On the occasion of the opening of the Hebrew University 6 страница

That there is a relationship between inhibition and anxiety is pretty evident. Some inhibitions obviously represent a relinquishment of a function because its exercise would produce anxiety. Many women are openly afraid of the sexual function. We class this anxiety under hysteria, just as we do the defensive symptom of disgust which, arising originally as a deferred reaction to the experiencing of a passive sexual act, appears later whenever the idea of such an act is presented. Furthermore, many obsessional acts turn out to be measures of precaution and security against sexual experiences and are thus of a phobic character.

This is not very illuminating. We can only note that disturbances of the sexual function are brought about by a great variety of means. (1) The libido may simply be turned away (this seems most readily to produce what we regard as an inhibition pure and simple); (2) the function may be less well carried out; (3) it may be hampered by having conditions attached to it, or modified by being diverted to other aims; (4) it may be prevented by security measures; (5) if it cannot be prevented from starting, it may be immediately interrupted by the appearance of anxiety; and (6), if it is nevertheless carried out, there may be a subsequent reaction of protest against it and an attempt to undo what has been done.

(b) The function of nutrition is most frequently disturbed by a disinclination to eat, brought about by a withdrawal of libido. An increase in the desire to eat is also a not uncommon thing. The compulsion to eat is attributed to a fear of starving; but this is a subject which has been but little studied. The symptom of vomiting is known to us as a hysterical defence against eating. Refusal to eat owing to anxiety is a concomitant of psychotic states (delusions of being poisoned).

(c) In some neurotic conditions locomotion is inhibited by a disinclination to walk or a weakness in walking. In hysteria there will be a paralysis of the motor apparatus, or this one special function of the apparatus will be abolished (abasia). Especially characteristic are the increased difficulties that appear in locomotion owing to the introduction of certain stipulations whose non-observance results in anxiety (phobia).

(d) In inhibition in work - a thing which we so often have to deal with as an isolated symptom in our therapeutic work - the subject feels a decrease in his pleasure in it or becomes less able to do it well; or he has certain reactions to it, like fatigue, giddiness or sickness, if he is obliged to go on with it. If he is a hysteric he will have to give up his work owing to the appearance of organic and functional paralyses which make it impossible for him to carry it on. If he is an obsessional neurotic he will be perpetually being distracted from his work or losing time over it through the introduction of delays and repetitions.

Our survey might be extended to other functions as well; but there would be nothing more to be learnt by doing so. For we should not penetrate below the surface of the phenomena presented to us. Let us then proceed to describe inhibition in such a way as to leave very little doubt about what is meant by it, and say that inhibition is the expression of a restriction of an ego-function. A restriction of this kind can itself have very different causes. Some of the mechanisms involved in this renunciation of function are well known to us, as is a certain general purpose which governs it.

This purpose is more easily recognizable in the specific inhibitions. Analysis shows that when activities like playing the piano, writing or even walking are subjected to neurotic inhibitions it is because the physical organs brought into play - the fingers or the legs - have become too strongly erotized. It has been discovered as a general fact that the ego-function of an organ is impaired if its erotogenicity - its sexual significance - is increased. It behaves, if I may be allowed a rather absurd analogy, like a maid-servant who refuses to go on cooking because her master has started a love-affair with her. As soon as writing, which entails making a liquid flow out of a tube on to a piece of white paper, assumes the significance of copulation, or as soon as walking becomes a symbolic substitute for treading upon the body of mother earth, both writing and walking are stopped because they represent the performance of a forbidden sexual act. The ego renounces these functions, which are within its sphere, in order not to have to undertake fresh measures of repression - in order to avoid a conflict with the id.

There are clearly also inhibitions which serve the purpose of self-punishment. This is often the case in inhibitions of professional activities. The ego is not allowed to carry on those activities, because they would bring success and gain, and these are things which the severe super-ego has forbidden. So the ego gives them up too, in order to avoid coming into conflict with the super-ego.

The more generalized inhibitions of the ego obey a different mechanism of a simple kind. When the ego is involved in a particularly difficult psychical task, as occurs in mourning, or when there is some tremendous suppression of affect or when a continual flood of sexual phantasies has to be kept down, it loses so much of the energy at its disposal that it has to cut down the expenditure of it at many points at once. It is in the position of a speculator whose money has become tied up in his various enterprises. I came across an instructive example of this kind of intense, though short-lived, general inhibition. The patient, an obsessional neurotic, used to be overcome by a paralysing fatigue which lasted for one or more days whenever something occurred which should obviously have thrown him into a rage. We have here a point from which it should be possible to reach an understanding of the condition of general inhibition which characterizes states of depression, including the gravest form of them, melancholia.

