psycho-analytic point of view which I shall lay before you is a
speculative system of ideas. On the contrary, it is the result of
experience, being founded either on direct observations or on
conclusions drawn from observation. Whether these have been drawn in an
adequate or a justifiable manner future advances in science will show;
after nearly two and a half decades and now that I am fairly well
advanced in years I may say, without boasting, that it was particularly
difficult, intense, and all-absorbing work that yielded these
observations. I have often had the impression that our opponents were
unwilling to consider this source of our statements, as if they looked
upon them as ideas derived subjectively which anyone could dispute at
his own sweet will. This attitude on the part of my opponents is not
quite comprehensible to me. Perhaps it comes from the circumstance that
physicians pay so little attention to neurotics and listen so carelessly
to what they say that it has become impossible for them to perceive
anything in the patients’ communications or to make detailed
observations from them. I will take this opportunity of assuring you
that in these lectures I shall make few controversial references, least
of all to individuals. I have never been able to convince myself of the
truth of the saying that “strife is the father of all things.” I think
the source of it was the philosophy of the Greek sophists and that it
errs, as does the latter, through the over estimation of dialectics. It
seems to me, on the contrary, that scientific controversy, so-called, is
on the whole quite unfruitful, apart from the fact that it is almost
always conducted in a highly personal manner. Until a few years ago I
could boast that I had only once been engaged in a regular scientific
dispute, and that with one single investigator, Löwenfeld of Munich. The
end of it was that we became friends and have remained so to this day.
But I did not repeat the experiment for a very long time because I was
not certain that the outcome would be the same.
Now you will surely judge that a refusal of this kind to discuss matters
publicly points to a high degree of inaccessibility to criticism, to
obstinacy, or, in the polite colloquialism of the scientific world, to
“pig-headedness.”[43] My reply to you would be that, should you have
arrived at a conviction by means of such hard work, you would also
thereby derive a certain right to maintain it with some tenacity.
Further, on my own behalf, I can say that in the course of my work I
have modified my views on important points, changed them or replaced
them by others, and have of course in each case published the fact. What
has been the result of this frankness? Some people have ignored my
corrections of myself altogether and still to-day criticize me in
respect of views which no longer mean the same to me. Others positively
reproach me for these changes and declare me to be unreliable on that
account. No one who changes his views once or twice deserves to be
believed, for it is only too likely that he will be mistaken again in
his latest assertions; but anyone who sticks to anything he has once
said, or refuses to give way upon it easily enough, is obstinate or
pig-headed; is it not so? What is to be done in the face of these
self-contradictory criticisms except to remain as one is and behave as
seems best to one? This is what I decided to do; and I am not deterred
from remodelling and improving my theories in accordance with later
experience. I have so far found nothing to alter in my fundamental
standpoint and I hope this will never be necessary.
So now I have to lay before you the psycho-analytic theory of neurotic
manifestations. For this purpose it will be simplest, on account of both
the analogy and the contrast, to take an example which links up with the
phenomena we have already considered. I will take a ‘symptomatic act’
which I see many people commit in my own consulting-room. The analyst
has little to offer to the people who come to a physician’s
consulting-room for half-an-hour to recount the lifelong misery of their
fate. His deeper comprehension makes it difficult for him to give, as
another might, the opinion that there is nothing wrong with them and
that they had better take a light course of hydrotherapy. One of our
colleagues once replied, with a shrug, when asked how he dealt with
consultation patients, that he “fined them so many crowns for ‘wasting
the time of the court.’” You will therefore not be surprised to hear
that even the busiest psycho-analysts are not much sought after for
consultations. I have had the ordinary door between the waiting-room and
my consulting-room supplemented by another door and covered with felt.
