MY VIEWS ON THE RÔLE OF SEXUALITY IN THE ETIOLOGY OF THE NEUROSES.[54]
I am of the opinion that my theory on the etiological significance of
the sexual moment in the neuroses can be best appreciated by following
its development. I will by no means make any effort to deny that it
passed through an evolution during which it underwent a change. My
colleagues can find the assurance in this admission that this theory is
nothing other than the result of continued and painstaking experiences.
In contradistinction to this whatever originates from speculation can
certainly appear complete at one go and continue unchanged.
Originally the theory had reference only to the morbid pictures
comprehended as “neurasthenia,” among which I found two types which
occasionally appeared pure, and which I described as “actual
neurasthenia” and “anxiety neurosis.” For it was always known that
sexual moments could play a part in the causation of these forms, but
they were found neither regularly effective, nor did one think of
conceding to them a precedence over other etiological influences. I was
above all surprised at the frequency of coarse disturbances in the vita
sexualis of nervous patients. The more I was in quest of such
disturbances, during which I remembered that all men conceal the truth
in things sexual, and the more skilful I became in continuing the
examination despite the incipient negation, the more regularly such
disease-forming moments were discovered in the sexual life, until it
seemed to me that they were but little short of universal. But one must
from the first be prepared for similar frequent occurrences of sexual
irregularities under the stress of the social relations of our society,
and one could therefore remain in doubt as to what part of the deviation
from the normal sexual function is to be considered as a morbid cause. I
could therefore only place less value on the regular demonstration of
sexual noxas than on other experiences which appeared to me to be less
equivocal. It was found that the form of the malady, be it neurasthenia
or anxiety neurosis, shows a constant relation to the form of the sexual
injury. In the typical cases of neurasthenia we could always demonstrate
masturbation or accumulated pollutions, while in anxiety neurosis we
could find such factors as coitus interruptus, “frustrated excitement,”
etc. The moment of insufficient discharge of the generated libido seemed
to be common to both. Only after this experience, which is easy to gain
and very often confirmed, had I the courage to claim for the sexual
influences a prominent place in the etiology of the neurosis. It also
happened that the mixed forms of neurasthenia and anxiety neurosis
occurring so often, showed the admixture of the etiologies accepted for
both, and that such a bipartition in the form of the manifestations of
the neurosis seemed to accord well with the polar characters of
sexuality (male and female).
At the same time, while I assigned to sexuality this significance in the
origin of the simple neurosis, I still professed for the psychoneuroses
(hysteria and obsessions) a purely psychological theory in which the
sexual moment was no differently considered than any other emotional
sources. Together with J. Breuer, and in addition to observations which
he has made on his hysterical patients fully a decade before, I have
studied the mechanism of the origin of hysterical symptoms by the
awakening of memories in hypnotic states. We obtained information which
permitted us to cross the bridge from Charcot’s traumatic hysteria to
the common non-traumatic hysteria. We reached the conception that the
hysterical symptoms are permanent results of psychic traumas, and that
the amount of affect belonging to them was pushed away from conscious
elaboration by special determinations, thus forcing an abnormal road
into bodily innervation. The terms “strangulated affect,” “conversion,”
and “ab-reaction,” comprise the distinctive characteristics of this
conception.
In the close relations of the psychoneuroses to the simple neuroses,
which can go so far that the diagnostic distinction is not always easy
for the unpracticed, it could happen that the cognition gained from one
sphere has also taken effect in the other. Leaving such influences out
of the question, the deep study of the psychic traumas also leads to the
same results. If by the “analytic” method we continue to trace the
psychic traumas from which the hysterical symptoms are derived, we
finally reach to experiences which belong to the patient’s childhood,
and concern his sexual life. This can be found even in such cases where
a banal emotion of a non-sexual nature has occasioned the outburst of
the disease. Without taking into account these sexual traumas of
childhood we could neither explain the symptoms, find their
determination intelligible, nor guard against their recurrence. The
incomparable significance of sexual experiences in the etiology of the
psychoneuroses seems therefore firmly established, and this fact remains
until today one of the main supports of the theory.
If we represent this theory by saying that the course of the life long
hysterical neurosis lies in the sexual experiences of early childhood
which are usually trivial in themselves, it surely would sound strange
enough. But if we take cognizance of the historical development of the
theory, and transfer the main content of the same into the sentence:
hysteria is the expression of a special behavior of the sexual function
of the individual, and that this behavior was already decisively
determined by the first effective influences and experiences of
childhood, we will perhaps be poorer in a paradox but richer in a motive
for directing our attention to a hitherto very neglected and most
significant aftereffect of infantile impressions in general.
