The psychical disorders of male potency 19 страница

The fact of the emergence of the transference in its crudely sexual form, whether affectionate or hostile, in every treatment of a neurosis, although this is neither desired nor induced by either doctor or patient, has always seemed to me the most irrefragable proof that the source of the driving forces of neurosis lies in sexual life. This argument has never received anything approaching the degree of attention that it merits, for if it had, investigations in this field would leave no other conclusion open. As far as I am concerned, this argument has remained the decisive one, over and above the more specific findings of analytic work.

¹ [In English in the original.]2 There was some consolation for the bad reception accorded to my contention of a sexual aetiology in the neuroses even by my more intimate circle of friends - for a vacuum rapidly formed itself about my person - in the thought that I was taking up the fight for a new and original idea. But, one day, certain memories gathered in my mind which disturbed this pleasing notion, but which gave me in exchange a valuable insight into the processes of human creative activity and the nature of human knowledge. The idea for which I was being made responsible had by no means originated with me. It had been imparted to me by three people whose opinion had commanded my deepest respect - by Breuer himself, by Charcot, and by Chrobak, the gynaecologist at the University, perhaps the most eminent of all our Vienna physicians. These three men had all communicated to me a piece of knowledge which, strictly speaking, they themselves did not possess. Two of them later denied having done so when I reminded them of the fact; the third (the great Charcot) would probably have done the same if it had been granted me to see him again. But these three identical opinions, which I had heard without understanding, had lain dormant in my mind for years, until one day they awoke in the form of an apparently original discovery.

One day, when I was a young house-physician, I was walking across the town with Breuer, when a man came up who evidently wanted to speak to him urgently. I fell behind. As soon as Breuer was free, he told me in his friendly, instructive way that this man was the husband of a patient of his and had brought him some news of her. The wife, he added, was behaving in such a peculiar way in society that she had been brought to him for treatment as a nervous case. He concluded: ‘These things are always secrets d’alcôve!’ I asked him in astonishment what he meant, and he answered by explaining the word alcôve (‘marriage-bed’) to me, for he failed to realize how extraordinary the matter of his statement seemed to me.

Some years later, at one of Charcot’s evening receptions, I happened to be standing near the great teacher at a moment when he appeared to be telling Brouardel a very interesting story about something that had happened during his day’s work. I hardly heard the beginning, but gradually my attention was seized by what he was talking of: a young married couple from a distant country in the East - the woman a severe sufferer, the man either impotent or exceedingly awkward. ‘Tâchez donc,’ I heard Charcot repeating, ‘je vous assure, vous y arriverez.’¹ Brouardel, who spoke less loudly, must have expressed his astonishment that symptoms like the wife’s could have been produced by such circumstances. For Charcot suddenly broke out with great animation: ‘Mais, dans des cas pareils c’est toujours la chose génitale, toujours... toujours... toujours’;² and he crossed his arms over his stomach, hugging himself and jumping up and down on his toes several times in his own characteristically lively way. I know that for a moment I was almost paralysed with amazement and said to myself: ‘Well, but if he knows that, why does he never say so?’ But the impression was soon forgotten; brain anatomy and the experimental induction of hysterical paralyses absorbed all my interest.

A year later, I had begun my medical career in Vienna as a lecturer in nervous diseases, and in everything relating to the aetiology of the neuroses I was still as ignorant and innocent as one could expect of a promising student trained at a university. One day I had a friendly message from Chrobak, asking me to take a woman patient of his to whom he could not give enough time, owing to his new appointment as a University teacher. I arrived at the patient’s house before he did and found that she was suffering from attacks of meaningless anxiety, and could only be soothed by the most precise information about where her doctor was at every moment of the day. When Chrobak arrived he took me aside and told me that the patient’s anxiety was due to the fact that although she had been married for eighteen years she was still virgo intacta. The husband was absolutely impotent. In such cases, he said, there was nothing for a medical man to do but to shield this domestic misfortune with his own reputation, and put up with it if people shrugged their shoulders and said of him: ‘He’s no good if he can’t cure her after so many years.’ The sole prescription for such a malady, he added, is familiar enough to us, but we cannot order it. It runs:

‘Rx Penis normalis

dosim

repetatur!’

I had never heard of such a prescription, and felt inclined to shake my head over my kind friend’s cynicism.

¹ [‘Go on trying! I promise you, you’ll succeed.’]

