PARAPRAXES 28 страница

It may perhaps interest you to learn how anyone could have formed such an idea as that the act of birth is the source and prototype of the affect of anxiety. Speculation had a very small share in it; what I did, rather, was to borrow from the naïve popular mind. Long years ago, while I was sitting with a number of other young hospital doctors at our mid-day meal in an inn, a house physician from the midwifery department told us of a comic thing that had happened at the last examination for midwives. A candidate was asked what it meant if meconium (excreta) made its appearance at birth in the water coming away, and she promptly replied: ‘it means the child’s frightened.’ She was laughed at and failed in the examination. But silently I took her side and began to suspect that this poor woman from the humbler classes had laid an unerring finger on an important correlation.

¹ [These Latin and German words, meaning ‘narrow place’, ’straits’, are from the same root as ‘angst’ (and ‘anxiety’).]6 If we now pass over to consider neurotic anxiety, what fresh forms and situations are manifested by anxiety? There is much to be described here. In the first place we find a general apprehensiveness, a kind of freely floating anxiety which is ready to attach itself to any idea that is in any way suitable, which influences judgement, selects what is to be expected, and lies in wait for any opportunity that will allow it to justify itself. We call this state ‘expectant anxiety’ or ‘anxious expectation’. People who are tormented by this kind of anxiety always foresee the most frightful of all possibilities, interpret every chance event as a premonition of evil and exploit every uncertainty in a bad sense. A tendency to an expectation of evil of this sort is to be found as a character trait in many people whom one cannot otherwise regard as sick; one calls them over-anxious or pessimistic. A striking amount of expectant anxiety, however, forms a regular feature of a nervous disorder to which I have given the name of ‘anxiety neurosis’ and which I include among the ‘actual’ neuroses.

A second form of anxiety, in contrast to the ones I have just described, is bound psychically and attached particular objects or situations. This is the anxiety of the extremely multifarious and often very strange ‘phobias’. Stanley Hall, the respected American psychologist, has recently taken the trouble to present us with a whole series of these phobias in all the magnificence of Greek names. This sounds like a list of the ten Plagues of Egypt, though their number goes far beyond ten. Listen to all the things that can become the object or content of a phobia: darkness, open air, open spaces, cats, spiders, caterpillars, snakes, mice, thunderstorms, sharp points, blood, enclosed spaces, crowds, solitude, crossing bridges, sea voyages and railway journeys, etc., etc. A first attempt at finding one’s way about in this confusion suggests a division into three groups. Some of the dreaded objects and situations have something uncanny about them for normal people as well, some relation to danger; and such phobias, therefore, do not strike us as unintelligible, though their strength is greatly exaggerated. Thus most of us have a sense of repulsion if we meet with a snake. Snake phobia, we might say, is a universal human characteristic; and Darwin has described most impressively how he could not avoid feeling fear of a snake that struck at him, even though he knew that he was protected from it by a thick sheet of glass. We may refer to a second group the cases in which a relation to a danger is still present, though we are accustomed to minimize the danger and not to anticipate it. The majority of situation phobias belong to this group. We know that there is more chance of an accident when we are on a railway-journey than when we stay at home - the chance of a collision; we know, too, that a ship may go down, in which case there is a probability of being drowned; but we do not think about these dangers, and travel by rail and ship without anxiety. It cannot be disputed that we should fall into the river if the bridge collapsed at the moment we were crossing it; but that happens so exceedingly seldom that it does not arise as a danger. Solitude, too, has its dangers and in certain circumstances we avoid it; but there is no question of our not being able to tolerate it under any condition even for a moment. Much the same is true of crowds, of enclosed spaces, of thunderstorms and so on. What in general appears to us strange in these phobias of neurotics is not so much their content as their intensity. The anxiety of phobias is positively overwhelming. And sometimes we get an impression that what neurotics are afraid of are not at all the same things and situations which may in certain circumstances cause anxiety in us too and which they describe by the same names.

We are left with a third group of phobias, which is quite beyond our comprehension. When a strong, grown-up man is unable owing to anxiety to walk along a street or cross a square in his own familiar home-town, when a healthy, well-developed woman is thrown into insensate anxiety because a cat has brushed against the edge of her dress or because a mouse has run across the room, how are we to relate these things to the danger which they obviously constitute for the phobic subject? In the case of such animal phobias there can be no question of an exaggeration of universal human antipathies, since, as though to demonstrate the contrary, there are numerous people who cannot pass by a cat without coaxing it and stroking it. The mouse that these women are so much afraid of is also [in German] one of the chief terms of affection; a girl who is delighted when her lover calls her one will often scream with terror when she sees the pretty creature which bears that name. In the case of the man with agoraphobia the only explanation that we can reach is that he is behaving like a small child. A child is actually taught as part of his education to avoid such situations as dangerous; and our agoraphobic will in fact be saved from his anxiety if we accompany him across the square.

