——————————————————————————————————————————————————————————————————————
Transcriber’s Note:
The name Freund at page 8, which is likely to be a reference to Freud,
has been corrected accordingly.
The erroneous Roman number vli in footnote 15 is corrected to be vii
just as a guess.
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THE INTERNATIONAL PSYCHO-ANALYTICAL LIBRARY
EDITED BY ERNEST JONES
NO. 2
PSYCHO-ANALYSIS
AND THE
WAR NEUROSES
by
Drs. S. FERENCZI (Budapest), KARL ABRAHAM (Berlin),
ERNST SIMMEL (Berlin) and ERNEST JONES (London)
Introduction by
Prof. SIGM. FREUD (Vienna)
[Illustration]
THE INTERNATIONAL PSYCHO-ANALYTICAL PRESS
LONDON VIENNA NEW YORK
1921
Copyright, 1921
C. Fromme, Printer, Vienna
CONTENTS
PAGE
I. Introduction by Prof. Sigm. Freud 1
II. Symposium held at the Fifth International Psycho-Analytical
Congress at Budapest, September 1918:
1. Dr. S. Ferenczi 5
2. Dr. Karl Abraham 22
3. Dr. Ernst Simmel 30
III. War Shock and Freud’s Theory of the Neuroses, by Dr.
Ernest Jones 44
I.
INTRODUCTION
BY PROFESSOR SIGM. FREUD, Vienna.
This little book on the War Neuroses, with which the Verlag opens the
“Internationale psychoanalytische Bibliothek”, deals with a subject
which until lately engaged the greatest current interest. When the
subject came up for discussion at the Fifth Psycho-Analytical Congress
at Budapest (September, 1918), official representatives of the Central
European Powers were present to obtain information from the lectures
and discussions. The hopeful result of this first meeting was the
promise that psycho-analytical institutions should be established,
where medical men qualified in analysis might find the means and time
to study the nature of these puzzling illnesses and the therapeutic
value of psycho-analysis in them. However, before these results could
be achieved the war came to an end, the government organisations broke
down, and interest in war neuroses gave place to other concerns. At
the same time, significantly enough, most of the neurotic diseases
which had been brought about by the war disappeared on the cessation
of the war conditions. The opportunity, therefore, for a thorough
investigation of these affections was unfortunately missed. However,
one must add, it is to be hoped that it will be a very long time
before such an opportunity again occurs. This episode, now a thing
of the past, has not been without importance for the spread of the
knowledge of psycho-analysis. Many medical men, who had previously held
themselves aloof from psycho-analysis, have been brought into close
touch with its theories through their service with the army compelling
them to deal with the question of the war neuroses. The reader can
easily gather from Ferenczi’s contribution to the subject with what
hesitation and misgivings this advance was made. Some of the factors,
such as the psycho-genetic origin of the symptoms, the significance
of unconscious impulses, and the part that the primary advantage of
being ill plays in the adjusting psychical conflicts (“flight into
disease”), all of which had long before been discovered and described
as operating in the neuroses of peace time, were found also in the
war neuroses and almost generally accepted. The work of E. Simmel has
shown what results may be obtained if the war neurotic is treated by
the cathartic method, which, as is well known, was the first stage of
the psycho-analytic technique.
From the advance thus made towards psycho-analysis, however, one
need not assume that the opposition to it has been reconciled or
neutralised. One might think that when a man, who had hitherto not
accepted any of a number of connected conclusions, suddenly finds
himself in the position of being convinced of the truth of a part
of them, he would weaken in his opposition and adopt an attitude of
respectful attention, lest the other part, of which he has no personal
experience, and therefore upon which he is unable to form a personal
opinion, should also prove to be correct.
This other part of the psycho-analytical theory which is not touched
upon in the study of the war neuroses is that the driving forces which
find expression in the formation of symptoms are sexual in nature, and
that the neurosis is the result of the conflict between the ego and the
sexual impulses which it has repudiated. The term “sexuality” is to be
taken here in the broader sense customary in psycho-analysis, and not
to be confused with the narrower sense of “genitality”. Now it is quite
correct, as Ernest Jones points out in his contribution, that this part
of the theory has not hitherto been demonstrated in relation to the
war neuroses. The work which could prove this part has not yet been
carried out. It may be that the war neuroses are unsuitable material
for this proof. However, the opponents of psycho-analysis, whose
repugnance to sexuality has shown itself to be stronger than their
logic, have hastened to proclaim that investigation of the war neuroses
has finally disproved this part of the psycho-analytical theory. In
this pronouncement they have been guilty of a slight confusion. If
the—up to the present superficial—investigation of war neuroses has not
shown that the sexual theory of the neuroses is correct, that is quite
another matter from showing that this theory is incorrect.
With an impartial attitude and some willingness it should not be
difficult to find the way to further elucidation.
