Студопедия

КАТЕГОРИИ:


Архитектура-(3434)Астрономия-(809)Биология-(7483)Биотехнологии-(1457)Военное дело-(14632)Высокие технологии-(1363)География-(913)Геология-(1438)Государство-(451)Демография-(1065)Дом-(47672)Журналистика и СМИ-(912)Изобретательство-(14524)Иностранные языки-(4268)Информатика-(17799)Искусство-(1338)История-(13644)Компьютеры-(11121)Косметика-(55)Кулинария-(373)Культура-(8427)Лингвистика-(374)Литература-(1642)Маркетинг-(23702)Математика-(16968)Машиностроение-(1700)Медицина-(12668)Менеджмент-(24684)Механика-(15423)Науковедение-(506)Образование-(11852)Охрана труда-(3308)Педагогика-(5571)Полиграфия-(1312)Политика-(7869)Право-(5454)Приборостроение-(1369)Программирование-(2801)Производство-(97182)Промышленность-(8706)Психология-(18388)Религия-(3217)Связь-(10668)Сельское хозяйство-(299)Социология-(6455)Спорт-(42831)Строительство-(4793)Торговля-(5050)Транспорт-(2929)Туризм-(1568)Физика-(3942)Философия-(17015)Финансы-(26596)Химия-(22929)Экология-(12095)Экономика-(9961)Электроника-(8441)Электротехника-(4623)Энергетика-(12629)Юриспруденция-(1492)Ядерная техника-(1748)

The infantile genital organization 3 страница




 

I have no doubt that the chronological and causal relations described here between the Oedipus complex, sexual intimidation (the threat of castration), the formation of the super-ego and the beginning of the latency period are of a typical kind; but I do not wish to assert that this type is the only possible one. Variations in the chronological order and in the linking-up of these events are bound to have a very important bearing on the development of the individual.

Since the publication of Otto Rank’s interesting study, The Trauma of Birth, even the conclusion arrived at by this modest investigation, to the effect that the boy’s Oedipus complex is destroyed by the fear of castration, cannot be accepted without further discussion. Nevertheless, it seems to me premature to enter into such a discussion at the present time, and perhaps inadvisable to begin a criticism or an appreciation of Rank’s view at this juncture.

 


THE LOSS OF REALITY IN NEUROSIS AND PSYCHOSIS (1924)

 

 

I have recently¹ indicated as one of the features which differentiate a neurosis from a psychosis the fact that in a neurosis the ego, in its dependence on reality, suppresses a piece of the id (of instinctual life), whereas in a psychosis, this same ego, in the service of the id, withdraws from a piece of reality. Thus for a neurosis the decisive factor would be the predominance of the influence of reality, whereas for a psychosis it would be the predominance of the id. In a psychosis, a loss of reality would necessarily be present, whereas in a neurosis, it would seem, this loss would be avoided.

 

But this does not at all agree with the observation which all of us can make that every neurosis disturbs the patient’s relation to reality in some way, that it serves him as a means of withdrawing from reality, and that, in its severe forms, it actually signifies a flight from real life. This contradiction seems a serious one; but it is easily resolved, and the explanation of it will in fact help us to understand neuroses.

For the contradiction exists only as long as we keep our eyes fixed on the situation at the beginning of the neurosis, in which the ego, in the service of reality, sets about the repression of an instinctual impulse. This, however, is not yet the neurosis itself. The neurosis consists rather in the processes which provide a compensation for the portion of the id that has been damaged - that is to say, in the reaction against the repression and in the failure of the repression. The loosening of the relation to reality is a consequence of this second step in the formation of a neurosis, and it ought not to surprise us if a detailed examination shows that the loss of reality affects precisely that piece of reality as a result of whose demands the instinctual repression ensued.

 

There is nothing new in our characterization of neurosis as the result of a repression that has failed. We have said this all along, and it is only because of the new context in which we are viewing the subject that it has been necessary to repeat it.

