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Autobiographical note 78 страница




 

I then understood that behind the train of thought in which she brought these open accusations against her father there lay concealed as usual a self-accusation. I met her half-way by assuring her that in my view the occurrence of leucorrhoea in young girls pointed primarily to masturbation, and I considered that all the other causes which were commonly assigned to that complaint were put in the background by masturbation.¹ I added that she was now on the way to finding an answer to her own question of why it was that precisely she had fallen ill - by confessing that she had masturbated, probably in childhood. Dora denied flatly that she could remember any such thing. But a few days later she did something which I could not help regarding as a further step towards the confession. For on that day she wore at her waist - a thing she never did on any other occasion before or after - a small reticule of a shape which had just come into fashion; and, as she lay on the sofa and talked, she kept playing with it - opening it, putting a finger into it, shutting it again, and so on. I looked on for some time, and then explained to her the nature of a ‘symptomatic act’.² I give the name of symptomatic acts to those acts which people perform, as we say, automatically, unconsciously, without attending to them, or as if in a moment of distraction. They are actions to which people would like to deny any significance, and which, if questioned about them, they would explain as being indifferent and accidental. Closer observation, however, will show that these actions, about which consciousness knows nothing or wishes to know nothing, in fact give expression to unconscious thoughts and impulses, and are therefore most valuable and instructive as being manifestations of the unconscious which have been able to come to the surface. There are two sorts of conscious attitudes possible towards these symptomatic acts. If we can ascribe inconspicuous motives to them we recognize their existence; but if no such pretext can be found for conscious use we usually fail altogether to notice that we have performed them. Dora found no difficulty in producing a motive: ‘Why should I not wear a reticule like this, as it is now the fashion to do?’ But a justification of this kind does not dismiss the possibility of the action in question having an unconscious origin. Though on the other hand the existence of such an origin and the meaning attributed to the act cannot be conclusively established. We must content ourselves with recording the fact that such a meaning fits in quite extraordinarily well with the situation as a whole and with the programme laid down by the unconscious.

 

¹ [Footnote added 1923:] This is an extreme view which I should no longer maintain to-day.

² See my Psychopathology of Everyday Life, 1901b.4

 

On some other occasion I will publish a collection of these symptomatic acts as they are to be observed in the healthy and in neurotics. They are sometimes very easy to interpret. Dora’s reticule, which came apart at the top in the usual way, was nothing but a representation of the genitals, and her playing with it, her opening it and putting her finger in it, was an entirely unembarrassed yet unmistakable pantomimic announcement of what she would like to do with them - namely, to masturbate. A very entertaining episode of a similar kind occurred to me a short time ago. In the middle of a session the patient - a lady who was no longer young - brought out a small ivory box, ostensibly in order to refresh herself with a sweet. She made some efforts to open it, and then handed it to me so that I might convince myself how hard it was to open. I expressed my suspicion that the box must mean something special, for this was the very first time I had seen it, although its owner had been coming to me for more than a year. To this the lady eagerly replied: ‘I always have this box about me; I take it with me wherever I go.’ She did not calm down until I had pointed out to her with a laugh how well her words were adapted to quite another meaning. The box - Dose, ðýîéò -, like the reticule and the jewel-case, was once again only a substitute for the shell of Venus, for the female genitals.

 

There is a great deal of symbolism of this kind in life, but as a rule we pass it by without heeding it. When I set myself the task of bringing to light what human beings keep hidden within them, not by the compelling power of hypnosis, but by observing what they say and what they show, I thought the task was a harder one than it really is. He that has eyes to see and ears to hear may convince himself that no mortal can keep a secret. If his lips are silent, he chatters with his finger-tips; betrayal oozes out of him at every pore. And thus the task of making conscious the most hidden recesses of the mind is one which it is quite possible to accomplish.

 

Dora’s symptomatic act with the reticule did not immediately precede the dream. She started the session which brought us the narrative of the dream with another symptomatic act. As I came into the room in which she was waiting she hurriedly concealed a letter which she was reading. I naturally asked her whom the letter was from, and at first she refused to tell me. Something then came out which was a matter of complete indifference and had no relation to the treatment. It was a letter from her grandmother, in which she begged Dora to write to her more often. I believe that Dora only wanted to play ‘secrets’ with me, and to hint that she was on the point of allowing her secret to be torn from her by the doctor. I was then in a position to explain her antipathy to every new doctor. She was afraid lest he might arrive at the foundation of her illness, either by examining her and discovering her catarrh, or by questioning her and eliciting the fact of her addiction to bed-wetting - lest he might guess, in short, that she had masturbated. And afterwards she would speak very contemptuously of the doctor whose perspicacity she had evidently over-estimated beforehand.

