Further remarks on the neuro-psychoses of defence 8 страница

That the method is confined within these limits is to a large extent explained by the circumstances in which I had to work it out. My material does in fact consist of chronic nervous cases derived from the more educated classes. I think it very probable that supplementary methods may be devised for treating children and the public who go for assistance to hospitals. I ought also to say that up to the present I have tried my treatment exclusively on severe cases of hysteria and obsessional neurosis; I cannot tell how it would turn out with those mild cases which, to all appearance at least, are cured by some unspecific kind of treatment lasting for a few months. It will readily be understood that a new therapy which calls for many sacrifices can only reckon on obtaining patients who have already tried the generally accepted methods without success, or whose condition has justified the inference that they could expect nothing from these supposedly more convenient and shorter therapeutic procedures. Thus it happened that I was obliged to tackle the hardest tasks straightaway with an imperfect instrument. The test has proved all the more convincing.

The main difficulties which still stand in the way of the psycho-analytic method of cure. It is no more than a necessary corollary to this complete ignorance that doctors consider themselves justified in using the most unfounded assurances for the consolation of their patients or in order to induce them to adopt therapeutic measures. ‘Come to my sanatorium for six weeks’, they will say, ‘and you will get rid of your symptoms’ (travel anxiety, obsessions, and so on).Sanatoria are, it is true, indispensable for calming acute attacks that may arise in the course of a psychoneurosis by diverting the patient’s attention, nursing him and taking care of him. But towards removing chronic conditions they achieve precisely nothing: and the superior sanatoria, which are supposed to be conducted on scientific lines, do no more than the ordinary hydropathic establishments.

It would be more dignified as well as more helpful to the patient - who, after all, has to come to terms with his ailments - for the doctor to tell the truth, as he knows it from his daily practice. The psychoneuroses as a genus are by no means mild illnesses. When hysteria sets in, no one can foretell when it will come to an end. We mostly comfort ourselves with the vain prophecy that ‘one day it will suddenly disappear’. Recovery often enough turns out to be merely an agreement to mutual toleration between the sick part of the patient and the healthy part; or it is the result of the transformation of a symptom into a phobia. A girl’s hysteria, calmed down with difficulty, revives in her as a wife after the short interruption of young married happiness. The only difference is that another person, the husband, is now driven by his own interests to keep silence about her condition. Even if an illness of this kind leads to no manifest incapacity on the patients’ part to carry on their life, it nearly always prevents free unfolding of their mental powers. Obsessions recur throughout their lives; and phobias and other restrictions upon the will have hitherto been unamenable to treatment of any kind. All this is kept from the knowledge of the layman. The father of a hysterical girl is consequently horrified if, for instance, he is asked to agree to her being given a year’s treatment, when she has perhaps only been ill for a few months. The layman is, as it were, deeply convinced in himself that all these psychoneuroses are unnecessary; so he has no patience with the processes of the illness and no readiness to make sacrifices for its treatment. If, in face of a case of typhus which lasts three weeks, or of a broken leg which takes six months to mend, he adopts a more understanding attitude, and if, as soon as his child shows the first signs of a curvature of the spine, he finds it reasonable that orthopaedic treatment should be carried on over several years, the difference in his behaviour is due to the better knowledge on the part of the physicians who pass on their knowledge honestly to the layman. Honesty on the part of the physician and willing acquiescence on the part of the layman will be established for the neuroses too, as soon as an insight into the nature of those affections becomes common property in the medical world. Radical treatment of these disorders will no doubt always require special training and will be incompatible with other kinds of medical activity. On the other hand, this class of physicians, which will, I believe, be a large one in the future, has the prospect of achieving noteworthy results and of obtaining a satisfying insight into the mental life of mankind.

THE PSYCHICAL MECHANISM OF FORGETFULNESS (1898)

The phenomenon of forgetfulness, which I should like to describe and then go on to explain in this paper, has doubtless been experienced by everyone in himself or been observed by him in others. It affects in particular the use of proper names - nomen propria - and it manifests itself in the following manner. In the middle of carrying on a conversation we find ourselves obliged to confess to the person we are talking to that we cannot hit on a name we wanted to mention at that moment, and we are forced to ask for his - usually ineffectual - help. ‘What is his name? I know it so well. It’s on the tip of my tongue. Just this minute it’s escaped me.’ An unmistakable feeling of irritation, similar to that which accompanies motor aphasia, now attends our further efforts to find the name, which we feel we had in our head only a moment before. In appropriate instances two accompanying features deserve our notice. First, an energetic deliberate concentration of the function which we call attention proves powerless, however long it is continued, to find the lost name. Secondly, in place of the name we are looking for, another name promptly appears, which we recognize as incorrect and reject, but which persists in coming back. Or else, instead of a substituted name, we find in our memory a single letter or syllable, which we. We say, for instance: ‘It begins with a "B".’ If we finally succeed, in one way or another, in discovering what the name is, we find in the great majority of cases that it does not begin with a ‘B’ and does not in fact contain the letter ‘B’ at all.

