began with a traumatic event in childhood, which was only later on found
to be a phantasy, at least in many cases. In consequence, the theory
became modified, and tried to find in the development of abnormal
phantasy the main etiological significance. The investigation of the
unconscious, made by the collaboration of many workers, carried on over
a space of ten years, provided an extensive empirical material, which
demonstrated that the incest-complex was the beginning of the morbid
phantasies. But it was no longer thought that the incest-complex was a
special complex of neurotic people. It was demonstrated to be a
constituent of a normal infantile psyche too. We cannot tell, by its
mere existence, if this complex will give rise to a neurosis or not. To
become pathogenic, it must give rise to a conflict; that is, the
complex, which in itself is harmless, has to become dynamic, and thus
give rise to a conflict.
Herewith, we come to a new and important question. The whole etiological
problem is altered, if the infantile “root-complex” is only a general
form, which is not pathogenic in itself, and requires, as we saw in our
previous exposition, to be subsequently set in action. Under these
circumstances, we dig in vain among the reminiscences of earliest
childhood, as they give us only the general forms of the later
conflicts, but not the conflict itself.
I believe the best thing I can do is to describe the further development
of the theory by demonstrating the case of that young lady whose story
you have heard in part in one of the former lectures. You will probably
remember that the shying of the horses, by means of the anamnestic
explanation, brought back the reminiscence of a comparable scene in
childhood. We here discussed the trauma theory. We found that we had to
look for the real pathological element in the exaggerated phantasy,
which took its origin in a certain retardation of the psychic sexual
development. We have now to apply our theoretical standpoint to the
origin of this particular type of illness, so that we may understand
how, just at that moment, this event of her childhood, which seemed to
be of such potency, could come to constellation.
The simplest way to come to an understanding of this important event
would be by making an exact inquiry into the circumstances of the
moment. The first thing I did was to question the patient about the
society in which she had been at that time, and as to what was the
farewell gathering to which she had been just before. She had been at a
farewell supper, given in honor of her best friend, who was going to a
foreign health-resort for a nervous illness. We hear that this friend is
happily married, and is the mother of one child. We have some right to
doubt this assertion of her happiness. If she were really happily
married, she probably would not be nervous and would not need a cure.
When I put my question differently, I learned that my patient had been
brought back into the host’s house as soon as she was overtaken by her
friends, as this house was the nearest place to bring her to in safety.
In her exhausted condition she received his hospitality. As the patient
came to this part of her history she suddenly broke off, was
embarrassed, fidgetted and tried to turn to another subject. Evidently
we had now come upon some disagreeable reminiscences, which suddenly
presented themselves. After the patient had overcome obstinate
resistances, it was admitted that something very remarkable had happened
that night. The host made her a passionate declaration of love, thus
giving rise to a situation that might well be considered difficult and
painful, considering the absence of the hostess. Ostensibly this
declaration came like a flash of lightning from a clear sky. A small
dose of criticism applied to this assertion will teach us that these
things never drop from the clouds, but have always their previous
history. It was the work of the following weeks to dig out piecemeal a
whole, long love-story.
I can thus roughly describe the picture I got at finally. As a child the
patient was thoroughly boyish, loved only turbulent games for boys,
laughed at her own sex, and flung aside all feminine ways and
occupations. After puberty, the time when the sex-question should have
come nearer to her, she began to shun all society; she hated and
despised, as it were, everything which could remind her even remotely of
the biological destination of mankind, and lived in a world of
phantasies which had nothing in common with the rude reality. So she
escaped, up to her twenty-fourth year, all the little adventures, hopes
and expectations which ordinarily move a woman of this age. (In this
respect women are very often remarkably insincere towards themselves and
towards the physician.) But she became acquainted with two men who were
destined to destroy the thorny hedge which had grown all around her. Mr.
A. was the husband of her best friend at the time; Mr. B. was the
bachelor-friend of this family. Both were to her taste. It seemed to her
pretty soon that Mr. B. was much more sympathetic to her, and from this
resulted a more intimate relationship between herself and him, and the
possibility of an engagement was discussed. Through her relations with
Mr. B., and through her friend, she met Mr. A. frequently. In an
inexplicable way his presence very often excited her and made her
nervous. Just at this time our friend went to a big party. All her
friends were there. She became lost in thought, and played as in a dream
with her ring, which suddenly slipped from her hand and rolled under the
table. Both men tried to find it, and Mr. B. managed to get it. With an
expressive smile he put the ring back on her finger and said: “You know
what this means?” At that moment a strange and irresistible feeling came
over her, she tore the ring from her finger and threw it out of the open
window. Evidently a painful moment ensued, and she soon left the
company, feeling deeply depressed. A short time later she found herself,
for her holidays, accidentally in the same health-resort where Mr. A.
and his wife were staying. Mrs. A. now became more and more nervous,
and, as she felt ill, had to stay frequently at home. The patient often
went out with Mr. A. alone. One day they were out in a small boat. She
was boisterously merry, and suddenly fell overboard. Mr. A. saved her
with great difficulty, and lifted her, half unconscious, into the boat.
He then kissed her. With this romantic event the bonds were woven fast.
To defend herself, our patient tried energetically to get herself
engaged to Mr. B., and to imagine that she loved him. Of course this
queer play did not escape the sharp eye of feminine jealousy. Mrs. A.,
her friend, felt the secret, was worried by it, and her nervousness grew
proportionately. It became more and more necessary for her to go to a
foreign health-resort. The farewell-party was a dangerous opportunity.
