between the two groups of instincts, we must digress considerably and
introduce a consideration which we must needs call _economic_. Thereby
we enter upon one of the most important but unfortunately one of the
most obscure domains of psychoanalysis. We ask ourselves whether a
fundamental purpose is recognizable in the workings of our psychological
apparatus, and answer immediately that this purpose is the pursuit of
pleasurable excitement. It seems as if our entire psychological activity
were directed toward gaining pleasurable stimulation, toward avoiding
painful ones; that it is regulated automatically by the _principle of
pleasure_. Now we should like to know, above all, what conditions cause
the creation of pleasure and pain, but here we fall short. We may only
venture to say that pleasurable excitation _in some way_ involves
lessening, lowering or obliterating the amount of stimuli present in the
psychic apparatus. This amount, on the other hand, is increased by pain.
Examination of the most intense pleasurable excitement accessible to
man, the pleasure which accompanies the performance of the sexual act,
leaves small doubt on this point. Since such processes of pleasure are
concerned with the destinies of quantities of psychic excitation or
energy, we call considerations of this sort economic. It thus appears
that we can describe the tasks and performances of the psychic apparatus
in different and more generalized terms than by the emphasis of the
pursuit of pleasure. We may say that the psychic apparatus serves the
purpose of mastering and bringing to rest the mass of stimuli and the
stimulating forces which approach it. The sexual instincts obviously
show their aim of pleasurable excitement from the beginning to the end
of their development; they retain this original function without much
change. The ego instincts strive at first for the same thing. But
through the influence of their teacher, necessity, the ego instincts
soon learn to adduce some qualification to the principle of pleasure.
The task of avoiding pain becomes an objective almost comparable to the
gain of pleasure; the ego learns that its direct gratification is
unavoidably withheld, the gain of pleasurable excitement postponed, that
always a certain amount of pain must be borne and certain sources of
pleasure entirely relinquished. This educated ego has become
"reasonable." It is no longer controlled by the principle of pleasure,
but by the _principle of fact_, which at bottom also aims at pleasure,
but pleasure which is postponed and lessened by considerations of fact.
The transition from the pleasure principle to that of fact is the most
important advance in the development of the ego. We already know that
the sexual instincts pass through this stage unwillingly and late. We
shall presently learn the consequence to man of the fact that his
sexuality admits of such a loose relation to the external realities of
his life. Yet one more observation belongs here. Since the ego of man
has, like the libido, its history of evolution, you will not be
surprised to hear that there are "ego-regressions," and you will want to
know what role this return of the ego to former phases of development
plays in neurotic disease.
TWENTY-THIRD LECTURE
GENERAL THEORY OF THE NEUROSES
_The Development of the Symptoms_
In the layman's eyes the symptom shows the nature of the disease, and
cure means removal of symptoms. The physician, however, finds it
important to distinguish the symptoms from the disease and recognizes
that doing away with the symptoms is not necessarily curing the disease.
Of course, the only tangible thing left over after the removal of the
symptoms is the capacity to build new symptoms. Accordingly, for the
time being, let us accept the layman's viewpoint and consider the
understanding of the symptoms as equivalent to the understanding of the
sickness.
The symptoms,--of course, we are dealing here with psychic (or
psychogenic) symptoms, and psychic illness--are acts which are
detrimental to life as a whole, or which are at least useless;
frequently they are obnoxious to the individual who performs them and
are accompanied by distaste and suffering. The principal injury lies in
the psychic exertion which they cost, and in the further exertion needed
to combat them. The price these efforts exact may, when there is an
extensive development of the symptoms, bring about an extraordinary
impoverishment of the personality of the patient with respect to his
available psychic energy, and consequently cripple him in all the
important tasks of life. Since such an outcome is dependent on the
amount of energy so utilized, you will readily understand that "being
sick" is essentially a practical concept. But if you take a theoretical
standpoint and disregard these quantitative relations, you can readily
say that we are all sick, or rather neurotic, since the conditions
favorable to the development of symptoms are demonstrable also among
normal persons.
As to the neurotic symptoms, we already know that they are the result of
a conflict aroused by a new form of gratifying the libido. The two
forces that have contended against each other meet once more in the
symptom; they become reconciled through the compromise of a symptom
development. That is why the symptom is capable of such resistance; it
is sustained from both sides. We also know that one of the two partners
to the conflict is the unsatisfied libido, frustrated by reality, which
must now seek other means for its satisfaction. If reality remains
inflexible even where the libido is prepared to take another object in
place of the one denied it, the libido will then finally be compelled to
resort to regression and to seek gratification in one of the earlier
stages in its organizations already out-lived, or by means of one of the
objects given up in the past. Along the path of regression the libido is
enticed by fixations which it has left behind at these stages in its
development.
