The Meaning of the Symptoms
IN the last lecture I explained to you that clinical psychiatry concerns itself very little with the form under which the symptoms appear or with the burden they carry, but that it is precisely here that psychoanalysis steps in and shows that the symptom carries a meaning and is connected with the experience of the patient. The meaning of neurotic symptoms was first discovered by J. Breuer in the study and felicitous cure of a case of hysteria which has since become famous (1880-82). It is true that P. Janet independently reached the same result; literary priority must in fact be accorded to the French scholar, since Breuer published his observations more than a decade later (1893-95) during his period of collaboration with me. On the whole it may be of small importance to us who is responsible for this discovery, for you know that every discovery is made more than once, that none is made all at once, and that success is not meted out according to deserts. America is not named after Columbus. Before Breuer and Janet, the great psychiatrist Leuret expressed the opinion that even for the deliria of the insane, if we only understood how to interpret them, a meaning could be found. I confess that for a considerable period of time I was willing to estimate very highly the credit due to P. Janet in the explanation of neurotic symptoms, because he saw in them the expression of subconscious ideas (idées inconscientes) with which the patients were obsessed. But since then Janet has expressed himself most conservatively, as though he wanted to confess that the term "subconscious" had been for him nothing more than a mode of speech, a shift, "une façon de parler," by the use of which he had nothing definite in mind. I now no longer understand Janet's discussions, but I believe that he has needlessly deprived himself of high credit.
The neurotic symptoms then have their meaning just like errors and the dream, and like these they are related to the livesof the persons in whom they appear. The importance of this insight into the nature of the symptom can best be brought home to you by way of examples. That it is borne out always and in all cases, I can only assert, not prove. He who gathers his own experience will be convinced of it. For certain reasons, however, I shall draw my instances not from hysteria, but from another fundamentally related and very curious neurosis concerning which I wish to say a few introductory words to you. This so-called compulsion neurosis is not so popular as the widely known hysteria; it is, if I may use the expression, not so noisily ostentatious, behaves more as a private concern of the patient, renounces bodily manifestations almost entirely and creates all its symptoms psychologically. Compulsion neurosis and hysteria are those forms of neurotic disease by the study of which psychoanalysis has been built up, and in whose treatment as well the therapy celebrates its triumphs. Of these the compulsion neurosis, which does not take that mysterious leap from the psychic to the physical, has through psychoanalytic research become more intimately comprehensible and transparent to us than hysteria, and we have come to understand that it reveals far more vividly certain extreme characteristics of the neuroses.
The chief manifestations of compulsion neurosis are these: the patient is occupied by thoughts that in reality do not interest him, is moved by impulses that appear alien to him, and is impelled to actions which, to be sure, afford him no pleasure, but the performance of which he cannot possibly resist. The thoughts may be absurd in themselves or thoroughly indifferent to the individual, often they are absolutely childish and in all cases they are the result of strained thinking, which exhausts the patient, who surrenders himself to them most unwillingly. Against his will he is forced to brood and speculate as though it were a matter of life or death to him. The impulses, which the patient feels within himself, may also give a childish or ridiculous impression, but for the most part they bear the terrifying aspect of temptations to fearful crimes, so that the patient not only denies them, but flees from them in horror and protects himself from actual execution of his desires through inhibitory renunciations and restrictions upon his personal liberty. As a matter of fact he never, not a single time, carries any of these impulses into effect; the result is always that hisevasion and precaution triumph. The patient really carries out only very harmless trivial acts, so-called compulsive acts, for the most part repetitions and ceremonious additions to the occupations of every-day life, through which its necessary performances—going to bed, washing, dressing, walking—become long-winded problems of almost insuperable difficulty. The abnormal ideas, impulses and actions are in nowise equally potent in individual forms and cases of compulsion neurosis; it is the rule, rather, that one or the other of these manifestations is the dominating factor and gives the name to the disease; that all these forms, however, have a great deal in common is quite undeniable.
Surely this means violent suffering. I believe that the wildest psychiatric phantasy could not have succeeded in deriving anything comparable, and if one did not actually see it every day, one could hardly bring oneself to believe it. Do not think, however, that you give the patient any help when you coax him to divert himself, to put aside these stupid ideas and to set himself to something useful in the place of his whimsical occupations. This is just what he would like of his own accord, for he possesses all his senses, shares your opinion of his compulsion symptoms, in fact volunteers it quite readily. But he cannot do otherwise; whatever activities actually are released under compulsion neurosis are carried along by a driving energy, such as is probably never met with in normal psychic life. He has only one remedy—to transfer and change. In place of one stupid idea he can think of a somewhat milder absurdity, he can proceed from one precaution and prohibition to another, or carry through another ceremonial. He may shift, but he cannot annul the compulsion. One of the chief characteristics of the sickness is the instability of the symptoms; they can be shifted very far from their original form. It is moreover striking that the contrasts present in all psychological experience are so very sharply drawn in this condition. In addition to the compulsion of positive and negative content, an intellectual doubt makes itself felt that gradually attacks the most ordinary and assured certainties. All these things merge into steadily increasing uncertainty, lack of energy, curtailment of personal liberty, despite the fact that the patient suffering from compulsion neurosis is originally a most energetic character, often of extraordinary obstinacy,as a rule intellectually gifted above the average. For the most part he has attained a desirable stage of ethical development, is overconscientious and more than usually correct. You can imagine that it takes no inconsiderable piece of work to find one's way through this maze of contradictory characteristics and symptoms. Indeed, for the present our only object is to understand and to interpret some symptoms of this disease.
Perhaps in reference to our previous discussions, you would like to know the position of present-day psychiatry to the problems of the compulsion neurosis. This is covered in a very slim chapter. Psychiatry gives names to the various forms of compulsion, but says nothing further concerning them. Instead it emphasizes the fact that those who show these symptoms are degenerates. That yields slight satisfaction, it is an ethical judgment, a condemnation rather than an explanation. We are led to suppose that it is in the unsound that all these peculiarities may be found. Now we do believe that persons who develop such symptoms must differ fundamentally from other people. But we would like to ask, are they more "degenerate" than other nervous patients, those suffering, for instance, from hysteria or other diseases of the mind? The characterization is obviously too general. One may even doubt whether it is at all justified, when one learns that such symptoms occur in excellent men and women of especially great and universally recognized ability. In general we glean very little intimate knowledge of the great men who serve us as models. This is due both to their own discretion and to the lying propensities of their biographers. Sometimes, however, a man is a fanatic disciple of truth, such as Emile Zola, and then we hear from him the strange compulsion habits from which he suffered all his life.[38]
Psychiatry has resorted to the expedient of speaking of "superior degenerates." Very well—but through psychoanalysis we have learned that these peculiar compulsion symptoms may be permanently removed just like any other disease of normal persons. I myself have frequently succeeded in doing this.
I will give you two examples only of the analysis of compulsion symptoms, one, an old observation, which cannot be replaced by anything more complete, and one a recent study. I am limiting myself to such a small number because in an account of thisnature it is necessary to be very explicit and to enter into every detail.
