The psycho-analytic VIew of psychogenic disturbance of VIsion 7 страница

We have already alluded to the multiplicity of the possible points of fixation; there are, in fact, as many as there are stages in the development of the libido. We must be prepared to find a similar multiplicity of the mechanisms of repression proper and of the mechanisms of irruption (or of symptom-formation), and we may already begin to suspect that it will not be possible to trace back all of these multiplicities to the developmental history of the libido alone.

It is easy to see that this discussion is beginning to trench upon the problem of ‘choice of neurosis’, which, however, cannot be taken in hand until preliminary work of another kind has been accomplished. Let us bear in mind for the present that we have already dealt with fixation, and that we have postponed the subject of symptom-formation; and let us restrict ourselves to the question of whether the analysis of Schreber’s case throws any light upon the mechanism of repression proper which predominates in paranoia.

At the climax of his illness, under the influence of visions which were ‘partly of a terrifying character, but partly, too, of an indescribable grandeur’ (73), Schreber became convinced of the imminence of a great catastrophe, of the end of the world. Voices told him that the work of the past 14,000 years had now come to nothing, and that the earth’s allotted span was only 212 years more (71); and during the last part of his stay in Flechsig’s clinic he believed that that period had already elapsed. He himself was ‘the only real man left alive’, and the few human shapes that he still saw - the doctor, the attendants, the other patients - he explained as being ‘miracled up, cursorily improvised men’. Occasionally the converse current of feeling also made itself apparent: a newspaper was put into his hands in which there was a report of his own death (81); he himself existed in a second, inferior shape, and in this second shape he one day quietly passed away (73). But the form of his delusion in which his ego was retained and the world sacrificed proved itself by far the more powerful. He had various theories of the cause of the catastrophe. At one time he had in mind a process of glaciation owing to the withdrawal of the sun; at another it was to be destruction by an earthquake, in the occurrence of which he, in his capacity of ‘seer of spirits’, was to act a leading part, just as another seer was alleged to have done in the Lisbon earthquake of 1755 (91). Or again, Flechsig was the culprit, since through his magic arts he had sown fear and terror among men, had wrecked the foundations of religion, and spread abroad general nervous disorders and immorality, so that devastating pestilences had descended upon mankind (91). In any case the end of the world was the consequence of the conflict which had broken out between him and Flechsig, or, according to the aetiology adopted in the second phase of his delusion, of the indissoluble bond which had been formed between him and God; it was, in fact, the inevitable result of his illness. Years afterwards, when Dr. Schreber had returned to human society, and could find no trace in the books, the musical scores, or the other articles of daily use which fell into his hands once more, of anything to bear out his theory that there had been a gap of vast duration in the history of mankind, he admitted that his view was no longer tenable: ’... I can no longer avoid recognizing that, externally considered, everything is as it used to be. Whether, nevertheless, there may not have been a profound internal change is a question to which I shall recur later.’ (84-5.) He could not bring himself to doubt that during his illness the world had come to an end and that, in spite of everything, the one that he now saw before him was a different one.

A world-catastrophe of this kind is not infrequent during the agitated stage in other cases of paranoia.¹ If we base ourselves on our theory of libidinal cathexis, and if we follow the hint given by Schreber’s view of other people as being ‘cursorily improvised men’, we shall not find it difficult to explain these catastrophes.² The patient has withdrawn from the people in his environment and from the external world generally the libidinal cathexis which he has hitherto directed on to them. Thus everything has become indifferent and irrelevant to him, and has to be explained by means of a secondary rationalization as being ‘miracled up, cursorily improvised’. The end of the world is the projection of this internal catastrophe; his subjective world has come to an end since his withdrawal of his love from it.³

After Faust has uttered the curses which free him from the world, the Chorus of Spirits sings:

Weh! Weh!

Du hast sie zerstört,

die schöne Welt,

mit mächtiger Faust!

sie stürzt, sie zerfällt!

Ein Halbgott hat sie zerschlagen!

......

Mächtiger

der Erdensöhne,

Prächtiger

baue sie wieder,

in deinem Busen baue sie auf!4

And the paranoic builds it again, not more splendid, it is true, but at least so that he can once more live in it. He builds it up by the world of his delusions. The delusional formation, which we take to be the pathological product, is in reality an attempt at recovery, a process of reconstruction. Such a reconstruction after the catastrophe is successful to a greater or lesser extent, but never wholly so; in Schreber’s words, there has been a ‘profound internal change’ in the world. But the human subject has recaptured a relation, and often a very intense one, to the people and things in the world, even though the relation is a hostile one now, where formerly it was hopefully affectionate. We may say, then, that the process of repression proper consists in a detachment of the libido from people - and things - that were previously loved. It happens silently; we receive no intelligence of it, but can only infer it from subsequent events. What forces itself so noisily upon our attention is the process of recovery, which undoes the work of repression and brings back the libido again on to the people it had abandoned. In paranoia this process is carried out by the method of projection. It was incorrect to say that the perception which was suppressed internally is projected outwards; the truth is rather, as we now see, that what was abolished internally returns from without. The thorough examination of the process of projection which we have postponed to another occasion will clear up our remaining doubts on this subject.

