SELECTED PAPERS ON HYSTERIA
AND
OTHER PSYCHONEUROSES
BY
PROF. SIGMUND FREUD
VIENNA
AUTHORIZED TRANSLATION
BY
A. A. BRILL, PH.D., M.D.
CHIEF OF NERVOUS DISPENSARY, BETH ISRAEL HOSPITAL; CLINICAL ASSISTANT,
DEPARTMENT OF PSYCHIATRY AND NEUROLOGY, COLUMBIA UNIVERSITY; ASSISTANT
IN MENTAL AND NERVOUS DISEASES, O. P. D., BELLEVUE HOSPITAL; ASSISTANT
VISITING PHYSICIAN, HOSPITAL FOR NERVOUS DISEASES.
NEW YORK
THE JOURNAL OF NERVOUS AND MENTAL DISEASE
PUBLISHING COMPANY
1909
Copyright 1909, by
THE JOURNAL OF NERVOUS AND MENTAL DISEASE PUBLISHING COMPANY.
CONTENTS.
PAGE.
TRANSLATOR’S PREFACE iii
CHAPTER.
I. THE PSYCHIC MECHANISM OF HYSTERICAL PHENOMENA 1
II. THE CASE OF MISS LUCY R. 14
III. THE CASE OF MISS ELISABETH V. R. 31
IV. THE PSYCHOTHERAPY OF HYSTERIA 75
V. THE DEFENSE NEURO-PSYCHOSES. A Tentative Psychological
Theory of Acquired Hysteria, many Phobias and Obsessions,
and Certain Hallucinatory Psychoses 121
VI. ON THE RIGHT TO SEPARATE FROM NEURASTHENIA A DEFINITE
SYMPTOM-COMPLEX AS “ANXIETY NEUROSIS” 133
VII. FURTHER OBSERVATIONS ON THE DEFENSE NEUROPSYCHOSES 155
VIII. ON PSYCHOTHERAPY 175
IX. MY VIEWS ON THE RÔLE OF SEXUALITY IN THE ETIOLOGY OF THE
NEUROSES 186
X. HYSTERICAL FANCIES AND THEIR RELATIONS TO BISEXUALITY 194
TRANSLATOR’S PREFACE.
In the first place I wish to express my gratitude to Doctors Frederick
Peterson, William A. White, and Ernest Jones, for their many helpful
suggestions in the translation of this work. This does not, however,
imply that they are in any way responsible for the numerous barbarisms
found in the translation, for this I, alone, ask the reader’s
indulgence. For one thing, it must be borne in mind that, aside from the
subject-matter, Freud is not easy to read, even in the original. Indeed,
I feel quite certain that only those who have read the original will
best appreciate the task of the translator. But no matter how devoid of
literary excellencies this translation may be, it can at least claim one
merit, to wit, it is a faithful reproduction of the author’s thoughts.
This is really all that should be required of a translation.
The chapters contained in this book were taken from three different
volumes of the author’s works, published at different intervals within
the last fifteen years. Although the first four chapters appear in the
“Studien über Hysterie” which was published by Breuer and Freud,[1]
still only the first chapter, “The Psychic Mechanism of Hysterical
Phenomena,” was written conjointly by both authors. The authorship of
the other three chapters belongs exclusively to Freud. The remaining six
chapters of the book were taken from Freud’s Collection of Small
Articles.[2]
It was by no means an easy task to compile in a single limited volume
Freud’s theories of the actual- and psychoneuroses. Freud’s views are
not only new and revolutionary, being based on an entirely new
psychology, but unless one is thoroughly familiar with their development
one is apt to misunderstand them. To obviate this it was thought best to
collect those chapters from the author’s works which fully illustrate
his theories and at the same time show the gradual evolution of his
psychology.
That Freud’s views have undergone some changes, or rather modifications,
within the last fifteen years we readily admit; but who will blame the
surgeon for modifying or rejecting some technique of his operation, if
after years of careful work he feels justified in so doing? Surely such
an action merits applause rather than reproach. It was only after
carefully investigating for years that Freud saw fit to change some of
his views, yet nothing was really totally discarded.
It is quite unnecessary to discuss here the whys and wherefores of the
modifications in question, these are fully explained in the text. But it
will not be mal à propos to say a few words concerning the technique of
the treatment.
