Autobiographical note 74 страница

In 1896, shortly after the appearance of my Studies on Hysteria (written in conjunction with Dr. J. Breuer, 1895), I asked an eminent fellow-specialist for his opinion on the psychological theory of hysteria put forward in that work. He bluntly replied that he considered it an unjustifiable generalization of conclusions which might hold good for a few cases. Since then I have seen an abundance of cases of hysteria, and I have been occupied with each case for a number of days, weeks, or years. In not a single one of them have I failed to discover the psychological determinants which were postulated in the Studies, namely, a psychical trauma, a conflict of affects, and an additional factor which I brought forward in later publications - a disturbance in the sphere of sexuality. It is of course not to be expected that the patient will come to meet the physician half-way with material which has become pathogenic for the very reason of its efforts to lie concealed; nor must the enquirer rest content with the first ‘No’ that crosses his path.¹

¹ Here is an instance of this. Another physician in Vienna, whose conviction of the unimportance of sexual factors in hysteria has probably been very much strengthened by such experiences as this, was consulted in the case of a fourteen-year-old girl who suffered from dangerous hysterical vomiting. He made up his mind to ask her the painful question whether by any chance she had ever had a love-affair with a man. ‘No!’ answered the child, no doubt with well-affected astonishment; and then repeated to her mother in her irreverent way: ‘Only fancy! the old stupid asked me if I was in love!’ She afterwards came to me for treatment, and proved - though not during our very first conversation, to be sure - to have been a masturbator for many years, with a considerable leucorrhoeal discharge (which had a close bearing on her vomiting). She had finally broken herself of the habit, but was tormented in her abstinence by the most acute sense of guilt, so that she looked upon every misfortune that befell her family as a divine punishment for her transgression. Besides this, she was under the influence of the romance of an unmarried aunt, whose pregnancy (a second determinant for her vomiting) was supposed to have been happily hidden from her. The girl was looked upon as a ‘mere child,’ but she turned out to be initiated into all the essentials of sexual relations.

5 In Dora’s case, thanks to her father’s shrewdness which I have remarked upon more than once already, there was no need for me to look about for the points of contact between the circumstances of the patient’s life and her illness, at all events in its most recent form. Her father told me that he and his family while they were at B-- had formed an intimate friendship with a married couple who had been settled there for several years. Frau K. had nursed him during his long illness, and had in that way, he said, earned a title to his undying gratitude. Herr K. had always been most kind to Dora. He had gone walks with her when he was there, and had made her small presents; but no one had thought any harm of that. Dora had taken the greatest care of the K.’s two little children, and been almost a mother to them. When Dora and her father had come to see me two years before in the summer, they had been just on their way to stop with Herr and Frau K., who were spending the summer on one of our lakes in the Alps. Dora was to have spent several weeks at the K.’s, while her father had intended to return home after a few days. During that time Herr K. had been staying there as well. As her father was preparing for his departure the girl had suddenly declared with the greatest determination that she was going with him, and she had in fact put her decision into effect. It was not until some days later that she had thrown any light upon her strange behaviour. She had then told her mother - intending that what she said should be passed on to her father - that Herr K. had had the audacity to make her a proposal while they were on a walk after a trip upon the lake. Herr K. had been called to account by her father and uncle on the next occasion of their meeting, but he had denied in the most emphatic terms having on his side made any advances which could have been open to such a construction. He had then proceeded to throw suspicion upon the girl, saying that he had heard from Frau K. that she took no interest in anything but sexual matters, and that she used to read Mantegazza’s Physiology of Love and books of that sort in their house on the lake. It was most likely, he had added, that she had been over-excited by such reading and had merely ‘fancied’ the whole scene she had described.

‘I have no doubt’, continued her father, ‘that this incident is responsible for Dora’s depression and irritability and suicidal ideas. She keeps pressing me to break off relations with Herr K. and more particularly with Frau K., whom she used positively to worship formerly. But that I cannot do. For, to begin with, I myself believe that Dora’s tale of the man’s immoral suggestions is a phantasy that has forced its way into her mind; and besides, I am bound to Frau K. by ties of honourable friendship and I do not wish to cause her pain. The poor woman is most unhappy with her husband, of whom, by the way, I have no very high opinion. She herself has suffered a great deal with her nerves, and I am her only support. With my state of health I need scarcely assure you that there is nothing wrong in our relations. We are just two poor wretches who give one another what comfort we can by an exchange of friendly sympathy. You know already that I get nothing out of my own wife. But Dora, who inherits my obstinacy, cannot be moved from her hatred of the K.’s. She had her last attack after a conversation in which she had again pressed me to break with them. Please try and bring her to reason.’

