THE ORIGIN AND DEVELOPMENT OF
PSYCHOANALYSIS?

By SigmuND FREUD

First Lecture

Ladies and Gentlemen: It is a new and somewhat.
embarrassing experience for me to appear as lecturer be-
fore students of the New World. I assume that I owe
this honor to the association of my name with the theme
of psychoanalysis, and consequently it is of psychoanalysis
that I shall aim to speak. I shall attempt to give you in very
brief form an historical survey of the origin and further
development of this new method of research and cure.

Granted that it is a merit to have created psychoanalysis,
it is not my merit. I was a student, busy with the passing
of my iast examinations, when another physician of
Vienna, Dr. Joseph Breuer, made the first application of
this method to the case of an hysterical girl (1880-82),
We must now examine the history of this case and its
treatment, which can be found in detail in “Studien über

_ Hysterie,” later published by Dr. Breuer and myself.

But first one word. I have noticed, with considerable
satisfaction, that the majority of my hearers do not belong
to the medical profession. Now do not fear that a medical
education is necessary to follow what I shall have to say.
We shall now accompany the doctors a little way, but soon
we shall take leave of them and follow Dr. Breuer on a
way which is quite his own.

1 These lectures were delivered at Clark University in 1916,
Translated from the German by Harry W. Chase, Fellow in Psy-
chology, Clark University, and revised by Prof. Freud. Published

with the permission of the author.
21

22 AN OUTLINE OF PSYCHOANALYSIS

Dr. Breuer’s patient was a girl of twenty-one, of a high
degree of intelligence. She had developed in the course
of her two years’ illness a series of physical and mental
disturbances which well deserved to be taken seriously.
She had a severe paralysis of both right extremities, with
anzesthesia, and at times the same affection of the members
of the left side of the body; disturbance of eye-movements,
and much impairment of vision; difficulty in maintaining
the position of the head, an intense Tussis nervosa, nausea
when she attempted to take nourishment, and at one time
for several weeks a loss of the power to drink, in spite of
tormenting thirst. Her power of speech was also dimin-
ished, and this progressed so far that she could neither
speak nor understand her mother tongue; and, finally, she
was subject to states of “absence,” of confusion, delirium,
alteration of her whole personality. These states will later
claim our attention. |

When one hears of such a case, one does not need to be
a physician to incline to the opinion that we are concerned
here with a serious injury, probably of the brain, for which
there is little hope of cure and which will probably lead to
the early death of the patient. The doctors will tell us,
however, that in one type of cases with just as unfavorable
symptoms, another, far more favorable, opinion is justified.
When one finds such a series of symptoms in the case of
a young girl, whose vital organs (heart, kidneys) are
shown by objective tests to be normal, but who has suffered
from strong emotional disturbances, and when the symp-
toms differ in certain finer characteristics from what one
might logically expect, in a case like this the doctors are
not too much disturbed. They consider that there is pres-
ent no organic lesion of the brain, but that enigmatical
state, known since the time of the Greek physicians as
hysteria, which can simulate a whole series of symptoms
of various diseases. They consider in such a case that the
life of the patient is not in danger and that a restoration
to health will probably come about of itself. The differen-

ORIGIN AND DEVELOPMENT 23

tiation of such an hysteria from a severe organic lesion is
not always very easy. But we do not need to know how
a differential diagnosis of this kind is made; you may be
sure that the case of Breuer’s patient was such that na
skillful physician could fail to diagnose an hysteria. We
may also add a word here from the history of the case.
‘The illness first appeared while the patient was caring for
ther father, whom she tenderly loved, during the severe
illness which led to his death, a task which she was com-
pelled to abandon because she herself fell ill.

So far it has seemed best to go with the doctors, but
‘we shall soon part company with them. You must not
think that the outlook of a patient with regard to medical
aid is essentially bettered when the diagnosis points to
hysteria rather than to organic disease of the brain.
Against the serious brain diseases medical skill is in most
wases powerless, but also in the case of hysterical affections
the doctor can do nothing. He must leave it to benign
mature, when and how his hopeful prognosis will be real-
‘ized.2, Accordingly, with the recognition of the disease as
chysteria, little is changed in the situation of the patient,
but there is a great change in the attitude of the doctor.
We can observe that he acts quite differently toward hys-
tericals than toward patients suffering from organic dis-
eases. He will not bring the same interest to the former as
‘to the latter, since their suffering is much less serious and
yet seems to set up the claim to be valued just as seriously.