For reasons given in the book the author has abandoned hypnotism and
used the pressure procedure, but this in turn was given up because it
was cumbersome for both doctor and patient and proved to be utterly
needless.
The technique is as follows: The patient lies on his back on a lounge,
the physician sitting behind the patient’s head at the head of the
lounge. In this way the patient remains free from all external
influences and impressions. The object is to avoid all muscular exertion
and distraction, thus allowing thorough concentration of attention on
the patient’s own psychic activities. The patient is then asked to give
a detailed account of his troubles, after having been told before to
repeat everything that occurs to his mind, even such thoughts as may
cause him embarrassment or mortification. On listening to such a history
one invariably notices many memory gaps, both in reference to time and
causal relations. These the patient is urged to fill in by concentration
of attention on the subject in question, and by repeating all the
unintentional thoughts originating in this connection. This is the so
called method of “free association!” The patient is required to relate
all his thoughts in the order of their sequence even if they seem
irrelevant to him. He must do away with all critique and remain
perfectly passive. It is in this way that we fathom the original meaning
of the symptom. But as the thoughts which originate in this manner are
of a disagreeable and painful nature they are pushed back with the
greatest resistance. This is further enhanced by the fact that the
hysterical symptom is the symbolic expression of the realization of a
repressed wish, and serves as a gratification for the patient. He
strives very hard, unconsciously of course, to retain the symptom, as it
is the only thing left to him from his former unattainable conscious
wishes and strivings. The object of the psychanalytic treatment is to
overcome all these resistances, and to reconduct to the patient’s
consciousness the thoughts underlying the symptoms. Here lies the
greatest difficulty, for just as in the normal life and the dream, a
psychoneurotic symptom is merely a symbolic or cryptic expression of the
original repressed thoughts. Every hysterical symptom, every obsession,
and every phobia, has a definite meaning, and as was shown by
Bleuler,[3] Jung,[4] Riklin,[5] and others,[6] the same holds true for
the psychoses proper.
To discover the hidden mechanism, one must make use of the author’s
developed method of interpretation, that is, one must look for
symbolic actions, lapses in speech, memory, etc., and above all, one
must resort to the analysis of dreams, as they give the most direct
access to the unconscious. No one is really qualified to use or
judge Freud’s psychanalytic method who has not thoroughly mastered
the Traumdeutung,[7] the Psychopathologie des Alltagsleben,[8] and
the Drei Abhandlungen zur Sexualtheorie,[9] and has not had
considerable experience in analyzing his own and other’s dreams and
psychopathological actions. It is especially in the Traumdeutung
that Freud has fully developed his psychanalytic technique and a
perfect knowledge of which is the sine qua non in the treatment. It
is only by following Freud in this manner that one can hope to solve
the hitherto unsolved riddles of the psychoneuroses and psychoses.
This treatment is more difficult than one can describe in a preface. It
not only presupposes a thorough knowledge of Freud but an equal
knowledge of normal and abnormal psychology. Those who have not acquired
this knowledge by reason of time or otherwise may remember the words of
the younger Pliny: _Ut enim de pictore scalptore fictore nisi artifex
indicare, ita nisi sapiens non potest perspicere sapientem_.
A. A. BRILL.
CHAPTER I.
THE PSYCHIC MECHANISM OF HYSTERICAL PHENOMENA.[10]
(PRELIMINARY COMMUNICATION.)
I.
Instigated by a number of accidental observations we have investigated
for a number of years the different forms and symptoms of hysteria in
order to discover the cause and the process which provoked the phenomena
in question for the first time, in a great many cases years back. In the
great majority of cases we did not succeed in elucidating this starting
point from the mere history, no matter how detailed it might have been,
partly because we had to deal with experiences about which discussion
was disagreeable to the patients, but mainly because they really could
not recall them; often they had no inkling of the causal connection
between the occasioning process and the pathological phenomenon. It was
generally necessary to hypnotize the patients and reawaken the memory of
that time in which the symptom first appeared, and we thus succeeded in
exposing that connection in a most precise and convincing manner.
This method of examination in a great number of cases has furnished us
with results which seem to be of theoretical as well as of practical
value.