 

The reproaches against her father for having made her ill, together with the self-reproach underlying them, the leucorrhoea, the playing with the reticule, the bed-wetting after her sixth year, the secret which she would not allow the doctors to tear from her - the circumstantial evidence of her having masturbated in childhood seems to me complete and without a flaw. In the present case I had begun to suspect the masturbation when she had told me of her cousin’s gastric pains, and had then identified herself with her by complaining for days together of similar painful sensations. It is well known that gastric pains occur especially often in those who masturbate. According to a personal communication made to me by Wilhelm Fliess, it is precisely gastralgias of this character which can be interrupted by an application of cocaine to the ‘gastric spot’ discovered by him in the nose, and which can be cured by the cauterization of the same spot. In confirmation of my suspicion Dora gave me two facts from her conscious knowledge: she herself had frequently suffered from gastric pains, and she had good reasons for believing that her cousin was a masturbator. It is a very common thing for patients to recognize in other people a connection which, on account of their emotional resistances, they cannot perceive in themselves. And, indeed, Dora no longer denied my supposition, although she still remembered nothing. Even the date which she assigned to the bed-wetting, when she said that it lasted ‘till a short time before the appearance of the nervous asthma’, appears to me to be of clinical significance. Hysterical symptoms hardly ever appear so long as children are masturbating, but only afterwards, when a period of abstinence has set in;¹ they form a substitute for masturbatory satisfaction, the desire for which continues to persist in the unconscious until another and more normal kind of satisfaction appears - where that is still attainable. For upon whether it is still attainable or not depends the possibility of a hysteria being cured by marriage and normal sexual intercourse. But if the satisfaction afforded in marriage is again removed - as it may be owing to coitus interruptus, psychological estrangement, or other causes - then the libido flows back again into its old channel and manifests itself once more in hysterical symptoms.

 

¹ This is also true in principle of adults; but in their case a relative abstinence, a diminution in the amount of masturbation, is a sufficient cause, so that, if the libido is very strong, hysteria and masturbation may be simultaneously present.6

 

I should like to be able to add some definite information as to when and under what particular influence Dora gave up masturbating; but owing to the incompleteness of the analysis I have only fragmentary material to present. We have heard that the bed-wetting lasted until shortly before she first fell ill with dyspnoea. Now the only light she was able to throw upon this first attack was that at the time of its occurrence her father was away from home for the first time since his health had improved. In this small recollection there must be a trace of an allusion to the aetiology of the dyspnoea. Dora’s symptomatic acts and certain other signs gave me good reasons for supposing that the child, whose bedroom had been next door to her parents’, had overheard her father in his wife’s room at night and had heard him (for he was always short of breath) breathing hard while they had intercourse. Children, in such circumstances, divine something sexual in the uncanny sounds that reach their ears. Indeed, the movements expressive of sexual excitement lie within them ready to hand, as innate pieces of mechanism. I maintained years ago that the dyspnoea and palpitations that occur in hysteria and anxiety neurosis are only detached fragments of the act of copulation; and in many cases, as in Dora’s, I have been able to trace back the symptom of dyspnoea or nervous asthma to the same exciting cause - to the patient’s having overheard sexual intercourse taking place between adults. The sympathetic excitement which may be supposed to have occurred in Dora on such an occasion may very easily have made the child’s sexuality veer round and have replaced her inclination to masturbation by an inclination to anxiety. A little while later, when her father was away and the child, devotedly in love with him, was wishing him back, she must have reproduced in the form of an attack of asthma the impression she had received. She had preserved in her memory the event which had occasioned the first onset of the symptom, and we can conjecture from it the nature of the train of thought, charged with anxiety, which had accompanied the attack. The first attack had come on after she had over-exerted herself on an expedition in the mountains, so that she had probably been really a little out of breath. To this was added the thought that her father was forbidden to climb mountains and was not allowed to over-exert himself, because he suffered from shortness of breath; then came the recollection of how much he had exerted himself with her mother that night, and the question whether it might not have done him harm; next came concern whether she might not have over-exerted herself in masturbating - an act which, like the other, led to a sexual orgasm accompanied by slight dyspnoea - and finally came a return of the dyspnoea in an intensified form as a symptom. Part of this material I was able to obtain directly from the analysis, but the rest required supplementing. But the way in which the occurrence of masturbation in Dora’s case was verified has already shown us that material belonging to a single subject can only be collected piece by piece at various times and in different connections.¹

 