Here the development toward perversion branches off sharply from that of
the neuroses. If the regressions do not awaken the resistance of the
ego, then a neurosis does not follow and the libido arrives at some
actual, even if abnormal, satisfaction. The ego, however, controls not
alone consciousness, but also the approaches to motor innervation, and
hence the realization of psychic impulses. If the ego then does not
approve this regression, the conflict takes place. The libido is locked
out, as it were, and must seek refuge in some place where it can find an
outlet for its fund of energy, in accordance with the controlling
demands for pleasurable gratification. It must withdraw from the ego.
Such an evasion is offered by the fixations established in the course of
its evolution and now traversed regressively, against which the ego had,
at the time, protected itself by suppressions. The libido, streaming
back, occupies these suppressed positions and thus withdraws from before
the ego and its laws. At the same time, however, it throws off all the
influences acquired under its tutelage. The libido could be guided so
long as there was a possibility of its being satisfied; under the double
pressure of external and internal denial it becomes unruly and harks
back to former and more happy times. Such is its character,
fundamentally unchangeable. The ideas which the libido now takes over in
order to hold its energy belong to the system of the unconscious, and
are therefore subject to its peculiar processes, especially elaboration
and displacement. Conditions are set up here which are entirely
comparable to those of dream formation. Just as the latent dream, the
fulfillment of a wish-phantasy, is first built up in the
unconsciousness, but must then pass through conscious processes before,
censored and approved, it can enter into the compromise construction of
the manifest dream, so the ideas representing the libido in the
unconscious must still contend against the power of the fore-conscious
ego. The opposition that has arisen against it in the ego follows it
down by a "counter-siege" and forces it to choose such an expression as
will serve at the same time to express itself. Thus, then, the symptom
comes into being as a much distorted offshoot from the unconscious
libidinous wish-fulfillment, an artificially selected ambiguity--with
two entirely contradictory meanings. In this last point alone do we
realize a difference between dream and symptom development, for the only
fore-conscious purpose in dream formation is the maintenance of sleep,
the exclusion from consciousness of anything which may disturb sleep;
but it does not necessarily oppose the unconscious wish impulse with an
insistent "No." Quite the contrary; the purpose of the dream may be more
tolerant, because the situation of the sleeper is a less dangerous one.
The exit to reality is closed only through the condition of sleep.
You see, this evasion which the libido finds under the conditions of the
conflict is possible only by virtue of the existing fixations. When
these fixations are taken in hand by the regression, the suppression is
side-tracked and the libido, which must maintain itself under the
conditions of the compromise, is led off or gratified. By means of such
a detour by way of the unconscious and the old fixations, the libido has
at last succeeded in breaking its way through to some sort of
gratification, however extraordinarily limited this may seem and however
unrecognizable any longer as a genuine satisfaction. Now allow me to add
two further remarks concerning this final result. In the first place, I
should like you to take note of the intimate connection between the
libido and the unconscious on the one hand, and on the other of the ego,
consciousness, and reality. The connection that is evidenced here,
however, does not indicate that originally they in any way belong
together. I should like you to bear continually in mind that everything
I have said here, and all that will follow, pertains only to the symptom
development of hysterical neurosis.
Where, now, can the libido find the fixations which it must have in
order to force its way through the suppressions? In the activities and
experiences of infantile sexuality, in its abandoned component-impulses,
its childish objects which have been given up. The libido again returns
to them. The significance of this period of childhood is a double one;
on the one hand, the instinctive tendencies which were congenital in the
child first showed themselves at this time; secondly, at the same time,
environmental influences and chance experiences were first awakening his
other instincts. I believe our right to establish this bipartite
division cannot be questioned. The assertion that the innate disposition
plays a part is hardly open to criticism, but analytic experience
actually makes it necessary for us to assume that purely accidental
experiences of childhood are capable of leaving fixations of the libido.
