The psycho-analytic VIew of psychogenic disturbance of VIsion 4 страница

This surprising sexualization of the state of heavenly bliss suggests the possibility that Schreber’s concept of the state of bliss is derived from a condensation of the two principal meanings of the German word ‘

selig’ - namely, ‘dead’ and ‘sensually happy’.¹ But this instance of sexualization will also give us occasion to examine the patient’s general attitude to the erotic side of life and to questions of sexual indulgence. For we psycho-analysts have hitherto supported the view that the roots of every nervous and mental disorder are chiefly to be found in the patient’s sexual life - some of us merely upon empirical grounds, others influenced in addition by theoretical considerations.

¹ Extreme instances of the two uses of the word are to be found in the phrase ‘mein seliger Vater’ [‘my late father’] and in these lines from the duet in Don Giovanni:

Ja, dein zu sein auf ewig,

wie selig werd’ ich sein.

[Ah, to be thine for ever -

How blissful I should be!]

But the fact that the same word should be used in our language in two such different situations cannot be without significance.

The samples of Schreber’s delusions that have already been given enable us without more ado to dismiss the suspicion that it might be precisely this paranoid disorder which would turn out to be the ‘negative case’ which has so long been sought for - a case in which sexuality plays only a very minor part. Schreber himself speaks again and again as though he shared our prejudice. He is constantly talking in the same breath of ‘nervous disorder’ and erotic lapses, as though the two things were inseparable.¹

Before his illness Senatspräsident Schreber had been a man of strict morals: ‘Few people’, he declares, and I see no reason to doubt his assertion, ‘can have been brought up upon such strict moral principles as I was, and few people, all through their lives, can have exercised (especially in sexual matters) a self-restraint conforming so closely to those principles as I may say of myself that I have done.’ (281.) After the severe spiritual struggle, of which the phenomena of his illness were the outward signs, his attitude towards the erotic side of life was altered. He had come to see that the cultivation of voluptuousness was incumbent upon him as a duty, and that it was only by discharging this duty that he could end the grave conflict which had broken out within him - or, as he thought, about him. Voluptuousness, so the voices assured him, had become ‘God-fearing’ and he could only regret that he was not able to devote himself to its cultivation the whole day long.² (285.)

¹ ‘When moral corruption ("voluptuous excesses") or perhaps nervous disorder had taken a strong enough hold upon the whole population of any terrestrial body’, then, thinks Schreber, bearing in mind the Biblical stories of Sodom and Gomorrah, the Deluge, etc., the world in question might come to a catastrophic end (52). - ‘[A rumour] sowed fear and terror among men, wrecked the foundations of religion, and spread abroad general nervous disorders and immorality, so that devastating pestilences have descended upon mankind.’ (91.) - ‘Thus it seems probable that by a "Prince of Hell" the souls meant the uncanny Power that was able to develop in a sense hostile to God as a result of moral depravity among men or of a general state of excessive nervous excitement following upon over-civilization.’ (163.)

² In connection with his delusions he writes: ‘This attraction, however, lost its terrors for the nerves in question, if, and in so far as, upon entering my body, they encountered a feeling of spiritual voluptuousness in which they themselves shared. For, if this happened, they found an equivalent or approximately equivalent substitute in my body for the state of heavenly bliss which they had lost, and which itself consisted in a kind of voluptuous enjoyment.’ (179-80.)

7 Such then, was the result of the changes produced in Schreber by his illness, as we find them expressed in the two main features of his delusional system. Before it he had been inclined to sexual asceticism and had been a doubter in regard to God; while after it he was a believer in God and a devotee of voluptuousness. But just as his re-conquered belief in God was of a peculiar kind, so too the sexual enjoyment which he had won for himself was of a most unusual character. It was not the sexual liberty of a man, but the sexual feelings of a woman. He took up a feminine attitude towards God; he felt that he was God’s wife.¹

