On the occasion of the opening of the Hebrew University 10 страница

Since we have traced back the generating of anxiety to a situation of danger, we shall prefer to say that symptoms are created in order to remove the ego from a situation of danger. If the symptoms are prevented from being formed, the danger does in fact materialize; that is, a situation analogous to birth is established in which the ego is helpless in the face of a constantly increasing instinctual demand - the earliest and original determinant of anxiety. Thus in our view the relation between anxiety and symptom is less close than was supposed, for we have inserted the factor of the danger-situation between them. We can also add that the generating of anxiety sets symptom formation going and is, indeed, a necessary prerequisite of it. For if the ego did not arouse the pleasure-unpleasure agency by generating anxiety, it would not obtain the power to arrest the process which is preparing in the id and which threatens danger. There is in all this an evident inclination to limit to a minimum the amount of anxiety generated and to employ it only as a signal; for to do otherwise would only result in feeling in another place the unpleasure which the instinctual process was threatening to produce, and that would not be a success from the standpoint of the pleasure principle, although it is one that occurs often enough in the neuroses.

Symptom-formation, then, does in fact put an end to the danger-situation. It has two aspects: one, hidden from view, brings about the alteration in the id in virtue of which the ego is removed from danger; the other, presented openly, shows what has been created in place of the instinctual process that has been affected - namely, the substitutive formation.

It would, however, be more correct to ascribe to the defensive process what we have just said about symptom-formation and to use the latter term as synonymous with substitute-formation. It will then be clear that the defensive process is analogous to the flight by means of which the ego removes itself from a danger that threatens it from outside. The defensive process is an attempt at flight from an instinctual danger. An examination of the weak points in this comparison will make things clearer.

One objection to it is that loss of an object (or loss of love on the part of the object) and the threat of castration are just as much dangers coming from outside as, let us say, a ferocious animal would be; they are not instinctual dangers. Nevertheless, the two cases are not the same. A wolf would probably attack us irrespectively of our behaviour towards it; but the loved person would not cease to love us nor should we be threatened with castration if we did not entertain certain feelings and intentions within us. Thus such instinctual impulses are determinants of external dangers and so become dangerous in themselves; and we can now proceed against the external danger by taking measures against the internal ones. In phobias of animals the danger seems to be still felt entirely as an external one, just as it has undergone an external displacement in the symptom. In obsessional neuroses the danger is much more internalized. That portion of anxiety in regard to the super-ego which constitutes social anxiety still represents an internal substitute for an external danger, while the other portion- moral anxiety - is already completely endopsychic.

Another objection is that in an attempt at flight from an impending external danger all that the subject is doing is to increase the distance between himself and what is threatening him. He is not preparing to defend himself against it or attempting to alter anything about it, as would be the case if he attacked the wolf with a stick or shot at it with a gun. But the defensive process seems to do something more than would correspond to an attempt at flight. It joins issue with the threatening instinctual process and somehow suppresses it or deflects it from its aims and thus renders it innocuous. This objection seems unimpeachable and must be given due weight. I think it is probable that there are some defensive processes which can truly be likened to an attempt at flight, while in others the ego takes a much more active line of self-protection and initiates vigorous counter-measures. But perhaps the whole analogy between defence and flight is invalidated by the fact that both the ego and the instinct in the id are parts of the same organization, not separate entities like the wolf and the child, so that any kind of behaviour on the part of the ego will result in an alteration in the instinctual process as well.

This study of the determinants of anxiety has, as it were, shown the defensive behaviour of the ego transfigured in a rational light. Each situation of danger corresponds to a particular period of life or a particular developmental phase of the mental apparatus and appears to be justifiable for it. In early infancy the individual is really not equipped to master psychically the large sums of excitation that reach him whether from without or from within. Again, at a certain period of life his most important interest really is that the people he is dependent on should not withdraw their loving care of him. Later on in his boyhood, when he feels that his father is a powerful rival in regard to his mother and becomes aware of his own aggressive inclinations towards him and of his sexual intentions towards his mother, he really is justified in being afraid of his father; and his fear of being punished by him can find expression through phylogenetic reinforcement in the fear of being castrated. Finally, as he enters into social relationships, it really is necessary for him to be afraid of his super-ego, to have a conscience; and the absence of that factor would give rise to severe conflicts, dangers and so on.

But this last point raises a fresh problem. Instead of the affect of anxiety let us take, for a moment, another affect - that of pain, for instance. It seems quite normal that at four years of age a girl should weep painfully if her doll is broken; or at six, if her governess reproves her; or at sixteen, if she is slighted by her young man; or at twenty-five, perhaps, if a child of her own dies. Each of these determinants of pain has its own time and each passes away when that time is over. Only the final and definitive determinants remain throughout life. We should think it strange if this same girl, after she had grown to be a wife and mother, were to cry over some worthless trinket that had been damaged. Yet that is how the neurotic behaves. Although all the agencies for mastering stimuli have long ago been developed within wide limits in his mental apparatus, and although he is sufficiently grown up to satisfy most of his needs for himself and has long ago learnt that castration is no longer practised as a punishment, he nevertheless behaves as though the old danger-situations still existed, and keeps hold of all the earlier determinants of anxiety.

