Contributions to the neue freie presse 8 страница

But Hans was not by any means a bad character; he was not even one of those children who at his age still give free play to the propensity towards cruelty and violence which is a constituent of human nature. On the contrary, he had an unusually kind-hearted and affectionate disposition; his father reported that the transformation of aggressive tendencies into feelings of pity took place in him at a very early age. Long before the phobia he had become uneasy when he saw the horses in a merry-go-round being beaten; and he was never unmoved if any one wept in his presence. At one stage in the analysis a piece of suppressed sadism made its appearance in a particular context:¹ but it was suppressed sadism, and we shall presently have to discover from the content what it stood for and what it was meant to replace. And Hans deeply loved the father against whom he cherished these death-wishes; and while his intellect demurred to such a contradiction,² he could not help demonstrating the fact of its existence, by hitting his father and immediately afterwards kissing the place he had hit. We ourselves, too, must guard against making a difficulty of such a contradiction. The emotional life of man is in general made up of pairs of contraries such as these.³ Indeed, if it were not so, repressions and neuroses would perhaps never come about. In the adult these pairs of contrary emotions do not as a rule become simultaneously conscious except at the climaxes of passionate love; at other times they usually go on suppressing each other until one of them succeeds in keeping the other altogether out of sight. But in children they can exist peaceably side by side for quite a considerable time.

¹ His wanting to beat and tease horses.

² See the critical question he addressed to his father (p. 2033).

³ Das heisst, ich bin kein ausgeklügelt Buch.

Ich bin ein Mensch mit seinem Widerspruch.

C. F. Meyer, Huttens letzte Tage.

[In fact, I am no clever work of fiction;

I am a man, with all his contradiction.]8

The most important influence upon the course of Hans’s psychosexual development was the birth of a baby sister when he was three and a half years old. That event accentuated his relations to his parents and gave him some insoluble problems to think about; and later, as he watched the way in which the infant was looked after, the memory-traces of his own earliest experiences of pleasure were revived in him. This influence, too, is a typical one: in an unexpectedly large number of life-histories, normal as well as pathological, we find ourselves obliged to take as our starting-point an outburst of sexual pleasure and sexual curiosity connected, like this one, with the birth of the next child. Hans’s behaviour towards the new arrival was just what I have described in The Interpretation of Dreams. In his fever a few days later he betrayed how little he liked the addition to the family. Affection for his sister might come later,¹ but his first attitude was hostility. From that time forward fear that yet another baby might arrive found a place among his conscious thoughts. In the neurosis, his hostility, already suppressed, was represented by a special fear - a fear of the bath. In the analysis he gave undisguised expression to his death-wish against his sister, and was not content with allusions which required supplementing by his father. His inner conscience did not consider this wish so wicked as the analogous one against his father; but it is clear that in his unconscious he treated both persons in the same way, because they both took his mummy away from him, and interfered with his being alone with her.

Moreover, this event and the feelings that were revived by it gave a new direction to his wishes. In his triumphant final phantasy he summed up all of his erotic wishes, both those derived from his auto-erotic phase and those connected with his object-love. In that phantasy he was married to his beautiful mother and had innumerable children whom he could look after in his own way.

¹ Cf. his plans of what he would do when his sister was old enough to speak (p. 2060).

(II)

One day while Hans was in the street he was seized with an attack of anxiety. He could not yet say what it was he was afraid of; but at the very beginning of this anxiety-state he betrayed to his father his motive for being ill, the advantage he derived from it. He wanted to stay with his mother and to coax with her; his recollection that he had also been separated from her at the time of the baby’s birth may also, as his father suggests, have contributed to his longing. It soon became evident that his anxiety was no longer reconvertible into longing; he was afraid even when his mother went with him. In the meantime indications appeared of what it was to which his libido (now changed into anxiety) had become attached. He gave expression to the quite specific fear that a white horse would bite him.

Disorders of this kind are called ‘phobias’, and we might classify Hans’s case as an agoraphobia if it were not for the fact that it is a characteristic of that complaint that the locomotion of which the patient is otherwise incapable can always be easily performed when he is accompanied by some specially selected person - in the last resort, by the physician. Hans’s phobia did not fulfil this condition; it soon ceased having any relation to the question of locomotion and became more and more clearly concentrated upon horses. In the early days of his illness, when the anxiety was at its highest pitch, he expressed a fear that ‘the horse’ll come into the room’, and it was this that helped me so much towards understanding his condition.

