Freud, Sigmund (1895-005/1924.en): On the psychical mechanism of hysterical phenomena

I

ON THE PSYCHICAL MECHANISM OF
HYSTERICAL PHENOMENA!
(In collaboration with Dr. Joseph Breuer, 1892)

I

timulated by a chance observation, we have for

a number of years been investigating the most

varied types and symptoms of hysteria with
reference to the exciting cause, the event which
evoked the phenomenon in question for the first
time, often many years before. In the great majority
of cases it is impossible to discover this starting-
point by straightforward interrogation of the patient,
be it ever so thorough; partly because it is often a
matter of experiences which the patient finds it
disagreeable to discuss, but chiefly because he really
does not remember and has no idea of the causal
connection between the exciting occurrence and the
pathological phenomenon. As a rule it is necessary
to hypnotise the patient and under hypnosis to
arouse recollections relating to the time when the
symptom first appeared; one can then succeed in
revealing this connection in the clearest and most
convincing manner.

In a great number of cases this method of ex-
amination has yielded results which appear to be valu-
able theoretically as well as practically. From the
theoretical point of view the results are valuable
because, for the pathology of hysteria, the accidental
factor is decisive to a far greater extent than is

3 First published in the Neurologisches Zentralblatt, 1893, Nos. ı
and 2. [Translated by John Rickman.)

1803 ON HYSTERICAL MECHANISMS 25

known or acknowledged. In regard to traumatic
hysteria it is obviously the accident which has
evoked the syndrome; and when we learn from the
utterances of patients in hysterical attacks that
they invariably hallucinate in every attack a repe-
tition of the original occurrence which evoked the
first, the causal connection then also becomes per-
fectly clear here. The question is more obscure in
the case of other phenomena.

Our experience has shown us, however, that the
most varied symptoms, usually regarded as spontane-
ous and, so to speak, idiopathic products of hysteria,
have just as strict a connection with the exciting
trauma as those mentioned above in which the rela-
tion of the two sets of facts to one another is trans-
parent. To exciting causes of this kind we have
been able to trace anzsthesias as well as neuralgias
of the most varied kind, often of many years dur-
ation, contractures and paralyses, hysterical attacks
and epileptoid convulsions which all observers had
taken for genuine cepilepsy, petit-mal, symptoms of
the nature of tics, chronic vomiting and anorexia
carried to the point of refusal of food, the most
varied disturbances of vision, constantly recurring
visual hallucinations—and the like. The dispropor-
tion between the many years duration ofan hysterical
symptom and the single occurrence which evoked
it is similar to that which we are accustomed to see
egularly in traumatic neurosis; it was quite fre-
quently in childhood that the events occurred pro-
ducing a more or less grave symptom which persisted
{rom that time onwards.

The connection is often so clear that it is quite
evident how the exciting event has happened to
produce just this and no other manifestation; the
phenomenon is determined in a perfectly clear manner

26 COLLECTED PAPERS u

by the cause; to take the most ordinary example,
a painful affect, which was originally excited while
eating but was suppressed, produces nausea and
vomiting, and this continues for months as hysterical
vomiting. A girl watching in harrowing anxiety at
the bedside of a sick person falls into a twilight
state and has a terrifying hallucination while her
right arm which is hanging over the back of the
chair ‘goes to sleep’; from this develops a paresis of
that arm with contracture and anzsthesia. She
wants to pray but can find no words; finally she
succeeds in repeating an English prayer which she
learnt in childhood. Then later a severe and highly
complicated bysteria develops in which she can
speak, write and understand only English, while for
a year and a half her mother-tongue remains un-
intelligible to her.—A child who is very ill at last
falls asleep, and its mother tries her utmost to keep
quiet and not to wake it; but just in consequence
of this resolution (hysterical counterwill) she makes
a clucking noise with her tongue. On another occasion
when she wishes to keep absolutely quiet this happens
again, and so a tic in the form of tongue-clicking
develops which for a number of years accompanies
every excitement.—A highly intelligent man assists
while his brother’s ankylosed hip is straightened
under an anzsthetic. At the instant when the joint
gives way with a crack he feels a violent pain in his
own hip-joint which lasts for almost a year; and so on.

