CHAPTER I.

THE PSYCHIC MECHANISM OF HYSTERICAL PHENOMENA.¹

(PRELIMINARY COMMUNICATION.)

I.

Instigated by a number of accidental observations we have
investigated for a number of years the different forms and symp-
toms of hysteria in order to discover the cause and the process
which provoked the phenomena in question for the first time, in
a great many cases years back. In the great majority of cases
we did not succeed in elucidating this starting point from the
mere history, no matter how detailed it might have been, partly
because we had to deal with experiences about which discussion
was disagreeable to the patients, but mainly because they really
could not recall them; often they had no inkling of the causal
connection between the occasioning process and the pathological
phenomenon. It was generally necessary to hypnotize the pa-
tients and reawaken the memory of that time in which the symp-
tom first appeared, and we thus succeeded in exposing that con-
nection in a most precise and convincing manner.

This method of examination in a great number of cases has
furnished us with results which seem to be of theoretical as well
as of practical value.

It is of theoretical value because it has shown to us that in
the determination of the pathology of hysteria the accidental
moment plays a much greater part than is generally known and
recognized. It is quite evident that in “traumatic” hysteria it is
the accident which evokes the syndrome. Moreover in hysterical
crises, if patients state that they hallucinate in each attack the
same process which evoked the first attack, here too, the causal
connection seems quite clear. The state of affairs is more obscure
in the other phenomena.

Our experiences have shown us that the most varied symptoms

¹Written in collaboration with Dr. Joseph Breuer. Neurologische Zen-
tralblatt, 1893, No. 1 and 2, later published in Studien ueber Hysterie, 1895.

2

which pass as spontaneous, or so to say idiopathic attainments
of hysteria, stand in just as stringent connection with the causal
trauma as the transparent phenomena mentioned. To such causal
moments we were able to refer neuralgias as well as the different
kinds of anesthesias often of years’ duration, contractures and
paralyses, hysterical attacks and epileptiform convulsions which
every observer has taken for real epilepsy, petit mal and tic-like
affections, persistent vomiting and anorexia, even the refusal of
nourishment, all kinds of visual disturbances, constantly recurring
visual hallucinations, and similar affections. The disproportion
between the hysterical symptoms of years’ duration and the
former cause is the same as the one we are regularly accustomed
to see in the traumatic neurosis. Very often they are experiences
of childhood which have established more or less intensive morbid
phenomena for all succeeding years.

The connection is often so clear that it is perfectly manifest
how the causal event produced just this and no other phenomenon.
It is quite clearly determined by the cause. Thus let us take the
most banal example; if a painful affect originates while eating
but is repressed, it may produce nausea and vomiting and con-
tinue for months as a hysterical symptom. A girl was anxiously
distressed while watching at a sick bed. She fell into a dreamy
state and experienced a frightful hallucination, and at the same
time her right arm hanging over the back of a chair became
numb. This resulted in a paralysis, contracture, and anesthesia
of that arm. She wanted to pray but could find no words, but
finally succeeded in uttering an English prayer for children.
Later, on developing a very grave and most complicated hysteria,
she spoke, wrote, and understood only English, whereas her
native tongue was incomprehensible to her for a year and a half.
A very sick child finally falls asleep. The mother exerts all her
will power to make no noise to awaken it, but just because she
resolved to do so she emits a clicking sound with her tongue
(“hysterical counter-will”). This was later repeated on another
occasion when she wished to be absolutely quiet, developing into
a tic which in the form of tongue clicking accompanied every
excitement for years. A very intelligent man was present while
his brother was anesthetized and his ankylosed hip stretched. At

3

the moment when the joint yielded and crackled he perceived
severe pain in his own hip which continued for almost a year.
In other cases the connection is not so simple, there being only
as it were a symbolic relation between the cause and the patho-
logical phenomenon, just as in the normal dream. Thus psychic
pain may result in neuralgia, or the affect of moral disgust may
cause vomiting. We have studied patients who were wont to
make the most prolific use of such symbolizations. In still other
cases such a determination is at first sight incomprehensible, yet
to this group belong the typical hysterical symptoms such as
hemianesthesia, contraction of visual field, epileptiform convul-
sions and many others. The explanation of our views on this
group we have to reserve for the more detailed discussion of the
subject.