A lady about thirty years old suffered from the most severe compulsions. I might indeed have helped her if caprice of fortune had not destroyed my work—perhaps I will yet have occasion to tell you about it. In the course of each day the patient often executed, among others, the following strange compulsive act. She ran from her room into an adjoining one, placed herself in a definite spot beside a table which stood in the middle of the room, rang for her maid, gave her a trivial errand to do, or dismissed her without more ado, and then ran back again. This was certainly not a severe symptom of disease, but it still deserved to arouse curiosity. Its explanation was found, absolutely without any assistance on the part of the physician, in the very simplest way, a way to which no one can take exception. I hardly know how I alone could have guessed the meaning of this compulsive act, or have found any suggestion toward its interpretation. As often as I had asked the patient: "Why do you do this? Of what use is it?" she had answered, "I don't know." But one day after I had succeeded in surmounting a grave ethical doubt of hers she suddenly saw the light and related the history of the compulsive act. More than ten years prior she had married a man far older than herself, who had proved impotent on the bridal night. Countless times during the night he had run from his room to hers to repeat the attempt, but each time without success. In the morning he said angrily: "It is enough to make one ashamed before the maid who does the beds," and took a bottle of red ink that happened to be in the room, and poured its contents on the sheet, but not on the place where such a stain would have been justifiable. At first I did not understand the connection between this reminiscence and the compulsive act in question, for the only agreement I could find between them was in the running from one room into another,—possibly also in the appearance of the maid. Then the patient led me to the table in the second room and let me discover a large spot on the cover. She explained also that she placed herself at the table in such a way that the maid could not miss seeing the stain. Now it was no longer possible to doubt the intimate relation of the scene afterher bridal night and her present compulsive act, but there were still a number of things to be learned about it.
In the first place, it is obvious that the patient identifies herself with her husband, she is acting his part in her imitation of his running from one room into the other. We must then admit—if she holds to this role—that she replaces the bed and sheet by table and cover. This may seem arbitrary, but we have not studied dream symbolism in vain. In dreams also a table which must be interpreted as a bed, is frequently seen. "Bed and board" together represent married life, one may therefore easily be used to represent the other.
The evidence that the compulsive act carries meaning would thus be plain; it appears as a representation, a repetition of the original significant scene. However, we are not forced to stop at this semblance of a solution; when we examine more closely the relation between these two people, we shall probably be enlightened concerning something of wider importance, namely, the purpose of the compulsive act. The nucleus of this purpose is evidently the summoning of the maid; to her she wishes to show the stain and refute her husband's remark: "It is enough to shame one before the maid." He—whose part she is playing—therefore feels no shame before the maid, hence the stain must be in the right place. So we see that she has not merely repeated the scene, rather she has amplified it, corrected it and "turned it to the good." Thereby, however, she also corrects something else,—the thing which was so embarrassing that night and necessitated the use of the red ink—impotence. The compulsive act then says: "No, it is not true, he did not have to be ashamed before the maid, he was not impotent." After the manner of a dream she represents the fulfillment of this wish in an overt action, she is ruled by the desire to help her husband over that unfortunate incident.
Everything else that I could tell you about this case supports this clue more specifically; all that we otherwise know about her tends to strengthen this interpretation of a compulsive act incomprehensible in itself. For years the woman has lived separated from her husband and is struggling with the intention to obtain a legal divorce. But she is by no means free from him; she forces herself to remain faithful to him, she retires from the world to avoid temptation; in her imagination sheexcuses and idealizes him. The deepest secret of her malady is that by means of it she shields her husband from malicious gossip, justifies her separation from him, and renders possible for him a comfortable separate life. Thus the analysis of a harmless compulsive act leads to the very heart of this case and at the same time reveals no inconsiderable portion of the secret of the compulsion neurosis in general. I shall be glad to have you dwell upon this instance, as it combines conditions that one can scarcely demand in other cases. The interpretation of the symptoms was discovered by the patient herself in one flash, without the suggestion or interference of the analyst. It came about by the reference to an experience, which did not, as is usually the case, belong to the half-forgotten period of childhood, but to the mature life of the patient, in whose memory it had remained unobliterated. All the objections which critics ordinarily offer to our interpretation of symptoms fail in this case. Of course, we are not always so fortunate.
And one thing more! Have you not observed how this insignificant compulsive act initiated us into the intimate life of the invalid? A woman can scarcely relate anything more intimate than the story of her bridal night, and is it without further significance that we just happened to come on the intimacies of her sexual life? It might of course be the result of the selection I have made in this instance. Let us not judge too quickly and turn our attention to the second instance, one of an entirely different kind, a sample of a frequently occurring variety, namely, the sleep ritual.
A nineteen-year old, well-developed, gifted girl, an only child, who was superior to her parents in education and intellectual activity, had been wild and mischievous in her childhood, but has become very nervous during the last years without any apparent outward cause. She is especially irritable with her mother, always discontented, depressed, has a tendency toward indecision and doubt, and is finally forced to confess that she can no longer walk alone on public squares or wide thoroughfares. We shall not consider at length her complicated condition, which requires at least two diagnoses—agoraphobia and compulsion neurosis. We will dwell only upon the fact that this girl has also developed a sleep ritual, under which she allows her parents to suffer much discomfort. In a certain sense, wemay say that every normal person has a sleep ritual, in other words that he insists on certain conditions, the absence of which hinders him from falling asleep; he has created certain observances by which he bridges the transition from waking to sleeping and these he repeats every evening in the same manner. But everything that the healthy person demands in order to obtain sleep is easily understandable and, above all, when external conditions necessitate a change, he adapts himself easily and without loss of time. But the pathological ritual is rigid, it persists by virtue of the greatest sacrifices, it also masks itself with a reasonable justification and seems, in the light of superficial observation, to differ from the normal only by exaggerated pedantry. But under closer observation we notice that the mask is transparent, for the ritual covers intentions that go far beyond this reasonable justification, and other intentions as well that are in direct contradiction to this reasonable justification. Our patient cites as the motive of her nightly precautions that she must have quiet in order to sleep; therefore she excludes all sources of noise. To accomplish this, she does two things: the large clock in her room is stopped, all other clocks are removed; not even the wrist watch on her night-table is suffered to remain. Flowerpots and vases are placed on her desk so that they cannot fall down during the night, and in breaking disturb her sleep. She knows that these precautions are scarcely justifiable for the sake of quiet; the ticking of the small watch could not be heard even if it should remain on the night-table, and moreover we all know that the regular ticking of a clock is conducive to sleep rather than disturbing. She does admit that there is not the least probability that flowerpots and vases left in place might of their own accord fall and break during the night. She drops the pretense of quiet for the other practice of this sleep ritual. She seems on the contrary to release a source of disturbing noises by the demand that the door between her own room and that of her parents remain half open, and she insures this condition by placing various objects in front of the open door. The most important observances concern the bed itself. The large pillow at the head of the bed may not touch the wooden back of the bed. The small pillow for her head must lie on the large pillow to form a rhomb; she then places her head exactly upon the diagonal of the rhomb. Before coveringherself, the featherbed must be shaken so that its foot end becomes quite flat, but she never omits to press this down and redistribute the thickness.