But there is another motive in this action. The physi-
cian, who through his studies has learned so much that is
hidden from the laity, can realize in his thought the causes
cand alterations of the brain disorders in patients suffering
from apoplexy or dementia, a representation which must
‚be right up to a certain point, for by it he is enabled to

2] know that this view no longer holds today, but in the lecture
I take myself and my hearers back to the time before 1880. If
things have become different since that time it has been largely dw
-to the work the history of which I sm sketching.

24 AN OUTLINE OF PSYCHOANALYSIS

‘ understand the nature of each symptom. But before the
details of hysterical symptoms, all his knowledge, his
anatomical-physiological and pathological education, desert
him. He cannot understand hysteria. He is in the same
position before it as the layman. And that is not agreeable
to any one, who is in the habit of setting such a high valu-
ation upon his knowledge. Hystericals, accordingly, tend
to lose his sympathy ; he considers them persons who over-
step the laws of his science, as the orthodox regard
heretics ; he ascribes to them all possible evils, blames them
for exaggeration and intentional deceit, “simulation,” and
he punishes them by withdrawing his interest.

Now Dr. Breuer did not deserve this reproach in this
case; he gave his patient sympathy and interest, although
at first he did not understand how to help her. Probably
this was easier for him on account of those superior quali-
ties of the patient’s mind and character, to which he bears
‘witness in his account of the case.

His sympathetic observation soon found‘ the means
which made the first help possible. It hadgbeen noticed
that the patient, in her states of “absencé,” of psychic
alteration, usually mumbled over several words to herself.
These seemed to spring from associations with which her
thoughts were busy. The doctor, who was able to get
these words, put her in a sort of hypnosis and repeated
them to her over and over, in order to bring up any asso-
ciations that they might have. The patient yielded’ to his
suggestion and reproduced for him those psychic creations
which controlled her thoughts during her “absences,” and
which betrayed themselves in these single spoken words.
These were fancies, deeply sad, often poetically beautiful,
day dreams, we might call them, which commonly took as
their starting point the situation of a girl beside the sick-
bed of her father. Whenever she had related a number
of such fancies, she was, as it were, freed and restored to
her normal mental life. This state of health would last
for several hours, and then give place on the next day to

-

a LG „ 2 5 r e é

' ORIGIN AND DEVELOPMENT 25

=

anew “absence,” which was removed in the same way by

relating the newly created fancies. It was impossible not

_ to get the impression that the psychic alteration which was
_ expressed in the “absence” was a consequence of the ex-

- citations originating from these intensely emotional fancy-

_ images. The patient herself, who at this time of her illness

_ strangely enough understood and spoke oes English, gave

this new kind of treatment the name “talking cure,” or
jokingly designated it as “chimney sw ne
The doctor soon hit upon the fact that through such

_ cleansing of the soul more could be accomplished than a

7

r

temporary removal of the constantly recurring mental
clouds.” Symptoms of the disease would disappear when
in hypnosis the patient could be made to remember the sit-
uation and the associative connections under which they
first appeared, provided free vent was given to the emotions
which they aroused. “There was in the summer a time
of intense heat, and the patient had suffered very much
from thirst; for, without any apparent reason, she had
suddenly become unable to drink. She would take a glass

of water in her hand, but as soon as it touched her lips

she would push it away as though suffering from hydro-
phobia. Obviously for these few seconds she was in her

_ absent state. She ate only fruit, melons and the like, in

order to relieve this tormenting thirst. When this had been

- going on about six weeks, she was talking one day in
- hypnosis about her English governess, whom she disliked,
and finally told, with every sign of disgust, how she had

_ come into the room of the governess, and how that lady’s
little dog, that she abhorred, had drunk out of a glass,

- Out of respect for the conventions the patient had re-

mained silent. Now, after she had given energetic expres-
sion to her restrained anger, she asked for a drink, drank

a large quantity of water without trouble, and woke from

hypnosis with the glass at her lips. The symptom there-

upon vanished permanently.” °
8 Studien tiber Hysterie, 2d ed., p. 26.

a FE

“vp
26 AN OUTLINE OF PSYCHOANALYSIS

Permit me to dwell for a moment on this experience.
No one had ever cured an hysterical symptom by such
means before, or had come so near understanding its cause.
This would be a pregnant discovery if the expectation
could be confirmed that still other, perhaps the majority
of symptoms, originated in this way and could be removed
by the same method. Breuer spared no pains to convince
himself of this and investigated the pathogenesis of the
other more serious symptoms in a more orderly way. Such
was indeed the case; almost all the symptoms originated —
in exactly this way, as remnants, as precipitates, if you
like, of affectively toned experiences, which for that reason
we later called “psychic traumata.” The nature of the
symptoms became clear through their relation to the scene
which caused them. They were, to use the technical term,
“determined” (determiniert) by the scene whose memory
traces they embodied, and so could no longer be described
as arbitrary or enigmatical functions of the neurosis.