The patient knew that her friend and rival was going off the same
evening, so Mr. A. would be alone. Certainly she did not see this
opportunity clearly, as women have the notable capacity “to think”
purely emotionally, and not intellectually. For this reason, it seems to
them as if they never thought about certain matters at all, but as a
matter of fact she had a queer feeling all the evening. She felt
extremely nervous, and when Mrs. A. had been accompanied to the station
and had gone, the hysterical attack occurred on her way back. I asked
her of what she had been thinking, or what she felt at the actual moment
when the trotting horses came along. Her answer was, she had only a
frightful feeling, the feeling that something dreadful was very near to
her, which she could not escape. As you know, the consequence was that
the exhausted patient was brought back into the house of the host, Mr.
A. A simple human mind would understand the situation without
difficulty. An uninitiated person would say: “Well, that is clear
enough, she only intended to return by one way or another to Mr. A.’s
house,” but the psychologist would reproach this layman for his
incorrect way of expressing himself, and would tell him that the patient
was not conscious of the motives of her behavior, and that it was,
therefore, not permissible to speak of the patient’s intention to return
to Mr. A.’s house.
There are, of course, learned psychologists who are capable of
furnishing many theoretical reasons for disputing the meaning of this
behavior. They base their reasons on the dogma of the identity of
consciousness and psyche. The psychology inaugurated by Freud recognized
long ago that it is impossible to estimate psychological actions as to
their final meaning by conscious motives, but that the objective
standard of their psychological results has to be applied for their
right evaluation. Now-a-days it cannot be contested any longer that
there are unconscious tendencies too, which have a great influence on
our modes of reaction, and on the effects to which these in turn give
rise. What happened in Mr. A.’s house bears out this observation; our
patient made a sentimental scene, and Mr. A. was induced to answer it
with a declaration of love. Looked at in the light of this last event,
the whole previous history seems to be very ingeniously directed towards
just this end, but throughout the conscience of the patient struggled
consciously against it. Our theoretical profit from this story is the
clear perception that an unconscious purpose or tendency has brought on
to the stage the scene of the fright from the horses, utilizing thus
very possibly that infantile reminiscence, where the shying horses
galloped towards the catastrophe. Reviewing the whole material, the
scene with the horses—the starting point of the illness—seems now to be
the keystone of a planned edifice. The fright, and the apparent
traumatic effect of the event in childhood, are only brought on the
stage in the peculiar way characteristic of hysteria. But what is thus
put on the stage has become almost a reality. We know from hundreds of
experiences that certain hysterical pains are only put on the stage in
order to reap certain advantages from the sufferer’s surroundings. The
patients not only believe that they suffer, but their sufferings are,
from a psychological standpoint, as real as those due to organic causes;
nevertheless, they are but stage-effects.
The Regression of Libido
This utilization of reminiscences to put on the stage any illness, or an
apparent etiology, is called a _regression of the libido_. The libido
goes back to reminiscences, and makes them actual, so that an apparent
etiology is produced. In this case, by the old theory, the fright from
the horses would seem to be based on a former shock. The resemblance
between the two scenes is unmistakable, and in both cases the patient’s
fright is absolutely real. At any rate, we have no reason to doubt her
assertions in this respect, as they are in full harmony with all other
experiences. The nervous asthma, the hysterical anxiety, the psychogenic
depressions and exaltations, the pains, the convulsions—they are all
very real, and that physician who has himself suffered from a
psychogenic symptom knows that it feels absolutely real. Regressively
re-lived reminiscences, even if they were but phantasies, are as real as
remembrances of events that have once been real.
As the term “regression of libido” shows, we understand by this
retrograde mode of application of the libido, a retreat of the libido to
former stages. In our example, we are able to recognize clearly the way
the process of regression is carried on. At that farewell party, which
proved a good opportunity to be alone with the host, the patient shrank
from the idea of turning this opportunity to her advantage, and yet was
overpowered by her desires, which she had never consciously realized up
to that moment. The libido was not used consciously for that definite
purpose, nor was this purpose ever acknowledged. The libido had to carry
it out through the unconscious, and through the pretext of the fright
caused by an apparently terrible danger. Her feeling at the moment when
the horses approached illustrates our formula most clearly; she felt as
if something inevitable had now to happen.
The process of regression is beautifully demonstrated in an illustration
already used by Freud. The libido can be compared with a stream which is
dammed up as soon as its course meets any impediment, whence arises an
inundation. If this stream has previously, in its upper reaches,
excavated other channels, then these channels will be filled up again by
reason of the damming below. To a certain extent they would appear to be
real river beds, filled with water as before, but at the same time, they
only have a temporary existence. It is not that the stream has
permanently chosen the old channels, but only for as long as the
impediment endures in the main stream. The affluents do not always carry
water, because they were from the first, as it were, not independent
streams, but only former stages of development of the main river, or
passing possibilities, to which an inundation has given the opportunity
for fresh existence. This illustration can directly be transferred to
the development of the application of the libido. The definite
direction, the main river, is not yet found during the childish
development of sexuality. The libido goes instead into all possible
by-paths, and only gradually does the definite form develop. But the
more the stream follows out its main channel, the more the affluents
will dry up and lose their importance, leaving only traces of former
activity. Similarly, the importance of the childish precursors of
sexuality disappears completely as a rule, only leaving behind certain
traces.