The war neuroses, in so far as they differ from the ordinary neuroses
of peace time through particular peculiarities, are to be regarded
as traumatic neuroses, whose existence has been rendered possible or
promoted through an ego-conflict. In Abraham’s contribution there
are plain indications of this ego-conflict; the English and American
authors whom Jones quotes have also recognised it. The conflict takes
place between the old ego of peace time and the new war-ego of the
soldier, and it becomes acute as soon as the peace-ego is faced with
the danger of being killed through the risky undertakings of his newly
formed parasitical double. Or one might put it, the old ego protects
itself from the danger to life by flight into the traumatic neurosis in
defending itself against the new ego which it recognises as threatening
its life. The National Army was therefore the condition, and fruitful
soil, for the appearance of war neuroses; they could not occur in
professional soldiers, or mercenaries.
The other feature of the war neurosis is that it is a traumatic
neurosis, such as is well known to occur in peace time after fright or
severe accidents, without any reference to an ego-conflict.
The theory of the sexual aetiology of the neuroses, or as we prefer to
call it, the sexual hunger (libido) theory, was originally put forward
only as regards the transference neuroses of peace conditions, and can
be easily demonstrated in them by using the analytic technique. But
its application to those other affections, which more recently we have
grouped together as the narcissistic neuroses, meets with difficulties.
Ordinary cases of Dementia praecox, Paranoia and Melancholia are
fundamentally very unsuitable material for the proof of the sexual
hunger (libido) theory and for reaching an understanding of it, for
which reason psychiatrists, who neglect the transference neuroses
cannot be reconciled to it. The traumatic neuroses (of peace time) have
always been reckoned to be the most refractory in this respect, so that
the appearance of the war neuroses does not add any fresh factor to the
former situation.
Only by advancing and making use of the idea of a “narcissistic sexual
hunger (libido)”, that is to say, a mass of sexual energy that attaches
itself to the ego and satisfies itself with this as otherwise it
does only with an object, has it been possible to extend the sexual
hunger (libido) theory to the narcissistic neuroses, and this entirely
legitimate development of the concept of sexuality bids fair to do for
these severer neuroses and for the psychoses all that one can expect
from an empirically and tentatively progressing theory. The traumatic
neurosis of peace time will also fit into this group when researches
into the correlation undoubtedly subsisting between shock, anxiety, and
narcissistic sexual hunger (libido) have reached success.
If the traumatic and war neuroses emphasise the influence of the danger
to life and not at all, or not clearly enough, that of the “denial of
love”, on the other hand the aetiological claim of the former factor
appearing there so powerfully, is lacking in the usual transference
neuroses of peace time. Indeed it is vulgarly supposed that these
latter sufferings are only promoted by indulgence, high-living and
ease, which provide an interesting contrast to the conditions of life
under which the war neuroses break out. If psycho-analysts, who find
their patients have become ill through the “denial of love”, through
the ungratified demands of the sexual hunger (libido), were to follow
the example of their opponents, they would maintain that either there
are no danger neuroses, or that the affections following on terror
are not neuroses. This has naturally never crossed their minds. On
the contrary, they see the convenient possibility of combining in one
conception the two apparently divergent sets of facts. In the traumatic
and war neuroses the ego of the individual protects itself from a
danger that either threatens it from without, or is embodied in a form
of the ego itself, in the transference neuroses of peace time the ego
regards its own sexual hunger (libido) as a foe, the demands of which
appear threatening to it. In both cases the ego fears an injury; in
the one case through the sexual hunger (libido) and in the other from
outside forces. One might even say that in the case of the war neuroses
the thing feared, is after all an inner foe, in distinction from the
pure traumatic neuroses and approximating to the transference neuroses.
The theoretical difficulties which stand in the way of such a unifying
conception do not appear to be insurmountable; one can with full right
designate the repression which underlies every neurosis, as a reaction
to a trauma, as an elementary traumatic neurosis.
Spring 1919.
II.
SYMPOSIUM
HELD AT THE FIFTH INTERNATIONAL PSYCHO-ANALYTICAL CONGRESS BUDAPEST,
SEPTEMBER 1918
1. DR. S. FERENCZI, Budapest.
_Ladies and Gentlemen_,
With your permission I will commence my exposition of the very serious
and important subject that is the theme of my lecture to-day with
the recital of a little story which will lead us straightway into
the revolutionising events of this war. A Hungarian, who had the
opportunity of observing at close quarters a part of the revolutionary
upheaval in Russia, told me that the new revolutionary rulers of a
Russian town found with consternation that the change from the old to
the new regime had not taken place as rapidly as it should have done
according to their doctrinal calculations. According to the teachings
of the materialistic idea of history they could have set up the new
social order immediately after they had got the entire power into their
hands. Instead of this, irresponsible elements, which were antagonistic
to any new order of things, obtained the upper hand, so that the power
gradually slipped from the hands of the originators of the revolution.