Only one variation from what might be expected must
be mentioned. It was not always a single experience which
occasioned the symptom, but usually several, perhaps many
similar, repeated traumata cooperated in this effect. It was
necessary to repeat the whole series of pathogenic mem-
ories in chronological sequence, and of course in reverse
order, the last first and the first last. It was quite impos-
sible to reach the first and often most essential trauma
directly, without first clearing away those coming later.

You will of course want to hear me speak of other
examples of the causation of hysterical symptoms beside
this of inability to drink on account of the disgust caused
by the dog drinking from the glass. I must, however, if
I hold to my program, limit myself to very few examples.
Breuer relates, for instance, that his patient’s visual dis-
turbances could be traced back to external causes, in the
following way: “The patient, with tears in her eyes, was
_ sitting by the sick-bed when her father suddenly asked her —

what time it was. She could not see distinctly, strained —

\

ORIGIN AND DEVELOPMENT 27

her eyes to see, brought the watch near her eyes so that

_ the dial seemed very large (macropia and strabismus

T

.conv.), or else she tried hard to suppress her tears, so that
the sick man might not see them.” *

All the pathogenic impressions sprang from the time
when she shared in the care of her sick father. “Once she

- was watching at night in the greatest anxiety for the

~

patient, who was in a high fever, and in suspense, for a
surgeon was expected from Vienna, to operate on the
patient. Her mother had gone out for a little while, and
Anna sat by the sick-bed, her right arm hanging over the
back of her chair. She fell into a revery and saw a black
snake emerge, as it were, from the wall and approach the
sick man as though to bite him. (It 1s very probable that

_ several snakes had actually been seen in the meadow be-

hind the house, that she had already been frightened by

them, and that these former experiences furnished the

material for the hallucination.) She tried to drive off the

creature, but was as though paralyzed. Her right arm,
which was hanging over the back of the chair, had “gone

to sleep,” become anzesthetic and paretic, and as she was
looking at it, the fingers changed into little snakes with
_deaths-heads. (The nails.) Probably she attempted to
drive away the snake with her paralyzed right hand, and
so the anxsthesia and paralysis of this member formed
associations with the snake hallucination. When this had
- vanished, she tried in her anguish to speak, but could not.
"She could not express herself in any language, until finally
she thought of the words of an English nursery song, and
thereafter she could think and speak only in this lan-
guage.” > When the memory of this scene was revived in
hypnosis the paralysis of the right arm, which had existed

since the beginning of the illness, was cured and the treat-
ment ended.

When, a number of years later, I began to use Breuer’s

4 Studien tiber Hysteric, 2d ed., p. 30.
5 Studien über Hysterie, 2d ed.. p. 31.

#

#3 AN OUTLINE OF PSYCHOANALYSIS

researches and treatment on my own patients, my experi-
ences completely coincided with his. In the case of a

woman of about forty, there was a tic, a peculiar smacking
noise which manifested itself whenever she was laboring

under any excitement, without any obvious cause. It had

its origin in two experiences which had this common ele-
ment, that she attempted to make no noise, but that by a
sort of counter-will this-noise broke the stillness. On the
first occasion, she had finally after much trouble put her
sick child to sleep, and she tried to be very quiet so as not
to awaken it. On the second occasion, during a ride with
both her children in a:'thunderstorm the horses took fright,
and she carefully avoided any noise for fear of frighten-
ing them still more.® I give this example instead of many
others which are cited in the Studien tiber Hysterie.
Ladies and gentlemen, if you will permit me to gen-
eralize, as is indispensable in so brief a presentation, we
may express our results up to this point in the formula:
Our hysterical patients suffer from reminiscences. Their
symptoms are the remnants and the memory symbols of
certain (traumatic ) experiences. -
A comparison with other memory symbols from other
sources wili perhaps enable us better to understand this
symbolism. The memorials and monuments with which
we adorn our great cities, are also such memory symbols.
If you walk through London you will find before one of
the greatest railway stations of the city a richly decorated
Gothic pillar—“Charing Cross.” One of the old Plan-
tagenet kings, in the thirteenth century, caused the body
of his beloved queen Eleanor to be borne to Westminster,

and had Gothic crosses erected at each of the stations

. -

6 Loc. cit., 2d ed., pp. 43-46. A selection from this book, aug-

mented by several later treatises on hysteria, lies before me, in an
English translation by Dr. A. A. Brill, of New York. It bears the
title Selected Papers on Hysteria and Other Psychoneuroses,

1009. [No. 4 of the Nervous and Mental Disease Monograph Series, —

New York.]