Her father’s words did not always quite tally with this pronouncement; for on other occasions he tried to put the chief blame for Dora’s impossible behaviour on her mother whose peculiarities made the house unbearable for every one. But I had resolved from the first to suspend my judgement of the true state of affairs till I had heard the other side as well.7 The experience with Herr K. - his making love to her and the insult to her honour which was involved - seems to provide in Dora’s case the psychical trauma which Breuer and I declared long ago to be the indispensable prerequisite for the production of a hysterical disorder. But this new case also presents all the difficulties which have since led me to go beyond that theory,¹ besides an additional difficulty of a special kind. For, as so often happens in histories of cases of hysteria, the trauma that we know of as having occurred in the patient’s past life is insufficient to explain or to determine the particular character of the symptoms; we should understand just as much or just as little of the whole business if the result of the trauma had been symptoms quite other than tussis nervosa, aphonia, depression, and taedium vitae. But there is the further consideration that some of these symptoms (the cough and the loss of voice) had been produced by the patient years before the time of the trauma, and that their earliest appearances belong to her childhood, since they occurred in her eighth year. If, therefore, the trauma theory is not to be abandoned, we must go back to her childhood and look about there for any influences or impressions which might have had an effect analogous to that of a trauma. Moreover, it deserves to be remarked that in the investigation even of cases in which the first symptoms had not already set in childhood I have been driven to trace back the patients’ life history to their earliest years.²

¹ I have gone beyond that theory, but I have not abandoned it; that is to say, I do not to-day consider the theory incorrect, but incomplete. All that I have abandoned is the emphasis laid upon the so-called ‘hypnoid state’, which was supposed to be occasioned in the patient by the trauma, and to be the foundation for all the psychologically abnormal events which followed. If, where a piece of joint work is in question, it is legitimate to make a subsequent division of property, I should like to take this opportunity of stating that the hypothesis of ‘hypnoid states’ - which many reviewers were inclined to regard as the central portion of our work - sprang entirely from the initiative of Breuer. I regard the use of such a term as superfluous and misleading, because it interrupts the continuity of the problem as to the nature of the psychological process accompanying the formation of hysterical symptoms.

² Cf. my paper on ‘The Aetiology of Hysteria’ (1896c).8

When the first difficulties of the treatment had been overcome, Dora told me of an earlier episode with Herr K., which was even better calculated to act as a sexual trauma. She was fourteen years old at the time. Herr K. had made an arrangement with her and his wife that they should meet him one afternoon at his place of business in the principal square of B-- so as to have a view of a church festival. He persuaded his wife, however, to stay at home, and sent away his clerks, so that he was alone when the girl arrived. When the time for the procession approached, he asked the girl to wait for him at the door which opened on to the staircase leading to the upper story, while he pulled down the outside shutters. He then came back, and, instead of going out by the open door, suddenly clasped the girl to him and pressed a kiss upon her lips. This was surely just the situation to call up a distinct feeling of sexual excitement in a girl of fourteen who had never before been approached. But Dora had at that moment a violent feeling of disgust, tore herself free from the man, and hurried past him to the staircase and from there to the street door. She nevertheless continued to meet Herr K. Neither of them ever mentioned the little scene; and according to her account Dora kept it a secret till her confession during the treatment. For some time afterwards, however, she avoided being alone with Herr K. The K.’s had just made plans for an expedition which was to last for some days and on which Dora was to have accompanied them. After the scene of the kiss she refused to join the party, without giving any reason.

In this scene - second in order of mention, but first in order of time - the behaviour of this child of fourteen was already entirely and completely hysterical. I should without question consider a person hysterical in whom an occasion for sexual excitement elicited feelings that were preponderantly or exclusively unpleasurable; and I should do so whether or no the person were capable of producing somatic symptoms. The elucidation of the mechanism of this reversal of affect is one of the most important and at the same time one of the most difficult problems in the psychology of the neuroses. In my own judgement I am still some way from having achieved this end; and I may add that within the limits of the present paper I shall be able to bring forward only a part of such knowledge on the subject as I do possess.