Then the leaders of the movement put their heads together in order to
find out what had gone wrong in their calculations. Finally they agreed
that perhaps the materialistic idea was after all too one-sided, as it
only took into consideration the economic and commercial relations,
and had forgotten to take into account one small matter, the feelings
and thoughts of man, in a word, the psyche. They were sufficiently
consistent to send emissaries immediately to German speaking countries,
in order to obtain psychological works, so that they might get at least
subsequently some knowledge of this neglected science. Many thousands
of human lives fell victims, perhaps to no purpose, to this omission
of the revolutionaries; the failure of their efforts resulted in their
making one discovery however, namely, that of the mind.
A somewhat similar thing has occurred among neurologists during
the war. The war has produced an enormous number of nervous
disorders which call for elucidation and cure; however, the
familiar organic-mechanistic explanation hitherto adopted—which
in some way corresponds to the materialistic idea of history in
sociology—completely failed. The mass-experiment of the war has
produced various severe neuroses, including those in which there could
be no question of a mechanical influence, and the neurologists have
likewise been forced to recognise that something was missing in their
calculations, and this something was again—the psyche.
To some extent we can forgive sociology for this omission; indeed
the estimation of mental elements in the science of society has
hitherto been in fact a very trifling one. However, we cannot spare
neurologists the reproach of having so long disregarded the pioneer
researches of Breuer and Freud concerning the psychical determination
of many nervous disturbances, and of having required the terrible
experiences of the war to set them right in this respect. And yet a
science—psycho-analysis—has existed for more than twenty years to which
many investigators had devoted the whole of their efforts, and which
had helped us to unexpected and important knowledge of the mechanisms
of mental life and its disturbances.
In my lecture today I shall confine myself to demonstrating the
introduction of psycho-analysis into modern neurology, an introduction
which has been effected to some small extent openly, but for the
most part with hesitation and under false colours, and I will
briefly communicate the theoretical principles upon which rest the
psycho-analytical conceptions of the “traumatic neuroses” which have
been observed during the war[1].
Soon after the outbreak of the war there flamed up again the great
controversy, which had been carried on for more than ten years,
concerning the nature of the traumatic neuroses which Oppenheim had in
his time placed in a class by themselves. Oppenheim hastened to make
use of the experiences of the war, which exposed so many thousands of
men to sudden shocks, as supporting his old views, according to which
the phenomena of these neuroses always came about, as the result of
physical alterations in the nervous centres, (or in the peripheral
nerves which secondarily affect those of the centre). The nature of
the shock itself and its influence upon the method of functioning
he described in very general, one might even say, phantastic terms.
Links were “cut out” from the chain of the innervation mechanism,
most delicate elements “displaced”, paths “blocked”, connections torn
asunder, obstacles to conduction created, etc. With these and similar
comparisons, from which, however, all basis in fact was tacking,
Oppenheim sketched an impressive picture of the material correlation of
the traumatic neuroses.
The alterations in structure which would take place in the brain
through the trauma Oppenheim conceived as a delicate physical process
similar to that which occurs in the iron filing when it comes into
contact with the magnet.
The sarcastic Gaupp designates such specious physical and physiological
speculations as brain mythology and molecular mythology. But in our
opinion he does mythology an injustice.
The material brought forward by Oppenheim to support his views was
in no way suited to uphold his abstruse theories. To be sure, he
described with his usual precision characteristic symptoms, which this
war has produced in deplorable numbers, and also gave to them somewhat
high-sounding names (Akinesia amnestica, Myotonoklonia trepidans) that
said nothing as to their nature; these descriptions, however, are not
especially convincing with reference to his theoretical conceptions[2].
There were, it is true, many who agreed with Oppenheim’s views, though
for the most part with limitations. Goldscheider holds that the cause
of these nervous symptoms is partly physical and partly psychical;
Cassierer, Schuster and Birnbaum are of the same opinion. Wollenberg’s
question, as to whether the war neuroses were caused through emotion
or shock, Aschaffenburg answered by stating that there was here
concerned the joint effect of emotion and concussion. As one of the few
who obstinately persisted in maintaining the mechanistic idea I will
mention Lilienstein, who categorically demanded that the word and the
concept of “mind”, also that of “functional” and “psychic”, and more
especially that of “psycho-genesis” should be struck out of the medical
terminology; he maintained that this would simplify the conflict
and facilitate the investigation, treatment and examination of the
casualties; the progressive anatomical technique would certainly sooner
or later discover the material foundations of the neuroses.
We must here refer to the train of thought pursued by V. Sarbó,
who seeks for the cause of the war neuroses in the microscopical
destruction of tissue and hemorrhages in the central organ of the
nervous system; these, he says, originate through direct concussion,
sudden pressure of the cerebro-spinal fluid, compression of the spinal
cord in the foramen magnum, etc. V. Sarbó’s theory is only supported
by a few authors. In this connection I might mention Sachs and Freud,
who consider that the shock puts the nerve cells into a condition
of heightened excitability and exhaustability, which is then the
immediate cause of the neuroses. Finally, Bauer and Fauser look upon
the traumatic neuroses as the nervous results of disturbances of the
endocrine glands produced by the shock, and as similar therefore to the
post-traumatic Basedow’s disease.