In other cases the connection is not so simple;
there exists only what may be called a symbolic
relation between the cause and the pathological
manifestation, such as normal people also fashion
in dreams; for example, a neuralgia links itself on
to some mental distress, or vomiting accompanies
a feeling of moral disgust. We have had under

1893 ON HYSTERICAL MECHANISMS 27

observation patients who habitually made extensive
use of such symbolism. In yet other cases a deter-
mination of this kind is not at the first glance clearly
intelligible; to these belong precisely the typical
hysterical symptoms—hemianzsthesia, contraction of
the field of vision, epileptiform convulsions and the
like. The exposition of our theories concerning this
group must be reserved for a more detailed con-
sideration of the subject.

Such observations seem to us to prove the patho-
genic analogy between ordinary hysteria and trau-
matic neurosis and to justify an extension of the
concept of traumatic hysteria. In traumatic neurosis
the active cause of illness is not the trifling bodily
injury but the affect of fright—the psychic trauma.
Similarly, our investigations of many, if not of the
majority, of hysterical symptoms have revealed
causes which must be described as psychic traumas.
Any experience which rouses the distressing affects
of fright, apprehension, shame, or psychical pain can
have this effect and it obviously depends on the sensi-
tiveness of the person concerned (as well as on a
further condition which we will refer to later) whether
the experience acquires the importance of a trauma.
We not infrequently find in ordinary hysteria several
partial traumas instead of one grand trauma—a
group of causes—which can only achieve traumatic
effectiveness by accumulation and which belong
together only in so far as they form parts of a whole
painful experience. In still other cases circumstances
in themselves apparently indifferent have attained
an otherwise unexpected importance as traumas,
either on account of their conjunction with really
effective experiences or because they occurred at a
moment of special susceptibility. This importance
they then retain henceforward.

28 COLLECTED PAPERS II

But the causal connection between the exciting
psychical trauma and the hysterical symptom is
not of such a kind that the trauma (like an agent
provocateur) sets going a symptom which then be-
comes independent and persists on its own account.
On the contrary, we are of opinion that the psychical
trauma, or the memory of it, acts as a kind of foreign
body constituting an effective agent in the present
even long after it first penetrated; and we see the
proof of this in a highly remarkable phenomenon
which also lends an important practical interest to
these results of our observations.

The discovery that we made, at first to our own
great surprise, was that when we had succeeded in
bringing the exciting event to clear recollection, and
had also succeeded in arousing with it the accom-
panying affect, and when the patient had related the
occurrence in as detailed a manner as possible and
had expressed his feeling in regard to it in words,
the various hysterical symptoms disappeared at once,
never to return. Recollection without affect is nearly
always quite ineffective; the original psychical pro-
cess must be repeated as vividly as possible, brought
into statum nascendi and then ‘talked out’. In the
case of excitation phenomena—contractures, neur-
algias, and hallucinations—the symptoms appear
again during this repetition in full intensity and then
disappear for ever. Defects in functioning, paralyses
and anzsthesias disappear in the same way, the
transitory exacerbation not being of course per-
ceptible in those cases.!

1 Delbeuf and Binet have clearly recognised the possibility of
such a therapy, as the following quotations show. Delbauf: Le
Magnötisme animal, Paris, 1889: ‘Since then it has been possible
to understand how the magnetist helps in bringing about recovery.
He restores the patient to the condition in which the illness esta-
blished itself and then with his words he attacks the illness, now
in statu nascendi.’ — Binet: Les Alierations de la personnalits, 1892,

One y be Inclined to Suspect that ı explan.
ation ]i nintentional Suggestion,, the patient
ExXpects to be yi of his suffe, ing as a fesult of the
Teatment, and this Pectation Might be the effec.
tive factor, not the « Iking out”, IS is not
the fact 3 the firs bservation f this ki d a

of the Patient, and it Pccasioned the observer the
Sreatest Surprise,
Inverting the phrase “cessante Causa cessar effectus’,
we may weil conclude from these observationg that
the Exciting eXperience continues in Some way to

tears; we thu;
Principally Jrom Veminiscences

P. Janet”, RB , Paris,
1880, there is 2 description of a Sure obtained in ar hysterica] girl
0 0 Te? u;

a an, .
ehe toxt it is mot Possible to separat What is new in the
content of this Provisiona] Communication from what is also to be
found in other authors, e, . Möbius and Strümpell, who have Put
forward similar views on 'ysteria, The nearest Approach to our
theoretica] and ‚therapentic deductions is found ina few recently
Published remarks of Benedikt’s Which we Propose to consider
elsewhere,

30 COLLECTED PAPERS u

and that the memory of them should not succumb
to the fate which we see overtaking all our memories;
perhaps these facts may become rather more. com-
prehensible in the light of the following consider-
ations.