In order to particularize Dora’s case it is not enough merely to draw attention to the reversal of affect; there has also been a displacement of sensation. Instead of the genital sensation which would certainly have been felt by a healthy girl in such circumstances,¹ Dora was overcome by the unpleasurable feeling which is proper to the tract of mucous membrane at the entrance to the alimentary canal - that is by disgust. The stimulation of her lips by the kiss was no doubt of importance in localizing the feeling at that particular place; but I think I can also recognize another factor in operation.²

The disgust which Dora felt on that occasion did not become a permanent symptom, and even at the time of the treatment it was only, as it were, potentially present. She was a poor eater and confessed to some disinclination for food. On the other hand, the scene had left another consequence behind it in the shape of a sensory hallucination which occurred from time to time and even made its appearance while she was telling me her story. She declared that she could still feel upon the upper part of her body the pressure of Herr K.’s embrace. In accordance with certain rules of symptom-formation which I have come to know, and at the same time taking into account certain other of the patient’s peculiarities, which were otherwise inexplicable, - such as her unwillingness to walk past any man whom she saw engaged in eager or affectionate conversation with a lady, - I have formed in my own mind the following reconstruction of the scene. I believe that during the man’s passionate embrace she felt not merely his kiss upon her lips but also the pressure of his erect member against her body. This perception was revolting to her; it was dismissed from her memory, repressed, and replaced by the innocent sensation of pressure upon her thorax, which in turn derived an excessive intensity from its repressed source. Once more, therefore, we find a displacement from the lower part of the body to the upper.³ On the other hand, the compulsive piece of behaviour which I have mentioned was formed as though it were derived from the undistorted recollection of the scene: she did not like walking past any man who she thought was in a state of sexual excitement, because she wanted to avoid seeing for a second time the somatic sign which accompanies it.

¹ Our appreciation of these circumstances will be facilitated when more light has been thrown upon them.

² The causes of Dora’s disgust at the kiss were certainly not adventitious, for in that case she could not have failed to remember and mention them. I happen to know Herr K., for he was the same person who had visited me with the patient’s father, and he was still quite young and of prepossessing appearance.

³ The occurrence of displacements of this kind has not been assumed for the purpose of this single explanation; the assumption has proved indispensable for the explanation of a large class of symptoms. Since treating Dora I have come across another instance of an embrace (this time without a kiss) causing a fright. It was a case of a young woman who had previously been devotedly fond of the man she was engaged to, but had suddenly begun to feel a coldness towards him, accompanied by severe depression, and on that account came to me for treatment. There was no difficulty in tracing the fright back to an erection on the man’s part, which she had perceived but had dismissed from her consciousness.

It is worth remarking that we have here three symptoms - the disgust, the sensation of pressure on the upper part of the body, and the avoidance of men engaged in affectionate conversation - all of them derived from a single experience, and that it is only by taking into account the interrelation of these three phenomena that we can understand the way in which the formation of the symptoms came about. The disgust is the symptom of repression in the erotogenic oral zone, which, as we shall hear, had been over-indulged in Dora’s infancy by the habit of sensual sucking. The pressure of the erect member probably led to an analogous change in the corresponding female organ, the clitoris; and the excitation of this second erotogenic zone was referred by a process of displacement to the simultaneous pressure against the thorax and became fixed there. Her avoidance of men who might possibly be in a state of sexual excitement follows the mechanism of a phobia, its purpose being to safeguard her against any revival of the repressed perception.

In order to show that such a supplement to the story was possible, I questioned the patient very cautiously as to whether she knew anything of the physical signs of excitement in a man’ body. Her answer, as touching the present, was ‘Yes’, but, as touching the time of the episode, ‘I think not’. From the very beginning I took the greatest pains with this patient not to introduce her to any fresh facts in the region of sexual knowledge; and I did this, not from any conscientious motives, but because I was anxious to subject my assumptions to a rigorous test in this case. Accordingly, I did not call a thing by its name until her allusions to it had become so unambiguous that there seemed very slight risk in translating them into direct speech. Her answer was always prompt and frank: she knew about it already. But the question of where her knowledge came from was a riddle which her memories were unable to solve. She had forgotten the source of all her information on this subject.¹

If I may suppose that the scene of the kiss took place in this way, I can arrive at the following derivation for the feelings of disgust.² Such feelings seem originally to be a reaction to the smell (and afterwards also to the sight) of excrement. But the genitals can act as a reminder of the excretory functions; and this applies especially to the male member, for that organ performs the function of micturition as well as the sexual function. Indeed, the function of micturition is the earlier known of the two, and the only one known during the pre-sexual period. Thus it happens that disgust becomes one of the means of affective expression in the sphere of sexual life. The Early Christian Father’s ‘inter urinas et faeces nascimur’ clings to sexual life and cannot be detached from it in spite of every effort at idealization. I should like, however, expressly to emphasize my opinion that the problem is not solved by the mere pointing out of this path of association. The fact that this association can be called up does not show that it actually will be called up. And indeed in normal circumstances it will not be. A knowledge of the paths does not render less necessary a knowledge of the forces which travel along them.³

¹ See the second dream.

