the feathers were at the bottom, making a protuberance there, also had a
meaning. It meant impregnating a woman; she did not neglect, though, to
obliterate the pregnancy again, for she had for years been terrified
that intercourse between her parents might result in another child and
present her with a rival. On the other hand, if the large bolster meant
the mother then the small pillow could only represent the daughter. Why
had this pillow to be placed diamond-wise upon the bolster and her head
be laid exactly in its middle lengthways? She was easily reminded that a
diamond is repeatedly used in drawings on walls to signify the open
female genitals. The part of the man (the father) she thus played
herself and replaced the male organ by her own head. (Cf. Symbolism of
beheading for castration.)
Horrible thoughts, you will say, to run in the mind of a virgin girl. I
admit that; but do not forget that I have not invented these ideas, only
exposed them. A ritual of this kind before sleep is also peculiar
enough, and you cannot deny the correspondence, revealed by the
interpretation, between the ceremonies and the phantasies. It is more
important to me, however, that you should notice that the ritual was the
outcome, not of one single phantasy, but of several together which of
course must have had a nodal point somewhere. Note, too, that the
details of the ritual reflect the sexual wishes both positively and
negatively, and serve in part as expressions of them, in part as
defences against them.
It would be possible to obtain much more out of the analysis of this
ritual by bringing it into its place in connection with the patient’s
other symptoms. But that is not our purpose at the moment. You must be
content with a reference to an erotic attachment to the father,
originating very early in childhood, which had enslaved this girl. It
was perhaps for this reason that she was so unfriendly towards her
mother. Also we cannot overlook the fact that the analysis of this
symptom has again led to the patient’s sexual life. The more insight we
gain into the meaning and purpose of neurotic symptoms, the less
surprising will this seem.
From two selected examples I have now shown you that neurotic symptoms
have meaning, like errors and like dreams, and that they are closely
connected with the events of the patient’s life. Can I expect you to
believe this exceptionally significant statement on the strength of two
examples? No. But can you expect me to go on quoting examples to you
until you declare yourselves convinced? Again, no; for in view of the
explicit treatment given to each individual case I should have to devote
five hours a week for a whole term to the consideration of this one
point in the theory of the neuroses. I will content myself therefore
with the samples given, as evidence of my statement; and will refer you
for more to the literature on the subject, to the classical
interpretation of symptoms in Breuer’s first case (hysteria), to the
striking elucidations of very obscure symptoms in dementia præcox,
so-called, made by C. G. Jung at a time when this investigator was a
mere psycho-analyst and did not yet aspire to be a prophet, and to all
the subsequent contributions with which our periodicals have been filled
since then. Precisely this type of investigation is plentiful. Analysis,
interpretation, and translation of neurotic symptoms has proved so
attractive to psycho-analysts that in comparison they have temporarily
neglected the other problems of the neuroses.
Anyone of you who makes the necessary effort to look up this question
will certainly be strongly impressed by the wealth of evidential
material. But he will also meet with a difficulty. The meaning of a
symptom lies, as we have seen, in its connection with the life of the
patient. The more individually the symptom has been formed, the more
clearly may we expect to establish this connection. Then the task
resolves itself specifically into a discovery, for every nonsensical
idea and every useless action, of the past situation in which the idea
was justified and the action served a useful purpose. The obsessive act
of the patient who ran to the table and rang for the maid is a perfect
model of this kind of symptom. But symptoms of quite a different type
are very frequently seen. They are what we call _typical_ symptoms of a
disease, in each case they are practically identical, the individual
differences in them vanish or at least fade away, so that it is
difficult to connect them with the patient’s life or to relate them to
special situations in his past. Let us consider the obsessional neurosis
again. The second patient’s ceremonies preparatory to sleep are in many
ways quite typical, although showing enough individual features as well
to make an “historical” interpretation, so to speak, possible. But all
obsessional patients are given to repetitions, to isolating certain of
their actions and to rhythmic performances. Most of them wash too much.
Those patients who suffer from agoraphobia (topophobia, fear of space),
no longer reckoned as an obsessional neurosis but now classified as
anxiety-hysteria, reproduce the same features of the pathological
picture often with fatiguing monotony. They fear enclosed spaces, wide,
open squares, long stretches of road, and avenues; they feel protected
if accompanied, or if a vehicle drives behind them, and so on.