No other part of his delusions is treated by the patient so exhaustively, one might almost say so insistently, as his alleged transformation into a woman. The nerves absorbed by him have, so he says, assumed in his body the character of female nerves of voluptuousness, and have given to his body a more or less female stamp, and more particularly to his skin a softness peculiar to the female sex (87). If he presses lightly with his fingers upon any part of his body, he can feel these nerves, under the surface of the skin, as a tissue of a thread-like or stringy texture; they are especially present in the region of the chest, where, in a woman, her breasts would be. ‘By applying pressure to this tissue, I am able to evoke a sensation of voluptuousness such as women experience, and especially in I think of something feminine at the same time.’ (277.) He knows with certainty that this tissue was originally nothing else than nerves of God, which could hardly have lost the character of nerves merely through having passed over into his body (279). By means of what he calls ‘drawing’ (that is, by calling up visual images) he is able to give both himself and the rays an impression that his body is fitted out with female breasts and genitals: ‘It has become so much a habit with me to draw female buttocks on to my body - honi soit qui mal y pense - that I do it almost involuntarily every time I stoop.’ (233.) He is ‘bold enough to assert that anyone who should happen to see me before the mirror with the upper portion of my torso bared - especially if the illusion is assisted by my wearing a little feminine finery - would receive an unmistakable impression of a female bust’. (280.) He calls for a medical examination, in order to establish the fact that his whole body has nerves of voluptuousness dispersed over it from head to foot, a state of things which is only to be found, in his opinion, in the female body, whereas, in the male, to the best of his knowledge, nerves of voluptuousness exist only in the sexual organs and their immediate vicinity (274). The spiritual voluptuousness which has been developed owing to this accumulation of nerves in his body is so intense that it only requires a slight effort of his imagination (especially when he is lying in bed) to procure him a feeling of sensual well-being that affords a tolerably clear adumbration of the sexual pleasure enjoyed by a woman during copulation (269).

¹ ‘Something occurred in my own body similar to the conception of Jesus Christ in an immaculate virgin, that is, in a woman who had never had intercourse with a man. On two separate occasions (and while I was still in Professor Flechsig’s institution) I have possessed female genitals, though somewhat imperfectly developed ones, and have felt a stirring in my body, such as would arise from the quickening of a human embryo. Nerves of God corresponding to male semen had, by a divine miracle, been projected into my body, and impregnation had thus taken place.’ (Introduction, 4.)

If we now recall the dream which the patient had during the incubation period of his illness, before he had moved to Dresden, it will become clear beyond a doubt that his delusion of being transformed into a woman was nothing else than a realization of the content of that dream. At that time he had rebelled against the dream with masculine indignation, and in the same way he began by striving against its fulfilment in his illness and looked upon his transformation into a woman as a disgrace with which he was threatened with hostile intention. But there came a time (it was in November, 1895) when he began to reconcile himself to the transformation and bring it into harmony with the higher purposes of God: ‘Since then, and with a full consciousness of what I did, I have inscribed upon my banner the cultivation of femaleness.’ (177-8.)

He then arrived at the firm conviction that it was God Himself who, for His own satisfaction, was demanding femaleness from him:

‘No sooner, however, am I alone with God (if I may so express it), than it becomes a necessity for me to employ every imaginable device and to summon up the whole of my mental faculties, and especially my imagination, in order to bring it about that the divine rays may have the impression as continuously as possible (or, since this is beyond mortal power at least at certain times of day) that I am a woman luxuriating in voluptuous sensations.’ (281.)

‘On the other hand, God demands a constant state of enjoyment, such as would be in keeping with the conditions of existence imposed upon souls by the Order of Things; and it is my duty to provide Him with this... in the shape of the greatest possible generation of spiritual voluptuousness. And if, in this process, a little sensual pleasure falls to my share, I feel justified in accepting it as some slight compensation for the inordinate measure of suffering and privation that has been mine for so many past years...’ (283.)

‘... I think I may even venture to advance the view based upon impressions I have received, that God would never take any steps towards effecting a withdrawal - the first result of which is invariably to alter my physical condition markedly for the worse - but would quietly and permanently yield to my powers of attraction, if it were possible for me always to be playing the part of a woman lying in my own amorous embraces, always to be casting my looks upon female forms, always to be gazing at pictures of women, and so on.’ (284-5.)