As regards inhibitions, then, we may say in conclusion that they are restrictions of the functions of the ego which have been either imposed as a measure of precaution or brought about as a result of an impoverishment of energy; and we can see without difficulty in what respect an inhibition differs from a symptom: for a symptom cannot any longer be described as a process that takes place within, or acts upon, the ego.2

II

The main characteristics of the formation of symptoms have long since been studied and, I hope, established beyond dispute. A symptom is a sign of, and a substitute for, an instinctual satisfaction which has remained in abeyance; it is a consequence of the process of repression. Repression proceeds from the ego when the latter - it may be at the behest of the super-ego - refuses to associate itself with an instinctual cathexis which has been aroused in the id. The ego is able by means of repression to keep the idea which is the vehicle of the reprehensible impulse from becoming conscious. Analysis shows that the idea often persists as an unconscious formation.

So far everything seems clear; but we soon come upon difficulties which have not as yet been solved. Up till now our account of what occurs in repression has laid great stress on this point of exclusion from consciousness. But it has left other points open to uncertainty. One question that arose was, what happened to the instinctual impulse which had been activated in the id and which sought satisfaction? The answer was an indirect one. It was that owing to the process of repression the pleasure that would have been expected from satisfaction had been transformed into unpleasure. But we were then faced with the problem of how the satisfaction of an instinct could produce unpleasure. The whole matter can be clarified, I think, if we commit ourselves to the definite statement that as a result of repression the intended course of the excitatory process in the id does not occur at all; the ego succeeds in inhibiting or deflecting it. If this is so the problem of ‘transformation of affect’ under repression disappears. At the same time this view implies a concession to the ego that it can exert a very extensive influence over processes in the id, and we shall have to find out in what way it is able to develop such surprising powers.

It seems to me that the ego obtains this influence in virtue of its intimate connections with the perceptual system - connections which, as we know, constitute its essence and provide the basis of its differentiation from the id. The function of this system, which we have called Pcpt.-Cs., is bound up with the phenomenon of consciousness. It receives excitations not only from outside but from within, and endeavours, by means of the sensations of pleasure and unpleasure which reach it from these quarters, to direct the course of mental events in accordance with the pleasure principle. We are very apt to think of the ego as powerless against the id; but when it is opposed to an instinctual process in the id it has only to give a ‘signal of unpleasure’ in order to attain its object with the aid of that almost omnipotent institution, the pleasure principle. To take this situation by itself for a moment, we can illustrate it by an example from another field. Let us imagine a country in which a certain small faction objects to a proposed measure the passage of which would have the support of the masses. This minority obtains command of the press and by its help manipulates the supreme arbiter, ‘public opinion’, and so succeeds in preventing the measure from being passed.

But this explanation opens up fresh problems. Where does the energy come from which is employed for giving the signal of unpleasure? Here we may be assisted by the idea that a defence against an unwelcome internal process will be modelled upon the defence adopted against an external stimulus, that the ego wards off internal and external dangers alike along identical lines. In the case of external danger the organism has recourse to attempts at flight. The first thing it does is to withdraw cathexis from the perception of the dangerous object; later on it discovers that it is a better plan to perform muscular movements of such a sort as will render perception of the dangerous object impossible even in the absence of any refusal to perceive it - that it is a better plan, that is, to remove itself from the sphere of danger. Repression is an equivalent of this attempt at flight. The ego withdraws its (preconscious) cathexis from the instinctual representative that is to be repressed and uses that cathexis for the purpose of releasing unpleasure (anxiety). The problem of how anxiety arises in connection with repression may be no simple one; but we may legitimately hold firmly to the idea that the ego is the actual seat of anxiety and give up our earlier view that the cathectic energy of the repressed impulse is automatically turned into anxiety. If I expressed myself earlier in the latter sense, I was giving a phenomenological description and not a metapsychological account of what was occurring.

