Contributions to the neue freie presse 10 страница

Furthermore, let me say in Hans’s favour (and I frankly admit my partisan attitude) that he is not the only child who has been overtaken by a phobia at some time or other in his childhood. Troubles of that kind are well known to be quite extraordinarily frequent, even in children the strictness of whose upbringing has left nothing to be desired. In later life these children either become neurotic or remain healthy. Their phobias are shouted down in the nursery because they are inaccessible to treatment and are decidedly inconvenient. In the course of months or years they diminish, and the child seems to recover; but no one can tell what psychological changes are necessitated by such a recovery, or what alterations in character are involved in it. When, however, an adult neurotic patient comes to us for psycho-analytic treatment (and let us assume that his illness has only become manifest after he has reached maturity), we find regularly that his neurosis has as its point of departure an infantile anxiety such as we have been discussing, and is in fact a continuation of it; so that, as it were, a continuous and undisturbed thread of psychical activity, taking its start from the conflicts of his childhood, has been spun through his life - irrespective of whether the first symptom of those conflicts has persisted or has retreated under the pressure of circumstances. I think, therefore, that Hans’s illness may perhaps have been no more serious than that of many other children who are not branded as ‘degenerates’; but since he was brought up without being intimidated, and with as much consideration and as little coercion as possible, his anxiety dared to show itself more boldly. With him there was no place for such motives as a bad conscience or a fear of punishment, which with other children must no doubt contribute to making the anxiety less. It seems to me that we concentrate too much upon symptoms and concern ourselves too little with their causes. In bringing up children we aim only at being left in peace and having no difficulties, in short, at training up a model child, and we pay very little attention to whether such a course of development is for the child’s good as well. I can therefore quite imagine that it may have been to Hans’s advantage to have produced this phobia. For it directed his parents’ attention to the unavoidable difficulties by which a child is confronted when in the course of his cultural training he is called upon to overcome the innate instinctual components of his mind; and his trouble brought his father to his assistance. It may be that Hans now enjoys an advantage over other children, in that he no longer carries within him that seed in the shape of repressed complexes which must always be of some significance for a child’s later life, and which undoubtedly brings with it a certain degree of deformity of character if not a predisposition to a subsequent neurosis. I am inclined to think that this is so, but I do not know if many others will share my opinion; nor do I know whether experience will prove me right.

But I must now enquire what harm was done to Hans by dragging to light in him complexes such as are not only repressed by children but dreaded by their parents. Did the little boy proceed to take some serious action as regards what he wanted from his mother? or did his evil intentions against his father give place to evil deeds? Such misgivings will no doubt have occurred to many doctors, who misunderstand the nature of psycho-analysis and think that wicked instincts are strengthened by being made conscious. Wise men like these are being no more than consistent when they implore us for heaven’s sake not to meddle with the evil things that lurk behind a neurosis. In so doing they forget, it is true, that they are physicians, and their words bear a fatal resemblance to Dogberry’s, when he advised the Watch to avoid all contact with any thieves they might happen to meet: ‘for such kind of men, the less you meddle or make with them, why, the more is for your honesty.’¹

On the contrary, the only results of the analysis were that Hans recovered, that he ceased to be afraid of horses, and that he got on to rather familiar terms with his father, as the latter reported with some amusement. But whatever his father may have lost in the boy’s respect he won back in his confidence: ‘I thought’, said Hans, ‘you knew everything, as you knew that about the horse.’ For analysis does not undo the effects of repression. The instincts which were formerly suppressed remain suppressed; but the same effect is produced in a different way. Analysis replaces the process of repression, which is an automatic and excessive one, by a temperate and purposeful control on the part of the highest agencies of the mind. In a word, analysis replaces repression by condemnation. This seems to bring us the long-looked-for evidence that consciousness has a biological function, and that with its entrance upon the scene an important advantage is secured.²

¹ At this point I cannot keep back an astonished question. Where do my opponents obtain their knowledge, which they produce with so much confidence, on the question whether the repressed sexual instincts play a part, and if so what part, in the aetiology of the neuroses, if they shut their patients’ mouths as soon as they begin to talk about their complexes or their derivatives? For the only alternative source of knowledge remaining open to them are my own writings and those of my adherents.

² [Footnote added 1923:] I am here using the word ‘consciousness’ in a sense which I later avoided, namely, to describe our normal processes of thought - such, that is, as are capable of consciousness. We know that thought processes of this kind may also take place preconsciously; and it is wiser to regard their actual ‘consciousness’ from a purely phenomenological standpoint. By this I do not, of course, mean to contradict the expectation that consciousness in this more limited sense of the word must also fulfil some biological function.