As I reserve the question whether the etiology of hysteria (and
compulsion neurosis) is to be found in the sexual infantile experiences
for a later more thorough discussion, I now return to the construction
of the theory expressed in some small preliminary publications in the
years 1895–1896.[55] The bringing into prominence of the assumed
etiological moments permitted us at the time to contrast the common
neuroses which are maladies with an actual etiology, with the
psychoneuroses which etiology was in the first place to be sought in the
sexual experiences of remote times. The theory culminates in the
sentence: In a normal vita sexualis no neurosis is possible.
If I still consider today this sentence as correct it is really not
surprising that after ten years labor on the knowledge of these
relations I passed a good way beyond my former point of view, and that I
now think myself in a position to correct by detailed experience the
imperfections, the displacements, and the misconceptions, from which
this theory then suffered. By chance my former rather meagre material
furnished me with a great number of cases in which infantile histories,
sexual seduction by grown-up persons or older children, played the main
rôle. I overestimated the frequency of these (otherwise not to be
doubted) occurrences, the more so because I was then in no position to
distinguish definitely the deceptive memories of hysterical patients
concerning their childhood, from the traces of the real processes,
whereas, I have since then learned to explain many a seduction fancy as
an attempt at defense against the reminiscence of their own sexual
activity (infantile masturbation). The emphasis laid on the “traumatic”
element of the infantile sexual experience disappeared with this
explanation, and it remained obvious that the infantile sexual
activities (be they spontaneous or provoked) dictate the course of the
later sexual life after maturity. The same explanation which really
corrects the most significant of my original errors perforce also
changed the conception of the mechanism of the hysterical symptoms.
These no longer appeared as direct descendants of repressed memories of
sexual infantile experiences, but between the symptoms and the infantile
impressions there slipped in the fancies (confabulations of memory) of
the patients which were mostly produced during the years of puberty and
which on the one hand, are raised from and over the infantile memories,
and on the other, are immediately transformed into symptoms. Only after
the introduction of the element of hysterical fancies did the structure
of the neurosis and its relation to the life of the patient become
transparent. It also resulted in a veritable surprising analogy between
these unconscious hysterical fancies and the romances which became
conscious as delusions in paranoia.
After this correction the “infantile sexual traumas” were in a sense
supplanted by the “infantilism of sexuality.” A second modification of
the original theory was not remote. With the accepted frequency of
seduction in childhood there also disappeared the enormous emphasis of
the accidental influences of sexuality to which I wished to shift the
main rôle in the causation of the disease without, however, denying
constitutional and hereditary moments. I even hoped to solve thereby the
problem of the selection of the neurosis, that is, to decide by the
details of the sexual infantile experience, the form of the
psychoneurosis into which the patient may merge. Though with reserve I
thought at that time that passive behavior during these scenes results
in the specific predisposition for hysteria, while active behavior
results in compulsion neurosis. This conception I was later obliged to
disclaim completely though some facts of the supposed connection between
passivity and hysteria, and activity and compulsion neurosis, can be
maintained to some extent. With the disappearance of the accidental
influences of experiences, the elements of constitution and heredity had
to regain the upper hand, but differing from the view generally in vogue
I placed the “sexual constitution” in place of the general neuropathic
predisposition. In my recent work, “Three Contributions to the Sexual
Theory.”[56] I have attempted to discuss the varieties of this sexual
constitution, the components of the sexual impulse in general, and its
origin from the contributory sources of the organism.
Still in connection with the changed conception of the “sexual infantile
traumas,” the theory continued to develop in a course which was already
indicated in the publications of 1894–1896. Even before sexuality was
installed in its proper place in the etiology, I had already stated as a
condition for the pathogenic efficaciousness of an experience that the
latter must appear to the ego as unbearable and thus evoke an exertion
for defense. To this defense I have traced the psychic splitting—or as
it was then called the splitting of consciousness—of hysteria. If the
defense succeeded, the unbearable experience with its resulting affect
was expelled from consciousness and memory; but under certain conditions
the thing expelled which was now unconscious, developed its activity,
and with the aid of the symptoms and their adhering affect it returned
into consciousness, so that the disease corresponded to a failure of the
defense. This conception had the merit of entering into the play of the
psychic forces, and hence approximate the psychic processes of hysteria
to the normal instead of shifting the characteristic of the neurosis
into an enigmatic and no further analyzable disturbance.
Further inquiries among persons who remained normal furnished the
unexpected result, that the sexual histories of their childhood need not
differ essentially from the infantile life of neurotics, and that
especially the rôle of seduction is the same in the former, so the
accidental influences receded still more in comparison to the moments of
“repression” (which I began to use instead of “defense”). It really does
not depend on the sexual excitements which an individual experiences in
his childhood but above all on his reactions towards these experiences,
and whether these impressions responded with “repression” or not. It
could be shown that spontaneous sexual manifestations of childhood were
frequently interrupted in the course of development by an act of
repression. The sexual maturity of neurotic individuals thus regularly
brings with it a fragment of “sexual repression” from childhood which
manifests itself in the requirements of real life. Psychoanalyses of
hysterical individuals show that the malady is the result of the
conflict between the libido and the sexual repression, and that their
symptoms have the value of a compromise between both psychic streams.