Allow me to pass over the other trivial incidents of this ritual; they would teach us nothing new and cause too great digression from our purpose. Do not overlook, however, the fact that all this does not run its course quite smoothly. Everything is pervaded by the anxiety that things have not been done properly; they must be examined, repeated. Her doubts seize first on one, then on another precaution, and the result is that one or two hours elapse during which the girl cannot and the intimidated parents dare not sleep.
These torments were not so easily analyzed as the compulsive act of our former patient. In the working out of the interpretations I had to hint and suggest to the girl, and was met on her part either by positive denial or mocking doubt. This first reaction of denial, however, was followed by a time when she occupied herself of her own accord with the possibilities that had been suggested, noted the associations they called out, produced reminiscences, and established connections, until through her own efforts she had reached and accepted all interpretations. In so far as she did this, she desisted as well from the performance of her compulsive rules, and even before the treatment had ended she had given up the entire ritual. You must also know that the nature of present-day analysis by no means enables us to follow out each individual symptom until its meaning becomes clear. Rather it is necessary to abandon a given theme again and again, yet with the certainty that we will be led back to it in some other connection. The interpretation of the symptoms in this case, which I am about to give you, is a synthesis of results, which, with the interruptions of other work, needed weeks and months for their compilation.
Our patient gradually learns to understand that she has banished clocks and watches from her room during the night because the clock is the symbol of the female genital. The clock, which we have learned to interpret as a symbol for other things also, receives this role of the genital organ through its relation to periodic occurrences at equal intervals. A woman may for instance be found to boast that her menstruation is as regular as clockwork. The special fear of our patient, however, wasthat the ticking of the clock would disturb her in her sleep. The ticking of the clock may be compared to the throbbing of the clitoris during sexual excitement. Frequently she had actually been awakened by this painful sensation and now this fear of an erection of the clitoris caused her to remove all ticking clocks during the night. Flowerpots and vases are, as are all vessels, also female symbols. The precaution, therefore, that they should not fall and break at night, was not without meaning. We know the widespread custom of breaking a plate or dish when an engagement is celebrated. The fragment of which each guest possesses himself symbolizes his renunciation of his claim to the bride, a renunciation which we may assume as based on the monogamous marriage law. Furthermore, to this part of her ceremonial our patient adds a reminiscence and several associations. As a child she had slipped once and fallen with a bowl of glass or clay, had cut her finger, and bled violently. As she grew up and learned the facts of sexual intercourse, she developed the fear that she might not bleed during her bridal night and so not prove to be a virgin. Her precaution against the breaking of vases was a rejection of the entire virginity complex, including the bleeding connected with the first cohabitation. She rejected both the fear to bleed and the contradictory fear not to bleed. Indeed her precautions had very little to do with a prevention of noise.
One day she guessed the central idea of her ceremonial, when she suddenly understood her rule not to let the pillow come in contact with the bed. The pillows always had seemed a woman to her, the erect back of the bed a man. By means of magic, we may say, she wished to keep apart man and wife; it was her parents she wished to separate, so to prevent their marital intercourse. She had sought to attain the same end by more direct methods in earlier years, before the institution of her ceremonial. She had simulated fear or exploited a genuine timidity in order to keep open the door between the parents' bedroom and the nursery. This demand had been retained in her present ceremonial. Thus she had gained the opportunity of overhearing her parents, a proceeding which at one time subjected her to months of sleeplessness. Not content with this disturbance to her parents, she was at that time occasionally able to gain her point and sleep between father and mother intheir very bed. Then "pillow" and "wooden wall" could really not come in contact. Finally when she became so big that her presence between the parents could not longer be borne comfortably, she consciously simulated fear and actually succeeded in changing places with her mother and taking her place at her father's side. This situation was undoubtedly the starting point for the phantasies, whose after-effects made themselves felt in her ritual.
If a pillow represented a woman, then the shaking of the featherbed till all the feathers were lumped at one end, rounding it into a prominence, must have its meaning also. It meant the impregnation of the wife; the ceremonial, however, never failed to provide for the annulment, of this pregnancy by the flattening down of the feathers. Indeed, for years our patient had feared that the intercourse between her parents might result in another child which would be her rival. Now, where the large pillow represents a woman, the mother, then the small pillow could be nothing but the daughter. Why did this pillow have to be placed so as to form a rhomb; and why did the girl's head have to rest exactly upon the diagonal? It was easy to remind the patient that the rhomb on all walls is the rune used to represent the open female genital. She herself then played the part of the man, the father, and her head took the place of the male organ. (Cf. the symbol of beheading to represent castration.)
Wild ideas, you will say, to run riot in the head of a virgin girl. I admit it, but do not forget that I have not created these ideas but merely interpreted them. A sleep ritual of this kind is itself very strange, and you cannot deny the correspondence between the ritual and the phantasies that yielded us the interpretation. For my part I am most anxious that you observe in this connection that no single phantasy was projected in the ceremonial, but a number of them had to be integrated,—they must have their nodal points somewhere in space. Observe also that the observance of the ritual reproduce the sexual desire now positively, now negatively, and serve in part as their rejection, again as their representation.
It would be possible to make a better analysis of this ritual by relating it to other symptoms of the patient. But we cannot digress in that direction. Let the suggestion suffice that the girl is subject to an erotic attachment to her father, the beginningof which goes back to her earliest childhood. That perhaps is the reason for her unfriendly attitude toward her mother. Also we cannot escape the fact that the analysis of this symptom again points to the sexual life of the patient. The more we penetrate to the meaning and purpose of neurotic symptoms, the less surprising will this seem to us.
By means of two selected illustrations I have demonstrated to you that neurotic symptoms carry just as much meaning as do errors and the dream, and that they are intimately connected with the experience of the patient. Can I expect you to believe this vitally significant statement on the strength of two examples? No. But can you expect me to cite further illustrations until you declare yourself convinced? That too is impossible, since considering the explicitness with which I treat each individual case, I would require a five-hour full semester course for the explanation of this one point in the theory of the neuroses. I must content myself then with having given you one proof for my assertion and refer you for the rest to the literature of the subject, above all to the classical interpretation of symptoms in Breuer's first case (hysteria) as well as to the striking clarification of obscure symptoms in the so-called dementia praecox by C. G. Jung, dating from the time when this scholar was still content to be a mere psychoanalyst—and did not yet want to be a prophet; and to all the articles that have subsequently appeared in our periodicals. It is precisely investigations of this sort which are plentiful. Psychoanalysts have felt themselves so much attracted by the analysis, interpretation and translation of neurotic symptoms, that by contrast they seem temporarily to have neglected other problems of neurosis.