The reason for this is obvious. Now it constantly happens when I admit
people from the waiting-room that they omit to close these doors,
leaving even both doors open behind them. When I see this happen, I at
once, with some stiffness, request him or her to go back and make good
the omission, no matter how fine a gentleman he may be nor how many
hours she had spent on her toilet. My action gives the impression of
being uncalled-for and pedantic; occasionally too I have found myself in
the wrong, when the person turned out to be one of those who cannot
themselves grasp a door-handle and are glad when those with them avoid
it. But in the majority of cases I was right, for anyone who behaves in
this way and leaves the door of a physician’s consulting-room open into
the waiting-room belongs to the rabble and deserves to be received with
coldness. Now don’t allow yourselves to be biassed before you have heard
the rest. This omission on the part of a patient occurs only when he has
been waiting alone in the outer room and thus leaves an empty room
behind him, never when others, strangers to him, have also been waiting
there. In the latter case he knows very well that it is to his own
interest not to be overheard while he talks to the physician and he
never neglects to close both doors carefully.
Occurring in this way, the patient’s omission is neither accidental nor
meaningless, and not even unimportant, for it betrays the visitor’s
attitude to the physician. He belongs to that large class who seek those
in high places, and wish to be dazzled and intimidated. Perhaps he had
made enquiries by telephone at what time he would be most likely to gain
admittance and had been expecting to find a crowd of applicants in a
queue, as if at the grocer’s in war-time. Then he is shown into an empty
room which, moreover, is most modestly furnished, and he is dumbfounded.
He must somehow make the physician atone for the superfluous respect he
had been prepared to show him; and so he omits to close the doors
between the waiting- and the consulting-rooms. He intends this to mean:
“Pooh! there is no one here and I daresay there won’t be, however long I
stay!” He would behave during the interview in an uncivil and
supercilious manner, too, if his presumption were not curbed at the
outset by a sharp reminder.
In the analysis of this little symptomatic act you find nothing that is
not already known to you; namely, the conclusion that it is no accident
but has in it motive, meaning, and intention; that it belongs to a
mental context which can be specified; and that it provides a small
indication of a more important mental process. But above all it implies
that the process thus indicated is not known to the consciousness of the
person who carries it out; for not one of the patients who left the two
doors open would have admitted that he wished to show any depreciation
of me by his neglect. Many of them could probably recall a sense of
disappointment on entering the empty waiting-room, but the connection
between this impression and the succeeding symptomatic act certainly
remained outside their consciousness.
Now let us place this little analysis of a symptomatic act by the side
of an observation made on a patient. I will choose one which is fresh in
my memory, and also because it can be described in comparatively few
words. A certain amount of detail is indispensable for any such account.
A young officer, home on short leave of absence, asked me to treat his
mother-in-law, who was living in the happiest surroundings and yet was
embittering her own and her family’s lives by a nonsensical idea. I
found her a well-preserved lady, fifty-three years of age, of a
friendly, simple disposition, who gave without hesitation the following
account of herself. She is most happily married, and lives in the
country with her husband who manages a large factory. She cannot say
enough of her husband’s kindness and consideration; theirs had been a
love-marriage thirty years ago, since when they had never had a cloud, a
quarrel, or a moment’s jealousy. Her two children have both married
well, but her husband’s sense of duty keeps him still at work. A year
before, an incredible and, to her, incomprehensible thing happened. She
received an anonymous letter telling her that her excellent husband was
carrying on an intrigue with a young girl, and believed it on the
spot—since then her happiness has been destroyed. The details were more
or less as follows: she had a housemaid with whom she discussed
confidential matters, perhaps rather too freely. This young woman
cherished a positively venomous hatred for another girl who had
succeeded better in life than herself, although of no better origin.
Instead of going into service, the other young woman had had a
commercial training, been taken into the factory and, owing to vacancies
caused by the absence of staff on service in the field, had been
promoted to a good position. She lived in the factory, knew all the
gentlemen, and was even addressed as “Miss.” The other one who had been
left behind in life was only too ready to accuse her former schoolmate
of all possible evil. One day our patient and her housemaid were
discussing an elderly gentleman who had visited the house and of whom it
was said that he did not live with his wife but kept a mistress. Why,
she did not know, but she suddenly said: “I cannot imagine anything more
awful than to hear that my husband had a mistress.” The next day she
received by post an anonymous letter in disguised handwriting which
informed her of the very thing she had just imagined. She
concluded—probably correctly—that the letter was the handiwork of her
malicious housemaid, for the woman who was named as the mistress of her
husband was the very girl who was the object of this housemaid’s hatred.