The fading of a memory or of its affect depends
on several factors. First and foremost it depends
on whether an energetic reaction (discharge of feeling)
supervened on the affective experience or not. By
reaction we here mean the whole range of voluntary
and involuntary reflexes, by which according to
experience the affects are habitually worked ofi—
from weeping up to an actual act of revenge. If
this reaction occurs with sufficient intensity a great
part of the affect disappears; common speech bears
witness to these facts of every-day observation in
the expressions ‘to cry oneself out’, ‘to storm one-
self out (sich austoben)’. If the reaction is suppressed
the affect remains attached to the memory. An
insult which is returned, if only in words, is remember-
ed differently from one which had to be endured in
silence. Common speech also recognizes this differ-
ence in the psychical and bodily consequences, and
most characteristically designates silently endured
suffering as a Kränkung,' wound, injury, morti-
fication. The reaction of an injured person to the
trauma has a really complete ‘cathartic’ effect only
if it takes the form of a fully adequate reaction, such
as an act of revenge. But man finds a surrogate
for such an act in speech, by the help of which the
affect may be almost as effectually “abreacted’.
In other cases talking is itself sufficient as a reflex,
for example, complaining or relieving the burden
of a secret (the confessional!). If a reaction of this

3 (There is no satisfactory translation of this highly expressive
German word, which is obviously allied to krank = ill._—Ed.]

1893 ON HYSTERICAL MECHANISMS 3I

kind by word or deed, or in the mildest cases by
tears, does not ensue, the memory of the occurrence
retains for a time its affective tone.

“Abreaction’ is, however, not the only kind of
solution at the disposal of the normal psychical
mechanism in a healthy person who has met with
a psychical trauma. Even if the memory is not
abreacted it becomes merged in the great complex
of associations, and is then ranged alongside of
other experiences which perhaps contradict it; thus
it undergoes correction by means of other ‘ideas.
After an accident, for example, the remembrance
of the danger and the subsequent (weakened) re-
production of the terror is accompanied by the
memory of the sequel, of the rescue and the con-
sciousness of present security. The memory of an
injury to the feelings is corrected by an objective
evaluation of the facts, consideration of one’s actual
worth and the like, and thus the normal man suc-
ceeds by means of associations in dissipating the
accompanying affect.

In addition to this there is also that general effac-
ing of impressions, that fading of recollection called
‘forgetting’, which tends more than anything else
to absorb ideas which have lost their affective tone.

Our observations have shown that those memories
which give rise to hysterical phenomena are retained
with wonderful freshness and with full affective
tone for a long period. But we must mention as a
further striking fact, to be turned to account later,
that these recollections are not at the disposal of
the patient in the way that his more commonplace
memories are. On the contrary, when the patient
is in his usual psychical condition these experiences
are completely absent from his memory or are
present to it only in the most summary manner.

COLLECTED PAPERS ıl

Only when patients are questioned under hypnosis
do these memories recur with the undiminished
vividness of recent events.

Thus for six months one of our patients under
hypnosis reproduced with hallucinatory vividness
everything which had excited her on the corres-
ponding day of the previous year (during an acute
hysteria); her mother’s diary, of which she knew
nothing, attested the perfect accuracy of the repro-
duction. Another patient lived through with hallu-
cinatory clearness—partly in hypnosis, partly in
spontaneous attacks—all the experiences of an hyster-
ical psychosis which she had suffered from ten years
before, and in regard to which amnesia had been
almost complete until the moment of the re-emerg-
ence. Several tiologically important recollections
dating back fifteen to twenty-five years were of
astonishing integrity, and intensity of feeling; on
reproduction their effect had the full force of new
experiences.

As a reason for this we can only conjecture that
these recollections have met with an exceptional
fate in reference to all the ordinary processes of
effacement discussed above, for we find that they
relate to traumas which have not been sufficiently
abreacted; closer investigation of the reasons which
have prevented the operation of the latter then shows
us at least two groups of conditions under which reac-
tion to the trauma does not ensue.

In the first group we reckon those cases in which
the patient has not reacted to the psychical trauma
because its nature excluded the possibility of any
such reaction, as in the case of the apparently irre-
trievable loss of a loved person, or when social
conditions made a reaction impossible, or when the
trauma concerned something which the patient

1893 ON HYSTERICAL MECHANISMS 33

wished to forget and therefore deliberately repressed'
and excluded from his conscious thoughts. Under
hypnosis we discover painful ideas of precisely this
character underlying the hysterical phenomena (e. g.
in the hysterical deliria of saints and nuns, of absti-
nent women and well-brought-up children).