If matters had lain entirely in my hands, I should have ventured to give the child the one remaining piece of enlightenment which his parents withheld from him. I should have confirmed his instinctive premonitions, by telling him of the existence of the vagina and of copulation; thus I should have still further diminished his unsolved residue, and put an end to his stream of questions. I am convinced that this new piece of enlightenment would have made him lose neither his love for his mother nor his own childish nature, and that he would have understood that his preoccupation with these important, these momentous things must rest for the present - until his wish to be big had been fulfilled. But the educational experiment was not carried so far.

That no sharp line can be drawn between ‘neurotic’ and ‘normal’ people - whether children or adults - that our conception of ‘disease’ is a purely practical one and a question of summation, that predisposition and the eventualities of life must combine before the threshold of this summation is overstepped, and that consequently a number of individuals are constantly passing from the class of healthy people into that of neurotic patients, while a far smaller number also make the journey in the opposite direction, - all of these are things which have been said so often and have met with so much agreement that I am certainly not alone in maintaining their truth. It is, to say the least of it, extremely probable that a child’s upbringing can exercise a powerful influence for good or for evil upon the predisposition which we have just mentioned as one of the factors in the occurrence of ‘disease’; but what that upbringing is to aim at and at what point it is to be brought to bear seem at present to be very doubtful questions. Hitherto education has only set itself the task of controlling, or, it would often be more proper to say, of suppressing, the instincts. The results have been by no means gratifying, and where the process has succeeded it has only been to the advantage of a small number of favoured individuals who have not been required to suppress their instincts. Nor has any one enquired by what means and at what cost the suppression of the inconvenient instincts has been achieved. Supposing now that we substitute another task for this one, and aim instead at making the individual capable of becoming a civilized and useful member of society with the least possible sacrifice of his own activity; in that case the information gained by psycho-analysis, upon the origin of pathogenic complexes and upon the nucleus of every nervous affection, can claim with justice that it deserves to be regarded by educators as an invaluable guide in their conduct towards children. What practical conclusions may follow from this, and how far experience may justify the application of those conclusions within our present social system, are matters which I leave to the examination and decision of others.

I cannot take leave of our small patient’s phobia without giving expression to a notion which has made its analysis, leading as it did to a recovery, seem of especial value to me. Strictly speaking, I learnt nothing new from this analysis, nothing that I had not already been able to discover (though often less distinctly and more indirectly) from other patients analysed at a more advanced age. But the neuroses of these other patients could in every instance be traced back to the same infantile complexes that were revealed behind Hans’s phobia. I am therefore tempted to claim for this neurosis of childhood the significance of being a type and a model, and to suppose that the multiplicity of the phenomena of repression exhibited by neuroses and the abundance of their pathogenic material do not prevent their being derived from a very limited number of processes concerned with identical ideational complexes.

POSTSCRIPT (1922)

A few months ago - in the spring of 1922 - a young man introduced himself to me and informed me that he was the ‘little Hans’ whose infantile neurosis had been the subject of the paper which I published in 1909. I was very glad to see him again, for about two years after the end of his analysis I had lost sight of him and had heard nothing of him for more than ten years. The publication of this first analysis of a child had caused a great stir and even greater indignation, and a most evil future had been foretold for the poor little boy, because he had been ‘robbed of his innocence’ at such a tender age and had been made the victim of a psycho-analysis.

But none of these apprehensions had come true. Little Hans was now a strapping youth of nineteen. He declared that he was perfectly well, and suffered from no troubles or inhibitions. Not only had he come through his puberty without any damage, but his emotional life had successfully undergone one of the severest of ordeals. His parents had been divorced and each of them had married again. In consequence of this he lived by himself; but he was on good terms with both of his parents, and only regretted that as a result of the breaking-up of the family he had been separated from the younger sister he was so fond of.

One piece of information given me by little Hans struck me as particularly remarkable; nor do I venture to give any explanation of it. When he read his case history, he told me, the whole of it came to him as something unknown; he did not recognize himself; he could remember nothing; and it was only when he came upon the journey to Gmunden that there dawned on him a kind of glimmering recollection that it might have been he himself that it happened to. So the analysis had not preserved the events from amnesia, but had been overtaken by amnesia itself. Any one who is familiar with psycho-analysis may occasionally experience something similar in sleep. He will be woken up by a dream, and will decide to analyse it then and there; he will then go to sleep again feeling quite satisfied with the result of his efforts; and next morning dream and analysis will alike be forgotten.

