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A General Introduction to Psychoanalysis
TWENTY-THIRD LECTURE
GENERAL THEORY OF THE NEUROSES
The Development of the Symptoms
IN the layman's eyes the symptom shows the nature of the disease, and cure means removal of symptoms. The physician, however, finds it important to distinguish the symptoms from the disease and recognizes that doing away with the symptoms is not necessarily curing the disease. Of course, the only tangible thing left over after the removal of the symptoms is the capacity to build new symptoms. Accordingly, for the time being, let us accept the layman's viewpoint and consider the understanding of the symptoms as equivalent to the understanding of the sickness.
The symptoms, – of course, we are dealing here with psychic (or psychogenic) symptoms, and psychic illness – are acts which are detrimental to life as a whole, or which are at least useless; frequently they are obnoxious to the individual who performs them and are accompanied by distaste and suffering. The principal injury lies in the psychic exertion which they cost, and in the further exertion needed to combat them. The price these efforts exact may, when there is an extensive development of the symptoms, bring about an extraordinary impoverishment of the personality of the patient with respect to his available psychic energy, and consequently cripple him in all the important tasks of life. Since such an outcome is dependent on the amount of energy so utilized, you will readily understand that "being sick" is essentially a practical concept. But if you take a theoretical standpoint and disregard these quantitative relations, you can readily say that we are all sick, or rather neurotic, since the conditions favorable to the development of symptoms are demonstrable also among normal persons.
As to the neurotic symptoms, we already know that they are the result of a conflict aroused by a new form of gratifying the libido. The two forces that have contended against each other meet once more in the symptom; they become reconciled through the compromise of a symptom development. That is why the symptom is capable of such resistance; it is sustained from both sides. We also know that one of the two partners to the conflict is the unsatisfied libido, frustrated by reality, which must now seek other means for its satisfaction. If reality remains inflexible even where the libido is prepared to take another object in place of the one denied it, the libido will then finally be compelled to resort to regression and to seek gratification in one of the earlier stages in its organizations already out-lived, or by means of one of the objects given up in the past. Along the path of regression the libido is enticed by fixations which it has left behind at these stages in its development.
Here the development toward perversion branches off sharply from that of the neuroses. If the regressions do not awaken the resistance of the ego, then a neurosis does not follow and the libido arrives at some actual, even if abnormal, satisfaction. The ego, however, controls not alone consciousness, but also the approaches to motor innervation, and hence the realization of psychic impulses. If the ego then does not approve this regression, the conflict takes place. The libido is locked out, as it were, and must seek refuge in some place where it can find an outlet for its fund of energy, in accordance with the controlling demands for pleasurable gratification. It must withdraw from the ego. Such an evasion is offered by the fixations established in the course of its evolution and now traversed regressively, against which the ego had, at the time, protected itself by suppressions. The libido, streaming back, occupies these suppressed positions and thus withdraws from before the ego and its laws. At the same time, however, it throws off all the influences acquired under its tutelage. The libido could be guided so long as there was a possibility of its being satisfied; under the double pressure of external and internal denial it becomes unruly and harks back to former and more happy times. Such is its character, fundamentally unchangeable. The ideas which the libido now takes over in order to hold its energy belong to the system of the unconscious, and are therefore subject to its peculiar processes, especially elaboration and displacement. Conditions are set up here which are entirely comparable to those of dream formation. Just as the latent dream, the fulfillment of a wish-phantasy, is first built up in the unconsciousness, but must then pass through conscious processes before, censored and approved, it can enter into the compromise construction of the manifest dream, so the ideas representing the libido in the unconscious must still contend against the power of the fore-conscious ego. The opposition that has arisen against it in the ego follows it down by a "counter-siege" and forces it to choose such an expression as will serve at the same time to express itself. Thus, then, the symptom comes into being as a much distorted offshoot from the unconscious libidinous wish-fulfillment, an artificially selected ambiguity – with two entirely contradictory meanings. In this last point alone do we realize a difference between dream and symptom development, for the only fore-conscious purpose in dream formation is the maintenance of sleep, the exclusion from consciousness of anything which may disturb sleep; but it does not necessarily oppose the unconscious wish impulse with an insistent "No." Quite the contrary; the purpose of the dream may be more tolerant, because the situation of the sleeper is a less dangerous one. The exit to reality is closed only through the condition of sleep.