If in later life an impediment arises, so that the damming of the libido
reanimates the old by-paths, the condition thus excited is properly a
new one, and something abnormal.
The former condition of the child is normal usage of the libido, whilst
the return of the libido towards the childish past is something
abnormal. Therefore, in my opinion, it is an erroneous terminology to
call the infantile sexual manifestations “perversions,” for it is not
permissible to give normal manifestations pathological terms. This
erroneous usage seems to be responsible for the confusion of the
scientific public. The terms employed in neurotic psychology have been
misapplied here, under the assumption that the abnormal by-paths of the
libido discovered in neurotic people are the same phenomena as are to be
found in children.
The Infantile Amnesia Criticized
The so-called _amnesia of childhood_, which plays an important part in
the “Three Contributions,” is a similar illegitimate retrograde
application from pathology. Amnesia is a pathological condition,
consisting in the repression of certain contents of the conscious. This
condition cannot possibly be the same as the antegrade amnesia of
children, which consists in an incapacity for intentional reproduction,
a condition we find also among savages. This incapacity for reproduction
dates from birth, and can be understood on obvious anatomical and
biological grounds. It would be a strange hypothesis were we willing to
regard this totally different quality of early infantile consciousness
as one to be attributed to repression, in analogy with the condition in
neurosis. The amnesia of neurosis is punched out, as it were, from the
continuity of memory, but the remembrances of earlier childhood exist in
separate islands in the continuity of the non-memory. This condition is
the opposite in every sense of the condition of neurosis, so that the
expression “amnesia,” generally used for this condition, is incorrect.
The “amnesia of childhood” is a conclusion _a posteriori_ from the
psychology of neurosis, just as is the “polymorphic perverse”
disposition of the child.
The Latent Sexual Period Criticized
This error in the theoretical conception is shown clearly in the
so-called _latent sexual period of childhood_. Freud has remarked that
the early infantile so-called sexual manifestations, which I now call
the phenomena of the pre-sexual stage, vanish after a while, and only
reappear much later. Everything that Freud has termed the “suckling’s
masturbation,” that is to say, all those sexual-like actions of which we
spoke before, are said to return later as real onanism. Such a process
of development would be biologically unique. In conformity with this
theory one would have to say, for instance, that when a plant forms a
bud, from which a blossom begins to unfold, the blossom is taken back
again before it is fully developed, and is again hidden within the bud,
to reappear later on in the same form. This impossible supposition is a
consequence of the assertion that the early infantile activities of the
pre-sexual stage are sexual phenomena, and that those manifestations,
which resemble masturbation, are genuinely acts of masturbation. In this
way Freud had to assert that there is a disappearance of sexuality, or,
as he calls it, a _latent sexual period_. What he calls a disappearance
of sexuality is nothing but the _real beginning of sexuality_,
everything preceding was but the fore-stage to which no real sexual
character can be imputed. In this way, the impossible phenomenon of the
latent period is very simply explained. This theory of the latent sexual
period is a striking instance of the incorrectness of the conception of
the early infantile sexuality. But there has been no error of
observation. On the contrary, the hypothesis of the latent sexual period
proves how exactly Freud noticed the apparent recommencement of
sexuality. The error lies in the conception. As we saw before, the first
mistake consists in a somewhat old-fashioned conception of the
multiplicity of instincts. If we accept the idea of two or more
instincts existing side by side, we must naturally conclude that, if one
instinct has not yet become manifest, it is present in nuce in
accordance with the theory of pre-formation. In the physical sphere we
should perhaps have to say that, when a piece of iron passes from the
condition of heat to the condition of light, the light was already
existent in nuce (latent) in the heat. Such assumptions are arbitrary
projections of human ideas into transcendental regions, contravening the
prescription of the theory of cognition.
We have thus no right to speak of a sexual instinct existing in nuce, as
we then give an arbitrary explanation of phenomena which can be
explained otherwise, and in a more adequate manner. We can speak of the
manifestations of a nutrition instinct, of the manifestations of a
sexual instinct, etc., but we have only the right to do so when the
function has quite clearly reached the surface. We only speak of light
when the iron is visibly luminous, but not when the iron is merely hot.
Freud, as an observer, sees clearly that the sexuality of neurotic
people is not entirely comparable with infantile sexuality, for there is
a great difference, for instance, between the uncleanliness of a child
of two years old and the uncleanliness of a katatonic patient of forty.
The former is a psychological and normal phenomenon; the latter is
extraordinarily pathological. Freud inserted a short passage in his
“Three Contributions” saying that the infantile form of neurotic
sexuality is either wholly, or at any rate partly, due to a regression.
That is, even in those cases where we might say, these are still the
same by-paths, we find that the function of the by-paths is still
increased by regression. Freud thus recognizes that the infantile
sexuality of neurotic people is _for the greater part_ a regressive
phenomenon. That this must be so is also shown through the further
insight obtained from the investigations of recent years, that the
observations concerning the psychology of the childhood of neurotic
people hold equally good for normal people. At any rate we can say that
the history of the development of infantile sexuality in persons with
neurosis differs but by a hair’s breadth from that of normal beings who
have escaped the attention of the expert appraiser. Striking differences
are exceptional.
Further Remarks on the Etiology of Neurosis
The more we penetrate into the heart of infantile development, the more
we receive the impression that as little can be found there of
etiological significance, as in the infantile shock. Even with the
acutest ferreting into history, we shall never discover why people
living on German soil had just such a fate, and why the Gauls another.