¹ An ‘end of the world’ based upon other motives is to be found at the climax of the ecstasy of love (cf. Wagner’s Tristan und Isolde); in this case it is not the ego but the single love-object which absorbs all the cathexes directed upon the external world.

² Cf. Abraham (1908) and Jung (1907). Abraham’s short paper contains almost all the essential views put forward in the present study of the case of Schreber.

³ He has perhaps withdrawn from it not only his libidinal cathexis, but his interest in general - that is, the cathexes that proceed from his ego as well. This question is discussed below.

4 [ Woe! Woe!

Thou hast it destroyed,

The beautiful world,

With powerful fist!

In ruins 'tis hurled,

By the blow of a demigod shattered!

.....

Mightier

For the children of men,

More splendid

Build it again,

In thine own bosom build it anew!]8 In the meantime, however, it is a source of some satisfaction to find that our newly acquired knowledge involves us in a number of further discussions.

(1) Our first reflection will tell us that it cannot be the case that this detachment of the libido occurs exclusively in paranoia; nor can it be that, where it occurs elsewhere, it has such disastrous consequences. It is quite possible that a detachment of the libido is the essential and regular mechanism of every repression. We can have no positive knowledge on that point until the other disorders that are based upon repression have been similarly examined. But it is certain that in normal mental life (and not only in periods of mourning) we are constantly detaching our libido in this way from people or from other objects without falling ill. When Faust freed himself from the world by uttering his curses, the result was not a paranoia or any other neurosis but simply a certain general frame of mind. The detachment of the libido, therefore, cannot in itself be the pathogenic factor in paranoia; there must be some special characteristic which distinguishes a paranoic detachment of the libido from other kinds. It is not difficult to suggest what that characteristic may be. What use is made of the libido after it has been set free by the process of detachment? A normal person will at once begin looking about for a substitute for the lost attachment; and until that substitute has been found the liberated libido will be kept in suspension within his mind, and will there give rise to tensions and colour his mood. In hysteria the liberated libido becomes transformed into somatic innervations or into anxiety. But in paranoia the clinical evidence goes to show that the libido, after it has been withdrawn from the object, is put to a special use. It will be remembered that the majority of cases of paranoia exhibit traces of megalomania, and that megalomania can by itself constitute a paranoia. From this it may be concluded that in paranoia the liberated libido becomes attached to the ego, and is used for the aggrandizement of the ego. A return is thus made to the stage of narcissism (known to us from the development of the libido), in which a person’s only sexual object is his own ego. On the basis of this clinical evidence we can suppose that paranoics have brought along with them a fixation at the stage of narcissism, and we can assert that the length of the step back from sublimated homosexuality to narcissism is a measure of the amount of regression characteristic of paranoia.

(2) An equally plausible objection can be based upon Schreber’s case history, as well as upon many others. For it can be urged that the delusions of persecution (which were directed against Flechsig) unquestionably made their appearance at an earlier date than the phantasy of the end of the world; so that what is supposed to have been a return of the repressed actually preceded the repression itself - and this is patent nonsense. In order to meet this objection we must leave the high ground of generalization and descend to the detailed consideration of actual circumstances, which are undoubtedly very much more complicated. We must admit the possibility that a detachment of the libido such as we are discussing might just as easily be a partial one, a drawing back from some single complex, as a general one. A partial detachment should be by far the commoner of the two, and should precede a general one, since to begin with it is only for a partial detachment that the influences of life provide a motive. The process may then stop at the stage of a partial detachment or it may spread to a general one, which will loudly proclaim its presence in the symptoms of megalomania. Thus the detachment of the libido from the figure of Flechsig may nevertheless have been what was primary in the case of Schreber; it was immediately followed by the appearance of the delusion, which brought back the libido on to Flechsig again (though with a negative sign to mark the fact that repression had taken place) and thus annulled the work of repression. And now the battle of repression broke out anew, but this time with more powerful weapons. In proportion as the object of contention became the most important thing in the external world, trying on the one hand to draw the whole of the libido on to itself, and on the other hand mobilizing all the resistances against itself, so the struggle raging around this single object became more and more comparable to a general engagement; till at length a victory for the forces of repression found expression in a conviction that the world had come to an end and that the self alone survived. If we review the ingenious constructions which were raised by Schreber’s delusion in the domain of religion - the hierarchy of God, the proved souls, the fore-courts of Heaven, the lower and the upper God - we can gauge in retrospect the wealth of sublimations which were brought down in ruin by the catastrophe of the general detachment of his libido.