² [‘But in this sort of case it’s always a question of the genitals - always, always, always.’]4

I have not of course disclosed the illustrious parentage of this scandalous idea in order to saddle other people with the responsibility for it. I am well aware that it is one thing to give utterance to an idea once or twice in the form of a passing aperçu, and quite another to mean it seriously - to take it literally and pursue it in the face of every contradictory detail, and to win it a place among accepted truths. It is the difference between a casual flirtation and a legal marriage with all its duties and difficulties. ‘Épouser les idées de...’¹ is no uncommon figure of speech, at any rate in French.

Among the other new factors which were added to the cathartic procedure as a result of my work and which transformed it into psycho-analysis, I may mention in particular the theory of repression and resistance, the recognition of infantile sexuality, and the interpreting and exploiting of dreams as a source of knowledge of the unconscious.

The theory of repression quite certainly came to me independently of any other source; I know of no outside impression which might have suggested it to me, and for a long time I imagined it to be entirely original, until Otto Rank (1911a) showed us a passage in Schopenhauer’s World as Will and Idea in which the philosopher seeks to give an explanation of insanity. What he says there about the struggle against accepting a distressing piece of reality coincides with my concept of repression so completely that once again I owe the chance of making a discovery to my not being well-read. Yet others have read the passage and passed it by without making this discovery, and perhaps the same would have happened to me if in my young days I had had more taste for reading philosophical works. In later years I have denied myself the very great pleasure of reading the works of Nietzsche, with the deliberate object of not being hampered in working out the impressions received in psycho-analysis by any sort of anticipatory ideas. I had therefore to be prepared - and I am so, gladly - to forgo all claims to priority in the many instances in which laborious psycho-analytic investigation can merely confirm the truths which the philosopher recognized by intuition.

¹ [‘To espouse an idea.’]5

The theory of repression is the corner-stone on which the whole structure of psycho-analysis rests. It is the most essential part of it; and yet it is nothing but a theoretical formulation of a phenomenon which may be observed as often as one pleases if one undertakes an analysis of a neurotic without resorting to hypnosis. In such cases one comes across a resistance which opposes the work of analysis and in order to frustrate it pleads a failure of memory. The use of hypnosis was bound to hide this resistance; the history of psycho-analysis proper, therefore, only begins with the new technique that dispenses with hypnosis. The theoretical consideration of the fact that this resistance coincides with an amnesia leads inevitably to the view of unconscious mental activity which is peculiar to psycho-analysis and which, too, distinguishes it quite clearly from philosophical speculations about the unconscious. It may thus be said that the theory of psycho-analysis is an attempt to account for two striking and unexpected facts of observation which emerge whenever an attempt is made to trace the symptoms of a neurotic back to their sources in his past life: the facts of transference and of resistance. Any line of investigation which recognizes these two facts and takes them as the starting-point of its work has a right to call itself psycho-analysis, even though it arrives at results other than my own. But anyone who takes up other sides of the problem while avoiding these two hypotheses will hardly escape a charge of misappropriation of property by attempted impersonation, if he persists in calling himself a psycho-analyst.

If anyone sought to place the theory of repression and resistance among the premisses instead of the findings of psycho-analysis, I should oppose him most emphatically. Such premisses of a general psychological and biological nature do exist, and it would be useful to consider them on some other occasion; but the theory of repression is a product of psycho-analytic work, a theoretical inference legitimately drawn from innumerable observations.6 Another product of this sort was the hypothesis of infantile sexuality. This, however, was made at a much later date. In the early days of tentative investigation by analysis no such thing was thought of. At first it was merely observed that the effects of present-day experiences had to be traced back to something in the past. But enquirers often find more than they bargain for. One was drawn further and further back into the past; one hoped at last to be able to stop at puberty, the period in which the sexual impulses are traditionally supposed to awake. But in vain; the tracks led still further back into childhood and into its earlier years. On the way, a mistaken idea had to be overcome which might have been almost fatal to the young science. Influenced by Charcot’s view of the traumatic origin of hysteria, one was readily inclined to accept as true and aetiologically significant the statements made by patients in which they ascribed their symptoms to passive sexual experiences in the first years of childhood - to put it bluntly, to seduction. When this aetiology broke down under the weight of its own improbability and contradiction in definitely ascertainable circumstances, the result at first was helpless bewilderment. Analysis had led back to these infantile sexual traumas by the right path, and yet they were not true. The firm ground of reality was gone. At that time I would gladly have given up the whole work, just as my esteemed predecessor, Breuer, had done when he made his unwelcome discovery. Perhaps I persevered only because I no longer had any choice and could not then begin again at anything else. At last came the reflection that, after all, one had no right to despair because one has been deceived in one’s expectations; one must revise those expectations. If hysterical subjects trace back their symptoms to traumas that are fictitious, then the new fact which emerges is precisely that they create such scenes in phantasy, and this psychical reality requires to be taken into account alongside practical reality. This reflection was soon followed by the discovery that these phantasies were intended to cover up the auto-erotic activity of the first years of childhood, to embellish it and raise it to a higher plane. And now, from behind the phantasies, the whole range of a child’s sexual life came to light.