_

ORIGIN AND DEVELOPMENT 29

where the coffin was set down. Charing Cross is the last
of these monuments, which preserve the memory of this
sad journey.’ In another part of the city, you will see &
high pillar of more modern construction, which is merely
called “the Monument.” This is in memory of the great
fire which broke out in the neighborhood in the year 1666,

“ and destroyed a great part of the city. These monuments

are memory symbols like the hysterical symptoms; so far
the comparison seems justified. But what would you say
to a Londoner who today stood sadly before the monu-
ment to the funeral of Queen Eleanor, instead of going
about his business with the haste engendered by modern
industrial conditions, or rejoicing with the young queen of
his own heart? Or to another, who before “the Monu-
ment’ bemoaned the burning of his loved native city, which
long since has arisen again so much more splendid than
before?

Now hystericals and all neurotics behave like these two
unpractical Londoners, not only in that they remember
the painful experiences of the distant past, but because
they are still strongly affected by them. They cannot
escape: from the past and neglect present reality in its
favor. This fixation of the mental life on the pathogenic
traumata is an essential, and practically a most significant
characteristic of the neurosis. I will willingly concede the
objection which you are probably formulating, as you think
over the history of Breuer’s patient. All her traumata
originated at the time when she was caring for her sick
father, and her symptoms could only be regarded as mem-
ory symbols of his sickness and death. They corresponded
to mourning, and a fixation on thoughts of the dead so
short a time after death is certainly not pathological, but
rather corresponds to normal emotional behavior. I con-
cede this: there is nothing abnormal in the fixation of

7 7Or rather the later copy of such a monument. The name
“Charing” is itself, as Dr. E. Jones tells me, derived from the
words “chére reine.”

\ a wu Lit ie

30 AN OUTLINE OF PSYCHOANALYSIS

feeling on the trauma shown by Breuer’s patient. But in
other cases, like that of the tic that I have mentioned, the
occasions for which lay ten and fifteen years back, the
characteristic of this abnormal clinging to the past is very
clear, and Breuer’s patient would probably have developed

it, if she had not come under the “cathartic treatment”
such a short time after the traumatic experiences and the
beginning of the disease.

We have so far only explained the relation of the hys-
terical symptoms to the life history of the patient; now by
considering two further factors which Breuer observed,
we may get a hint as to the processes of the beginning of
the illness and those of the cure. With regard to the first,
it is especially to be noted that Breuer’s patient in almost
all pathogenic situations had to suppress a strong excite-
ment, instead of giving vent to it by appropriate words
and deeds. In the little experience with her governess’
dog, she suppressed, through regard for the conventions,
all manifestations of her very intense disgust. While she
was seated by her father’s sick bed, she was careful to
betray nothing of her anxiety and her painful depression
to the patient. When, iater, she reproduced the same scene
before the physician, the emotion which she had suppressed
on the occurrence of the scene burst out with especial
strength, as though it had been pent up all along. The
symptom which had been caused by that scene reached its
greatest intensity while the doctor was striving to revive
the memory of the scene, and vanished after it had been
fully laid bare. On the other hand, experience shows that
if the patient 1s reproducing the traumatic scene to the
physician, the process has no curative effect if, by some
peculiar chance, there is no development of emotion. It
is apparently these emotional processes upon which the
illness of the patient and the restoration to health are de-
pendent. We feel justified in regarding “emotion” as a
quantity which may become increased, derived and dis-
placed. So we are forced to the conclusion that the patient

ORIGIN AND DEVELOPMENT 31

fell itl because the emotion developed in the pathogenic
situation was prevented from escaping normally, and that
the essence of the sickness lies in the fact that these “im-
prisoned” (eimgeklemmt) emotions undergo a series of
abnormal changes. In part they are preserved as a lasting
charge and as a source of constant disturbance in psychical
life; in part they undergo a change into unusual bodily
innervations and inhibitions, which present themselves as
the physical symptoms of the case. We have coined the
name “hysterical conversion” for the latter process. Part
of our mental energy is, under normal conditions, con-
ducted off by way of physical innervation and gives what
we call “the expression of emotions.” Hysterical conver-
sion exaggerates this part of the course of a mental process
which is emotionally colored; it corresponds to a far more
intense emotional expression, which finds outlet by new
paths. If a stream flows in two channels, an overflow of
one will take place as soon as the current in the other
meets with an obstacle.