(3) A third consideration which arises from the views that have been developed in these pages is as follows. Are we to suppose that a general detachment of the libido from the external world would be an effective enough agent to account for the ‘end of the world’? Or would not the ego-cathexes which still remained in existence have been sufficient to maintain rapport with the external world? To meet this difficulty we should either have to assume that what we call libidinal cathexis (that is, interest emanating from erotic sources) coincides with interest in general, or we should have to consider the possibility that a very widespread disturbance in the distribution of libido may bring about a corresponding disturbance in the ego-cathexes. But these are problems which we are still quite helpless and incompetent to solve. It would be otherwise if we could start out from some well-grounded theory of instincts; but in fact we have nothing of the kind at our disposal. We regard instinct as being the concept on the frontier-line between the somatic and the mental, and see in it the psychical representative of organic forces. Further, we accept the popular distinction between ego-instincts and a sexual instinct; for such a distinction seems to agree with the biological conception that the individual has a double orientation, aiming on the one hand at self-preservation and on the other at the preservation of the species. But beyond this are only hypotheses, which we have taken up - and are quite ready to drop again - in order to help us to find our bearings in the chaos of the obscurer processes of the mind. What we expect from psycho-analytic investigations of pathological mental processes is precisely that they shall drive us to some conclusions on questions connected with the theory of instincts. These investigations, however, are in their infancy and are only being carried out by isolated workers, so that the hopes we place in them must still remain unfulfilled. We can no more dismiss the possibility that disturbances of the libido may react upon the ego-cathexes than we can overlook the converse possibility - namely, that a secondary or induced disturbance of the libidinal processes may result from abnormal changes in the ego. Indeed, it is probable that processes of this kind constitute the distinctive characteristic of psychoses. How much of all this may apply to paranoia it is impossible at present to say. There is one consideration, however, on which I should like to lay stress. It cannot be asserted that a paranoic, even at the height of the repression, withdraws his interest from the external world completely - as must be considered to occur in certain other kinds of hallucinatory psychosis (such a Meynert’s amentia). The paranoic perceives the external world and takes into account any alterations that may happen in it, and the effect it makes upon him stimulates him to invent explanatory theories (such as Schreber’s ‘cursorily improvised men’). It therefore appears to me far more probable that the paranoic’s altered relation to the world is to be explained entirely or in the main by the loss of his libidinal interest.

(4) It is impossible to avoid asking, in view of the close connection between the two disorders, how far this conception of paranoia will affect our conception of dementia praecox. I am of opinion that Kraepelin was entirely justified in taking the step of separating off a large part of what had hitherto been called paranoia and merging it, together with catatonia and certain other forms of disease, into a new clinical unit - though ‘dementia praecox’ was a particularly unhappy name to choose for it. The designation chosen by Bleuler for the same group of forms - ‘schizophrenia’ - is also open to the objection that the name appears appropriate only so long as we forget its literal meaning. For otherwise it prejudices the issue, since it is based on a characteristic of the disease which is theoretically postulated - a characteristic, moreover, which does not belong exclusively to that disease, and which, in the light of other considerations, cannot be regarded as the essential one. However, it is not on the whole of very great importance what names we give to clinical pictures. What seems to me more essential is that paranoia should be maintained as an independent clinical type, however frequently the picture it offers may be complicated by the presence of schizophrenic features. For, from the standpoint of the libido theory, while it would resemble dementia praecox in so far as the repression proper would in both disorders have the same principal feature - detachment of the libido, together with its regression on to the ego - it would be distinguished from dementia praecox by having its dispositional fixation differently located and by having a different mechanism for the return of the repressed (that is, for the formation of symptoms). It would seem to me the most convenient plan to give dementia praecox the name of paraphrenia. This term has no special connotation, and it would serve to indicate a relationship with paranoia (a name which cannot be changed) and would further recall hebephrenia, an entity which is now merged in dementia praecox. It is true that the name has already been proposed for other purposes; but this need not concern us, since the alternative applications have not passed into general use.