The further we get away, in analytical investigations from the epoch of
the manifest neurosis, the less can we expect to find the real motive of
the neurosis, since the dynamic disproportions grow fainter and fainter
the further we go back into the past. In constructing our theory so as
to deduce the neurosis from causes in the distant past, we are first and
foremost obeying the impulse of our patients to withdraw themselves as
far as possible from the critical present. The pathogenic conflict
exists _only in the present moment_. It is just as if a nation wanted to
regard its miserable political conditions at the actual moment as due to
the past; as if the Germany of the 19th century had attributed its
political dismemberment and incapacity to its suppression by the Romans,
instead of having sought the actual sources of her difficulties in the
present. _Only_ in the _actual present_ are the effective causes, and
only here are the possibilities of removing them.
The Etiological Significance of the Actual Present
A greater part of the psychoanalytic school is under the spell of the
conception that the conflicts of childhood are conditio sine qua non for
the neuroses. It is not only the theorist, who studies the psychology of
childhood from scientific interest, but the practical man also, who
believes that he has to turn the history of infancy inside out to find
there the dynamic source of the actual neurosis—it were a fruitless
enterprise if done under this presumption. In the meantime, the most
important factor escapes the analyst, namely, the conflict and the
claims of the present time. In the case before us, we should not
understand any of the motives which produced the hysterical attacks if
we looked for them in earliest childhood. It is the form alone which
those reminiscences determine to a large extent, but the dynamic
originates from the present time. The insight into the actual meaning of
these motives is real understanding.
We can now understand why that moment was pathogenic, as well as why it
chose those particular symbols. Through the conception of regression,
the theory is freed from the narrow formula of the importance of the
events in childhood, and the actual conflict thus gets that significance
which, from an empirical standpoint, belongs to it implicitly. Freud
himself introduced the conception of regression in his “Three
Contributions,” acknowledging rightly that our observations do not
permit us to seek the cause of neurosis exclusively in the past. If it
is true, then, that reminiscent matter becomes active again as a rule by
regression, we have to consider the following question: Have, perhaps,
the apparent effective results of reminiscences to be referred in
general to a regression of the libido? As I said before, Freud suggested
in his “Three Contributions,” that the infantilism of neurotic sexuality
was, _for the greater part, due to the regression of the libido_. This
statement deserves greater prominence than it there received. Freud did
give it this prominence in his later works to a somewhat greater extent.
The recognition of the regression of the libido very largely reduces the
etiological significance of the events of childhood. It has already
seemed to us rather astonishing that the Œdipus- or the Electra-complex
should have a determining value in regard to the onset of a neurosis,
since these complexes exist in everyone. They exist even with those
persons who have never known their own father and mother, but have been
educated by their step-parents. I have analyzed cases of this kind, and
found that the incest-complex was as well developed as in other
patients. It seems to us that this is good proof that the incest-complex
is much more a purely regressive production of phantasies than a
reality. From this standpoint, the events in childhood are only
significant for the neuroses in so far as they are revived later through
a regression of the libido. That this must be true to a great extent is
also shown by the fact that the infantile sexual shock never causes
hysteria, nor does the incest-complex, which is common to everyone. The
neurosis only begins as soon as the incest-complex becomes actuated by
regression.
So we come to the question, why does the libido make a regression? To
answer it we must study carefully under what circumstances regression
arises. In treating this problem with my patients, I generally give the
following example: While a mountain climber is attempting the ascent of
a certain peak, he happens to meet with an insurmountable obstacle, let
us say, some precipitous rocky wall which cannot be surmounted. After
having vainly sought for another path, he will have to return and
regretfully abandon the climbing of that peak. He will say to himself:
“It is not in my power to surmount this difficulty, so I will climb
another easier mountain.” In this case, we find there is a normal
utilization of the libido. The man returns, when he finds an
insurmountable difficulty, and uses his libido, which could not attain
its original aim, for the ascent of another mountain. Now let us imagine
that this rocky wall was not really unclimbable so far as his physique
was concerned, but that from mere nervousness he withdrew from this
somewhat difficult enterprise. In this case, there are two
possibilities: I. The man will be annoyed by his own cowardice, and will
wish to prove himself less timid on another occasion, or perhaps will
even admit that with his timidity he ought never to undertake such a
difficult ascent. At any rate, he will acknowledge that he has not
sufficient moral capacity for these difficulties. He therefore uses that
libido, which did not attain its original aim, for a useful
self-criticism, and for sketching a plan by which he may be able, with
due regard to his moral capacity, to realize his wish to climb. II. The
possibility is, that the man does not realize his own cowardice, and
declares off-hand that this mountain is physically unattainable,
although he is quite able to see that, with sufficient courage, the
obstacle could have been overcome. But he prefers to deceive himself.
Thus the psychological situation which is of importance for our problem
is created.
The Etiological Significance of Failure of Adaptation
Probably this man knows very well that it would have been physically
possible to overcome the difficulty, that he was only morally incapable
of doing so. He rejects this idea on account of its painful nature. He
is so conceited that he cannot admit to himself his cowardice. He brags
of his courage and prefers to declare things impossible rather than his
own courage inadequate. But through this behavior he comes into
opposition with his own self: on the one hand he has a right view of the
situation, on the other he hides this knowledge from himself, behind the
illusion of his infallible courage. He represses the proper view, and
forcibly tries to impress his subjective, illusive opinion upon reality.