In Schreber’s system the two principal elements of his delusions (his transformation into a woman and his favoured relation to God) are linked in his assumption of a feminine attitude towards God. It will be an unavoidable part of our task to show that there is an essential genetic relation between these two elements. Otherwise our attempts at elucidating Schreber’s delusions will leave us in the absurd position described in Kant’s famous simile in the Critique of Pure Reason - we shall be like a man holding a sieve under a he-goat while some one else milks it.

II ATTEMPTS AT INTERPRETATION

There are two angles from which we could attempt to reach an understanding of this history of a case of paranoia and to lay bare in it the familiar complexes and motive forces of mental life. We might start either from the patient’s own delusional utterances or from the exciting causes of his illness.

The former method must seem enticing since the brilliant example given us by Jung in his interpretation of a case of dementia praecox which was far severer than this one and which exhibited symptoms far more remote from the normal. The high level of our present patient’s intelligence, too, and his communicativeness, seem likely to facilitate the accomplishment of our task along these lines. He himself not in frequently presses the key into our hands, by adding a gloss, a quotation or an example to some delusional proposition in an apparently incidental manner, or even by expressly denying some parallel to it that has arisen in his own mind. For when this happens, we have only to follow our usual psycho-analytic technique - to strip his sentence of its negative form, to take his example as being the actual thing, or his quotation or gloss as being the original source - and we find ourselves in possession of what we are looking for, namely a translation of the paranoid mode of expression into the normal one.

It is perhaps worth giving a more detailed illustration of this procedure. Schreber complains of the nuisance created by the so-called ‘miracled birds’ or ‘talking birds’, to which he ascribes a number of very remarkable qualities (208-14). It is his belief that they are composed of former ‘fore-courts of Heaven’, that is, of human souls which have entered into a state of bliss, and that they have been loaded with ptomaine¹ poison and set on to him. They have been brought to the condition of repeating ‘meaningless phrases which they have learnt by heart’ and which have been ‘dinned into them’. Each time that they have discharged their load of ptomaine poison on to him - that is each time that they have ‘reeled off the phrases which have been dinned into them, as it were’ - they become to some extent absorbed into his soul, with the words ‘The deuce of a fellow!’ or ‘Deuce take it!’ which are the only words they are still capable of using to express a genuine feeling. They cannot understand the meaning of the words they speak, but they are by nature susceptible to similarity of sounds, though the similarity need not necessarily be a complete one. Thus it is immaterial to them whether one says:

‘Santiago’ or ‘Karthago’,

‘Chinesentum’ or ‘Jesum Christum’,

‘Abendrot’ or ‘Atemnot’,

‘Ariman’ or ‘Ackermann’ etc.² (210.)

As we read this description, we cannot avoid the idea that what it really refers to must be young girls. In a carping mood people often compare them to geese, ungallantly accuse then of having ‘the brains of a bird’ and declare that they can say nothing but phrases learnt by rote and they betray their lack of education by confusing foreign words that sound alike. The phrase ‘The deuce of a fellow!’, which is the only thing that they are serious about, would in that case be an allusion to the triumph of the young man who has succeeded in impressing them. And, sure enough, a few pages later we come upon a passage in which Schreber confirms this interpretation: ‘For purposes of distinction, I have as a joke given girls’ names to a great number of the remaining bird-souls; since by their inquisitiveness, their voluptuous bent, etc., they one and all most readily suggest a comparison with little girls. Some of these girls’ names have since been adopted by the rays of God and have been retained as a designation of the bird-souls in question.’ (214.) This easy interpretation of the ‘miracled birds’ gives us a hint which may help us towards understanding the enigmatic ‘fore-courts of Heaven’.

¹ [German ‘Leichengift’, literally ‘corpse poison’.]

