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CONTRIBUTIONS TO A DISCUSSION ON SUICIDE

I. INTRODUCTORY REMARKS

Gentlemen, - You have all listened with much satisfaction to the plea put forward by an educationalist who will not allow an unjustified charge to be levelled against the institution that is so dear to him. But I know that in any case you were not inclined to give easy credence to the accusation that schools drive their pupils to suicide. Do not let us be carried too far, however, by our sympathy with the party which has been unjustly treated in this instance. Not all the arguments put forward by the opener of the discussion seem to me to hold water. If it is the case that youthful suicide occurs not only among pupils in secondary schools but also among apprentices and others, this fact does not acquit the secondary schools; it must perhaps be interpreted as meaning that as regards its pupils the secondary school takes the place of the traumas with which other adolescents meet in other walks of life. But a secondary school should achieve more than not driving its pupils to suicide. It should give them a desire to live and should offer them support and backing at a time of life at which the conditions of their development compel them to relax their ties with their parental home and their family. It seems to me indisputable that schools fail in this, and in many respects fall short of their duty of providing a substitute for the family and of arousing interest in life in the world outside. This is not a suitable occasion for a criticism of secondary schools in their present shape; but perhaps I may emphasize a single point. The school must never forget that it has to deal with immature individuals who cannot be denied a right to linger at certain stages of development and even at certain disagreeable ones. The school must not take on itself the inexorable character of life: it must not seek to be more than a game of life.

II. CONCLUDING REMARKS

Gentlemen, - I have an impression that, in spite of all the valuable material that has been brought before us in this discussion, we have not reached a decision on the problem that interests us. We were anxious above all to know how it becomes possible for the extraordinarily powerful life instinct to be overcome: whether this can only come about with the help of a disappointed libido or whether the ego can renounce its self-preservation for its own egoistic motives. It may be that we have failed to answer this psychological question because we have no adequate means of approaching it. We can, I think, only take as our starting-point the condition of melancholia, which is so familiar to us clinically, and a comparison between it and the affect of mourning. The affective processes in melancholia, however, and the vicissitudes undergone by the libido in that condition, are totally unknown to us. Nor have we arrived at a psycho-analytic understanding of the chronic affect of mourning. Let us suspend our judgement till experience has solved this problem.

LETTER TO DR. FRIEDRICH S. KRAUS ON ANTHROPOPHYTEIA

My Dear Dr. Krauss,

You have asked me what scientific value can in my opinion be claimed by collections of erotic jokes, witticisms, funny stories, etc. I know you have not felt any doubt of being able to justify the making of such collections. You merely wanted me to bear witness from the standpoint of a psychologist to the fact that material of this kind is not only useful but indispensable.

There are two points upon which I should principally like to insist. When all is said and done, the erotic quips and comic anecdotes that you have collected and published in Anthropophyteia have only been produced and repeated because they gave pleasure both to their narrators and their hearers. It is not difficult to guess which components of the sexual instinct (compounded as it is from so many elements) find satisfaction in this manner. These tales give us direct information as to which of the component instincts of sexuality are retained in a given group of people as particularly efficient in producing pleasure; and in this way they give the neatest confirmation of the findings reached by the psycho-analytic examination of neurotics. Allow me to indicate the most important example of this kind. Psycho-analysis has led us to assert that the anal region - normally and not only in perverse individuals - is the site of an erotogenic sensitivity, and that in certain ways it behaves exactly like a genital organ. Doctors and psychologists, when told of there being an anal erotism and an anal character derived from it, have been highly indignant. At this point Anthropophyteia comes to the help of psycho-analysis by showing how universally people dwell with pleasure upon this part of the body, its performances and indeed the product of its function. If this were not so, all these anecdotes would be bound to give rise to disgust in their hearers or else the whole mass of the population would have to be ‘perverse’ in the sense in which the word is used in works dealing with ‘psychopathia sexualis’ in a moralizing tone. It would not be hard to give other instances of how the material collected by the authors of Anthropophyteia has been of value for the researches of sexual psychology. Its value may even be increased, perhaps, by the circumstance (not in itself an advantage) that the collectors know nothing of the theoretical findings of psycho-analysis and have brought together the material without any guiding principles.