Such observations seem to demonstrate the pathogenic analogy
between simple hysteria and traumatic neurosis and justify a
broader conception of “traumatic hysteria.” The active etio-
logical factor in traumatic neurosis is really not the insignificant
bodily injury but the affect of the fright, that is, the psychic
trauma. In an analogous manner our investigations show that
the causes of many, if not of all, cases of hysteria can be
designated as psychic traumas. Every experience which pro-
duces the painful affect of fear, anxiety, shame or of psychic
pain may act as a psychic trauma. Whether an experience be-
comes of traumatic importance naturally depends on the person
affected as well on the determination to be mentioned later. In
ordinary hysteria instead of one big trauma we not seldom find
many partial traumas, grouped causes which can be of traumatic
significance only when summarized and which belong together
in so far as they form small fragments of the sorrowful tale.
In still other cases apparently indifferent circumstances gain trau-
matic dignity through their connection with the real effective
event or with a period of time of special excitability which they
then retain but which otherwise would have no significance.

Nevertheless the causal connection between the provoking
psychic trauma and the hysterical phenomena does not perhaps
resemble the trauma which as the agent provocateur would call
forth the symptom which would become independent and con-
tinue to exist. We have to claim still more, namely, that the

4

psychic trauma or the memory of the same acts like a foreign
body which even long after its penetration must continue to in-
fluence like a new causative factor. The proof of this we see
in a most remarkable phenomenon which at the same time gives
to our discoveries a distinct practical interest.

We found, at first to our greatest surprise, that the individual
hysterical symptoms immediately disappeared without returning
if we succeeded in thoroughly awakening the memories of the
causal process with its accompanying affect, and if the patient
circumstantially discussed the process giving free play to the
affect. Affectless memories are almost utterly useless. The
psychic process originally rebuffed must be reproduced as vividly
as possible so as to bring it back into the statum nascendi and
then be thoroughly “talked over.” At the same time if we deal
with such exciting manifestations as convulsions, neuralgias and
hallucinations they appear once more with their full intensity
and then vanish forever. Functional attacks like paralyses and
anesthesias likewise disappear, but naturally without any appre-
ciable distinctness of their momentary aggravation.¹⁾

It is quite reasonable to suspect that one deals here with an
unintentional suggestion. The patient expects to be relieved of
his suffering and it is this expectation and not the discussion
that is the effectual factor. But this is not so. The first obser-
vation of this kind in which a most complicated case of hysteria
was analyzed and the individual causal symptoms separately ab-
rogated, occurred in the year 1881, that is, in a “pre-suggestive”
time. It was brought about through a spontaneous autohypnosis
of the patient and caused the examiner the greatest suprise.

In reversing the sentence: cessante causa cessant effectus, we

¹⁾The possibility of such a therapy was clearly recognized by Delboeuf
and Binet, as is shown by the accompanying quotations: Delboeuf, Le
magnétisme animal, Paris, 1889: “On s’expliquerait dès lors comment le
magnétiseur aide à guerison. Il remet le sujet dans l’état où le mal s’est
manifesté et combat par la parole le même mal, mais renaissant.” (Binet,
Les altérations de la personnalité, 1892, p. 243): “. . . peut-être verra-t-
on qu’en reportant le malade par un artifice mental, au moment même ou
le symptome a apparu paur la premiere fois, on rend ce malade plus
docile a une suggestion curative.” In the interesting book of Janet,
L’Automatisme Psychologique, Paris, 1889, we find the description of a
cure brought about in a hysterical girl by a process similar to our method.

5

may conclude from this observation that the causal process con-
tinues to act in some way even after years, not indirectly by means
of a chain of causal connecting links but directly as a provoking
cause, just perhaps as in the awakened consciousness where the
memory of a psychic pain may later call forth tears. The hysteric
suffers mostly from reminiscences.³⁾

II.

