by the types of sickness which the war has just now made so
frequent--the so-called traumatic neuroses. Even before the war there
were such cases after railroad collisions and other frightful
occurrences which endangered life. The traumatic neuroses are,
fundamentally, not the same as the spontaneous neuroses which we have
been analysing and treating; moreover, we have not yet succeeded in
bringing them within our hypotheses, and I hope to be able to make clear
to you wherein this limitation lies. Yet on one point we may emphasize
the existence of a complete agreement between the two forms. The
traumatic neuroses show clear indications that they are grounded in a
fixation upon the moment of the traumatic disaster. In their dreams
these patients regularly live over the traumatic situation; where there
are attacks of an hysterical type, which permit of an analysis, we learn
that the attack approximates a complete transposition into this
situation. It is as if these patients had not yet gotten through with
the traumatic situation, as if it were actually before them as a task
which was not yet mastered. We take this view of the matter in all
seriousness; it shows the way to an _economic_ view of psychic
occurrences. For the expression "traumatic" has no other than an
economic meaning, and the disturbance permanently attacks the
management of available energy. The traumatic experience is one which,
in a very short space of time, is able to increase the strength of a
given stimulus so enormously that its assimilation, or rather its
elaboration, can no longer be effected by normal means.
This analogy tempts us to classify as traumatic those experiences as
well upon which our neurotics appear to be fixated. Thus the possibility
is held out to us of having found a simple determining factor for the
neurosis. It would then be comparable to a traumatic disease, and would
arise from the inability to meet an overpowering emotional experience.
As a matter of fact this reads like the first formula, by which Breuer
and I, in 1893-1895, accounted theoretically for our new observations. A
case such as that of our first patient, the young woman separated from
her husband, is very well explained by this conception. She was not able
to get over the unfeasibility of her marriage, and has not been able to
extricate herself from this trauma. But our very next, that of the girl
attached to her father, shows us that the formula is not sufficiently
comprehensive. On the one hand, such baby love of a little girl for her
father is so usual, and so often outlived that the designation
"traumatic" would carry no significance; on the other hand, the history
of the patient teaches us that this first erotic fixation apparently
passed by harmlessly at the time, and did not again appear until many
years later in the symptoms of the compulsion neurosis. We see
complications before us, the existence of a greater wealth of
determining factors in the disease, but we also suspect that the
traumatic viewpoint will not have to be given up as wrong; rather it
will have to subordinate itself when it is fitted into a different
context.
Here again we must leave the road we have been traveling. For the time
being, it leads us no further and we have many other things to find out
before we can go on again. But before we leave this subject let us note
that the fixation on some particular phase of the past has bearings
which extend far beyond the neurosis. Every neurosis contains such a
fixation, but every fixation does not lead to a neurosis, nor fall into
the same class with neuroses, nor even set the conditions for the
development of a neurosis. Mourning is a type of emotional fixation on a
theory of the past, which also brings with it the most complete
alienation from the present and the future. But mourning is sharply
distinguished from neuroses that may be designated as pathological forms
of mourning.
It also happens that men are brought to complete deadlock by a traumatic
experience that has so completely shaken the foundations on which they
have built their lives that they give up all interest in the present and
future, and become completely absorbed in their retrospections; but
these unhappy persons are not necessarily neurotic. We must not
overestimate this one feature as a diagnostic for a neurosis, no matter
how invariable and potent it may be.
Now let us turn to the second conclusion of our analysis, which however
we will hardly need to limit subsequently. We have spoken of the
senseless compulsive activities of our first patient, and what intimate
memories she disclosed as belonging to them; later we also investigated
the connection between experience and symptom and thus discovered the
purpose hidden behind the compulsive activity. But we have entirely
omitted one factor that deserves our whole attention. As long as the
patient kept repeating the compulsive activity she did not know that it
was in any way related with the experience in question. The connection
between the two was hidden from her, she truthfully answered that she
did not know what compelled her to do this. Once, suddenly, under the
influence of the cure, she hit upon the connection and was able to tell
it to us. But still she did not know of the end in the service of which
she performed the compulsive activities, the purpose to correct a
painful part of the past and to place the husband, still loved by her,
upon a higher level. It took quite a long time and a great deal of
trouble for her to grasp and admit to me that such a motive alone could
have been the motive force of the compulsive activity.