In the classificatory system of the neuroses no definite position has hitherto been assigned to ‘phobias’. It seems certain that they should only be regarded as syndromes which may form part of various neuroses and that we need not rank them as an independent pathological process. For phobias of the kind to which little Hans’s belongs, and which are in fact the most common, the name of ‘anxiety-hysteria’ seems to me not inappropriate; I suggested the term to Dr. W. Stekel when he was undertaking a description of neurotic anxiety states,¹ and I hope it will come into general use. It finds its justification in the similarity between the psychological structure of these phobias and that of hysteria - a similarity which is complete except upon a single point. That point, however, is a decisive one and well adapted for purposes of differentiation. For in anxiety-hysteria the libido which has been liberated from the pathogenic material by repression is not converted (that is, diverted from the mental sphere into a somatic innervation), but is set free In the clinical cases that we meet with, this ‘anxiety-hysteria’ may be combined with ‘conversion-hysteria’ in any proportion. There exist cases of pure conversion-hysteria without any trace of anxiety, just as there are cases of simple anxiety-hysteria, which exhibit feelings of anxiety and phobias, but have no admixture of conversion. The case of little Hans is one of the latter sort.

¹ Nervöse Angstzustände und ihre Behandlung, 1908.0

Anxiety-hysterias are the most common of all psychoneurotic disorders. But, above all, they are those which make their appearance earliest in life; they are par excellence the neuroses of childhood. When a mother uses such phrases as that her child’s ‘nerves’ are in a bad state, we can be certain that in nine cases out of ten the child is suffering from some kind of anxiety or from many kinds at once. Unfortunately the finer mechanism of these highly significant disorders has not yet been sufficiently studied. It has not yet been established whether anxiety-hysteria is determined, in contradistinction to conversion-hysteria and other neuroses, solely by constitutional factors or solely by accidental experiences, or by what combination of the two.¹ It seems to me that of all neurotic disorders it is the least dependent upon a special constitutional predisposition and that it is consequently the most easily acquired at any time of life.

One essential characteristic of anxiety-hysterias is very easily pointed out. An anxiety-hysteria tends to develop more and more into a ‘phobia’. In the end the patient may have got rid of all his anxiety, but only at the price of subjecting himself to all kinds of inhibitions and restrictions. From the outset in anxiety-hysteria the mind is constantly at work in the direction of once more psychically binding the anxiety which has become liberated; but this work can neither bring about a retransformation of the anxiety into libido, nor can it establish any contact with the complexes which were the source of the libido. Nothing is left for it but to cut off access to every possible occasion that might lead to the development of anxiety, by erecting mental barriers in the nature of precautions, inhibitions, or prohibitions; and it is these defensive structures that appear to us in the form of phobias and that constitute to our eyes the essence of the disease.

The treatment of anxiety-hysteria may be said hitherto to have been a purely negative one. Experience has shown that it is impossible to effect the cure of a phobia (and even in certain circumstances dangerous to attempt to do so) by violent means, that is, by first depriving the patient of his defences and then putting him in a situation in which he cannot escape the liberation of his anxiety. Consequently, nothing can be done but to leave the patient to look for protection wherever he thinks he may find it; and he is merely regarded with a not very helpful contempt for his ‘incomprehensible cowardice’.

Little Hans’s parents were determined from the very beginning of his illness that he was neither to be laughed at nor bullied, but that access must be obtained to his repressed wishes by means of psycho-analysis. The extraordinary pains taken by Hans’s father were rewarded by success, and his reports will give us an opportunity of penetrating into the fabric of this type of phobia and of following the course of its analysis.

¹ [Footnote added 1923:] The question which is raised here has not been pursued further. But there is no reason to suppose that anxiety-hysteria is an exception to the rule that both predisposition and experience must co-operate in the aetiology of a neurosis. Rank’s view of the effects of the trauma of birth seems to throw special light upon the predisposition to anxiety-hysteria which is so strong in childhood.

1 I think it is not unlikely that the extensive and detailed character of the analysis may have made it somewhat obscure to the reader. I shall therefore begin by giving a brief resume of it, in which I shall omit all distracting side-issues and shall draw attention to the results as they came to light one after the other.

The first thing we learn is that the outbreak of the anxiety state was by no means so sudden as appeared at first sight. A few days earlier the child had woken from an anxiety-dream to the effect that his mother had gone away, and that now he had no mother to coax with. This dream alone points to the presence of a repressive process of ominous intensity. We cannot explain it, as we can so many other anxiety-dreams, by supposing that the child had in his dream felt anxiety arising from some somatic cause and had made use of the anxiety for the purpose of fulfilling an unconscious wish which would otherwise have been deeply repressed.¹ We must regard it rather as a genuine punishment and repression dream, and, moreover, as a dream which failed in its function, since the child woke from his sleep in a state of anxiety. We can easily reconstruct what actually occurred in the unconscious. The child dreamt of exchanging endearments with his mother and of sleeping with her; but all the pleasure was transformed into anxiety, and all the ideational content into its opposite. Repression had defeated the purpose of the mechanism of dreaming.