It is of theoretical value because it has shown to us that in the
determination of the pathology of hysteria the accidental moment plays a
much greater part than is generally known and recognized. It is quite
evident that in “traumatic” hysteria it is the accident which evokes the
syndrome. Moreover in hysterical crises, if patients state that they
hallucinate in each attack the same process which evoked the first
attack, here too, the causal connection seems quite clear. The state of
affairs is more obscure in the other phenomena.
Our experiences have shown us _that the most varied symptoms which pass
as spontaneous, or so to say idiopathic attainments of hysteria, stand
in just as stringent connection with the causal trauma as the
transparent phenomena mentioned_. To such causal moments we were able to
refer neuralgias as well as the different kinds of anesthesias often of
years duration, contractures and paralyses, hysterical attacks and
epileptiform convulsions which every observer has taken for real
epilepsy, petit mal and tic-like affections, persistent vomiting and
anorexia, even the refusal of nourishment, all kinds of visual
disturbances, constantly recurring visual hallucinations, and similar
affections. The disproportion between the hysterical symptom of years
duration and the former cause is the same as the one we are regularly
accustomed to see in the traumatic neurosis. Very often they are
experiences of childhood which have established more or less intensive
morbid phenomena for all succeeding years.
The connection is often so clear that it is perfectly manifest how the
causal event produced just this and no other phenomenon. It is quite
clearly determined by the cause. Thus let us take the most banal
example; if a painful affect originates while eating but is repressed,
it may produce nausea and vomiting and continue for months as a
hysterical symptom. A girl was anxiously distressed while watching at a
sick bed. She fell into a dreamy state and experienced a frightful
hallucination, and at the same time her right arm hanging over the back
of a chair became numb. This resulted in a paralysis, contracture, and
anesthesia of that arm. She wanted to pray but could find no words, but
finally succeeded in uttering an English prayer for children. Later, on
developing a very grave and most complicated hysteria, she spoke, wrote,
and understood only English, whereas her native tongue was
incomprehensible to her for a year and a half. A very sick child finally
falls asleep. The mother exerts all her will power to make no noise to
awaken it, but just because she resolved to do so she emits a clicking
sound with her tongue (“hysterical counter-will”). This was later
repeated on another occasion when she wished to be absolutely quiet,
developing into a tic which in the form of tongue clicking accompanied
every excitement for years. A very intelligent man was present while his
brother was anesthetized and his ankylosed hip stretched. At the moment
when the joint yielded and crackled he perceived severe pain in his own
hip which continued for almost a year.
In other cases the connection is not so simple, there being only as it
were a symbolic relation between the cause and the pathological
phenomenon, just as in the normal dream. Thus psychic pain may result in
neuralgia, or the affect of moral disgust may cause vomiting. We have
studied patients who were wont to make the most prolific use of such
symbolization. In still other cases such a determination is at first
sight incomprehensible, yet to this group belong the typical hysterical
symptoms such as hemianesthesia, contraction of visual field,
epileptiform convulsions and many others. The explanation of our views
on this group we have to reserve for the more detailed discussion of the
subject.
_Such observations seem to demonstrate the pathogenic analogy between
simple hysteria and traumatic neurosis and justify a broader conception
of “traumatic hysteria.”_ The active etiological factor in traumatic
neurosis is really not the insignificant bodily injury but the affect of
the fright, that is, the psychic trauma. In an analogous manner our
investigations show that the causes of many, if not of all, cases of
hysteria can be designated as psychic traumas. Every experience which
produces the painful affect of fear, anxiety, shame or of psychic pain
may act as a psychic trauma. Whether an experience becomes of traumatic
importance naturally depends on the person affected as well as on the
determination to be mentioned later. In ordinary hysteria instead of one
big trauma we not seldom find many partial traumas, grouped causes which
can be of traumatic significance only when summarized and which belong
together in so far as they form small fragments of the sorrowful tale.
In still other cases apparently indifferent circumstances gain traumatic
dignity through their connection with the real effective event or with a
period of time of special excitability which they then retain but which
otherwise would have no significance.
Nevertheless the causal connection between the provoking psychic trauma
and the hysterical phenomena does not perhaps resemble the trauma which
as the _agent provocateur_ would call forth the symptom which would
become independent and continue to exist. We have to claim still more,
namely, that the psychic trauma or the memory of the same acts like a
foreign body which even long after its penetration must continue to
influence like a new causative factor. The proof of this we see in a
most remarkable phenomenon which at the same time gives to our
discoveries a distinct practical interest.