The two forms of anxiety that I have just described - the freely floating expectant anxiety and the sort which is bound to phobias - are independent of each other. One is not a higher stage, as it were, of the other; and they only appear simultaneously in exceptional cases and, so to speak, accidentally. The most powerful general apprehensiveness need not be expressed in phobias; people whose whole existence is restricted by agoraphobia may be entirely free from pessimistic expectant anxiety. Some phobias - for instance, agoraphobia and railway phobia - are demonstrably acquired at a fairly mature age, while others - such as fear of darkness, thunderstorms and animals - seem to have been present from the first. Those of the former kind have the significance of severe illnesses; the latter make their appearance rather as eccentricities or whims. If a person exhibits one of these latter, one may suspect as a rule that he will have other similar ones. I must add that we class all these phobias as anxiety hysteria; that is to say, we regard them as a disorder closely related to the familiar conversion hysteria.

The third of the forms of neurotic anxiety faces us with the puzzling fact that here the connection between anxiety and a threatening danger is completely lost to view. For instance, anxiety may appear in hysteria as an accompaniment to hysterical symptoms, or in some chance condition of excitement in which, it is true, we should expect some manifestation of affect but least of all one of anxiety; or it may make its appearance, divorced from any determinants and equally incomprehensible to us and to the patient, as an unrelated attack of anxiety. Here there is no sign whatever of any danger or of any cause that could be exaggerated into one. We next learn from these spontaneous attacks that the complex which we describe as a state of anxiety is capable of fragmentation. The total attack can be represented by a single, intensely developed symptom, by a tremor, a vertigo, by palpitation of the heart, or by dyspnoea; and the general feeling by which we recognize anxiety may be absent or have become indistinct. Yet these conditions, which we describe as ‘anxiety-equivalents’, have to be equated with anxiety in all clinical and aetiological respects.

Two questions now arise. Can we relate neurotic anxiety, in which danger plays little or no part, to realistic anxiety, which is invariably a reaction to danger? And how are we to understand neurotic anxiety? We shall certainly be inclined in the first instance to hold fast to our expectation that where there is anxiety there must be something that one is afraid of.

Clinical observation affords us a number of hints towards understanding neurotic anxiety, and I will give you their tenor:-

(a) It is not difficult to establish the fact that expectant anxiety or general apprehensiveness is closely dependent on certain happenings in sexual life, or, let us say, certain employments of the libido. The simplest and most instructive case of this sort occurs in people who expose themselves to what is known as unconsummated excitation - that is, people in whom violent sexual excitations meet with no sufficient discharge, cannot be brought to a satisfying conclusion - men for instance, while they are engaged to be married, and women whose husbands are insufficiently potent or, as a precaution, perform the sexual act in an incomplete or curtailed fashion. In such circumstances the libidinal excitation vanishes and anxiety appears in its place whether in the form of expectant anxiety or in attacks and anxiety-equivalents. Interruption of the sexual act as a precaution, if it is practised as a sexual régime, is such a regular cause of anxiety neurosis in men, but more particularly in women, that in medical practice it is advisable in such cases to begin by investigating this aetiology. It will then be found on countless occasions that the anxiety neurosis disappears when the sexual abuse is discontinued.

The fact of there being a connection between sexual restraint and anxiety states is, so far as I know, no longer disputed even by physicians who have no contact with psycho-analysis. But I can well believe that an attempt is made to reverse the relation and to put forward the view that the people concerned are such as are already inclined to apprehensiveness and for that reason practise restraint in sexual matters as well. This, however, is decisively contradicted by the behaviour of women, whose sexual activity is essentially of a passive nature - is determined, that is to say, by their treatment by the man. The more passionate a woman is - the more inclined, therefore, to sexual intercourse and the more capable of being satisfied - the more certain she is to react with manifestations of anxiety to a man’s impotence or to coitus interruptus, whereas in the case of anaesthetic women or those without much libido such ill-treatment plays a far smaller part.

Of course, the sexual abstinence now so warmly recommended by doctors only has the same importance in generating anxiety states when the libido which is prevented from finding a satisfying discharge is correspondingly strong and has not been dealt with for the greater part by sublimation. Indeed, the decision on whether the outcome is to be illness or not always lies with quantitative factors. Even where what is in question is not illness but the form assumed by a person’s character, it is easy to recognize that sexual restriction goes hand in hand with some kind of anxiousness and hesitancy, while intrepidity and impudent daring bring along with them a free indulgence of sexual needs. However much these relations are altered and complicated by a variety of cultural influences, it nevertheless remains true of the average of mankind that anxiety has a close connection with sexual limitation.

