Some neurotic mechanisms in jealousy, paranoia and homosexuality 2 страница

Free Association. - The effect of the hypnotic condition upon the patient had been so greatly to increase his ability to make associations that he was able straight away to find the path - inaccessible to his conscious reflection - which led from the symptom to the thoughts and memories connected with it. The abandonment of hypnosis seemed to make the situation hopeless, until the writer recalled a remark of Bernheim’s to the effect that things that had been experienced in a state of somnambulism were only apparently forgotten and that they could be brought into recollection at any time if the physician insisted forcibly enough that the patient knew them. The writer therefore endeavoured to insist on his unhypnotized patients giving him their associations, so that from the material thus provided he might find the path leading to what had been forgotten or fended off. He noticed later that the insistence was unnecessary and that copious ideas almost always arose in the patient’s mind, but that they were held back from being communicated and even from becoming conscious by certain objections put by the patient in his own way. It was to be expected - though this was still unproved and not until later confirmed by wide experience - that everything that occurred to a patient setting out from a particular starting-point must also stand in an internal connection with that starting-point; hence arose the technique of educating the patient to give up the whole of his critical attitude and of making use of the material which was thus brought to light for the purpose of uncovering the connections that were being sought. A strong belief in the strict determination of mental events certainly played a part in the choice of this technique as a substitute for hypnosis.

The ‘Fundamental Technical Rule’ of this procedure of ‘free association’ has from that time on been maintained in psycho-analytic work. The treatment is begun by the patient being required to put himself in the position of an attentive and dispassionate self-observer, merely to read off all the time the surface of his consciousness, and on the one hand to make a duty of the most complete honesty while on the other not to hold back any idea from communication, even if (1) he feels that it is too disagreeable or if (2) he judges that it is nonsensical or (3) too unimportant or (4) irrelevant to what is being looked for. It is uniformly found that precisely those ideas which provoke these last-mentioned reactions are of particular value in discovering the forgotten material.

Psycho-analysis as an Interpretive Art. - The new technique altered the picture of the treatment so greatly, brought the physician into such a new relation to the patient and produced so many surprising results that it seemed justifiable to distinguish the procedure from the cathartic method by giving it a new name. The present writer gave this method of treatment, which could now be extended to many other forms of neurotic disorder, the name of psycho-analysis. Now, in the first resort, this psycho-analysis was an art of interpretation and it set itself the task of carrying deeper the first of Breuer’s great discoveries - namely, that neurotic symptoms are significant substitutes for other mental acts which have been omitted. It was now a question of regarding the material produced by the patients’ associations as though it hinted at a hidden meaning and of discovering that meaning from it. Experience soon showed that the attitude which the analytic physician could most advantageously adopt was to surrender himself to his own unconscious mental activity, in a state of evenly suspended attention, to avoid so far as possible reflection and the construction of conscious expectations, not to try to fix anything that he heard particularly in his memory, and by these means to catch the drift of the patient’s unconscious with his own unconscious. It was then found that, except under conditions that were too unfavourable, the patient’s associations emerged like allusions, as it were, to one particular theme and that it was only necessary for the physician to go a step further in order to guess the material which was concealed from the patient himself and to be able to communicate it to him. It is true that this work of interpretation was not to be brought under strict rules and left a great deal of play to the physician’s tact and skill; but, with impartiality and practice, it was usually possible to obtain trustworthy results - that is to say, results which were confirmed by being repeated in similar cases. At a time when so little was as yet known of the unconscious, the structure of the neuroses and the pathological processes underlying them, it was a matter for satisfaction that a technique of this kind should be available, even if it had no better theoretical basis. Moreover it is still employed in analyses at the present day in the same manner, though with a sense of greater assurance and with a better understanding of its limitations.7

The Interpretation of Parapraxes and Haphazard Acts. - It was a triumph for the interpretative art of psycho-analysis when it succeeded in demonstrating that certain common mental acts of normal people, for which no one had hitherto attempted to put forward a psychological explanation, were to be regarded in the same light as the symptoms of neurotics: that is to say, they had a meaning, which was unknown to the subject but which could easily be discovered by analytic means. The phenomena in question were such events as the temporary forgetting of familiar words and names, forgetting to carry out prescribed tasks, everyday slips of the tongue and of the pen, misreadings, losses and mislayings of objects, certain errors, instances of apparently accidental self-injury, and finally habitual movements carried out seemingly without intention or in play, tunes hummed ‘thoughtlessly’, and so on. All of these were shorn of their physiological explanation, if any such had ever been attempted, were shown to be strictly determined and were revealed as an expression of the subject’s suppressed intentions or as a result of a clash between two intentions one of which was permanently or temporarily unconscious. The importance of this contribution to psychology was of many kinds. The range of mental determinism was extended by it in an unforeseen manner; the supposed gulf between normal and pathological mental events was narrowed; in many cases a useful insight was afforded into the play of mental forces that must be suspected to lie behind the phenomena. Finally, a class of material was brought to light which is calculated better than any other to stimulate a belief in the existence of unconscious mental acts even in people to whom the hypothesis of something at once mental and unconscious seems strange and even absurd. The study of one’s own parapraxes and haphazard acts, for which most people have ample opportunities, is even to-day the best preparation for an approach to psycho-analysis. In analytic treatment, the interpretation of parapraxes retains a place as a means of uncovering the unconscious, alongside the immeasurably more important interpretation of associations.