The best procedure for getting hold of the missing name is, as is generally known, ‘not to think of it’ - that is, to divert from the task that part of the attention over which one has voluntary control. After a while, the missing name ‘shoots’ into one’s mind; one cannot prevent oneself from calling it out aloud - to the great astonishment of one’s companion, who has already forgotten the episode and who has in any case only taken very little interest in the speaker’s efforts. ‘Really,’ he is apt to say, ‘it makes no difference what the man is called; only go on with your story.’ The whole of the time until the matter is cleared up, and even after the intentional diversion, one feels preoccupied to a degree which cannot in fact be explained by the amount of interest possessed by the whole affair.¹

In a few cases which I have myself experienced of forgetting names in this way, I have succeeded, by means of psychical analysis, in accounting to myself for the chain of events; and I shall now describe in detail the simplest and clearest case of this kind.

During my summer holidays I once went for a carriage drive from the lovely city of Ragusa to a town nearby in Herzegovina. Conversation with my companion centred, as was natural, round the condition of the two countries (Bosnia and Herzegovina) and the character of their inhabitants. I talked about the various peculiarities of the Turks living there, as I had heard them described years before by a friend and colleague who had lived among them as a doctor for many years. A little later, our conversation turned to the subject of Italy and of pictures, and I had occasion to recommend my companion strongly to visit Orvieto some time, in order to see the frescoes there of the end of the world and the Last Judgement, with which one of the chapels in the cathedral had been decorated by a great artist. But the artist’s name escaped me and I could not recall it. I exerted my powers of recollection, made all the details of the day I spent in Orvieto pass before my memory and convinced myself that not the smallest part of it had been obliterated or become indistinct. On the contrary, I was able to conjure up the pictures with greater sensory vividness than is usual with me. I saw before my eyes with especial sharpness the artist’s self-portrait - with a serious face and folded hands - which he has put in a corner of one of the pictures, next to the portrait of his predecessor in the work, Fra Angelico da Fiesole; but the artist’s name, ordinarily so familiar to me, remained obstinately in hiding, nor could my travelling companion help me out. My continued efforts met with no success beyond bringing up the names of two other artists, who I knew could not be the right ones. These were Botticelli and, in the second place, Boltraffio.² The repetition of the sound ‘Bo’ in the two substitutive names might perhaps have led a novice to suppose that it belonged to the missing name as well, but I took good care to steer clear of that expectation.

¹ Nor by any feeling of unpleasure one may have at being inhibited in a psychical act.

² The first of these names was very familiar to me; the second, on the other hand, I hardly knew.

Since I had no access to any reference books on my journey, I had for several days to put up with this lapse of memory and with the inner torment associated with it which recurred at frequent intervals each day, until I fell in with a cultivated Italian who freed me from it by telling me the name: Signorelli. I was myself able to add the artist’s first name, Luca. Soon my ultra-clear memory of the master’s features, as depicted in his portrait, faded away.

What influences had led me to forget the name Signorelli which was so familiar to me and which is so easily impressed on the memory? And what paths had led to its replacement by the names Botticelli and Boltraffio? A short excursion back into the circumstances in which the forgetting had taken place sufficed to throw a light on both questions.

Shortly before I had come to the subject of the frescoes in the cathedral at Orvieto, I had been telling my travelling-companion something I had heard from my colleague years ago about the Turks in Bosnia. They treat doctors with special respect and they show, in marked contrast to our own people, an attitude of resignation towards the dispensations of fate. If the doctor has to inform the father of a family that one of his relatives is about to die, his reply is: ‘Herr, what is there to be said? If he could be saved, I know you would help him.’ Another recollection lay in my memory close to this story. The same colleague had told me what overriding importance these Bosnians attached to sexual enjoyments. One of his patients said to him once: ‘Herr, you must know, that if that comes to an end then life is of no value.’ At the time, it seemed to the doctor and me that the two character-traits of the Bosnian people illustrated by this could be assumed to be intimately connected with each other. But when I remembered these stories on my drive into Herzegovina, I suppressed the second one, in which the subject of sexuality was touched on. It was soon after this that the name Signorelli escaped me and that the names Botticelli and Boltraffio appeared as substitutes.