² [ Santiago’ or ‘Carthage’,

‘Chinese-dom’ or ‘Jesus Christ’,

‘Sunset’ or ‘Breathlessness’,

‘Ahriman’ or ‘Farmer’.]1

I am quite aware that a psycho-analyst needs no small amount of tact and restraint whenever in the course of his work he goes beyond the typical instances of interpretation and that his listeners or readers will only follow him as far a their own familiarity with analytic technique will allow them. He has every reason, therefore, to guard against the risk that an increased display of acumen on his part may be accompanied by a diminution in the certainty and trustworthiness of his results. It is thus only natural that one analyst will tend too much in the direction of caution and another too much in the direction of boldness. It will not be possible to define the proper limits of justifiable interpretation until many experiments have been made and until the subject has become more familiar. In working upon the case of Schreber I have had a policy of restraint forced on me by the circumstance that the opposition to his publishing the Denkwürdigkeiten was so far effective as to withhold a considerable portion of the material from our knowledge - the portion, too, which would in all probability have thrown the most important light upon the case.¹ Thus, for instance, the third chapter of the book opens with this promising announcement: ‘I shall now proceed to describe certain events which occurred to other members of my family and which may conceivably have been connected with the soul-murder I have postulated; for there is at any rate something more or less problematical about all of them, something not easily explicable upon the lines of ordinary human experience.’ (33.) But the next sentence, which is also the last of the chapter, is as follows: ‘The remainder of this chapter has been withheld from print as being unsuitable for publication.’ I shall therefore have to be satisfied if I can succeed in tracing back at any rate the nucleus of the delusional structure with some degree of certainty to familiar human motives.

¹ ‘When we survey the contents of this document’, writes Dr. Weber in his report, ‘and consider the mass of indiscretions in regard to himself and other persons which it contains, when we observe the unblushing manner in which he describes situations and events which are of the most delicate nature and indeed, in an aesthetic sense, utterly impossible, when we reflect upon his use of strong language of the most offensive kind, and so forth, we shall find it quite impossible to understand how a man, distinguished apart from this by his tact and refinement, could contemplate taking a step so compromising to himself in the public eye, unless we bear in mind the fact that...’ etc. etc. (402.) Surely we can hardly expect that a case history which sets out to give a picture of deranged humanity and its struggles to rehabilitate itself should exhibit ‘discretion’ and ‘aesthetic’ charm.

With this object in view I shall now mention a further small piece of the case history to which sufficient weight is not given in the reports, although the patient himself has done all he can to put it in the foreground. I refer to Schreber’s relations to his first physician, Geheimrat Prof. Flechsig of Leipzig.

As we already know, Schreber’s case at first took the form of delusions of persecution, and did not begin to lose it until the turning-point of his illness (the time of his ‘reconciliation’). From that time onwards the persecutions became less and less intolerable, and the ignominious purpose which at first underlay his threatened emasculation began to be superseded by a purpose in consonance with the Order of Things. But the first author of all these acts of persecution was Flechsig, and he remains their instigator throughout the whole course of the illness.¹

Of the actual nature of Flechsig’s enormity and its motives the patient speaks with the characteristic vagueness and obscurity which may be regarded as marks of an especially intense work of delusion-formation, if it is legitimate to judge paranoia on the model of a far more familiar mental phenomenon - the dream. Flechsig, according to the patient, committed, or attempted to commit, ‘soul-murder’ upon him - an act which, he thought, was comparable with the effort made by the devil or by demons to gain possession of a soul and may have had its prototype in events which occurred between members of the Flechsig and Schreber families long since deceased (22 ff.). We should be glad to learn more of the meaning of this ‘soul-murder’, but at this point our sources relapse once more into a tendentious silence: ‘As to what constitutes the true essence of soul-murder, and as to its technique, if I may so describe it, I am able to say nothing beyond what has already been indicated. There is only this, perhaps, to be added... (The passage which follows is unsuitable for publication.)’ (28.) As a result of this omission we are left in the dark on the question of what is meant by ‘soul-murder’. We shall refer later on to the only hint upon the subject which has evaded censorship.