The second group of conditions is not determined
by the content of the recollection, but by the mental
condition of the patient at the moment when the
given experience occurred. That is to say, among
the exciting factors of hysterical symptoms we also
discover under hypnosis ideas which though not in
themselves significant owe their preservation to the
circumstance that they happen to coincide with a
seriously disabling affect, for example, terror, or
with a directly abnormal mental condition, such as
the half-hypnotic twilight state of day-dreaming,
auto-hypnosis, and the like. In these cases it is the
nature of these conditions which made a reaction
to the experience impossible.

Naturally both determinants may and often do
occur together. This happens when a trauma effective
enough in itself occurs during a state of seriously
disabling affect or of altered consciousness; but it
seems that in many persons an abnormal state of
this kind is produced as the result of a psychic
trauma which then in its turn makes a reaction
impossible.

Both groups of determining conditions have this
in common: that the psychical traumas which are
not resolved by reaction will also fail of solution by
means of associative absorption. In the first group
the patient’s intention to do so causes him to forget

1 [This is the first occasion on which this term was used. Later
it became the author's technical term for the unconseious process
by which thoughts are exchuded from consciousness.—Ed.]

3

34 COLLECTED PAPERS IT

the painful experiences and consequently to exclude
them from association as far as possible. In the
second group the associative absorption does not
succeed because sufficient associative connection
does not exist between the normal state of conscious-
ness and the pathological state in which these ideas
originally arose. We shall have immediate occasion
to go more closely into these conditions.

Thus it may be said that the ideas which have
become pathogenic are preserved with such fresh-
ness and affective force because the normal process
of absorption by abreaction and by reproduction
in a state of unrestrained association is denied
them.

II

In describing the conditions which according to
our experience are decisive for the development of
hysterical phenomena from psychical traumas, we
mentioned the abnormal states of consciousness in
which such pathological ideas arise; and we laid
stress on the fact that the recollection of the effective
psychical trauma is not to be found in the normal
memory of the patient, but in his memory under
hypnosis. Indeed, the more we occupied ourselves
with these phenomena the more certain did our
conviction become that that splitting of conscious-
ness, which is so striking in the well-known classical
cases of double conscience, exists in a rudimentary
fashion in every hysteria and that the tendency to
this dissociation—and therewith to the production
of abnormal states of consciousness, which may be
included under the term ‘hypnoid’—is a fundamental
manifestation of this neurosis. This view is in agree-
ment with those of Binet and the two Janets; we
have not had the opportunity, however, to confirm

1893 ON HYSTERICAL MECHANISMS 35

their highly remarkable discoveries in reference to
anssthetic patients.

We should like therefore to supplement the often-
quoted phrase ‘hypnosis is an artificial hysteria’
with another—namely, “he existence of hypnoid
states forms the foundation and condition of hys-
teria’. There is one thing common to all these hypnoid
states and to hypnosis, in spite of all their differences
—namely, that the ideas which emerge in them are
marked by great intensity of feeling but are cut off
from associative connection with the rest of the content
of conseiousness. These hypnoid states are capable of
association among themselves and the ideas belonging
to them may in this way attain different degrees
of psychical organization. Incidentally, however, the
nature of these states and the degree of their inac-
cessibility to the rest of conscious processes would
very probably vary in a fashion similar to that of
hypnosis, which ranges from light sleepiness to som-
nambulism, from complete recollection to absolute
amnesia.

If such hypnoid states exist before the manifest
illness, they provide a foothold upon which the
affect establishes itself with its pathogenic recollection
and its subsequent somatic manifestations. This
situation corresponds to dispositional hysteria. But
our observations show that a severe trauma (such
as that in a traumatic neurosis) or a troublesome
suppression (for instance, of sexual affect) can effect
a splitting of groups of ideas in people previously
free from it, and this would constitute the mechanism
of psychically acquired hysteria. Between the ex-
tremes of these two forms we must recognize a
series within which the readiness to dissociation in
the persons concerned and the volume of affect
toused by the trauma varies inversely.