 

¹ ‘Neurosis and Psychosis’ (1924b)5

 

Incidentally, the same objection arises in a specially marked manner when we are dealing with a neurosis in which the exciting cause (the ‘traumatic scene’) is known, and in which one can see how the person concerned turns away from the experience and consigns it to amnesia. Let me go back by way of example to a case analysed a great many years ago,¹ in which the patient, a young woman, was in love with her brother-in-law. Standing beside her sister’s death-bed, she was horrified at having the thought: ‘Now he is free and can marry me.’ This scene was instantly forgotten, and thus the process of regression, which led to her hysterical pains, was set in motion. It is instructive precisely in this case, moreover, to learn along what path the neurosis attempted to solve the conflict. It took away from the value of the change that had occurred in reality, by repressing the instinctual demand which had emerged - that is, her love for her brother-in-law. The psychotic reaction would have been a disavowal of the fact of her sister’s death.

 

We might expect that when a psychosis comes into being, something analogous to the process in a neurosis occurs, though, of course, between different agencies of the mind; thus we might expect that in a psychosis, too, two steps could be discerned, of which the first would drag the ego away, this time from reality, while the second would try to make good the damage done and re-establish the subject’s relations to reality at the expense of the id. And, in fact, some analogy of the sort can be observed in a psychosis. Here, too, there are two steps, the second of which has the character of a reparation. But beyond that the analogy gives way to a far more extensive similarity between the two processes. The second step of the psychosis is indeed intended to make good the loss of reality, not, however, at the expense of a restriction of the id - as happens in neurosis at the expense of the relation to reality - but in another, more autocratic manner, by the creation of a new reality which no longer raises the same objections as the old one that has been given up. The second step, therefore, both in neurosis and psychosis, is supported by the same trends. In both cases it serves the desire for power of the id, which will not allow itself to be dictated to by reality. Both neurosis and psychosis are thus the expression of a rebellion on the part of the id against the external world, of its unwillingness - or, if one prefers, its incapacity - to adapt itself to the exigencies of reality, to ’ÁõÜã÷ç [Necessity]. Neurosis and psychosis differ from each other far more in their first, introductory, reaction than in the attempt at reparation which follows it.

 

¹ In Studies on Hysteria (1895d).6

 

Accordingly, the initial difference is expressed thus in the final outcome: in neurosis a piece of reality is avoided by a sort of flight, whereas in psychosis it is remodelled. Or we might say: in psychosis, the initial flight is succeeded by an active phase of remodelling; in neurosis, the initial obedience is succeeded by a deferred attempt at flight. Or again, expressed in yet another way: neurosis does not disavow the reality, it only ignores it; psychosis disavows it and tries to replace it. We call behaviour ‘normal’ or ‘healthy’, if it combines certain features of both reactions - if it disavows the reality as little as does a neurosis, but if it then exerts itself, as does a psychosis, to effect an alteration of that reality. Of course, this expedient, normal, behaviour leads to work being carried out on the external world; it does not stop, as in psychosis, at effecting internal changes. It is no longer autoplastic but alloplastic.

 

In a psychosis, the transforming of reality is carried out upon the psychical precipitates of former relations to it - that is, upon the memory-traces, ideas and judgements which have been previously derived from reality and by which reality was represented in the mind. But this relation was never a closed one; it was continually being enriched and altered by fresh perceptions. Thus the psychosis is also faced with the task of procuring for itself perceptions of a kind which shall correspond to the new reality; and this is most radically effected by means of hallucination. The fact that, in so many forms and cases of psychosis, the paramnesias, the delusions and the hallucinations that occur are of a most distressing character and are bound up with a generation of anxiety - this fact is without doubt a sign that the whole process of remodelling is carried through against forces which oppose it violently. We may construct the process on the model of a neurosis, with which we are more familiar. There we see that a reaction of anxiety sets in whenever the repressed instinct makes a thrust forward, and that the outcome of the conflict is only a compromise and does not provide complete satisfaction. Probably in a psychosis the rejected piece of reality constantly forces itself upon the mind, just as the repressed instinct does in a neurosis, and that is why in both cases the consequences too are the same. The elucidation of the various mechanisms which are designed, in the psychoses, to turn the subject away from reality and to reconstruct reality - this is a task for specialized psychiatric study which has not yet been taken in hand.