Nevertheless, on this groundwork of similarity the various patients
construct individual conditions of their own, moods, one might call
them, which directly contrast with other cases. One fears narrow streets
only, another wide streets only, one can walk only when few people are
about, others only when surrounded with people. Similarly in hysteria,
beside the wealth of individual features there are always plenty of
common typical symptoms which appear to resist an easy interpretation on
historical lines. Do not let us forget that it is these typical symptoms
which enable us to take our bearings in forming a diagnosis. Supposing
we do trace back a typical symptom in a case of hysteria to an
experience or to a chain of similar experiences (for instance, an
hysterical vomiting to a series of impressions of a disgusting nature),
it will be confusing to discover in another case of vomiting an entirely
dissimilar series of apparently causative experiences. It almost looks
as though hysterical patients must vomit, for some unknown reason, and
as though the historical factors revealed by analysis were but pretexts,
seized upon by an inner necessity, when opportunity offered, to serve
its purpose.
This brings us to the discouraging conclusion that although individual
forms of neurotic symptoms can certainly be satisfactorily explained by
their relation to the patient’s experiences, yet our science fails us
for the far more frequent typical symptoms in the same cases. In
addition to this, I have not nearly explained to you all the
difficulties that arise during a resolute pursuit of the historical
meaning of a symptom. Nor shall I do so; for although my intention is to
conceal nothing from you and to gloss over nothing, I do not need to
confuse you and stupefy you at the outset of our studies together. It is
true that our understanding of symptom-interpretation has only just
begun, but we will hold fast to the knowledge gained and proceed to
overcome step by step the difficulties of the unknown. I will try to
cheer you with the thought that it is hardly possible to presume a
fundamental difference between the one kind of symptom and the other. If
the individual form of symptom is so unmistakably connected with the
patient’s experiences, it is possible that the typical symptom relates
to an experience which is itself typical and common to all humanity.
Other regularly recurring features of a neurosis, such as the repetition
and doubt of the obsessional neurosis, may be universal reactions which
the patient is compelled to exaggerate by the nature of the morbid
change. In short, there is no reason to give up hastily in despair; let
us see what more we can find out.
There is a very similar difficulty met with in the theory of dreams, one
which I could not deal with in the course of our previous discussions of
dreams. The manifest content of dreams is multifarious and highly
differentiated individually, and we have shown exhaustively what can be
obtained by analysis from this content. But there are also dreams which
may in the same way be called _typical_ and occur in everybody, dreams
with an identical content, which present the same difficulties to
analysis. These are the dreams of falling, flying, floating, swimming,
of being hindered, of being naked, and certain other anxiety-dreams;
which yield first this, then that, interpretation, according to the
person concerned, without any explanation of their monotonous and
typical recurrence. But we notice that in these dreams also the common
groundwork is embroidered with additions of an individually varying
character. Most probably they too will prove to fit in with other
knowledge about the dream-life, gained from a study of other kinds of
dreams—not by any forcible twist, but by a gradual widening of our
comprehension of these things.
EIGHTEENTH LECTURE
FIXATION UPON TRAUMATA: THE UNCONSCIOUS
I said last time that we would take, as a starting-point for further
work, the knowledge we have gained already, and not the doubts which it
has roused in us. We have not yet even begun to discuss two of the most
interesting conclusions arising from the analysis of the two examples.
First: both the patients give the impression that they are “_fixed_” to
a particular point in their past, that they do not know how to release
themselves from it, and are consequently alienated from both present and
future. They are marooned in their illness, as it were; just as in
former times people used to withdraw to the cloister to live out their
unhappy fate there. In the case of the first patient, it was the
marriage to the husband, which in reality had long ago come to an end,
that had settled this doom upon her. Her symptoms enabled her to
continue her relationship with him; we could perceive in them the voices
which pleaded for him, excused him, exalted him, lamented his loss.
Although she is young and could attract other men, she has seized upon
every possible real and imaginary (magical) precaution that will
preserve her fidelity to him. She will not meet strangers, she neglects
her appearance; moreover, she cannot readily rise from any chair which
she sits upon, and she refuses to sign her name and can give no
presents, because no one must have anything which is hers.
With the second patient, the young girl, it is the erotic attachment to
the father established in the years before puberty that plays this part
in her life. She also has herself perceived that she cannot marry as
long as she is so ill. We may suspect that she became so ill in order to
be unable to marry and so to remain with her father.
We cannot avoid asking the question how, by what means, and impelled by
what motives, anyone can take up such an extraordinary and unprofitable
attitude towards life. Provided, that is, that this attitude is a
universal character of neurosis and is not a special peculiarity of
these two patients. As a matter of fact, this is so; it is a universal
trait common to every neurosis, and one of great practical significance.
Breuer’s first hysterical patient was _fixated_, in the same way, to the
time when her father was seriously ill and she nursed him. In spite of
her recovery, she has remained to some extent cut off from life since
that time; for although she has remained healthy and active, she did not
take up the normal career of a woman. In every one of our patients we
learn through analysis that the symptoms and their effects have set the
sufferer back into some past period of his life. In the majority of
cases it is actually a very early phase of the life-history which has
been thus selected, a period in childhood, even, absurd as it may sound,
the period of existence as a suckling infant.