² Here, as in all similar cases, the reader must be prepared to be met not by one but by several causes - by overdetermination.

³ All these discussions contain much that is typical and valid for hysteria in general. The subject of erection solves some of the most interesting hysterical symptoms. The attention that women pay to the outlines of men’s genitals as seen through their clothing becomes, when it has been repressed, a source of the very frequent cases of avoiding company and of dreading society. - It is scarcely possible to exaggerate the pathogenic significance of the comprehensive tie uniting the sexual and the excremental, a tie which is at the basis of a very large number of hysterical phobias.

1 I did not find it easy, however, to direct the patient’s attention to her relations with Herr K. She declared that she had done with him. The uppermost layer of all her associations during the sessions, and everything of which she was easily conscious and of which she remembered having been conscious the day before, was always connected with her father. It was quite true that she could not forgive her father for continuing his relations with Herr K. and more particularly with Frau K. But she viewed those relations in a very different light from that in which her father wished them to appear. In her mind there was no doubt that what bound her father to this young and beautiful woman was a common love-affair. Nothing that could help to confirm this view had escaped her perception, which in this connection was pitilessly sharp; here there were no gaps to be found in her memory. Their acquaintance with the K.’s had begun before her father’s serious illness; but it had not become intimate until the young woman had officially taken on the position of nurse during that illness, while Dora’s mother had kept away from the sick-room. During the first summer holidays after his recovery things had happened which must have opened everyone’s eyes to the true character of this ‘friendship’. The two families had taken a suite of rooms in common at the hotel. One day Frau K. had announced that she could not keep the bedroom which she had up till then shared with one of her children. A few days later Dora’s father had given up his bedroom, and they had both moved into new rooms - the end rooms, which were only separated by the passage, while the rooms they had given up had not offered any such security against interruption. Later on, whenever she had reproached her father about Frau K., he had been in the habit of saying that he could not understand her hostility and that, on the contrary, his children had every reason for being grateful to Frau K. Her mother, whom she had asked for an explanation of this mysterious remark, had told her that her father had been so unhappy at that time that he had made up his mind to go into the wood and kill himself, and that Frau K., suspecting as much, had gone after him and had persuaded him by her entreaties to preserve his life for the sake of his family. Of course, Dora went on, she herself did not believe this story; no doubt the two of them had been seen together in the wood, and her father had thereupon invented this fairy tale of his suicide so as to account for their rendezvous.¹

When they had returned to B--, her father had visited Frau K. every day at definite hours, while her husband was at his business. Everybody had talked about it and had questioned her about it pointedly. Herr K. himself had often complained bitterly to her mother, though he had spared her herself any allusions to the subject - which she seemed to attribute to delicacy of feeling on his part. When they had all gone for walks together, her father and Frau K. had always known how to manage things so as to be alone with each other. There could be no doubt that she had taken money from him, for she spent more than she could possibly have afforded out of her own purse or her husband’s. Dora added that her father had begun to make handsome presents to Frau K., and in order to make these less conspicuous had at the same time become especially liberal towards her mother and herself. And, while previously Frau K. had been an invalid and had even been obliged to spend months in a sanatorium for nervous disorders because she had been unable to walk, she had now become a healthy and lively woman.

¹ This is the point of connection with her own pretence at suicide, which may thus be regarded as the expression of a longing for a love of the same kind.2

Even after they had left B-- for the manufacturing town, these relations, already of many years’ standing, had been continued. From time to time her father used to declare that he could not endure the rawness of the climate, and that he must do something for himself; he would begin to cough and complain, until suddenly he would start off to B--, and from there write the most cheerful letters home. All these illnesses had only been pretexts for seeing his friend again. Then one day it had been decided that they were to move to Vienna and Dora began to suspect a hidden connection. And sure enough, they had scarcely been three weeks in Vienna when she heard that the K.’s had moved there as well. They were in Vienna, so she told me, at that very moment, and she frequently met her father with Frau K. in the street. She also met Herr K. very often, and he always used to turn round and look after her; and once when he had met her out by herself he had followed her for a long way, so as to make sure where she was going and whether she might not have a rendezvous.

On one occasion during the course of the treatment her father again felt worse, and went off to B-- for several weeks; and the sharp-sighted Dora had soon unearthed the fact that Frau K. had started off to the same place on a visit to her relatives there. It was at this time that Dora’s criticisms of her father were the most frequent: he was insincere, he had a strain of falseness in his character, he only thought of his own enjoyment, and he had a gift for seeing things in the light which suited him best.