The Interpretation of Dreams. - A new approach to the depths of mental life was opened when the technique of free association was applied to dreams, whether one’s own or those of patients in analysis. In fact, the greater and better part of what we know of the processes in the unconscious levels of the mind is derived from the interpretation of dreams. Psycho-analysis has restored to dreams the importance which was generally ascribed to them in ancient times, but it treats them differently. It does not rely upon the cleverness of the dream-interpreter but for the most part hands the task over to the dreamer himself by asking him for his associations to the separate elements of the dream. By pursuing these associations further we obtain knowledge of thoughts which coincide entirely with the dream but which can be recognized - up to a certain point - as genuine and completely intelligible portions of waking mental activity. Thus the recollected dream emerges as the manifest dream content, in contrast to the latent dream-thoughts discovered by interpretation. The process which has transformed the latter into the former, that is to say into ‘the dream’, and which is undone by the work of interpretation, may be called the ‘dream-work’.8

We also describe the latent dream-thoughts, on account of their connection with waking life, as ’residues of the day’. By the operation of the dream-work (to which it would be quite incorrect to ascribe any ‘creative’ character) the latent dream thoughts are condensed in a remarkable way, are distorted by the displacement of psychical intensities and are arranged with a view to being represented in visual pictures; and, besides all this, before the manifest dream is arrived at, they are submitted to a process of secondary revision which seeks to give the new product something in the nature of sense and coherence. Strictly speaking, this last process does not form a part of the dream-work.

The Dynamic Theory of Dream-Formation. The motive power for the formation of dreams is not provided by the latent dream-thoughts or day’s residues, but by an unconscious impulse, repressed during the day, with which the day’s residues have been able to establish contact and which contrives to make a wish-fulfilment for itself out of the material of the latent thoughts. Thus every dream is on the one hand the fulfilment of a wish on the part of the unconscious and on the other hand (in so far as it succeeds in guarding the state of sleep against being disturbed) the fulfilment of the normal wish to sleep which set the sleep going. If we disregard the unconscious contribution to the formation of the dream and limit the dream to its latent thoughts, it can represent anything with which waking life has been concerned - a reflection, a warning, an intention, a preparation for the immediate future or, once again, the satisfaction of an unfulfilled wish. The unrecognizability, strangeness and absurdity of the manifest dream are partly the result of the translation of the thoughts into a different, so to say archaic, method of expression, but partly the effect of a restrictive, critically disapproving agency in the mind which does not entirely cease to function during sleep. It is plausible to suppose that the ‘dream-censorship’, which we regard as being responsible in the first instance for the distortion of the dream-thoughts into the manifest dream, is an expression of the same mental forces which during the day-time had held back or repressed the unconscious wishful impulse.

It has been worth while to enter in some detail into the explanation of dreams, since analytic work has shown that the dynamics of the formation of dreams are the same as those of the formation of symptoms. In both cases we find a struggle between two trends, of which one is unconscious and ordinarily repressed and strives towards satisfaction - that is, wish-fulfilment - while the other, belonging probably to the conscious ego, is disapproving and repressive. The outcome of this conflict is a compromise-formation (the dream or the symptom) in which both trends have found an incomplete expression. The theoretical importance of this conformity between dreams and symptoms is illuminating. Since dreams are not pathological phenomena, the fact shows that the mental mechanisms which produce the symptoms of illness are equally present in normal mental life, that the same uniform law embraces both the normal and the abnormal and that the findings of research into neurotics or psychotics cannot be without significance for our understanding of the healthy mind.