¹ The proof of infantile masturbation in other cases is established in a precisely similar way. The evidence for it is mostly of a similar nature: indications of the presence of leucorrhoea, bed-wetting, hand-ceremonials (obsessional washing), and such things. It is always possible to discover with certainty from the nature of the symptoms of the case whether the habit was discovered by the person in charge of the child or not, or whether this sexual activity was brought to an end by long efforts on the child’s part to break itself of the habit, or by a sudden change. In Dora’s case the masturbation had remained undiscovered, and had come to an end at a single blow (cf. her secret, her fear of doctors, and the replacement by dyspnoea). The patients, it is true, invariably dispute the conclusiveness of circumstantial evidence such as this, and they do so even when they have retained a conscious recollection of the catarrh or of their mother’s warning (e.g. ‘That makes people stupid; it’s dangerous’). But some time later the memory, which has been so long repressed, of this piece of infantile sexual life emerges with certainty, and it does so in every instance. I am reminded of the case of a patient of mine suffering from obsessions, which were direct derivatives of infantile masturbation. Her peculiarities, such as self-prohibitions and self-punishments, the feeling that if she had done this she must not do that, the idea that she must not be interrupted, the introduction of pauses between one procedure (with her hands) and the next, her hand-washing, etc, - all of these turned out to be unaltered fragments of her nurse’s efforts to break her of the habit. The only thing which had remained permanently in her memory were the words of warning: ‘Ugh! That’s dangerous!’ Compare also in this connection my Three Essays on the Theory of Sexuality, 1905d.

 

There now arise a whole series of questions of the greatest importance concerning the aetiology of hysteria: is Dora’s case to be regarded as aetiologically typical? does it represent the only type of causation? and so on. Nevertheless, I am sure that I am taking the right course in postponing my answer to such questions until a considerable number of other cases have been similarly analysed and published. Moreover, I should have to begin by criticizing the way in which the questions are framed. Instead of answering ‘Yes’ or ‘No’ to the question whether the aetiology of this case is to be looked for in masturbation during childhood, I should first have to discuss the concept of aetiology as applied to the psychoneuroses. It would then become evident that the standpoint from which I should be able to answer the question would be very widely removed from the standpoint from which it was put. Let it suffice if we can reach the conviction that in this case the occurrence of masturbation in childhood is established, and that its occurrence cannot be an accidental element nor an immaterial one in the conformation of the clinical picture.¹

 

¹ Dora’s brother must have been concerned in some way with her having acquired the habit of masturbation; for in this connection she told me, with all the emphasis which betrays the presence of a ‘screen memory’, that her brother used regularly to pass on all his infectious illnesses to her, and that while he used to have them lightly she used, on the contrary, to have them severely. In the dream her brother as well as she was saved from ‘destruction’; he, too, had been subject to bed-wetting, but had got over the habit before his sister. Her declaration that she had been able to keep abreast with her brother up to the time of her first illness, but that after that she had fallen behind him in her studies, was in a certain sense also a ‘screen memory’. It was as though she had been a boy up till that moment, and had then become girlish for the first time. She had in truth been a wild creature; but after the ‘asthma’ she became quiet and well-behaved. That illness formed the boundary between two phases of her sexual life, of which the first was masculine in character, and the second feminine.

 

A consideration of the significance of the leucorrhoea to which Dora admitted promises to give us a still better understanding of her symptoms. She had learnt to call her affection a ‘catarrh’ at the time when her mother had had to visit Franzensbad on account of a similar complaint; and the word ‘catarrh’ acted once again as a ‘switch-word’ and enabled the whole set of thoughts upon her father’s responsibility for her illness to manifest themselves in the symptom of the cough. The cough, which no doubt originated in the first instance from a slight actual catarrh, was, moreover, an imitation of her father (whose lungs were affected), and could serve as an expression of her sympathy and concern for him. But besides this, it proclaimed aloud, as it were, something of which she may then have been still unconscious: ‘I am my father’s daughter. I have a catarrh, just as he has. He has made me ill, just as he has made Mother ill. It is from him that I have got my evil passions, which are punished by illness.’¹

 

¹ This word played the same part with the fourteen-year old girl whose case history I have compressed into a few lines on p. 1365 n. I had established the child in a pension with an intelligent lady, who took charge of her for me. The lady reported that the little girl could not bear her to be in the room while she was going to bed, and that when she was in bed she had a marked cough, of which there was no trace in the daytime. When the girl was questioned about these symptoms, the only thing that occurred to her was that her grandmother coughed in the same way, and that she was said to have a catarrh. It was clear from this that the child herself had a catarrh, and that she did not want to be observed while she performed her evening ablutions. This catarrh which, thanks to its name, had been displaced from the lower to the upper part of her body, exhibited a quite unusual degree of intensity.