You see, this evasion which the libido finds under the conditions of the conflict is possible only by virtue of the existing fixations. When these fixations are taken in hand by the regression, the suppression is side-tracked and the libido, which must maintain itself under the conditions of the compromise, is led off or gratified. By means of such a detour by way of the unconscious and the old fixations, the libido has at last succeeded in breaking its way through to some sort of gratification, however extraordinarily limited this may seem and however unrecognizable any longer as a genuine satisfaction. Now allow me to add two further remarks concerning this final result. In the first place, I should like you to take note of the intimate connection between the libido and the unconscious on the one hand, and on the other of the ego, consciousness, and reality. The connection that is evidenced here, however, does not indicate that originally they in any way belong together. I should like you to bear continually in mind that everything I have said here, and all that will follow, pertains only to the symptom development of hysterical neurosis.
Where, now, can the libido find the fixations which it must have in order to force its way through the suppressions? In the activities and experiences of infantile sexuality, in its abandoned component-impulses, its childish objects which have been given up. The libido again returns to them. The significance of this period of childhood is a double one; on the one hand, the instinctive tendencies which were congenital in the child first showed themselves at this time; secondly, at the same time, environmental influences and chance experiences were first awakening his other instincts. I believe our right to establish this bipartite division cannot be questioned. The assertion that the innate disposition plays a part is hardly open to criticism, but analytic experience actually makes it necessary for us to assume that purely accidental experiences of childhood are capable of leaving fixations of the libido. I do not see any theoretical difficulties here. Congenital tendencies undoubtedly represent the after-effects of the experiences of an earlier ancestry; they must also have once been acquired; without such acquired characters there could be no heredity. And is it conceivable that the inheritance of such acquired characters comes to a standstill in the very generation that we have under observation? The significance of infantile experience, however, should not, as is so often done, be completely ignored as compared with ancestral experiences or those of our adult years; on the contrary, they should meet with an especial appreciation. They have such important results because they occur in the period of uncompleted development, and because of this very fact are in a position to cause a traumatic effect. The researches on the mechanics of development by Roux and others have shown us that a needle prick into an embryonic cell mass which is undergoing division results in most serious developmental disturbances. The same injury to a larva or a completed animal can be borne without injury.
The libido fixation of adults, which we have referred to as representative of the constitutional factor in the etiological comparison of the neuroses, can be thought of, so far as we are concerned, as divisible into two separate factors, the inherited disposition and the tendency acquired in early childhood. We know that a schematic representation is most acceptable to the student. Let us combine these relations as follows:
The hereditary sexual constitution provides us with manifold tendencies, varying with the special emphasis given one or the other component of the instinct, either individually or in combination. With the factor of infantile experience, there is again built up a complementary series within the sexual constitution which is perfectly comparable with our first series, namely, the gradations between disposition and the chance experiences of the adult. Here again we find the same extreme cases and similar relations in the matter of substitution. At this point the question becomes pertinent as to whether the most striking regressions of the libido, those which hark back to very early stages in sexual organization, are not essentially conditioned by the hereditary constitutional factor. The answer to this question, however, may best be put off until we are in a position to consider a wider range in the forms of neurotic disease.