Another advantage of a wider character is presented in particular by erotic jokes, in the strict sense, just as it is by jokes in general. I have shown in my study of jokes that the revelation of what is normally the repressed unconscious element in the mind can, under certain provisions, become a source of pleasure and thus a technique for the construction of jokes. In psycho-analysis to-day we describe a congeries of ideas and its associated affect as a ‘complex’; and we are prepared to assert that many of the most admired jokes are ‘complexive jokes’ and that they owe their exhilarating and cheerful effect to the ingenious uncovering of what are as a rule repressed complexes. It would carry me too far afield if I were to bring forward instances here in proof of this thesis, but I can assert that the outcome of such an examination of the evidence is that the jokes, both erotic and of other sorts, which are in popular circulation provide an excellent auxiliary means of investigating the unconscious human mind - in the same way as do dreams, myths and legends, with the exploitation of which psycho-analysis is already actively

engaged.

It is therefore safe to hope that the psychological importance of folklore will be more and more clearly recognized, and that the relations between that branch of study and psycho-analysis will soon become more intimate.

I remain, dear Dr. Krauss, yours very sincerely,

FREUD

June 26,1910 3

TWO INSTANCES OF PATHOGENIC PHANTASIES

REVEALED BY THE PATIENTS THEMSELVESA

A short while ago I saw a patient, about twenty years of age, who gave an unmistakable picture (confirmed by other opinions) of a dementia praecox (hebephrenia). During the initial stages of his illness he had exhibited periodic changes of mood and had made a considerable improvement. While he was in this favourable condition he was removed from the institution by his parents and for about a week he was regaled with entertainments of every kind to celebrate his supposed recovery. His relapse followed immediately upon this week of festivities. When he was brought back to the institution, he said that the consulting physician had advised him ‘to flirt with his mother a little’. There can be no doubt that in this delusory paramnesia he was giving expression to the excitement which had been provoked in him by being in his mother’s company and which had been the immediate provocation of his relapse.B

More than ten years ago, at a time when the findings and hypotheses of psycho-analysis were known to only a few people, the following events were reported to me from a trustworthy source. A girl, who was the daughter of a medical man, fell ill of hysteria with local symptoms. Her father denied that it was hysteria and arranged for various somatic treatments to be initiated, which brought little improvement. One day a woman friend of the patient’s said to her: ‘Have you never thought of consulting Dr. F.?’ To which the patient replied: ‘What good would that be? I know he’d say to me: "Have you ever had the idea of having sexual intercourse with your father?"' - It seems unnecessary for me to say explicitly that it has never been my practice and is not my practice to-day to ask such questions. But it is worth remarking that much of what patients report of the words and actions of their physicians may be understood as revelations of their own pathogenic phantasies.

REVIEW OF WILHELM NEUTRA’S LETTERS TO NEUROTIC WOMEN

It should be taken as an encouraging sign of the awakening interest in psychotherapy that a second edition of this book has been called for so quickly. Unluckily we cannot hail the book itself as an encouraging phenomenon. The author, who is an assistant physician in the Gainfarn hydropathic institute near Vienna, has borrowed the form of Oppenheim’s Psychotherapeutische Briefe and has given that form a psycho-analytic content. This is in a sense ill-judged, since psycho-analysis cannot be satisfactorily combined with Oppenheim’s (or, if that is preferred, Dubois’) technique of ‘persuasion’; it looks for it therapeutic results along quite other paths. What is more important, however, is the fact that the author fails to attain the merits of his model - tact and moral seriousness - and that in his presentation of psycho-analytic theory he often drops into empty rhetoric and is also guilty of some misstatements. Nevertheless much of what he writes is neatly and aptly expressed; and the book may pass muster as a work for popular consumption. In a more serious, scientific exposition of the subject the author would have had to indicate the sources of his views and assertions with greater conscientiousness.

PSYCHO-ANALYTIC NOTES ON AN AUTOBIOGRAPHICAL ACCOUNT OF A CASE OF PARANOIA (DEMENTIA PARANOIDES) (1911)

The analytic investigation of paranoia presents difficulties of a peculiar nature to physicians who, like myself, are not attached to public institutions. We cannot accept patients suffering from this complaint, or, at all events, we cannot keep them for long, since we cannot offer treatment unless there is some prospect of therapeutic success. It is only in exceptional circumstances, therefore, that I succeed in getting more than a superficial view of the structure of paranoia - when, for instance, the diagnosis (which is not always an easy matter) is uncertain enough to justify an attempt at influencing the patient, or when, in spite of an assured diagnosis, I yield to the entreaties of the patient’s relatives and undertake to treat him for a time. Apart from this, of course, I see plenty of cases of paranoia and of dementia praecox, and I learn as much about them as other psychiatrists do about their cases; but that is not enough, as a rule, to lead to any analytic conclusions.