NOTES UPON A CASE OF OBSESSIONAL NEUROSIS (1909)

The matter contained in the following pages will be of two kinds. In the first place I shall give some fragmentary extracts from the history of a case of obsessional neurosis. This case judged by its length, the injuriousness of its effects, and the patient’s own view of it, deserves to be classed as a moderately severe one; the treatment, which lasted for about a year, led to the complete restoration of the patient’s personality, and to the removal of his inhibitions. In the second place, starting out from this case, and also taking other cases into account which I have previously analysed, I shall make some disconnected statements of an aphoristic character upon the genesis and finer psychological mechanism of obsessional processes, and I shall thus hope to develop my first observations on the subject, published in 1896.¹

A programme of this kind seems to me to require some justification. For it might otherwise be thought that I regard this method of making a communication as perfectly correct and as one to be imitated; whereas in reality I am only accommodating myself to obstacles, some external and others inherent in the subject, and I should gladly have communicated more if it had been right or possible for me to do so. I cannot give a complete history of the treatment, because that would involve my entering in detail into the circumstances of my patient’s life. The importunate interest of a capital city, focused with particular attention upon my medical activities, forbids my giving a faithful picture of the case. On the other hand I have come more and more to regard the distortions usually resorted to in such circumstances as useless and objectionable. If the distortions are slight, they fail in their object of protecting the patient from indiscreet curiosity; while if they go beyond this they require too great a sacrifice, for they destroy the intelligibility of the material, which depends for its coherence precisely upon the small details of real life. And from this latter circumstance follows the paradoxical truth that it is far easier to divulge the patient’s most intimate secrets than the most innocent and trivial facts about him; for, whereas the former would not throw any light on his identity, the latter, by which he is generally recognized, would make it obvious to every one.

¹ ‘Further Remarks on the Neuro-Psychoses of Defence’, 1896b (Section II. ‘The Nature and Mechanism of Obsessional Neurosis’).8

Such is my excuse for having curtailed so drastically the history of this case and its treatment. And I can offer still more cogent reasons for having confined myself to the statement only of some disconnected results of the psycho-analytic investigation of obsessional neuroses. I must confess that I have not yet succeeded in completely penetrating the complicated texture of a severe case of obsessional neurosis, and that, if I were to reproduce the analysis, it would be impossible for me to make the structure, such as by the help of analysis we know or suspect it to be, visible to others through the mass of therapeutic work superimposed upon it. What add so greatly to the difficulty of doing this are the resistances of the patients and the forms in which they are expressed. But even apart from this it must be admitted that an obsessional neurosis is in itself not an easy thing to understand - much less so than a case of hysteria. Actually, indeed, we should have expected to find the contrary. The language of an obsessional neurosis - the means by which it expresses its secret thoughts - is, as it were, only a dialect of the language of hysteria; but it is a dialect in which we ought to be able to find our way about more easily, since it is more nearly related to the forms of expression adopted by our conscious thought than is the language of hysteria. Above all, it does not involve the leap from a mental process to a somatic innervation - hysterical conversion - which can never be fully comprehensible to us.

Perhaps it is only because we are less familiar with obsessional neuroses that we do not find these expectations confirmed by the facts. Persons suffering from a severe degree of obsessional neurosis present themselves far less frequently for analytic treatment than hysterical patients. They dissimulate their condition in daily life, too, as long as they possibly can, and often call in a physician only when their complaint has reached such an advanced stage as, had they been suffering, for instance, from tuberculosis of the lungs, would have led to their being refused admission to a sanatorium. I make this comparison, moreover, because, as with the chronic infectious disease which I have just mentioned, we can point to a number of brilliant therapeutic successes in severe no less than in light cases of obsessional neurosis, where these have been taken in hand at an early stage.

In these circumstances there is no alternative but to report the facts in the imperfect and incomplete fashion in which they are known and in which it is legitimate to communicate them. The crumbs of knowledge offered in these pages, though they have been laboriously enough collected, may not in themselves prove very satisfying; but they may serve as a starting-point for the work of other investigators, and common endeavour may bring the success which is perhaps beyond the reach of individual effort.

