itself little about the actual form of the individual symptom or the
content of it; but that psycho-analysis has made this its
starting-point, and has ascertained that the symptom itself has a
meaning and is connected with experiences in the life of the patient.
The meaning of neurotic symptoms was first discovered by J. Breuer in
the study and successful cure of a case of hysteria (1880–82), which has
since then become famous. It is true that P. Janet independently reached
the same result; in fact, priority in publication must be granted to the
French investigator, for Breuer did not publish his observations until
more than a decade later (1893–95), during the period of our work
together. Incidentally, it is of no great importance to us who made the
discovery, for you know that every discovery is made more than once, and
none is made all at once, nor is success meted out according to deserts.
America is not called after Columbus. Before Breuer and Janet, the great
psychiatrist Leuret expressed the opinion that even the delusions of the
insane would prove to have some meaning, if only we knew how to
translate them. I confess that for a long time I was willing to accord
Janet very high recognition for his explanation of neurotic symptoms,
because he regarded them as expressions of “_idées inconscientes_”
possessing the patient’s mind. Since then, however, Janet has taken up
an attitude of undue reserve, as if he meant to imply that the
Unconscious had been nothing more to him than a manner of speaking, a
makeshift, _une façon de parler_, and that he had nothing “real” in
mind. Since then I have not understood Janet’s views, but I believe that
he has gratuitously deprived himself of great credit.
Neurotic symptoms then, just like errors and dreams, have their meaning
and, like these, are related to the life of the person in whom they
appear. This is an important matter which I should like to demonstrate
to you by some examples. I can merely assert, I cannot prove, that it is
so in every case; anyone observing for himself will be convinced of it.
For certain reasons though, I shall not take these examples from cases
of hysteria, but from another very remarkable form of neurosis, closely
allied in origin to the latter, about which I must say a few preliminary
words. This, which we call _the obsessional neurosis_, is not so popular
as the widely-known _hysteria_; it is, if I may so express myself, not
so noisily ostentatious, behaves more as if it were a private affair of
the patient’s, dispenses almost entirely with bodily manifestations and
creates all its symptoms in the mental sphere. The obsessional neurosis
and hysteria are the two forms of neurotic disease upon the study of
which psycho-analysis was first built up, and in the treatment of which
also our therapy celebrates its triumphs. In the obsessional neurosis,
however, that mysterious leap from the mental to the physical is absent,
and it has really become more intimately comprehensible and transparent
to us through psycho-analytic research than hysteria; we have come to
understand that it displays far more markedly certain extreme features
of the neurotic constitution.
The obsessional neurosis[45] takes this form: the patient’s mind is
occupied with thoughts that do not really interest him, he feels
impulses which seem alien to him, and he is impelled to perform actions
which not only afford him no pleasure but from which he is powerless to
desist. The thoughts (obsessions) may be meaningless in themselves or
only of no interest to the patient; they are often absolutely silly; in
every case they are the starting-point of a strained concentration of
thought which exhausts the patient and to which he yields most
unwillingly. Against his will he has to worry and speculate as if it
were a matter of life or death to him. The impulses which he perceives
within him may seem to be of an equally childish and meaningless
character; mostly, however, they consist of something terrifying, such
as temptations to commit serious crimes, so that the patient not only
repudiates them as alien, but flees from them in horror, and guards
himself by prohibitions, precautions, and restrictions against the
possibility of carrying them out. As a matter of fact he never,
literally not even once, carries these impulses into effect; flight and
precautions invariably win. What he does really commit are very
harmless, certainly trivial acts—what are termed the obsessive
actions—which are mostly repetitions and ceremonial elaborations of
ordinary everyday performances, making these common necessary
actions—going to bed, washing, dressing, going for walks, etc.—into
highly laborious tasks of almost insuperable difficulty. The morbid
ideas, impulses, and actions are not by any means combined in the same
proportions in individual types and cases of the obsessional neurosis;
on the contrary, the rule is that one or another of these manifestations
dominates the picture and gives the disease its name; but what is common
to all forms of it is unmistakable enough.
This is a mad disease, surely. I don’t think the wildest psychiatric
phantasy could have invented anything like it, and if we did not see it
every day with our own eyes we could hardly bring ourselves to believe
in it. Now do not imagine that you can do anything for such a patient by
advising him to distract himself, to pay no attention to these silly
ideas, and to do something sensible instead of his nonsensical
practices. This is what he would like himself; for he is perfectly aware
of his condition, he shares your opinion about his obsessional symptoms,
he even volunteers it quite readily. Only he simply cannot help himself;
the actions performed in an obsessional condition are supported by a
kind of energy which probably has no counterpart in normal mental life.