 

There is, therefore, a further analogy between a neurosis and a psychosis, in that in both of them the task which is undertaken in the second step is partly unsuccessful. For the repressed instinct is unable to procure a full substitute (in neurosis); and the representation of reality cannot be remoulded into satisfying forms (not, at least, in every species of mental illness). But the emphasis is different in the two cases. In a psychosis it falls entirely on the first step, which is pathological in itself and cannot but lead to illness. In a neurosis, on the other hand, it falls on the second step, on the failure of the repression, whereas the first step may succeed, and does succeed in innumerable instances without overstepping the bounds of health - even though it does so at a certain price and not without leaving behind traces of the psychical expenditure it has called for. These distinctions, and perhaps many others as well, are a result of the topographical difference in the initial situation of the pathogenic conflict - namely whether in it the ego yielded to its allegiance to the real world or to its dependence on the id.

 

A neurosis usually contents itself with avoiding the piece of reality in question and protecting itself against coming into contact with it. The sharp distinction between neurosis and psychosis, however, is weakened by the circumstance that in neurosis, too, there is no lack of attempts to replace a disagreeable reality by one which is more in keeping with the subject’s wishes. This is made possible by the existence of a world of phantasy, of a domain which became separated from the real external world at the time of the introduction of the reality principle. This domain has since been kept free from the demands of the exigencies of life, like a kind of ‘reservation’; it is not inaccessible to the ego, but is only loosely attached to it. It is from this world of phantasy that the neurosis draws the material for its new wishful constructions, and it usually finds that material along the path of regression to a more satisfying real past.

 

It can hardly be doubted that the world of phantasy plays the same part in psychosis and that there, too, it is the storehouse from which the materials or the pattern for building the new reality are derived. But whereas the new, imaginary external world of a psychosis attempts to put itself in the place of external reality, that of a neurosis, on the contrary, is apt, like the play of children, to attach itself to a piece of reality - a different piece from the one against which it has to defend itself - and to lend that piece a special importance and a secret meaning which we (not always quite appropriately) call a symbolic one. Thus we see that both in neurosis and psychosis there comes into consideration the question not only of a loss of reality but also of a substitute for reality.

 


A SHORT ACCOUNT OF PSYCHO-ANALYSIS (1924)

 

 

Psycho-analysis may be said to have been born with the twentieth century; for the publication in which it emerged before the world as something new - my Interpretation of Dreams - bears the date ‘1900’. But, as may well be supposed, it did not drop from the skies ready-made. It had its starting-point in older ideas, which it developed further; it sprang from earlier suggestions, which it elaborated. Any history of it must therefore begin with an account of the influences which determined its origin and should not overlook the times and circumstances that preceded its creation.

 

Psycho-analysis grew up in a narrowly-restricted field. At the outset, it had only a single aim - that of understanding something of the nature of what were known as the ‘functional’ nervous diseases, with a view to overcoming the impotence which had so far characterized their medical treatment. The neurologists of that period had been brought up to have a high respect for chemico-physical and pathologico-anatomical facts; and they were latterly under the influence of the findings of Hitzig and Fritsch, of Ferrier, Goltz and others, who seemed to have established an intimate and possibly exclusive connection between certain functions and particular parts of the brain. They did not know what to make of the psychical factor and could not understand it. They left it to the philosophers, the mystics and - the quacks; and they considered it unscientific to have anything to do with it. Accordingly they could find no approach to the secrets of the neuroses, and in particular of the enigmatic ‘hysteria’, which was, indeed, the prototype of the whole species. As late as in 1885, when I was studying at the Salpêtrière, I found that people were content to account for hysterical paralyses by a formula which asserted that they were founded on slight functional disturbances of the same parts of the brain which, when they were severely damaged, led to the corresponding organic paralyses.