With this sexual activity of the first years of childhood the inherited constitution of the individual also came into its own. Disposition and experience are here linked up in an indissoluble aetiological unity. For disposition

exaggerates impressions which would otherwise have been completely commonplace and have had no effect, so that they become traumas giving rise to stimulations and fixations; while experiences awaken factors in the disposition which, without them, might have long remained dormant and perhaps never have developed. The last word on the subject of traumatic aetiology was spoken later by Abraham, when he pointed out that the sexual constitution which is peculiar to children is precisely calculated to provoke sexual experiences of a particular kind - namely traumas.

In the beginning, my statements about infantile sexuality were founded almost exclusively on the findings of analysis in adults which led back into the past. I had no opportunity of direct observations on children. It was therefore a very great triumph when it became possible years later to confirm almost all my inferences by direct observation and the analysis of very young children - a triumph that lost some of its magnitude as one gradually realized that the nature of the discovery was such that one should really be ashamed of having had to make it. The further one carried these observations on children, the more self-evident the facts became; but the more astonishing, too, did it become that one had taken so much trouble to overlook them.

Such a certain conviction of the existence and importance of infantile sexuality can, however, only be obtained by the method of analysis, by pursuing the symptoms and peculiarities of neurotics back to their ultimate sources, the discovery of which then explains whatever is explicable in them and enables whatever is modifiable to be changed. I can understand that one would arrive at different results if, as C. G. Jung has recently done, one first forms a theoretical conception of the nature of the sexual instinct and then seeks to explain the life of children on that basis. A conception of this kind is bound to be selected arbitrarily or in accordance with irrelevant considerations, and runs the risk of proving inadequate for the field to which one is seeking to apply it. It is true that the analytic method, too, leads to certain ultimate difficulties and obscurities in regard to sexuality and its relation to the total life of the individual. But these problems cannot be got rid of by speculation; they must await solution through other observations or through observations in other fields.

8 I need say little about the interpretation of dreams. It came as the first fruits of the technical innovation I had adopted when, following a dim presentiment, I decided to replace hypnosis by free association. My desire for knowledge had not at the start been directed towards understanding dreams. I do not know of any outside influence which drew my interest to them or inspired me with any helpful expectations. Before Breuer and I ceased to meet I only just had time to tell him in a single sentence that I now understood how to translate dreams. Since this was how the discovery came about, it followed that the symbolism in the language of dreams was almost the last thing to become accessible to me, for the dreamer’s associations help very little towards understanding symbols. I have held fast to the habit of always studying things themselves before looking for information about them in books, and therefore I was able to establish the symbolism of dreams for myself before I was led to it by Scherner’s work on the subject. It was only later that I came to appreciate to its full extent this mode of expression of dreams. This was partly through the influence of the works of Stekel, who at first did such very creditable work but afterwards went totally astray. The close connection between psycho-analytic dream-interpretation and the art of interpreting dreams as practised and held in such high esteem in antiquity only became clear to me much later. Later on I found the essential characteristic and most important part of my dream theory - the derivation of dream-distortion from an internal conflict, a kind of inner dishonesty - in a writer who was ignorant, it is true, of medicine, though not of philosophy, the famous engineer J. Popper, who published his Phantasien eines Realisten under the name of Lynkeus.

The interpretation of dreams became a solace and a support to me in those arduous first years of analysis, when I had to master the technique, clinical phenomena and therapy of the neuroses all at the same time. At that period I was completely isolated and in the network of problems and accumulation of difficulties I often dreaded losing my bearings and also my confidence. There were often patients with whom an unaccountably long time elapsed before my hypothesis, that a neurosis was bound to become intelligible through analysis, proved true; but these patients’ dreams, which might be regarded as analogues of their symptoms, almost always confirmed the hypothesis.

It was only my success in this direction that enabled me to persevere. The result is that I have acquired a habit of gauging the measure of a psychologist’s understanding by his attitude to dream-interpretation; and I have observed with satisfaction that most of the opponents of psycho-analysis avoid this field altogether or else display remarkable clumsiness if they attempt to deal with it. Moreover, I soon saw the necessity of carrying out a self-analysis, and this I did with the help of a series of my own dreams which led me back through all the events of my childhood; and I am still of the opinion to-day that this kind of analysis may suffice for anyone who is a good dreamer and not too abnormal.