This brings us to a further question: how is it possible, from an economic point of view, for a mere process of withdrawal and discharge, like the withdrawing of a preconscious ego-cathexis, to produce unpleasure or anxiety, seeing that, according to our assumptions, unpleasure and anxiety can only arise as a result of an increase in cathexis? The reply is that this causal sequence should not be explained from an economic point of view. Anxiety is not newly created in repression; it is reproduced as an affective state in accordance with an already existing mnemic image. If we go further and enquire into the origin of that anxiety - and of affects in general - we shall be leaving the realm of pure psychology and entering the borderland of physiology. Affective states have become incorporated in the mind as precipitates of primaeval traumatic experiences, and when a similar situation occurs they are revived like mnemic symbols. I do not think I have been wrong in likening them to the more recent and individually acquired hysterical attack and in regarding them as its normal prototypes. In man and the higher animals it would seem that the act of birth, as the individual’s first experience of anxiety, has given the affect of anxiety certain characteristic forms of expression. But, while acknowledging this connection, we must not lay undue stress on it nor overlook the fact that biological necessity demands that a situation of danger should have an affective symbol, so that a symbol of this kind would have to be created in any case. Moreover, I do not think that we are justified in assuming that whenever there is an outbreak of anxiety something like a reproduction of the situation of birth goes on in the mind. It is not even certain whether hysterical attacks, though they were originally traumatic reproductions of this sort, retain that character permanently.

As I have shown elsewhere, most of the repressions with which we have to deal in our therapeutic work are cases of after-pressure. They presuppose the operation of earlier, primal repressions which exert an attraction on the more recent situation. Far too little is known as yet about the background and preliminary stages of repression. There is a danger of over-estimating the part played in repression by the super-ego. We cannot at present say whether it is perhaps the emergence of the super-ego which provides the line of demarcation between primal repression and after-pressure. At any rate, the earliest outbreaks of anxiety, which are of a very intense kind, occur before the super-ego has become differentiated. It is highly probable that the immediate precipitating causes of primal repressions are quantitative factors such as an excessive degree of excitation and the breaking through of the protective shield against stimuli.

This mention of the protective shield sounds a note which recalls to us the fact that repression occurs in two different situations - namely, when an undesirable instinctual impulse is aroused by some external perception, and when it arises internally without any such provocation. We shall return to this difference later. But the protective shield exists only in regard to external stimuli, not in regard to internal instinctual demands.

So long as we direct our attention to the ego’s attempt at flight we shall get no nearer to the subject of symptom-formation. A symptom arises from an instinctual impulse which has been detrimentally affected by repression. If the ego, by making use of the signal of unpleasure, attains its object of completely suppressing the instinctual impulse, we learn nothing of how this has happened. We can only find out about it from those cases in which repression must be described as having to a greater or less extent failed. In this event the position, generally speaking, is that the instinctual impulse has found a substitute in spite of repression, but a substitute which is very much reduced, displaced and inhibited and which is no longer recognizable as a satisfaction. And when the substitutive impulse is carried out there is no sensation of pleasure; its carrying out has, instead, the quality of a compulsion.

In thus degrading a process of satisfaction to a symptom, repression displays its power in a further respect. The substitutive process is prevented, if possible, from finding discharge though motility; and even if this cannot be done, the process is forced to expend itself in making alterations in the subject’s own body and is not permitted to impinge upon the external world. It must not be transformed into action. For, as we know, in repression the ego is operating under the influence of external reality and therefore it debars the substitutive process from having any effect upon that reality.

Just as the ego controls the path to action in regard to the external world, so it controls access to consciousness. In repression it exercises its power in both directions, acting in the one manner upon the instinctual impulse itself and in the other upon the representative of that impulse. At this point it is relevant to ask how I can reconcile this acknowledgement of the might of the ego with the description of its position which I gave in The Ego and the Id. In that book I drew a picture of its dependent relationship to the id and to the super-ego and revealed how powerless and apprehensive it was in regard to both and with what an effort it maintained its show of superiority over them. This view has been widely echoed in psycho-analytic literature. Many writers have laid much stress on the weakness of the ego in relation to the id and of our rational elements in the face of the daemonic forces within us; and they display a strong tendency to make what I have said into a corner-stone of a psycho-analytic Weltanschauung. Yet surely the psycho-analyst, with his knowledge of the way in which repression works, should, of all people, be restrained from adopting such an extreme and one-sided view.

I must confess that I am not at all partial to the fabrication of Weltanschauungen. Such activities may be left to philosophers, who avowedly find it impossible to make their journey through life without a Baedeker of that kind to give them information on every subject. Let us humbly accept the contempt with which they look down on us from the vantage-ground of their superior needs. But since we cannot forgo our narcissistic pride either, we will draw comfort from the reflection that such ‘Handbooks to Life’ soon grow out of date and that it is precisely our short-sighted, narrow and finicky work which obliges them to appear in new editions, and that even the most up-to-date of them are nothing but attempts to find a substitute for the ancient, useful and all-sufficient Church Catechism. We know well enough how little light science has so far been able to throw on the problems that surround us. But however much ado the philosophers may make, they cannot alter the situation. Only patient, persevering research, in which everything is subordinated to the one requirement of certainty, can gradually bring about a change. The benighted traveller may sing aloud in the dark to deny his own fears; but, for all that, he will not see an inch further beyond his nose.

