ON PSYCHOANALYSIS[175]
After many years' experience I now know that it is extremely difficult
to discuss psychoanalysis at public meetings and at congresses. There
are so many misconceptions of the matter, so many prejudices against
certain psychoanalytic views, that it becomes an almost impossible task
to reach mutual understanding in public discussion. I have always found
a quiet conversation on the subject much more useful and fruitful than
heated discussions _coram publico_. However, having been honoured by
an invitation from the Committee of this Congress as a representative
of the psychoanalytic movement, I will do my best to discuss some of
the fundamental theoretical conceptions of psychoanalysis. I must limit
myself to this part of the subject because I am quite unable to place
before my audience all that psychoanalysis means and strives for, all
its various applications, its psychology, its theoretical tendencies,
its importance for the realm of the so-called "Geisteswissenschaften,"
_e.g._ Mythology, Comparative Religion, Philosophy, &c. But if I am to
discuss certain theoretical problems fundamental to psychoanalysis, I
must presuppose my audience to be well acquainted with the development
and main results of psychoanalytic researches. Unfortunately, it often
happens that people believe themselves entitled to judge psychoanalysis
who have not even read the literature. It is my firm conviction that no
one is competent to form a judgment concerning the subject until he has
studied the fundamental works on psychoanalysis.
In spite of the fact that Freud's theory of neurosis has been worked out
in great detail, it cannot be said to be, on the whole, very clear or
easily accessible. This justifies my giving you a very short abstract
of his fundamental views concerning the theory of neurosis.
You are aware that the original theory that hysteria and the related
neuroses take their origin in a trauma or shock of sexual character
in early childhood, was given up about fifteen years ago. It soon
became obvious that the sexual trauma could not be the real cause of
a neurosis, since trauma is found so universally; there is scarcely a
human being who has not had some sexual shock in early youth, and yet
comparatively few have incurred a neurosis in later life. Freud himself
soon became aware that several of the patients who related an early
traumatic event, had only invented the story of a so-called trauma; it
had never taken place in reality, and was a mere creation of phantasy.
Moreover, on further investigation it became quite obvious that even
a trauma which had actually occurred was not always responsible for
the whole of the neurosis, although it does sometimes look as if the
structure of the neurosis depended entirely upon the trauma. If a
neurosis were the inevitable consequence of a trauma it would be quite
incomprehensible why neurotics are not incomparably more numerous.
This apparently heightened shock-effect was clearly based upon the
_exaggerated and morbid phantasy_ of the patient. Freud also saw that
this same phantasy manifested itself in relatively early bad habits,
which he called infantile perversities. His new conception of the
ætiology of a neurosis was based upon this further understanding and
traced the neurosis back to some sexual activity in early infancy; this
conception led on to his recent view that the neurotic is "fixed" to a
certain period of his early infancy, because he still seems to preserve
some trace of it, direct or indirect, in his mental attitude. Freud
also makes the attempt to classify or to differentiate the neuroses,
including dementia præcox, according to the stage of the infantile
development in which the fixation took place.
From the standpoint of this theory, the neurotic appears to be entirely
dependent upon his infantile past, and all his troubles in later
life, his moral conflicts, and deficiencies, seem to be derived
from the powerful influence of that period. The therapy and its main
preoccupation are in full accord with this view, and are chiefly
concerned with the unravelling of this infantile fixation, which is
understood as an unconscious attachment of the sexual libido to certain
infantile phantasies and habits.