The psycho-analytic investigation of paranoia would be altogether impossible if the patients themselves did not possess the peculiarity of betraying (in a distorted form, it is true) precisely those things which other neurotics keep hidden as a secret. Since paranoics cannot be compelled to overcome their internal resistances, and since in any case they only say what they choose to say, it follows that this is precisely a disorder in which a written report or a printed case history can take the place of personal acquaintance with the patient. For this reason I think it is legitimate to base analytic interpretations upon the case history of a patient suffering from paranoia (or, more precisely, from dementia paranoides) whom I have never seen, but who has written his own case history and brought it before the public in print.

I refer to Dr. jur. Daniel Paul Schreber, formerly Senatspräsident in Dresden, whose book, Denkwürdigkeiten eines Nervenkranken [Memoirs of a Nerve Patient], was published in 1903, and, if I am rightly informed, aroused considerable interest among psychiatrists. It is possible that Dr. Schreber may still be living to-day and that he may have dissociated himself so far from the delusional system which he put forward in 1903 as to be pained by these notes upon his book. In so far, however, as he still retains his identity with his former personality, I can rely upon the arguments with which he himself - ‘a man of superior mental gifts and endowed with an unusual keenness alike of intellect and of observation’¹ - countered the efforts that were made to restrain him from publishing his memoirs: ‘I have been at no pains’, he writes, ‘to close my eyes to the difficulties that would appear to lie in the path of publication, and in particular to the problem of paying due regard to the susceptibilities of certain persons still living. On the other hand, I am of opinion that it might well be to the advantage both of science and of the recognition of religious truths if, during my life-time, qualified authorities were enabled to undertake some examination of my body and to hold some enquiry into my personal experiences. To this consideration all feelings of a personal character must yield.’² He declares in another passage that he has decided to keep to his intention of publishing the book, even if the consequence were to be that his physician, Geheimrat Dr. Flechsig of Leipzig, brought an action against him. He urges upon Dr. Flechsig, however, the same considerations that I am now urging upon him himself: ‘I trust’, he says, ‘that even in the case of Geheimrat Prof. Dr. Flechsig any personal susceptibilities that he may feel will be outweighed by a scientific interest in the subject-matter of my memoirs.’ (446.)³

Though all the passages from the Denkwürdigkeiten upon which my interpretations are based will be quoted verbatim in the following pages, I would ask my readers to make themselves acquainted with the book by reading it through at least once beforehand.

¹ This piece of self-portraiture, which is certainly not unjustified, will be found on page 35 of his book.

² Preface, iii.

³ [Throughout this paper figures in brackets with no preceding ‘p.’ are page references to the original German edition of Schreber’s memoirs - Denkwürdigkeiten eines Nervenkranken, Leipzig, Oswald Mutze.]

IC ASE HISTORY

‘I have suffered twice from nervous disorders’, writes Dr. Schreber, ‘and each time as a result of mental overstrain. This was due on the first occasion to my standing as a candidate for election to the Reichstag while I was Landgerichtsdirektor at Chemnitz, and on the second occasion to the very heavy burden of work that fell upon my shoulders when I entered on my new duties as Senatspräsident in the Oberlandesgericht in Dresden.’ (34.)

Dr. Schreber’s first illness began in the autumn of 1884, and by the end of 1885 he had completely recovered. During this period he spent six months in Flechsig’s clinic, and the latter, in a formal report which he drew up at a later date, described the disorder as an attack of severe hypochondria. Dr. Schreber assures us that this illness ran its course ‘without the occurrence of any incidents bordering upon the sphere of the supernatural’. (35.)

Neither the patient’s own account, nor the reports of the physicians which are reprinted at the end of his book, tell us enough about his previous history or his personal circumstances. I am not even in a position to give the patient’s age at the time of his illness, though the high judicial position which he had attained before his second illness establishes some sort of lower limit. We learn that Dr. Schreber had been married long before the time of his ‘hypochondria’. ‘The gratitude of my wife’, he writes, ‘was perhaps even more heartfelt; for she revered Professor Flechsig as the man who had restored her husband to her, and hence it was that for years she kept his portrait standing upon her writing-table.’ (36.) And in the same place: ‘After my recovery from my first illness I spent eight years with my wife - years, upon the whole, of great happiness, rich in outward honours, and only clouded from time to time by the oft repeated disappointment of our hope that we might be blessed with children.’

In June, 1893, he was notified of his prospective appointment as Senatspräsident, and he took up his duties on the first of October of the same year. Between these two dates¹ he had some dreams, though it was not until later that he came to attach any importance to them. He dreamt two or three times that his old nervous disorder had come back; and this made him as miserable in the dream as the discovery that it was only a dream made him happy when he woke up. Once, in the early hours of the morning, moreover, while he was in a state between sleeping and waking, the idea occurred to him ‘that after all it really must be very nice to be a woman submitting to the act of copulation’. (36.) This idea was one which he would have rejected with the greatest indignation if he had been fully conscious.