I EXTRACTS FROM THE CASE HISTORY

A youngish man of university education introduced himself to me with the statement that he had suffered from obsessions ever since his childhood, but with particular intensity for the last four years. The chief features of his disorder were fears that something might happen to two people of whom he was very fond - his father and a lady whom he admired. Besides this he was aware of compulsive impulses - such as an impulse, for instance, to cut his throat with a razor; and further he produced prohibitions, sometimes in connection with quite unimportant things. He had wasted years, he told me, in fighting against these ideas of his, and in this way had lost much ground in the course of his life. He had tried various treatments, but none had been of any use to him except a course of hydrotherapy at a sanatorium near ---; and this, he thought, had probably only been because he had made an acquaintance there which had led to regular sexual intercourse. Here he had no opportunities of the sort, and he seldom had intercourse and only at irregular intervals. He felt disgust at prostitutes. Altogether, he said, his sexual life had been stunted; masturbation had played only a small part in it, in his sixteenth or seventeenth year. His potency was normal; he had first had intercourse at the age of twenty-six.

He gave me the impression of being a clear-headed and shrewd person. When I asked him what it was that made him lay such stress upon telling me about his sexual life, he replied that that was what he knew about my theories. Actually, however, he had read none of my writings, except that a short time before he had been turning over the pages of one of my books¹ and had come across the explanation of some curious verbal associations which had so much reminded him of some of his own ‘efforts of thought’ in connection with his ideas that he had decided to put himself in my hands.

¹ The Psychopathology of Everyday Life.0

(A) THE BEGINNING OF THE TREATMENT

The next day I made him pledge himself to submit to the one and only condition of the treatment - namely, to say everything that came into his head, even if it was unpleasant to him, or seemed unimportant or irrelevant or senseless. I then gave him leave to start his communications with any subject he pleased, and he began thus:¹

He had a friend, he told me, of whom he had an extraordinarily high opinion. He used always to go to him when he was tormented by some criminal impulse, and ask him whether he despised him as a criminal. His friend used then to give him moral support by assuring him that he was a man of irreproachable conduct, and had probably been in the habit, from his youth onwards, of taking a dark view of his own life. At an earlier date, he went on, another person had exercised a similar influence over him. This was a nineteen-year-old student (he himself had been fourteen or fifteen at the time) who had taken a liking to him, and had raised his self-esteem to an extraordinary degree, so that he appeared to himself to be a genius. This student had subsequently become his tutor, and had suddenly altered his behaviour and begun treating him as though he were an idiot. At length he had noticed that the student was interested in one of his sisters, and had realized that he had only taken him up in order to gain admission into the house. This had been the first great blow of his life.

He then proceeded without any apparent transition:-

¹ What follows is based upon notes made on the evening of the day of treatment, and adheres as closely as possible to my recollection of the patient’s words. - I feel obliged to offer a warning against the practice of noting down what the patient says during the actual time of treatment. The consequent withdrawal of the physician’s attention does the patient more harm than can be made up for by any increase in accuracy that may be achieved in the reproduction of his case history.

(B) INFANTILE SEXUALITY

‘My sexual life began very early. I can remember a scene during my fourth or fifth year. (From my sixth year onwards I can remember everything.) This scene came into my head quite distinctly, years later. We had a very pretty young governess called Fräulein Peter.¹ One evening she was lying on the sofa lightly dressed, and reading. I was lying beside her, and begged her to let me creep under her skirt. She told me I might, so long as I said nothing to any one about it. She had very little on, and I fingered her genitals and the lower part of her body, which struck me as very queer. After this I was left with a burning and tormenting curiosity to see the female body. I can still remember the intense excitement with which I waited at the Baths (which I was still allowed to go to with the governess and my sisters) for the governess to undress and get into the water. I can remember more things from my sixth year onwards. At that time we had another governess, who was also young and good-looking. She had abscesses on her buttocks which she was in the habit of pressing out at night. I used to wait eagerly for that moment, to appease my curiosity. It was just the same at the Baths - though Fräulein Lina was more reserved than her predecessor.’ (In reply to a question which I threw in, ‘As a rule,’ the patient told me, ‘I did not sleep in her room, but mostly with my parents.’) ‘I remember a scene which must have taken place when I was seven years old.² We were sitting together one evening - the governess, the cook, another servant-girl, myself and my brother, who was eighteen months younger than me. The young women were talking, and I suddenly became aware of Fräulein Lina saying: "It could be done with the little one; but Paul" (that was I) "is too clumsy, he would be sure to miss it." I did not understand clearly what was meant, but I felt the slight and began to cry. Lina comforted me, and told me how a girl, who had done something of the kind with a little boy she was in charge of, had been put in prison for several months. I do not believe she actually did anything wrong with me, but I took a great many liberties with her. When I got into her bed I used to uncover her and touch her, and she made no objections. She was not very intelligent, and clearly had very strong sexual cravings. At twenty-three she had already had a child. She afterwards married its father, so that to-day she is a Frau Hofrat. Even now I often see her in the street.

