Freud, Sigmund (1894-001/1912.en): The Defense Neuro-Psychoses

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CHAPTER V.

THE DEFENSE NEURO-PSYCHOSES.

A TENTATIVE PSYCHOLOGICAL THEORY OF 'ACQUIRED HYSTERIA,
MANY PHOBIAS AND OBSESSIONS, AND CERTAIN HALLU-
CINATORY PSYCHOSES.

After an exhaustive study of many nervous patients afflicted
with phobias and obsessions a tentative explanation of these symp-
toms urged itself upon me. This helped me afterwards happily to
divine the origin of such morbid ideas in new and other cases, and
I therefore believe it worthy of reporting and further examina-
tion. Simultaneously with this “psychological theory of phobias
and obsessions,” the examination of these patients resulted in a
contribution to the theory of hysteria, or rather in an alteration of
the same, which seems to imply an important and common charac-
ter to hysteria as well as the mentioned neuroses. Furthermore
I had the opportunity to look into the psychological mechanism of
a form of indubitable psychic disease and found that my at-
tempted observation shows an intelligible connection between
these psychoses and the two neuroses mentioned. At the conclu-
sion of this theme I will describe the supporting hypothesis which
I have used in all three cases.

I.

I am beginning with that alteration which seems to be neces-
sary for the theory of the hysterical neuroses.

That the symptom-complex of hysteria as far as it can be un-
derstood justifies the assumption of a splitting of consciousness
with the formation of separate psychic groups, has attained gen-
eral recognition since P. Janet, J. Breuer, and others have given
out their interesting work. Less understood are the opinions con-
cerning the origin of this splitting of consciousness and concern-
ing the rôle played by this character in the structure of the hys-
terical neuroses.

According to Janet’s¹ theory, the splitting of consciousness is a

¹⁾État mental des hystériques, Paris, 1893 and 1894. Quelques défini-
tions récentes de l’hystérie, Arch. de Neurol., 1893, XXXV–VI.

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primary feature of the hysterical alteration. It is due to a con-
genital weakness of the capacity for psychic synthesis, and to a
narrowing of the “field of consciousness” (champ du conscience)
which as a psychic stigma proves the degeneration of hysterical
individuals.

In contradistinction to Janet’s views, which in my opinion admit
the most manifold objections, are those advocated by J. Breuer
in our joint communication. According to Breuer, the “basis
and determination” of hysteria is the occurrence of peculiar
dream-like conscious states with a narrowed association capacity,
for which he proposes the name “hypnoid states.” The splitting
of consciousness is secondary and acquired, and originates be-
cause the ideas emerging in the hypnoid states are isolated from
associative communication with the rest of consciousness.

I can now demonstrate two other extreme forms of hysteria in
which it is impossible to show that the splitting of consciousness
is primary in the sense of Janet. In the first of these forms I
could repeatedly show that the splitting of the content of con-
sciousness was an arbitrary act of the patient, that is, it was
initiated through an exertion of the will which motive can be
stated. I naturally do not maintain that the patient intended to
produce a splitting of his consciousness; the patient’s intention
was different, but instead of attaining its aim it provoked a split-
ting of consciousness.

In the third form of hysteria, as we have demonstrated by psy-
chic-analysis of intelligent patients, the splitting of consciousness
plays only an insignificant and perhaps really no rôle. This in-
cludes those cases in which there had been no reaction to the trau-
matic stimulus and which were then adjusted and cured by ab-
reaction. They are the pure retention hysterias.

In connection with the phobias and obsessions I have only to
deal here with the second form of hysteria which for reasons to
be presently explained I will designate as defense hysteria and
thus distinguish it from the hypnoid and retention hysterias. Pre-
liminarily I am able to call my cases of defense hysteria
“acquired” hysterias for they show neither marked hereditary
taints nor any degenerative disfigurements. ?

In those patients whom I have analyzed there existed psychic
health until the moment in which a case of incompatibility oc-
curred.