Let us devote a little time to the consideration of the fact that analytic investigation of neurotics shows the libido to be bound up with the infantile sexual experiences of these persons. In this light they seem of enormous importance for both the life and health of mankind. With respect to therapeutic work their importance remains undiminished. But when we do not take this into account we can herein readily recognize the danger of being misled by the situation as it exists in neurotics into adopting a mistaken and one-sided orientation toward life. In figuring the importance of the infantile experiences we must also subtract the influences arising from the fact that the libido has returned to them by regression, after having been forced out of its later positions. Thus we approach the opposite conclusion, that experiences of the libido had no importance whatever in their own time, but rather acquired it at the time of regression. You will remember that we were led to a similar alternative in the discussion of the Oedipus-complex.
A decision on this matter will hardly be difficult for us. The statement is undoubtedly correct that the hold which the infantile experiences have on the libido – with the pathogenic influences this involves – is greatly augmented by the regression; still, to allow them to become definitive would nevertheless be misleading. Other considerations must be taken into account as well. In the first place, observation shows, in a way that leaves no room for doubt, that infantile experiences have their particular significance which is evidenced already during childhood. There are, furthermore, neuroses in children in which the factor of displacement in time is necessarily greatly minimized or is entirely lacking, since the illness follows as an immediate consequence of the traumatic experience. The study of these infantile neuroses keeps us from many dangerous misunderstandings of adult neuroses, just as the dreams of children similarly serve as the key to the understanding of the dreams of adults. As a matter of fact, the neuroses of children are very frequent, far more frequent than is generally believed. They are often overlooked, dismissed as signs of badness or naughtiness, and often suppressed by the authority of the nursery; in retrospect, however, they may be easily recognized later. They occur most frequently in the form of anxiety hysteria. What this implies we shall learn upon another occasion. When a neurosis breaks out in later life, analysis regularly shows that it is a direct continuation of that infantile malady which had perhaps developed only obscurely and incipiently. However, there are cases, as already stated, in which this childish nervousness continues, without any interruption, as a lifelong affliction. We have been able to analyze a very few examples of such neuroses during childhood, while they were actually going on; much more often we had to be satisfied with obtaining our insight into the childhood neurosis subsequently, when the patient is already well along in life, under conditions in which we are forced to work with certain corrections and under definite precautions.
Secondly, we must admit that the universal regression of the libido to the period of childhood would be inexplicable if there were nothing there which could exert an attraction for it. The fixation which we assume to exist towards specific developmental phases, conveys a meaning only if we think of it as stabilizing a definite amount of libidinous energy. Finally, I am able to remind you that here there exists a complementary relationship between the intensity and the pathogenic significance of the infantile experiences to the later ones which is similar to that studied in previous series. There are cases in which the entire causal emphasis falls upon the sexual experiences of childhood, in which these impressions take on an effect which is unmistakably traumatic and in which no other basis exists for them beyond what the average sexual constitution and its immaturity can offer. Side by side with these there are others in which the whole stress is brought to bear by the later conflicts, and the emphasis the analysis places on childhood impressions appears entirely as the work of regression. There are also extremes of "retarded development" and "regression," and between them every combination in the interaction of the two factors.
These relations have a certain interest for that pedagogy which assumes as its object the prevention of neuroses by an early interference in the sexual development of the child. So long as we keep our attention fixed essentially on the infantile sexual experiences, we readily come to believe we have done everything for the prophylaxis of nervous afflictions when we have seen to it that this development is retarded, and that the child is spared this type of experience. Yet we already know that the conditions for the causation of neuroses are more complicated and cannot in general be influenced through one single factor. The strict protection in childhood loses its value because it is powerless against the constitutional factor; furthermore, it is more difficult to carry out than the educators imagine, and it brings with it two new dangers that cannot be lightly dismissed. It accomplishes too much, for it favors a degree of sexual suppression which is harmful for later years, and it sends the child into life without the power to resist the violent onset of sexual demands that must be expected during puberty. The profit, therefore, which childhood prophylaxis can yield is most dubious; it seems, indeed, that better success in the prevention of neuroses can be gained by attacking the problem through a changed attitude toward facts.