We found, at first to our greatest surprise, _that the individual
hysterical symptoms immediately disappeared without returning if we
succeeded in thoroughly awakening the memories of the causal process
with its accompanying affect, and if the patient circumstantially
discussed the process giving free play to the affect_. Affectless
memories are almost utterly useless. The psychic process originally
rebuffed must be reproduced as vividly as possible so as to bring it
back into the _statum nascendi_ and then be thoroughly “talked over.” At
the same time if we deal with such exciting manifestations as
convulsions, neuralgias and hallucinations they appear once more with
their full intensity and then vanish forever. Functional attacks like
paralyses and anesthesias likewise disappear, but naturally without any
appreciable distinctness of their momentary aggravation.[11]
It is quite reasonable to suspect that one deals here with an
unintentional suggestion. The patient expects to be relieved of his
suffering and it is this expectation and not the discussion that is the
effectual factor. But this is not so. The first observation of this kind
in which a most complicated case of hysteria was analyzed and the
individual causal symptoms separately abrogated, occurred in the year
1881, that is in a “pre-suggestive” time. It was brought about through a
spontaneous autohypnosis of the patient and caused the examiner the
greatest surprise.
In reversing the sentence: _cessante causa cessat effectus_, we may
conclude from this observation that the causal process continues to act
in some way even after years, not indirectly by means of a chain of
causal connecting links but directly as a provoking cause, just perhaps
as in the awakened consciousness where the memory of a psychic pain may
later call forth tears. _The hysteric suffers mostly from
reminiscences._[12]
II.
It would seem at first rather surprising that long-forgotten experiences
should effect so intensively, and that their recollections should not be
subject to the decay into which all our memories merge. We will perhaps
gain some understanding of these facts by the following examinations.
The blurring or loss of an affect of memory depends on a great many
factors. In the first place it is of great consequence whether there was
an energetic reaction to the affectful experience or not. By reaction we
here understand a whole series of voluntary or involuntary reflexes,
from crying to an act of revenge, through which according to experience
affects are discharged. If the success of this reaction is of sufficient
strength it results in the disappearance of a great part of the affect.
Language attests this fact of daily observation, in such expressions as
“to give vent to one’s feeling,” to be “relieved by weeping,” etc.
If the reaction is suppressed the affect remains united with the memory.
An insult retaliated, be it only in words, is differently recalled than
one that had to be taken in silence. Language also recognizes this
distinction between the psychic and physical results and designates most
characteristically the silently endured suffering as “grievance.” The
reaction of the person injured to the trauma has really no perfect
“cathartic” effect unless it is an adequate reaction like revenge. But
man finds a substitute for this action in speech through which help the
affect can well nigh be ab-reacted[13] (“abreagirt”). In other cases
talking in the form of deploring and giving vent to the torments of the
secret (confession) is in itself an adequate reflex. If such reaction
does not result through deeds, words, or in the lightest case through
weeping, the memory of the occurrence retains above all the affective
accentuation.
The ab-reaction (abreagiren), however, is not the only form of discharge
at the disposal of the normal psychic mechanism of the healthy person
who has experienced a psychic trauma. The memory of the trauma even
where it has not been ab-reacted enters into the great complex of the
association. It joins the other experiences which are perhaps
antagonistic to it and thus undergoes correction through the other
ideas. For example, after an accident the memory of the danger and
(dimmed) repetition of the fright is accompanied by the recollection of
the further course, the rescue, and the consciousness of present
security. The memory of a grievance may be corrected by a rectification
of the state of affairs by reflecting upon one’s own dignity and similar
things. Thus the normal person is able to cause a disappearance of the
accompanying affect by means of association.
In addition there appears that general blurring of impressions, that
fading of memories which we call “forgetting,” and which above all wears
out the affective ideas no longer active.