Although she at once saw through the plot and had seen enough of such
cowardly accusations in her own surroundings to place little credence in
them, our patient was nevertheless prostrated by this letter. She became
terribly excited and at once sent for her husband to overwhelm him with
reproaches. The husband laughingly denied the accusation and did the
best thing he could. He sent for the family physician (who also attended
the factory), and he did his best to calm the unhappy lady. The next
thing they did was also most reasonable. The housemaid was dismissed,
but not the supposed mistress. From that time on the patient claims to
have repeatedly brought herself to a calm view of the matter, so that
she no longer believes the contents of the letter; but it has never gone
very deep nor lasted very long. It was enough to hear the young woman’s
name mentioned, or to meet her in the street, for a new attack of
suspicion, agony, and reproaches to break out.
This is the clinical picture of this excellent woman’s case. It did not
require much experience of psychiatry to perceive that, in contrast to
other neurotics, she described her symptoms too mildly—as we say,
dissimulated them—and that she had never really overcome her belief in
the anonymous letter.
Now what attitude does a psychiatrist take up to such a case? We know
already what he would say to the symptomatic act of a patient who does
not close the waiting-room doors. He explains it as an accident, without
interest psychologically, and no concern of his. But he cannot continue
to take up this attitude in regard to the case of the jealous lady. The
symptomatic action appears to be unimportant; the symptom calls for
notice as a grave matter. Subjectively it involves intense suffering,
and objectively it threatens to break up a family; its claim to
psychiatric interest is therefore indisputable. First the psychiatrist
tries to characterize the symptom by some essential attribute. The idea
with which this lady torments herself cannot be called nonsensical in
itself; it does happen that elderly husbands contract relationships with
young women. But there is something else about it that is nonsensical
and incomprehensible. The patient has absolutely no grounds, except the
anonymous letter, for supposing that her loving and faithful husband
belongs to this category of men, otherwise not so uncommon. She knows
that this communication carries no proof, she can explain its origin
satisfactorily; she ought therefore to be able to say to herself that
she has no grounds for her jealousy and she does even say so, but she
suffers just as much as if she regarded her jealousy as well-founded.
Ideas of this kind that are inaccessible to logic and the arguments of
reality are unanimously described as _delusions_. The good lady suffers
therefore, from a _delusion of jealousy_. That is evidently the
essential characteristic of the case.
Having established this first point, our psychiatric interest increases.
When a delusion cannot be dissipated by the facts of reality, it
probably does not spring from reality. Where else then does it spring
from? Delusions can have the most various contents; why is the content
of it in this case jealousy? What kind of people have delusions, and
particularly delusions of jealousy? Now we should like to listen to the
psychiatrist, but he leaves us in the lurch here. He considers only one
of our questions. He will examine the family history of this woman and
will _perhaps_ bring us the answer that the kind of people who suffer
from delusions are those in whose families similar or different
disorders have occurred repeatedly. In other words, this lady has
developed a delusion because she had an hereditary predisposition to do
so. That is certainly something; but is it all that we want to know? Is
it the sole cause of her disease? Does it satisfy us to assume that it
is unimportant, arbitrary, or inexplicable that one kind of delusion
should have been developed instead of another? And are we to understand
the proposition—that the hereditary predisposition is decisive—also in a
negative sense; that is, that no matter what experiences and emotions
life had brought her she was destined some time or other to produce a
delusion? You will want to know why scientific psychiatry gives no
further explanation. And I reply: “Only a rogue gives more than he has.”
The psychiatrist knows of no path leading to any further explanation in
such a case. He has to content himself with a diagnosis and, in spite of
wide experience, with a very uncertain prognosis of its future course.