The closest analogy to this behaviour in our nervous patients is
provided by the forms of illness recently made so common by the war—the
so-called _traumatic neuroses_. Of course similar cases had occurred
before the war, after railway accidents and other terrifying experiences
involving danger to life. The traumatic neuroses are not fundamentally
the same as those which occur spontaneously, which we investigate
analytically and are accustomed to treat; neither have we been
successful so far in correlating them with our views on other subjects;
later on I hope to show you where this limitation lies. Yet there is a
complete agreement between them on one point which may be emphasized.
The traumatic neuroses demonstrate very clearly that a fixation to the
moment of the traumatic occurrence lies at their root. These patients
regularly reproduce the traumatic situation in their dreams; in cases
showing attacks of an hysterical type in which analysis is possible, it
appears that the attack constitutes a complete reproduction of this
situation. It is as though these persons had not yet been able to deal
adequately with the situation, as if this task were still actually
before them unaccomplished. We take this attitude of theirs in all
seriousness; it points the way to what we may call an _economic_
conception of the mental processes. The term ‘_traumatic_’ has actually
no other meaning but this _economic_ one. An experience which we call
traumatic is one which within a very short space of time subjects the
mind to such a very high increase of stimulation that assimilation or
elaboration of it can no longer be effected by normal means, so that
lasting disturbances must result in the distribution of the available
energy in the mind.
This analogy tempts us also to classify as traumatic those experiences
to which our nervous patients seem to be fixated. In this way we should
be provided with a simple condition for a neurotic illness; it would be
comparable to a traumatic illness and would result from an incapacity to
deal with an overpowering affective experience. Indeed, the first
formula in which Breuer and I, in 1893–95, reduced our new observations
to a theory was expressed very similarly. A case like that of the first
patient described, the young woman separated from her husband, fits very
well into this description; she had not been able to “get over” the
impracticability of her marriage and was still attached to her trauma.
But the second case of the young girl who was tied to her father shows
us at once that the formula is not comprehensive enough. On the one
hand, an infantile adoration of her father by a little girl is such a
common experience and so frequently grown out of that the term
‘traumatic’ would lose all its meaning if applied to it; on the other
hand, the history of the case shows that this first erotic fixation was
gone through by the patient quite harmlessly at the time, to all
appearances, and only several years later came to expression in the
obsessional neurosis. So we see that there are complications ahead, a
considerable variety and number of determining factors in neurosis; but
we divine that the traumatic view will not necessarily be abandoned as
false, and that it will fit in and have to be co-ordinated properly
elsewhere.
Here again we must leave the path we have been following. At the moment
it will take us no further, and we have much more to learn before we can
find a satisfactory continuation of it. But before leaving the subject
of fixation to traumata it should be noted that it is a phenomenon
manifested extensively outside the neuroses; every neurosis contains
such a fixation, but not every fixation leads to a neurosis, or is
necessarily combined with a neurosis, or arises in the course of a
neurosis. Grief is a prototype and perfect example of an affective
fixation upon something that is past, and, like the neuroses, it also
involves a state of complete alienation from the present and the future.
But even the lay public distinguishes clearly between grief and
neurosis. On the other hand, there are neuroses which may be described
as morbid forms of grief.
It does also happen that persons may be brought to a complete standstill
in life by a traumatic experience which has shaken the whole structure
of their lives to the foundations, so that they give up all interest in
the present and the future, and live permanently absorbed in their
retrospections; but these unhappy persons do not necessarily become
neurotic. Therefore this single feature must not be overestimated as a
characteristic of neurosis, however invariable and significant it may be
otherwise.
Now let us turn to the second conclusion to be drawn from our analyses;
it is one upon which we shall not need to impose any subsequent
limitation. With the first patient we have heard of the senseless
obsessive act she performed and of the intimate memories she recalled in
connection with it; we also considered the relation between the two, and
deduced the purpose of the obsessive act from its connection with the
memory. But there is one factor which we have entirely neglected, and
yet it is one which deserves our fullest attention. As long as the
patient continued this performance she did not know that it was in any
way connected with the previous experience; the connection between the
two things was hidden; she could quite truly answer that she did not
know what impulse led her to do it. Then it happened suddenly that,
under the influence of the treatment, she found this connection and was
able to tell it. But even then she knew nothing of the purpose she had
in performing the action, the purpose that was to correct a painful
event of the past and to raise the husband she loved in her own
estimation. It took a long time and much effort for her to grasp, and
admit to me, that such a motive as this alone could have been the
driving force behind the obsessive act.