The influence which had made the name Signorelli inaccessible to memory, or, as I am accustomed to say, had ‘repressed’ it, could only proceed from the story I had suppressed about the value set on death and sexual enjoyment. If that was so, we ought to be able to discover the intermediate ideas which had served to connect the two themes. The affinity between their content - in the one case, the Last Judgement, ‘Doomsday’, and in the other, death and sexuality- seems to be very slight; and since the matter concerned the repression from memory of a name, it was on the face of it probable that the connection was between one name and another. Now, ‘Signor’ means ‘Herr, and the ‘Herr’ is also present in the name ‘Herzegovina’. Moreover it was certainly not without relevance that both the patients’ remarks which I was to recall contained a ‘Herr’ as a form of address to the doctor. The translation of ‘Signor’ into ‘Herr’ was therefore the means by which the story that I had suppressed had drawn after it into repression the name I was looking for. The whole process was clearly made easier by the fact that during the last few days in Ragusa I had been speaking Italian continually - that is, that I had become accustomed to translating German into Italian in my head.¹

When I tried to recover the name of the artist, to bring it back out of repression, the influence of the tie which the name had entered into in the meantime inevitably made itself felt. I did find an artist’s name, but not the right one. It was a displaced name, and the line of displacement was laid down by the names that were contained in the repressed topic. ‘Botticelli’ contains the same final syllables as ‘Signorelli’; the final syllables - which, unlike the first part of the word, ‘Signor’, could not make a direct connection with the name ‘Herzegovina’ - had therefore returned; but the influence of the name ‘Bosnia’, which is regularly associated with the name ‘Herzegovina’, had shown itself by directing the substitution to two artists’ names which began with the same syllable ‘Bo’: ‘Botticelli’ and then ‘Boltraffio’. The finding of the name ‘Signorelli’ is thus seen to have been interfered with by the topic which lay behind it, in which the names ‘Bosnia’ and ‘Herzegovina’ appear.

¹ ‘A far-fetched, forced explanation’, it will be said. This impression to establish a connection with what is not suppressed; and for this purpose it does not scorn even the path of external association. There is the same ‘forced’ situation when rhymes have to be made.

For this topic to have been able to produce such effects it is not enough that I should have suppressed it once in conversation - an event brought about by chance motives. We must assume rather that the topic itself was also intimately bound up with trains of thought which were in a state of repression in me - that is, with trains of thought which, in spite of the intensity of the interest taken in them, were meeting with a resistance that was keeping them from being worked over by a particular psychical agency and thus from becoming conscious. That this was really true at that time of the topic of ‘death and sexuality’ I have plenty of evidence, which I need not bring up here, derived from my own self-investigation. But I may draw attention to one consequence of these repressed thoughts. Experience has taught me to require that every psychical product shall be fully elucidated and even overdetermined. Accordingly, it seemed to me that the second substitutive name, ‘Boltraffio’, called for a further determination; for so far only its initial letters had been accounted for, by their assonance with ‘Bosnia’. I now recollected that these repressed thoughts had never engrossed me more than they had a few weeks before after I had received a certain piece of news. The place where the news reached me was called ‘Trafoi’ and this name is too much like the second half of the name ‘Boltraffio’ not to have had a determining effect on my choice of the latter. In the following small schematic diagram, I have attempted to reproduce the relations which have now been brought to light.Fig. 1

It is perhaps not without interest for its own sake to be able to see into the history of a psychical event of this kind, which is among the most trivial disturbances that can affect the control of the psychical apparatus and which is compatible with an otherwise untroubled state of psychical health. But the example elucidated here receives an immensely added interest when we learn that it may serve as nothing more nor less than a model for the pathological processes to which the psychical symptoms of the psychoneuroses - hysteria, obsessions and paranoia - owe their origin. In both cases we find the same elements and the same play of forces between those elements. In the same manner as here and by means of similar superficial associations, a repressed train of thought takes possession in neuroses of an innocent recent impression and draws it down with itself into repression. The same mechanism which causes the substitute names ‘Botticelli’ and ‘Boltraffio’ to emerge from ‘Signorelli’ (a substitution by means of intermediate or compromise ideas) also governs the formation of obsessional thoughts and paranoic paramnesias. Again, we have seen that such cases of forgetfulness have the characteristic of liberating continuous unpleasure till the moment the problem is solved - a characteristic which is unintelligible apart from this, and something which was in fact unintelligible to the person I was talking to; but there is a complete analogy to it in the way in which collections of repressed thoughts attach their capacity for producing affect to some symptom whose psychical content seems to our judgement totally unsuited to such a liberation of affect. Finally, the resolution of the whole tension by a communication of the correct name from an external quarter is itself a good example of the efficacy of psycho-analytic therapy, which aims at correcting the repressions and displacements and which removes the symptoms by re-instating the genuine psychical object.