Now can psycho-analysis do better than this? Yes, certainly I hope to
show you that even in such an obscure case as this it is possible to
discover something which makes closer comprehension possible. First, I
shall ask you to notice this incomprehensible detail; that the anonymous
letter on which her delusion is founded was positively provoked by the
patient herself, by her saying to the scheming housemaid the day before
that nothing could be more awful than to hear that her husband had an
intrigue with a young woman. She first put the idea of sending the
letter into the servant’s mind by this. So the delusion acquires a
certain independence of the letter; it existed beforehand as a fear—or,
as a wish?—in her mind. Besides this, the further small indications
revealed in the bare two hours of analysis are noteworthy. The patient
responded very coldly, it is true, to the request to tell me her further
thoughts, ideas, and recollections, after she had finished her story.
She declared that nothing came to her mind, she had told me everything;
and after two hours the attempt had to be given up, because she
announced that she felt quite well already and was certain that the
morbid idea would not return. Her saying this was naturally due to
resistance and to the fear of further analysis, In these two hours she
had let fall some remarks, nevertheless, which made a certain
interpretation not only possible but inevitable, and this interpretation
threw a sharp light on the origin of the delusion of jealousy. There
actually existed in her an infatuation for a young man, for the very
son-in-law who had urged her to seek my assistance. Of this infatuation
she herself knew nothing or only perhaps very little; in the
circumstances of their relationship it was easily possible for it to
disguise itself as harmless tenderness on her part. After what we have
already learnt it is not difficult to see into the mind of this good
woman and excellent mother. Such an infatuation, such a monstrous,
impossible thing, could not come into her conscious mind; it persisted,
nevertheless, and unconsciously exerted a heavy pressure. Something had
to happen, some sort of relief had to be found; and the simplest
alleviation lay in that mechanism of displacement which so regularly
plays its part in the formation of delusional jealousy. If not merely
she, old woman that she was, were in love with a young man, but if only
her old husband too were in love with a young mistress, then her
torturing conscience would be absolved from the infidelity. The phantasy
of her husband’s infidelity was thus a cooling balm on her burning
wound. Of her own love she never became conscious; but its reflection in
the delusion, which brought such advantages, thus became compulsive,
delusional and conscious. All arguments against it could naturally avail
nothing; for they were directed only against the reflection, and not
against the original to which its strength was due and which lay buried
out of reach in the Unconscious.
Let us now piece together the results of this short, obstructed
psycho-analytic attempt to understand this case. It is assumed of course
that the information acquired was correct, a point which I cannot submit
to your judgement here. First of all, the delusion is no longer
senseless and incomprehensible; it is sensible, logically motivated, and
has its place in connection with an affective experience of the
patient’s. Secondly, it has arisen as a necessary reaction to another
mental process which has itself been revealed by other indications; and
it owes its delusional character, its quality of resisting real and
logical objections, to this relation with this other mental process. It
is something desired in itself, a kind of consolation. Thirdly, the fact
that the delusion is one of jealousy and no other is unmistakably
determined by the experience underlying the disease. You will also
recognize the two important analogies with the symptomatic act we
analysed; namely, the discovery of the sense or intention behind the
symptom and the relation of it to something in the given situation which
is unconscious.