 

Of course this lack of understanding affected the treatment of these pathological conditions badly as well. In general this consisted in measures designed to ‘harden’ the patient - in the prescription of medicines and in attempts, mostly very ill-contrived and executed in an unfriendly manner, at bringing mental influences to bear on him by threats, jeers and warnings and by exhorting him to make up his mind to ‘pull himself together’. Electrical treatment was given out as being a specific cure for nervous conditions; but anyone who has endeavoured to carry out Erb’s detailed instructions must marvel at the space that phantasy can occupy even in what professes to be an exact science. The decisive turn was taken in the eighties, when the phenomena of hypnotism made one more attempt to find admission to medical science - this time with more success than so often before, thanks to the work of Liébeault, Bernheim, Heidenhain and Forel. The essential thing was that the genuineness of these phenomena was recognized. Once this had been admitted, two fundamental and unforgettable lessons could not fail to be drawn from hypnotism. First, one was given convincing proof that striking somatic changes could after all be brought about solely by mental influences, which in this case one had oneself set in motion. Secondly, one received the clearest impression - especially from the behaviour of subjects after hypnosis - of the existence of mental processes that one could only describe as ‘unconscious’. The ‘unconscious’ had, it is true, long been under discussion among philosophers as a theoretical concept; but now for the first time, in the phenomena of hypnotism, it became something actual, tangible and subject to experiment. Apart from all this, hypnotic phenomena showed an unmistakable similarity to the manifestations of some neuroses.

 

It is not easy to over-estimate the importance of the part played by hypnotism in the history of the origin of psycho-analysis. From a theoretical as well as from a therapeutic point of view, psycho-analysis has at its command a legacy which it has inherited from hypnotism.

Hypnosis also proved a valuable aid in the study of the neuroses - once again, first and foremost, of hysteria. Charcot’s experiments created a great impression. He suspected that certain paralyses which appeared after a trauma (an accident) were of a hysterical nature, and he showed that, by suggesting a trauma under hypnosis, he was able to provoke paralyses of the same sort artificially. The expectation was thus raised that traumatic influences might in all cases play a part in the production of hysterical symptoms. Charcot himself made no further efforts towards a psychological understanding of hysteria; but his pupil, Pierre Janet, took up the question and was able to show, with the help of hypnosis, that the symptoms of hysteria were firmly dependent on certain unconscious thoughts (idées fixes). Janet attributed to hysteria a supposed constitutional incapacity for holding mental processes together - an incapacity which led to a disintegration (dissociation) of mental life.

 

Psycho-analysis, however, was not in any way based on these researches of Janet’s. The decisive factor in its case was the experience of a Viennese physician, Dr. Josef Breuer. In 1881, independently of any outside influence, he was able with the help of hypnosis to study and restore to health a highly-gifted girl who suffered from hysteria. Breuer’s findings were not given to the public until fifteen years later, after he had taken the present writer (Freud) into collaboration. This case of Breuer’s retains its unique significance for our understanding of the neuroses to this day; so that we cannot avoid dwelling on it a little longer. It is essential to realize clearly in what its peculiarity consisted. The girl had fallen ill while she was nursing her father, to whom she was tenderly attached. Breuer was able to establish that all her symptoms were related to this period of nursing and could be explained by it. Thus it had for the first time become possible to obtain a complete view of a case of this puzzling neurosis, and all its symptoms had turned out to have a meaning. Further, it was a universal feature of the symptoms that they had arisen in situations involving an impulse to an action which, however, had not been carried out but had for other reasons been suppressed. The symptoms had, in fact, appeared in place of the actions that were not performed. Thus, to explain the aetiology of hysterical symptoms, we were led to the subject’s emotional life (to affectivity) and to the interplay of mental forces (to dynamics); and since then these two lines of approach have never been dropped.

 

The precipitating causes of the symptoms were compared by Breuer to Charcot’s traumas. Now it was a remarkable fact that all these traumatic precipitating causes, and all the mental impulses starting from them, were lost to the patient’s memory, as though they had never happened; while their products - the symptoms - persisted unaltered, as though, so far as they were concerned, there was no such thing as the effacing effect of time. Here, therefore, we had a fresh proof of the existence of mental processes which were unconscious but for that very reason especially powerful - processes which we had first come to know in post-hypnotic suggestion. The therapeutic procedure adopted by Breuer was to induce the patient, under hypnosis, to remember the forgotten traumas and to react to them with powerful expressions of affect. When this had been done, the symptom, which had till then taken the place of these expressions of emotion, disappeared. Thus one and the same procedure served simultaneously the purposes of investigating and of getting rid of the ailment; and this unusual conjunction was later retained in psycho-analysis.