This is, so far as I can see, the essence of Freud's theory. But this
conception neglects the following important question: What is the cause
of this fixation of the libido to the old infantile phantasies and
habits? We have to remember that almost all persons have at some time
had infantile phantasies and habits exactly corresponding to those
of a neurotic, but they do not become fixed to them; consequently,
they do not become neurotic later on. The ætiological secret of the
neurosis, therefore, does not consist in the mere _existence_ of
infantile phantasies, but lies in the so-called _fixation_. The manifold
statements of the existence of infantile sexual phantasies in neurotic
cases are worthless, in so far as they attribute an ætiological value
to them, for the same phantasies can be found in normal individuals as
well, a fact which I have often proved. It is only the fixation which
seems to be characteristic. It is important to demand the nature of
the proofs of the real existence of this infantile fixation. Freud, an
absolutely sincere and thorough empiricist, would never have evolved
this hypothesis had he not had sufficient grounds for it. The grounds
are found in the results of the psychoanalytic investigations of the
unconscious. Psychoanalysis discloses the unconscious existence of
manifold phantasies, which have their end root in the infantile past
and turn around the so-called "_Kern-complex_," or nucleus-complex,
which may be designated in male individuals as the Œdipus-complex
and in females as the Electra-complex. These terms convey their own
meaning exactly. The whole tragic fate of Œdipus and Electra took place
within the narrow confines of the family, just as the child's fate
lies wholly within the family boundaries. Hence the Œdipus conflict is
very characteristic of an infantile conflict, so also is the Electra
conflict. The existence of these conflicts in infancy is largely
proven by means of psychoanalytic experience. It is in the realm of
this complex that the fixation is supposed to have taken place. Through
the highly potent and effective existence of the nucleus-complex in
the unconscious of neurotics, Freud was led to the hypothesis, that
the neurotic has a peculiar fixation or attachment to it. Not the mere
existence of this complex--for everybody has it in the unconscious--but
the very strong attachment to it is what is typical of the neurotic.
He is far more influenced by this complex than the normal person; many
examples in confirmation of this statement will be found in every one of
the recent psychoanalytic histories of neurotic cases.
We must admit that this conception is a very plausible one, because
the hypothesis of fixation is based upon the well-known fact, that
certain periods of human life, and particularly infancy, do sometimes
leave determining traces for ever. The only question is whether this
principle is a sufficient explanation or not. If we examine persons who
have been neurotic from infancy it seems to be confirmed, for we see
the nucleus-complex as a permanent and powerful activity throughout
the whole life. But if we take cases which never show any considerable
traces of neurosis except at the particular time when they break down,
and there are many such, this principle becomes doubtful. If there
is such a thing as fixation, it is not permissible to base upon it a
new hypothesis, claiming that at times during certain epochs of life
the fixation becomes loosened and ineffective, while at others it
suddenly becomes strengthened and effective. In such cases we find the
nucleus-complex as active and as potent as in those which apparently
support the theory of fixation. Here a critical attitude is peculiarly
justifiable, when we consider the often-repeated observation that the
moment of the outbreak of the disease is by no means indifferent; as a
rule it is most critical. It usually occurs _at the moment when a new
psychological adjustment, that is, a new adaptation, is demanded_. Such
moments facilitate the outbreak of a neurosis, as every experienced
neurologist knows. This fact seems to me extremely significant. If
the fixation were indeed real we should expect to find its influence
constant, _i.e._ a neurosis continuous throughout life. This is
obviously not the case. The psychological determination of a neurosis
is only partially due to an early infantile predisposition; it is due
to a certain actual cause as well. And if we carefully examine the kind
of infantile phantasies and events to which the neurotic individual
is attached, we shall be obliged to agree that there is nothing in
them specific for neurosis. Normal individuals have pretty much the
same kind of internal and external experiences, and are attached to
them to an even astonishing degree, without developing a neurosis.