Whoever among you takes the trouble to look into the matter will undoubtedly be deeply impressed by the wealth of evidential material. But he will also encounter difficulties. We have learned that the meaning of a symptom is found in its relation to the experience of the patient. The more highly individualized the symptom is, the sooner we may hope to establish these relations. Therefore the task resolves itself specifically into the discovery for every nonsensical idea and useless action of a past situation wherein the idea had been justified and the action purposeful. A perfect example for this kind of symptom is the compulsive act of our patient who ran to the table and rangfor the maid. But there are symptoms of a very different nature which are by no means rare. They must be called typical symptoms of the disease, for they are approximately alike in all cases, in which the individual differences disappear or shrivel to such an extent that it is difficult to connect them with the specific experiences of the patient and to relate them to the particular situations of his past. Let us again direct our attention to the compulsion neurosis. The sleep ritual of our second patient is already quite typical, but bears enough individual features to render possible what may be called anhistoricinterpretation. But all compulsive patients tend to repeat, to isolate their actions from others and to subject them to a rhythmic sequence. Most of them wash too much. Agoraphobia (topophobia, fear of spaces), a malady which is no longer grouped with the compulsion neurosis, but is now called anxiety hysteria, invariably shows the same pathological picture; it repeats with exhausting monotony the same feature, the patient's fear of closed spaces, of large open squares, of long stretched streets and parkways, and their feeling of safety when acquaintances accompany them, when a carriage drives after them, etc. On this identical groundwork, however, the individual differences between the patients are superimposed—moods one might almost call them, which are sharply contrasted in the various cases. The one fears only narrow streets, the other only wide ones, the one can go out walking only when there are few people abroad, the other when there are many. Hysteria also, aside from its wealth of individual features, has a superfluity of common typical symptoms that appear to resist any facile historical methods of tracing them. But do not let us forget that it is by these typical symptoms that we get our bearings in reaching a diagnosis. When, in one case of hysteria we have finally traced back a typical symptom to an experience or a series of similar experiences, for instance followed back an hysterical vomiting to its origin in a succession of disgust impressions, another case of vomiting will confuse us by revealing an entirely different chain of experiences, seemingly just as effective. It seems almost as though hysterical patients must vomit for some reason as yet unknown, and that the historic factors, revealed by analysis, are chance pretexts, seized on asopportunity best offered to serve the purposes of a deeper need.
Thus we soon reach the discouraging conclusion that although we can satisfactorily explain the individual neurotic symptom by relating it to an experience, our science fails us when it comes to the typical symptoms that occur far more frequently. In addition, remember that I am not going into all the detailed difficulties which come up in the course of resolutely hunting down an historic interpretation of the symptom. I have no intention of doing this, for though I want to keep nothing from you, and so paint everything in its true colors, I still do not wish to confuse and discourage you at the very outset of our studies. It is true that we have only begun to understand the interpretation of symptoms, but we wish to hold fast to the results we have achieved, and struggle forward step by step toward the mastery of the still unintelligible data. I therefore try to cheer you with the thought that a fundamental between the two kinds of symptoms can scarcely be assumed. Since the individual symptoms are so obviously dependent upon the experience of the patient, there is a possibility that the typical symptoms revert to an experience that is in itself typical and common to all humanity. Other regularly recurring features of neurosis, such as the repetition and doubt of the compulsion neurosis, may be universal reactions which are forced upon the patient by the very nature of the abnormal change. In short, we have no reason to be prematurely discouraged; we shall see what our further results will yield.
We meet a very similar difficulty in the theory of dreams, which in our previous discussion of the dream I could not go into. The manifest content of dreams is most profuse and individually varied, and I have shown very explicitly what analysis may glean from this content. But side by side with these dreams there are others which may also be termed "typical" and which occur similarly in all people. These are dreams of identical content which offer the same difficulties for their interpretation as the typical symptom. They are the dreams of falling, flying, floating, swimming, of being hemmed in, of nakedness, and various other anxiety dreams that yield first one and then another interpretation for the different patients, without resulting in an explanation of their monotonous and typicalrecurrence. In the matter of these dreams also, we see a fundamental groundwork enriched by individual additions. Probably they as well can be fitted into the theory of dream life, built up on the basis of other dreams,—not however by straining the point, but by the gradual broadening of our views.
Traumatic Fixation—The Unconscious
ISAID last time that we would not continue our work from the standpoint of our doubts, but on the basis of our results. We have not even touched upon two of the most interesting conclusions, derived equally from the same two sample analyses.
In the first place, both patients give us the impression of beingfixatedupon some very definite part of their past; they are unable to free themselves therefrom, and have therefore come to be completely estranged both from the present and the future. They are now isolated in their ailment, just as in earlier days people withdrew into monasteries there to carry along the burden of their unhappy fates. In the case of the first patient, it is her marriage with her husband, really abandoned, that has determined her lot. By means of her symptoms she continues to deal with her husband; we have learned to understand those voices which plead his case, which excuse him, exalt him, lament his loss. Although she is young and might be coveted by other men, she has seized upon all manner of real and imaginary (magic) precautions to safeguard her virtue for him. She will not appear before strangers, she neglects her personal appearance; furthermore, she cannot bring herself to get up readily from any chair on which she has been seated. She refuses to give her signature, and finally, since she is motivated by her desire not to let anyone have anything of hers, she is unable to give presents.
In the case of the second patient, the young girl, it is an erotic attachment for her father that had established itself in the years prior to puberty, which plays the same role in her life. She also has arrived at the conclusion that she may not marry so long as she is sick. We may suspect she became ill in order that she need not marry, and that she might stay with her father.
It is impossible to evade the question of how, in what manner, and driven by what motives, an individual may come by such a remarkable and unprofitable attitude toward life. Granted of course that this bearing is a general characteristic of neurosis, and not a special peculiarity of these two cases, it is nevertheless a general trait in every neurosis of very great importance in practice. Breuer's first hysterical patient was fixated in the same manner upon the time when she nursed her very sick father. In spite of her recuperation she has, in certain respects, since that time, been done with life; although she remained healthy and able, she did not enter on the normal life of women. In every one of our patients we may see, by the use of analysis, that in his disease-symptoms and their results he has gone back again into a definite period of his past. In the majority of cases he even chooses a very early phase of his life, sometime a childhood phase, indeed, laughable as it may appear, a phase of his very suckling existence.
The closest analogies to these conditions of our neurotics are furnished by the types of sickness which the war has just now made so frequent—the so-called traumatic neuroses. Even before the war there were such cases after railroad collisions and other frightful occurrences which endangered life. The traumatic neuroses are, fundamentally, not the same as the spontaneous neuroses which we have been analysing and treating; moreover, we have not yet succeeded in bringing them within our hypotheses, and I hope to be able to make clear to you wherein this limitation lies. Yet on one point we may emphasize the existence of a complete agreement between the two forms. The traumatic neuroses show clear indications that they are grounded in a fixation upon the moment of the traumatic disaster. In their dreams these patients regularly live over the traumatic situation; where there are attacks of an hysterical type, which permit of an analysis, we learn that the attack approximates a complete transposition into this situation. It is as if these patients had not yet gotten through with the traumatic situation, as if it were actually before them as a task which was not yet mastered. We take this view of the matter in all seriousness; it shows the way to aneconomicview of psychic occurrences. For the expression "traumatic" has no other than an economic meaning, and the disturbance permanently attacks the managementof available energy. The traumatic experience is one which, in a very short space of time, is able to increase the strength of a given stimulus so enormously that its assimilation, or rather its elaboration, can no longer be effected by normal means.