Strümpell was one of the first to oppose the purely organic-mechanistic
idea of the war neuroses. He had, moreover, for some time previously
referred to certain psychical factors in the causation of the traumatic
neuroses. He made the accurate observation that in railway accidents,
etc., those who suffered from a severe neurosis were for the most
part those who had an _interest_ in being able to prove an injury as
caused by the trauma: for example, persons who were insured against
accidents and wished to obtain a large sum of money, or those who
instituted proceedings against the railway company for compensation
for injury. Similar or much more severe shocks have, however, no
lasting nervous results if the accident happens during sport through
one’s own carelessness, especially under circumstances that exclude
the hope of compensation for injury as those mentioned, so that the
patient has no interest in remaining ill, but every interest in the
speediest recovery. Strümpell asserts that the shock neuroses always
develop secondarily and purely psycho-genetically as the result of
desire of gain; he gave medical men the well-meant advice not to
take seriously the complaints of these patients, like Oppenheim,
but to bring them back as soon as possible to life and work through
the smallest allowance or through withdrawal of their pension. The
representations of Strümpell created a great impression in the medical
world even in peace time; they led to the idea of the “compensation
hysteria”; the sufferers, however, were treated not much better than
if they were malingerers. Strümpell now suggests that the war neuroses
are also neuroses of covetousness, which serve the patients’ purpose in
getting free from the military authorities with the highest possible
pension. Accordingly he demands a strict examination and expert opinion
of the neuroses occurring in military persons. The content of the
pathogenic ideas is always a wish—the wish for material compensation,
for remaining far from infections and danger—and this wish acts
along auto-suggestive paths in fixing more firmly the symptoms, the
persistence of morbid sensations and of innervation disturbances of
motility.
Much of the foregoing train of thought of Strümpell sounds to the
analyst very probable. For he knows from his analytical experience that
neurotic symptoms in general represent wish fulfilments, and also the
fixation of unpleasant mental impressions and their pathogenic state
is familiar to him. Still he has to reproach the one-sidedness of
Strümpell’s train of thought: for instance, in the undue prominence of
the cognitive aspect of the pathogenic experience and the neglect of
its affective side, as well as the complete ignoring of the unconscious
psychical processes, with which already Kurt Singer, Schuster and
Gaupp had reproached him. Strümpell also has a presentiment that these
neurotic forms of illness can only be explained by means of a psychical
investigation; he does not, however, tell us his method of work with
reference to this. Probably he understands by psychical exploration
simply a careful questioning of the patient as to his material
circumstances and concerning his motives for seeking a pension. We must
on the other hand protect ourselves in that he calls this exploration
“a method of individual psycho-analysis”. There is only one procedure
that has a right to this name, that which the strict method of
psycho-analysis has made its own.
As an argument in favour of the psycho-genesis of the war neuroses it
is a remarkable fact, which has been pointed out by Mörchen, Bonhöffer
and others, that the traumatic neuroses are practically never seen in
prisoners of war. The prisoners of war have no interest in remaining
sick after being captured, and they cannot reckon on compensation,
pension and sympathy from their surroundings while they are away from
home. They feel themselves in their captivity secure for the time
being from the dangers of the war. The theory of the mechanistic shock
can never explain to us this difference in the behaviour of our own
soldiers and prisoners of war.
Evidence as regards the psycho-genesis rapidly accumulated. Schuster
and many other observers refer to the disproportion between the trauma
and its results on the nervous system. Severe neuroses arise from
minimal shocks, while it is just the severe wounds accompanied by great
shock that for the most part are not followed by nervous disturbances.
Kurt Singer lays still greater stress on the disproportion between
trauma and neurosis, and even endeavours to explain this fact
psychologically: “In the kind of psychic trauma that comes on in a
flash, in the terror, in the paralysing horror, we are concerned with
cases of difficulty or impossibility of adaptation to the stimulus”.
In a severe wound there is a discharge of the suddenly increased
tension without anything further; when, however, no severe external
injury exists the excessive affect is discharged “by means of a sudden
abreaction through physical phenomena”. As the Freudian expression
“abreaction” shows, psycho-analysis must have been in the mind of
the writer when he thought out this theory. The expression sounds
like a delayed response to the Breuer-Freudian conversion theory.
However, it soon appears that Singer represents this process far too
rationalistically; he looks upon the symptoms of the traumatic neuroses
as the result of an effort on the part of the patient to find a
comprehensible explanation of the (to him) inexplicable morbid process.
Thus the work of this author is still far removed from the dynamic
conception of the psychical processes of which psycho-analysis has
taught us.