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curred in their ideation, that is, until there appeared an experi
ence, idea, or feeling which evoked such a painful affect that the
person decided to forget it because he did not trust his own
ability to remove the resistance between the unbearable ideas and
his ego.

Neo

Such incompatible ideas originate in the feminine sex on the
basis of sexual experiences and feelings. With all desired pre-
cision the patients recall their efforts of defense, their intention
“to push it away,” not to think of it, to repress it. As appropriate
examples I can easily cite the following cases from my own ex-
perience: A young lady reproached herself because, while nursing
her sick father, she thought of a young man who made a slight
erotic impression on her; a governess fell in love with her em-
ployer and decided to crowd it out of her mind because it was
incompatible with her pride, etc.

I am unable to maintain that the exertion of the will, in crowd-
ing such thoughts out of one’s mind, is a pathological act, nor am
I able to state whether and how, the intentional forgetting suc-
ceeds in these persons who remain well under the same psychic
influences. I only know that in the patients whom I analyzed
such “forgetting” was unsuccessful and led to either a hysteria,
obsession, or a hallucinatory psychosis. The ability to produce,
by the exertion of the will one of these states all of which are con-
nected with the splitting of consciousness, is to be considered as
the expression of a pathological disposition, but it need not neces-
sarily be identified with personal or hereditary “degeneration.”

Over the road leading from the patient’s exertion of the will to
the origin of a neurotic symptom I formed a conception which in
the current psychological abstractions may be thus expressed:
The task assumed by the defensive ego to treat the incompatible
idea as “non arrivée” can not be directly accomplished. The
memory trace as well as the affect adhering to the idea are here
and can not be exterminated. The task can however, be brought
to an approximate solution if it is possible to change the strong
idea into a weak one and to take away the affect or sum of ex-
citement which adheres to it. The weak idea will then exert
almost no claims on the association work; but the separated sum
of excitement must be utilized in another direction.

Meta

Thus far the processes are the same in hysteria, in phobias and

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obsessions, but from now on their ways part. The unbearable
idea in hysteria is rendered harmless because the sum of excite-
ment is transformed into physical manifestations, a process for
which I would like to propose the term conversion.
The conversion may be total or partial, and follows that motor
or sensory innervation which is either ultimately or more loosely
connected with the traumatic experience. In this way the ego
succeeds in freeing itself from opposition but instead it becomes
burdened with a memory symbol which remains in consciousness
as an unadjusted motor innervation, or as a constantly recurring
hallucinatory sensation similar to a parasite. It thus remains
fixed until a conversion takes place in the opposite direction. The
memory symbol of the repressed idea does not perish, but from
now on forms the nucleus for a second psychic group.
I will follow up this view of the psycho-physical processes in
hysteria with a few more words. If such a nucleus for an hys-
terical splitting is once formed in a “traumatic moment” it then
increases in other moments which might be designated as “auxil-
iary traumatic” as soon as a newly formed similar impression
succeeds in breaking through the barrier formed by the will and
in adding new affects to the weakened idea, and in forcing for a
while the associative union of both psychic groups until a new
conversion produces defense. The condition thus attained in
hysteria in regard to the distribution of the excitement, proves
to be unstable in most cases. As shown by the familiar contrast
of the attacks and the persistent symptoms, the excitement which
was pushed on a false path (in the bodily innervation) now and
then returns to the idea from which it was discharged and forces
the person to associative elaboration or to adjustment in hysterical
attacks. The effect of Breuer’s cathartic method consists in the
fact that it consciously reconducts the excitement from the phy-
sical into the psychic spheres and then forces an adjustment of
the contradiction through intellectual work, and a discharge of
the excitement through speech.
If the splitting of consciousness in acquired hysteria is due to
an act of volition we can explain with surprising simplicity the re-
markable fact that hypnosis regularly broadens the narrowed
consciousness of hysteria, and causes the split off psychic groups
to become accessible. For we know that it is peculiar to all

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sleep-like states to remove that distribution of excitement which
depends on the “will” of the conscious personality.