The second illness set in at the end of October 1893 with a torturing bout of sleeplessness. This forced him to return to the Flechsig clinic, where, however, his condition grew rapidly worse. The further course of the illness is described in a Report drawn up subsequently by the director of the Sonnenstein Asylum: ‘At the commencement of his residence there² he expressed more hypochondriacal ideas, complained that he had softening of the brain, that he would soon be dead, etc. But ideas of persecution were already finding their way into the clinical picture, based upon sensory illusions which, however, seemed only to appear sporadically at first; while simultaneously a high degree of hyperaesthesia was observable - great sensitiveness to light and noise. - Later, the visual and auditory illusions became much more frequent, and, in conjunction with coenaesthetic disturbances, dominated the whole of his feeling and thought. He believed that he was dead and decomposing, that he was suffering from the plague; he asserted that his body was being handled in all kinds of revolting ways; and, as he himself declares to this day, he went through worse horrors than any one could have imagined, and all on behalf of a holy purpose. The patient was so much pre-occupied with these pathological experiences that he was inaccessible to any other impression and would sit perfectly rigid and motionless for hours (hallucinatory stupor). On the other hand, they tortured him to such a degree that he longed for death. He made repeated attempts at drowning himself in his bath, and asked to be given the "cyanide that was intended for him". His delusional ideas gradually assumed a mystical and religious character; he was in direct communication with God, he was the plaything of devils, he saw "miraculous apparitions", he heard "holy music", and in the end he even came to believe that he was living in another world.’ (380.)

¹ And therefore before he could have been affected by the overwork caused by his new post, to which he attributes his illness.

² In Professor Flechsig’s clinic at Leipzig.1

It may be added that there were certain people by whom he thought he was being persecuted and injured, and upon whom he poured abuse. The most prominent of these was his former physician, Flechsig, whom he called a ‘soul-murderer’; and he used to call out over and over again: ‘Little Flechsig!’ putting a sharp stress upon the first word (383). He was moved from Leipzig, and, after a short interval spent in another institution, was brought in June 1894 to the Sonnenstein Asylum, near Pirna, where he remained until his disorder assumed its final shape. In the course of the next few years the clinical picture altered in a manner which can best be described in the words of Dr. Weber, the director of the asylum.

‘I need not enter any further into the details of the course of the disease. I must, however, draw attention to the manner in which, as time went on, the initial comparatively acute psychosis, which had directly involved the patient’s entire mental life and deserved the name of "hallucinatory insanity", developed more and more clearly (one might almost say crystallized out) into the paranoic clinical picture that we have before us to-day.’ (385.) The fact was that, on the one hand, he had developed an ingenious delusional structure, in which we have every reason to be interested, while, on the other hand, his personality had been reconstructed and now showed itself, except for a few isolated disturbances, capable of meeting the demands of everyday life.

Dr. Weber, in his Report of 1899, makes the following remarks: ‘It thus appears that at the present time, apart from certain obvious psychomotor symptoms which cannot fail to strike even the superficial observer as being pathological, Herr Senatspräsident Dr. Schreber shows no signs of confusion or of psychical inhibition, nor is his intelligence noticeably impaired. His mind is collected, his memory is excellent, he has at his disposal a very considerable store of knowledge (not merely upon legal questions, but in many other fields), and he is able to reproduce it in a connected train of thought. He takes an interest in following events in the world of politics, science and art, etc., and is constantly occupied with such matters... and an observer who was uninstructed upon his general condition would scarcely notice anything peculiar in these directions. In spite of all this, however, the patient is full of ideas of pathological origin, which have formed themselves into a complete system; they are more or less fixed, and seem to be inaccessible to correction by means of any objective appreciation and judgement of the external facts.’ (305-6.)

Thus the patient’s condition had undergone a great change, and he now considered himself capable of carrying on an independent existence. He accordingly took appropriate steps with a view to regaining control over his own affairs and to securing his discharge from the asylum. Dr. Weber set himself to prevent the fulfilment of these intentions and drew up reports in opposition to them. Nevertheless, in his Report dated 1900, he felt obliged to give this appreciative account of the patient’s character and conduct: ‘Since for the last nine months Herr Präsident Schreber has taken his meals daily at my family board, I have had the most ample opportunities of conversing with him upon every imaginable topic, Whatever the subject was that came up for discussion (apart, of course, from his delusional ideas), whether it concerned events in the field of administration and law, of politics, art, literature or social life - in short, whatever the topic, Dr. Schreber gave evidence of a lively interest, a well-informed mind, a good memory, and a sound judgement; his ethical outlook, moreover, was one which it was impossible not to endorse. So, too, in his lighter talk with the ladies of the party, he was both courteous and affable, and when he touched upon matters in a more humorous vein he invariably displayed tact and decorum. Never once, during these innocent talks round the dining-table, did he introduce subjects which should more properly have been raised at a medical consultation.’ (397-8.) Indeed, on one occasion during this period when a business question arose which involved the interests of his whole family, he entered into it in a manner which showed both his technical knowledge and his common sense (401 and 510).