¹ ‘Even now the voices that talk with me call out your name to me hundreds of times each day. They name you in certain constantly recurring connections, and especially as being the first author of the injuries I have suffered. And yet the personal relations which existed between us for a time have, so far as I am concerned, long since faded into the background; so that I myself could have little enough reason to be for ever recalling you to my mind, and still less for doing so with any feelings of resentment.’ (‘Open Letter to Professor Flechsig’, viii.)

However this may be, a further development of Schreber’s delusions soon took place, which affected his relations to God without altering his relations to Flechsig. Hitherto he had regarded Flechsig (or rather his soul) as his only true enemy and had looked upon God Almighty as his ally; but now he could not avoid the thought that God Himself had played the part of accessory, if not of instigator, in the plot against him. (59.) Flechsig, however, remained the first seducer, to whose influence God had yielded (60). He had succeeded in making his way up to heaven with his whole soul or a part of it and in becoming a ‘leader of rays’, without dying or undergoing any preliminary purification.¹ (56.) The Flechsig soul continued to play this role even after the patient had been moved from the Leipzig clinic to Dr. Pierson’s asylum. The influence of the new environment was shown by the Flechsig soul being joined by the soul of the chief attendant, whom the patient recognized as a person who had formerly lived in the same block of flats as himself. This was represented as being the von W. soul.² The Flechsig soul then introduced the system of ‘soul-division’, which assumed large proportions. At one time there were as many as forty to sixty sub-divisions of the Flechsig soul; two of its larger divisions were known as the ‘upper Flechsig’ and the ‘middle Flechsig’. The von W. soul (the chief attendant’s) behaved in just the same fashion (111). It was sometimes most entertaining to notice the way in which these two souls, in spite of their alliance, carried on a feud with one another, the aristocratic pride of the one pitted against the professorial vanity of the other (113). During his first weeks at Sonnenstein (to which hr, was finally moved in the summer of 1894) the soul of his new physician, Dr. Weber, came into play; and shortly afterwards the change-over took place in the development of his delusions which we have come to know as his ‘reconciliation’.

¹ According to another and significant version, which, however, was soon rejected, Professor Flechsig had shot himself either at Weissenburg in Alsace or in a police cell at Leipzig. The patient saw his funeral go past, though not in the direction that was to be expected in view of the relative positions of the University Clinic and the cemetery. On other occasions Flechsig appeared to him in the company of a policeman, or in conversation with his wife. Schreber was a witness of this conversation by the method of ‘nerve-connection’, and in the course of it Professor Flechsig called himself ‘God Flechsig’ to his wife, so that she was inclined to think he had gone mad. (82.)

² The voices informed him that in the course of an official enquiry this von W. had made some untrue statements about him, either deliberately or out of carelessness, and in particular had accused him of masturbation. As a punishment for this he was now obliged to wait on the patient (108).4

During this later stay at Sonnenstein, when God had begun to appreciate him better, a raid was made upon the souls, which had been multiplied so much as to become a nuisance. As a result of this, the Flechsig soul survived in only one or two shapes, and the von W. soul in only a single one. The latter soon disappeared altogether. The divisions of the Flechsig soul, which slowly lost both their intelligence and their power, then came to be described as the ‘posterior Flechsig’ and the ‘"Oh well!" Party’. That the Flechsig soul retained its importance to the last, is made clear by Schreber’s prefatory ‘Open Letter to Herr Geheimrat Prof. Dr. Flechsig’.

In this remarkable document Schreber expresses his firm conviction that the physician who influenced him had the same visions and received the same disclosures upon supernatural things as he himself. He protests on the very first page that the author of the Denkwürdigkeiten has not the remotest intention of making an attack upon the doctor’s honour, and the same point is earnestly and emphatically repeated in the patient’s presentations of his position (343, 445). It is evident that he is endeavouring to distinguish the ‘soul Flechsig’ from the living man of the same name, the Flechsig of his delusions from the real Flechsig.¹