Only one thing is open to him—he can displace and he can exchange;
instead of one silly idea he can adopt another of a slightly milder
character, from one precaution or prohibition he can proceed to another,
instead of one ceremonial rite he can perform another. He can displace
his sense of compulsion, but he cannot dispel it. This capacity for
displacing all the symptoms, involving radical alteration of their
original forms, is a main characteristic of the disease; it is,
moreover, striking that in this condition the ‘_opposite-values_’
(_polarities_) pervading mental life appear to be exceptionally sharply
differentiated. In addition to compulsions of both positive and negative
character, doubt appears in the intellectual sphere, gradually spreading
until it gnaws even at what is usually held to be certain. All these
things combine to bring about an ever-increasing indecisiveness, loss of
energy, and curtailment of freedom; and that although the obsessional
neurotic is originally always a person of a very energetic disposition,
often highly opinionated, and as a rule intellectually gifted above the
average. He has usually attained to an agreeably high standard of
ethical development, is over-conscientious, and more than usually
correct. You may imagine that it is a sufficiently arduous task to find
one’s bearings in this maze of contradictory character-traits and morbid
manifestations. At the moment our aim is merely to interpret some
symptoms of this disease.
Perhaps in view of our previous discussions you would like to know what
present-day psychiatry has to offer concerning the obsessional neurosis;
it is but a miserable contribution, however. Psychiatry has given names
to the various compulsions; and has nothing more to say about them. It
asserts instead that persons exhibiting these symptoms are “degenerate.”
That is not much satisfaction to us; it is no more than an estimate of
their value, a condemnation instead of an explanation. We are intended,
I suppose, to conclude that deterioration from type would naturally
produce all kinds of oddities in people. Now, we do believe that people
who develop such symptoms must be somewhat different in type from other
human beings; but we should like to know whether they are more
“degenerate” than other nervous patients, than hysterical or insane
people. The characterization is clearly again much too general. One may
even doubt whether it is justified at all when one learns that such
symptoms occur in men and women of exceptional ability who have left
their mark on their generation. Thanks to their own discretion and the
untruthfulness of biographers we usually learn very little of an
intimate nature about our exemplary great men; but it does happen
occasionally that one of them is a fanatic about truth like Émile
Zola,[46] and then we hear of the many extraordinary obsessive habits
from which he suffered throughout life.
Psychiatry has got out of this difficulty by dubbing these people
“_dégénerés superieurs_.” Very well; but psycho-analysis has shown that
these extraordinary obsessional symptoms can be removed permanently,
like the symptoms of other diseases, and as in other people who are not
degenerate. I myself have frequently succeeded in doing so.
I shall only give you two examples of analysis of obsessional symptoms;
one is an old one, but I have never found a better; and one is a recent
one. I shall limit myself to these two because an account of this kind
must be very explicit and go into great detail.
A lady of nearly thirty years of age suffered from very severe
obsessional symptoms. I might perhaps have been able to help her if my
work had not been destroyed by the caprice of fate—perhaps I shall tell
you about it later. In the course of a day she would perform the
following peculiar obsessive act, among others, several times over. She
would run out of her room into the adjoining one, there take up a
certain position at the table in the centre of the room, ring for her
maid, give her a trivial order or send her away without, and then run
back again. There was certainly nothing very dreadful about this, but it
might well arouse curiosity. The explanation presented itself in the
simplest and most unexceptionable manner, without any assistance on the
part of the analyst. I cannot imagine how I could even have suspected
the meaning of this obsession or could possibly have suggested an
interpretation for it. Every time I had asked the patient, “Why do you
do this? What is the meaning of it?” she had answered, “I don’t know.”
But one day, after I had succeeded in overcoming a great hesitation on
her part, involving a matter of principle, she suddenly did know, for
she related the history of the obsessive act. More than ten years
previously she had married a man very much older than herself, who had
proved impotent on the wedding-night. Innumerable times on that night he
had run out of his room into hers in order to make the attempt, but had
failed every time. In the morning he had said angrily: “It’s enough to
disgrace one in the eyes of the maid who does the beds,” and seizing a
bottle of red ink which happened to be at hand he poured it on the
sheet, but not exactly in the place where such a mark might have been.
At first I did not understand what this recollection could have to do
with the obsessive act in question; for I could see no similarity
between the two situations, except in the running from one room into the
other, and perhaps also in the appearance of the servant on the scene.
The patient then led me to the table in the adjoining room, where I
found a great mark on the table-cover. She explained further that she
stood by the table in such a way that when the maid came in she could
not miss seeing this mark. After this, there could no longer be any
doubt about the connection between the current obsessive act and the
scene of the wedding-night, though there was still a great deal to learn
about it.
It was clear, first of all, that the patient identified herself with her
husband; in imitating his running from one room into another she acted
his part. To keep up the similarity we must assume that she has
substituted the table and table-cover for the bed and sheet. This might
seem too arbitrary; but then we have not studied dream-symbolism in
vain. In dreams a table is very often found to represent a bed. “Bed and
board” together mean marriage, so that the one easily stands for the
other.