III

To return to the problem of the ego. The apparent contradiction is due to our having taken abstractions too rigidly and attended exclusively now to the one side and now to the other of what is in fact a complicated state of affairs. We were justified, I think, in dividing the ego from the id, for there are certain considerations which necessitate that step. On the other hand the ego is identical with the id, and is merely a specially differentiated part of it. If we think of this part by itself in contradistinction to the whole, or if a real split has occurred between the two, the weakness of the ego becomes apparent. But if the ego remains bound up with the id and indistinguishable from it, then it displays its strength. The same is true of the relation between the ego and the super-ego. In many situations the two are merged; and as a rule we can only distinguish one from the other when there is a tension or conflict between them. In repression the decisive fact is that the ego is an organization and the id is not. The ego is, indeed, the organized portion of the id. We should be quite wrong if we pictured the ego and the id as two opposing camps and if we supposed that, when the ego tries to suppress a part of the id by means of repression, the remainder of the id comes to the rescue of the endangered part and measures its strength with the ego. This may often be what happens, but it is certainly not the initial situation in repression. As a rule the instinctual impulse which is to be repressed remains isolated. Although the act of repression demonstrates the strength of the ego, in one particular it reveals the ego’s powerlessness and how impervious to influence are the separate instinctual impulses of the id. For the mental process which has been turned into a symptom owing to repression now maintains its existence outside the organization of the ego and independently of it. Indeed, it is not that process alone but all its derivatives which enjoy, as it were, this same privilege of extra-territoriality; and whenever they come into associative contact with a part of the ego-organization, it is not at all certain that they will not draw that part over to themselves and thus enlarge themselves at the expense of the ego. An analogy with which we have long been familiar compared a symptom to a foreign body which was keeping up a constant succession of stimuli and reactions in the tissue in which it was embedded. It does sometimes happen that the defensive struggle against an unwelcome instinctual impulse is brought to an end with the formation of a symptom. As far as can be seen, this is most often possible in hysterical conversion. But usually the outcome is different. The initial act of repression is followed by a tedious or interminable sequel in which the struggle against the instinctual impulse is prolonged into a struggle against the symptom.

In this secondary defensive struggle the ego presents two faces with contradictory expressions. The one line of behaviour it adopts springs from the fact that its very nature obliges it to make what must be regarded as an attempt at restoration or reconciliation. The ego is an organization. It is based on the maintenance of free intercourse and of the possibility of reciprocal influence between all its parts. Its desexualized energy still shows traces of its origin in its impulsion to bind together and unify, and this necessity to synthesize grows stronger in proportion as the strength of the ego increases. It is therefore only natural that the ego should try to prevent symptoms from remaining isolated and alien by using every possible method to bind them to itself in one way or another, and to incorporate them into its organization by means of those bonds. As we know, a tendency of this kind is already operative in the very act of forming a symptom. A classical instance of this are those hysterical symptoms which have been shown to be a compromise between the need for satisfaction and the need for punishment. Such symptoms participate in the ego from the very beginning, since they fulfil a requirement of the super-ego, while on the other hand they represent positions occupied by the repressed and points at which an irruption has been made by it into the ego-organization. They are a kind of frontier-station with a mixed garrison. (Whether all primary hysterical symptoms are constructed on these lines would be worth enquiring into very carefully.) The ego now proceeds to behave as though it recognized that the symptom had come to stay and that the only thing to do was to accept the situation in good part and draw as much advantage from it as possible. It makes an adaptation to the symptom - to this piece of the internal world which is alien to it - just as it normally does to the real external world. It can always find plenty of opportunities for doing so. The presence of a symptom may entail a certain impairment of capacity, and this can be exploited to appease some demand on the part of the super-ego or to refuse some claim from the external world. In this way the symptom gradually comes to be the representative of important interests; it is found to be useful in asserting the position of the self and becomes more and more closely merged with the ego and more and more indispensable to it. It is only very rarely that the physical process of ‘healing’ round a foreign body follows such a course as this. There is a danger, too, of exaggerating the importance of a secondary adaptation of this kind to a symptom, and of saying that the ego has created the symptom merely in order to enjoy its advantages. It would be equally true to say that a man who had lost his leg in the war had got it shot away so that he might thenceforward live on his pension without having to do any more work.