You will find primitive people, especially, very much bound to their
infantility. It now begins to look as if this so-called fixation were
a normal phenomenon, and that the importance of infancy for the later
mental attitude is natural and prevails everywhere. The fact that the
neurotic seems to be markedly influenced by his infantile conflicts,
shows that it is less a matter of fixation than of a peculiar use which
he makes of his infantile past. It looks as if he exaggerated its
importance, and attributed a very great artificial value to it (Adler,
a pupil of Freud's, expresses a very similar view). It would be unjust
to say that Freud confined himself to the hypothesis of fixation; he
also was conscious of the impression I have just discussed. He called
this phenomenon of reactivation or secondary exaggeration of infantile
reminiscences "regression." But in Freud's conception it appears as
if the incestuous desires of the Œdipus-complex were the real cause
of the regression to infantile phantasies. If this were the case,
we should have to postulate an unexpected intensity of the primary
incestuous tendencies. This view led Freud to his recent comparison
between the so-called psychological "incest-barrier" in children and
the "incest-taboo" in primitive man. He supposes that a real incestuous
desire has led the primitive man to the invention of a protective law;
while to me it looks as if the incest-taboo is one among numerous taboos
of all sorts, and due to the typical superstitious fear of primitive
man, a fear existing independently of incest and its interdiction. I am
able to attribute as little particular strength to incestuous desires in
childhood as in primitive humanity. I do not even seek the reason for
regression in primary incestuous or any other sexual desires. I must
state that a purely sexual ætiology of neurosis seems to me much too
narrow. I base this criticism upon no prejudice against sexuality, but
upon an intimate acquaintance with the whole problem.
Therefore I suggest that the psychoanalytic theory should be liberated
from the purely sexual standpoint. In place of it I should like to
introduce an _energic view-point_ into the psychology of neurosis.
All psychological phenomena can be considered as manifestations of
energy, in the same way as all physical phenomena are already understood
as energic manifestations since Robert Mayer discovered the law of the
conservation of energy. This energy is subjectively and psychologically
conceived as _desire_. I call it _libido_, using the word in the
original meaning of this term, which is by no means only sexual.
Sallustius applies the term exactly in the way we do here: "_Magis in
armis et militaribus equis, quam in scortis et conviviis libidinem
habebant._"
From a broader standpoint libido can be understood as vital energy in
general, or as Bergson's _élan vital_. The first manifestation of this
energy in the suckling is the instinct of _nutrition_. From this stage
the libido slowly develops through manifold varieties of the act of
sucking into the sexual function. Hence I do not consider the act of
sucking as a sexual act. The pleasure in sucking can certainly not be
considered as sexual pleasure, but as pleasure in nutrition, for it
is nowhere proved that pleasure is sexual in itself. This process of
development continues into adult life and is connected with a constantly
increased adaptation to the external world. Whenever the libido, in
the process of adaptation, meets an obstacle, an accumulation takes
place which normally gives rise to an increased effort to overcome
the obstacle. But if the obstacle seems to be insurmountable, and the
individual renounces the overcoming of it, the stored-up libido makes
a regression. In place of being employed in the increased effort, the
libido now gives up the present task and returns to a former and more
primitive way of adaptation. We meet with the best examples of such
regressions very frequently in hysterical cases where a disappointment
in love or marriage gives rise to the neurosis. There we find the
well-known disturbances of nutrition, resistance against eating,
dyspeptic symptoms of all sorts, etc. In these cases the regressive
libido, turning away from its application to the work of adaptation,
holds sway over the function of nutrition and provokes considerable
disturbance. Such cases are obvious examples of regression. Similar
effects of regression are to be found in cases where there are no
troubles in the function of nutrition, and here we readily find a
regressive revival of reminiscences of a time long past. We find a
revival of the images of the parents, of the Œdipus-complex. Here things
and events of infancy--never before important--suddenly become so. They
are regressively reanimated. Take away the obstacle in the path of life
and this whole system of infantile phantasies at once breaks down and
becomes again as inactive and as ineffective as before. But do not let
us forget that, to a certain extent, it is at work influencing us always
and everywhere. I cannot forbear to mention that this view comes very
near Janet's hypothesis of the substitution of the "parties supérieures"
of a function by its "parties inférieures." I would also remind you of
Claparède's conception of neurotic symptoms as emotional reflexes of a
primitive nature.
Therefore I no longer find the cause of a neurosis in the past, but in
the present. I ask, what is the necessary task which the patient will
not accomplish? The whole list of his infantile phantasies does not give
me any sufficient ætiological explanation, because I know that these
phantasies are only puffed up by the regressive libido, which has not
found its natural outlet into a new form of adjustment to the demands of
life.