Symbolism. - In the course of investigating the form of expression brought about by the dream-work, the surprising fact emerged that certain objects, arrangements and relations are represented, in a sense indirectly, by ‘symbols’, which are used by the dreamer without his understanding them and to which as a rule he offers no associations. Their translation has to be provided by the analyst, who can himself only discover it empirically by experimentally fitting it into the context. It was later found that linguistic usage, mythology and folklore afford the most ample analogies to dream-symbols. Symbols, which raise the most interesting and hitherto unsolved problems, seem to be a fragment of extremely ancient inherited mental equipment. The use of a common symbolism extends far beyond the use of a common language.

The Aetiological Significance of Sexual Life. - The second novelty which emerged after the hypnotic technique had been replaced by free associations was of a clinical nature. It was discovered in the course of the prolonged search for the traumatic experiences from which hysterical symptoms appeared to be derived.The more carefully the search was pursued the more extensive seemed to be the network of aetiologically significant impressions involved, but the further back, too, did they reach into the patient’s puberty or childhood. At the same time they assumed a uniform character and eventually it became inevitable to bow before the evidence and recognize that at the root of the formation of every symptom there were to be found traumatic experiences from early sexual life. Thus a sexual trauma stepped into the place of an ordinary trauma and the latter was seen to owe its aetiological significance to an associative or symbolic connection with the former, which had preceded it. An investigation of cases of common nervousness (falling into the two classes of neurasthenia and anxiety neurosis) which was simultaneously undertaken led to the conclusion that these disorders could be traced to contemporary abuses in the patients’ sexual life and could be removed if these were brought to an end. It was thus easy to infer that neuroses in general are an expression of disturbances in sexual life, the so-called actual-neuroses being the consequences (by chemical agency) of contemporary injuries and the psycho-neuroses the consequences (by psychical modification) of bygone injuries to a biological function which had hitherto been gravely neglected by science. None of the theses of psycho-analysis has met with such tenacious scepticism or such embittered resistance as this assertion of the preponderating aetiological significance of sexual life in the neuroses. It should, however, be expressly remarked that, in its development up to the present day, psycho-analysis has found no reason to retreat from this opinion.

Infantile Sexuality. - As a result of its aetiological researches, psycho-analysis found itself in the position of dealing with a subject the very existence of which had scarcely been suspected previously. Science had become accustomed to consider sexual life as beginning with puberty and regarded manifestations of sexuality in children as rare signs of abnormal precocity and degeneracy. But now psycho-analysis revealed a wealth of phenomena, remarkable, yet of regular occurrence, which made it necessary to date back the beginning of the sexual function in children almost to the commencement of extra-uterine existence; and it was asked with astonishment how all this could have come to be overlooked.The first glimpses of sexuality in children had indeed been obtained through the analytic examination of adults and were consequently saddled with all the doubts and sources of error that could be attributed to such a belated retrospect; but subsequently (from 1908 onwards) a beginning was made with the analysis of children themselves and with the unembarrassed observation of their behaviour, and in this way direct confirmation was reached for the whole factual basis of the new view.

Sexuality in children showed a different picture in many respects from that in adults, and, surprisingly enough, it exhibited numerous traces of what, in adults, were condemned as ‘perversions’. It became necessary to enlarge the concept of what was sexual, till it covered more than the impulsion towards the union of the two sexes in the sexual act or towards provoking particular pleasurable sensations in the genitals. But this enlargement was rewarded by the new possibility of grasping infantile, normal and perverse sexual life as a single whole.

The analytic researches carried out by the writer fell, to begin with, into the error of greatly overestimating the importance of seduction as a source of sexual manifestations in children and as a root for the formation of neurotic symptoms. This misapprehension was corrected when it became possible to appreciate the extraordinarily large part played in the mental life of neurotics by the activities of phantasy, which clearly carried more weight in neurosis than did external reality. Behind these phantasies there came to light the material which allows us to draw the picture which follows of the development of the sexual function.

The Development of the Libido. - The sexual instinct, the dynamic manifestation of which in mental life we shall call ‘libido’, is made up of component instincts into which it may once more break up and which are only gradually united into well-defined organizations. The sources of these component instincts are the organs of the body and in particular certain specially marked erotogenic zones; but contributions are made to libido from every important functional process in the body. At first the individual component instincts strive for satisfaction independently of one another, but in the course of development they become more and more convergent and concentrated. The first (pregenital) stage of organization to be discerned is the oral one, in which - in conformity with the suckling’s predominant interest - the oral zone plays the leading part. This is followed by the sadistic-anal organization, in which the anal zone and the component instinct of sadism are particularly prominent; at this stage the difference between the sexes is represented by the contrast between active and passive. The third and final stage of organization is that in which the majority of the component instincts converge under the primacy of the genital zones. As a rule this development is passed through swiftly and unobtrusively; but some individual portions of the instincts remain behind at the prodromal stages of the process and thus give rise to fixations of libido, which are important as constituting predispositions for subsequent irruptions of repressed impulses and which stand in a definite relation to the later development of neuroses and perversions. (See the article on ‘The Libido Theory’.)