‚*

36 COLLECTED PAPERS u

We have nothing new to say concerning the origin
of dispositional hypnoid states. They often develop,
we believe, from the ‘day-dreams’ so frequently met
with also in healthy people, great opportunity for
which is provided, for instance, in the femininc
occupation of needlework. The question why the
‘pathological associations’ formed in such states are
so strong and why they influence somatic processes
so much more strongly than ideas habitually do is
part of the problem of the operation of hypnotic
suggestion in general. Our experiences teach us
nothing new on this point; they do, however, illuminate
the contradiction between the statement ‘hysteria
is a psychosis’ and the fact that one finds among
hysterics people with the clearest and most critical
intellects, of great strength of character and will-
power. These characteristics in such people are
valid for their waking thoughts; in the hypnoid
state they become alienated from their conscious
personalities as we all are in dreams. But whereas
our dream-psychoses do not influence our waking
existence the products of hypnoid states intrude as
hysterical phenomena into waking life.

IV

Almost the same conclusions that we have just
formed concerning hysterical symptoms of long
duration may be repeated concerning hysterical
attacks. As is well known, we possess a schematic
description of the ‘grande attague’, worked out by
Charcot, according to which four phases may be
recognized in a complete attack: (1) the epileptoid,
(2) that of violent movements, (3) that of “attitudes
bassionnelles’ (the hallucinatory phase), and (4) that
of the concluding delirium. According to Charcot,
all the various forms of an hysterical attack ( (which

1893 ON HYSTERICAL MECHANISMS

as a matter of fact are more frequently observed
than the full grande altaque) are derived from a
shortening, lengthening, omission or isolation of these
separate phases.

Our attempt at explanation has to do with the third
phase, the attitudes passionnelles. When this is well-
marked it will reveal itself as an hallucinatory re-
production of a memory important for the outbreak
of the hysteria, i. €. the memory of the one grand
trauma in what is called zar 2£oyiv traumatic hysteria,
or of a series of inter-related partial traumas which lie
at the root of ordinary hysteria. The remaining
alternative is that the attack will reproduce those ex-
periences which were raised to importance by happen-
ing to occur at a time of special sensitivity to traumas.

But there are also attacks which seems to consist of
nothing but motor symptoms and in which the
phase passionnelle is lacking. If we can succeed in
establishing a rapport with the patient during such
general <lonic attacks, during tonic catalepsy, Or
during an aftaque de sommeil, or, better still, if we
succeed in summoning up an attack while the patient
is under hypnosis, we find that these attacks too
are based on the memory of a psychic trauma of
series of traumas which usually finds expression in
an hallucinatory phase. For instance, a little girl
has suffered for years from attacks of general con-
vulsions which might have been epilepsy and had
in fact been taken for it. To establish a differential
diagnosis she was hypnotised and was promptly
seized by an attack. ‘When asked: “What do you
see now?’ she answered:“ The dog, the dogis coming!”
Further enquiry revealed that the first attack of
the kind had appeared after she had been chased
by a mad dog. Therapeutic success later confirmed
the diagnosis of a psychogenic malady.—A clerk

38 COLLECTED PAPERS I

who had become hysterical in consequence of being
assaulted by his superior suffered from attacks
during which he fell to the ground in a frenzy of
rage, but without uttering a word or betraying any
signs of an hallucination. An attempt to produce the
attack under hypnosis proved successful, and the
patient revealed that he was again living through
the situation in which his superior had openly in-
sulted him in the street and thrashed him with a
stick. A few days afterwards he returned com-
plaining that the same attack had occurred again,
and this time he revealed under hypnosis that he had
been living through the situation which provoked
theactualoutbreak of the disease, i. e. the trial in court
where he failed to obtain compensation for the injury.

The memories which come to the fore in hysterical
attacks, or can be wakened during them, correspond
also in all other respects with the exciting occurrences
which we have found at the root of hysterical symp-
toms of long duration. Like these, they relate to
psychic traumas which have remained unresolved by
abreaction or by associative mental operations; and
like these, they—or at least their essential con-
stituents—are absent from the store of memories
of which normal consciousness is made up; they
belong to the ideational content of hypnoid states
of consciousness with their narrow fields of asso-
ciation. Finally, they also admit of the therapeutic
test. Our observations have often demonstrated that a
memory of this kind which had hitherto provoked such
attacks lost this power as soon asit was brought during
hypnosis to a reaction or to associative readjustment.

