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 patients
and reawaken the memory of that time in which the symptom first
appeared, and we thus succeeded in exposing that connection 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

¹ Written in collaboration with Dr. Joseph Breuer.

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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
the moment when the joint yielded and crackled he perceived
severe pain in his own hip which continued for almost a year.

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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 symbolization. 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
psychic trauma or the memory of the same acts like a foreign
body which even long after its penetration must continue to in-
 

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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 status 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 for-
ever. Functional attacks like paralyses and
anæsthesias likewise disappear, but naturally without any appre-
ciable distinctness of their momentary aggravation.²⁾
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 surprise.
In reversing the sentence: cessante causa cessat effectus, we
may conclude from this observation that the causal process con-
tinues to act in some way even after years, not indirectly by means.

²⁾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 guérison. 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 meme 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.

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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
well nigh be ab-reacted⁴⁾ (“abreagirt”). In other cases talking

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.

⁴⁾The German abreagiren has no exact English equivalent. It will there-
fore be rendered throughout the text by “ab-react,” the literal meaning

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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
patients in a hypnotic state reproduced with hallucinatory vivid-
ness throughout half a year all that excited her during an acute

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.