It would seem at first rather surprising that long-forgotten
experiences should effect so intensively, and that their recol-
lections should not be subject to the decay into which all our
memories merge. We will perhaps gain some understanding of
these facts by the following examinations.

The blurring or loss of an affect of memory depends on a
great many factors. In the first place it is of great consequence
whether there was an energetic reaction to the affectful experi-
ence or not. By reaction we here understand a whole series of
voluntary or involuntary reflexes, from crying to an act of
revenge, through which according to experience affects are dis-
charged. If the success of this reaction is of sufficient strength
it results in the disappearance of a great part of the affect.
Language attests this fact of daily observation, in such ex-
pressions as “to give vent to one’s feeling,” to be “relieved by
weeping,” etc.

If the reaction is suppressed the affect remains united with the
memory. An insult retaliated, be it only in words, is differ-
ently recalled than one that had to be taken in silence. Language
also recognizes this distinction between the psychic and physical
results and designates most characteristically the silently endured
suffering as “grievance.” The reaction of the person injured
to the trauma has really no perfect “cathartic” effect unless
it is an adequate reaction like revenge. But man finds a substi-
tute for this action in speech through which help the affect can
shall discuss hereafter.

³⁾We are unable to distinguish in this preliminary contribution what
there is new in this content and what can be found in such other authors
as Moebius and Strümpell who present similar views on hysteria. The
greatest similarity to our theoretical and therapeutical accomplishments we
accidentally found in some published observations of Benedict which we
shall discuss hereafter.

6

well nigh be ab-reacted⁴⁾ (“abreagirt”). In other cases talking
in the form of deploring and giving vent to the torments of the
secret (confession) is in itself an adequate reflex. If such reac-
tion does not result through deeds, words, or in the lightest case
through weeping, the memory of the occurrence retains above all
the affective accentuation.

The ab-reaction (abreagiren), however, is not the only form
of discharge at the disposal of the normal psychic mechanism of
the healthy person who has experienced a psychic trauma. The
memory of the trauma even where it has not been ab-reacted
enters into the great complex of the association. It joins the
other experiences which are perhaps antagonistic to it and thus
undergoes correction through the other ideas. For example,
after an accident the memory of the danger and (dimmed)
repetition of the fright is accompanied by the recollection of the
further course, the rescue, and the consciousness of present
security. The memory of a grievance may be corrected by a
rectification of the state of affairs by reflecting upon one’s own
dignity and similar things. Thus the normal person is able to
cause a disappearance of the accompanying affect by means of
association.

In addition there appears that general blurring of impressions,
that fading of memories which we call “forgetting,” and which
above all wears out the affective ideas no longer active.

It follows from our observations that those memories which
become the causes of hysterical phenomena have been preserved
for a long time with wonderful freshness and with their perfect
emotional tone. As a further striking and a later realizable fact
we have to mention that the patients do not perhaps have the
same control of these as of their other memories of life. On
the contrary, these experiences are either completely lacking
from the memory of the patients in their usual psychic state or
at most exist greatly abridged. Only after the patients are ques-
tioned in the hypnotic state do these memories appear with the
undiminished vividness of fresh occurrences. Thus one of our

⁴⁾The German abreagiren has no exact English equivalent. It will there-
fore be rendered throughout the text by “ab-react,” the literal meaning
is to react away from or to react off. It has different shades of meaning,
from defense reaction to emotional catharsis, which can be discerned from
the context.

7

patients in a hypnotic state reproduced with hallucinatory vivid-
ness throughout half a year all that excited her during an acute
hysteria on the same days of the preceding year. Her mother’s
diary which was unknown to the patient proved the faultless
accuracy of the reproduction. Another patient, partly in hypnosis
and partly in spontaneous attacks, went through with a halluci-
natory distinctness all experiences of a hysterical psychosis which
she passed through ten years before and for the greatest part of
which she was amnesic until its reappearance. She also showed
with surprising integrity and sentient force some etiologically
important memories of fifteen to twenty-five years’ duration
which on their return acted with the full affective force of new
experiences.