The result of this contradiction is that the libido is divided, and that
the two parts are directed against one another. He opposes his wish to
climb a mountain by his artificial self-created opinion, that its ascent
is impossible. He does not turn to the real impossibility, but to an
artificial one, to a self-given limitation; thus he is in disharmony
with himself, and from this moment has an internal conflict. Now insight
into his cowardice will get the upper hand; now obstinacy and pride. In
either case the libido is engaged in a useless civil war. Thus the man
becomes incapable of any enterprise. He will never realize his wish to
climb a mountain, and he goes perfectly astray as to his moral
qualities. He is therefore less capable of performing his work, he is
not fully adapted, he can be compared to a neurotic patient. The libido
which withdrew from before this difficulty has neither led to honest
self-criticism, nor to a desperate struggle to overcome the obstacle; it
has only been used to maintain his cheap pretence that the ascent was
really impossible, even heroic courage could have availed nothing. Such
a reaction is called an _infantile reaction_. It is very characteristic
of children, and of naïve minds, not to find the fault in their own
shortcomings, but in external circumstances, and to impute to these
their own subjective judgment. This man solves his problem in an
infantile way, that is, he replaces the suitable mode of adaptation of
our former case by a mode of adaptation belonging to the infantile mind.
This is regression. His libido withdraws from an obstacle which cannot
be surmounted, and replaces a real action by an infantile illusion.
These cases are very commonly met with in practice among neurotics. I
will remind you here of those well-known cases in which young girls
become hysterical with curious suddenness just when they are called upon
to decide about their engagements. As an instance, I should like to
describe to you the case of two sisters, separated only by one year in
age. They were similar in capacities and characters; their education was
the same; they grew up in the same surroundings, and under the influence
of their parents. Both were healthy; neither the one nor the other
showed any nervous symptoms. An attentive observer might have discovered
that the elder daughter was the more beloved by the parents. This
affection depended on a certain sensitiveness which this daughter
showed. She asked for more affection than the younger one, was also
somewhat precocious and more serious. Besides, she showed some charming
childish traits, just those things which, through their slightly
capricious and unbalanced character, make a personality especially
charming. No wonder that father and mother had a great joy in their
elder daughter. As both sisters became of marriageable age, almost at
the same time they became intimately acquainted with two young men, and
the possibility of their marriages soon approached. As is generally the
case, certain difficulties existed. Both girls were young and had very
little experience of the world. Both men were relatively young too, and
in positions which might have been better; they were only at the
beginning of a career, but nevertheless, both were capable young men.
Both girls lived in a social atmosphere which gave them the right to
certain social expectations. It was a situation in which a certain doubt
as to the suitability of either marriage was permissible. Moreover, both
girls were insufficiently acquainted with their prospective husbands,
and were therefore not quite sure of their love. There were many
hesitations and doubts. Here it was noticed that the elder girl always
showed greater waverings in her decisions. From these hesitations some
painful moments arose between the girls and the young men, who naturally
longed for more certainty. At such moments the elder sister was much
more excited than the younger one. Several times she went weeping to her
mother, complaining of her own hesitation. The younger one was somewhat
more decided, and put an end to the unsettled situation by accepting her
suitor. She thus got over her difficulty and the further events ran
smoothly. As soon as the admirer of the elder sister became aware that
the younger one had put matters on a surer footing, he rushed to his
lady and begged in a somewhat passionate way for her acceptance. His
passion irritated and frightened her a little, although she was really
inclined to follow her sister’s example. She answered in a somewhat
haughty and offhand way. He replied with sharp reproaches, causing her
to get still more excited. The end was a scene with tears, and he went
away in an angry mood. At home, he told the story to his mother, who
expressed the opinion that this girl was really unsuitable for him, and
that it would be perhaps better to choose some one else. The girl, for
her part, doubted very much if she really loved this man. It suddenly
seemed to her impossible to follow him to an unknown destiny, and to be
obliged to leave her beloved parents. From that moment, she was
depressed; she showed unmistakable signs of the greatest jealousy
towards her sister, but would neither see nor admit that she was
jealous. The former affectionate relations with her parents changed
also. Instead of her earlier childlike affection, she betrayed a
lamentable state of mind, which increased sometimes to pronounced
irritability; weeks of depression ensued. Whilst the younger sister
celebrated her wedding, the elder went to a distant health-resort for a
nervous intestinal trouble. I shall not continue the history of the
disease; it ended in an ordinary hysteria.
In analyzing this case, great resistance to the sexual problem was
found. The resistance depended on many perverse phantasies, the
existence of which would not be admitted by the patient. The question,
whence arose such perverse phantasies, so unexpected in a young girl,
brought us to the discovery that once as a child, eight years old, she
had found herself suddenly confronted in the street by an exhibitionist.
She was rooted to the spot by fright, and even much later ugly images
persecuted her in her dreams. Her younger sister was with her at the
time. The night after the patient told me this, she dreamed of a man in
a gray suit, who seemed about to do in front of her what the
exhibitionist had done. She awoke with a cry of terror. The first
association to the gray suit was a suit of her father’s, which he had
been wearing on an excursion which she made with him when she was about
six years old. This dream connects the father, without any doubt, with
the exhibitionist. This must be done for some reason. Did something
happen with the father, which could possibly call forth this
association? This problem met with great resistance from the patient.
But she could not get rid of it. At the next sitting she reproduced some
early reminiscences, when she had noticed her father undressing himself.