Among the various factors, therefore, which contribute to a failure in recollection or a loss of memory, the part played by repression must not be overlooked; and it can be demonstrated not only in neurotics but (in a manner that is qualitatively the same) in normal people as well. It may be asserted quite generally that the ease (and ultimately the faithfulness, too) with which a given impression is awakened in the memory depends not only on the psychical constitution of the individual, the strength of the impression when it was fresh, the interest directed towards it at the time, the psychical constellation at the present time, the interest that is now devoted to its awakening, the connections into which the impression has been drawn, and so on - not only on such things but also on the favourable or unfavourable attitude of a particular psychical factor which refuses to reproduce anything that might liberate unpleasure, or that might subsequently lead to the liberation of unpleasure. Thus the function of memory, which we like to regard as an archive open to anyone who is curious, is in this way subjected to restriction by a trend of the will, just as is any part of our activity directed to the external world. Half the secret of hysterical amnesia is uncovered when we say that hysterical people do not know what they do not want to know; and psycho-analytic treatment, which endeavours to fill up such gaps of memory in the course of its work, leads us to the discovery that the bringing back of those lost memories is opposed by a certain resistance which has to be counterbalanced by work proportionate to its magnitude. In the case of psychical processes which are on the whole normal, it cannot, of course, be claimed that the influence of this one-sided factor in the revival of memories in any way regularly overcomes all the other factors that must be taken into account.¹

¹ It would be a mistake to believe that the mechanism which I have brought to light in these pages only operates in rare cases. It is, on the contrary, a very common one. On one occasion, for instance, when I was meaning to describe the same small incident to a colleague of mine, the name of my authority for the stories about Bosnia suddenly escaped me. The reason for this was as follows. Just before, I had been playing cards. My authority was called Pick. Now ‘Pick’ and ‘Herz’ are two of the four suits in the pack. Moreover the two words were connected by an anecdote in which this same person pointed to himself and said: ‘I’m not called "Herz", but "Pick".’ ‘Herz’ appears in the name ‘Herzegovina’ and the heart itself, as a sick bodily organ, played a part in the thoughts I have described as having been repressed.

In connection with the tendentious nature of our remembering and forgetting, I not long ago experienced an instructive example - instructive because of what it betrayed - of which I should like to add an account here. I was intending to pay a twenty-four-hour visit to a friend of mine who unfortunately lives very far away, and I was full of the things I was going to tell him. But before this I felt under an obligation to call on a family of my acquaintance in Vienna, one of whose members had moved to the town in question, so as to take their greetings and messages with me to the absent relative. They told me the name of the pension in which he lived, and also the name of the street and the number of the house, and, in view of my bad memory, wrote the address on a card, which I put in my wallet. The next day, when I had arrived at my friend’s, I began: ‘I’ve only one duty to carry out that may interfere with our being together; it’s a call, and it shall be the first thing I do. The address is in my wallet.’ To my astonishment, however, it was not to be found there. So now I had to fall back on my memory, after all. My memory for names is not particularly good, but it is incomparably better than for figures and numbers. I may have been paying medical visits at a certain house for a year on end, and yet, if I should have to be driven there by a cab driver, I should have difficulty in remembering the number of the house. But in this case I had taken special note of the house number; it was ultra-clear, as if to jeer at me - for no trace remained in my recollection of the name of the pension or the street. I had forgotten all the data in the address which might have served as a starting - point for discovering the pension; and, quite against my usual habit, I had retained the number of the house, which was useless for the purpose. In consequence, I was unable to make the call. I was consoled remarkably quickly, and I devoted myself entirely to my friend. When I was back again in Vienna and standing in front of my writing desk, I knew without a moment’s hesitation where it was that, in my ‘absent-mindedness’, I had put the card with the address on it. In my unconscious hiding of the thing the same intention had been operative as in my curiously modified act of forgetting.