Let us return to the consideration of the symptoms. They serve as substitutes for the gratification which has been forborne, by a regression of the libido to earlier days, with a return to former development phases in their choice of object and in their organization. We learned some time ago that the neurotic is held fast somewhere in his past; we now know that it is a period of his past in which his libido did not miss the satisfaction which made him happy. He looks for such a time in his life until he has found it, even though he must hark back to his suckling days as he retains them in his memory or as he reconstructs them in the light of later influences. The symptom in some way again yields the old infantile form of satisfaction, distorted by the censoring work of the conflict. As a rule it is converted into a sensation of suffering and fused with other causal elements of the disease. The form of gratification which the symptom yields has much about it that alienates one's sympathy. In this we omit to take into account, however, the fact that the patients do not recognize the gratification as such and experience the apparent satisfaction rather as suffering, and complain of it. This transformation is part of the psychic conflict under the pressure of which the symptom must be developed. What was at one time a satisfaction for the individual must now awaken his antipathy or disgust. We know a simple but instructive example for such a change of feeling. The same child that sucked the milk with such voracity from its mother's breast is apt to show a strong antipathy for milk a few years later, which is often difficult to overcome. This antipathy increases to the point of disgust when the milk, or any substituted drink, has a little skin over it. It is rather hard to throw out the suggestion that this skin calls up the memory of the mother's breast, which was once so intensely coveted. In the meantime, to be sure, the traumatic experience of weaning has intervened.
There is something else that makes the symptoms appear remarkable and inexplicable as a means of libidinous satisfaction. They in no way recall anything from which we normally are in the habit of expecting satisfaction. They usually require no object, and thereby give up all connection with external reality. We understand this to be a result of turning away from fact and of returning to the predominance of pleasurable gratification. But it is also a return to a sort of amplified autoeroticism, such as was yielded the sex impulse in its earliest satisfactions. In the place of a modification in the outside world, we have a physical change, in other words, an internal reaction in place of an external one, an adjustment instead of an activity. Viewed from a phylogenetic standpoint, this expresses a very significant regression. We will grasp this better when we consider it in connection with a new factor which we are still to discover from the analytic investigation of symptom development. Further, we recall that in symptom formation the same processes of the unconscious have been at work as in dream formation – elaboration and displacement. Similarly to the dream, the symptom represents a fulfillment, a satisfaction after the manner of the infantile; by the utmost elaboration this satisfaction can be compressed into a single sensation or innervation, or by extreme displacement it may be restricted to a tiny element of the entire libidinous complex. It is no wonder that we often have difficulties in recognizing in the symptom the libidinous satisfaction which we anticipate and always find verified.
I have indicated that we must still become familiar with a new factor. It is something really surprising and confusing. You know that by analysis of the symptoms we arrive at a knowledge of the infantile experiences upon which the libido is fixated and out of which the symptoms are formed. Well, the surprising thing is this, that these infantile scenes are not always true. Indeed, in the majority of cases they are untrue, and in some instances they are directly contrary to historical truth. You see that this discovery, as no other, serves either to discredit the analysis which has led to such a result, or to discredit the patients upon whose testimony the analysis, as well as the whole understanding of neuroses, is built up. In addition there is something else utterly confusing about it. If the infantile experiences, revealed by analysis, were in every case real, we should have the feeling of walking on sure ground; if they were regularly falsified, disclosed themselves as inventions or phantasies of the patients, we should have to leave this uncertain ground and find a surer footing elsewhere. But it is neither the one nor the other, for when we look into the matter we find that the childhood experiences which are recalled or reconstructed in the course of the analysis may in some in some instances be false, in others undeniably true, and in the majority of cases a mixture of truth and fiction. The symptoms then are either the representation of actual experiences to which we may ascribe an influence in the fixation of the libido, or the representation of phantasies of the patient which, of course, can be of no etiological significance. It is hard to find one's way here. The first foothold is given perhaps by an analogous discovery, namely, that the same scattered childhood memories that individuals always have had and have been conscious of prior to an analysis may be falsified as well, or at least may contain a generous mixture of true and false. Evidence of error very seldom offers difficulties, and we at least gain the satisfaction of knowing that the blame for this unexpected disappointment is not to be laid at the door of analysis, but in some way upon the patients.