I think that by thus unrolling the story of the development of psycho-analysis I have shown what it is, better than by a systematic description of it. I did not at first perceive the peculiar nature of what I had discovered. I unhesitatingly sacrificed my growing popularity as a doctor, and the increase in attendance during my consulting hours, by making a systematic enquiry into the sexual factors involved in the causation of my patients’ neuroses; and this brought me a great many new facts which finally confirmed my conviction of the practical importance of the sexual factor. I innocently addressed a meeting of the Vienna Society for Psychiatry and Neurology with Krafft-Ebing in the chair, expecting that the material losses I had willingly undergone would be made up for by the interest and recognition of my colleagues. I treated my discoveries as ordinary contributions to science and hoped they would be received in the same spirit. But the silence which my communications met with, the void which formed itself about me, the hints that were conveyed to me, gradually made me realize that assertions on the part played by sexuality in the aetiology of the neuroses cannot count upon meeting with the same kind of treatment as other communications. I understood that from now onwards I was one of those who have ‘disturbed the sleep of the world’, as Hebbel says, and that I could not reckon upon objectivity and tolerance. Since, however, my conviction of the general accuracy of my observations and conclusions grew even stronger, and since neither my confidence in my own judgement nor my moral courage were precisely small, the outcome of the situation could not be in doubt. I made up my mind to believe that it had been my fortune to discover some particularly important facts and connections, and I was prepared to accept the fate that sometimes accompanies such discoveries.

I pictured the future as follows: - I should probably succeed in maintaining myself by means of the therapeutic success of the new procedure, but science would ignore me entirely during my lifetime; some decades later, someone else would infallibly come upon the same things - for which the time was not now ripe - would achieve recognition for them and bring me honour as a forerunner whose failure had been inevitable. Meanwhile, like Robinson Crusoe, I settled down as comfortably as possible on my desert island. When I look back to those lonely years, away from the pressures and confusions of to-day, it seems like a glorious heroic age. My ‘splendid isolation’¹ was not without its advantages and charms. I did not have to read any publications, nor listen to any ill-informed opponents; I was not subject to influence from any quarter; there was nothing to hustle me. I learnt to restrain speculative tendencies and to follow the unforgotten advice of my master, Charcot: to look at the same things again and again until they themselves begin to speak. My publications, which I was able to place with a little trouble, could always lag far behind my knowledge, and could be postponed as long as I pleased, since there was no doubtful ‘priority’ to be defended. The Interpretation of Dreams, for instance, was finished in all essentials at the beginning of 1896 but was not written out until the summer of 1899. The analysis of ‘Dora’ was over at the end of 1899; the case history was written in the next two weeks, but was not published until 1905. Meanwhile my writings were not reviewed in the medical journals, or, if as an exception they were reviewed, they were dismissed with expressions of scornful or pitying superiority. Occasionally a colleague would make some reference to me in one of his publications; it would be very short and not at all flattering - words such as ‘eccentric’, ‘extreme’, or ‘very peculiar’ would be used. It once happened that an assistant at the clinic in Vienna where I gave my University lectures asked me for permission to attend the course. He listened very attentively and said nothing; after the last lecture was over he offered to join me outside. As we walked away, he told me that with his chief’s knowledge he had written a book combating my views; he regretted very much, however, that he had not first learnt more about them from my lectures, for in that case he would have written much of it differently. He had indeed enquired at the clinic whether he had not better first read The Interpretation of Dreams, but had been advised against doing so - it was not worth the trouble. He then himself compared the structure of my theory, so far as he now understood it, with that of the Catholic Church as regards its internal solidity. In the interests of the salvation of his soul, I shall assume that this remark implied a certain amount of appreciation. But he concluded by saying that it was too late to alter anything in his book, since it was already in print. Nor did my colleague think it necessary later to make any public avowal of his change of views on the subject of psycho-analysis; but preferred, in his capacity as a regular reviewer for a medical journal, to follow its development with flippant comments.