Abraham has very convincingly shown ¹ that the turning away of the libido from the external world is a particularly clearly-marked feature in dementia praecox. From this feature we infer that the repression is effected by means of detachment of the libido. Here once more we may regard the phase of violent hallucinations as a struggle between repression and an attempt at recovery by bringing the libido back again on to its objects. Jung, with extraordinary analytic acumen, has perceived that the deliria² and motor stereotypes occurring in this disorder are the residues of former object-cathexes, clung to with great persistence. This attempt at recovery, which observers mistake for the disease itself, does not, as in paranoia, make use of projection, but employs a hallucinatory (hysterical) mechanism. This is one of the two major respects in which dementia praecox differs from paranoia; and this difference can be explained genetically from another direction. The second difference is shown by the outcome of the disease in those cases where the process has not remained too restricted. The prognosis is on the whole more unfavourable than in paranoia. The victory lies with repression and not, as in the former, with reconstruction. The regression extends not merely to narcissism (manifesting itself in the shape of megalomania) but to a complete abandonment of object-love and a return to infantile auto-erotism. The dispositional fixation must therefore be situated further back than in paranoia, and must lie some where at the beginning of the course of development from auto-erotism to object-love. Moreover, it is not at all likely that homosexual impulsions, which are so frequently - perhaps invariably - to be found in paranoia, play an equally important part in the aetiology of that far more comprehensive disorder, dementia praecox.

¹ In the paper already quoted.

² [In French and German psychiatry the word ‘delirium’ is often used of delusional states.]3

Our hypotheses as to the dispositional fixations in paranoia and paraphrenia make it easy to see that a case may begin with paranoic symptoms and may yet develop into a dementia praecox, and that paranoid and schizophrenic phenomena may be combined in any proportion. And we can understand how a clinical picture such as Schreber’s can come about, and merit the name of a paranoid dementia, from the fact that in its production of a wishful phantasy and of hallucinations it shows paraphrenic traits, while in its exciting cause, in its use of the mechanism of projection, and in its outcome it exhibits a paranoid character. For it is possible for several fixations to be left behind in the course of development, and each of these in succession may allow an irruption of the libido that has been pushed off - beginning, perhaps, with the later acquired fixations, and going on, as the illness develops, to the original ones that lie nearer the starting-point. We should be glad to know to what conditions the relatively favourable issue of the present case is due; for we cannot willingly attribute the whole responsibility for the outcome to anything so casual as the ‘improvement due to change in domicile’,¹ which set in after the patient’s removal from Flechsig’s clinic. But our insufficient acquaintance with the intimate circumstances of the history of the case makes it impossible to give an answer to this interesting question. It may be suspected, however, that what enabled Schreber to reconcile himself to his homosexual phantasy, and so made it possible for his illness to terminate in something approximating to a recovery, may have been the fact that his father-complex was in the main positively toned and that in real life the later years of his relationship with an excellent father had probably been unclouded.

¹ Cf. Riklin (1905).4 Since I neither fear the criticism of others nor shrink from criticizing myself, I have no motive for avoiding the mention of a similarity which may possibly damage our libido theory in the estimation of many of my readers. Schreber’s ‘rays of God’, which are made up of a condensation of the sun’s rays, of nerve fibres, and of spermatozoa, are in reality nothing else than a concrete representation and projection outwards of libidinal cathexes; and they thus lend his delusions a striking conformity with our theory. His belief that the world must come to an end because his ego was attracting all the rays to itself, his anxious concern at a later period, during the process of reconstruction, lest God should sever His ray-connection with him, - these and many other details of Schreber’s delusional structure sound almost like endopsychic perceptions of the processes whose existence I have assumed in these page as the basis of our explanation of paranoia. I can nevertheless call a friend and fellow-specialist to witness that I had developed my theory of paranoia before I became acquainted with the contents of Schreber’s book. It remains for the future to decide whether there is more delusion in my theory than I should like to admit, or whether there is more truth in Schreber’s delusion than other people are as yet prepared to believe.

Lastly, I cannot conclude the present work, which is once again only a fragment of a larger whole, without foreshadowing the two chief theses towards the establishment of which the libido theory of the neuroses and psychoses is advancing: namely, that the neuroses arise in the main from a conflict between the ego and the sexual instinct, and that the forms which the neuroses assume retain the imprint of the course of development followed by the libido - and by the ego.