¹ Dr. Alfred Adler, who was formerly an analyst, once drew attention in a privately delivered paper to the peculiar importance which attaches to the very first communications made by patients. Here is an instance of this. The patient’s opening words laid stress upon the influence exercised over him by men, that is to say, upon the part played in his life by homosexual object-choice; but immediately afterwards they touched upon a second motif, which was to become of great importance later on, namely, the conflict between man and woman and the opposition of their interests. Even the fact that he remembered his first pretty governess by her surname, which happened to be a man’s first name, must be taken into account in this connection. In middle-class circles in Vienna it is more usual to call a governess by her first name, and it is by that name that she is more commonly remembered.

² The patient subsequently admitted that this scene probably occurred one or two years later.2

‘When I was six years old I already suffered from erections, and I know that once I went to my mother to complain about them. I know too that in doing so I had some misgivings to get over, for I had a feeling that there was some connection between this subject and my ideas and inquisitiveness, and at that time I used to have a morbid idea that my parents knew my thoughts; I explained this to myself by supposing that I had spoken them out loud, without having heard myself do it. I look on this as the beginning of my illness. There were certain people, girls, who pleased me very much, and I had a very strong wish to see them naked. But in wishing this I had an uncanny feeling, as though something must happen if I thought such things, and as though I must do all sorts of things to prevent it.’

(In reply to a question he gave an example of these fears: ‘For instance, that my father might die.’) ‘Thoughts about my father’s death occupied my mind from a very early age and for a long period of time, and greatly depressed me.’

At this point I learnt with astonishment that the patient’s father, with whom his obsessional fears were, after all, occupied now, had died several years previously.3 The events in his sixth or seventh year which the patient described in the first hour of his treatment were not merely, as he supposed, the beginning of his illness, but were already the illness itself. It was a complete obsessional neurosis, wanting in no essential element, at once the nucleus and the prototype of the later disorder, - an elementary organism, as it were, the study of which could alone enable us to obtain a grasp of the complicated organization of his subsequent illness. The child, as we have seen, was under the domination of a component of the sexual instinct, the desire to look, as a result of which there was a constant recurrence in him of a very intense wish connected with persons of the female sex who pleased him - the wish, that is, to see them naked. This wish corresponds to the later obsessional or compulsive idea; and if the quality of compulsion was not yet present in the wish, this was because the ego had not yet placed itself in complete opposition to it and did not yet regard it as something foreign to itself. Nevertheless, opposition to this wish from some source or other was already in activity, for its occurrence was regularly accompanied by a distressing affect.¹ A conflict was evidently in progress in the mind of this young libertine. Side by side with the obsessive wish, and intimately associated with it, was an obsessive fear: every time he had a wish of this kind he could not help fearing that something dreadful would happen. This something dreadful was already clothed in a characteristic indeterminateness which was thenceforward to be an invariable feature of every manifestation of the neurosis. But in a child it is not hard to discover what it is that is veiled behind an indeterminateness of this kind. If the patient can once be induced to give a particular instance in place of the vague generalities which characterize an obsessional neurosis, it may be confidently assumed that the instance is the original and actual thing which has tried to hide itself behind the generalization. Our present patient’s obsessive fear, therefore, when restored to its original meaning, would run as follows: ‘If I have this wish to see a woman naked, my father will be bound to die.’ The distressing affect was distinctly coloured with a tinge of uncanniness and superstition, and was already beginning to give rise to impulses to do something to ward off the impending evil. These impulses were subsequently to develop into the protective measures which the patient adopted.

¹ Yet attempts have been made to explain obsessions without taking the affects into account!4

We find, accordingly: an erotic instinct and a revolt against it; a wish which has not yet become compulsive and, struggling against it, a fear which is already compulsive; a distressing affect and an impulsion towards the performance of defensive acts. The inventory of the neurosis has reached its full muster. Indeed, something more is present, namely, a kind of delusion or delirium with the strange content that his parents knew his thoughts because he spoke them out loud without his hearing himself do it. We shall not go far astray if we suppose that in making this attempt at an explanation the child had some inkling of those remarkable mental processes which we describe as unconscious and which we cannot dispense with if we are to throw any scientific light upon this obscure subject. ‘I speak my thoughts out loud, without hearing them’ sounds like a projection into the external world of our own hypothesis that he had thoughts without knowing anything about them; it sounds like an endopsychic perception of what has been repressed.

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