It follows from our observations that those memories which become the
causes of hysterical phenomena have been preserved for a long time with
wonderful freshness and with their perfect emotional tone. As a further
striking and a later realizable fact we have to mention that the
patients do not perhaps have the same control of these as of their other
memories of life. On the contrary, _these experiences are either
completely lacking from the memory of the patients in their usual
psychic state or at most exist greatly abridged_. Only after the
patients are questioned in the hypnotic state do these memories appear
with the undiminished vividness of fresh occurrences. Thus one of our
patients in a hypnotic state reproduced with hallucinatory vividness
throughout half a year all that excited her during an acute hysteria on
the same days of the preceding year. Her mother’s diary which was
unknown to the patient proved the faultless accuracy of the
reproduction. Another patient, partly in hypnosis and partly in
spontaneous attacks, went through with a hallucinatory distinctness all
experiences of a hysterical psychosis which she passed through ten years
before and for the greatest part of which she was amnesic until its
reappearance. She also showed with surprising integrity and sentient
force some etiologically important memories of fifteen to twenty-five
years’ duration which on their return acted with the full affective
force of new experiences.
The reason for this we can only find in the fact that in all the
aforesaid relations these memories assume an exceptional position in
reference to disappearance. _It was really shown that these memories
correspond to traumas which were not sufficiently ab-reacted to_
(“abreagirt”). On closer investigation of the reasons for this
prevention we can find at least two series of determinants through which
the reaction to the trauma was discontinued.
To the first group we add those cases in which the patient has not
reacted to psychic traumas because the nature of the trauma precluded a
reaction as in the case of an irremediable loss of a beloved person or
because social relations made the reaction impossible, or because it
concerned things which the patient wished to forget and which he
therefore intentionally inhibited and repressed from his conscious
memory. It is just those painful things which in the hypnotic state are
found to be the basis of hysterical phenomena (hysterical delirium of
saints, nuns, abstinent women, and well-bred children).
The second series of determinants is not conditioned by the content of
the memories but by the psychic states with which the corresponding
experiences in the patient have united. As a cause of hysterical
symptoms one really finds in hypnosis presentations which are
insignificant in themselves but which owe their preservation to the fact
that they originated during a severe paralyzing affect like fright or
directly in abnormal psychic conditions, as in the semi-hypnotic dreamy
states of reveries, in autohypnosis and similar states. Here it is the
nature of these conditions which make a reaction to the incident
impossible.
To be sure both determinants may unite, and as a matter of fact they
often do. This is the case when a trauma in itself effective occurs in a
state of a powerful paralyzing affect or in a transformed consciousness.
But due to the psychic trauma it may also happen that in many persons
one of these abnormal states occurs which in turn makes a reaction
impossible.
What is common to both groups of determinants is the fact that those
psychic traumas which are not rectified by reaction are also prevented
from adjustment by associative elaboration. In the first group it is due
to the resolution of the patient who wishes to forget the painful
experiences and in this way, if possible, to exclude them from
association, and in the second group the associative elaboration does
not succeed because there is no productive associative relationship
between the normal and pathological state of consciousness in which
these presentations originated. We shall soon have occasion to discuss
more fully these relationships.
Hence we can say, _that the reason why the pathogenically formed
presentations retain their freshness and affective force is because they
are not subject to the normal waste through ab-reaction and reproduction
in conditions of uninhibited association_.
III.
When we discussed the conditions which, according to our experience, are
decisive in the development of hysterical phenomena from psychic
traumas, we were forced to speak of abnormal states of consciousness in
which such pathogenic presentations originate, and we had to emphasize
the fact that the recollection of the effective psychic trauma is not to
be found in the normal memory of the patient but in the hypnotized
memory. The more we occupied ourselves with these phenomena the more
certain became our convictions _that the splitting of consciousness, so
striking in the familiar classical cases of double consciousness, exists
rudimentarily in every hysteria, and that the tendency to this
dissociation, and with it the tendency towards the appearance of
abnormal states of consciousness which we comprehend as “hypnoid
states,” is the chief phenomenon of this neurosis_. In this view we
agree with Binet and with both the Janets about whose most remarkable
findings in anesthetics we have had no experience.
Hence, to the often cited axiom, “Hypnosis is artificial hysteria,” we
would like to add another: “The existence of hypnoid states is the basis
and determination of hysteria.” These hypnoid states in all their
diversities agree among themselves and with hypnosis in the fact that
their emerged presentations are very intensive but are excluded from the
associative relations of the rest of the content of consciousness. The
hypnoid states are associable among themselves, and their ideation may
thus attain various high degrees of psychic organization. In other
respects the nature of these states and the degree of their
exclusiveness differ from the rest of the conscious processes as do the
various states in hypnosis, which range from light somnolence to
somnambulism, and from perfect memory to absolute amnesia.