The relation between the scene after the unhappy bridal night and the
tender motive of the patient yield what we have called the meaning of
the compulsive activity. But both the "whence" and the "why" remained
hidden from her as long as she continued to carry out the compulsive
act. Psychological processes had been going on within her for which the
compulsive act found an expression. She could, in a normal frame of
mind, observe their effect, but none of the psychological antecedents
of her action had come to the knowledge of her consciousness. She had
acted in just the same manner as a hypnotized person to whom Bernheim
had given the injunction that five minutes after his awakening in the
ward he was to open an umbrella, and he had carried out this order on
awakening, but could give no motive for his so doing. We have exactly
such facts in mind when we speak of the existence of _unconscious
psychological processes_. Let anyone in the world account for these
facts in a more correct scientific manner, and we will gladly withdraw
completely our assumption of unconscious psychological processes. Until
then, however, we shall continue to use this assumption, and when anyone
wants to bring forward the objection that the unconscious can have no
reality for science and is a mere makeshift, (_une facon de parler_), we
must simply shrug our shoulders and reject his incomprehensible
statement resignedly. A strange unreality which can call out such real
and palpable effects as a compulsion symptom!
In our second patient we meet with fundamentally the same thing. She had
created a decree which she must follow: the pillow must not touch the
head of the bed; yet she does not know how it originated, what its
meaning is, nor to what motive it owes the source of its power. It is
immaterial whether she looks upon it with indifference or struggles
against it, storms against it, determines to overcome it. She must
nevertheless follow it and carry out its ordinance, though she asks
herself, in vain, why. One must admit that these symptoms of compulsion
neurosis offer the clearest evidence for a special sphere of
psychological activity, cut off from the rest. What else could be back
of these images and impulses, which appear from one knows not where,
which have such great resistance to all the influences of an otherwise
normal psychic life; which give the patient himself the impression that
here are super-powerful guests from another world, immortals mixing in
the affairs of mortals. Neurotic symptoms lead unmistakably to a
conviction of the existence of an unconscious psychology, and for that
very reason clinical psychiatry, which recognizes only a conscious
psychology, has no explanation other than that they are present as
indications of a particular kind of degeneration. To be sure, the
compulsive images and impulses are not themselves unconscious--no more
so than the carrying out of the compulsive-acts escapes conscious
observation. They would not have been symptoms had they not penetrated
through into consciousness. But their psychological antecedents as
disclosed by the analysis, the associations into which we place them by
our interpretations, are unconscious, at least until we have made them
known to the patient during the course of the analysis.
Consider now, in addition, that the facts established in our two cases
are confirmed in all the symptoms of all neurotic diseases, that always
and everywhere the meaning of the symptoms is unknown to the sufferer,
that analysis shows without fail that these symptoms are derivatives of
unconscious experiences which can, under various favorable conditions,
become conscious. You will understand then that in psychoanalysis we
cannot do without this unconscious psyche, and are accustomed to deal
with it as with something tangible. Perhaps you will also be able to
understand how those who know the unconscious only as an idea, who have
never analyzed, never interpreted dreams, or never translated neurotic
symptoms into meaning and purpose, are most ill-suited to pass an
opinion on this subject. Let us express our point of view once more. Our
ability to give meaning to neurotic symptoms by means of analytic
interpretation is an irrefutable indication of the existence of
unconscious psychological processes--or, if you prefer, an irrefutable
proof of the necessity for their assumption.
But that is not all. Thanks to a second discovery of Breuer's, for which
he alone deserves credit and which appears to me to be even more
far-reaching, we are able to learn still more concerning the
relationship between the unconscious and the neurotic symptom. Not alone
is the meaning of the symptoms invariably hidden in the unconscious; but
the very existence of the symptom is conditioned by its relation to this
unconscious. You will soon understand me. With Breuer I maintain the
following: Every time we hit upon a symptom we may conclude that the
patient cherishes definite unconscious experiences which withhold the
meaning of the symptoms. Vice versa, in order that the symptoms may come
into being, it is also essential that this meaning be unconscious.
Symptoms are not built up out of conscious experiences; as soon as the
unconscious processes in question become conscious, the symptom
disappears. You will at once recognize here the approach to our therapy,
a way to make symptoms disappear. It was by these means that Breuer
actually achieved the recovery of his patient, that is, freed her of her
symptoms; he found a technique for bringing into her consciousness the
unconscious experiences that carried the meaning of her symptoms, and
the symptoms disappeared.
This discovery of Breuer's was not the result of a speculation, but of a
felicitous observation made possible by the cooperation of the patient.
You should therefore not trouble yourself to find things you already
know to which you can compare these occurrences, rather you should
recognize herein a new fundamental fact which in itself is capable of
much wider application. Toward this further end permit me to go over
this ground again in a different way.
The symptom develops as a substitution for something else that has
remained suppressed. Certain psychological experiences should normally
have become so far elaborated that consciousness would have attained
knowledge of them. This did not take place, however, but out of these
interrupted and disturbed processes, imprisoned in the unconscious, the
symptom arose. That is to say, something in the nature of an interchange
had been effected; as often as therapeutic measures are successful in
again reversing this transposition, psychoanalytic therapy solves the
problem of the neurotic symptom.
