The psycho-analytic VIew of psychogenic disturbance of VIsion 6 страница

Vollendet er mit Donnergang.³

His father, acting on medical advice, had been in the habit of paying an annual visit to Marienbad. This patient’s infantile attitude towards his father took effect in two successive phases. As long as his father was alive it showed itself in unmitigated rebelliousness and open discord, but immediately after his death it took the form of a neurosis based upon abject submission and deferred obedience to him.

¹ [The German word for ‘sun’ is feminine: ‘die Sonne’.]

² Also Sprach Zarathustra, Part III. It was only as a child that Nietzsche too knew his father.

³ [’And with a tread of thunder he accomplishes his prescribed journey.’]7

Thus in the case of Schreber we find ourselves once again on the familiar ground of the father-complex.¹ The patient’s struggle with Flechsig became revealed to him as a conflict with God, and we must therefore construe it as an infantile conflict with the father whom he loved; the details of that conflict (of which we know nothing) are what determined the content of his delusions. None of the material which in other cases of the sort is brought to light by analysis is absent in the present one: every element is hinted at in one way or another. In infantile experiences such as this the father appears as an interferer with the satisfaction which the child is trying to obtain; this is usually of an auto-erotic character, though at a later date it is often replaced in phantasy by some other satisfaction of a less inglorious kind.² In the final stage of Schreber’s delusion a magnificent victory was scored by the infantile sexual urge; for voluptuousness became God-fearing, and God Himself (his father) never tired of demanding it from him. His father’s most dreaded threat, castration, actually provided the material for his wishful phantasy (at first resisted but later accepted) of being transformed into a woman. His allusion to an offence covered by the surrogate idea ‘soul-murder’ could not be more transparent. The chief attendant was discovered to be identical with his neighbour von W., who, according to the voices, had falsely accused him of masturbation (108). The voices said, as though giving grounds for the threat of castration: ‘For you are to be represented as being given over to voluptuous excesses.’³ (127-8.) Finally, we come to the enforced thinking (47) to which the patient submitted himself because he supposed that God would believe he had become an idiot and would withdraw from him if he ceased thinking for a moment. This is a reaction (with which we are also familiar in other connections) to the threat or fear of losing one’s reason4 as a result of indulging in sexual practices and especially in masturbation. Considering the enormous number of delusional ideas of a hypochondriacal nature5 which the patient developed, no great importance should perhaps be attached to the fact that some of them coincide word for word with the hypochondriacal fears of masturbators.6

¹ In the same way, Schreber’s ‘feminine wishful phantasy’ is simply one of the typical forms taken by the infantile nuclear complex.

² See some remarks on this subject in my analysis of the ‘Rat Man’.

³ The systems of ‘representing’ and of ‘noting down’ (126), taken in conjunction with the ‘proved souls’, point back to experiences in the patient’s school days.

4 ‘This was the end in view, as was frankly admitted at an earlier date in the phrase "We want to destroy your reason", which I have heard proceeding from the upper God upon countless occasions.’ (206 n.)

5 I must not omit to remark at this point that I shall not consider any theory of paranoia trustworthy unless it also covers the hypochondriacal symptoms by which that disorder is almost invariably accompanied. It seems to me that hypochondria stands in the same relation to paranoia as anxiety neurosis does to hysteria.

6 ‘For this reason attempts were made to pump out my spinal cord. This was done by means of so-called "little men" who were placed in my feet. I shall have more to say presently on the subject of these "little men", who showed some resemblance to the phenomena of the same name which I have already discussed in Chapter VI. There used as a rule to be two of them - a "little Flechsig" and a "little von W." - And I used to hear their voices, too, in my feet.’ (154.) Von W. was the man who was supposed to have accused Schreber of masturbation. The ‘little men’ are described by Schreber himself as being among the most remarkable and, in some respects, the most puzzling phenomena of his illness (157). It looks as though they were the product of a condensation of children and - spermatozoa.

Any one who was more daring than I am in making interpretations, or who was in touch with Schreber’s family and consequently better acquainted with the society in which he moved and the small events of his life, would find it an easy matter to trace back innumerable details of his delusions to their sources and so discover their meaning, and this in spite of the censorship to which the Denkwürdigkeiten have been subjected. But as it is, we must necessarily content ourselves with this shadowy sketch of the infantile material which was used by the paranoic disorder in portraying the current conflict.