I could not in general dispute Dora’s characterization of her father; and there was one particular respect in which it was easy to see that her reproaches were justified. When she was feeling embittered she used to be overcome by the idea that she had been handed over to Herr K. as the price of his tolerating the relations between her father and his wife; and her rage at her father’s making such a use of her was visible behind her affection for him. At other times she was quite well aware that she had been guilty of exaggeration in talking like this. The two men had of course never made a formal agreement in which she was treated as an object for barter; her father in particular would have been horrified at any such suggestion. But he was one of those men who know how to evade a dilemma by falsifying their judgement upon one of the conflicting alternatives. If it had been pointed out to him that there might be danger for a growing girl in the constant and unsupervised companionship of a man who had no satisfaction from his own wife, he would have been certain to answer that he could rely upon his daughter, that a man like K. could never be dangerous to her, and that his friend was himself incapable of such intentions, or that Dora was still a child and was treated as a child by K. But as a matter of fact things were in a position in which each of the two men avoided drawing any conclusions from the other’s behaviour which would have been awkward for his own plans. It was possible for Herr K. to send Dora flowers every day for a whole year while he was in the neighbourhood, to take every opportunity of giving her valuable presents, and to spend all his spare time in her company, without her parents noticing anything in his behaviour that was characteristic of love-making.

3 When a patient brings forward a sound and incontestable train of argument during psycho-analytic treatment, the physician is liable to feel a moment’s embarrassment, and the patient may take advantage of it by asking: ‘This is all perfectly correct and true, isn’t it? What do you want to change in now that I’ve told it you?’ But it soon becomes evident that the patient is using thoughts of this kind, which the analysis cannot attack, for the purpose of cloaking others which are anxious to escape from criticism and from consciousness. A string of reproaches against other people leads one to suspect the existence of a string of self-reproaches with the same content. All that need be done is to turn back each particular reproach on to the speaker himself. There is something undeniably automatic about this method of defending oneself against a self-reproach by making the same reproach against some one else. A model of it is to be found in the tu quoque arguments of children; if one of them is accused of being a liar, he will reply without an instant’s hesitation: ‘You’re another.’ A grown-up person who wanted to throw back abuse would look for some really exposed spot in his antagonist and would not necessarily lay the chief stress upon the same content being repeated. In paranoia the projection of a reproach on to another person without any alteration in its content and therefore without any consideration for reality becomes manifest as the process of forming delusions.

Dora’s reproaches against her father had a ‘lining’ or ‘backing’ of self-reproaches of this kind with a corresponding content in every case, as I shall show in detail. She was right in thinking that her father did not wish to look too closely into Herr K.’s behaviour to his daughter, for fear of being disturbed in his own love-affair with Frau K. But Dora herself had done precisely the same thing. She had made herself an accomplice in the affair, and had dismissed from her mind every sign which tended to show its true character. It was not until after her adventure by the lake that her eyes were opened and that she began to apply such a severe standard to her father. During all the previous years she had given every possible assistance to her father’s relations with Frau K. She would never go to see her if she thought her father was there; but, knowing that in that case the children would have been sent out, she would turn her steps in a direction where she would be sure to meet them, and would go for a walk with them. There had been some one in the house who had been anxious at an early stage to open her eyes to the nature of her father’s relations with Frau K., and to induce her to take sides against her. This was her last governess, an unmarried woman, no longer young, who was well-read and of advanced views.¹ The teacher and her pupil were for a while upon excellent terms, until suddenly Dora became hostile to her and insisted on her dismissal. So long as the governess had any influence she used it for stirring up feeling against Frau K. She explained to Dora’s mother that it was incompatible with her dignity to tolerate such an intimacy between her husband and another woman; and she drew Dora’s attention to all the obvious features of their relations. But her efforts were in vain. Dora remained devoted to Frau K. and would hear of nothing that might make her think ill of her relations with her father. On the other hand she very easily fathomed the motives by which her governess was actuated. She might be blind in one direction, but she was sharp-sighted enough in the other. She saw that the governess was in love with her father. When he was there, she seemed to be quite another person: at such times she could be amusing and obliging. While the family were living in the manufacturing town and Frau K. was not on the horizon, her hostility was directed against Dora’s mother, who was then her more immediate rival. Up to this point Dora bore her no ill-will. She did not become angry until she observed that she herself was a subject of complete indifference to the governess, whose pretended affection for her was really meant for her father. While her father was away from the manufacturing town the governess had no time to spare for her, would not go for walks with her, and took no interest in her studies. No sooner had her father returned from B-- than she was once more ready with every sort of service and assistance. Thereupon Dora dropped her.

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