But the beginnings of this psychological situation go back further still. During the preceding summer Hans had had similar moods of mingled longing and apprehension, in which he had said similar things; and at that time they had secured him the advantage of being taken by his mother into her bed. We may assume that since then Hans had been in a state of intensified sexual excitement, the object of which was his mother. The intensity of this excitement was shown by his two attempts at seducing his mother (the second of which occurred just before the outbreak of his anxiety); and he found an incidental channel of discharge for it by masturbating every evening and in that way obtaining gratification. Whether the sudden change-over of this excitement into anxiety took place spontaneously, or as a result of his mother’s rejection of his advances, or owing to the accidental revival of earlier impressions by the ‘precipitating cause’ of his illness (about which we shall hear presently) - this we cannot decide; and, indeed, it is a matter of indifference, for these three alternative possibilities cannot be regarded as mutually incompatible. The fact remains that his sexual excitement suddenly changed into anxiety.

¹ See my Interpretation of Dreams.2

We have already described the child’s behaviour at the beginning of his anxiety, as well as the first content which he assigned to it, namely, that a horse would bite him. It was at this point that the first piece of therapy was interposed. His parents represented to him that his anxiety was the result of masturbation, and encouraged him to break himself of the habit. I took care that when they spoke to him great stress was laid upon his affection for his mother, for that was what he was trying to replace by his fear of horses. This first intervention brought a slight improvement, but the ground was soon lost again during a period of physical illness. Hans’s condition remained unchanged. Soon afterwards he traced back his fear of being bitten by a horse to an impression he had received at Gmunden. A father had addressed his child on her departure with these words of warning: ‘Don’t put your finger to the horse; if you do, it’ll bite you.’ The words, ‘don’t put your finger to’, which Hans used in reporting this warning, resembled the form of words in which the warning against masturbation had been framed. It seemed at first, therefore, as though Hans’s parents were right in supposing that what he was frightened of was his own masturbatory indulgence. But the whole nexus remained loose, and it seemed to be merely by chance that horses had become his bugbear.

I had expressed a suspicion that Hans’s repressed wish might now be that he wanted at all costs to see his mother’s widdler. As his behaviour to a new maid fitted in with this hypothesis, his father gave him his first piece of enlightenment, namely, that women have no widdlers. He reacted to this first effort at helping him by producing a phantasy that he had seen his mother showing her widdler.¹ This phantasy and a remark made by him in conversation, to the effect that his widdler was ‘fixed in, of course’, allow us our first glimpse into the patient’s unconscious mental processes. The fact was that the threat of castration made to him by his mother some fifteen months earlier was now having a deferred effect upon him. For his phantasy that his mother was doing the same as he had done (the familiar tu quoque repartee of inculpated children) was intended to serve as a piece of self-justification; it was a protective or defensive phantasy. At the same time we must remark that it was Hans’s parents who had extracted from the pathogenic material operating in him the particular theme of his interest in widdlers. Hans followed their lead in this matter, but he had not yet taken any line of his own in the analysis. And no therapeutic success was to be observed. The analysis had passed far away from the subject of horses; and the information that women have no widdlers was calculated, if anything, to increase his concern for the preservation of his own.

¹ [Footnote added 1924:] The context enables us to add: ‘and touching it’ (p. 2024). After all, he himself could not show his widdler without touching it.3