SCREEN MEMORIES (1899)

In the course of my psycho-analytic treatment of cases of hysteria, obsessional neurosis, etc., I have often had to deal with fragmentary recollections which have remained in the patient’s memory from the earliest years of his childhood. As I have shown elsewhere, great pathogenic importance must be attributed to the impressions of that time of life. But the subject of childhood memories is in any case bound to be of psychological interest, for they bring into striking relief a fundamental difference between the psychical functioning of children and of adults. No one calls in question the fact that the experiences of the earliest years of our childhood leave ineradicable traces in the depths of our minds. If, however, we seek in our memories to ascertain what were the impressions that were destined to influence us to the end of our lives, the outcome is either nothing at all or a relatively small number of isolated recollections which are often of dubious or enigmatic importance. It is only from the sixth or seventh year onwards - in many cases only after the tenth year - that our lives can be reproduced in memory as a connected chain of events. From that time on, however, there is also a direct relation between the psychical significance of an experience and its retention in the memory. Whatever seems important on account of its immediate or directly subsequent effects is recollected; whatever is judged to be inessential is forgotten. If I can remember an event a long time after its occurrence, I regard the fact of having retained it in my memory as evidence of its having made a deep impression on me at the time. I feel surprised at forgetting; and I feel even more surprised, perhaps, at remembering something apparently indifferent.

It is only in certain pathological mental conditions that the relation holding in normal adults between the psychical significance of an event and its retention in memory once more ceases to apply. For instance, a hysteric habitually shows amnesia for some or all of the experiences which led to the onset of his illness and which from that very fact have become important to him and, apart from that fact, may have been important on their own account. The analogy between pathological amnesia of this kind and the normal amnesia affecting our early years seems to me to give a valuable hint at the intimate connection that exists between the psychical content of neuroses and our infantile life.

We are so much accustomed to this lack of memory of the impressions of childhood that we are apt to overlook the problem underlying it and are inclined to explain it as a self-evident consequence of the rudimentary character of the mental activities of children. Actually, however, a normally developed child of three or four already exhibits an enormous amount of highly organized mental functioning in the comparisons and inferences which he makes and in the expression of his feelings; and there is no obvious reason why amnesia should overtake these psychical acts, which carry no less weight than those of a later age.

Before dealing with the psychological problems attaching to the earliest memories of childhood, it would of course be essential to make a collection of material by circularizing a fairly large number of normal adults and discovering what kind of recollections they are able to produce from these early years. A first step in this direction was taken in 1895 by V. and C. Henri, who sent round a paper of questions drawn up by them. The highly suggestive results of their questionnaire, which brought in replies from 123 persons, were published by the two authors in 1897. I have no intention at present of discussing the subject as a whole, and I shall therefore content myself with emphasizing the few points which will enable me to introduce the notion of what I have termed ‘screen memories’.

The age to which the content of the earliest memories of childhood is usually referred back is the period between the ages of two and four. (This is the case with 88 persons in the series observed by the Henris.) There are some, however, whose memory reaches back further - even to the time before the completion of their first year; and, on the other hand, there are some whose earliest recollections go back only to their sixth, seventh, or even eighth year. There is nothing at the moment to show what else is related to these individual differences; is to be noticed, say the Henris, that a person whose earliest recollection goes back to a very tender age - to the first year of his life, perhaps - will also have at his disposal further detached memories from the following years, and that he will be able to reproduce his experiences as a continuous chain from an earlier point of time - from about his fifth year - than is possible for other people, whose first recollection dates from a later time. Thus not only the date of the appearance of the first recollection but the whole function of memory may, in the case of some people, be advanced or retarded.

Quite special interest attaches to the question of what is the usual content of these earliest memories of childhood. The psychology of adults would necessarily lead us to expect that those experiences would be selected as worth remembering which had aroused some powerful emotion or which, owing to their consequences, had been recognized as important soon after their occurrence. And some indeed of the observations collected by the Henris appear to fulfil this expectation. They report that the most frequent content of the first memories of childhood are on the one hand occasions of fear, shame, physical pain, etc., and on the other hand important events such as illnesses, deaths, fires, births of brothers and sisters, etc. We might therefore be inclined to assume that the principle governing the choice of memories is the same in the case of children as in that of adults. It is intelligible - though the fact deserves to be explicitly mentioned - that the memories retained from childhood should necessarily show evidence of the difference between what attracts the interest of a child and of an adult. This easily explains why, for instance, one woman reports that she remembers a number of accidents that occurred to her dolls when she was two years old but has no recollection of the serious and tragic events she might have observed at the same period.

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