I am far from having told you of all the observations that speak in favour of the genetic relation I have asserted to exist between libido and anxiety. Among them, for instance, is the influence on anxiety disorders of certain phases of life to which, as in the case of puberty and the time of the menopause, a considerable increase in the production of libido may be attributed. In some states of excitement, too, it is possible to observe directly a mixture of libido and anxiety and the final replacement of libido by anxiety. The impression one gains from all these facts is twofold: first, that what is in question is an accumulation of libido which is kept away from its normal employment, and secondly, that here we are entirely in the sphere of somatic processes. How anxiety arises from libido is not at first discernible; we can only recognize that libido is absent and that anxiety is observed in its place.

(b) A second pointer is to be found in the analysis of the psychoneuroses, and especially of hysteria. We have seen that in this illness anxiety often appears in company with the symptoms, but that unbound anxiety appears, too, manifested as an attack or as a chronic condition. The patients cannot say what it is they are afraid of, and, by the help of an unmistakable secondary revision, link it to the first phobias that come to hand - such as dying, going mad, or having a stroke. If the situation out of which the anxiety (or the symptoms accompanied by anxiety) arose is subjected to analysis, we can as a rule discover what normal course of psychical events has failed to occur and has been replaced by phenomena of anxiety. To express it in another way: we construct the unconscious process as it would have been if it had not experienced any repression and had proceeded unhindered into consciousness. This process would have been accompanied by a particular affect, and we now learn to our surprise that this affect accompanying the normal course of events is invariably replaced by anxiety after repression has occurred, no matter what its own quality may be. Thus, when we have a hysterical anxiety-state before us, its unconscious correlate may be an impulse of a similar character - anxiety, shame, embarrassment - or, just as easily, a positive libidinal excitation or a hostile aggressive one, such as rage or anger. Anxiety is therefore the universally current coinage for which any affective impulse is or can be exchanged if the ideational content attached to it is subjected to repression.

(c) We make a third discovery when we come to patients suffering from obsessional actions, who seem in a remarkable way exempt from anxiety. If we try to hinder their carrying out of their obsessional action - their washing or their ceremonial - or if they themselves venture upon an attempt to give up one of their compulsions, they are forced by the most terrible anxiety to yield to the compulsion. We can see that the anxiety was screened by the obsessional action, and that the latter was only performed in order to avoid the anxiety. In an obsessional neurosis, therefore, anxiety which would otherwise inevitably set in is replaced by the formation of a symptom, and if we turn to hysteria we find a similar relation: the result of the process of repression is either a generating of anxiety pure and simple, or anxiety accompanied by the formation of a symptom, or a more complete formation of a symptom without anxiety. It would thus seem not to be wrong in an abstract sense to assert that in general symptoms are only formed to escape an otherwise unavoidable generating of anxiety. If we adopt this view, anxiety is placed, as it were, in the very centre of our interest in the problems of neurosis.

Our observations on anxiety neurosis led us to conclude that the deflection of the libido from its normal employment, which causes the development of anxiety, takes place in the region of somatic processes. Analyses of hysteria an obsessional neurosis yield the additional conclusion that a similar deflection with the same outcome may also be the result of a refusal on the part of the psychical agencies. This much, therefore, we know about the origin of neurotic anxiety. It still sounds fairly indefinite; but for the moment I see no path that would lead us further. The second problem we set ourselves - of establishing a connection between neurotic anxiety, which is libido put to an abnormal employment, and realistic anxiety, which corresponds to a reaction to danger - seems even harder to solve. One might suppose that these were two quite disparate things; and yet we have no means of distinguishing in our feelings between realistic anxiety and neurotic anxiety.

We finally arrive at the connection we are in search of, if we take as our starting-point the opposition we have so often asserted between the ego and the libido. As we know, the generation of anxiety is the ego’s reaction to danger and the signal for taking flight. If so, it seems plausible to suppose that in neurotic anxiety the ego is making a similar attempt at flight from the demand by its libido, that it is treating this internal danger as though it were an external one. This would therefore fulfil our expectation that where anxiety is shown there is something one is afraid of. But the analogy could be carried further. Just as the attempt at flight from an external danger is replaced by standing firm and the adoption of expedient measures of defence, so too the generation of neurotic anxiety gives place to the formation of symptoms, which results in the anxiety being bound.