I do not see any theoretical difficulties here. Congenital tendencies
undoubtedly represent the after-effects of the experiences of an earlier
ancestry; they must also have once been acquired; without such acquired
characters there could be no heredity. And is it conceivable that the
inheritance of such acquired characters comes to a standstill in the
very generation that we have under observation? The significance of
infantile experience, however, should not, as is so often done, be
completely ignored as compared with ancestral experiences or those of
our adult years; on the contrary, they should meet with an especial
appreciation. They have such important results because they occur in the
period of uncompleted development, and because of this very fact are in
a position to cause a traumatic effect. The researches on the mechanics
of development by Roux and others have shown us that a needle prick into
an embryonic cell mass which is undergoing division results in most
serious developmental disturbances. The same injury to a larva or a
completed animal can be borne without injury.
The libido fixation of adults, which we have referred to as
representative of the constitutional factor in the etiological
comparison of the neuroses, can be thought of, so far as we are
concerned, as divisible into two separate factors, the inherited
disposition and the tendency acquired in early childhood. We know that a
schematic representation is most acceptable to the student. Let us
combine these relations as follows:
Disposition as accidental
Cause of the determined by experiences
neurosis == libido fixation + (traumatic
element)
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+-------------------------+------------------------+
| |
Sexual constitution Infantile experience
(pre-historic experience)
The hereditary sexual constitution provides us with manifold tendencies,
varying with the special emphasis given one or the other component of
the instinct, either individually or in combination. With the factor of
infantile experience, there is again built up a complementary series
within the sexual constitution which is perfectly comparable with our
first series, namely, the gradations between disposition and the chance
experiences of the adult. Here again we find the same extreme cases and
similar relations in the matter of substitution. At this point the
question becomes pertinent as to whether the most striking regressions
of the libido, those which hark back to very early stages in sexual
organization, are not essentially conditioned by the hereditary
constitutional factor. The answer to this question, however, may best be
put off until we are in a position to consider a wider range in the
forms of neurotic disease.
Let us devote a little time to the consideration of the fact that
analytic investigation of neurotics shows the libido to be bound up with
the infantile sexual experiences of these persons. In this light they
seem of enormous importance for both the life and health of mankind.
With respect to therapeutic work their importance remains undiminished.
But when we do not take this into account we can herein readily
recognize the danger of being misled by the situation as it exists in
neurotics into adopting a mistaken and one-sided orientation toward
life. In figuring the importance of the infantile experiences we must
also subtract the influences arising from the fact that the libido has
returned to them by regression, after having been forced out of its
later positions. Thus we approach the opposite conclusion, that
experiences of the libido had no importance whatever in their own time,
but rather acquired it at the time of regression. You will remember that
we were led to a similar alternative in the discussion of the
Oedipus-complex.
A decision on this matter will hardly be difficult for us. The statement
is undoubtedly correct that the hold which the infantile experiences
have on the libido--with the pathogenic influences this involves--is
greatly augmented by the regression; still, to allow them to become
definitive would nevertheless be misleading. Other considerations must
be taken into account as well. In the first place, observation shows, in
a way that leaves no room for doubt, that infantile experiences have
their particular significance which is evidenced already during
childhood. There are, furthermore, neuroses in children in which the
factor of displacement in time is necessarily greatly minimized or is
entirely lacking, since the illness follows as an immediate consequence
of the traumatic experience. The study of these infantile neuroses keeps
us from many dangerous misunderstandings of adult neuroses, just as the
dreams of children similarly serve as the key to the understanding of
the dreams of adults. As a matter of fact, the neuroses of children are
very frequent, far more frequent than is generally believed. They are
often overlooked, dismissed as signs of badness or naughtiness, and
often suppressed by the authority of the nursery; in retrospect,
however, they may be easily recognized later. They occur most frequently
in the form of _anxiety hysteria_. What this implies we shall learn upon
another occasion. When a neurosis breaks out in later life, analysis
regularly shows that it is a direct continuation of that infantile
malady which had perhaps developed only obscurely and incipiently.
However, there are cases, as already stated, in which this childish
nervousness continues, without any interruption, as a lifelong
affliction. We have been able to analyze a very few examples of such
neuroses during childhood, while they were actually going on; much more
often we had to be satisfied with obtaining our insight into the
childhood neurosis subsequently, when the patient is already well along
in life, under conditions in which we are forced to work with certain
corrections and under definite precautions.