Therapeutic success, however, is not our primary aim; we endeavour rather to enable the patient to obtain a conscious grasp of his unconscious wishes. And this we can achieve by working upon the basis of the hints he throws out, and so, with the help of our interpretative technique, presenting the unconscious complex to his consciousness in our own words. There will be a certain degree of similarity between that which he hears from us and that which he is looking for, and which, in spite of all resistances, is trying to force its way through to consciousness; and it is this similarity that will enable him to discover the unconscious material. The physician is a step in front of him in knowledge; and the patient follows along his own road, until the two meet at the appointed goal. Beginners in psycho-analysis are apt to assimilate these two events, and to suppose that the moment at which one of the patient’s unconscious complexes has become known to them is also the moment at which the patient himself recognizes it. They are expecting too much when they think that they will cure the patient by informing him of this piece of knowledge; for he can do no more with the information than make use of it to help himself in discovering the unconscious complex where it is anchored in his unconscious. A first success of this sort had now been achieved with Hans. Having partly mastered his castration complex, he was now able to communicate his wishes in regard to his mother. He did so, in what was still a distorted form, by means of the phantasy of the two giraffes, one of which was calling out in vain because Hans had taken possession of the other. He represented the ‘taking possession of’ pictorially as ‘sitting down on’. His father recognized the phantasy as a reproduction of a bedroom scene which used to take place in the morning between the boy and his parents; and he quickly stripped the underlying wish of the disguise which it still wore. The boy’s father and mother were the two giraffes. The reason for the choice of a giraffe-phantasy for the purposes of disguise was fully explained by a visit that the boy had paid to those same large beasts at Schönbrunn a few days earlier, by the giraffe-drawing, belonging to an earlier period, which had been preserved by his father, and also, perhaps, by an unconscious comparison based upon the giraffe’s long, stiff neck.¹ It may be remarked that the giraffe, as being a large animal and interesting on account of its widdler, was a possible competitor with the horse for the role of bugbear; moreover, the fact that both his father and his mother appeared as giraffes offered a hint which had not yet been followed up, as regards the interpretation of the anxiety-horses.

¹ Hans’s admiration of his father’s neck later on would fit in with this.4

Immediately after the giraffe story Hans produced two minor phantasies: one of his forcing his way into a forbidden space at Schönbrunn, and the other of his smashing a railway-carriage window on the Stadtbahn. In each case the punishable nature of the action was emphasized, and in each his father appeared as an accomplice. Unluckily his father failed to interpret either of these phantasies, so that Hans himself gained nothing from telling them. In an analysis, however, a thing which has not been understood inevitably reappears; like an unlaid ghost, it cannot rest until the mystery has been solved and the spell broken.

There are no difficulties in the way of our understanding these two criminal phantasies. They belonged to Hans’s complex of taking possession of his mother. Some kind of vague notion was struggling in the child’s mind of something that he might do with his mother by means of which his taking possession of her would be consummated; for this elusive thought he found certain pictorial representations, which had in common the qualities of being violent and forbidden, and the content of which strikes us as fitting in most remarkably well with the hidden truth. We can only say that they were symbolic phantasies of intercourse, and it was no irrelevant detail that his father was represented as sharing in his actions: ‘I should like’, he seems to have been saying, ‘to be doing something with my mother, something forbidden; I do not know what it is, but I do know that you are doing it too.’

The giraffe phantasy strengthened a conviction which had already begun to form in my mind when Hans expressed his fear that ‘the horse’ll come into the room’; and I thought the right moment had now arrived for informing him that he was afraid of his father because he himself nourished jealous and hostile wishes against him - for it was essential to postulate this much with regard to his unconscious impulses. In telling him this, I had partly interpreted his fear of horses for him: the horse must be his father - whom he had good internal reasons for fearing. Certain details of which Hans had shown he was afraid, the black on horses’ mouths and the things in front of their eyes (the moustaches and eyeglasses which are the privilege of a grown-up man), seemed to me to have been directly transposed from his father on to the horses.

By enlightening Hans on this subject I had cleared away his most powerful resistance against allowing his unconscious thoughts to be made conscious; for his father was himself acting as his physician. The worst of the attack was now over; there was a plentiful flow of material; the little patient summoned up courage to describe the details of his phobia, and soon began to take an active share in the conduct of the analysis.¹

¹ Even in analyses in which the physician and the patient are strangers, fear of the father plays one of the most important parts as a resistance against the reproduction of the unconscious pathogenic material. Resistances are sometimes in the nature of ‘motifs’. But sometimes, as in the present instance, one piece of the unconscious material is capable from its actual content of operating as an inhibition against the reproduction of another piece.

It was only then that we learnt what the objects and impressions were of which Hans was afraid. He was not only afraid of horses biting him - he was soon silent upon that point - but also of carts, of furniture-vans, and of buses (their common quality being, as presently became clear, that they were all heavily loaded), of horses that started moving, of horses that looked big and heavy, and of horses that drove quickly. The meaning of these specifications was explained by Hans himself: he was afraid of horses falling down, and consequently incorporated in his phobia everything that seemed likely to facilitate their falling down.