The difficulty in understanding now lies else here. The anxiety which signifies a flight of the ego from its libido is after all supposed to be derived from that libido itself. This is obscure and it reminds us not to forget that after all a person’s libido is fundamentally something of his and cannot be contrasted with him as something external. It is the topographical dynamics of the generation of anxiety which are still obscure to us - the question of what mental energies are produced in what process and from what mental systems they derive. This is once more a question which I cannot promise to answer: but there are two other tracks which we must not fail to follow and in doing so we shall once more be making use of direct observation and analytic enquiry as a help to our speculations. We will turn to the genesis of anxiety in children and to the source of the neurotic anxiety which is attached to phobias.

Apprehensiveness in children is something very usual, and it seems most difficult to distinguish whether it is neurotic or realistic anxiety. Indeed the value of making the distinction is put in question by the behaviour of children. For on the one hand we are not surprised if a child is frightened of all strangers, or of new situations and things; and we account for this reaction very easily as being due to his weakness and ignorance. Thus we attribute to children a strong inclination to realistic anxiety and we should regard it as quite an expedient arrangement if this apprehensiveness were an innate heritage in them. Children would merely be repeating in this the behaviour of prehistoric men and of modern primitive peoples who as a result of their ignorance and helplessness are afraid of every novelty and of many familiar things which no longer cause us any anxiety to-day. And it would fit in perfectly with our expectation if children’s phobias, in part at least, were the same as those which we may attribute to the primaeval periods of human development.

On the other hand we cannot overlook the fact that not all children are anxious to the same degree, and that precisely children who exhibit a special timidity towards objects and in situations of every kind turn out later to be neurotic. Thus the neurotic disposition betrays itself also by an outspoken tendency to realistic anxiety; apprehensiveness appears to be the primary thing and we reach the conclusion that the reason why children and, later, growing youths and girls are afraid of the height of their libido is because in fact they are afraid of everything. The genesis of anxiety from libido would in this way be denied; and if one examined into the determinants of realistic anxiety, consistency would lead one to the view that consciousness of one’s own weakness and helplessness - inferiority according to Adler’s terminology, - if it can be prolonged from childhood into adult life, is the final basis of neuroses.

This sounds so simple and seductive that it has a claim on our attention. It is true that it would involve a displacement of the riddle of the neurotic state. The continued existence of the sense of inferiority - and thus, of what determine anxiety and the formation of symptoms - seems so well assured that what calls for an explanation is rather how, as an exception, what we know as health can come about. But what is revealed by a careful examination of apprehensiveness in children? At the very beginning, what children are afraid of is strange people; situations only become important because they include people, and impersonal things do not come into account at all until later. But a child is not afraid of these strangers because he attributes evil intentions to them and compares his weakness with their strength, and accordingly assesses them as dangers to his existence, safety and freedom from pain. A child who is mistrustful in this way and terrified of the aggressive instinct which dominates the world is a theoretical construction that has quite miscarried. A child is frightened of a strange face because he is adjusted to the sight of a familiar and beloved figure - ultimately of his mother. It is his disappointment and longing that are transformed into anxiety - his libido, in fact, which has become unemployable, which cannot at that time be held in suspense and is discharged as anxiety. And it can scarcely be a matter of chance, either, that in this situation which is the prototype of the anxiety of children there is a repetition of the determinant of the first state of anxiety during the act of birth - namely, separation from the mother.

In children the first phobias relating to situations are those of darkness and solitude. The former of these often persists throughout life; both are involved when a child feels the absence of some loved person who looks after it - its mother, that is to say. While I was in the next room, I heard a child who was afraid of the dark call out: ‘Do speak to me, Auntie! I’m frightened!’ ‘Why, what good would that do? You can’t see me.’ To this the child replied: ‘If someone speaks, it gets lighter.’ Thus a longing felt in the dark is transformed into a fear of the dark. Far from its being the case that neurotic anxiety is only secondary and a special case of realistic anxiety, we see on the contrary that in a small child something that behaves like realistic anxiety shares its essential feature - origin from unemployed libido - with neurotic anxiety. Innately, children seem to have little true realistic anxiety. In all the situations which can later become determinants of phobias (on heights, on narrow bridges over water, on railway journeys, on ships) children exhibit no anxiety; and, to be sure, the greater their ignorance the less their anxiety. It would have been a very good thing if they had inherited more of such life-preserving instincts, for that would have greatly facilitated the task of watching over them to prevent their running into one danger after another. The fact is that children, to begin with, over-estimate their strength and behave fearlessly because they are ignorant of dangers. They will run along the brink of the water, climb on to the window-sill, play with sharp objects and with fire - in short, do everything that is bound to damage them and to worry those in charge of them. When in the end realistic anxiety is awakened in them, that is wholly the result of education; for they cannot be allowed to make the instructive experiences themselves.