If such hypnoid states already exist before the manifested disease they
prepare the soil upon which the affect establishes the pathogenic
memories and their somatic resulting manifestations. This behavior
corresponds to the predisposed hysteria. But the results of our
observations show that a severe trauma (like that of a traumatic
neurosis) or a painful suppression (perhaps of a sexual affect) may
bring about a splitting of presentation groups even in persons otherwise
not predisposed. This would then be the mechanism of the psychically
acquired hysteria. Between the extremes of these two forms we have to
admit a series in which the facility of dissociation in the concerned
individuals and the magnitude of the affect of the trauma vary
inversely.
We are unable to give anything new concerning the formation of the
predisposed hypnoid states. We presume that they often develop from
“reveries” very common to the normal for which, for example, the
feminine handwork offers so much opportunity. The questions why “the
pathological associations” formed in such states are so firm and why
they exert a stronger influence on the somatic processes than other
presentations, all fall together with the problem of the effectivity of
hypnotic suggestions in general. Our experiences in this matter do not
show us anything new, on the other hand they throw light on the
contradiction between the sentence “Hysteria is a psychosis” and the
fact that among hysterics one may meet persons of the clearest
intellects, the strongest wills, greatest principles, and of the
subtlest minds. In these cases such characteristics are only true for
the waking thought of the person, for in his hypnotic state he is
alienated just as we are in the dream. Yet, whereas our dream psychoses
do not influence our waking state, the products of hypnotic states
project as hysterical phenomena into the waking state.
IV.
Almost the same assertions that we have advanced in reference to the
continuous hysterical symptoms we may also repeat concerning hysterical
crises. As is known we have Charcot’s schematic description of the
“major” hysterical attack which when complete shows four phases: (1) The
epileptoid, (2) the grand movements, (3) the emotional—_attitudes
passionnelles_ (hallucinatory phase), and (4) the delirious. By
shortening or prolonging the attack and by isolating the individual
phases Charcot caused a succession of all those forms of the hysterical
attack which are really observed more frequently than the complete
_grande attaque_.
Our attempted explanation refers to the third phase, that is the
_attitudes passionnelles_. Wherever it is prominent it contains the
hallucinatory reproduction of a memory which was significant for the
hysterical onset. It is the memory of a grand trauma, the so called κατ’
ἐξοχὴν of traumatic hysteria or of a series of connected partial traumas
found at the basis of the common hysteria. Finally the attack may bring
back that occurrence which on account of its meeting with a moment of
special predisposition was raised to a trauma.
There are also attacks which ostensibly consist only of motor phenomena
and lack the passionnelle phase. If it is possible during such an attack
of general twitching, cataleptic rigidity or an _attaque de sommeil_, to
put one’s self _en rapport_ with the patient, or still better, if one
succeeds in evoking the attack in a hypnotic state, it will then be
found that here, too, the root of it is the memory of a psychic trauma,
or of a series of traumas which make themselves otherwise prominent in
an hallucinatory phase. A little girl had suffered for years from
attacks of general convulsions which could be and were taken for
epileptic. She was hypnotized for purposes of differential diagnosis and
she immediately merged into one of her attacks. On being asked what she
saw she said, “The dog, the dog is coming,” and it was really found that
the first attack of this kind appeared after she was pursued by a mad
dog. The success of the therapy then verified our diagnosis.
An official who became hysterical as a result of ill treatment on the
part of his employer suffered from attacks, during which he fell to the
floor raging furiously without uttering a word or displaying any
hallucinations. The attack was provoked in a state of hypnosis and he
then stated that he lived through the scene during which his employer
insulted him in the street and struck him with a cane. A few days later
he came to me complaining that he had the same attack, but this time it
was shown in the hypnosis that he went through the scene which was
really connected with the onset of his disease; it was the scene in the
court room when he was unable to get satisfaction for the ill treatment
which he received, etc.
The memories which appear in hysterical attacks or which can be awakened
in them correspond in all other respects to the causes which we have
found as the basis of the continuous hysterical symptoms. Like these
they refer to psychic traumas which were prevented from alleviation by
ab-reaction or by associative elaboration, like these they lack entirely
or in their essential components the memory possibilities of normal
consciousness and appear to belong to the ideation of hypnoid states of
consciousness with limited associations. Finally they are also amenable
to therapeutic proof. Our observations have often taught us that a
memory which has always evoked attacks becomes incapacitated when in a
hypnotic state it is brought to reaction and associative correction.