Accordingly, Breuer's discovery still remains the foundation of
psychoanalytic therapy. The assertion that the symptoms disappear when
one has made their unconscious connections conscious, has been borne out
by all subsequent research, although the most extraordinary and
unexpected complications have been met with in its practical execution.
Our therapy does its work by means of changing the unconscious into the
conscious, and is effective only in so far as it has the opportunity of
bringing about this transformation.
Now we shall make a hasty digression so that you do not by any chance
imagine that this therapeutic work is too easy. From all we have learned
so far, the neurosis would appear as the result of a sort of ignorance,
the incognizance of psychological processes that we should know of. We
would thus very closely approximate the well-known Socratic teachings,
according to which evil itself is the result of ignorance. Now the
experienced physician will, as a rule, discover fairly readily what
psychic impulses in his several patients have remained unconscious.
Accordingly it would seem easy for him to cure the patient by imparting
this knowledge to him and freeing him of his ignorance. At least the
part played by the unconscious meaning of the symptoms could easily be
discovered in this manner, and it would only be in dealing with the
relationship of the symptoms to the experiences of the patient that the
physician would be handicapped. In the face of these experiences, of
course, he is the ignorant one of the two, for he did not go through
these experiences, and must wait until the patient remembers them and
tells them to him. But in many cases this difficulty could be readily
overcome. One can question the relatives of the patient concerning these
experiences, and they will often be in a position to point out those
that carry any traumatic significance; they may even be able to inform
the analyst of experiences of which the patient knows nothing because
they occurred in the very early years of his life. By a combination of
such means it would seem that the pathogenic ignorance of the patient
could be cleared up in a short time and without much trouble.
If only that were all! We have made discoveries for which we were at
first unprepared. Knowing and knowing is not always the same thing;
there are various kinds of knowing that are psychologically by no means
comparable. "_Il y a fagots et fagots_,"[39] as Moliere says. The
knowledge of the physician is not the same as that of the patient and
cannot bring about the same results. The physician can gain no results
by transferring his knowledge to the patient in so many words. This is
perhaps putting it incorrectly, for though the transference does not
result in dissolving the symptoms, it does set the analysis in motion,
and calls out an energetic denial, the first sign usually that this has
taken place. The patient has learned something that he did not know up
to that time, the meaning of his symptoms, and yet he knows it as little
as before. So we discover there is more than one kind of ignorance. It
will require a deepening of our psychological insight to make clear to
us wherein the difference lies. But our assertion nevertheless remains
true that the symptoms disappear with the knowledge of their meaning.
For there is only one limiting condition; the knowledge must be founded
on an inner change in the patient which can be attained only through
psychic labors directed toward a definite end. We have here been
confronted by problems which will soon lead us to the elaboration of a
dynamics of symptom formation.
I must stop to ask you whether this is not all too vague and too
complicated? Do I not confuse you by so often retracting my words and
restricting them, spinning out trains of thought and then rejecting
them? I should be sorry if this were the case. However, I strongly
dislike simplification at the expense of truth, and am not averse to
having you receive the full impression of how many-sided and complicated
the subject is. I also think that there is no harm done if I say more on
every point than you can at the moment make use of. I know that every
hearer and reader arranges what is offered him in his own thoughts,
shortens it, simplifies it and extracts what he wishes to retain. Within
a given measure it is true that the more we begin with the more we have
left. Let me hope that, despite all the by-play, you have clearly
grasped the essential parts of my remarks, those about the meaning of
symptoms, about the unconscious, and the relation between the two. You
probably have also understood that our further efforts are to take two
directions: first, the clinical problem--to discover how persons become
sick, how they later on accomplish a neurotic adaptation toward life;
secondly, a problem of psychic dynamics, the evolution of the neurotic
symptoms themselves from the prerequisites of the neuroses. We will
undoubtedly somewhere come on a point of contact for these two problems.
I do not wish to go any further to-day, but since our time is not yet up
I intend to call your attention to another characteristic of our two
analyses, namely, the memory gaps or amnesias, whose full appreciation
will be possible later. You have heard that it is possible to express
the object of psychoanalytic treatment in a formula: all pathogenic
unconscious experience must be transposed into consciousness. You will
perhaps be surprised to learn that this formula can be replaced by
another: all the memory gaps of the patient must be filled out, his
amnesias must be abolished. Practically this amounts to the same thing.