 

Let us next attempt to put together the various determinants that we have found for Dora’s attacks of coughing and hoarseness. In the lowest stratum we must assume the presence of real and organically determined irritation of the throat - which acted like the grain of sand around which an oyster forms its pearl. This irritation was susceptible to fixation, because it concerned a part of the body which in Dora had to a high degree retained its significance as an erotogenic zone. And the irritation was consequently well fitted to give expression to excited states of the libido. It was brought to fixation by what was probably its first psychical coating - her sympathetic imitation of her father - and by her subsequent self-reproaches on account of her ‘catarrh’. The same group of symptoms, moreover, showed itself capable of representing her relations with Herr K.; it could express her regret at his absence and her wish to make him a better wife. After a part of her libido had once more turned towards her father, the symptom obtained what was perhaps its last meaning; it came to represent sexual intercourse with her father by means of Dora’s identifying herself with Frau K. I can guarantee that this series is by no means complete. Unfortunately, an incomplete analysis cannot enable us to follow the chronological sequence of the changes in a symptom’s meaning, or to display clearly the succession and coexistence of its various meanings. It may legitimately be expected of a complete analysis that it should fulfil these demands.

 

I must now proceed to touch upon some further relations existing between Dora’s genital catarrh and her hysterical symptoms. At a time when any psychological elucidation of hysteria was still very remote, I used to hear experienced fellow-doctors who were my seniors maintain that in the case of hysterical patients suffering from leucorrhoea any increase in the catarrh was regularly followed by an intensification of the hysterical troubles, and especially of loss of appetite and vomiting. No one was very clear about the nature of the connection but I fancy the general inclination was towards the opinion held by gynaecologists. According to their hypothesis, as is well known, disorders of the genitals exercise upon the nervous functions a direct and far-reaching influence in the nature of an organic disturbance - though a therapeutic test of this theory is apt to leave one in the lurch. In the light of our present knowledge we cannot exclude the possibility of the existence of a direct organic influence of this sort; but it is at all events easier to indicate its psychical coating. The pride taken by women in the appearance of their genitals is quite a special feature of their vanity; and disorders of the genitals which they think calculated to inspire feelings of repugnance or even disgust have an incredible power of humiliating them, of lowering their self-esteem, and of making them irritable, sensitive, and distrustful. An abnormal secretion of the mucous membrane of the vagina is looked upon as a source of disgust.

 

It will be remembered that Dora had a lively feeling of disgust after being kissed by Herr K., and that we saw grounds for completing her story of the scene of the kiss by supposing that, while she was being embraced, she noticed the pressure of the man’s erect member against her body. We now learn further that the same governess whom Dora cast off on account of her faithlessness had, from her own experience of life, propounded to Dora the view that all men were frivolous and untrustworthy. To Dora that must mean that all men were like her father. But she thought her father suffered from venereal disease - for had he not handed it on to her and her mother? She might therefore have imagined to herself that all men suffered from venereal disease, and naturally her conception of venereal disease was modelled on her one experience of it - a personal one at that. To suffer from venereal disease, therefore, meant for her to be afflicted with a disgusting discharge. So may we not have here a further motive for the disgust she felt at the moment of the embrace? Thus the disgust which was transferred on to the contact of the man would be a feeling which had been projected according to the primitive mechanism I have already mentioned (p. 1373), and would be related ultimately to her own leucorrhoea.

 

I suspect that we are here concerned with unconscious processes of thought which are twined around a pre-existing structure of organic connections, much as festoons of flowers are twined around a wire; so that on another occasion one might find other lines of thought inserted between the same points of departure and termination. Yet a knowledge of the thought connections which have been effective in the individual case is of a value which cannot be exaggerated for clearing up the symptoms. It is only because the analysis was prematurely broken off that we have been obliged in Dora’s case to resort to framing conjectures and filling in deficiencies. Whatever I have brought forward for filling up the gaps is based upon other cases which have been more thoroughly analysed.