This does not, of course, answer all the questions arising out of this
case. On the contrary, it bristles with further problems, some of which
have not yet proved soluble at all, while others cannot be solved owing
to the unfavourable circumstances met with in this case. For instance,
why does this happily-married lady fall in love with her son-in-law, and
why does relief come to her in the form of this kind of reflection, this
projection of her own state of mind on to her husband, when other forms
of relief were also possible? Do not think that it is idle and
uncalled-for to propound these questions. We have already a good deal of
material at hand to provide possible answers. The patient had come to
that critical time of life which brings a sudden and unwelcome increase
of sexual desire to a woman; that may have been sufficient in itself. Or
there may have been an additional reason, in that the sexual capacity of
her excellent and faithful husband may have been for some years
insufficient for the still vigorous woman’s needs. Observation has
taught us that it is just such men, whose fidelity is thus a matter of
course, who treat their wives with particular tenderness and are
unusually considerate of their nervous ailments. Neither is it
unimportant, moreover, that the object of this abnormal infatuation
should be her daughter’s young husband. A strong erotic attachment to
the daughter, with its roots in the individual sexual constitution of
the mother, often manages to maintain itself in such a transformation. I
may perhaps remind you in this connection that the relation between
mother-in-law and son-in-law has from time immemorial been regarded by
mankind as a particularly sensitive one, which among primitive races has
given rise to very powerful taboos and precautions.[44] On the positive
as well as on the negative side it frequently exceeds the limits
regarded as desirable in civilized society. Of these three possible
factors, whether one of them has been at work in the case before us, or
two of them, or whether all three together have taken part, I cannot
tell you; though only because the analysis of the case could not be
continued beyond the second hour.
I perceive now that I have been speaking entirely of things which you
were not yet prepared to understand. I did so in order to carry out the
comparison between psychiatry and psycho-analysis. But I may ask you one
thing at this point: Have you observed anything in the nature of a
contradiction between the two? Psychiatry does not employ the technical
methods of psycho-analysis, neglects any consideration of the content of
the delusion, and in pointing to heredity gives us but a general and
remote ætiology instead of first disclosing the more specific and
immediate one. But is any contradiction or opposition contained in this?
Is not the one rather a supplement to the other? Is the hereditary
factor inconsistent with the importance of experience and would they not
both work together most effectively? You will admit that there is
nothing essential in the work of psychiatry which could oppose
psycho-analytic researches. It is therefore the psychiatrists who oppose
it, and not psychiatry itself. Psycho-Analysis stands to psychiatry more
or less as histology does to anatomy; in one, the outer forms of organs
are studied, in the other, the construction of these out of the tissues
and constituent elements. It is not easy to conceive of any
contradiction between these two fields of study, in which the work of
the one is continued in the other. You know that nowadays anatomy is the
basis of the scientific study of medicine; but time was when dissecting
human corpses in order to discover the internal structure of the body
was as much a matter for severe prohibition as practising
psycho-analysis in order to discover the internal workings of the human
mind seems to-day to be a matter for condemnation. And, presumably at a
not too distant date, we shall have perceived that there can be no
psychiatry which is scientifically radical without a thorough knowledge
of the deep-seated unconscious processes in mental life.
There may be some of you who perhaps are friendly enough towards
psycho-analysis, often attacked as it is, to wish that it would justify
itself in another direction also, that is, therapeutically. You know
that psychiatric therapy has hitherto been unable to influence
delusions. Can psycho-analysis do so perhaps, by reason of its insight
into the mechanism of these symptoms? No, I have to tell you that it
cannot; for the present, at any rate, it is just as powerless as any
other therapy to heal these sufferers. It is true that we can understand
what has happened to the patient; but we have no means by which we can
make him understand it himself. You have heard that I could not continue
the analysis of this delusion beyond the first preliminaries. Would you
then maintain that analysis of such cases is undesirable because it
remains fruitless? I do not think so. It is our right, yes, and our
duty, to pursue our researches without respect to the immediate gain
effected. The day will come, where and when we know not, when every
little piece of knowledge will be converted into power, and into
therapeutic power. Even if psycho-analysis showed itself as unsuccessful
with all other forms of nervous and mental diseases as with delusions,
it would still remain justified as an irreplaceable instrument of
scientific research. It is true that we should not be in a position to
practise it; the human material on which we learn lives, and has its own
will, and must have its own motives in order to participate in the work;
and it would then refuse to do so. I will therefore close my lecture for
to-day by telling you that there are large groups of nervous
disturbances for which this conversion of our own advance in knowledge
into therapeutic power has actually been carried out; and that with
these diseases, otherwise so refractory, our measures yield, under
certain conditions, results which give place to none in the domain of
medical therapy.
SEVENTEENTH LECTURE
THE MEANING OF SYMPTOMS