All this would be proof enough that the obsessive act is full of
meaning; it _seems_ to be a representation, a repetition of that
all-important scene. But we are not bound to stop at this semblance; if
we investigate more closely the relation between the two situations we
shall probably find out something more, the purpose of the obsessive
act. The kernel of it evidently lies in the calling of the maid, to whom
she displays the mark, in contrast to her husband’s words: “It’s enough
to disgrace one before the servant.” In this way he, whose part she is
playing, is _not_ ashamed before the servant, the stain is where it
ought to be. We see therefore that she has not simply repeated the
scene, she has continued it and corrected it, transformed it into what
it ought to have been. This implies something else, too, a correction of
the circumstance which made that night so distressing, and which made
the red ink necessary: namely, the husband’s impotence. The obsessive
act thus says: “No, it is not true, he was not disgraced before the
servant, he was not impotent.” As in a dream she represents this wish as
fulfilled, in a current obsessive act, which serves the purpose of
restoring her husband’s credit after that unfortunate incident.
Everything else which I could tell you about this lady fits in with
this, or, more correctly stated, everything else that we know about her
points to this interpretation of the obsessive act, in itself so
incomprehensible. She had been separated from her husband for years and
was trying to make up her mind to divorce him legally. But there would
have been no prospect of being free from him in her mind; she forced
herself to be true to him. She withdrew from the world and from everyone
so that she might not be tempted, and in her phantasies she excused and
idealized him. The deepest secret of her illness was that it enabled her
to shield him from malicious gossip, to justify her separation from him,
and to make a comfortable existence apart from her possible for him. The
analysis of a harmless obsessive act thus leads straight to the inmost
core of the patient’s disease, and at the same time betrays a great deal
of the secret of the obsessional neurosis in general. I am quite willing
that you should spend some time over this example, for it unites
conditions which cannot reasonably be expected in all cases. The
interpretation of the symptom was discovered by the patient herself in a
flash, without guidance or interference from the analyst, and it had
arisen in connection with an event which did not belong, as it commonly
does, to a forgotten period in childhood, but which had occurred in the
patient’s adult life and was clear in her memory. All those objections
which critics habitually raise against our interpretations of symptoms
are quite out of place here. To be sure, we cannot always be so
fortunate.
And one thing more! Has it not struck you that this innocent obsessive
act leads directly to this lady’s most private affairs? A woman can
hardly have anything more intimate to relate than the story of her
wedding-night; and is it by chance and without special significance that
we are led straight to the innermost secrets of her sexual life? It
might certainly be due to the choice I made of this example. Let us not
decide this point too quickly; but let us turn to the second example,
which is of a totally different nature, and belongs to a very common
type, that of rituals preparatory to sleep.
A well-grown clever girl of 19, the only child of her parents, superior
to them in education and intellectual activity, was a wild,
high-spirited child, but of late years had become very nervous without
any apparent cause. She was very irritable, particularly with her
mother, was discontented and depressed, inclined to indecision and
doubt, finally confessing that she could no longer walk alone through
squares and wide streets. We will not go very closely into her
complicated condition, which requires at least two diagnoses:
agoraphobia and obsessional neurosis; but will turn our attention to the
ritual elaborated by this young girl preparatory to going to bed, as a
result of which she caused her parents great distress. In a certain
sense, every normal person may be said to carry out a ritual before
going to sleep, or at least, he requires certain conditions without
which he is hindered in going to sleep; the transition from waking life
to sleep has been made into a regular formula which is repeated every
night in the same manner. But everything that a healthy person requires
as a condition of sleep can be rationally explained, and if the external
circumstances make any alteration necessary he adapts himself easily to
it without waste of time. The morbid ritual on the other hand is
inexorable, it will be maintained at the greatest sacrifices; it is
disguised, too, under rational motives and appears superficially to
differ from the normal only in a certain exaggerated carefulness of
execution. On a closer examination, however, it is clear that the
disguise is insufficient, that the ritual includes observances which go
far beyond what reason can justify and even some which directly
contravene this. As the motive of her nightly precautions, our patient
declares that she must have silence at night and must exclude all
possibility of noise. She does two things for this purpose; she stops
the large clock in her room and removes all other clocks out of the
room, including even the tiny wrist-watch on her bed-table. Flower-pots
and vases are placed carefully together on the writing-table, so that
they cannot fall down in the night and break, and so disturb her sleep.