After reflecting a bit we can easily understand what is so confusing in this matter. It is the slight regard for reality, the neglect to keep fact distinct from phantasy. We are apt to feel insulted that the patient has wasted our time with invented tales. There is an enormous gap in our thinking between reality and invention and we accord an entirely different valuation to reality. The patient, too, takes this same viewpoint in his normal thinking. When he offers the material which, by way of the symptom, leads back to the wish situations which are modeled upon the childhood experiences, we are at first, to be sure, in doubt whether we are dealing with reality or with phantasy. Later certain traits determine this decision; we are confronted with the task of acquainting the patient with them. This can never be accomplished without difficulty. If at the outset we tell him that he is going to reveal phantasies with which he has veiled his childhood history, just as every people weaves myths around its antiquity, we notice (to our comfort) that his interest in the further pursuit of the subject suddenly diminishes. He, too, wants to discover realities, and despises all "notions." But if until this is accomplished we allow him to believe that we are investigating the actual occurrences of his childhood, we run the risk of later being charged with error and with our apparent gullibility. For a long time he is unable to reconcile himself to the idea of considering phantasy and reality on equal terms and he tends, with reference to the childish experiences to be explained, to neglect for the time being the difference between the real and the imaginary. And yet this is obviously the only correct attitude toward these psychological products because they are, in a sense, real. It is a fact that the patient is able to create such phantasies for himself, and this is of scarcely less importance for his neurosis than if he had really undergone the experience which he imagines. These phantasies possess psychological reality in contrast to physical reality, and so we gradually come to understand that in the realm of neuroses the psychological reality is the determining factor.
Among the experiences which recur continually in the early history of neurotics and, in fact, are never lacking, some are of particular significance and accordingly I consider them worthy of special treatment. I shall enumerate a few examples of this species: observation of the parental intercourse, seduction by an adult, and the threat of castration. It would be a grievous error to assume that physical reality can never be accorded them; this may often be proved beyond doubt by the testimony of adult relatives. So, for example, it is not at all unusual if the little boy who begins to play with his penis, and does not yet know that one must conceal this, is threatened by his parents or nurse with the cutting off of the organ or the guilty hand. Parents often admit upon questioning that they thought they had done the right thing by this intimidation; many individuals retain a correct, conscious memory of these threats, especially if it has occurred in later childhood. When the mother or some other woman makes the threat she usually delegates the responsibility of executing it to the father or to the doctor. In the famous Struwelpeter by the pediatrist Hoffman, of Frankfort, rhymes which owe their popularity to his very fine understanding of the sexual and other complexes of childhood, you find a milder substitute for castration in the cutting off of the thumbs as a punishment for insistent sucking. But it is highly improbable that the threat of castration is actually made as often as it occurs in the analyses of neurotics. We are content to understand that the child imaginatively constructs this threat for himself from suggestions, from the knowledge that auto-erotic satisfaction is forbidden, and from the impression of castration he has received in discovering the female genital. It is, moreover, in no way impossible that the little child, so long as he is not credited with any understanding or memory, will, even in families outside the proletariat, become a witness to the sexual act between his parents or some other group-ups, and it cannot be disproved that the child subsequently understands this impression, and may react upon it. But when this intercourse is described with minute details which could hardly have been observed, or if it turns out to be, as it so frequently does, an intercourse which was not face to face, more ferarum, there is no longer any doubt that this phantasy is derived from the observation of the intercourse of animals (dogs) and the unsatisfied curiosity of the child in his period of puberty. The greatest feat of the imagination is the phantasy of having witnessed the coitus of the parents while still unborn in the mother's womb. Of especial interest is the phantasy of having been seduced, because so often it is not a phantasy at all, but a real memory. But luckily it is not real so often as first appears from the results of analysis. Seduction by older children, or children of the same age, is much more frequent than seduction by adults, and if, in the case of little girls, the father quite regularly appears as the seducer in the occurrences which they relate, neither the fantastic nature of this accusation nor its motive can be doubted. The child as a rule covers the autoerotic period of his sexual activity, where there has been no actual seduction, with the seduction-phantasy. He spares himself the shame of onanism by imagining the presence of an object for his desires in that early period. As a matter of fact, you must not be misled in attributing sexual misuse of the child by its nearest male relatives solely and always to phantasy. Most analysts have probably treated cases in which such relations were real and could be proved beyond doubt, with the qualification that in such cases they belong to the later years of childhood and were transposed to an earlier time.