Hauptmann, Schmidt and others drew attention to the relation in time
in the development of the symptoms in the war neuroses. If it is a
question of a mechanical injury then the effect should be strongest
immediately after the operation of the force. Instead of which one
finds that the men thrown into a state of shock still make purposive
endeavours to arrange for their safety the moment after the trauma,
such as to get to the dressing station, etc., and only after having
put themselves under safe conditions do they collapse and the symptoms
develop. In some cases the symptoms appear only when the men have to
return to the firing line after a period of rest. Schmidt is quite
right when he refers this conduct of the patients to the psychical
factors; he suggests that the neurotic symptoms develop only after the
state of a transitory disturbance of consciousness has disappeared
and the men who have suffered the shock re-experience in memory the
dangerous situation. We would say: These injured men behave like the
mother who rescues her child from a danger which threatens its life
with calm imperturbability and disregard of death, but faints after the
act has been accomplished. It is immaterial as regards the judgment
of the psychological situation that here the person saved was not a
beloved stranger, but the beloved person himself.
I place Nonne in the forefront of those authors who have laid
particular stress on the psycho-genesis of the traumatic neuroses of
the war. Not only because he recognised that the symptoms of the war
shock neuroses were without exception hysterical, but because he was
also able to cause the severest war neurotic symptoms to disappear for
a time or to recall them by hypnotic and suggestive measures. This
excluded the possibility even of a “molecular” disturbance in the
nerve tissues; a disturbance that can be set right by means of psychic
influences can itself have been nothing else than psychical.
This therapeutic argument had the greatest effect; by degrees a marked
silence fell over the mechanistic school, and attempts were frequently
made to explain their former utterances psycho-genetically. The quarrel
from now onwards lay entirely between the supporters of the various
psychological theories.
How is one to explain the method of working of psychical factors, and
also the fact of the psychogenic condition being more severe than the
impressive forms of disorders of organic origin?
One is reminded of the old theory of Charcot, that terror and the
memory of it can produce in a similar manner physical symptoms
after the nature of hypnosis and auto-hypnosis, just as they are
intentionally brought about by the post-hypnotic command of the
hypnotist.
This reverting to Charcot means nothing less than paving the way to
fruitless speculations and the re-discovery of the sources from which
finally psycho-analysis sprang; for we know that the first researches
of Breuer and Freud into the psychical mechanisms of hysterical
phenomena originated directly from the influence of Charcot’s clinical
and experimental experiences. Hysterics suffer from reminiscences:
this, the primary axiom of the germinating psycho-analysis, is really
the continuation, deepening, and generalisation of the ideas of Charcot
applied to the neuroses of shock; the idea of the lasting effect of a
sudden affect and of the association of certain expressions of affect
with the memory of the thing experienced is common to both.
Let us now compare with this the views of German neurologists on
the genesis of the war neuroses. Goldscheider says: “Sudden and
terrifying impressions can leave behind affects direct and also with
the associative help of ideation; to these memory pictures are due the
results of increased and lowered excitability. Thus it is the emotion,
the terror, which bestows upon the trauma the distribution and fixation
of the nervous results of the stimulus, which never occurs with the
purely physical stimulus itself”. It is easy to recognise that this
description is borrowed from the traumatic theory of Charcot and the
Freudian conversion theory.
Gaupp’s opinion is similar: “In spite of all the methods of modern
experimental psychology and of all the more precise and more delicate
methods of technique for neurological and psychiatric investigation,
there remains a residue, and not an insignificant one, in which we do
not arrive at a diagnosis by means of the present exact neurological
and psychiatric investigation of the condition at the moment present,
but only through its connection with an exact anamnesis and with a
laborious exploration of the pathogenesis of the existing condition”.
Gaupp accepts even explicitly a Freudian postulation, in that he
describes the war neuroses as a flight from psychic conflicts into
illness and, alluding to psycho-analysis, he says: “Much preferable
is the postulate of the effects of the unconscious on consciousness
and the physical system than a psychological theory which seeks by
words taken from the sciences of anatomy and physiology to gloss over
the fact that the path from the physical to the mental and vice versa
is entirely unknown to us”. In another place he goes still further
and puts the psycho-analytical postulate of the unconscious in the
centre of the whole problem. “If one only admits that mental processes
can react upon the body even when they do not lie in the conscious
field of vision, then most of the supposed difficulties disappear”.
In this connection Hauptmann must also be mentioned. He looks upon
the traumatic neuroses as mental illnesses psycho-genetically
elaborated and caused through emotional factors, and their symptoms as
“unconscious further elaboration of the emotional factors along paths
of least resistance”.
Bonhoeffer seems to have completely accepted the psychologically
complex experiences of psycho-analysis. He holds that the traumatic
symptoms are “psycho-neurotic fixations, dissociation phenomena which
have been rendered possible through the resultant splitting off of the
affect from its ideational content under the influence of the violent
emotion”.
