VII

OBSESSIONS AND PHOBIAS:
THEIR PSYCHICAL MECHANISMS AND THEIR
ÆTIOLOGY¹

(1895)

I shall begin by challenging two assertions often
found repeated with regard to the syndromes:
obsessions and phobias. I must state, first, that
they should not be included under **neurasthenia** proper,
since the patients afflicted with these symptoms are
often neurasthenics, but as often not; and secondly,
that we are not justified in regarding them as the
effect of mental degeneration, because they are
found in persons no more degenerate than the major-
ity of neurotics in general, because at times they
improve, and indeed at times we even succeed in
curing them.²

Obsessions and phobias are separate neuroses,
with a special mechanism and ætiology which I have
succeeded in demonstrating in a certain number of
cases, and which, I hope, will prove similar in a
large number of new cases.

As regards classification of the subject, I propose
to exclude a group of intense **obsessions** which are
nothing but memories, unaltered images of important
experiences. As an example, I will cite Pascal’s
**obsession**: he always thought he saw an abyss on

¹ First published in the *Revue Neurologique*, 1895, t. III. [Trans-
lated by M. Meyer.]

² I am very glad to find that the authors of the most recent
work on this subject express opinions very similar to mine. Cf.
Gélineau, *Des peurs maladives ou phobies*, 1894, and Hack Tuke,
*On Imperative Ideas, Brain*, 1894.

1805 OBSESSIONS AND PHOBIAS 129

his left hand ‘after he had ncarly been thrown into
the Seine in his coach’. These obsessions and phobias,
which might be called iraumatic, are allied to the
symptoms of hysteria.

Apart from this group we must distinguish:
(a) obsessions proper; (5) phobias. The essential
difference between them is the following:

Two components are found in every obsession:
(7) an idea that forces itself upon the patient; (2) an
associated emotional state. Now in the group of
phobias this emotional state is always one of ‘morbid
anxiety’, while in true obsessions other emotional
states, such as doubt, remorse, anger, may occur
in the same capacity as fear does in the phobias. I
will first attempt to explain the remarkable psycho-
logical mechanism of true obsessions, a mechanism
quite different from that of the phobias.

I

In many true obsessions it is quite plain that the
emotional state is the chief element, since this state
persists unchanged while the idea associated with
it varies. The girl in Case ı quoted below, for example,
felt remorse in some degree for all sorts of reasons—
for having stolen, for having ill-treated her sisters, for
having counterfeited money, etc. Persons who doubt
have many doubts at the same time or consecutively.
In them it is the emotional state which remains con-
stant; the idea changes. In other cases the idea, too,
seems fixed, as in Case 4, the girl who persecuted ser-
vantsin the houschold with anincomprehensiblehatred,
constantly changing the individual object, however.

Now a careful psychological analysis of these
cases shows that the emotional state, as such, is
always justified. Case 1, the girl who suffered from
remorse, had good reasons for it; the women in Case 3
o

130 COLLECIED FAPERS vıl

who doubted their resistance against temptation
knew very well why. The girl in Case 4, who detested
servants, was justified in complaining, etc. Only,
and it is in these two characteristics that the patho-
logical sign lies, (I) the emotional state persists
continually, and (2) the associated idea is no longer
the appropriate original one, ztiologically related
to the obsession, but is one which replaces it, a
substitute for it.

The proof of this is the fact that we can always
find in the previous history of the patient, at the
beginning of the obsession, the original idea that
has been replaced. The replaced ideas all have
common attributes; they correspond to really painful
experiences in his sexual life which the person is
striving to forget. He succeeds merely in replacing
the irreconcilable idea by another ill-adapted to the
emotional state, which for its part remains unchanged.
It is this incongruity between the emotional state
and the associated idea that accounts for the ab-
surdity so characteristic of obsessions. I will now
bring forward my observations and conclude with a
tentative theory and explanation.

Case 1. A girl reproached herself for things which
she knew were absurd, for having stolen, for having
counterfeited money, for having dabbled in magic,
etc. according to whatever she had been reading
during the day.

Reinstatement of the veplaced idea. She reproached
herself with the onanism she had been practising
secretly without being able to renounce it. She was
cured by careful surveillance which prevented her
masturbating.

Case 2. A young man, a medical student, suffered
from an analogous obsession. He reproached himself
for all sorts of immoral acts: for having killed his

1895 OBSESSIONS AND PHOBIAS 131

cousin, for having violated his sister, for having set
fire to a house, etc. He got to the point of having
to turn round in the street to see if he had not killed
the last passer-by.