We accordingly recognize that the characteristic moment of
hysteria is not the splitting of consciousness but the ability of
conversion and as an important part of the hitherto unknown dis-
position of hysteria we can mention the psycho-physical adapta-
tion for the transference of a great sum of excitement into bodily
innervation.

The adaptation does not in itself exclude psychic health, and
leads to hysteria only in event of a psychic incompatibility or
accumulation of excitement. With this turn, we—Breuer and I
—come near to the familiar definitions of hysteria of Oppenheim²
and Strumpel³ and deviate from Janet,⁴ who assigns to the split-
ting of consciousness too great a rôle in the characteristics of
hysteria. The description here given can lay claim to the fact
that it explains the connection between the conversion and the
hysterical splitting of consciousness.

II.

In a predisposed person if there is no adaptation for conversion
and still for the purpose of defense a separation of the unbearable
idea from its affect is undertaken, the affect must then remain in
the psychic sphere. The weakened idea remains apart from all
association in consciousness, but its freed affect attaches itself to
other not in themselves unbearable ideas, which on account of
this “false” connection become obsessions. This is in brief the
psychological theory of the obsessions and phobias concerning
which I have spoken above.

²Oppenheim: Hysteria is an exaggerated expression of emotion. But
the “expression of emotion” represents that amount of psychic excite-
ment which normally experiences conversion.

³Strümpel: The disturbance of hysteria lies in the psycho-physical, there
where the physical and psychical are connected with each other.

⁴Janet, in the second chapter of his spirited essay “Quelques defini-
tions,” etc., has treated the objection that the splitting of consciousness
belongs also to the psychoses and the so called psychaesthenia, but in my
opinion he has not satisfactorily solved it. It is essentially this objection
which urged him to call hysteria a form of degeneration. But through
no characteristic is he able to separate sufficiently the hysterical splitting
of consciousness from the psychopathic, etc.

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war

le

I will now state what parts demanded in this theory can be di-
rectly demonstrated and what parts I have supplemented. Be-
sides the end product of the process, the obsession, we can in the
first place directly demonstrate the source from which the affect
in the false connection originates. In all cases that I have an-
alyzed it was the sexual life that has furnished a painful affect
of precisely the same character as the one attached to the obses-
sion. It is not theoretically excluded that this affect could not
occasionally originate in other spheres, but I must say that thus
far I have found no other origin. Moreover, one can readily
understand that it is precisely the sexual life which furnishes the
most manifold occasions for the appearance of unbearable ideas.

my

Moreover, the exertion of the will, the attempt at defence,
upon which this theory lays stress is demonstrated by the most
unequivocal utterances of the patients. At least in a number of
cases the patients themselves inform us that the phobia or obses-
sion appeared only after the exertion of the will manifestly gained
its point. “Something very disagreeable happened to me once
and I have exerted all my power to push it away, not to think of
it. When I have finally succeeded I have gotten the other thing
instead, which I have not lost since.” With these words a patient
verified the main points of the theory here developed.

?

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Not all who suffer from obsessions are so clear concerning the
origin of the same. As a rule when we call the patient’s atten-
tion to the original idea of a sexual nature we receive the follow-
ing answer: “It could not have come from that. Why I have not
thought much about it. For a moment I was frightened, then I
distracted myself and since then it has not bothered me.” In
this, so frequent objection, we have the proof that the obsession
represents a compensation or substitute for the unbearable sexual
idea, and that it has taken its place in consciousness.

Between the patient’s exertion of the will which succeeds in
repressing the unacceptable sexual idea and the appearance of the
obsession, which though in itself of little intensity, is here fur-
nished with inconceivably strong affect, there is a yawning gap
which the theory here developed will fill. The separation of the
sexual idea from its affect and the connection of the latter with
another suitable but not unbearable idea—these are processes
which take place unconsciously which we can only presume but not