This analogy tempts us to classify as traumatic those experiences as well upon which our neurotics appear to be fixated. Thus the possibility is held out to us of having found a simple determining factor for the neurosis. It would then be comparable to a traumatic disease, and would arise from the inability to meet an overpowering emotional experience. As a matter of fact this reads like the first formula, by which Breuer and I, in 1893-1895, accounted theoretically for our new observations. A case such as that of our first patient, the young woman separated from her husband, is very well explained by this conception. She was not able to get over the unfeasibility of her marriage, and has not been able to extricate herself from this trauma. But our very next, that of the girl attached to her father, shows us that the formula is not sufficiently comprehensive. On the one hand, such baby love of a little girl for her father is so usual, and so often outlived that the designation "traumatic" would carry no significance; on the other hand, the history of the patient teaches us that this first erotic fixation apparently passed by harmlessly at the time, and did not again appear until many years later in the symptoms of the compulsion neurosis. We see complications before us, the existence of a greater wealth of determining factors in the disease, but we also suspect that the traumatic viewpoint will not have to be given up as wrong; rather it will have to subordinate itself when it is fitted into a different context.
Here again we must leave the road we have been traveling. For the time being, it leads us no further and we have many other things to find out before we can go on again. But before we leave this subject let us note that the fixation on some particular phase of the past has bearings which extend far beyond the neurosis. Every neurosis contains such a fixation, but every fixation does not lead to a neurosis, nor fall into the same class with neuroses, nor even set the conditions for the development of a neurosis. Mourning is a type of emotional fixation on a theory of the past, which also brings with it the most completealienation from the present and the future. But mourning is sharply distinguished from neuroses that may be designated as pathological forms of mourning.
It also happens that men are brought to complete deadlock by a traumatic experience that has so completely shaken the foundations on which they have built their lives that they give up all interest in the present and future, and become completely absorbed in their retrospections; but these unhappy persons are not necessarily neurotic. We must not overestimate this one feature as a diagnostic for a neurosis, no matter how invariable and potent it may be.
Now let us turn to the second conclusion of our analysis, which however we will hardly need to limit subsequently. We have spoken of the senseless compulsive activities of our first patient, and what intimate memories she disclosed as belonging to them; later we also investigated the connection between experience and symptom and thus discovered the purpose hidden behind the compulsive activity. But we have entirely omitted one factor that deserves our whole attention. As long as the patient kept repeating the compulsive activity she did not know that it was in any way related with the experience in question. The connection between the two was hidden from her, she truthfully answered that she did not know what compelled her to do this. Once, suddenly, under the influence of the cure, she hit upon the connection and was able to tell it to us. But still she did not know of the end in the service of which she performed the compulsive activities, the purpose to correct a painful part of the past and to place the husband, still loved by her, upon a higher level. It took quite a long time and a great deal of trouble for her to grasp and admit to me that such a motive alone could have been the motive force of the compulsive activity.
The relation between the scene after the unhappy bridal night and the tender motive of the patient yield what we have called the meaning of the compulsive activity. But both the "whence" and the "why" remained hidden from her as long as she continued to carry out the compulsive act. Psychological processes had been going on within her for which the compulsive act found an expression. She could, in a normal frame of mind, observe their effect, but none of the psychologicalantecedents of her action had come to the knowledge of her consciousness. She had acted in just the same manner as a hypnotized person to whom Bernheim had given the injunction that five minutes after his awakening in the ward he was to open an umbrella, and he had carried out this order on awakening, but could give no motive for his so doing. We have exactly such facts in mind when we speak of the existence ofunconscious psychological processes. Let anyone in the world account for these facts in a more correct scientific manner, and we will gladly withdraw completely our assumption of unconscious psychological processes. Until then, however, we shall continue to use this assumption, and when anyone wants to bring forward the objection that the unconscious can have no reality for science and is a mere makeshift, (une façon de parler), we must simply shrug our shoulders and reject his incomprehensible statement resignedly. A strange unreality which can call out such real and palpable effects as a compulsion symptom!
In our second patient we meet with fundamentally the same thing. She had created a decree which she must follow: the pillow must not touch the head of the bed; yet she does not know how it originated, what its meaning is, nor to what motive it owes the source of its power. It is immaterial whether she looks upon it with indifference or struggles against it, storms against it, determines to overcome it. She must nevertheless follow it and carry out its ordinance, though she asks herself, in vain, why. One must admit that these symptoms of compulsion neurosis offer the clearest evidence for a special sphere of psychological activity, cut off from the rest. What else could be back of these images and impulses, which appear from one knows not where, which have such great resistance to all the influences of an otherwise normal psychic life; which give the patient himself the impression that here are super-powerful guests from another world, immortals mixing in the affairs of mortals. Neurotic symptoms lead unmistakably to a conviction of the existence of an unconscious psychology, and for that very reason clinical psychiatry, which recognizes only a conscious psychology, has no explanation other than that they are present as indications of a particular kind of degeneration. To be sure, the compulsive images and impulses are not themselves unconscious—no more so than the carrying out of the compulsive-acts escapes consciousobservation. They would not have been symptoms had they not penetrated through into consciousness. But their psychological antecedents as disclosed by the analysis, the associations into which we place them by our interpretations, are unconscious, at least until we have made them known to the patient during the course of the analysis.
Consider now, in addition, that the facts established in our two cases are confirmed in all the symptoms of all neurotic diseases, that always and everywhere the meaning of the symptoms is unknown to the sufferer, that analysis shows without fail that these symptoms are derivatives of unconscious experiences which can, under various favorable conditions, become conscious. You will understand then that in psychoanalysis we cannot do without this unconscious psyche, and are accustomed to deal with it as with something tangible. Perhaps you will also be able to understand how those who know the unconscious only as an idea, who have never analyzed, never interpreted dreams, or never translated neurotic symptoms into meaning and purpose, are most ill-suited to pass an opinion on this subject. Let us express our point of view once more. Our ability to give meaning to neurotic symptoms by means of analytic interpretation is an irrefutable indication of the existence of unconscious psychological processes—or, if you prefer, an irrefutable proof of the necessity for their assumption.
But that is not all. Thanks to a second discovery of Breuer's, for which he alone deserves credit and which appears to me to be even more far-reaching, we are able to learn still more concerning the relationship between the unconscious and the neurotic symptom. Not alone is the meaning of the symptoms invariably hidden in the unconscious; but the very existence of the symptom is conditioned by its relation to this unconscious. You will soon understand me. With Breuer I maintain the following: Every time we hit upon a symptom we may conclude that the patient cherishes definite unconscious experiences which withhold the meaning of the symptoms. Vice versa, in order that the symptoms may come into being, it is also essential that this meaning be unconscious. Symptoms are not built up out of conscious experiences; as soon as the unconscious processes in question become conscious, the symptom disappears. You will at once recognize here the approach to our therapy, a wayto make symptoms disappear. It was by these means that Breuer actually achieved the recovery of his patient, that is, freed her of her symptoms; he found a technique for bringing into her consciousness the unconscious experiences that carried the meaning of her symptoms, and the symptoms disappeared.
This discovery of Breuer's was not the result of a speculation, but of a felicitous observation made possible by the coöperation of the patient. You should therefore not trouble yourself to find things you already know to which you can compare these occurrences, rather you should recognize herein a new fundamental fact which in itself is capable of much wider application. Toward this further end permit me to go over this ground again in a different way.