The reason for this we can only find in the fact that in all
the aforesaid relations these memories assume an exceptional
position in reference to disappearance. It was really shown that
these memories correspond to traumas which were not sufficiently
ab-reacted to (“abreagirt”). On closer investigation of the
reasons for this prevention we can find at least two series of
determinants through which the reaction to the trauma was dis-
continued.

To the first group we add those cases in which the patient has
not reacted to psychic traumas because the nature of the trauma
precluded a reaction as in the case of an irremediable loss of a
beloved person or because social relations made the reaction im-
possible, or because it concerned things which the patient wished
to forget and which he therefore intentionally inhibited and re-
pressed from his conscious memory. It is just those painful
things which in the hypnotic state are found to be the basis of
hysterical phenomena (hysterical delirium of saints, nuns, absti-
nent women, and well-bred children).

The second series of determinants is not conditioned by the
content of the memories but by the psychic states with which the
corresponding experiences in the patient have united. As a cause
of hysterical symptoms one really finds in hypnosis presentations
which are insignificant in themselves but which owe their preser-
vation to the fact that they originated during a severe paralyzing
affect like fright or directly in abnormal psychic conditions, as in
the semi-hypnotic dreamy states of reverie, in auto-hypnosis and

8

similar states. Here it is the nature of these conditions which
makes a reaction to the incident impossible.

To be sure both determinants may unite, and as a matter of fact
they often do. This is the case when a trauma in itself effective
occurs in a state of a powerful paralyzing affect or in a trans-
formed consciousness. But due to the psychic trauma it may also
happen that in many persons one of these abnormal states occurs
which in turn makes a reaction impossible.

What is common to both groups of determinants is the fact
that those psychic traumas which are not rectified by reaction are
also prevented from adjustment by associate elaboration. In
the first group it is due to the resolution of the patient who
wishes to forget them from experiences and in this way, if
possible, to exclude them from association, and in the second
group the associative elaboration does not succeed because there
is no productive associative relationship between the normal and
pathological state of consciousness in which these presentations
originated. We shall soon have occasion to discuss more fully
these relationships.

Hence we can say, that the reason why the pathogenically
formed presentations retain their freshness and affective force
is because they are not subject to the normal waste through
ab-reaction and reproduction in conditions of uninhibited asso-
ciation.

III.

When we discussed the conditions which, according to our
experience, are decisive in the development of hysterical phe-
nomena from psychic traumas, we were forced to speak of ab-
normal states of consciousness in which such pathogenic pres-
entations originate, and we had to emphasize the fact that the
recollection of the effective psychic trauma is not to be found in
the normal memory of the patient but in the hypnotized memory.
The more we occupied ourselves with these phenomena the more
certain became our convictions that the splitting of consciousness,
so striking in the familiar classical cases of double consciousness,
exists rudimentarily in every hysteria, and that the tendency to
this dissociation, and with it the tendency towards the appear-
ance of abnormal states of consciousness which we comprehend
as “hypnoid states,” is the chief phenomenon of this neurosis.

9

In this view we agree with Binet and with both the Janets about
whose most remarkable findings with anesthetics we have had no
experience.

Hence, to the often cited axiom, “Hypnosis is artificial
hysteria,” we would like to add another: “The existence of
hypnoid states is the basis and determination of hysteria.” These
hypnoid states in all their diversities agree among themselves and
with hypnosis in the fact that their emerged presentations are
very intensive but are excluded from the associative relations of
the rest of the content of consciousness. The hypnoid states are
associable among themselves, and their ideation may thus attain
various high degrees of psychic organization. In other respects
the nature of these states and the degree of their exclusiveness
differ from the rest of the conscious processes as do the various
states in hypnosis, which range from light somnolence to somnam-
bulism, and from perfect memory to absolute amnesia.

If such hypnoid states already exist before the manifested dis-
ease they prepare the soil upon which the affect establishes the
pathogenic memories and their somatic resulting manifestations.

This behavior corresponds to the predisposed hysteria. But the
results of our observations show that a severe trauma (like that
of a traumatic neurosis) or a painful suppression (perhaps of a
sexual affect) may bring about a splitting of presentation groups
even in persons otherwise not predisposed. This would then be
the mechanism of the psychically acquired hysteria. Between
the extremes of these two forms we have to admit a series in
which the facility of dissociation in the concerned individuals and
the magnitude of the affect of the trauma vary inversely.