It not at all infrequently happens that it is only after doing a certain amount of psycho-analytic work with a patient that an analyst can succeed in learning the actual content of a phobia, the precise form of words of an obsessional impulse, and so on. Repression has not only descended upon the unconscious complexes, but it is continually attacking their derivatives as well, and even prevents the patient from becoming aware of the products of the disease itself. The analyst thus finds himself in the position, curious for a doctor, of coming to the help of a disease, and of procuring it its due of attention. But only those who entirely misunderstand the nature of psycho-analysis will lay stress upon this phase of the work and suppose that on its account harm is likely to be done by analysis. The fact is that you must catch your thief before you can hang him, and that it requires some expenditure of labour to get securely hold of the pathological structures - at the destruction of which the treatment is aimed.

I have already remarked in the course of my running commentary on the case history that it is most instructive to plunge in this way into the details of a phobia, and thus arrive at a conviction of the secondary nature of the relation between the anxiety and its objects. It is this that accounts for phobias being at once so curiously diffuse and so strictly conditioned. It is evident that the material for the particular disguises which Hans’s fear adopted was collected from the impressions to which he was all day long exposed owing to the Head Customs House being situated on the opposite side of the street. In this connection, too, he showed signs of an impulse - though it was now inhibited by his anxiety - to play with the loads on the carts, with the packages, casks and boxes, like the street-boys.

It was at this stage of the analysis that he recalled the event, insignificant in itself, which immediately preceded the outbreak of the illness and may no doubt be regarded as the precipitating cause of its outbreak. He went for a walk with his mother, and saw a bus-horse fall down and kick about with its feet. This made a great impression on him. He was terrified, and thought the horse was dead; and from that time on he thought that all horses would fall down. His father pointed out to him that when he saw the horse fall down he must have thought of him, his father, and have wished that he might fall down in the same way and be dead. Hans did not dispute this interpretation; and a little while later he played a game consisting of biting his father, and so showed that he accepted the theory of his having identified his father with the horse he was afraid of. From that time forward his behaviour to his father was unconstrained and fearless, and in fact a trifle overbearing. Nevertheless his fear of horses persisted; nor was it yet clear through what chain of associations the horse’s falling down had stirred up his unconscious wishes.

Let me summarize the results that had so far been reached. Behind the fear to which Hans first gave expression, the fear of a horse biting him, we had discovered a more deeply seated fear, the fear of horses falling down; and both kinds of horses, the biting horse and the falling horse, had been shown to represent his father, who was going to punish him for the evil wishes he was nourishing against him. Meanwhile the analysis had moved away from the subject of his mother.

Quite unexpectedly, and certainly without any prompting from his father, Hans now began to be occupied with the ‘lumf’ complex, and to show disgust at things that reminded him of evacuating his bowels. His father, who was reluctant to go with him along that line, pushed on with the analysis through thick and thin in the direction in which he wanted to go. He elicited from Hans the recollection of an event at Gmunden, the impression of which lay concealed behind that of the falling bus-horse. While they were playing at horses, Fritzl, the playmate of whom he was so fond, but at the same time, perhaps, his rival with his many girl friends, had hit his foot against a stone and had fallen down, and his foot had bled. Seeing the bus-horse fall had reminded him of this accident. It deserves to be noticed that Hans, who was at the moment concerned with other things, began by denying that Fritzl had fallen down (though this, was the event which formed the connection between the two scenes) and only admitted it at a later stage of the analysis. It is especially interesting, however, to observe the way in which the transformation of Hans’s libido into anxiety was projected on to the principal object of his phobia, on to horses. Horses interested him the most of all the large animals; playing at horses was his favourite game with the other children. I had a suspicion - and this was confirmed by Hans’s father when I asked him - that the first person who had served Hans as a horse must have been his father; and it was this that had enabled him to regard Fritzl as a substitute for his father when the accident happened at Gmunden. When repression had set in and brought a revulsion of feeling along with it, horses, which had till then been associated with so much pleasure, were necessarily turned into objects of fear.

But, as we have already said, it was owing to the intervention of Hans’s father that this last important discovery was made of the way in which the precipitating cause of the illness had operated. Hans himself was occupied with his lumf interests, and thither at last we must follow him. We learn that formerly Hans had been in the habit of insisting upon accompanying his mother to the W. C., and that he had revived this custom with his friend Berta at a time when she was filling his mother’s place, until the fact became known and he was forbidden to do so. Pleasure taken in looking on while some one one loves performs the natural functions is once more a ‘confluence of instincts’, of which we have already noticed an instance in Hans. In the end his father went into the lumf symbolism, and recognized that there was an analogy between a heavily loaded cart and a body loaded with faeces, between the way in which a cart drives out through a gateway and the way in which faeces leave the body, and so on.

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