You may ask why the neurotic has a special inclination not to accomplish
his necessary tasks. Here let me point out that no living being adjusts
itself easily and smoothly to new conditions. The principle of the
_minimum of effort_ is valid everywhere.
A sensitive and somewhat inharmonious character, as a neurotic always
is, will meet special difficulties and perhaps more unusual tasks in
life than a normal individual, who as a rule has only to follow the
well-established line of an ordinary life. For the neurotic there is
no established way, for his aims and tasks are apt to be of a highly
individual character. He tries to follow the more or less uncontrolled
and half-conscious way of normal people, not fully realizing his own
critical and very different nature, which imposes upon him more effort
than the normal person is required to exert. There are neurotics who
have shown their increased sensitiveness and their resistance against
adaptation in the very first weeks of life, in their difficulty in
taking the mother's breast, and in their exaggerated nervous reactions,
&c. For this portion of a neurotic predisposition it will always be
impossible to find a psychological ætiology, for it is anterior to
all psychology. But this predisposition--you may call it "congenital
sensitiveness" or by what name you like--is the cause of the first
resistances against adaptation. In such case, the way of adaptation
being blocked, the biological energy we call libido does not find its
appropriate outlet or activity and therefore replaces an up-to-date and
suitable form of adaptation by an abnormal or primitive one.
In neurosis we speak of an infantile attitude or the predominance of
infantile phantasies and desires. In so far as infantile impressions
and desires are of obvious importance in normal people they are equally
influential in neurosis, but they have here no ætiological significance,
they are reactions merely, being chiefly secondary and regressive
phenomena. It is perfectly true, as Freud states, that infantile
phantasies determine the form and further development of neurosis, but
this is not ætiology. Even when we find perverted sexual phantasies of
which we can prove the existence in childhood, we cannot consider them
of ætiological significance. A neurosis is not really originated by
infantile sexual phantasies and the same must be said of the sexualism
of neurotic phantasy in general. It is not a primary phenomenon based
upon a perverted sexual disposition, but merely secondary and a
consequence of a failure to apply the stored-up libido in a suitable
way. I realize that this is a very old view, but this does not prevent
its being true. The fact that the patient himself very often believes
that this infantile phantasy is the real cause of the neurosis, does
not prove that he is right in his belief, or that a theory following
the same belief is right either. It may look as if it were so, and I
must confess that indeed very many cases do have that appearance. At all
events, it is perfectly easy to understand how Freud came to this view.
Every one having any psychoanalytic experience will agree with me here.
To sum up: I cannot see the real ætiology of a neurosis in the various
manifestations of infantile sexual development and their corresponding
phantasies. The fact that they are exaggerated and put into the
foreground in neurosis is a consequence of the stored-up energy or
libido. The psychological trouble in neurosis, and neurosis itself,
can be considered _as an act of adaptation that has failed_. This
formulation might reconcile certain views of Janet's with Freud's view,
that a neurosis is--under a certain aspect--an attempt at self-cure; a
view which can be and has been applied to many diseases.
Here the question arises whether it is still advisable to bring to light
all the patient's phantasies by analysis, if we now consider them as
of no ætiological significance. Psychoanalysis hitherto has proceeded
to the unravelling of these phantasies because they were considered to
be ætiologically significant. My altered view concerning the theory
of neurosis does not change the procedure of psychoanalysis. The
technique remains the same. We no longer imagine we are unearthing the
end-root of the disease, but we have to pull up the sexual phantasies
because the energy which the patient needs for his health, that is, for
his adaptation, is attached to them. By means of psychoanalysis the
connexion between the conscious and the libido in the unconscious is
re-established. Thus you restore this unconscious libido to the command
of conscious intention. Only in this way can the formerly split-off
energy become again applicable to the accomplishment of the necessary
tasks of life. Considered from this standpoint, psychoanalysis no longer
appears to be a mere reduction of the individual to his primitive sexual
wishes, but it becomes clear that, if rightly understood, it is a
_highly moral task of immense educational value_.
FOOTNOTES:
[Footnote 175: Paper given before the 17th International Medical
Congress, London, 1913.]