Part 10

I was thus led into regarding the neuroses as being without exception disturbances of the sexual function, the so-called “actual” neuroses being the direct toxic expression of such disturbances and the psycho-neuroses their mental expression. My conscience as a physician felt pleased at my having arrived at this conclusion. I hoped that I had filled up a gap in medical science, which, in dealing with a function of such great biological importance, had failed to take into account any injuries beyond those caused by infection or by gross anatomical lesions. The standpoint of medicine was, moreover, favored by the view that sexuality was not something purely mental. It had a somatic side as well, and it was possible to assign special chemical processes to it and to attribute sexual excitement to the presence of some particular, though at present unknown, substance. There must also have been some good reason why the true spontaneous neuroses resembled no group of diseases more closely than the phenomena of intoxication and abstinence, which are produced by the administration or privation of certain toxic substances, or than Basedow’s disease, which is known to depend upon the product of the thyroid gland.

Since that time I have had no opportunity of returning to the investigation of the actual neuroses; nor has this part of my work been continued by anyone else. If I look back today at my early findings, they strike me as being the first rough outlines of what is probably a far more complicated subject. But on the whole they seem to me still to hold good. I should have been very glad if I had been able, later on, to make a psychoanalytical examination of some more cases of simple juvenile neurasthenia, but unluckily the occasion did not arise. To avoid misconceptions, I should like to make it clear that I am far from denying the existence of mental conflicts and of neurotic complexes in neurasthenia. All that I am asserting is that the symptoms of these patients are not mentally determined or removable by analysis, but that they must be regarded as direct toxic consequences of disturbed sexual chemical processes.

During the years that followed the publication of the _Studien_, having reached these conclusions upon the part played by sexuality in the ætiology of the neuroses, I read some papers on the subject before various medical societies, but was only met with incredulity and contradiction. Breuer did what he could for some time longer to throw the great weight of his personal influence into the scales in my favor, but he effected nothing and it was easy to see that he too shrank from recognizing the sexual ætiology of the neuroses. He might have crushed me or at least disconcerted me by pointing to his own first patient, in whose case sexual factors had ostensibly played no part whatever. But he never did so, and I could not understand why this was until I came to interpret the case correctly and to reconstruct, from some remarks which he had made, the conclusion of his treatment of it. After the work of catharsis had seemed to be completed, the girl had suddenly developed a condition of “transference love”; he had not connected this with her illness, and had therefore retired in dismay. It was obviously painful to him to be reminded of this apparent _contretemps_. His attitude towards me oscillated for some time between appreciation and bitter criticism; then accidental difficulties arose, as they never fail to do in a strained situation, and we parted.

Another result of my taking up the study of nervous disorders in general was that I altered the technique of catharsis. I abandoned hypnosis and sought to replace it by some other method, because I was anxious not to be restricted to treating hysteriform conditions. Increasing experience had also given rise to two grave doubts in my mind as to the use of hypnosis even as a means to catharsis. The first was that even the most brilliant results were liable to be suddenly wiped away if my personal relation with the patient became disturbed. It was true that they became reestablished if a reconciliation could be effected; but such an occurrence showed that the personal emotional relation between doctor and patient was after all stronger than the whole cathartic process, and it was precisely that factor which escaped every effort at control. And one day I had an experience which showed me in the crudest light what I had long suspected. One of my most acquiescent patients, with whom hypnosis had enabled me to bring about the most marvellous results, and whom I was engaged in relieving of her suffering by tracing back her attacks of pain to their origins, as she woke up on one occasion, threw her arms round my neck. The unexpected entrance of a servant relieved us from a painful discussion, but from that time onwards there was a tacit understanding between us that hypnotic treatment should be discontinued. I was modest enough not to attribute the event to my own irresistible personal attraction, and I felt that I had now grasped the nature of the element of mystery that was at work behind hypnosis. In order to exclude it, or at all events to isolate it, it was necessary to abandon hypnosis.