In the numerous applications to the courts, by which Dr. Schreber endeavoured to regain his liberty, he did not in the least disavow his delusions or make any secret of his intention of publishing the Denkwürdigkeiten. On the contrary, he dwelt upon the importance of his ideas to religious thought, and upon their invulnerability to the attacks of modern science; but at the same time he laid stress upon the ‘absolute harmlessness’ (430) of all the actions which, as he was aware, his delusions obliged him to perform. Such, indeed, were his acumen and the cogency of his logic that finally, and in spite of his being an acknowledged paranoic, his efforts were crowned with success. In July, 1902, Dr. Schreber’s civil rights were restored, and in the following year his Denkwürdigkeiten eines Nervenkranken appeared, though in a censored form and with many valuable portions omitted.

3 The Court Judgement that gave Dr. Schreber back his liberty summarizes the content of his delusional system in a few sentences: ‘He believed that he had a mission to redeem the world and to restore it to its lost state of bliss. This, however, he could only bring about if he were first transformed from a man into a woman.’ (475.)

For a more detailed account of his delusions as they appeared in their final shape we may turn to Dr. Weber’s Report of 1899: ‘The culminating point of the patient’s delusional system is his belief that he has a mission to redeem the world, and to restore mankind to their lost state of bliss. He was called to this task, so he asserts, by direct inspiration from God, just as we are taught that the Prophets were; for nerves in a condition of great excitement, as his were for a long time, have precisely the property of exerting an attraction upon God - though this is touching on matters which human speech is scarcely, if at all, capable of expressing, since they lie entirely outside the scope of human experience and, indeed, have been revealed to him alone. The most essential part of his mission of redemption is that it must be preceded by his transformation into a woman. It is not to be supposed that he wishes to be transformed into a woman; it is rather a question of a "must" based upon the Order of Things, which there is no possibility of his evading, much as he would personally prefer to remain in his own honourable and masculine station in life. But neither he nor the rest or mankind can regain the life beyond except by his being transformed into a woman (a process which may occupy many years or even decades) by means of divine miracles. He himself, of this he is convinced, is the only object upon which divine miracles are worked, and he is thus the most remarkable human being who has ever lived upon earth. Every hour and every minute for years he has experienced these miracles in his body, and he has had them confirmed by the voices that have conversed with him. During the first years of his illness certain of his bodily organs suffered such destructive injuries as would inevitably have led to the death of any other man: he lived for a long time without a stomach, without intestines, almost without lungs, with a torn oesophagus, without a bladder, and with shattered ribs, he used sometimes to swallow part of his own larynx with his food, etc. But divine miracles ("rays") always restored what had been destroyed, and therefore, as long as he remains a man, he is altogether immortal. These alarming phenomena have ceased long ago, and his "femaleness" has become prominent instead. This is a matter of a process of development which will probably require decades, if not centuries, for its completion, and it is unlikely that anyone now living will survive to see the end of it. He has a feeling that enormous numbers of "female nerves" have already passed over into his body, and out of them a new race of men will proceed, through a process of direct impregnation by God. Not until then, it seems, will he be able to die a natural death, and, along with the rest of mankind, will he regain a state of bliss. In the meantime not only the sun, but trees and birds, which are in the nature of "bemiracled residues of former human souls", speak to him in human accents, and miraculous things happen everywhere around him.’ (386-8.)

The interest felt by the practical psychiatrist in such delusional formations as these is, as a rule, exhausted when once he has ascertained the character of the products of the delusion and has formed an estimate of their influence on the patient’s general behaviour: in his case marvelling is not the beginning of understanding. The psycho-analyst, in the light of his knowledge of the psychoneuroses, approaches the subject with a suspicion that even thought-structures so extraordinary as these and so remote from our common modes of thinking are nevertheless derived from the most general and comprehensible impulses of the human mind; and he would be glad to discover the motives of such a transformation as well as the manner in which it has been accomplished. With this aim in view, he will wish to go more deeply into the details of the delusion and into the history of its development.

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