The connection with the scene on the morning after the unhappy
bridal-night, and the patient’s own tender feeling for her husband,
together, make up what we have called the “meaning” of the obsessive
act. But both sides of this meaning were hidden from her, she understood
neither the _whence_ nor the _whither_ of her act, as long as she
carried it on. Mental processes had been at work in her, therefore, of
which the obsessive act was the effect; she was aware in a normal manner
of their effect; but nothing of the mental antecedents of this effect
had come to the knowledge of her consciousness. She was behaving exactly
like a subject under hypnotism whom Bernheim had ordered to open an
umbrella in the ward five minutes after he awoke, but who had no idea
why he was doing it. This is the kind of occurrence we have in mind when
we speak of the existence of _unconscious mental processes_; we may
challenge anyone in the world to give a more correctly scientific
explanation of this matter, and will then gladly withdraw our inference
that unconscious mental processes exist. Until they do, however, we will
adhere to this inference and, when anyone objects that in a scientific
sense the Unconscious has no reality, that it is a mere makeshift, _une
façon de parler_, we must resign ourselves with a shrug to rejecting his
statement as incomprehensible. Something unreal, which can nevertheless
produce something so real and palpable as an obsessive action!
In the second patient fundamentally the same thing is found. She has
instituted a rule that the bolster must not touch the back of the
bedstead, and she had to carry out this rule, but she does not know
whence it comes, what it means, or to what it owes its strength. Whether
she regards it indifferently, or struggles against it, or rages against
it, or determines to overcome it, matters not; it will be followed. It
must be followed; in vain she asks herself why. It is undeniable that
these symptoms of the obsessional neurosis, these ideas and these
impulses which arise no man knows where and which oppose such a powerful
resistance against all the influences to which an otherwise normal
mental life is susceptible, give the impression, even to the patients
themselves, of being all-powerful visitants from another world, immortal
beings mingling in the whirlpool of mortal things. In these symptoms
lies the clearest indication of a special sphere of mental activity cut
off from all the rest. They show the way unmistakably to conviction on
the question of the unconscious in the mind; and for that very reason
clinical psychiatry, which only recognizes a psychology of
consciousness, can do nothing with these symptoms except to stigmatize
them as signs of a special kind of degeneration. Naturally, the
obsessive ideas and impulses are not themselves unconscious, any more
than is the performance of the obsessive acts. They would not have
become symptoms if they had not penetrated into consciousness. But the
mental antecedents of them disclosed by analysis, the connections into
which they fit after interpretation, are unconscious, at least until the
time when we make the patient conscious of them by the work of the
analysis.
Consider now, in addition, that the facts established in these two cases
are confirmed in every symptom of every neurotic disease; that always
and everywhere the meaning of the symptoms is unknown to the sufferer;
that analysis invariably shows that these symptoms are derived from
unconscious mental processes which can, however, under various
favourable conditions, become conscious. You will then understand that
we cannot dispense with the unconscious part of the mind in
psycho-analysis, and that we are accustomed to deal with it as with
something actual and tangible. Perhaps you will also be able to realize
how unfitted all those who only know the Unconscious as a phrase, who
have never analysed, never interpreted dreams, or translated neurotic
symptoms into their meaning and intention, are to form an opinion on
this matter. I will repeat the substance of it again in order to impress
it upon you: The fact that it is possible to find meaning in neurotic
symptoms by means of analytic interpretation is an irrefutable proof of
the existence—or, if you prefer it, of the necessity for assuming the
existence—of unconscious mental processes.
But that is not all. Thanks to a second discovery of Breuer’s, for which
he alone deserves credit and which seems to me even more far-reaching in
its significance than the first, more still has been learnt about the
relation between the Unconscious and the symptoms of neurotics. Not
merely is the meaning of the symptom invariably unconscious; there
exists also a connection of a substitutive nature between the two; the
existence of the symptom is only possible by reason of this unconscious
activity. You will soon understand what I mean. With Breuer, I maintain
the following: Every time we meet with a symptom we may conclude that
definite unconscious activities which contain the meaning of the symptom
are present in the patient’s mind. Conversely, this meaning must be
unconscious before a symptom can arise from it. Symptoms are not
produced by conscious processes; as soon as the unconscious processes
involved are made conscious the symptom must vanish. You will perceive
at once that here is an opening for therapy, a way by which symptoms can
be made to disappear. It was by this means that Breuer actually achieved
the recovery of his patient, that is, freed her from her symptoms; he
found a method of bringing into her consciousness the unconscious
processes which contained the meaning of her symptoms and the symptoms
vanished.