But hypnosis had been of immense help in the cathartic treatment, by widening the field of the patient’s consciousness and putting within his reach knowledge which he did not possess in his waking life. It seemed no easy task to find a substitute for it. While I was in this perplexity, a recollection came to my help of an experiment which I had often witnessed while I was with Bernheim. When the subject awoke from the state of somnambulism, he seemed to have lost all memory of what had happened while he was in that state. But Bernheim maintained that the memory was present all the same; and if he insisted on the subject remembering, if he asseverated that he knew it all and had only to say it, and if at the same time he laid his hand on the subject’s forehead, then the forgotten memories used in fact to return, hesitatingly at first, but eventually in a flood and with complete clarity. I determined that I would act in the same way. My patients, I reflected, must in fact “know” all the things which had hitherto only been made accessible to them by hypnosis; and assurances and encouragement on my part, assisted perhaps by the touch of my hand, would, I thought, have the power of forcing the forgotten facts and connections into consciousness. No doubt this seemed a more laborious process than putting them under hypnosis, but it might prove highly instructive. So I abandoned hypnosis, only retaining my practice of requiring the patient to lie upon a sofa while I sat behind him, seeing him, but not seen myself.

III

My expectations were fulfilled; I was set free from hypnosis. But along with the change in technique, the process of catharsis took on a new complexion. Hypnosis had screened from view an interplay of forces which now came in sight, and the understanding of which gave a solid foundation to my theory.

How had it come about that the patients had forgotten so many of the facts of their external and internal lives, but could nevertheless recollect them if a particular technique was applied? Observation supplied an exhaustive answer to these questions. Everything that had been forgotten had in some way or other been painful; it had been either alarming or disagreeable or shameful, by the standards of the subject’s personality. The thought arose spontaneously: it was precisely on that account that it had been forgotten, i. e. that it had not remained conscious. In order to make it conscious again, in spite of this, it was necessary to overcome something that fought against one in the patient; it was necessary to make an expenditure of effort on one’s own part in order to compel and subdue it. The amount of effort required of the physician varied in different cases; it increased in direct proportion to the difficulty of what had to be remembered. The expenditure of force on the part of the physician was evidently the measure of a _resistance_ on the part of the patient. It was only necessary to translate into words what I myself had observed, and I was in possession of the theory of _repression_.

It was now easy to reconstruct the pathogenic process. Let us keep to a simple example, in which a particular impulsion had arisen in the subject’s mind, but was opposed by other powerful tendencies. We should have expected the mental _conflict_ which now arose to take the following course. The two dynamic quantities—for our present purposes let us call them “the instinct” and “the resistance”—would struggle with each other for some time in the fullest light of consciousness, until the instinct was repudiated and the charge[9] of energy withdrawn from it. This would have been the normal solution. In a neurosis, however, (for reasons which were still unknown) the conflict found a different outcome. The ego drew back, as it were, after the first shock of its conflict with the objectionable impulse; it debarred the impulse from access to consciousness and to direct motor discharge, but at the same time the impulse retained its full charge of energy. I named this process _repression_; it was a novelty, and nothing like it had ever before been recognized in mental life. It was obviously a primary mechanism of defence, comparable to an attempt at flight, and was only a fore-runner of the later developed normal condemning judgment. The first act of repression involved further consequences. In the first place, the ego was obliged to protect itself against the constant threat of a renewed advance on the part of the repressed impulse by making a permanent expenditure of energy, a _counter-charge_, and it thus impoverished itself. On the other hand, the repressed impulse, which was now _unconscious_, was able to find means of discharge and of substitutive gratification by circuitous routes and thus to bring the whole purpose of the repression to nothing. In the case of conversion-hysteria, the circuitous route led to the nerve supply of the body; the repressed impulse broke through at some point or other and produced _symptoms_. The symptoms were thus results of a compromise, for although they were substitutive gratifications, they were nevertheless distorted and deflected from their aim, owing to the resistance of the ego.

The theory of repression became the foundation-stone of our understanding of the neuroses. A different view had now to be taken of the task of therapy. Its aim was no longer to “abreact” an effect which had got onto the wrong lines, but to uncover repressions and replace them by acts of judgment which might result either in the acceptance or in the rejection of what had formerly been repudiated. I showed my recognition of the new situation by no longer calling my method of investigation and treatment _catharsis_ but _psychoanalysis_.