In obse4160ssional neurosis and paranoia the forms which the symptoms assume become very valuable to the ego because they obtain for it, not certain advantages, but a narcissistic satisfaction which it would otherwise be without. The systems which the obsessional neurotic constructs flatter his self-love by making him feel that he is better than other people because he is specially cleanly or specially conscientious. The delusional constructions of the paranoic offer to his acute perceptive and imaginative powers a field of activity which he could not easily find elsewhere.

All of this results in what is familiar to us as the ‘(secondary) gain from illness’ which follows a neurosis. This gain comes to the assistance of the ego in its endeavour to incorporate the symptom and increases the symptom’s fixation. When the analyst tries subsequently to help the ego in its struggle against the symptom, he finds that these conciliatory bonds between ego and symptom operate on the side of the resistances and that they are not easy to loosen.

The two lines of behaviour which the ego adopts towards the symptom are in fact directly opposed to each other. For the other line is less friendly in character, since it continues in the direction of repression. Nevertheless the ego, it appears, cannot be accused of inconsistency. Being of a peaceable disposition it would like to incorporate the symptom and make it part of itself. It is from the symptom itself that the trouble comes. For the symptom, being the true substitute for and derivative of the repressed impulse, carries on the role of the latter; it continually renews its demands for satisfaction and thus obliges the ego in its turn to give the signal of unpleasure and put itself in a posture of defence.

The secondary defensive struggle against the symptom takes many shapes. It is fought out on different fields and makes use of a variety of methods. We shall not be able to say much about it until we have made an enquiry into the various different instances of symptom-formation. In doing this we shall have an opportunity of going into the problem of anxiety - a problem which has long been looming in the background. The wisest plan will be to start from the symptoms produced by the hysterical neurosis; for we are not as yet in a position to consider the conditions in which the symptoms of obsessional neurosis, paranoia and other neuroses are formed.

IV

Let us start with an infantile hysterical phobia of animals - for instance, the case of ‘Little Hans’, whose phobia of horses was undoubtedly typical in all its main features. The first thing that becomes apparent is that in a concrete case of neurotic illness the state of affairs is much more complex than one would suppose so long as one was dealing with abstractions. It takes a little time to find one’s bearings and to decide which the repressed impulse is, what substitutive symptom it has found and where the motive for repression lies.

‘Little Hans’ refused to go out into the street because he was afraid of horses. This was the raw material of the case. Which part of it constituted the symptom? Was it his having the fear? Was it his choice of an object for his fear? Was it his giving up of his freedom of movement? Or was it more than one of these combined? What was the satisfaction which he renounced? And why did he have to renounce it?

At a first glance one is tempted to reply that the case is not so very obscure. ‘Little Hans’s’ unaccountable fear of horses was the symptom and his inability to go out into the streets was an inhibition, a restriction which his ego had imposed on itself so as not to arouse the anxiety-symptom. The second point is clearly correct; and in the discussion which follows I shall not concern myself any further with this inhibition. But as regards the alleged symptom, a superficial acquaintance with the case does not even disclose its true formulation. For further investigation shows that what he was suffering from was not a vague fear of horses but a quite definite apprehension that a horse was going to bite him. This idea, indeed, was endeavouring to withdraw from consciousness and get itself replaced by an undefined phobia in which only the anxiety and its object still appeared. Was it perhaps this idea that was the nucleus of his symptom?

We shall not make any headway until we have reviewed the little boy’s psychical situation as a whole as it came to light in the course of the analytic treatment. He was at the time in the jealous and hostile Oedipus attitude towards his father, whom nevertheless - except in so far as his mother was the cause of estrangement - he dearly loved. Here, then, we have a conflict due to ambivalence: a well-grounded love and a no less justifiable hatred directed towards one and the same person. ‘Little Hans’s’ phobia must have been an attempt to solve this conflict. Conflicts of this kind due to ambivalence are very frequent and they can have another typical outcome, in which one of the two conflicting feelings (usually that of affection) becomes enormously intensified and the other vanishes. The exaggerated degree and compulsive character of the affection alone betray the fact that it is not the only one present but is continually on the alert to keep the opposite feeling under suppression, and enable us to postulate the operation of a process which we call repression by means of reaction-formation (in the ego). Cases like ‘Little Hans’s’ show no traces of a reaction-formation of this kind. There are clearly different ways of egress from a conflict due to ambivalence.

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