Perhaps I may be allowed to add a few words with a view to establishing the causes of this conflict that broke out it relation to the feminine wishful phantasy. As we know, when a wishful phantasy makes its appearance, our business is to bring it into connection with some frustration, some privation in real life. Now Schreber admits having suffered a privation of the kind. His marriage, which he describes as being in other respects a happy one, brought him no children; and in particular it brought him no son who might have consoled him for the loss of his father and brother and upon whom he might have drained off his unsatisfied homosexual affections.¹ His family line threatened to die out, and it seems that he felt no little pride in his birth and lineage. ‘Both the Flechsigs and the Schrebers were members of "the highest nobility of Heaven", as the phrase went. The Schrebers in particular bore the title of "Margraves of Tuscany and Tasmania"; for souls, urged by some sort of personal vanity, have a custom of adorning themselves with somewhat high-sounding titles borrowed from this world.’² (24.) The great Napoleon obtained a divorce from Josephine (though only after severe internal struggles) because she could not propagate the dynasty.³ Dr. Schreber may have formed a phantasy that if he were a woman he would manage the business of having children more successfully; and he may thus have found his way back into the feminine attitude towards his father which he had exhibited in the earliest years of his childhood. If that were so, then his delusion that as a result of his emasculation the world was to be peopled with ‘a new race of men, born from the spirit of Schreber’ (288) - a delusion the realization of which he was continually postponing to a more and more remote future - would also be designed to offer him an escape from his childlessness. If the ‘little men’ whom Schreber himself finds so puzzling were children, then we should have no difficulty in understanding why they were collected in such great numbers on his head (158): they were in truth the ‘children of his spirit’.4

¹ ‘After my recovery from my first illness I spent eight years with my wife - years, upon the whole, of great happiness, rich in outward honours, and only clouded from time to time by the oft-repeated disappointment of our hope that we might be blessed with children.’ (36).

² He goes on from this remark, which preserves in his delusions the good-natured irony of his saner days, to trace back through former centuries the relations between the Flechsig and Schreber families. In just the same way a young man who is newly engaged, and cannot understand how he can have lived so many years without knowing the girl he is now in love with, will insist that he really made her acquaintance at some earlier time.

³ In this connection it is worth mentioning a protest entered by the patient against some statements made in the medical report: ‘I have never trifled with the idea of obtaining a divorce, nor have I displayed any indifference to the maintenance of our marriage tie, such as might be inferred from the expression used in the report to the effect that "I am always ready with the rejoinder that my wife can get a divorce if she likes".’ (436.)

4 Cf. what I have said about the method of representing patrilineal descent and about the birth of Athena in my analysis of the ‘Rat Man’ (1909d), p. 2183 n.

III ON THE MECHANISM OF PARANOIA

We have hitherto been dealing with the father-complex, which was the dominant element in Schreber’s case and with the wishful phantasy round which the illness centred. But in all of this there is nothing characteristic of the form of disease known as paranoia, nothing that might not be found (and that has not in fact been found) in other kinds of neuroses. The distinctive character of paranoia (or of dementia paranoides) must be sought for elsewhere - namely, in the particular form assumed by the symptoms; and we shall expect to find that this is determined, not by the nature of the complexes themselves, but by the mechanism by which the symptoms are formed or by which repression is brought about. We should be inclined to say that what was characteristically paranoic about the illness was the fact that the patient, as a means of warding off a homosexual wishful phantasy, reacted precisely with delusions of persecution of this kind.

These considerations therefore lend an added weight to the circumstance that we are in point of fact driven by experience to attribute to homosexual wishful phantasies an intimate (perhaps an invariable) relation to this particular form of disease. Distrusting my own experience on the subject, I have during the last few years joined with my friends C. G. Jung of Zurich and Sándor Ferenczi of Budapest in investigating upon this single point a number of cases of paranoid disorder which have come under observation. The patients whose histories provided the material for this enquiry included both men and women, and varied in race, occupation, and social standing. Yet we were astonished to find that in all of these cases defence against a homosexual wish was clearly recognizable at the very centre of the conflict which underlay the disease and that it was in an attempt to master an unconsciously reinforced current of homosexuality that they had all of them come to grief.¹ This was certainly not what we had expected. Paranoia is precisely a disorder in which a sexual aetiology is by no means obvious; far from this, the strikingly prominent features in the causation of paranoia, especially among males, are social humiliations and slights. But if we go into the matter only a little more deeply, we shall be able to see that the really operative factor in these social injuries lies in the part played in them by the homosexual components of emotional life. So long as the individual is functioning normally and it is consequently impossible to see into the depths of his mental life, we may doubt whether his emotional relations to his neighbours in society have anything to do with sexuality, either actually or in their genesis. But delusions never fail to uncover these relations and to trace back the social feelings to their roots in a directly sensual erotic wish. So long as he was healthy, Dr. Schreber, too, whose delusions culminated in a wishful phantasy of an unmistakably homosexual nature, had, by all accounts, shown no signs of homosexuality in the ordinary sense of the word.