Birnbaum showed in his excellent summary of the literature of the
traumatic neuroses that in many of the explanations of these neuroses
(for example, in Strümpell’s theory of covetousness) is summed up a
psychogenic wish of hysteria, and says: “If the psychogenic wish,
the wish fixation, etc. is an essential component of hysteria then
it belongs unconditionally in the definition of the disorder”.
Psycho-analysis has long maintained this; as is well known, it regards
the neurotic symptoms as expressions of unconscious wishes or as
reactions to them.
Vogt also refers to the “famous Freudian statement” according to which
the troubled mind flies into illness and he acknowledges that “the
compulsion which originates from this is more often unconscious than
conscious”. Liepmann divides the symptoms of the traumatic neuroses
into the direct results of the psychic trauma and into “finally
adjusted psychic mechanisms”. Schuster speaks of symptoms which are
evoked by means of “unconscious processes”.
You see, therefore, ladies and gentlemen, that the experiences among
war neurotics gradually led further than to the discovery of the mind;
they led neurologists very nearly to the discovery of psycho-analysis.
When we read in the more recent literature on the subject, of the ideas
and views which have become so familiar,—abreaction, unconscious,
psychic mechanisms, separation of the affect from its idea, etc.,—we
might easily imagine ourselves to be in a circle of psycho-analysts,
and yet it has never occurred to these investigators to ask
themselves whether, after these experiences in the war neuroses, the
psycho-analytical concepts cannot be made use of in the explanation of
the usual neuroses and psychoses which were well known to us in peace
times. The specificity of the war trauma is universally denied; in
general, it is said, that the war neuroses contain nothing and have
added nothing new to the already known symptomatology of the neuroses;
even the Munich Congress of German Neurologists formally demanded the
elimination of the word and concept, “war neurosis”. If, however, the
peace and war neuroses are identical in their nature, then neurologists
will be obliged to make use of all these ideas of emotional shock, of
the fixation of pathogenic memories, and of their continued activity in
the unconscious, etc., also in the explanation of the usual hysterias,
the obsessional neuroses and the psychoses. They will be astonished how
easy it will be for them to traverse the path trodden by Freud, and
will regret having shown such obstinate resistance to his hints.
To the question of the disposition to fall sick with a war neurosis
the authors gave contradictory answers. Most of them follow the views
of Gaupp, Laudenheimer and others, according to whom most of the war
neurotics are _ab ovo_ neuropaths or psychopaths, the shock merely
playing the part of the releasing factor. Bonhoeffer says direct:
“The possibility of a psychopathological condition being evoked by
psychogenic factors is the criterion of a degenerative predisposition”.
Forster and Jendrassik say the same thing. Nonne, on the contrary,
finds that the deciding factor in falling a victim to war neuroses
lies less in the personal constitution than in the nature of the
operating injury. Psycho-analysis takes a median position with regard
to this question, which Freud has frequently and expressly stated.
It speaks of an “aetiological succession” in the predisposition,
the traumatic occasion figuring as reciprocal value with this. A
trifling predisposition and severe shock can produce the same effects
as an increased predisposition and a much lesser degree of shock.
Psycho-analysis, however, is not content with the theoretical allusion
to this condition, but it endeavours—with success—to separate the
complex idea of the “disposition” into simpler elements and establish
those constitutional factors that influence the choice of neurosis (the
special tendency to fall sick with this or that neurosis). I shall
return later to the question as to where psycho-analysis looks for the
special disposition to falling sick with a traumatic neurosis.
The literature concerning the symptomatology of the neuroses of the
war is simply immense. According to Gaupp, for example, the following
hysterical symptoms are to be observed. “Attacks of a slight nature
up to those of the severest kind, with an _arc de cercle_ lasting for
hours, sometimes with epileptic frequency, astasia-abasia, anomalies of
the position and movement of the body even to going on all fours, all
the varieties of tic and shaking tremors, paralyses and contractures
in monoplegic, hemiplegic and paraplegic forms, deafness and deaf and
dumbness, stuttering and stammering, aphonia and rhythmical screaming,
blindness with or without blepharo-spasm, all kinds of disturbances of
sensation, and most of all twilight states in quantities never before
met with and in combination with phenomena of physical irritation
and disorders”. You see, it is like a museum of glaring hysterical
symptoms, and whoever has once seen it will plainly have to decline
Oppenheim’s view, according to which purely neurotic symptoms are
rarely seen in the traumatic neuroses of the war. Schuster draws
attention to the frequent vasomotor and trophic phenomena; according to
him, these are no longer psychogenic. Psycho-analysis, however, will
agree with those who hold that these symptoms can originate to some
extent from psychic causes, analogous to the physical alterations which
can be produced under hypnosis. Finally, all the authors allude to the
alterations in disposition, apathy and over-excitability, etc. after
the trauma.