The Process of Finding an Object, and the Oedipus Complex. - In the first instance the oral component instinct finds satisfaction by attaching itself to the sating of the desire for nourishment; and its object is the mother’s breast. It then detaches itself, becomes independent and at the same time auto-erotic, that is, it finds an object in the child’s own body. Others of the component instincts also start by being auto-erotic and are not until later diverted on to an external object. It is a particularly important fact that the component instincts belonging to the genital zone habitually pass through a period of intense auto-erotic satisfaction. The component instincts are not all equally serviceable in the final genital organization of libido; some of them (for instance, the anal components) are consequently left aside and suppressed, or undergo complicated transformations.

In the very earliest years of childhood (approximately between the ages of two and five) a convergence of the sexual impulses occurs of which, in the case of boys, the object is the mother. This choice of an object, in conjunction with a corresponding attitude of rivalry and hostility towards the father, provides the content of what is known as the Oedipus complex, which in every human being is of the greatest importance in determining the final shape of his erotic life. It has been found to be characteristic of a normal individual that he learns to master his Oedipus complex, whereas the neurotic subject remains involved in it.

The Diphasic Onset of Sexual Development. - Towards the end of the fifth year this early period of sexual life normally comes to an end. It is succeeded by a period of more or less complete latency, during which ethical restraints are built up, to act as defences against the desires of the Oedipus complex. In the subsequent period of puberty, the Oedipus complex is revivified in the unconscious and embarks upon further modifications. It is only at puberty that the sexual instincts develop to their full intensity; but the direction of that development, as well as all the predispositions for it, have already been determined by the early efflorescence of sexuality during childhood which preceded it. This diphasic development of the sexual function - in two stages, interrupted by the latency period - appears to be a biological peculiarity of the human species and to contain the determining factor for the origin of neuroses.

The Theory of Repression. - These theoretical considerations, taken together with the immediate impressions derived from analytic work, lead to a view of the neuroses which may be described in the roughest outline as follows. The neuroses are the expression of conflicts between the ego and such of the sexual impulses as seem to the ego incompatible with its integrity or with its ethical standards. Since these impulses are not ego-syntonic, the ego has repressed them: that is to say, it has withdrawn its interest from them and has shut them off from becoming conscious as well as from obtaining satisfaction by motor discharge. If in the course of analytic work one attempts to make these repressed impulses conscious, one becomes aware of the repressive forces in the form of resistance. But the achievement of repression fails particularly readily in the case of the sexual instincts. Their dammed-up libido finds other ways out from the unconscious: for it regresses to earlier phases of development and earlier attitudes towards objects, and, at weak points in the libidinal development where there are infantile fixations, it breaks through into consciousness and obtains discharge. What results is a symptom and consequently in its essence a substitutive sexual satisfaction. Nevertheless the symptom cannot entirely escape from the repressive forces of the ego and must therefore submit to modifications and displacements exactly as happens with dreams - by means of which its characteristic of being a sexual satisfaction becomes unrecognizable. Consequently symptoms are in the nature of compromises between the repressed sexual instincts and the repressing ego-instincts; they represent a wish-fulfilment for both partners to the conflict simultaneously, but one which is incomplete for each of them. This is quite strictly true of the symptoms of hysteria, while in the symptoms of obsessional neurosis there is often a stronger emphasis upon the side of the repressing function owing to the erection of reaction-formations, which are assurances against sexual satisfaction.

Transference. - If further proof were needed of the truth that the motive forces behind the formation of neurotic symptoms are of a sexual nature, it would be found in the fact that in the course of analytic treatment a special emotional relation is regularly formed between the patient and the physician. This goes far beyond rational limits. It varies between the most affectionate devotion and the most obstinate enmity and derives all of its characteristics from earlier erotic attitudes of the patient’s which have become unconscious. This transference alike in its positive and in its negative form is used as a weapon by the resistance; but in the hands of the physician it becomes the most powerful therapeutic instrument and it plays a part scarcely to be over-estimated in the dynamics of the process of cure.

The Corner-Stones of Psycho-Analytic Theory. - The assumption that there are unconscious mental processes, the recognition of the theory of resistance and repression, the appreciation of the importance of sexuality and of the Oedipus complex - these constitute the principal subject-matter of psycho-analysis and the foundations of its theory. No one who cannot accept them all should count himself a psycho-analyst.