The motor phenomena of the hysterical attack can partly be interpreted
as the memory of a general form of reaction of the accompanying affect,
or partly as a direct motor expression of this memory (like the
fidgeting of the whole body which even infants make use of), and partly,
like the hysterical stigmata—the continuous symptoms—they are
inexplainable on this assumption.
Of special significance for the hysterical attack is the aforementioned
theory, namely, that in hysteria there are presentation groups which
come to light in hypnoid states which are excluded from the rest of the
associative process but are associable among themselves, thus
representing a more or less highly organized rudimentary second
consciousness, a _condition seconde_. A persistent hysterical symptom
therefore corresponds to a projection of this second state into a bodily
innervation otherwise controlled by the normal consciousness. A
hysterical attack gives evidence of a higher organization of this second
state, and if of recent origin it signifies a moment in which this
hypnoid consciousness gained control of the whole existence, and hence
we have an acute hysteria, but if it is a recurrent attack containing a
memory we simply have a repetition of the same. Charcot has already
given utterance to the fact that the hysterical attack must be the
rudiment of a _condition seconde_. During the attack the control of the
whole bodily innervation is transferred to the hypnoid consciousness. As
familiar experiences show, the normal consciousness is not always
repressed, it may even perceive the motor phenomena of the attack while
the psychic processes of the same escape its cognizance.
The typical course of a grave hysteria, as everybody knows, is as
follows: At first an ideation is formed in the hypnoid state which after
sufficient development gains control in a period of “acute hysteria” of
the bodily innervation and the existence of the patient thus forming
persistent symptoms and attacks, and then with the exception of some
remnants there is a recovery. If the normal personality can regain the
upper hand, all that survived the hypnoid ideation then returns in
hysterical attacks and at times it reproduces, in the personality,
states which are again amenable to influences and capable of being
affected by traumas. Frequently a sort of equilibrium then results among
the psychic groups which are united in the same person; attack and
normal life go hand in hand without influencing each other. The attack
then comes spontaneously just as memories are wont to come, it may also
be provoked just as memories may be by the laws of association. The
provocation of the attack results either through stimulating a
hysterogenic zone or through a new experience which by similarity
recalls the pathogenic experience. We hope to be able to show that there
is no essential difference between the apparently two diverse
determinants, and that in both cases the hyperesthetic memory is
touched. In other cases there is a great lability of equilibrium, the
attack appears as a manifestation of the hypnoid remnant of
consciousness as often as the normal person becomes exhausted and
incapacitated. We cannot disregard the fact that in such cases the
attack becomes denuded of its original significance and may return as a
contentless motor reaction.
It remains a task for future investigation to discover what conditions
are decisive in determining whether a hysterical individuality should
manifest itself in attacks, in persistent symptoms, or in a mingling of
both.
V.
We can now understand in what manner the psychotherapeutic method
propounded by us exerts its curative effect. _It abrogates the efficacy
of the original not ab-reacted presentation of affording an outlet to
the strangulated affect through speech. It brings it to associative
correction by drawing it into normal consciousness (in mild hypnosis) or
it is done away with through the physician’s suggestion just as happens
in somnambulism with amnesia._
We maintain that the therapeutic gain obtained by applying this process
is quite significant. To be sure we do not cure the hysterical
predisposition as we do not block the way for the recurrence of hypnoid
states; moreover, in the productive stage of acute hysteria our
procedure is unable to prevent the replacement of the carefully
abrogated phenomena by new ones. But when this acute stage has run its
course and its remnants continue as persistent hysterical symptoms and
attacks, our radical method usually removes them forever, and herein it
seems to surpass the efficacy of direct suggestion as practiced at
present by psychotherapists.
If by disclosing the psychic mechanisms of hysterical phenomena we have
taken a step forward on the path so successfully started by Charcot with
his explanation and experimental imitation of hystero-traumatic
paralysis, we are well aware that in doing this we have only advanced
our knowledge in the mechanisms of hysterical symptoms and not in the
subjective causes of hysteria. We have but touched upon the etiology of
hysteria and could only throw light on the causes of the acquired forms,
the significance of the accidental moments in the neurosis.