¹ Further confirmation is afforded by Maeder’s analysis of a paranoid patient J. B. (1910). The present paper, I regret to say, was completed before I had an opportunity of reading Maeder’s work.0

I shall now endeavour (and I think the attempt is neither unnecessary nor unjustifiable) to show that the knowledge of psychological processes, which, thanks to psycho-analysis, we now possess, already enables us to understand the part played by a homosexual wish in the development of paranoia. Recent investigations¹ have directed our attention to a stage in the development of the libido which it passes through on the way from auto-erotism to object-love.² This stage has been given the name of narcissism. What happens is this. There comes a time in the development of the individual at which he unifies his sexual instincts (which have hitherto been engaged in auto-erotic activities) in order to obtain a love-object; and he begins by taking himself, his own body, as his love-object, and only subsequently proceeds from this to the choice of some person other than himself as his object. This half-way phase between auto-erotism and object-love may perhaps be indispensable normally; but it appears that many people linger unusually long in this condition, and that many of its features are carried over by them into the later stages of their development. What is of chief importance in the subject’s self thus chosen as a love object may already be the genitals. The line of development then leads on to the choice of an external object with similar genitals - that is, to homosexual object-choice - and thence to heterosexuality. People who are manifest homosexuals in later life have, it may be presumed, never emancipated themselves from the binding condition that the object of their choice must possess genitals like their own; and in this connection the infantile sexual theories which attribute the same kind of genitals to both sexes exert much influence.

¹ Sadger (1910) and Freud (1910c).

² Freud, Three Essays on the Theory of Sexuality (1905d).1

After the stage of heterosexual object-choice has been reached, the homosexual tendencies are not, as might be supposed, done away with or brought to a stop; they are merely deflected from their sexual aim and applied to fresh uses. They now combine with portions of the ego-instincts and, as ‘attached’ components, help to constitute the social instincts, thus contributing an erotic factor to friendship and comradeship, to esprit de corps and to the love of mankind in general. How large a contribution is in fact derived from erotic sources (with the sexual aim inhibited) could scarcely be guessed from the normal social relations of mankind. But it is not irrelevant to note that it is precisely manifest homosexuals, and among them again precisely those that set themselves against an indulgence in sensual acts, who are distinguished by taking a particularly active share in the general interests of humanity - interests which have themselves sprung from a sublimation of erotic instincts.

In my Three Essays on the Theory of Sexuality I have expressed the opinion that each stage in the development of psychosexuality affords a possibility of ‘fixation, and thus of a dispositional point. People who have not freed themselves completely from the stage of narcissism - who, that is to say, have at that point a fixation which may operate as a disposition to a later illness - are exposed to the danger that some unusually intense wave of libido, finding no other outlet, may lead to a sexualization of their social instincts and so undo the sublimations which they had achieved in the course of their development. This result may be produced by anything that causes the libido to flow backwards (i.e. that causes a ‘regression’): whether, on the one hand, the libido becomes collaterally reinforced owing to some disappointment over a woman, or is directly dammed up owing to a mishap in social relations with other men - both of these being instances of ‘frustration’; or whether, on the other hand, there is a general intensification of the libido, so that it becomes too powerful to find an outlet along the channels which are already open to it, and consequently bursts through its banks at the weakest spot. Since our analyses show that paranoics endeavour to protect themselves against any such sexualization of their social instinctual cathexes, we are driven to suppose that the weak spot in their development is to be looked for somewhere between the stages of auto-erotism, narcissism and homosexuality, and that their disposition to illness (which may perhaps be susceptible of more precise definition) must be located in that region. A similar disposition would have to be assigned to patients suffering from Kraepelin’s dementia praecox or (as Bleuler has named it) schizophrenia; and we shall hope later on to find clues which will enable us to trace back the differences between the two disorders (as regards both the form they take and the course they run) to corresponding differences in the patients’ dispositional fixations.