Later History of Psycho-Analysis. - Psycho-analysis was carried approximately thus far by the work of the writer of this article, who for more than ten years was its sole representative. In 1906 the Swiss psychiatrists Bleuler and C. G. Jung began to play a lively part in analysis; in 1907 a first conference of its supporters took place at Salzburg; and the young science soon found itself the centre of interest both among psychiatrists and laymen. Its reception in Germany, with her morbid craving for authority, was not precisely to the credit of German science and moved even so cool a partisan as Bleuler to an energetic protest. Yet no condemnation or dismissal at official congresses served to hold up the internal growth or external expansion of psycho-analysis. In the course of the next ten years it extended far beyond the frontiers of Europe and became especially popular in the United States of America, and this was due in no small degree to the advocacy and collaboration of Putnam (Boston), Ernest Jones (Toronto; later London), Flournoy (Geneva), Ferenczi (Budapest), Abraham (Berlin), and many others besides. The anathema which was imposed upon psycho-analysis led its supporters to combine in an international organization which in the present year (1922) is holding its eighth private Congress in Berlin and now includes local groups in Vienna, Budapest, Berlin, Holland, Zurich, London, New York, Calcutta and Moscow. This development was not interrupted even by the World War. In 1918-19 Dr. Anton von Freund of Budapest founded the Internationaler Psychoanalytischer Verlag, which publishes journals and books concerned with psycho analysis, and in 1920 Dr. M. Eitingon opened in Berlin the first psycho-analytic clinic for the treatment of neurotics without private means. Translations of the writer’s principal works, which are now in preparation, into French, Italian and Spanish, testify to a growing interest in psycho-analysis in the Latin world as well.

Between 1911 and 1913 two movements of divergence from psycho-analysis took place, evidently with the object of mitigating its repellent features. One of these (sponsored by C. G. Jung), in an endeavour to conform to ethical standards, divested the Oedipus complex of its real significance by giving it only a symbolic value, and in practice neglected the uncovering of the forgotten and, as we may call it, ‘prehistoric’ period of childhood. The other (originated by Alfred Adler in Vienna) reproduced many factors from psycho-analysis under other names - repression, for instance, appeared in a sexualized version as the ‘masculine protest’. But in other respects it turned away from the unconscious and the sexual instincts, and endeavoured to trace back the development of character and of the neuroses to the ‘will to power’, which by means of overcompensation strives to check the dangers arising from ‘organ inferiority’. Neither of these movements, with their systematic structures, had any permanent influence on psycho-analysis. In the case of Adler’s theories it soon became clear that they had very little in common with psycho-analysis, which they were designed to replace.

More Recent Advances in Psycho-Analysis. - Since psycho-analysis has become the field of work for such a large number of observers it has made advances, both in extent and depth; but unfortunately these can receive only the briefest mention in the present article.

Narcissism. - The most important theoretical advance has certainly been the application of the libido theory to the repressing ego. The ego itself came to be regarded as a reservoir of what was described as narcissistic libido, from which the libidinal cathexes of objects flowed out and into which they could be once more withdrawn. By the help of this conception it became possible to embark upon the analysis of the ego and to make a clinical distinction of the psychoneuroses into transference neuroses and narcissistic disorders. In the former (hysteria and obsessional neurosis) the subject has at his disposal a quantity of libido striving to be transferred on to extraneous objects, and use is made of this in carrying out analytic treatment; on the other hand, the narcissistic disorders (dementia praecox, paranoia, melancholia) are characterized by a withdrawal of the libido from objects and they are therefore scarcely accessible to analytic therapy. But their therapeutic inaccessibility has not prevented analysis from making the most fruitful beginnings in the deeper study of these illnesses, which are counted among the psychoses.

Development of Technique. - After the analyst’s curiosity had, as it were, been gratified by the elaboration of the technique of interpretation, it was inevitable that interest should turn to the problem of discovering the most effective way of influencing the patient. It soon became evident that the physician’s immediate task was to assist the patient in getting to know, and afterwards in overcoming, the resistances which emerged in him during treatment and of which, to begin with, he himself was unaware. And it was found at the same time that the essential part of the process of cure lay in the overcoming of these resistances and that unless this was achieved no permanent mental change could be brought about in the patient. Since the analyst’s efforts have in this way been directed upon the patient’s resistance, analytic technique has attained a certainty and delicacy rivalling that of surgery. Consequently, everyone is strongly advised against undertaking psycho-analytic treatments without a strict training, and a physician who ventures upon them on the strength of his medical qualification is in no respect better than a layman.

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