The symptom develops as a substitution for something else that has remained suppressed. Certain psychological experiences should normally have become so far elaborated that consciousness would have attained knowledge of them. This did not take place, however, but out of these interrupted and disturbed processes, imprisoned in the unconscious, the symptom arose. That is to say, something in the nature of an interchange had been effected; as often as therapeutic measures are successful in again reversing this transposition, psychoanalytic therapy solves the problem of the neurotic symptom.
Accordingly, Breuer's discovery still remains the foundation of psychoanalytic therapy. The assertion that the symptoms disappear when one has made their unconscious connections conscious, has been borne out by all subsequent research, although the most extraordinary and unexpected complications have been met with in its practical execution. Our therapy does its work by means of changing the unconscious into the conscious, and is effective only in so far as it has the opportunity of bringing about this transformation.
Now we shall make a hasty digression so that you do not by any chance imagine that this therapeutic work is too easy. From all we have learned so far, the neurosis would appear as the result of a sort of ignorance, the incognizance of psychological processes that we should know of. We would thus very closely approximate the well-known Socratic teachings, according to which evil itself is the result of ignorance. Now the experienced physician will, as a rule, discover fairly readilywhat psychic impulses in his several patients have remained unconscious. Accordingly it would seem easy for him to cure the patient by imparting this knowledge to him and freeing him of his ignorance. At least the part played by the unconscious meaning of the symptoms could easily be discovered in this manner, and it would only be in dealing with the relationship of the symptoms to the experiences of the patient that the physician would be handicapped. In the face of these experiences, of course, he is the ignorant one of the two, for he did not go through these experiences, and must wait until the patient remembers them and tells them to him. But in many cases this difficulty could be readily overcome. One can question the relatives of the patient concerning these experiences, and they will often be in a position to point out those that carry any traumatic significance; they may even be able to inform the analyst of experiences of which the patient knows nothing because they occurred in the very early years of his life. By a combination of such means it would seem that the pathogenic ignorance of the patient could be cleared up in a short time and without much trouble.
If only that were all! We have made discoveries for which we were at first unprepared. Knowing and knowing is not always the same thing; there are various kinds of knowing that are psychologically by no means comparable. "Il y a fagots et fagots,"[39]as Molière says. The knowledge of the physician is not the same as that of the patient and cannot bring about the same results. The physician can gain no results by transferring his knowledge to the patient in so many words. This is perhaps putting it incorrectly, for though the transference does not result in dissolving the symptoms, it does set the analysis in motion, and calls out an energetic denial, the first sign usually that this has taken place. The patient has learned something that he did not know up to that time, the meaning of his symptoms, and yet he knows it as little as before. So we discover there is more than one kind of ignorance. It will require a deepening of our psychological insight to make clear to us wherein the difference lies. But our assertion nevertheless remains true that the symptoms disappear with the knowledge of their meaning. For there is only one limiting condition;the knowledge must be founded on an inner change in the patient which can be attained only through psychic labors directed toward a definite end. We have here been confronted by problems which will soon lead us to the elaboration of a dynamics of symptom formation.
I must stop to ask you whether this is not all too vague and too complicated? Do I not confuse you by so often retracting my words and restricting them, spinning out trains of thought and then rejecting them? I should be sorry if this were the case. However, I strongly dislike simplification at the expense of truth, and am not averse to having you receive the full impression of how many-sided and complicated the subject is. I also think that there is no harm done if I say more on every point than you can at the moment make use of. I know that every hearer and reader arranges what is offered him in his own thoughts, shortens it, simplifies it and extracts what he wishes to retain. Within a given measure it is true that the more we begin with the more we have left. Let me hope that, despite all the by-play, you have clearly grasped the essential parts of my remarks, those about the meaning of symptoms, about the unconscious, and the relation between the two. You probably have also understood that our further efforts are to take two directions: first, the clinical problem—to discover how persons become sick, how they later on accomplish a neurotic adaptation toward life; secondly, a problem of psychic dynamics, the evolution of the neurotic symptoms themselves from the prerequisites of the neuroses. We will undoubtedly somewhere come on a point of contact for these two problems.
I do not wish to go any further to-day, but since our time is not yet up I intend to call your attention to another characteristic of our two analyses, namely, the memory gaps or amnesias, whose full appreciation will be possible later. You have heard that it is possible to express the object of psychoanalytic treatment in a formula: all pathogenic unconscious experience must be transposed into consciousness. You will perhaps be surprised to learn that this formula can be replaced by another: all the memory gaps of the patient must be filled out, his amnesias must be abolished. Practically this amounts to the same thing. Therefore an important role in the development of his symptoms must be accredited to the amnesias of the neurotic. Theanalysis of our first case, however, will hardly justify this valuation of the amnesia. The patient has not forgotten the scene from which the compulsion act derives—on the contrary, she remembers it vividly, nor is there any other forgotten factor which comes into play in the development of these symptoms. Less clear, but entirely analogous, is the situation in the case of our second patient, the girl with the compulsive ritual. She, too, has not really forgotten the behavior of her early years, the fact that she insisted that the door between her bedroom and that of her parents be kept open, and that she banished her mother out of her place in her parents' bed. She recalls all this very clearly, although hesitatingly and unwillingly. Only one factor stands out strikingly in our first case, that though the patient carries out her compulsive act innumerable times, she is not once reminded of its similarity with the experience after the bridal-night; nor was this memory even suggested when by direct questions she was asked to search for its motivation. The same is true of the girl, for in her case not only her ritual, but the situation which provoked it, is repeated identically night after night. In neither case is there any actual amnesia, no lapse of memory, but an association is broken off which should have called out a reproduction, a revival in the memory. Such a disturbance is enough to bring on a compulsion neurosis. Hysteria, however, shows a different picture, for it is usually characterized by most grandiose amnesias. As a rule, in the analysis of each hysterical symptom, one is led back to a whole chain of impressions which, upon their recovery, are expressly designated as forgotten up to the moment. On the one hand this chain extends back to the earliest years of life, so that the hysterical amnesias may be regarded as the direct continuation of the infantile amnesias, which hides the beginnings of our psychic life from those of us who are normal. On the other hand, we discover with surprise that the most recent experiences of the patient are blurred by these losses of memory—that especially the provocations which favored or brought on the illness are, if not entirely wiped out by the amnesia, at least partially obliterated. Without fail important details have disappeared from the general picture of such a recent memory, or are placed by false memories. Indeed it happens almost regularly that just before the completion of an analysis, certainmemories of recent experiences suddenly come to light. They had been held back all this time, and had left noticeable gaps in the context.
We have pointed out that such a crippling of the ability to recall is characteristic of hysteria. In hysteria symptomatic conditions also arise (hysterical attacks) which need leave no trace in the memory. If these things do not occur in compulsion-neuroses, you are justified in concluding that these amnesias exhibit psychological characteristics of the hysterical change, and not a general trait of the neuroses. The significance of this difference will be more closely limited by the following observations. We have combined two things as the meaning of a symptom, its "whence," on the one hand, and its "whither" or "why," on the other. By these we mean to indicate the impressions and experiences whence the symptom arises, and the purpose the symptom serves. The "whence" of a symptom is traced back to impressions which have come from without, which have therefore necessarily been conscious at some time, but which may have sunk into the unconscious—that is, have been forgotten. The "why" of the symptom, its tendency, is in every case an endopsychic process, developed from within, which may or may not have become conscious at first, but could just as readily never have entered consciousness at all and have been unconscious from its inception. It is, after all, not so very significant that, as happens in the hysterias, amnesia has covered over the "whence" of the symptom, the experience upon which it is based; for it is the "why," the tendency of the symptom, which establishes its dependence on the unconscious, and indeed no less so in the compulsion neuroses than in hysteria. In both cases the "why" may have been unconscious from the very first.