Again, she came one day excited and terribly shaken, and told me that
she had had an abominable vision, absolutely distinct. In bed at night,
she felt herself again a child of two or three years old, and she saw
her father standing by her bed in an obscene attitude. The story was
gasped out piece by piece, obviously with the greatest internal
struggle. This was followed by violent reproaches, of how dreadful it is
that a father should ever behave to his child in such a terrible manner.
Nothing is less probable than that the father really did this. It is
only a phantasy, probably first constructed in the course of the
analysis from that same need of discovering a cause which once induced
the physician to form the theory that hysteria was only caused by such
impressions. This case seemed to me suitable to demonstrate the meaning
of the theory of regression, and to show at the same time the source of
the theoretical mistakes so far. We saw that both sisters were
originally only slightly different. From the moment of the engagement
their ways were totally separated. They seemed now to have quite
different characters. The one, vigorous in health, and enjoying life,
was a good and courageous woman, willing to undertake the natural
demands of life; the other was sad, ill-tempered, full of bitterness and
malice, disinclined to make any effort towards a reasonable life,
egotistical, quibbling, and a nuisance to all about her. This striking
difference was only brought out when the one sister happily passed
through the difficulties of her engagement, whilst the other did not.
For both, it hung to a certain extent only on a hair, whether the affair
would be broken off or not. The younger one, somewhat calmer, was
therefore more deliberate, and able to find the right word at the right
moment. The elder one was more spoiled and more sensitive, consequently
more influenced by her emotions, and could not find the right word, nor
had she the courage to sacrifice her pride to put things straight
afterwards. This little circumstance had a very important effect.
Originally the conditions were much the same for both sisters. The
greater sensitiveness of the elder produced the difference. The question
now is: Whence arose this sensitiveness with its unfortunate results?
The analysis demonstrated the existence of an extraordinarily developed
sexuality of infantile phantastic character; in addition, an incestuous
phantasy towards the father. We have a quick and easy solution of the
problem of this sensitiveness, if we admit that these phantasies had a
lively, and therefore effective existence. We might thus readily
understand why this girl was so sensitive. She was shut up in her own
phantasies and strongly attached to her father. Under these
circumstances, it would have been really a wonder had she been willing
to love and marry another man. The more we pursue our need for a
causation, and pursue the development of these phantasies back to their
beginning, the greater grow the difficulties of the analysis, that is to
say, the resistances as we call them. At the end we should find that
impressive scene, that obscene act, whose improbability has already been
established. This scene has exactly the character of a subsequent
phantastic formation. Therefore, we have to conceive these difficulties,
which we called “resistances,” at least in this part of the analysis, as
an opposition of the patient against the formation of such phantasies,
and not as a resistance against the conscious admittance of a painful
remembrance.
You will ask with astonishment, to what aim the patient contrives such a
phantasy? You will even be inclined to suggest that the physician forced
the patient to invent it, otherwise she would probably never have
produced such an absurd idea. I do not venture to doubt that there have
been cases in which, by dint of the physician’s desire to find a cause,
especially under the influence of the shock-theory, the patient has been
brought to contrive such phantasies. But the physician would never have
come to this theory, had he not followed the patient’s line of thought,
thus taking part in this retrograde movement of the libido which we call
regression. The physician, consequently, only carried right through to
its consequence what the patient was afraid to carry out, namely, a
regression, a falling back of the libido to its former desires. The
analysis, in following the libido-regression, does not always follow the
exact way marked by its historical development, but very often rather a
later phantasy, which only partly depends on former realities. In our
case, only some of the circumstances are real, and it is but much later
that they get their great importance, namely, at the moment when the
libido regresses. Wherever the libido takes hold of a reminiscence, we
may expect that this reminiscence will be elaborated and altered, as
everything that is touched by the libido revives, takes on dramatic
form, and becomes systematized. We have to admit that, in our case,
almost the greater part of these phantasies became significant
subsequently, after the libido had made a regression, after it had taken
hold of everything that could be suitable, and had made out of all this
a phantasy. Then that phantasy, keeping pace with the retrograde
movement of the libido, came back at last to the father and put upon him
all the infantile sexual desires. Even so it was thought in ancient
times that the golden age of Paradise lay in the past! In the case
before us we know that all the phantasies brought out by analysis did
become subsequently of importance. From this standpoint only, we are not
able to explain the beginning of the neurosis; we should constantly move
in a circle. The critical moment for this neurosis was that in which the
girl and man were inclined to love one another, but in which an
inopportune sensitiveness on the part of the patient caused the
opportunity to slip by.
_The Conception of Sensitiveness._—We might say, and the
psychoanalytical conception inclines in this direction, that this
critical sensitiveness arises from some peculiar psychological personal
history, which determined this end. We know that such sensitiveness in a
psychogenic neurosis is always a symptom of a discord within the
subject’s self, a symptom of a struggle between two divergent
tendencies. Both tendencies have their own previous psychological story.
In this case, we are able to show that this special resistance, the
content of that critical sensitiveness, is, as a matter of fact,
connected in the patient’s previous history, with certain infantile
sexual manifestations, and also with that so-called traumatic event—all
things which are capable of casting a shadow on sexuality. This would be
so far plausible if the sister of the patient had not lived more or less
the same life, without experiencing all these consequences. I mean, she
did not develop a neurosis. So we have to agree that the patient
experienced these things in a special way, perhaps more intensely than
the younger one. Perhaps also, the events of her earlier childhood were
to her of a disproportionate importance. But if it had been the case to
such a marked extent, something of it would surely have been noticed
earlier. In later youth, the earlier events of childhood were as much
forgotten by the patient as by her sister. Another supposition is
therefore possible. This critical sensitiveness is not the consequence
of the special previous past history, but springs from something that
had existed all along. A careful observer of small children can notice,
even in early infancy, any unusual sensitiveness. I once analyzed a
hysterical patient who showed me a letter written by her mother when
this patient was two and a half years old. Her mother wrote about her
and her sister. The elder was always good-tempered and enterprising, but
the other was always in difficulties with both people and things. The
first one became in later life hysterical, the other one katatonic.