2 In taking the view, then, that what lies at the core of the conflict in cases of paranoia among males is a homosexual wishful phantasy of loving a man, we shall certainly not forget that the confirmation of such an important hypothesis can only follow upon the investigation of a large number of instances of every variety of paranoic disorder. We must therefore be prepared, if need be, to limit our assertion to a single type of paranoia. Nevertheless, it is a remarkable fact that the familiar principal forms of paranoia can all be represented as contradictions of the single proposition: ‘I (a man) love him (a man)’; and indeed that they exhaust all the possible ways in which such contradictions could be formulated.

The proposition ‘I (a man) love him’ is contradicted by:

(a) Delusions of persecution; for they loudly assert:

‘I do not love him - I hate him.’

This contradiction, which must have run thus in the unconscious,¹ cannot, however, become conscious to a paranoiac in this form. The mechanism of symptom-formation in paranoia requires that internal perceptions - feelings - shall be replaced by external perceptions. Consequently the proposition ‘I hate him’ becomes transformed by projection into another one: ‘He hates (persecutes) me, which will justify me in hating him.’ And thus the impelling unconscious feeling makes its appearance as though it were the consequence of an external perception:

‘I do not love him - I hate him, because HE PERSECUTES ME.’

Observation leaves room for no doubt that the persecutor is some one who was once loved.

(b) Another element is chosen for contradiction in erotomania, which remains totally unintelligible on any other view:

‘I do not love him - I love her.’

And in obedience to the same need for projection, the proposition is transformed into: ‘I observe that she loves me.’

‘I do not love him - I love her, because SHE LOVES ME.’

Many cases of erotomania might give an impression that they could be satisfactorily explained as being exaggerated or distorted heterosexual fixations, if our attention were not attracted by the circumstance that these infatuations invariably begin, not with any internal perception of loving, but with an external perception of being loved. But in this form of paranoia the intermediate proposition ‘I love her’ can also become conscious, because the contradiction between it and the original proposition is not a diametrical one, not so irreconcilable as that between love and hate: it is, after all, possible to love her as well as him. It can thus come about that the proposition which has been substituted by projection (‘she loves me’) may make way again for the ‘basic language’ proposition ‘I love her’.

¹ Or in the ‘basic language’, as Schreber would say.3

(c) The third way in which the original proposition can be contradicted would be by delusions of jealousy, which we can study in the characteristic forms in which they appear in each sex.

(á) Alcoholic delusions of jealousy. The part played by alcohol in this disorder is intelligible in every way. We know that that source of pleasure removes inhibitions and undoes sublimations. It is not infrequently disappointment over a woman that drives a man to drink - but this means, as a rule, that he resorts to the public-house and to the company of men, who afford him the emotional satisfaction which he has failed to get from his wife at home. If now these men become the objects of a strong libidinal cathexis in his unconscious, he will ward it off with the third kind of contradiction:

‘It is not I who love the man - she loves him’, and he suspects the woman in relation to all the men whom he himself is tempted to love.

Distortion by means of projection is necessarily absent in this instance, since, with the change of the subject who loves, the whole process is in any case thrown outside the self. The fact that the woman loves the men is a matter of external perception to him; whereas the facts that he himself does not love but hates, or that he himself loves not this but that person, are matters of internal perception.

(â) Delusions of jealousy in women are exactly analogous.

‘It is not I who love the women - he loves them.’ The jealous woman suspects her husband in relation to all the women by whom she is herself attracted owing to her homosexuality and the dispositional effect of her excessive narcissism. The influence of the time of life at which her fixation occurred is clearly shown by the selection of the love-objects which she imputes to her husband; they are often old and quite inappropriate for a real love relation - revivals of the nurses and servants and girls who were her friends in childhood, or sisters who were her actual rivals.

[(d)] Now it might be supposed that a proposition consisting of three terms, such as ‘I love him’, could only be contradicted in three different ways. Delusions of jealousy contradict the subject, delusions of persecution contradict the verb, and erotomania contradicts the object. But in fact a fourth kind of contradiction is possible - namely, one which rejects the proposition as a whole:

‘I do not love at all - I do not love any one.’ And since, after all, one’s libido must go somewhere, this proposition seems to be the psychological equivalent of the proposition: ‘I love only myself.’ So that this kind of contradiction would give us megalomania, which we may regard as a sexual overvaluation of the ego and may thus set beside the overvaluation of the love-object with which we are already familiar.¹

It is of some importance in connection with other parts of the theory of paranoia to notice that we can detect an element of megalomania in most other forms of paranoic disorder. We are justified in assuming that megalomania is essentially of an infantile nature and that, as development proceeds, it is sacrificed to social considerations. Similarly, an individual’s megalomania is never so vehemently suppressed as when he is in the grip of an overpowering love:

Denn wo die Lieb’ erwachet, stirbt

das Ich, der finstere Despot.²

After this discussion of the unexpectedly important part played by homosexual wishful phantasies in paranoia, let us return to the two factors in which we expected from the first to find the distinguishing marks of paranoia, namely, the mechanism by which the symptoms are formed and the mechanism by which repression is brought about.