We are unable to give anything new concerning the formation
of the predisposed hypnoid states. We presume that they often
develop from “reveries” very common to the normal for which,
for example, feminine handwork offers so much opportunity.
The questions why “the pathological associations” formed in
such states are so firm and why they exert a stronger influence
on the somatic processes than other presentations, all fall together
with the problem of the effectivity of hypnotic suggestions in
general. Our experiences in this matter do not show us any-
thing new, on the other hand they throw light on the contra-
diction between the sentence “Hysteria is a psychosis” and the

10

fact that among hysterics one may meet persons of the clearest
intellects, the strongest wills, greatest principles, and of the
subtlest minds. In these cases such characteristics are only true
for the waking thought of the person, for in his hypnotic state
he is alienated just as we are in the dream. Yet, whereas our
dream psychoses do not influence our waking state, the products
of hypnotic states project as hysterical phenomena into the wak-
ing state.

IV.

Almost the same assertions that we have advanced in reference
to the continuous hysterical symptoms we may also repeat con-
cerning hysterical crises. As is known we have Charcot’s
schematic description of the “major” hysterical attack which
when complete shows four phases: (1) The epileptoid, (2) the
grand movements, (3) the emotional–-
(hallucinatory phase), and (4) the delirious. By shortening or
prolonging the attack and by isolating the individual phases
Charcot caused a succession of all those forms of the hysterical
attack which are really observed more frequently than the com-
plete-
 

Our attempted explanation refers to the third phase, that is,
the -. Wherever it is prominent it contains
the hallucinatory reproduction of a memory which was significant
for the hysterical onset. It is the memory of a grand trauma,
the so-called - of traumatic hysteria or of a series of con-
nected partial traumas found at the basis of the common hysteria.
Finally the attack may bring back that occurrence which on ac-
count of its meeting with a moment of special predisposition was
raised to a trauma.

There are also attacks which ostensibly consist only of motor
phenomena and lack the passionnelle phase. It is possible dur-
ing such an attack of general twitching, cataleptic rigidity or an
-, to put one’s self - with the patient,
or still better, if one succeeds in evoking the attack in a hypnotic
state, it will then be found that here, too, the root of it is the
memory of a psychic trauma, or of a series of traumas which
make themselves otherwise prominent in an hallucinatory phase.
A little girl had suffered for years from attacks of general con-
vulsions which could be and were taken for epileptic. She was

II

hypnotized for purposes of differential diagnosis and she imme-
diately merged into one of her attacks. On being asked what she
say she said, “The dog, the dog is coming,” and it was really
found that the first attack of this kind appeared after she was
pursued by a mad dog. The success of the therapy then verified
our diagnosis.

An official who became hysterical as a result of ill treatment
on the part of his employer suffered from attacks, during which
he fell to the floor raging furiously without uttering a word or
displaying any hallucinations. The attack was provoked in a
state of hypnosis and he then stated that he lived through the
scene during which his employer insulted him in the street and
struck him with a cane. A few days later he came to me com-
plaining that he had the same attack, but this time it was shown
in the hypnosis that he went through the scene which was really
connected with the onset of his disease; it was the scene in the
court room when he was unable to get satisfaction for the ill
treatment which he received, etc.

The memories which appear in hysterical attacks or which
can be awakened in them correspond in all other respects to the
causes which we have found as the basis of the continuous
hysterical symptoms. Like these they refer to psychic traumas
which were prevented from alleviation by ab-reaction or by asso-
ciative elaboration, like these they lack entirely or in their essential
components the memory possibilities of normal consciousness and
appear to belong to the ideation of hypnoid states of conscious-
ness with limited associations. Finally they are also amenable to
therapeutic proof. Our observations have often taught us that
a memory which has always evoked attacks become incapacitated
when in a hypnotic state it is brought to reaction and associative
correction.