Therefore an important role in the development of his symptoms must be
accredited to the amnesias of the neurotic. The analysis of our first
case, however, will hardly justify this valuation of the amnesia. The
patient has not forgotten the scene from which the compulsion act
derives--on the contrary, she remembers it vividly, nor is there any
other forgotten factor which comes into play in the development of these
symptoms. Less clear, but entirely analogous, is the situation in the
case of our second patient, the girl with the compulsive ritual. She,
too, has not really forgotten the behavior of her early years, the fact
that she insisted that the door between her bedroom and that of her
parents be kept open, and that she banished her mother out of her place
in her parents' bed. She recalls all this very clearly, although
hesitatingly and unwillingly. Only one factor stands out strikingly in
our first case, that though the patient carries out her compulsive act
innumerable times, she is not once reminded of its similarity with the
experience after the bridal-night; nor was this memory even suggested
when by direct questions she was asked to search for its motivation. The
same is true of the girl, for in her case not only her ritual, but the
situation which provoked it, is repeated identically night after night.
In neither case is there any actual amnesia, no lapse of memory, but an
association is broken off which should have called out a reproduction, a
revival in the memory. Such a disturbance is enough to bring on a
compulsion neurosis. Hysteria, however, shows a different picture, for
it is usually characterized by most grandiose amnesias. As a rule, in
the analysis of each hysterical symptom, one is led back to a whole
chain of impressions which, upon their recovery, are expressly
designated as forgotten up to the moment. On the one hand this chain
extends back to the earliest years of life, so that the hysterical
amnesias may be regarded as the direct continuation of the infantile
amnesias, which hides the beginnings of our psychic life from those of
us who are normal. On the other hand, we discover with surprise that the
most recent experiences of the patient are blurred by these losses of
memory--that especially the provocations which favored or brought on the
illness are, if not entirely wiped out by the amnesia, at least
partially obliterated. Without fail important details have disappeared
from the general picture of such a recent memory, or are placed by false
memories. Indeed it happens almost regularly that just before the
completion of an analysis, certain memories of recent experiences
suddenly come to light. They had been held back all this time, and had
left noticeable gaps in the context.
We have pointed out that such a crippling of the ability to recall is
characteristic of hysteria. In hysteria symptomatic conditions also
arise (hysterical attacks) which need leave no trace in the memory. If
these things do not occur in compulsion-neuroses, you are justified in
concluding that these amnesias exhibit psychological characteristics of
the hysterical change, and not a general trait of the neuroses. The
significance of this difference will be more closely limited by the
following observations. We have combined two things as the meaning of a
symptom, its "whence," on the one hand, and its "whither" or "why," on
the other. By these we mean to indicate the impressions and experiences
whence the symptom arises, and the purpose the symptom serves. The
"whence" of a symptom is traced back to impressions which have come from
without, which have therefore necessarily been conscious at some time,
but which may have sunk into the unconscious--that is, have been
forgotten. The "why" of the symptom, its tendency, is in every case an
endopsychic process, developed from within, which may or may not have
become conscious at first, but could just as readily never have entered
consciousness at all and have been unconscious from its inception. It
is, after all, not so very significant that, as happens in the
hysterias, amnesia has covered over the "whence" of the symptom, the
experience upon which it is based; for it is the "why," the tendency of
the symptom, which establishes its dependence on the unconscious, and
indeed no less so in the compulsion neuroses than in hysteria. In both
cases the "why" may have been unconscious from the very first.
By thus bringing into prominence the unconscious in psychic life, we
have raised the most evil spirits of criticism against psychoanalysis.
Do not be surprised at this, and do not believe that the opposition is
directed only against the difficulties offered by the conception of the
unconscious or against the relative inaccessibility of the experiences
which represent it. I believe it comes from another source. Humanity, in
the course of time, has had to endure from the hands of science two
great outrages against its naive self-love. The first was when humanity
discovered that our earth was not the center of the universe, but only
a tiny speck in a world-system hardly conceivable in its magnitude. This
is associated in our minds with the name "Copernicus," although
Alexandrian science had taught much the same thing. The second occurred
when biological research robbed man of his apparent superiority under
special creation, and rebuked him with his descent from the animal
kingdom, and his ineradicable animal nature. This re-valuation, under
the influence of Charles Darwin, Wallace and their predecessors, was not
accomplished without the most violent opposition of their
contemporaries. But the third and most irritating insult is flung at the
human mania of greatness by present-day psychological research, which
wants to prove to the "I" that it is not even master in its own home,
but is dependent upon the most scanty information concerning all that
goes on unconsciously in its psychic life. We psychoanalysts were
neither the first, nor the only ones to announce this admonition to look
within ourselves. It appears that we are fated to represent it most
insistently and to confirm it by means of empirical data which are of
importance to every single person. This is the reason for the widespread
revolt against our science, the omission of all considerations of
academic urbanity, and emancipation of the opposition from all
restraints of impartial logic. We were compelled to disturb the peace of
the world, in addition, in another manner, of which you will soon come
to know.
NINETEENTH LECTURE
GENERAL THEORY OF THE NEUROSES
_Resistance and Suppression_