It is possible to take repression as a centre and to bring all the elements of psychoanalytic theory into relation with it. But before doing so, I have a further remark of a polemical nature to make. According to Janet’s view, a hysteric was a wretched person who, on account of a constitutional weakness, was unable to hold her mental acts together, and it was for that reason that she fell a victim to mental dissociation and to a restriction of the field of her consciousness. The results of psychoanalytical investigations, on the other hand, showed that these phenomena were the result of dynamic factors—of mental conflict and of repression. This distinction seems to me to be far-reaching enough to put an end to the glib repetition of the view that whatever is of value in psychoanalysis is merely borrowed from the ideas of Janet. The reader will have learned from my account that historically psychoanalysis is completely independent of Janet’s discoveries, just as, in its content, it diverges from them and goes far beyond them. Janet’s works would never have had the implications which have made psychoanalysis of such importance to the mental sciences and have made it attract such universal interest. I always treated Janet himself with respect, since his discoveries coincided, to a considerable extent, with those of Breuer, which had been made earlier, but were published later than his. But when, in the course of time, psychoanalysis became a subject of discussion in France, Janet behaved ill, showed ignorance of the facts and used ugly arguments. And finally he revealed himself to my eyes and destroyed the value of his own work by declaring that when he had spoken of ‘unconscious’ mental acts, he had meant nothing by the phrase—it had been no more than a _façon de parler_.

But the study of pathogenic repressions and of other phenomena which have still to be mentioned compelled psychoanalysis to take the concept of the “unconscious” seriously. Psychoanalysis regarded everything mental as being in the first instance unconscious; the further quality of “consciousness” might also be present, or again it might be absent. This, of course, provoked a denial from the philosophers, for whom “conscious” and “mental” were identical, and who protested that they could not conceive of such a monstrosity as the “unconscious mental.” There was no help for it, however, and this idiosyncrasy of the philosophers could only be disregarded with a shrug. Experience (gained from pathological material, of which the philosophers were ignorant) of the frequency and power of impulses of which one knew nothing directly, and whose existence had to be inferred like some fact in the external world, left no alternative open. It could be pointed out, incidentally, that this was only treating one’s own mental life as one had always treated other people’s. One did not hesitate to ascribe mental processes to other people, although one had no immediate consciousness of them and could only infer them from their words and actions. But what held good for other people must be applicable to oneself. Anyone who tried to push the argument further and to conclude from it that one’s own hidden processes belonged actually to a second consciousness would be faced with the concept of a consciousness of which one knew nothing, of an “unconscious consciousness”—and this would scarcely be preferable to the assumption of an “unconscious mental.” If, on the other hand, one declared, like some other philosophers, that one was prepared to take pathological phenomena into account, but that the processes underlying them ought not to be described as mental but as “psychoid,” the difference of opinion would degenerate into an unfruitful dispute about words, though, even so, expediency would decide in favour of keeping the expression “unconscious mental.” The further question as to the ultimate nature of this unconscious is no wiser or more profitable than the older one as to the nature of the conscious.

It would be more difficult to explain concisely how it came about that psychoanalysis made a further distinction in the unconscious, and separated it into a _preconscious_ and an unconscious proper. It will be sufficient to say that it appeared a legitimate course to supplement the theories which were a direct expression of experience by hypotheses which were designed to facilitate the handling of the material and related to matters which could not be a subject of immediate observation. The very same procedure is adopted by the older sciences. The sub-division of the unconscious is part of an attempt to picture the apparatus of the mind as being built up of a number of _instances_ or systems, whose inter-relations may be expressed in spatial terms, without reference, of course, to the actual anatomy of the brain. (I have described this as the _topographical method of approach_.) Such ideas as these are part of a speculative superstructure of psychoanalysis, any portion of which can be abandoned or changed without loss or regret the moment its inadequacy has been proved. But there is still plenty to be described that lies closer to actual experience.

I have already mentioned that my investigation of the precipitating and underlying causes of the neuroses led me more and more frequently to conflicts between the subject’s sexual impulses and his resistances to sexuality. In my search for the pathogenic situations in which the repressions of sexuality had set in and in which the symptoms, as substitutes for what was repressed, had their origin, I was carried further and further back into the patient’s life and ended by reaching the first years of his childhood. What poets and students of human nature had always asserted turned out to be true: the impressions of that remote period of life, though they were for the most part buried in amnesia, left ineradicable traces upon the individual’s growth and in particular laid the foundations of any nervous disorder that was to follow. But since these experiences of childhood were always concerned with sexual excitations and the reaction against them, I found myself faced by the fact of infantile sexuality—once again a novelty and a contradiction of one of the strongest of human prejudices. Childhood was looked upon as “innocent” and free from the lusts of sex, and the fight with the demon of “sensuality” was not thought to begin until the troubled age of puberty. Such occasional sexual activities as it had been impossible to overlook in children were put down as signs of degeneracy and premature depravity or as a curious freak of nature. Few of the findings of psychoanalysis have met with such universal contradiction or have aroused such an outburst of indignation as the assertion that the sexual function starts at the beginning of life and reveals its presence by important signs even in childhood. And yet no other finding of analysis can be demonstrated so easily and so completely.