Out of this chaos of symptoms the “trembling” neurosis stands out
through its frequency and conspicuousness. You all know those
pathetic creatures who hobble along through the streets with shaking
knees, uncertain gait and peculiar motor disturbances. They give
the impression of being helpless and incurable invalids; and yet
experience shows that also this traumatic form of illness is purely
psychogenic. A single treatment with electricity and suggestion, a
few hypnotic sittings are often sufficient in rendering these men
capable of doing some work, if only temporarily and under certain
conditions. Erben has made the most careful investigation into these
disturbances of innervation; he found that these disturbances are
only suspended or increased when the respective group of muscles
carry out an action or intend to do so. His explanation for this
is, that here the “volitional impulse makes a path for the spasm”,
which, however, is only the physiological paraphrase of the facts
of the case. Psycho-analysis suspects here a psychical motivation:
the activity of an unconscious contrary wish which puts itself in the
way of the consciously wished act. This is indeed most striking in
those patients of Erben who are prevented from going forward through
the most violent attacks of shaking, but can carry out the much more
difficult task of going backwards without trembling. Erben also here
has a complicated physiological explanation ready, but forgets that
the movement backwards, which removes the patient from the dangerous
goal of the forward movement—and finally from the front line—does
not need to be disturbed by any contrary wish. The remaining kinds
of motor disturbances demand a similar interpretation, in particular
the striking, uncontrollable running of many neurotics, so like the
propulsion in paralysis agitans. These are the men who do not recover
from the effect of the terror and are still always flying from dangers
to which they were once exposed.
Many investigators, including non-psycho-analysts, came to the
conclusion from these and similar observations, that these disturbances
are not the direct effects of the trauma, but psychical reactions to it
and act in the service of the instinct of self-preservation against the
repetition of the unpleasant occurrence. We know that also the normal
organism has at its disposal such protective measures. The symptoms of
the terror, such as the immovable legs, the tremblings, the hesitating
speech, seem to be useful automatisms; one is reminded by them of
certain animals which simulate being dead when danger threatens. And if
Bonhoeffer looks upon these traumatic disturbances as fixations of the
means of expression of the terrible emotion which has been suffered,
Nonne goes further and discovers that “the hysterical symptoms
represent partly a reminiscence of inborn guard and defence mechanisms,
the suppression of which in those individuals whom we call hysterical
has not taken place in the normal degree or not at all”. According
to Hamburger the most frequently occurring type of disturbances of
standing, walking and speech associated with shaking tremors represents
a “complex of ideas of feebleness, weakness, refusal and exhaustion”,
and Gaupp sees in the same symptoms the lapse into infantile and
puerile states of obvious helplessness. Some authors actually speak of
the “fixation” in the traumatic posture of the body and innervation.
It cannot escape the notice of anyone with a knowledge of
psycho-analysis how near these authors, without knowing it, are to
psycho-analysis. The “expressions of fixations of movements” described
by them are in reality only paraphrases of the Breuer-Freudian
hysterical conversion, and the lapse into atavistic and infantile
methods of reaction is nothing more nor less than what Freud called
special attention to as the regressive character of the neurotic
symptoms, all of which according to him only signify reversions into
ontogenetic and phylogenetic stages of development already overcome.
At any rate we have definite proof that neurologists have now decided
to _interpret_ certain nervous symptoms, that is to say, refer them
to unconscious psychical contents, which would never have occurred to
anyone to do before the introduction of psycho-analysis.
I will now speak of the few authors who occupy themselves with the war
neuroses from the psycho-analytical points of view.
Stern has published a work on the psycho-analytical treatment of the
war neuroses in war hospitals. I have not been able to see the work in
the original, but I learn from the abstracts that the author proceeds
from the point of view of repression and finds the situation of the
serving soldier particularly suited to the production of neuroses in
consequence of the suppression of affects which his service demands.
Schuster admits that the investigations of Freud “however one may feel
towards them” have thrown a ray of light on the psycho-genesis of
the neuroses; they assist in revealing the hidden connection between
symptom and psychical content which still exists though difficult to
discover. Mohr treats the war neuroses by the cathartic method of
Breuer and Freud, by getting the patients to live through the critical
scenes again and brings about an abreaction of their affects by
letting them re-experience the terrible emotion. Simmel is the only
one up to the present who has occupied himself methodically with the
psycho-catharsis of the war neuroses, and he will give his own report
of his experiences to the Congress. Finally, I will mention my own
investigations concerning the psychology of the war neuroses, in which
I made the attempt to bring the traumatic forms of disorder into the
category of psycho-analysis.