¹ [In English in the original.]1

Whatever personal sensitiveness I possessed became blunted during those years, to my advantage. I was saved from becoming embittered, however, by a circumstance which is not always present to help lonely discoverers. Such people are as a rule tormented by the need to account for the lack of sympathy or the aversion of their contemporaries, and feel this attitude as a distressing contradiction of the security of their own sense of conviction. There was no need for me to feel so; for psycho-analytic theory enabled me to understand this attitude in my contemporaries and to see it as a necessary consequence of fundamental analytic premisses. If it was true that the set of facts I had discovered were kept from the knowledge of patients themselves by internal resistances of an affective kind, then these resistances would be bound to appear in healthy people too, as soon as some external source confronted them with what was repressed. It was not surprising that they should be able to justify this rejection of my ideas on intellectual grounds though it was actually affective in origin. The same thing happened equally often with patients; the arguments they advanced were the same and were not precisely brilliant. In Falstaff’s words, reasons are ‘as plenty as blackberries’. The only difference was that with patients one was in a position to bring pressure to bear on them so as to induce them to get insight into their resistances and overcome them, whereas one had to do without this advantage in dealing with people who were ostensibly healthy. How to compel these healthy people to examine the matter in a cool and scientifically objective spirit was an unsolved problem which was best left to time to clear up. In the history of science one can clearly see that often the very proposition which has at first called out nothing but contradiction has later come to be accepted, although no new proofs in support of it have been brought forward.

It was hardly to be expected, however, that during the years when I alone represented psycho-analysis I should develop any particular respect for the world’s opinion or any bias towards intellectual appeasement.2

II

From the year 1902 onwards, a number of young doctors gathered round me with the express intention of learning, practising and spreading the knowledge of psycho-analysis. The stimulus came from a colleague who had himself experienced the beneficial effects of analytic therapy. Regular meetings took place on certain evenings at my house, discussions were held according to certain rules and the participants endeavoured to find their bearings in this new and strange field of research and to interest others in it. One day a young man who had passed through a technical training college introduced himself with a manuscript which showed very unusual comprehension. We persuaded him to go through the Gymnasium [Secondary School] and the University and to devote himself to the non-medical side of psycho-analysis. The little society acquired in him a zealous and dependable secretary and I gained in Otto Rank a most loyal helper and co-worker.¹

The small circle soon expanded, and in the course of the next few years often changed its composition. On the whole I could tell myself that it was hardly inferior, in wealth and variety of talent, to the staff of any clinical teacher one could think of. It included from the beginning the men who were later to play such a considerable, if not always a welcome, part in the history of the psycho-analytic movement. At that time, however, one could not yet guess at these developments. I had every reason to be satisfied, and I think I did everything possible to impart my own knowledge and experience to the others. There were only two inauspicious circumstances which at last estranged me inwardly from the group. I could not succeed in establishing among its members the friendly relations that ought to obtain between men who are all engaged upon the same difficult work; nor was I able to stifle the disputes about priority for which there were so many opportunities under these conditions of work in common. The difficulties in the way of giving instruction in the practice of psycho-analysis, which are quite particularly great and are responsible for much in the present dissensions, were evident already in this private Vienna Psycho-Analytical Society. I myself did not venture to put forward a still unfinished technique and a theory still in the making with an authority which would probably have enabled the others to avoid some wrong turnings and ultimate disasters. The self-reliance of intellectual workers, their early independence of their teacher, is always gratifying from a psychological point of view; but it is only of advantage to science if those workers fulfil certain personal conditions which are none too common. For psycho-analysis in particular a long and severe discipline and training in self-discipline would have been required. In view of the courage displayed by their devotion to a subject so much frowned upon and so poor in prospects, I was disposed to tolerate much among the members to which I should otherwise have made objection. Besides doctors, the circle included others - men of education who had recognized something important in psycho-analysis: writers, painters and so on. My Interpretation of Dreams and my book on jokes, among others, had shown from the beginning that the theories of psycho-analysis cannot be restricted to the medical field, but are capable of application to a variety of other mental sciences.

¹ [Footnote added 1924:] Now director of the Internationaler Psychoanalytischer Verlag [International Psycho-Analytical Publishing House] and editor of the Zeitschrift and Imago from their inception.3 In 1907 the situation changed all at once and contrary to all expectations. It appeared that psycho-analysis had unobtrusively awakened interest and gained friends, and that there were even some scientific workers who were ready to acknowledge it. A communication from Bleuler had informed me before this that my works had been studied and made use of in the Burghölzli. In January 1907, the first member of the Zurich clinic came to Vienna - Dr. Eitingon.¹ Other visits followed, which led to an animated exchange of ideas. Finally, on the invitation of C. G. Jung, at that time still assistant physician at the Burghölzli, a first meeting took place at Salzburg in the spring of 1908, which brought together friends of psycho-analysis from Vienna, Zurich and other places. One of the results of this first Psycho-Analytical Congress was the founding of a periodical called the Jahrbuch für psychoanalytische und psychopathologische Forschungen, under the direction of Bleuler and Freud and edited by Jung, which first appeared in 1909. This publication gave expression to an intimate co-operation between Vienna and Zurich.

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