These far-reaching differences, which go back into earliest childhood,
cannot depend on the more or less accidental events of life, but have to
be considered as being innate differences. From this point of view, we
cannot any longer pretend that her special previous psychological
history caused this sensitiveness at that critical moment; it would be
more correct to say: This innate sensitiveness is manifested most
distinctly in uncommon situations.
This surplus of sensitiveness is found very often as an enrichment of a
personality contributing even more to the charm of the character than to
its detriment. But in difficult and uncommon situations the advantage
very often turns into a disadvantage, as the inopportunely excited
emotion renders calm consideration impossible. Nothing could be more
incorrect than to consider this sensitiveness as eo ipso a morbid
constituent of a character. If it really were so, we should have to
regard at least one third of humanity as pathological. Only if the
consequences of this sensitiveness are destructive to the individual
have we a right to consider this quality as abnormal.
_Primary Sensitiveness and Regression._—We come to this difficulty when
we crudely oppose the two conceptions as to the significance of the
previous psychological history as we have done here; in reality, the two
are not mutually exclusive. A certain innate sensitiveness leads to a
special psychological history, to special reactions to infantile events,
which are not without their own influence on the development of the
childish conception of life. Events bound up with powerful impressions
can never pass without leaving some trace on sensitive people. Some of
these often remain effective throughout life, and such events can exert
an apparently determining influence on the whole mental development.
Dirty and disillusional experiences in the domain of sexuality are
specially apt to frighten a sensitive person for years and years. Under
these conditions, the mere thought of sexuality raises the greatest
resistances. As the creation of the shock-theory proved, we are too much
inclined, in consequence of our knowledge of such cases, to attribute
the emotional development of a person more or less to accidents. The
earlier shock-theory went too far in this respect. We must never forget
that _the world is, in the first place, a subjective phenomenon. The
impressions we receive from these happenings are also our own doing._ It
is not the case that the impressions are forced on us unconditionally,
but our disposition gives the value to the impressions. A man with
stored-up libido will as a rule have quite different impressions, much
more vivid impressions, than one who organizes his libido into a rich
activity. Such a sensitive person will have a more profound impression
from certain events which might harmlessly pass over a less sensitive
subject. Therefore, in conjunction with the accidental impression, we
have to consider seriously the subjective conditions. Our former
considerations, and the observation of the concrete case especially,
show us that the important subjective condition is the regression. It is
shown by experience in practice, that the effect of regression is so
enormous, so important and so impressive, that we might perhaps be
inclined to attribute the effect of accidental events to the mechanism
of regression only. Without any doubt, there are cases in which
everything is dramatized, where even the traumatic events are artefacts
of the imagination, and in which the few real events are subsequently
entirely distorted through phantastic elaboration. We can simply say,
that there is not a single case of neurosis, in which the emotional
value of the preceding event is not considerably aggravated through the
regression of libido, and even where great parts of the infantile
development seem to be of extraordinary importance, they only gain this
through regression.
As is always the case, truth is found in the middle. The previous
history has certainly a determining historic value, which is reinforced
by the regression. Sometimes the traumatic significance of the previous
history comes more into the foreground; sometimes only the regressive
meaning. These observations have naturally to be applied to the
infantile sexual events too. Obviously there are cases in which brutal
sexual accidents justify the shadow thrown on sexuality, and explain
thoroughly the later resistance of the individual towards sexuality.
Dreadful impressions other than sexual can also sometimes leave behind a
permanent feeling of insecurity, which may determine the individual in a
hesitating attitude towards reality. Where real events of undoubted
traumatic potentiality are wanting—as is generally the case with
neurosis—there the mechanism of regression prevails. Of course, you
could object that we have no criterion for the potential effect of the
trauma or shock, as this is a highly relative conception. It is not
quite so; we have in the standard of the average normal a criterion for
the potential effect of a shock. Whatever is capable of making a strong
and persistent impression upon a normal person must be considered as
having a determining influence for neurotics also. But we may not
straightway attribute any importance, even in neurosis, to impressions
which in a normal case would disappear and be forgotten. In most of the
cases where any event has an unexpected traumatic influence, we shall
find in all probability a regression, that is to say, a secondary
phantastic dramatization. The earlier in childhood an impression is said
to have arisen, the more suspicious is its reality. Animals and
primitive people have not that readiness in reproducing memories from a
single impression which we find among civilized people. Very young
children have by no means that impressionability which we find in older
children. A certain higher development of the mental faculties is a
necessary condition for impressionability. Therefore we may agree that
the earlier a patient places some significant event in his childhood,
the more likely it will be a phantastic and regressive one. Important
impressions are only to be expected from later youth. At any rate, we
have generally to attribute to the events of earliest childhood, that
is, from the fifth year backwards, but a regressive importance.
Sometimes the regression does play an overwhelming part in later years,
but even then one must not ascribe too little importance to accidental
experiences. It is well known that, in the later course of a neurosis,
the accidental events and the regression together form a vicious circle.