POSTSCRIPT

(1912)

In dealing with the case history of Senatspräsident Schreber I purposely restricted myself to a minimum of interpretation and I feel confident that every reader with a knowledge of psycho-analysis will have learned from the material which I presented more than was explicitly stated by me, and that he will have found no difficulty in drawing the threads closer and in reaching conclusions at which I no more than hinted. By a happy chance the same issue of this periodical as that in which my own paper appeared showed that the attention of some other contributors had been directed to Schreber’s autobiography, and made it easy to guess how much more material remains to be gathered from the symbolic content of the phantasies and delusions of this gifted paranoic.¹

Since I published my work upon Schreber, a chance acquisition of knowledge has put me in a position to appreciate one of his delusional beliefs more adequately, and to recognize the wealth of its bearing upon mythology. I mentioned on p. 2425 the patient’s peculiar relation to the sun, and I was led to explain the sun as a sublimated ‘father-symbol’. The sun used to speak to him in human language and thus revealed itself to him as a living being. Schreber was in the habit of abusing it and shouting threats at it; he declares, moreover, that when he stood facing it and spoke aloud, its rays would turn pale before him. After his ‘recovery’ he boasts that he can gaze at it without any difficulty and without being more than slightly dazzled by it, a thing which would naturally have been impossible for him formerly.²

It is to this delusional privilege of being able to gaze at the sun without being dazzled that the mythological interest attaches. We read in Reinach³ that the natural historians of antiquity attributed this power to the eagle alone, who, as a dweller in the highest regions of the air, was brought into especially intimate relation with the heavens, with the sun, and with lightning.4 We learn from the same sources, moreover, that the eagle puts his young to a test before recognizing them as his legitimate offspring. Unless they can succeed in looking into the sun without blinking they are thrown out of the eyrie.

¹ Cf. Jung (1911, 164 and 207); and Spielrein (1911, 350).

² See the footnote to page 139 of Schreber’s book.

³ Reinach (1905-12, 3, 80), quoting Keller (1887).

4 Representations of eagles were set up at the highest points of temples, so as to serve as ‘magical’ lightning-conductors. (Cf. Reinach, loc. cit.)6

There can be no doubt about the meaning of this animal myth. It is certain that this is merely ascribing to animals something that is a hallowed custom among men. The procedure gone through by the eagle with his young is an ordeal, a test of lineage, such as is reported of the most various races of antiquity. Thus the Celts living on the banks of the Rhine used to entrust their new-born babies to the waters of the river, in order to ascertain whether they were truly of their own blood. The clan of Psylli, who inhabited what is now Tripoli, boasted that they were descended from snakes, and used to expose their infants to contact with them; those who were true-born children of the clan were either not bitten or recovered rapidly from the effects of the bite.¹ The assumption underlying these trials leads us deep into the totemic habits of thought of primitive peoples. The totem - an animal, or a natural force animistically conceived, to which the tribe traces back its origin - spares the members of the tribe as being its own children, just as it itself is honoured by them as being their ancestor and is spared by them. We have here arrived at the consideration of matters which, as it seems to me, may make it possible to arrive at a psycho-analytic explanation of the origins of religion.

The eagle, then, who makes his young look into the sun and requires of them that they shall not be dazzled by its light, is behaving as though he were himself a descendant of the sun and were submitting his children to a test of their ancestry. And when Schreber boasts that he can look into the sun unscathed and undazzled, he has rediscovered the mythological method of expressing his filial relation to the sun, and has confirmed us once again in our view that the sun is a symbol of the father. It will be remembered that during his illness Schreber gave free expression to his family pride,² and that we discovered in the fact of his childlessness a human motive for his having fallen ill with a feminine wishful phantasy. Thus the connection between his delusional privilege and the basis of his illness becomes evident.

¹ For lists of references see Reinach, loc. cit. and ibid., 1, 74.

² The Schrebers are ‘members of the highest nobility of Heaven’ (24). - ‘Adel’ is the attribute of an ‘Adler’. [‘Adel’ means ‘nobility’ or ‘noble’. ‘Adler’ means ‘eagle’ or ‘noble (person)’.]7

This short postscript to my analysis of a paranoid patient may serve to show that Jung had excellent grounds for his assertion that the mythopoeic forces of mankind are not extinct, but that to this very day they give rise in the neuroses to the same psychical products as in the remotest past ages. I should like to take up a suggestion that I myself made some time ago,¹ and add that the same holds good of the forces that construct religions. And I am of opinion that the time will soon be ripe for us to make an extension of a thesis which has long been asserted by psycho-analysts, and to complete what has hitherto had only an individual and ontogenetic application by the addition of its anthropological counterpart, which is to be conceived phylogenetically. ‘In dreams and in neuroses’, so our thesis has run, ‘ we come once more upon the child and the peculiarities which characterize his modes of thought and his emotional life.’ ‘And we come upon the savage too,’ we may now add, ‘upon the primitive man, as he stands revealed to us in the light of the researches of archaeology and of ethnology.’

¹ ‘Obsessive Acts and Religious Practices’ (1907b).8

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