She knows that these precautions have only an illusory justification in
the demand for quiet; the ticking of the little watch could not be
heard, even if it lay on the table by the bed; and we all know that the
regular ticking of a pendulum-clock never disturbs sleep, but is more
likely to induce it. She also admits that her fear that the flower-pots
and vases, if left in their places at night, might fall down of
themselves and break is utterly improbable. For some other practices in
her ritual this insistence upon silence as a motive is dropped; indeed,
by ordaining that the door between her bedroom and that of her parents
shall remain half-open (a condition which she ensures by placing various
objects in the doorway) she seems, on the contrary, to open the way to
sources of noise. The most important observances are concerned with the
bed itself, however. The bolster at the head of the bed must not touch
the back of the wooden bedstead. The pillow must lie across the bolster
exactly in a diagonal position and in no other; she then places her head
exactly in the middle of this diamond, lengthways. The eiderdown must be
shaken before she puts it over her, so that all the feathers sink to the
foot-end; she never fails, however, to press this out and redistribute
them all over it again.
I will pass over other trivial details of her ritual; they would teach
us nothing new and lead us too far from our purpose. Do not suppose,
though, that all this is carried out with perfect smoothness. Everything
is accompanied by the anxiety that it has not all been done properly; it
must be tested and repeated; her doubts fix first upon one, then
another, of the precautions; and the result is that one or two hours
elapse before the girl herself can sleep, or lets the intimidated
parents sleep.
The analysis of these torments did not proceed so simply as that of the
former patient’s obsessive act. I had to offer hints and suggestions of
its interpretation which were invariably received by her with a positive
denial or with scornful doubt. After this first reaction of rejection,
however, there followed a period in which she herself took up the
possibilities suggested to her, noted the associations they aroused,
produced memories, and established connections until she herself had
accepted all the interpretations in working them out for herself. In
proportion as she did this she began to relax the performance of her
obsessive precautions and before the end of the treatment she had given
up the whole ritual. I must also tell you that analytic work, as we
conduct it nowadays, definitely excludes any uninterrupted concentration
on a single symptom until its meaning becomes fully clear. It is
necessary, on the contrary, to abandon a given theme again and again, in
the assurance that one will come upon it anew in another context. The
interpretation of the symptom, which I am now going to tell you, is
therefore a synthesis of the results which, amid the interruptions of
work on other points, took weeks and months to procure.
The patient gradually learnt to understand that she banished clocks and
watches from her room at night because they were symbols of the female
genitals. Clocks, which we know may have other symbolic meanings besides
this, acquire this significance of a genital organ by their relation to
periodical processes and regular intervals. A woman may be heard to
boast that menstruation occurs in her as regularly as clockwork. Now
this patient’s special fear was that the ticking of the clocks would
disturb her during sleep. The ticking of a clock is comparable to the
throbbing of the clitoris in sexual excitation. This sensation, which
was distressing to her, had actually on several occasions wakened her
from sleep; and now her fear of an erection of the clitoris expressed
itself by the imposition of a rule to remove all going clocks and
watches far away from her during the night. Flower-pots and vases are,
like all receptacles, also symbols of the female genitals. Precautions
to prevent them from falling and breaking during the night are therefore
not lacking in meaning. We know the very widespread custom of breaking a
vessel or a plate on the occasion of a betrothal; everyone present
possesses himself of a fragment in symbolic acceptance of the fact that
he may no longer put forward any claims to the bride, presumably a
custom which arose with monogamy. The patient also contributed a
recollection and several associations to this part of her ritual. Once
as a child she had fallen while carrying a glass or porcelain vessel,
and had cut her finger which had bled badly. As she grew up and learnt
the facts about sexual intercourse, she developed the apprehension that
on her wedding-night she would not bleed and so would prove not to be a
virgin. Her precautions against the vases breaking signified a rejection
of the whole complex concerned with virginity and with the question of
bleeding during the first act of intercourse; a rejection of the anxiety
both that she would bleed and that she would not bleed. These
precautions were in fact only remotely connected with the prevention of
noise.
One day she divined the central idea of her ritual when she suddenly
understood her rule not to let the bolster touch the back of the bed.
The bolster had always seemed a woman to her, she said, and the upright
back of the bedstead a man. She wished therefore, by a magic ceremony,
as it were, to keep man and woman apart; that is to say, to separate the
parents and prevent intercourse from occurring. Years before the
institution of her ritual, she had attempted to achieve this end by a
more direct method. She had simulated fear, or had exploited a tendency
to fear, so that the door between her bedroom and that of her parents
should not be closed. This regulation was still actually included in her
present ritual; in this way she managed to make it possible to overhear
her parents; a proceeding which at one time had caused her months of
sleeplessness. Not content with disturbing her parents in this way, she
at that time even succeeded occasionally in sleeping between the father
and mother in their bed. “Bolster” and “bedstead” were then really
prevented from coming together. As she finally grew too big to be
comfortable in the same bed with the parents, she achieved the same
thing by consciously simulating fear and getting her mother to change
places with her and to give up to her her place by the father. This
incident was undoubtedly the starting-point of phantasies, the effect of
which was evident in the ritual.