In this connection I will allude to a discussion which branches
out in all directions on the question whether an affect can still
act psycho-genetically when the person concerned immediately loses
consciousness. Goldscheider and many others still maintain that a
psychical effect is made impossible through swooning, and Aschaffenburg
adheres to the view that loss of consciousness before falling ill
guards against the neurosis. Nonne rightly opposes this view, and
points out that unconscious mental streams could act psychically in
spite of the loss of consciousness. L. Mann, relying on Breuer’s
hypnoidal theory, puts forward the view that the loss of consciousness
before falling ill does not protect but disposes to the appearance of
the neurosis, by preventing the discharge of the affects. Orlovsky
expresses himself the most rationally on this vexed question; he points
out the possibility that the swooning itself can be a psychogenic
symptom, a flight into unconsciousness, which would spare the person
concerned the conscious experiencing of the painful situation and
sensations.
The possibility of the psychogenic formation of symptoms during a faint
is quite comprehensible to those of us who are psycho-analysts. This
problem could be started only by authors who take up a standpoint,
obsolete to psycho-analysis, that equates mental with conscious.
I do not know, ladies and gentlemen, whether you also have obtained
the impression from all these quotations and references (which are
only taken at random from the literature) that an advance, even though
one that is not admitted, has taken place in the attitude of leading
neurologists towards the teachings of psycho-analysis. Moreover, candid
recognition is not lacking; for example, the expression of Nonne, that
Freud’s experiences concerning the elaboration in the unconscious have
received interesting illuminations and corroborations through the
experiences of the war.
However, the same sentence of acknowledgement also contains a
nihilistic opinion of Nonne concerning psycho-analysis; he states
that Freud’s idea of the almost exclusively sexual foundation of
hysteria has been conclusively disproved during the war. We can no
longer leave this unanswered, which after all is only a partial
denial of psycho-analysis: also we can very easily give the answer.
The war neuroses, according to psycho-analysis, belong to a group of
neuroses in which not only is the genital sexuality affected, as in
ordinary hysteria, but also its precursor, the so-called narcissism,
self-love, just as in dementia praecox and paranoia. I grant that
the sexual foundation of these so-called narcissistic neuroses is
less easily apparent, particularly to those who equate sexuality and
genitality and have neglected to use the word “sexual” in the sense
of the old platonic Eros. Psycho-analysis, however, returns to this
extremely ancient standpoint when it treats all tender and sensual
relations of the man to his own or to the opposite sex, emotional
feelings towards friends, relatives and fellow-creatures generally,
even the affective behaviour towards one’s own ego and body, partly
under the rubric “erotism”, otherwise “sexuality”. It cannot be denied
that those to whom this idea is strange cannot so easily be convinced
of the correctness of Freud’s postulation of the sexual theory in a
narcissistic neurosis in particular, for example, in the traumatic
neurosis. We should like to advise them to examine themselves into the
usual (non-traumatic) hysteria and obsessional neuroses also, and to
keep strictly to the methods of free association, dream and symptom
interpretation proposed by Freud; then they will be much more easily
convinced of the correctness of the sexual theories of the neuroses,
and agreement about the sexual background of the war neuroses will
follow. At any rate the triumph concerning the overthrow of the sexual
theories is somewhat premature.
The observation that I have made as regards the participation of sexual
factors in the formation of symptoms in the traumatic neuroses also
shows that in traumatic neurotics the genital sexual hunger (libido)
and potency is generally greatly injured; in many cases it can even be
entirely suspended and that for long periods. This condition which is a
positive one is alone sufficient to demonstrate the rashness of Nonne’s
conclusion[3].
Ladies and gentlemen: With what I have said I have discharged the chief
task of my paper, which was the critical survey of the literature on
the war neuroses from the standpoint of psycho-analysis. However,
I will make use of this rare opportunity to tell you some of the
observations I have made myself, and I will present points of view
which may help to explain these conditions psycho-analytically.
In the psychical sphere of the traumatic neuroses there predominate
such symptoms as hypochondriacal depression, terror, anxiousness, and a
high degree of irritability with a tendency to outbursts of anger. Most
of these symptoms can be traced back to _increased ego-sensitiveness_
(in particular the hypochondria and the incapability of tolerating
physical or mental discomfort). This over-sensitiveness arises from
the fact that in consequence of the shock, which has been experienced
once or repeatedly, the interest and sexual hunger (libido) of the
patients is withdrawn from the object into the ego. There thus comes
about a damming-up of the sexual hunger (libido) in the ego, which is
expressed in those abnormal hypochondriacal organic sensations and
over-sensitiveness. Frequently this heightened ego-love degenerates
into a kind of infantile narcissism: the patients would like to be
pampered, cared for, and pitied like children. One can therefore speak
of a reversion into the childish stage of self-love. This heightening
corresponds to the diminution of object-love, often also of genital
potency. A man who is already predisposed to narcissism will of course
sooner fall a victim to a traumatic neurosis; still no one is entirely
immune from it, since the stage of narcissism forms a significant
fixation point in the development of the sexual hunger (libido) of
every human being. The combination with other narcissistic neuroses,
especially paranoia and dementia, frequently occurs.