The withdrawal from the experiences of life leads to regression, and the
regression aggravates the resistances towards life.
In the conception of regression psychoanalysis has made one of the most
important discoveries which have been made in this sphere. Not only has
the earlier exposition of the genesis of neurosis been already
subverted, or at least widely modified, but, at the same time, the
_actual conflict_ has received its proper valuation.
The Significance of the Actual Conflict
In the case I have described, we saw that we could understand the
symptomatological dramatization as soon as it could be conceived as an
expression of the actual conflict. Here the psychoanalytic theory agrees
with the results of the association-experiments, of which I spoke in my
lectures[10] at Clark University. The association-experiment, with a
neurotic person, gives us a series of references to certain conflicts of
the actual life, which we call complexes. These complexes contain those
problems and difficulties which have brought the patient into opposition
with himself. Generally we find a love-conflict of an obvious character.
From the standpoint of the association-experiment, neurosis seems to be
something quite different from what it appeared from the standpoint of
the earlier psychoanalytic theory. Considered from the standpoint of the
latter theory, neurosis seemed to be a growth which had its roots in
earliest childhood, and overgrew the normal structure. Considered from
the standpoint of the association-experiment, neurosis seems to be a
reaction from an actual conflict, which is naturally found also among
normal people, but among them the conflict is solved without too great
difficulty. The neurotic remains in the grip of his conflict, and his
neurosis seems, more or less, to be the consequence of this stagnation.
So we may say that the result of the association-experiments tell in
favor of the theory of regression.
With the former historical conception of neurosis, we thought we
understood clearly why a neurotic person, with his powerful
parent-complex, had such great difficulty in adapting himself to life.
Now that we know that normal persons have the same complex, and in
principle have to pass through just the same psychological development
as a neurotic, we can no longer explain neurosis as a certain
development of phantasy-systems. The really illuminating way to put the
problem is a prospective one. We do not ask any longer if the patient
has a father- or a mother-complex, or unconscious incest-phantasies
which worry him. To-day, we know that every one has such things. The
belief that only neurotics had these complexes was an error. We ask now:
What is the task which the patient does not wish to fulfil? From which
necessary difficulties of life does the patient try to withdraw himself?
When people try always to adapt themselves to the conditions of life,
the libido is employed rightly and adequately. When this is not the
case, the libido is stored up and produces regressive symptoms. The
inadequate adaptation, that is to say, the abnormal indecision of
neurotics in face of difficulties, is easily accounted for by their
strong subjection to their phantasies, in consequence of which reality
seems to them, wholly or partly, more unreal, valueless and
uninteresting than to normal people. These heightened phantasies are the
results of innumerable regressions. The ultimate and deepest root is the
innate sensitiveness, which causes difficulties even to the infant at
the mother’s breast, in the form of unnecessary irritation and
resistances. Call it sensitiveness or whatever you like, this unknown
element of predisposition is in every case of neurosis.
The Etiological Significance of Phantasy Criticized
The apparent etiological development of neurosis, discovered by
psychoanalysis, is in reality only the work of causally connected
phantasies, which the patient has created from that libido which at
times he did not employ in the biological adaptation. Thus, these
apparently etiological phantasies seem to be forms of compensation,
disguises, for an unfulfilled adaptation to reality. The vicious circle
previously mentioned between the withdrawing in the face of difficulties
and the regression into the world of phantasies, is naturally
well-suited to give the illusion of an apparent striking causal
relationship, so that both the patient and the physician believe in it.
In such a development accidental experiences are only “extenuating
circumstances.” I feel I must make allowance for those critics who, on
reading the history of psychoanalytic patients, get the impression of
phantastic elaboration. Only they make the mistake of attributing the
phantastic artefacts and far-fetched arbitrary symbolism to the
suggestion and to the awful phantasy of the physician, instead of to the
unequalled fertility of phantasy on the part of the patient. Of a truth,
there is a good deal of artificial elaboration in the phantasies of a
psychoanalytic case. There are generally significant signs of the
patient’s active imagination. The critics are not so wrong when they say
that their neurotic patients have no such phantasies. I have no doubt
that patients are unconscious of the greater part of their own
phantasies. A phantasy only “really” exists in the unconscious, when it
has some notable effect upon the conscious, _e. g._, in the form of a
dream; otherwise, we may say with a clear conscience that it is not
real. Every one who overlooks the frequently nearly imperceptible
effects of unconscious phantasies upon the conscious, or renounces the
fundamental, and technically incontestable analysis of dreams, can
easily overlook the phantasies of his patients altogether. We are,
therefore, inclined to smile when we hear this repeated objection. But
we must admit that there is some truth in it. The regressive tendency of
the patient is strengthened by the attention bestowed on it, and
directed to the unconscious, that is to say, to the phantasies he
discovers and forms during analysis. We might even perhaps go so far as
to say that, during the time of analysis, this phantasy-production is
greatly increased, as the patient is strengthened in his regressive
tendency, by the interest taken by the physician and originates even
more phantasies than he did before. Hence, our critics have repeatedly
stated that a conscientious therapy of the neurosis should go in exactly
the opposite direction to that taken by psychoanalysis; in other words,
it has been the chief endeavor of therapy, hitherto, to extricate the
patient from his unhealthy phantasies and bring him back again to real
life.
Footnote 10:
Am. Journ. Psych., April, 1910.