If, then, there are children who come some way to meet this education in anxiety, and who go on to find dangers themselves that they have not been warned against, this is sufficiently explained by the fact that they have a greater amount of innate libidinal need in their constitution or have been prematurely spoiled by libidinal satisfaction. It is not to be wondered at if such children include, too, the later neurotics: as we know, what most facilitates the development of a neurosis is an incapacity to tolerate a considerable damming-up of libido over any great length of time. You will observe that here once more the constitutional factor comes into its rights - and these, indeed, we have never sought to dispute. We are only on our guard against those who in its favour neglect all other claims, and who introduce the constitutional factor at points at which the combined results of observation and analysis show that it does not belong or must take the last place.

Let me sum up what we have learnt from our observations of the apprehensiveness of children. Infantile anxiety has very little to do with realistic anxiety, but, on the other hand, is closely related to the neurotic anxiety of adults. Like the latter, it is derived from unemployed libido and it replaces the missing love-object by an external object or by a situation.5 You will be glad to hear that the analysis of phobias has not much more that is new to teach us. For the same thing happens with them as with children’s anxiety: unemployable libido is being constantly transformed into an apparently realistic anxiety and thus a tiny external danger is introduced to represent the claims of the libido. There is nothing to be wondered at in this agreement, for the infantile phobias are not only the prototype of the later ones which we class as ‘anxiety hysteria’ but are actually their precondition and the prelude to them. Every hysterical phobia goes back to an infantile anxiety and is a continuation of it, even if it has a different content and must thus be given another name. The difference between the two disorders lies in their mechanism. In order that libido shall be changed into anxiety, it no longer suffices in the case of adults for the libido to have become momentarily unemployable in the form of a longing. Adults have long since learnt how to hold such libido in suspense or to employ it in some other way. If, however, the libido belongs to a psychical impulse which has been subjected to repression, then circumstances are re-established similar to those in the case of a child in whom there is still no distinction between conscious and unconscious; and by mean of regression to the infantile phobia a passage is opened, as it were, through which the transformation of libido into anxiety can be comfortably accomplished.

As you will recall, we have dealt with repression at great length, but in doing so we have always followed the vicissitudes only of the idea that is to be repressed - naturally, since this was easier to recognize and describe. We have always left on one side the question of what happens to the affect that was attached to the repressed idea; and it is only now that we learn that the immediate vicissitude of that affect is to be transformed into anxiety, whatever quality it may have exhibited apart from this in the normal course of events. This transformation of affect is, however, by far the most important part of the process of repression. It is not so easy to speak of this, since we cannot assert the existence of unconscious affects in the same sense as that of unconscious ideas. An idea remains the same, except for the one difference, whether it is conscious or unconscious; we can state what it is that corresponds to an unconscious idea. But an affect is a process of discharge and must be judged quite differently from an idea; what corresponds to it in the unconscious cannot be declared without deeper reflection and a clarification of our hypotheses about psychical processes. And that we cannot undertake here. We will, however, emphasize the impression we have now gained that the generation of anxiety is intimately linked to the system of the unconscious.

I have said that transformation into anxiety - it would be better to say discharge in the form of anxiety - is the immediate vicissitude of libido which is subjected to repression. I must add that that vicissitude is not the only or the definitive one. In the neuroses processes are in action which endeavour to bind this generating of anxiety and which even succeed in doing so in various ways. In phobias, for instance, two phases of the neurotic process can be clearly distinguished. The first is concerned with repression and the changing of libido into anxiety, which is then bound to an external danger. The second consists in the erection of all the precautions and guarantees by means of which any contact can be avoided with this danger, treated as it is like an external thing. Repression corresponds to an attempt at flight by the ego from libido which is felt as a danger. A phobia may be compared to an entrenchment against an external danger which now represents the dreaded libido. The weakness of the defensive system in phobias lies, of course, in the fact that the fortress which has been so greatly strengthened towards the outside remains assailable from within. A projection outwards of the danger of libido can never succeed thoroughly. For that reason, in other neuroses other systems of defence are in use against the possible generation of anxiety. That is a most interesting part of the psychology of the neuroses; but unluckily it would lead us too far and it presupposes a deeper specialized knowledge. I will only add one thing more. I have already spoken to you of the ‘anticathexis’ which is employed by the ego in the process of repression and which must be permanently maintained in order that the repression may have stability. This anticathexis has the task of carrying through the various forms of defence against the generating of anxiety after repression.

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