You see that we are in a fair way to arrive at a purely
psychological theory of hysteria, in which we assign the
first rank to the affective processes. A second observation
_ of Breuer compels us to ascribe to the altered condition of
consciousness a great part in determining the character-
istics of the disease. His patient showed many sorts of
mental states, conditions of “absence,” confusion and alter-
_ ation of character, besides her normal state. In her nor-
mal state she was entirely ignorant of the pathogenic
scenes and of their connection with her symptoms. She
had forgotten those scenes, or at any rate had dissociated
them from their pathogenic connection. When the patient
was hypnotized, it was possible, after considerabie diffi-
culty, to recall those scenes to her memory, and by this
means of recall the symptoms were removed. It would
have been extremely perplexing to know how to interpret
this fact, if hypnotic practice and experiments had not
pointed out the way. Through the study of hypnotic

=

82 AN OUTLINE OF PSYCHOANALYSIS

phenomena, the conception, strange though it was at fırst,
has become familiar, that in one and the same individual
several mental groupings are possible, which may remain
relatively independent of each other, “know nothing” of
each other, and which may cause a splitting of conscious- -
ness along lines which they lay down. Cases of such 4°
sort, known as “double personality” (“double conscience’), —
occasionally appear spontaneously. If in such a division
of personality consciousness remains constantly bound up
with one of the two states, this is called the conscious
mental state, and the other the unconscious. In the well-
known phenomena of so-called post hypnotic suggestion,
in which a command given in hypnosis is later executed in
the normal state as though by an imperative suggestion,
we have an excellent basis for understanding how the ui-
conscious state can influence the conscious, although the
latter is ignorant of the existence of the former. In the
same way it is quite possible to explain the facts in hys-
terical cases. Breuer ‘came to the conclusion that the
hysterical symptoms originated in such peculiar mental
states, which he called “hypnoidal states” (hypnoide Zus-
tande). Experiences of an emotional nature, which occur
during such hypnoidal states easily become pathogenic,
since such states do not present the conditions for a normal
draining off of the emotion of the exciting processes. And
as a result there arises a peculiar product of this exciting
process, that 1s, the symptom, and this is projected like a
foreign body into the normal state. The latter has, then,
no conception of the significance of the hypnoidal patho-
genic situation. Where a symptom arises, we also find an
amnesia, a memory gap, and the filling of this gap includes
the removal of the conditions under which the symptom
originated.

I am afraid that this portion of my treatment will not
seem very clear, but you must remember that we are deal-
ing here with new and difficult views, which perhaps could
not be made much clearer. This all goes to show that our

ORIGIN AND DEVELOPMENT 33

knowledge in this field is not yet very far advanced.
Breuer’s idea of the hypnoidal states has, moreover, been
shown to be superfluous and a hindrance to further inves-
tigation, and has been dropped from present conceptions
of psychoanalysis. Later I shall at least suggest what
other influences and processes have been disclosed besides
that of the hypnoidal states, to which Breuer limited the
causal moment.

You have probably also felt, and rightly, that Breuer’s
investigations gave you only a very incomplete theory and
insufficient explanation of the phenomena which we have
observed. But complete theories do not fall from Heaven,
and you would have had still greater reason to be dis-
trustful, had any one offered you at the beginning of his
servations a well-rounded theory, without any gaps; such
a theory could only be the child of his speculations and not
the fruit of an unprejudiced investigation of the facts.

Second Lecture

Ladies and Gentlemen: At about the same time that
Breuer was using the “talking-cure” with his patient, M.
Charcot began in Paris, with the hystericals of the Sal-
petriére, those researches which were to lead to a new
understanding of the disease. These results were, how-
ever, not yet known in Vienna. But when about ten years
later Breuer and J published our preliminary communica~
tion on the psychic mechanism of hysterical phenomena,
which grew out of the cathartic treatment of Breuer’s first
_ patient, we were both of us under the spell of Charcot’s
investigations. We made the pathogenic experiences of
our patients, whch acted as psychic traumata, equivalent
to those physical traumata whose influence on hysterical
paralyses Charcot had determined ; and Breuer’s hypothesis
of hypnoidal states is itself only an echo of the fact that
Charcot had artificially reproduced those traumatic paral.
yses in hypnosis. {

The great French observer, whose student I was during