Without a comprehensive discussion of my conception of repression I
could not explain any further this part of the theory. It suffices to
refer here to my “Three Contributions to the Sexual Theory,” where I
have made an attempt to throw some light on the somatic processes in
which the essence of sexuality is to be sought. I have stated there that
the constitutional sexual predisposition of the child is more
irregularly multifarious than one would expect, that it deserves to be
called “polymorphous-perverse,” and that from this predisposition the so
called normal behavior of the sexual functions results through a
repression of certain components. By referring to the infantile
character of sexuality, I could form a simple connection among normal,
perversions, and neurosis. The normal resulted through the repression of
certain partial impulses and components of the infantile predisposition,
and through the subordination of the rest under the primacy of the
genital zones for the service of the function of procreation. The
perversions corresponded to disturbances of this connection due to a
superior compulsive like development of some of the partial impulses,
while the neurosis could be traced to a marked repression of the
libidinous strivings. As almost all perversive impulses of the infantile
predisposition are demonstrable as forces of symptom formation in the
neurosis, in which, however, they exist in a state of repression, I
could designate the neurosis as the “negative” of the perversion.
I think it worth emphasizing that with all changes my ideas on the
etiology of the psychoneuroses still never disavowed or abandoned two
points of view, to wit, the estimation of sexuality and infantilism. In
other respects we have in place of the accidental influences the
constitutional moments, and instead of the pure psychologically intended
defense we have the organic “sexual repression.” Should anybody ask
where a cogent proof can be found for the asserted etiological
significance of sexual factors in the psychoneuroses, and argue that
since an outburst of these diseases can result from the most banal
emotions, and even from somatic causes, a specific etiology in the form
of special experiences of childhood must therefore be disavowed; I
mention as an answer for all these arguments the psychoanalytic
investigation of neurotics as the source from which the disputed
conviction emanates. If one only makes use of this method of
investigation he will discover that the symptoms represent the whole or
a partial sexual manifestation of the patient from the sources of the
normal or perverse partial impulses of sexuality. Not only does a good
part of the hysterical symptomatology originate directly from the
manifestations of the sexual excitement, not only are a series of
erogenous zones in strengthening infantile attributes raised in the
neurosis to the importance of genitals, but even the most complicated
symptoms become revealed as the converted representations of fancies
having a sexual situation as a content. He who can interpret the
language of hysteria can understand that the neurosis only deals with
the repressed sexuality. One should, however, understand the sexual
function in its proper sphere as circumscribed by the infantile
predisposition. Where a banal emotion has to be added to the causation
of the disease, the analysis regularly shows that the sexual components
of the traumatic experience, which are never missing, have exercised the
pathogenic effect.
We have unexpectedly advanced from the question of the causation of the
psychoneuroses to the problem of its essence. If we wish to take
cognizance of what we discovered by psychoanalysis we can only say that
the essence of these maladies lies in disturbances of the sexual
processes, in those processes in the organism which determine the
formation and utilization of the sexual libido. We can hardly avoid
perceiving these processes in the last place as chemical, so that we can
recognize in the so called actual neuroses the somatic effects of
disturbances in the sexual metabolism, while in the psychoneuroses we
recognize besides the psychic effects of the same disturbances. The
resemblance of the neuroses to the manifestations of intoxication and
abstinence following certain alkaloids, and to Basedow’s and Addison’s
diseases, obtrudes itself clinically without any further ado, and just
as these two diseases should no more be described as “nervous diseases,”
so will the genuine “neuroses” soon have to be removed from this class
despite their nomenclature.
Everything that can exert harmful influences in the processes serving
the sexual function therefore belongs to the etiology of the neurosis.
In the first place we have the noxas directly affecting the sexual
functions insofar as they are accepted as injuries by the sexual
constitution which is changeable through culture and breeding. In the
second place, we have all the different noxas and traumas which may also
injure the sexual processes by injuring the organism as a whole. But we
must not forget that the etiological problem in the neuroses is at least
as complicated as in the causation of any other disease. One single
pathogenic influence almost never suffices, it mostly requires a
multiplicity of etiological moments reinforcing one another, and which
can not be brought in contrast to one another. It is for that reason
that the state of neurotic illness is not sharply separated from the
normal. The disease is the result of a summation, and the measure of the
etiological determinations can be completed from any one part. To seek
the etiology of the neurosis exclusively in heredity or in the
constitution would be no less one sided than to attempt to raise to the
etiology the accidental influences of sexuality alone, even though the
explanations show that the essence of this malady lies only in a
disturbance of the sexual processes of the organism.