Reinstatement. He had been much affected by
reading in a quasi-medical book that onanism, to
which he was addicted, destroyed one’s morale.

Case 3. Several women complained of an impulsion
to throw themselves out of the window, to cut their
children with knives, scissors, etc.

Reinstatement. Typical temptation-obsessions..——
They were women who, not being at all satisfied in
marriage, had to struggle against the desires and
voluptuous ideas that haunted them in the presence
of men.

Case 4. A girl who was perfectly sane and very
intelligent displayed an uncontrollable hatred against
servants in the household. It had been provoked by
an impertinent servant, and had been transferred
from servant to servant, to a degree that rendered
housekeeping impossible. The feeling was a mixture
of hate and disgust. As a reason for it she stated
that the vulgarity of these girls sullied her idea of love.

Reinstatement. This girl had accidentally been
witness of an amorous scene in which her mother had
taken part. She had hidden her face, had stopped
up her ears, and had done her utmost to forget it,
as it disgusted her and made her feel quite unable
to remain with her mother whom she loved tenderly.
She succeeded in her efforts; but her anger at the
person who had profaned her idea of love continued
to exist within her, and this emotional state soon
linked itself to the image of a person who could be
a substitute for her mother.

Case 5. A young girl had become almost completely
isolated on account of an obsessive fear of incontin-
08

132 COLLECTED PAPERS VI

ence of urine. She could no longer leave her room
or receive visitors without having urinated a number
of times. When at home or entirely alone the fear
did not trouble her.

Reinstatement. It was an obsession of temptation or
mistrust. She did not mistrust her bladder, but her
resistance against amorous inclinations. The origin
of the obsession shows this well. She had once in
a theatre, at the sight of a man who pleased her,
felt an amorous desire, accompanied (as spontaneous
pollutions in women always are) by the desire to
urinate. She was obliged to leave the theatre, and
from that moment on she was a prey to the fear of
reproducing the same sensation, but the desire to
urinate had replaced the amorous one. She was
completely cured.

Although the cases enumerated show varying
degrees of complexity, they have the following in
common: the original (intolerable) idea has been
replaced by another idea, the substituted idea. In
the cases which I now append the original idea has
also been replaced, but not by another idea; it has
been replaced by acts or impulses which originally
served as measures of relief or as Protective proced-
ures, and are now incongruously associated with an
emotional state that does not fit them, but that
has persisted in its original form and was also origin-
ally justified.

Case 6. Obsession of arithmomania.—A woman
became obliged to count the boards in the floor, the
steps in the staircase, etc.—acts which she performed
in a state of ridiculous distress.

Reinstatement. She had begun the counting in
order to turn her mind from obsessive ideas of
temptation. She had succeeded in so doing, but the
impulse to count had replaced the original obsession.

1895 OBSESSIONS xp PHOBIAS 133

Case 7. Obsessive brooding and Speculating.—_A
Woman suffered from attacks of this Obsession that
Ceased only when she was ill, and then gave Place

not to breathe? etc.
Reinstatemeng, At the very beginning she had

>
begun to catechize herself and busy herself with
serious Problems. This quieted her at first, but
with time the habit of Speculation replaced the
phobja, For more than fifteen Years periods of fear
(Pathophobja) and of obsessive Speculating had
alternated in her.

Case 8. Folie du doute, Doubting mania. Seyera]
Cases showed the typical Symptoms of this obsession
but were explained very simply, These Persons had
Suffered or were still Suffering irom various ob-
Sessions, and the knowledge that the obsessions had
disturbed all their acts and had many a time inter-

134 COLLECTED PAPERS wi

finger-nails. As an explanation she stated that she
could not make her toilet while obsessive ideas
occupied her, nor immediately after. As a result,
she had become accustomed to wait a definite period
after each return of the obsessive idea.

Case 10. Folie du doute. Fear of paper.—A young
woman had suffered scruples after having written a
letter; at the same time she collected all the pieces
of paper she saw, which she explained by confessing
to a love which she had formerly refused to admit.
As she was constantly repeating her lover’s name,
she was seized with a fear that the name might have
slipped off the end of her pen, that she might have
written it upon some bit of paper in a pensive mo-
ment.!

Case 11. Mysophobia.--A woman who washed her
hands constantly and touched door-handles only with
her elbow.

Reinsiatement. The case of Lady Macbeth. The
washing was symbolic, designed to replace by physic-
al purity the moral purity which she regretted
having lost. She tormented herself with remorse for
conjugal infidelity, the memory of which she had
resolved to banish from her mind. She also washed
her genitalia.