 

After the present writer had, during the early nineties, confirmed Breuer’s results in a considerable number of patients, the two, Breuer and Freud, together decided on a publication, Studies on Hysteria (1895d), which contained their findings and an attempt at a theory based on them. This asserted that hysterical symptoms arose when the affect of a mental process cathected with a strong affect was forcibly prevented from being worked over consciously in the normal way and was thus diverted into a wrong path. In cases of hysteria, according to this theory, the affect passed over into an unusual somatic innervation (‘conversion’), but could be given another direction and got rid of (‘abreacted’), if the experience were revived under hypnosis. The authors gave this procedure the name of ‘catharsis’ (purging, setting free of a strangulated affect).

 

The cathartic method was the immediate precursor of psycho-analysis; and, in spite of every extension of experience and of every modification of theory, is still contained within it as its nucleus. But it was no more than a new medical procedure for influencing certain nervous diseases, and nothing suggested that it might become a subject for the most general interest and for the most violent contradiction.5

 

II

 

Soon after the publication of Studies on Hysteria the partnership between Breuer and Freud came to an end. Breuer, who was in reality a consultant in internal medicine, gave up treating nervous patients, and Freud devoted himself to the further perfection of the instrument left over to him by his elder collaborator. The technical novelties which he introduced and the discoveries which he made changed the cathartic method into psycho-analysis. The most momentous step, no doubt, was his determination to do without the assistance of hypnosis in his technical procedure. He did so for two reasons: first, because, in spite of a course of instruction with Bernheim at Nancy, he did not succeed in inducing hypnosis in a sufficient number of cases, and secondly, because he was dissatisfied with the therapeutic results of catharsis based on hypnosis. It is true that these results were striking and appeared after a treatment of short duration, but they turned out not to be permanent and to depend too much on the patient’s personal relations with the physician. The abandonment of hypnosis made a breach in the course of development of the procedure up to then, and it meant a fresh start.

 

Hypnosis had, however, performed the service of restoring to the patient’s memory what he had forgotten. It was necessary to find some other technique to replace it; and the idea occurred to Freud of substituting for it the method of ‘free association’. That is to say, he pledged his patients to refrain from any conscious reflection and to abandon themselves, in a state of quiet concentration, to following the ideas which occurred to them spontaneously (involuntarily) - ‘to skim off the surface of their consciousness’. They were to communicate these ideas to the physician even if they felt objections to doing so, if, for instance, the thoughts seemed too disagreeable, too senseless, too unimportant or irrelevant. The choice of free association as a means of investigating the forgotten unconscious material seems so strange that a word in justification of it will not be out of place. Freud was led to it by an expectation that the so-called ‘free’ association would prove in fact to be unfree, since, when all conscious intellectual purposes had been suppressed, the ideas that emerged would be seen to be determined by the unconscious material. This expectation was justified by experience. When the ‘fundamental rule of psycho-analysis’ which has just been stated was obeyed, the course of free association produced a plentiful store of ideas which could put one on the track of what the patient had forgotten. To be sure, this material did not bring up what had actually been forgotten, but it brought up such plain and numerous hints at it that, with the help of a certain amount of supplementing and interpreting, the doctor was able to guess (to reconstruct) the forgotten material from it. Thus free association together with the art of interpretation performed the same function as had previously been performed by hypnotism.

 

It looked as though our work had been made much more difficult and complicated; but the inestimable gain was that an insight was now obtained into an interplay of forces which had been concealed from the observer by the hypnotic state. It became evident that the work of uncovering what had been pathogenically forgotten had to struggle against a constant and very intense resistance. The critical objections which the patient raised in order to avoid communicating the ideas which occurred to him, and against which the fundamental rule of psycho-analysis was directed, had themselves already been manifestations of this resistance. A consideration of the phenomena of resistance led to one of the corner-stones of the psycho-analytic theory of the neuroses - the theory of repression. It was plausible to suppose that the same forces which were now struggling against the pathogenic material being made conscious had at an earlier time made the same efforts with success. A gap in the aetiology of neurotic symptoms was thus filled. The impressions and mental impulses, for which the symptoms were now serving as substitutes, had not been forgotten without reason or on account of a constitutional in capacity for synthesis (as Janet supposed); they had, though the influence of other mental forces, met with a repression the success and evidence of which was precisely their being debarred from consciousness and excluded from memory. It was only in consequence of this repression that they had become pathogenic - that is, had succeeded in manifesting themselves along unusual paths as symptoms.