The motor phenomena of hysterical attacks are
to be explained partly as a general mode of reaction
to the affect which accompanies the memory, and
may be compared, for example, with the beating

1893 ON HYSTERICAL MECHANISMS 39

movements of all the limbs which even an infant
makes use of for this purpose; and partly as signifying
direct emotional expressions of this memory; although
they also elude this explanation to some extent as
«do the hysterical stigmata in chronic symptoms.

There is yet another aspect of the hysterical
attack which reveals itself in the light of the theory
we have just indicated: that in hysteria there are
present ideational groups (arising in hypnoid states)
which, cut off from associative relations with the
remainder but associable inter se, establish a more
or less highly organized nucleus of a second conscious-
ness, a condılion seconde. An hysterical symptom of
long duration then corresponds to an intrusion of
this condition seconde into the somatic innervations
usually controlled by normal consciousness; an hyster-
ical attack, however, gives evidence of a higher or-
ganization of this condition seconde and, when of
recent origin, signifies the moment at which this
hypnoid consciousness takes possession of the sub-
ject’s whole personality (i. e. an acute hysteria); but
recurring attacks which contain a memory signify a
recurrence of this moment. Charcot has already
suggested that the hysterical attack is probably the
nucleus of a condition seconde. During the attack,
control of the entire somatic innervation has passed
to the hypnoid consciousness. Experience shows
that in these cases normal consciousness is not always
completely superseded; it may even perceive the
motor phenomena of the attack while the psychic
processes of the latter escape its notice.

The typical course of a severe hysteria is, as is
well known, that first an ideational content is formed
in hypnoid states, which then, when sufficiently
developed, takes possession during a period of ‘acute
hysteria’ of the somatic innervation and personality

40 COLLECIED PAPERS 4

of the patient, creates chronic symptoms and attacks,
and then recedes until mere vestiges of it are left.
If therefore the normal personality can regain con-
trol, what remains of the hypnoid ideational contents
then returns in hysterical attacks and again tempor-
arily produces in the patient similar states, which
are again susceptible themselves and predisposing
to the influence of traumas. A sort of equilibrium
between the psychical groups united in the same
personality is then frequently established; attacks
and normal life exist side by side without affecting
one another. The attacks then arise spontaneously,
as memories commonly do; but they may also be
provoked, just as any memory may be aroused ac-
cording to the laws of association. Provocation of
an attack occurs either by stimulation of an hystero-
genic zone or by a new experience resembling the
pathogenic experience. We hope to be able to show
that no essential difference exists between the two
conditions, apparently so distinct; that in both
cases a hyperzsthetic memory has been stirred. In
other cases this equilibrium is very unstable; the attack
appears as an expression of the vestiges of hypnoid con-
sciousness whenever the normal personality is exhaus-
tedand powerless. It is not impossible that in such cases
the attack may be divested of its original significance
and may return as a motor reaction without content.

It remains a task for further enquiry to discover
what are the conditions determining whether in any
given patient an hysteria will take the form of attacks,
or chronic symptoms, or a combination of both.

v
It is now clear how the method of psychotherapy
which we have just described leads to recovery. By
providing an opportunity for the pent-up affect to

1893 ON HYSTERICAL MECHANISMS 4I

discharge itself in words the therapy deprives of its
effective power the idea which was not originally
abreacted; by conducting it into normal conscious-
ness (in light hypnosis) it brings it into associative
readjustment or else dispels it by means of the
physicians’ suggestion, as happens in cases of
somnambulism combined with amnesia.

We regard the therapeutic effect achieved by
employing this procedure as important. We naturally
cannot cure that element in hysteria which is dis-
positional; we can do nothing against the return of
hypnoid states. Even during the productive state
of an acute hysteria our procedure cannot prevent
the phenomena which have just been removed with
such difficulty being forthwith replaced by new ones.
But when the acute stage has passed off and its
vestiges remain in the form of chronic hysterical
symptoms and attacks our method will frequently
remove them in turn, and the results are permanent
because radical. It therefore appears to us that in
this respect it far surpasses the effect of removal
by direct suggestion which is now practised by
psychotherapeutists.

Although, by thus disclosing the psychical mechan-
ism of hysterical phenomena, we have now made a
further step along the path which Charcot first
opened up so successfully with his explanations and
experimental imitations of hystero-traumatic para-
lyses, we nevertheless do not conceal from ourselves
that it is only the mechanism of the hysterical
symptom that has been brought within our grasp
and not the inner causes of hysteria. We have but
touched upon the ztiology of hysteria and have
really only been able to throw light on the causes
of its acquired forms—the significance of the accident-
al factor for this neurosis.