By thus bringing into prominence the unconscious in psychic life, we have raised the most evil spirits of criticism against psychoanalysis. Do not be surprised at this, and do not believe that the opposition is directed only against the difficulties offered by the conception of the unconscious or against the relative inaccessibility of the experiences which represent it. I believe it comes from another source. Humanity, in the course of time, has had to endure from the hands of science two great outrages against its naive self-love. The first was when humanity discoveredthat our earth was not the center of the universe, but only a tiny speck in a world-system hardly conceivable in its magnitude. This is associated in our minds with the name "Copernicus," although Alexandrian science had taught much the same thing. The second occurred when biological research robbed man of his apparent superiority under special creation, and rebuked him with his descent from the animal kingdom, and his ineradicable animal nature. This re-valuation, under the influence of Charles Darwin, Wallace and their predecessors, was not accomplished without the most violent opposition of their contemporaries. But the third and most irritating insult is flung at the human mania of greatness by present-day psychological research, which wants to prove to the "I" that it is not even master in its own home, but is dependent upon the most scanty information concerning all that goes on unconsciously in its psychic life. We psychoanalysts were neither the first, nor the only ones to announce this admonition to look within ourselves. It appears that we are fated to represent it most insistently and to confirm it by means of empirical data which are of importance to every single person. This is the reason for the widespread revolt against our science, the omission of all considerations of academic urbanity, and emancipation of the opposition from all restraints of impartial logic. We were compelled to disturb the peace of the world, in addition, in another manner, of which you will soon come to know.
Resistance and Suppression
IN order to progress in our understanding of the neuroses, we need new experiences and we are about to obtain two. Both are very remarkable and were at the time of their discovery, very surprising. You are, of course, prepared for both from our discussions of the past semester.
In the first place: When we undertake to cure a patient, to free him from the symptoms of his malady, he confronts us with a vigorous, tenacious resistance that lasts during the whole time of the treatment. That is so peculiar a fact that we cannot expect much credence for it. The best thing is not to mention this fact to the patient's relatives, for they never think of it otherwise than as a subterfuge on our part in order to excuse the length or the failure of our treatment. The patient, moreover, produces all the phenomena of this resistance without even recognizing it as such; it is always a great advance to have brought him to the point of understanding this conception and reckoning with it. Just consider, this patient suffers from his symptoms and causes those about him to suffer with him. He is willing, moreover, to take upon himself so many sacrifices of time, money, effort and self-denial in order to be freed. And yet he struggles, in the very interests of his malady, against one who would help him. How improbable this assertion must sound! And yet it is so, and if we are reproached with its improbability, we need only answer that this fact is not without its analogies. Whoever goes to a dentist with an unbearable toothache may very well find himself thrusting away the dentist's arm when the man makes for his sick tooth with a pair of pincers.
The resistance which the patient shows is highly varied, exceedingly subtle, often difficult to recognize, Protean-like in its manifold changes of form. It means that the doctor must become suspicious and be constantly on his guard against thepatient. In psychoanalytic therapy we make use, as you know, of that technique which is already familiar to you from the interpretation of dreams. We tell the patient that without further reflection he should put himself into a condition of calm self-observation and that he must then communicate whatever results this introspection gives him—feelings, thoughts, reminiscences, in the order in which they appear to his mind. At the same time, we warn him expressly against yielding to any motive which would induce him to choose or exclude any of his thoughts as they arise, in whatever way the motive may be couched and however it may excuse him from telling us the thought: "that is too unpleasant," or "too indiscreet" for him to tell; or "it is too unimportant," or "it does not belong here," "it is nonsensical." We impress upon him the fact that he must skim only across the surface of his consciousness and must drop the last vestige of a critical attitude toward that which he finds. We finally inform him that the result of the treatment and above all its length is dependent on the conscientiousness with which he follows this basic rule of the analytic technique. We know, in fact, from the technique of interpreting dreams, that of all the random notions which may occur, those against which such doubts are raised are invariably the ones to yield the material which leads to the uncovering of the unconscious.
The first reaction we call out by laying down this basic technical rule is that the patient directs his entire resistance against it. The patient tries in every way to escape its requirements. First he will declare that he cannot think of anything, then, that so much comes to his mind that it is impossible to seize on anything definite. Then we discover with no slight displeasure that he has yielded to this or that critical objection, for he betrays himself by the long pauses which he allows to occur in his speaking. He then confesses that he really cannot bring himself to this, that he is ashamed to; he prefers to let this motive get the upper hand over his promise. He may say that he did think of something but that it concerns someone else and is for that reason exempt. Or he says that what he just thought of is really too trivial, too stupid and too foolish. I surely could not have meant that he should take such thoughts into account. Thus it goes on, with untold variations, in the face of which wecontinually reiterate that "telling everything" really means telling everything.
One can scarcely find a patient who does not make the attempt to reserve some province for himself against the intrusion of the analysis. One patient, whom I must reckon among the most highly intelligent, thus concealed an intimate love relation for weeks; and when he was asked to explain this infringement of our inviolable rule, he defended his action with the argument that he considered this one thing was his private affair. Naturally, analytic treatment cannot countenance such right of sanctuary. One might as well try in a city like Vienna to allow an exception to be made of great public squares like the Hohe Markt or the Stephans Platz and say that no one should be arrested in those places—and then attempt to round up some particular wrong-doer. He will be found nowhere but in those sanctuaries. I once brought myself around to permit such an exception in the case of a man on whose capacity for work a great deal depended, and who was bound by his oath of service, which forbade him to tell anyone of certain things. To be sure, he was satisfied with the results—but not I; I resolved never to repeat such an attempt under these conditions.