Before going further into the question of infantile sexuality, I must mention an error into which I fell for a while and which might well have had fatal consequences for the whole of my work. Under the pressure of the technical procedure which I used at that time, the majority of my patients reproduced from their childhood, scenes in which they were sexually seduced by some grown-up person. With female patients the part of seducer was almost always assigned to their father. I believed these stories, and consequently supposed that I had discovered the roots of the subsequent neurosis in these experiences of sexual seduction in childhood. My confidence was strengthened by a few cases in which relations of this kind with a father, uncle or elder brother had continued up to an age at which memory was quite to be trusted. If the reader feels inclined to shake his head at my credulity, I cannot altogether blame him; though I may plead that this was at a time when I was intentionally keeping my critical faculty in abeyance so as to preserve an unprejudiced and receptive attitude towards the many novelties which were coming to my notice every day. When, however, I was at last obliged to recognize that these scenes of seduction had never taken place, and that they were only phantasies which my patients had made up or which I myself had perhaps forced upon them, I was for some time completely at a loss. My confidence alike in my technique and in its results suffered a severe blow, it could not be disputed that I had arrived at these scenes by a technical method which I considered correct, and their subject-matter was unquestionably related to the symptoms from which my investigation had started. When I had pulled myself together, I was able to draw the right conclusions from my discovery: namely, that the neurotic symptoms were not related directly to actual events but to phantasies embodying wishes, and that, as far as the neurosis was concerned, psychical reality was of more importance than material reality. I do not believe even now that I forced the seduction-phantasies upon my patients, that I “suggested” them. I had, in fact, stumbled for the first time upon the _Œdipus complex_, which was later to assume such an overwhelming importance, but which I did not recognize as yet in its disguise of phantasy. Moreover, seduction during childhood retained a certain share, though a humbler one, in the ætiology of neuroses. But the seducers turned out as a rule to have been older children.

It will be seen, then, that my mistake was of the same kind as would be made by someone who believed that the legendary story of the early kings of Rome (as told by Livy) was historical truth instead of what it is in fact—a reaction against the memory of times and circumstances that were insignificant and occasionally, perhaps, inglorious. When the mistake had been cleared up, the path to the study of the sexual life of children lay open. It thus became possible to apply psychoanalysis to another field of science and to use its data as a means of discovering a new piece of biological knowledge.

The sexual function, as I found, is in existence from the very beginning of the individual’s life, though at first it is assimilated to the other vital functions and does not become independent of them until later; it has to pass through a long and complicated process of development before it becomes what we are familiar with as the normal sexual life of the adult. It begins by manifesting itself in the activity of a whole number of _component instincts_. These are dependent upon _erotogenic zones_ in the body; some of them make their appearance in pairs of opposite impulses (such as sadism and masochism or the impulses to look and to be looked at); they operate independently of one another in their search for pleasure, and they find their object for the most part in the subject’s own body. Thus, to begin with, they are non-centralized and predominantly _auto-erotic_. Later they begin to be co-ordinated; a first stage of organization is reached under the dominance of the _oral_ components, an _anal-sadistic_ stage follows, and it is only after the third stage has at last been reached that the primacy of the _genitals_ is established and that the sexual function begins to serve the ends of reproduction. In the course of this process of development a number of elements of the various component instincts turn out to be unserviceable for this last end and are therefore left on one side or turned to other uses, while others are diverted from their aims and carried over into the genital organization. I gave the name of _libido_ to the energy of the sexual instincts and to that form of energy alone. I was next driven to suppose that the libido does not always pass through its prescribed course of development smoothly. As a result either of the excessive strength of certain of the components or of experiences involving premature gratification, _fixations_ of the libido may occur at various points in the course of its development. If subsequently a repression takes place, the libido flows back to these points (a process described as _regression_), and it is from them that the energy breaks through in the form of a symptom. Later on it further became clear that the localization of the point of fixation is what determines the _choice of neurosis_, that is, the form in which the subsequent illness makes its appearance.