¹ ‘I am accordingly obliged to admit as a possibility that everything in the first chapters of my Denkwürdigkeiten which is connected with the name of Flechsig may only refer to the soul Flechsig as distinguished from the living man. For that his soul has a separate existence is a certain fact, though it cannot be explained upon any natural basis.’ (342-3.)5 The study of a number of cases of delusions of persecution has led me as well as other investigators to the view that the relation between the patient and his persecutor can be reduced to a simple formula.¹ It appears that the person to whom the delusion ascribes so much power and influence, in whose hands all the threads of the conspiracy converge, is, if he is definitely named, either identical with some one who played an equally important part in the patient’s emotional life before his illness, or is easily recognizable as a substitute for him. The intensity of the emotion is projected in the shape of external power, while its quality is changed into the opposite. The person who is now hated and feared for being a persecutor was at one time loved and honoured. The main purpose of the persecution asserted by the patient’s delusion is to justify the change in his emotional attitude.

Bearing this point of view in mind, let us now examine the relations which had formerly existed between Schreber and his physician and persecutor, Flechsig. We have already heard that, in the years 1884 and 1885, Schreber suffered from a first attack of nervous disorder, which ran its course ‘without the occurrence of any incidents bordering upon the sphere of the supernatural’ (35). While he was in this condition, which was described as ‘hypochondria’ and seems not to have overstepped the limits of a neurosis, Flechsig acted as his doctor. At that time Schreber spent six months in the University Clinic at Leipzig. We learn that after his recovery he had cordial feelings towards his doctor. ‘The main thing was that, after a fairly long period of convalescence which I spent in travelling, I was finally cured; and it was therefore impossible that I should feel anything at that time but the liveliest gratitude towards Professor Flechsig. I gave a marked expression to this feeling both in a personal visit which I subsequently paid him and in what I deemed to be an appropriate honorarium.’ (35-6.) It is true that Schreber’s encomium in the Denkwürdigkeiten upon this first treatment of Flechsig’s is not entirely with out reservations; but that can easily be understood if we consider that his attitude had in the meantime been reversed. The passage immediately following the one that has just been quoted bears witness to the original warmth of his feelings towards the physician who had treated him so successfully: ‘The gratitude of my wife was perhaps even more heartfelt; for she revered Professor Flechsig as the man who had restored her husband to her, and hence it was that for years she kept his portrait standing upon her writing-table.’ (36.)

¹ Cf. Abraham, 1908. In the course of this paper its author, referring to a correspondence between us, scrupulously attributes to myself an influence upon the development of his views.6

Since we cannot obtain any insight into the causes of the first illness (a knowledge of which is undoubtedly indispensable for properly elucidating the second and severer illness) we must now plunge at random into an unknown concatenation of circumstances. During the incubation period of his illness, as we are aware (that is, between June 1893, when he was appointed to his new post, and the following October, when he took up his duties), he repeatedly dreamt that his old nervous disorder had returned. Once, moreover, when he was half asleep, he had a feeling that after all it must be nice to be a woman submitting to the act of copulation. The dreams and the phantasy are reported by Schreber in immediate succession; and if we also bring together their subject-matter, we shall be able to infer that, at the same time as his recollection of his illness, a recollection of his doctor was also aroused in his mind, and that the feminine attitude which he assumed in the phantasy was from the first directed towards the doctor. Or it may be that the dream of his illness having returned simply expressed some such longing as: ‘I wish I could see Flechsig again!’ Our ignorance of the mental content of the first illness bars our way in this direction. Perhaps that illness had left behind in him a feeling of affectionate dependence upon his doctor, which had now, for some unknown reason, become intensified to the pitch of an erotic desire. This feminine phantasy which was still kept impersonal, was met at once by an indignant repudiation - a true ‘masculine protest’, to use Adler’s expression, but in a sense different from his.¹ But in the severe psychosis which broke out soon afterwards the feminine phantasy carried everything before it; and it only requires a slight correction of the characteristic paranoic indefiniteness of Schreber’s mode of expression to enable us to divine the fact that the patient was in fear of sexual abuse at the hands of his doctor himself. The exciting cause of his illness, then, was an outburst of homosexual libido; the object of this libido was probably from the very first his doctor, Flechsig; and his struggles against the libidinal impulse produced the conflict which gave rise to the symptoms.

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