We cannot avoid the impression that such experiences of childhood are in some way necessary to the neurosis, that they are claimed by its iron rule. If they exist in reality, then well and good, but if reality has withheld them they are constructed from suggestions and supplemented by the imagination. The result is the same, and to this day we have been unable to trace any difference in the results, whether fancy or fact played the larger part in these childish occurrences. Here again we encounter one of the complementary relationships so frequently met with; it is, to be sure, the most estranging of all those we have become acquainted with. Whence comes the need for these phantasies, and the material for them? There can be no doubt as to the sources of the impulse, but we must explain why the same phantasies are always created with the same content. I have an answer in readiness which I know you will think very far-fetched. I am of the opinion that these primal phantasies– so I should like to term these, and certainly some others also – are a phylogenetic possession. In them the individual reaches out beyond his own life, into the experiences of antiquity, where his own experience has become all too rudimentary. It seems very possible to me that everything which is obtained during an analysis in the guise of phantasy, the seduction of children, the release of sexual excitement by watching parental intercourse, the threat of castration – or rather castration itself – were once realities in the primeval existence of mankind and that the imaginative child is merely filling in the gaps of individual truth with prehistoric truth. We have again and again suspected that the psychology of neuroses stores up more of the antiquities of human development than all other sources.
What we have just discussed makes it necessary for us to enter further into the origin and significance of that mental activity that is called imagination. As you well know, it enjoys universal esteem, although we have never clearly understood its place in the psychic life. I have this much to say about it. As you know, the ego of man is slowly educated by the influence of external necessity to an appreciation of reality and a pursuit of the principle of reality, and must therefore renounce temporarily or permanently various objects and goals of its strivings for satisfaction, sexual and otherwise. But renunciation of gratification has always been difficult for man. He cannot accomplish it without something in the nature of compensation. Accordingly he has reserved for himself a psychological activity wherein all these abandoned sources of pleasures and means of pleasurable gratification are granted a further existence, a form of existence in which they are freed from the requirements of reality and what we like to call the test of reality. Every impulse is soon transformed into the form of its own fulfillment. There is no doubt that dwelling on the imagined fulfillment of a given wish affords some satisfaction, although the realization that it is unreal is unobscured. In the activity of the imagination, man enjoys that freedom from external compulsion that he has long since renounced. He has made it possible to be alternately a pleasure-seeking animal and a reasoning human being. He finds that the scant satisfaction that he can force out of reality is not enough. "There is no getting along without auxiliary-constructions," Th. Fontaine once said. The creation of the psychic realm of fancy has its complete counterpart in the establishment of "preserves" and "conservation projects" in those places where the demands of husbandry, traffic and industry threaten quickly to change the original face of the earth into something unrecognizable. The national reserves maintain this old condition of things, which otherwise has everywhere been regretfully sacrificed to necessity. Everything may grow and spread there as it will, even that which is useless and harmful. The psychic realm of phantasy is such a reservation withdrawn from the principles of reality.