Compulsion neurotics are exceedingly adept at making this technical rule almost useless by bringing to bear all their over-conscientiousness and their doubts upon it. Patients suffering from anxiety-hysteria sometimes succeed in reducing it to absurdity by producing only notions so remote from the thing sought for that analysis is quite unprofitable. But it is not my intention to go into the way in which these technical difficulties may be met. It is enough to know that finally, by means of resolution and perseverance, we do succeed in wresting a certain amount of obedience from the patient toward this basic rule of the technique; the resistance then makes itself felt in other ways. It appears in the form of an intellectual resistance, battles by means of arguments, and makes use of all difficulties and improbabilities which a normal yet uninstructed thinking is bound to find in the theory of analysis. Then we hear from one voice alone the same criticisms and objections which thunder about us in mighty chorus in the scientific literature. Therefore the critics who shout to us from outside cannot tell us anything new. It is a veritable tempest in a teapot. Still the patientcan be argued with, he is anxious to persuade us to instruct him, to teach him, to lead him to the literature, so that he may continue working things out for himself. He is very ready to become an adherent of psychoanalysis on condition that analysis spare him personally. But we recognize this curiosity as a resistance, as a diversion from our special objects, and we meet it accordingly. In those patients who suffer from compulsion neuroses, we must expect the resistance to display special tactics. They frequently allow the analysis to take its way, so that it may succeed in throwing more and more light on the problems of the case, but we finally begin to wonder how it is that this clearing up brings with it no practical progress, no diminution of the symptom. Then we may discover that the resistance has entrenched itself in the doubts of the compulsion neurosis itself and in this position is able successfully to resist our efforts. The patient has said something like this to himself: "This is all very nice and interesting. And I would be glad to continue it. It would affect my malady considerably if it were true. But I don't believe that it is true and as long as I don't believe it, it has nothing to do with my sickness." And so it may go on for a long time until one finally has shaken this position itself; it is then that the decisive battle takes place.
The intellectual resistances are not the worst, one can always get ahead of them. But the patient can also put up resistances, within the limits of the analysis, whose conquest belongs to the most difficult tasks of our technique. Instead of recalling, he actually goes again through the attitudes and emotions of his previous life which, by means of the so-called "transference," can be utilized as resistances to the physician and the treatment. If the patient is a man, he takes this material as a rule from his relations to his father, in whose place he now puts the physician, and in so doing constructs a resistance out of his struggle for independence of person and opinion; out of his ambition to equal or to excel his father; out of his unwillingness to assume the burden of gratitude a second time in his life. For long times at a stretch one receives the impression that the patient desires to put the physician in the wrong and to let him feel his helplessness by triumphing over him, and that this desire has completely replaced his better intention of making an end to his sickness. Women are adepts at exploiting, for thepurposes of the resistance, a tender, erotically tinged transference to the physician. When this leaning attains a certain intensity, all interest for the actual situation of the treatment is lost, together with every sense of the responsibility which was assumed by undertaking it. The never-failing jealousy as well as the embitterment over the inevitable repudiation, however gently effected, all must serve to spoil the personal understanding between patient and physician and thus to throw out one of the most powerful propelling forces of the analysis.
Resistances of this sort must not be narrow-mindedly condemned. They contain so much of the most important material of the patient's past and reproduce it in such a convincing manner, that they become of the greatest aid to the analysis, if a skillful technique is able to turn them in the right direction. It is only remarkable that this material is at first always in the service of the resistance, for which it serves as a barrier against the treatment. One can also say that here are traits of character, adjustments of the ego which were mobilized in order to defeat the attempted change. We are thus able to learn how these traits arose under the conditions of the neurosis, as a reaction to its demands, and to see features more clearly in this character which could otherwise not have shown up so clearly or at least not to this extent, and which one may therefore designate as latent. You must also not get the impression that we see an unforeseen endangering of the analytic influence in the appearance of these resistances. On the contrary, we know that these resistances must come to light; we are dissatisfied only when we do not provoke them in their full strength and so make them plain to the patient Indeed, we at last understand that overcoming these resistances is the essential achievement of analysis and is that portion of the work which alone assures us that we have accomplished something with the patient.
You must also take into account the fact that any accidental occurrences which arise during the treatment will be made use of by the patient as a disturbance—every diverting incident, every statement about analysis from an inimical authority in his circle, any chance illness or any organic affection which complicates the neurosis; indeed, he even uses every improvement of his condition as a motive for abating his efforts. You will then have gained an approximate, though still an incomplete pictureof the forms and devices of the resistance which must be met and overcome in the course of every analysis. I have given this point such detailed consideration because I am about to inform you that our dynamic conception of the neurosis is based on this experience with the resistance of neurotic patients against the banishment of their symptoms. Breuer and I both originally practiced psycho-therapy by means of hypnosis. Breuer's first patient was treated throughout under a condition of hypnotic suggestibility, and I at first followed his example. I admit that my work at that time progressed easily and agreeably and also took much less time. But the results were capricious and not permanent; therefore I finally gave up hypnotism. Then only did I realize that no insight into the forces which produce these diseases was possible as long as one used hypnotism. The condition of hypnosis could prevent the physician from realizing the existence of a resistance. Hypnosis drives back the resistance and frees a certain field for the work of analysis, but similarly to the doubt in the compulsion neurosis, in so doing it clogs the boundaries of this field till they become impenetrable. That is why I can say that true psychoanalysis began when the help of hypnotism was renounced.
But if the establishment of the resistance thus becomes a matter of such importance, then surely we must give our caution full rein, and follow up any doubts as to whether we are not all too ready in our assumption of their existence. Perhaps there really are neurotic cases in which associations appear for other reasons, perhaps the arguments against our hypothesis really deserve more consideration and we are unjustified in conveniently rejecting all intellectual criticisms of analysis as a resistance. Indeed, ladies and gentlemen, but our judgment was by no means readily arrived at. We had opportunity to observe every critical patient from the first sign of the resistance till after its disappearance. In the course of the treatment, the resistance is moreover constantly changing in intensity. It is always on the increase as we approach a new theme, is strongest at the height of its elaboration, and dies down again when this theme has been abandoned. Furthermore, unless we have made some unusual and awkward technical error, we never have to deal with the full measure of resistance of which the patient is capable. We could therefore convince ourselves that thesame man took up and discarded his critical attitude innumerable times in the course of the analysis. Whenever we are on the point of bringing before his consciousness some piece of unconscious material which is especially painful to him, then he is critical in the extreme. Even though he had previously understood and accepted a great deal, nevertheless all record of these gains seems now to have been wiped out. He may, in his desire to resist at any cost, present a picture of veritable emotional feeblemindedness. If one succeeds in helping him to overcome this new resistance, then he regains his insight and his understanding. Thus his criticism is not an independent function to be respected as such; it plays the role of handy-man to his emotional attitude and is guided by his resistance. If something displeases him, he can defend himself against it very ingeniously and appear most critical. But if something strikes his fancy, then he may show himself easily convinced. Perhaps none of us are very different, and the patient under analysis shows this dependence of the intellect on the emotional life so plainly only because, under the analysis, he is so hard pressed.
In what way shall we now account for the observation that the patient so energetically resists our attempts to rid him of his symptoms and to make his psychic processes function in a normal way? We tell ourselves that we have here come up against strong forces which oppose any change in the condition; furthermore, that these forces must be identical with those which originally brought about the condition. Some process must have been functional in the building up of these symptoms, a process which we can now reconstruct by means of our experiences in solving the meaning of the symptoms. We already know from Breuer's observations that the existence of a symptom presupposes that some psychic process was not carried to its normal conclusion, so that it could not become conscious. The symptom is the substitute for that which did not take place. Now we know where the forces whose existence we suspect must operate. Some violent antagonism must have been aroused to prevent the psychic process in question from reaching consciousness, and it therefore remained unconscious. As an unconscious thought it had the power to create a symptom. The same struggle during the analytic treatment opposes anew the efforts to carry this unconscious thought over into consciousness. Thisprocess we felt as a resistance. That pathogenic process which is made evident to us through the resistance, we will namerepression.