 

A conflict between two groups of mental trends had to be looked on as the ground for repression and accordingly as the cause of every neurotic illness. And here experience taught us a new and surprising fact about the nature of the forces that were struggling against each other. Repression invariably proceeded from the sick person’s conscious personality (his ego) and took its stand on aesthetic and ethical motives; the impulses that were subjected to repression were those of selfishness and cruelty, which can be summed up in general as evil, but above all sexual wishful impulses, often of the crudest and most forbidden kind. Thus the symptoms were a substitute for forbidden satisfactions and the illness seemed to correspond to an incomplete subjugation of the immoral side of human beings.

 

Advance in knowledge made ever clearer the enormous part played in mental life by sexual wishful impulses, and led to a detailed study of the nature and development of the sexual instinct.¹ But we also came upon another purely empirical finding, in the discovery that the experiences and conflicts of the first years of childhood play an unsuspectedly important part in the individual’s development and leave behind them ineffaceable dispositions bearing upon the period of maturity. This led to the revelation of something that had hitherto been fundamentally overlooked by science - infantile sexuality, which, from the tenderest age onwards, is manifested both in physical reactions and in mental attitudes. In order to bring together this sexuality of children with what is described as the normal sexuality of adults and the abnormal sexual life of perverts, the concept of what was sexual had itself to be corrected and widened in a manner which could be justified by the evolution of the sexual instinct.

 

After hypnosis was replaced by the technique of free association, Breuer’s cathartic procedure turned into psycho-analysis, which for more than a decade was developed by the author (Freud) alone. During that time psycho-analysis gradually acquired a theory which appeared to give a satisfactory account of the origin, meaning and purpose of neurotic symptoms and provided a rational basis for medical attempts at curing the complaint. I will once again enumerate the factors that go to make up this theory. They are: emphasis on instinctual life (affectivity), on mental dynamics, on the fact that even the apparently most obscure and arbitrary mental phenomena invariably have a meaning and a causation, the theory of psychical conflict and of the pathogenic nature of repression, the view that symptoms are substitutive satisfactions, the recognition of the aetiological importance of sexual life, and in particular of the beginnings of infantile sexuality. From a philosophical standpoint this theory was bound to adopt the view that the mental does not coincide with the conscious, that mental processes are in themselves unconscious and are only made conscious by the functioning of special organs (agencies or systems). By way of completing this list, I will add that among the affective attitudes of childhood the complicated emotional relation of children to their parents - what is known as the Oedipus complex - came into prominence. It became ever clearer that this was the nucleus of every case of neurosis, and in the patient’s behaviour towards his analyst certain phenomena of his emotional transference emerged which came to be of great importance for theory and technique alike.

 

¹ Freud, Three Essays on the Theory of Sexuality (1905d)8

 

In the form which it thus assumed, the psycho-analytic theory of the neuroses already contained a number of things which ran counter to accepted opinions and inclinations and which were calculated to provoke astonishment, repugnance and scepticism in outsiders: for instance, the attitude of psycho-analysis to the problem of the unconscious, its recognition of an infantile sexuality and the stress it laid on the sexual factor in mental life generally. But more was to follow.III




Поделиться с друзьями:


Дата добавления: 2014-12-23; Просмотров: 388; Нарушение авторских прав?; Мы поможем в написании вашей работы!


Нам важно ваше мнение! Был ли полезен опубликованный материал? Да | Нет



studopedia.su - Студопедия (2013 - 2024) год. Все материалы представленные на сайте исключительно с целью ознакомления читателями и не преследуют коммерческих целей или нарушение авторских прав! Последнее добавление




Генерация страницы за: 0.049 сек.