We certainly have no right to begin by assuming that these two mechanisms are identical, and that symptom-formation follows the same path as repression, each proceeding along it, perhaps, in an opposite direction. Nor does there seem to be any great probability that such an identity exists. Nevertheless, we shall refrain from expressing any opinion on the subject until we have completed our investigation.

¹ Three Essays on the Theory of Sexuality. The same view and the same formulation will be found in the papers by Abraham and Maeder to which I have already referred.

² From the Ghazals of Muhammad ibn Muhammad (Jãlal al-Din) Rumi, translated by Rückert.

[For when the flames of love arise,

Then Self, the gloomy tyrant, dies.]4

The most striking characteristic of symptom-formation in paranoia is the process which deserves the name of projection. An internal perception is suppressed, and, instead, its content, after undergoing a certain kind of distortion, enters consciousness in the form of an external perception. In delusions of persecution the distortion consists in a transformation of affect; what should have been felt internally as love is perceived externally as hate. We should feel tempted to regard this remarkable process as the most important element in paranoia and as being absolutely pathognomonic for it, if we were not opportunely reminded of two things. In the first place, projection does not play the same part in all forms of paranoia; and, in the second place, it makes its appearance not only in paranoia but under other psychological conditions as well, and in fact it has a regular share assigned to it in our attitude towards the external world. For when we refer the causes of certain sensations to the external world, instead of looking for them (as we do in the case of others) inside ourselves, this normal proceeding, too, deserves to be called projection. Having thus been made aware that more general psychological problems are involved in the question of the nature of projection, let us make up our minds to postpone the investigation of it (and with it that of the mechanism of paranoic symptom-formation in general) until some other occasion; and let up now turn to consider what ideas we can collect on the subject of the mechanism of repression in paranoia. I should like to say at once, in justification of this temporary renunciation, that we shall find that the manner in which the process of repression occurs is far more intimately connected with the developmental history of the libido and with the disposition to which it gives rise than is the manner in which symptoms are formed.

In psycho-analysis we have been accustomed to look upon pathological phenomena as being derived in a general way from repression. If we examine what is spoken of as ‘repression’ more closely, we shall find reason to split the process up into three phases which are easily distinguishable from one another conceptually.5

(1) The first phase consists in fixation, which is the precursor and necessary condition of every ‘repression’. Fixation can be described in this way. One instinct or instinctual component fails to accompany the rest along the anticipated normal path of development, and, in consequence of this inhibition in its development, it is left behind at a more infantile stage. The libidinal current in question then behaves in relation to later psychological structures like one belonging to the system of the unconscious, like one that is repressed. We have already shown that these instinctual fixations constitute the basis for the disposition to subsequent illness, and we may now add that they constitute above all the basis for the determination of the outcome of the third phase of repression.

(2) The second phase of repression is that of repression proper - the phase to which most attention has hitherto been given. It emanates from the more highly developed systems of the ego - systems which are capable of being conscious - and may in fact be described as a process of ‘after-pressure’. It gives an impression of being an essentially active process, while fixation appears in fact to be a passive lagging behind. What undergo repression may either be the psychical derivatives of the original lagging instincts, when these have become reinforced and so come into conflict with the ego (or ego-syntonic instincts), or they may be psychical trends which have for other reasons aroused strong aversion. But this aversion would not in itself lead to repression, unless some connection had been established between the unwelcome trends which have to be repressed and those which have been repressed already. Where this is so, the repulsion exercised by the conscious system and the attraction exercised by the unconscious one tend in the same direction towards bringing about repression. The two possibilities which are here treated separately may in practice, perhaps, be less sharply differentiated, and the distinction between them may merely depend upon the greater or lesser degree in which the primarily repressed instincts contribute to the result.

(3) The third phase, and the most important as regards pathological phenomena, is that of failure of repression, of irruption, of return of the repressed. This irruption takes its start from the point of fixation, and it implies a regression of the libidinal development to that point.6

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