Secondly, we must admit that the universal regression of the libido to
the period of childhood would be inexplicable if there were nothing
there which could exert an attraction for it. The fixation which we
assume to exist towards specific developmental phases, conveys a meaning
only if we think of it as stabilizing a definite amount of libidinous
energy. Finally, I am able to remind you that here there exists a
complementary relationship between the intensity and the pathogenic
significance of the infantile experiences to the later ones which is
similar to that studied in previous series. There are cases in which the
entire causal emphasis falls upon the sexual experiences of childhood,
in which these impressions take on an effect which is unmistakably
traumatic and in which no other basis exists for them beyond what the
average sexual constitution and its immaturity can offer. Side by side
with these there are others in which the whole stress is brought to bear
by the later conflicts, and the emphasis the analysis places on
childhood impressions appears entirely as the work of regression. There
are also extremes of "retarded development" and "regression," and
between them every combination in the interaction of the two factors.
These relations have a certain interest for that pedagogy which assumes
as its object the prevention of neuroses by an early interference in the
sexual development of the child. So long as we keep our attention fixed
essentially on the infantile sexual experiences, we readily come to
believe we have done everything for the prophylaxis of nervous
afflictions when we have seen to it that this development is retarded,
and that the child is spared this type of experience. Yet we already
know that the conditions for the causation of neuroses are more
complicated and cannot in general be influenced through one single
factor. The strict protection in childhood loses its value because it is
powerless against the constitutional factor; furthermore, it is more
difficult to carry out than the educators imagine, and it brings with it
two new dangers that cannot be lightly dismissed. It accomplishes too
much, for it favors a degree of sexual suppression which is harmful for
later years, and it sends the child into life without the power to
resist the violent onset of sexual demands that must be expected during
puberty. The profit, therefore, which childhood prophylaxis can yield is
most dubious; it seems, indeed, that better success in the prevention of
neuroses can be gained by attacking the problem through a changed
attitude toward facts.
Let us return to the consideration of the symptoms. They serve as
substitutes for the gratification which has been forborne, by a
regression of the libido to earlier days, with a return to former
development phases in their choice of object and in their organization.
We learned some time ago that the neurotic is held fast somewhere in his
past; we now know that it is a period of his past in which his libido
did not miss the satisfaction which made him happy. He looks for such a
time in his life until he has found it, even though he must hark back to
his suckling days as he retains them in his memory or as he reconstructs
them in the light of later influences. The symptom in some way again
yields the old infantile form of satisfaction, distorted by the
censoring work of the conflict. As a rule it is converted into a
sensation of suffering and fused with other causal elements of the
disease. The form of gratification which the symptom yields has much
about it that alienates one's sympathy. In this we omit to take into
account, however, the fact that the patients do not recognize the
gratification as such and experience the apparent satisfaction rather as
suffering, and complain of it. This transformation is part of the
psychic conflict under the pressure of which the symptom must be
developed. What was at one time a satisfaction for the individual must
now awaken his antipathy or disgust. We know a simple but instructive
example for such a change of feeling. The same child that sucked the
milk with such voracity from its mother's breast is apt to show a strong
antipathy for milk a few years later, which is often difficult to
overcome. This antipathy increases to the point of disgust when the
milk, or any substituted drink, has a little skin over it. It is rather
hard to throw out the suggestion that this skin calls up the memory of
the mother's breast, which was once so intensely coveted. In the
meantime, to be sure, the traumatic experience of weaning has
intervened.
There is something else that makes the symptoms appear remarkable and
inexplicable as a means of libidinous satisfaction. They in no way
recall anything from which we normally are in the habit of expecting
satisfaction. They usually require no object, and thereby give up all
connection with external reality. We understand this to be a result of
turning away from fact and of returning to the predominance of
pleasurable gratification. But it is also a return to a sort of
amplified autoeroticism, such as was yielded the sex impulse in its
earliest satisfactions. In the place of a modification in the outside
world, we have a physical change, in other words, an internal reaction
in place of an external one, an adjustment instead of an activity.
Viewed from a phylogenetic standpoint, this expresses a very significant
regression. We will grasp this better when we consider it in connection
with a new factor which we are still to discover from the analytic
investigation of symptom development. Further, we recall that in symptom
formation the same processes of the unconscious have been at work as in
dream formation--elaboration and displacement. Similarly to the dream,
the symptom represents a fulfillment, a satisfaction after the manner of
the infantile; by the utmost elaboration this satisfaction can be
compressed into a single sensation or innervation, or by extreme
displacement it may be restricted to a tiny element of the entire
libidinous complex. It is no wonder that we often have difficulties in
recognizing in the symptom the libidinous satisfaction which we
anticipate and always find verified.