1 The dream from the analysis of which we have derived this information corresponded, as we have seen, to an intention which Dora carried with her into her sleep. It was therefore repeated each night until the intention had been carried out; and it reappeared years later when an occasion arose for forming an analogous intention. The intention might have been consciously expressed in some such words as these: ‘I must fly from this house, for I see that my virginity is threatened here; I shall go away with my father, and I shall take precautions not to be surprised while I am dressing in the morning.’ These thoughts were clearly expressed in the dream; they formed part of a mental current which had achieved consciousness and a dominating position in waking life. Behind them can be discerned obscure traces of a train of thought which formed part of a contrary current and had consequently been suppressed. This other train of thought culminated in the temptation to yield to the man, out of gratitude for the love and tenderness he had shown her during the last few years, and it may perhaps have revived the memory of the only kiss she had so far had from him. But according to the theory which I developed in my Interpretation of Dreams such elements as these are not enough for the formation of a dream. On that theory a dream is not an intention represented as having been carried out, but a wish represented as having been fulfilled, and, moreover, in most cases a wish dating from childhood. It is our business now to discover whether this principle may not be contradicted by the present dream.

 

The dream does in fact contain infantile material, though it is impossible at a first glance to discover any connections between that material and Dora’s intention of flying from Herr K.’s house and the temptation of his presence. Why should a recollection have emerged of her bed-wetting when she was a child and of the trouble her father used to take to teach the child clean habits? We may answer this by saying that it was only by the help of this train of thought that it was possible to suppress the other thoughts which were so intensely occupied with the temptation to yield or that it was possible to secure the dominance of the intention which had been formed of combating those other thoughts. The child decided to fly with her father; in reality she fled to her father because she was afraid of the man who was pursuing her; she summoned up an infantile affection for her father so that it might protect her against her present affection for a stranger. Her father was himself partly responsible for her present danger, for he had handed her over to this strange man in the interests of his own love-affair. And how much better it had been when that same father of hers had loved no one more than her, and had exerted all his strength to save her from the dangers that had then threatened her! The infantile, and now unconscious, wish to put her father in the strange man’s place had the potency necessary for the formation of a dream. If there were a past situation similar to a present one, and differing from it only in being concerned with one instead of with the other of the two persons mentioned in the wish, that situation would become the main one in the dream. But there had been such a situation. Her father had once stood beside her bed, just as Herr K. had the day before, and had woken her up, with a kiss perhaps, as Herr K. may have meant to do. Thus her intention of flying from the house was not in itself capable of producing a dream; but it became so by being associated with another intention which was founded upon infantile wishes. The wish to replace Herr K. by her father provided the necessary motive power for the dream. Let me recall the interpretation I was led to adopt of Dora’s reinforced train of thought about her father’s relations with Frau K. My interpretation was that she had at that point summoned up an infantile affection for her father so as to be able to keep her repressed love for Herr K. in its state of repression. This same sudden revulsion in the patient’s mental life was reflected in the dream.

 

I have made one or two observations in my Interpretation of Dreams on the relation between the waking thoughts which are continued into sleep (the ‘day’s residues’) and the unconscious wish which forms the dream. I will quote them here as they stand, for I have nothing to add to them, and the analysis of this dream of Dora’s proves afresh that the facts are as I have supposed: ‘I am ready to admit that there is a whole class of dreams the instigation to which arises principally or even exclusively from the residues of daytime life; and I think that even my wish that I might at long last become a Professor Extraordinarius¹ might have allowed me to sleep through the night in peace if my worry over my friend’s health had not still persisted from the previous day. But the worry alone could not have made a dream. The motive force which the dream required had to be provided by a wish; it was the business of the worry to get hold of a wish to act as the motive force of the dream.

 

‘The position may be explained by an analogy. A daytime thought may very well play the part of entrepeneur for a dream; but the entrepeneur, who, as people say, has the idea and the initiative to carry it out, can do nothing without capital; he needs a capitalist who can afford the outlay, and the capitalist who provides the psychical outlay for the dream is invariably and indisputably, whatever may be the thoughts of the previous day, a wish from the unconscious.’

 

Any one who has learnt to appreciate the delicacy of the fabric of structures such as dreams will not be surprised to find that Dora’s wish that her father might take the place of the man who was her tempter called up in her memory not merely a casual collection of material from her childhood, but precisely such material as was most intimately bound up with the suppression of her temptation. For if Dora felt unable to yield to her love for the man, if in the end she repressed that love instead of surrendering to it, there was no factor upon which her decision depended more directly than upon her premature sexual enjoyment and its consequence - her bed-wetting, her catarrh, and her disgust. An early history of this kind can afford a basis for two kinds of behaviour in response to the demands of love in maturity - which of the two will depend upon the summation of constitutional determinants in the subject. He will either exhibit an abandonment to sexuality which is entirely without resistances and borders upon perversity; or there will be a reaction - he will repudiate sexuality, and will at the same time fall ill of a neurosis. In the case of our present patient, her constitution and the high level of her intellectual and moral upbringing decided in favour of the latter course.




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