The motor phenomena of the hysterical attack can partly be
interpreted as the memory of a general form of reaction of the
accompanying affect, or partly as a direct motor expression of
this memory (like the fidgeting of the whole body which even
infants make use of), and partly, like the hysterical stigmata–
the continuous symptoms—they are inexplicable on this assump-
tion.

Of special significance for the hysterical attack is the afore-
mentioned theory, namely, that in hysteria there are presenta-

12

tion groups which come to light in hypnoid states which are
excluded from the rest of the associative process but are as-
sociable among themselves, thus representing a more or less
highly organized rudimentary second consciousness, a condition
seconde. A persistent hysterical symptom therefore corresponds
to a projection of this second state into a bodily innervation
otherwise controlled by the normal consciousness. A hysterical
attack gives evidence of a higher organization of this second
state, and if of recent origin it signifies a moment in which this
hypnoid consciousness gained control of the whole existence, and
hence we have an acute hysteria, but if it is a recurrent attack
containing a memory we simply have a repetition of the same.
Charcot has already given utterance to the fact that the hysterical
attack must be the rudiment of a condition seconde. During the
attack the control of the whole bodily innervation is transferred
to the hypnoid consciousness. As familiar experiences show, the
normal consciousness is not always repressed, it may even perceive
the motor phenomena of the attack while the psychic processes of
the same escape its cognizance.

The typical course of a grave hysteria, as everybody knows, is
as follows: At first an ideation is formed in the hypnoid state
which after sufficient development gains control in a period of
“acute hysteria” of the bodily innervation and the existence of
the patient thus forming persistent symptoms and attacks, and
then with the exception of some remnants there is a recovery.
If the normal personality can regain the upper hand, all that
survived the hypnoid ideation then returns in hysterical attacks
and at times it reproduces, in the personality, states which are
again amenable to influences and capable of being affected by
traumas. Frequently a sort of equilibrium then results among
the psychic groups which are united in the same person; attack
and normal life go hand in hand without influencing each other.
The attack then comes spontaneously just as memories are wont
to come; it may also be provoked just as memories may be by
the laws of association. The provocation of the attack results
either through stimulating a hysterogenic zone or through a new
experience which by similarity recalls the pathogenic experience.
We hope to be able to show that there is no essential difference
between the apparently two diverse determinants, and that in both
cases the hyperesthetic memory is touched. In other cases there

13

is a great lability of equilibrium, the attack appears as a mani-
festation of the hypnoid remnant of consciousness as often as the
normal person becomes exhausted and incapacitated. We cannot
disregard the fact that in such cases the attack becomes denuded
of its original significance and may return as a contentless motor
reaction.

It remains a task for future investigation to discover what con-
ditions are decisive in determining whether a hysterical individ-
uality should manifest itself in attacks, in persistent symptoms,
or in a mingling of both.

V.

We can now understand in what manner the psychotherapeutic
method propounded by us exerts its curative effect. It abrogates
the efficacy of the original not ab-reacted presentation by afford-
ing an outlet to the strangulated affect through speech. It
brings it to associative correction by drawing it into normal con-
sciousness (in mild hypnosis) or it is done away with through
the physician’s suggestion just as happens in somnambulism with
amnesia.

We maintain that the therapeutic gain obtained by applying
this process is quite insignificant. To be sure we do not cure the
hysterical predispositon as we do not block the way for the
recurrence of hypnoid states; moreover, in the productive stage
our procedure is unable to prevent the replace-
ment of the carefully abrogated phenomena by new ones. But
when this acute stage has run its course and its remnants con-
tinue as persistent hysterical symptoms and attacks, our radical
method usually removes them forever, and herein it seems to
surpass the efficacy of direct suggestion as practiced at present
by psychotherapists.

If by disclosing the psychic mechanisms of hysterical phe-
nomena we have taken a step forward on the path so successfully
started by Charcot with his explanation and experimental imita-
tion of hystero-traumatic paralysis, we are well aware that in
doing this we have only advanced our knowledge of the mechan-
isms of hysterical symptoms and not in the subjective causes of
hysteria. We have but touched upon the etiology of hysteria and
could only throw light on the causes of the acquired forms, the
significance of the accidental moments in the neurosis.