As regards the theory and explanation of this
substitution, I will content myself with answering
three questions that arise here.

ı. How does this substitution come about ?

It seems to be the expression of a special mental
disposition. At least, a ‘similar heredity’ is often
enough found in obsessional cases, as in hysteria.
Thus the patient in my second case related to me

1 C£. the popular German song:
Auf jedes weiße Blatt Papier möcht’ ich es schreiben:
Dein ist mein Herz und soll es ewig, ewig bleiben.

1895 OBSESSIONS AND PHOBIAS 135

that his father had suffered from similar symptoms.
He once introduced me to a second cousin who had
obsessions and convulsive tic, and to his sister’s
daughter, aged eleven, who already showed ob-
sessions (probably of remorse).

2. What is the motive for this substitution ?

I think it may be regarded as a defensive reaction
(Abwehr) of the ego against the intolerable idea.
Among my patients several remember a deliberate
effort to banish the idea or the painful recollection
of the voice of conscience. (See Cases 3, 4, II.)
In other cases the repugnance is banished by an
unconscious process that has left no trace in the
patients’ memory.

3. Why does the emotional state that is attached
to the obsessive idea persist instead of vanishing like
other conditions of the ego?

This question may be answered by applying to
it the theory of the genesis of hysterical symptoms
developed by Breuer and myself.! I will here only
remark that by the very fact of the substitution the
disappearance of the emotional state is rendered
impossible.

u

In addition to these two groups of true obsessions
there is the class of ‘phobias’, which must now be
considered. I have already mentioned the great
difference between obsessions and phobias: that in
the latter the emotion is always one of anxiety,
fear. I might add that obsessions are varied and
more individualized, phobias are more uniform and
typical. But this distinetion is not all-important.

Among the phobias two groups may be differen-
tiated, according to the nature of the object feared:

! See, No. Il of this volume, p. 24.

I 36 COLLECTED PAPERS VII

(1) common phobias, an exaggerated fear of all those
things that everyone detests or fears to some extent:
such as night, solitude, death, illness, dangers in
general, snakes, etc.; (2) specific phobias, the fear
of special circumstances that inspire no fear in the
normal man; for example, agoraphobia and the
other phobias of locomotion. It is interesting to
note that these phobias have not the obsessive
feature that characterizes true obsessions and the
common phobias. The emotional state appears in
them only under special conditions which the patient
carefully avoids.

The mechanism of phobias is entirely different
from that of obsessions. Substitution is no longer
the predominant feature in the former; psychological
analysis reveals no intolerable replaced idea in them.
Nothing is ever found but the anxiety state which,
by a sort of selection, brings up all the ideas adapted
to become the subject of the phobia. In the case
of agoraphobia, etc., we often find the recollection
of a state of Sanic; and what the patient actually
fears is a repetition of such an attack under those
special conditions in which he believes he cannot
escape it.

The fear of this emotional state, which underlies
all phobias, is not derived from any memory what-
ever; we must ask what the source of this over-
powering nervous state can be.

I hope to be able to demonstrate, on another
occasion, that there is some reason for distinguishing
a special neurosis, the anxiety-neurosis,t of which
the chief symptom is this emotional state. I shall
then enumerate its various symptoms and lay stress
on those which differentiate this neurosis from
neurasthenia, with which it is nowconfounded. Phobias,

1 See No. V of this volume, p. 76.

137

then, are a part of the anxiety-neurosis, and are
almost always accompanied by other symptoms
belonging to it.

The anxiety-neurosis has a sexual origin too, as
far as I can see, but it does not attach itself to ideas
taken from sexual life; properly speaking, it has no
psychical mechanism. Its specific cause is the accumul-
ation of sexual tension, produced by abstinence or by
frustrated sexual excitation (using the term as a
general formula for the effects of coitus reservatus, 
of relative impotence in the husband, of excitation
without satisfaction in engaged couples, of enforced
abstinence, etc.).

It is under such conditions, extremely frequent in
modern civilized society, especially among women,
that anxiety-neurosis develops; phobias are a psych-
ical manifestation of it.

In conclusion I will state that combinations of a
phobia and an obsession proper may co-exist, and
that indeed this is a very frequent occurrence. We
may find that a phobia had developed at the be-
ginning of the disease as a symptom of anxiety-
neurosis. The thought-content of the phobia accom-
panying the state of fear may be replaced by another
idea or perhaps by a *protective procedure* that lessens
the fear. Case 7 (obsessive speculating) presents a
neat example of this group, a phobia coupled with
a true obsession evolved by substitution.