Why this should be so calls for a rather long reply. First of all, we must sift the facts. In a great number of cases the old determinants of anxiety do really lapse, after having produced neurotic reactions. The phobias of very young children, fears of being alone or in the dark or with strangers - phobias which can almost be called normal - usually pass off later on; the child ‘grows out of them’, as we say about some other disturbances of childhood. Animal phobias, which are of such frequent occurrence, undergo the same fate and many conversion hysterias of early years find no continuation in later life. Ceremonial actions appear extremely often in the latency period, but only a very small percentage of them develop later into a full obsessional neurosis. In general, so far as we can tell from our observations of town children belonging to the white races and living according to fairly high cultural standards, the neuroses of childhood are in the nature of regular episodes in a child’s development, although too little attention is still being paid to them. Signs of childhood neuroses can be detected in all adult neurotics without exception; but by no means all children who show those signs become neurotic in later life. It must be, therefore, that certain determinants of anxiety are relinquished and certain danger-situations lose their significance as the individual becomes more mature. Moreover, some of these danger-situations manage to survive into later times by modifying their determinants of anxiety so as to bring them up to date. Thus, for instance, a man may retain his fear of castration in the guise of a syphilidophobia, after he has come to know that it is no longer customary to castrate people for indulging their sexual lusts, but that, on the other hand, severe diseases may overtake anyone who thus gives way to his instincts. Other determinants of anxiety, such as fear of the super-ego, are destined not to disappear at all but to accompany people throughout their lives. In that case the neurotic will differ from the normal person in that his reactions to the dangers in question will he unduly strong. Finally, being grown-up affords no absolute protection against a return of the original traumatic anxiety-situation. Each individual has in all probability a limit beyond which his mental apparatus fails in its function of mastering the quantities of excitation which require to be disposed of.

These minor rectifications cannot in any way alter the fact which is here under discussion, that a great many people remain infantile in their behaviour in regard to danger and do not overcome determinants of anxiety which have grown out of date. To deny this would be to deny the existence of neurosis, for it is precisely such people whom we call neurotics. But how is this possible? Why are not all neuroses episodes in the development of the individual which come to a close when the next phase is reached? Whence comes the element of persistence in these reactions to danger? Why does the affect of anxiety alone seem to enjoy the advantage over all other affects of evoking reactions which are distinguished from the rest in being abnormal and which, through their inexpediency, run counter to the movement of life? In other words, we have once more come unawares upon the riddle which has so often confronted us: whence does neurosis come - what is its ultimate, its own peculiar raison d’être? After tens of years of psycho-analytic labours, we are as much in the dark about this problem as we were at the start.

X

Anxiety is the reaction to danger. One cannot, after all, help suspecting that the reason why the affect of anxiety occupies a unique position in the economy of the mind has something to do with the essential nature of danger. Yet dangers are the common lot of humanity; they are the same for everyone. What we need and cannot lay our finger on is some factor which will explain why some people are able to subject the affect of anxiety, in spite of its peculiar quality, to the normal workings of the mind, or which decides who is doomed to come to grief over that task. Two attempts to find a factor of this kind have been made; and it is natural that such efforts should meet with a sympathetic reception, since they promise help to meet a tormenting need. The two attempts in question are mutually complementary; they approach the problem at opposite ends. The first was made by Alfred Adler more than ten years ago. His contention, reduced to its essence, was that the people who came to grief over the task set them by danger were those who were too greatly impeded by some organic inferiority. If it were true that simplex sigillum veri, we should welcome such a solution as a deliverance. But on the contrary, our critical studies of the last ten years have effectively demonstrated the total inadequacy of such an explanation - an explanation, moreover, which sets aside the whole wealth of material that has been discovered by psycho-analysis.

The second attempt was made by Otto Rank in 1923 in his book, The Trauma of Birth. It would be unjust to put his attempt on the same level as Adler’s except in this single point which concerns us here, for it remains on psycho-analytic ground and pursues a psycho-analytic line of thought, so that it may be accepted as a legitimate endeavour to solve the problems of analysis. In this matter of the relation of the individual to danger Rank moves away from the question of organic defect in the individual and concentrates on the variable degree of intensity of the danger. The process of birth is the first situation of danger, and the economic upheaval which it produces becomes the prototype of the reaction of anxiety. We have already traced the line of development which connects this first danger-situation and determinant of anxiety with all the later ones, and we have seen that they all retain a common quality in so far as they signify in a certain sense a separation from the mother - at first only in a biological sense, next as a direct loss of object and later as a loss of object incurred indirectly. The discovery of this extensive concatenation is an undoubted merit of Rank’s construction. Now the trauma of birth overtakes each individual with a different degree of intensity, and the violence of his anxiety-reaction varies with the strength of the trauma; and it is the initial amount of anxiety generated in him which, according to Rank, decides whether he will ever learn to control it - whether he will become neurotic or normal.

It is not our business to criticize Rank’s hypothesis in detail here. We have only to consider whether it helps to solve our particular problem. His formula - that those people become neurotic in whom the trauma of birth was so strong that they have never been able completely to abreact it - is highly disputable from a theoretical point of view. We do not rightly know what is meant by abreacting the trauma. Taken literally, it implies that the more frequently and the more intensely a neurotic person reproduces the affect of anxiety the more closely will he approach to mental health - an untenable conclusion. It was because it did not tally with the facts that I gave up the theory of abreaction which had played such a large part in the cathartic method. To lay so much stress, too, on the variability in the strength of the birth trauma is to leave no room for the legitimate claims of hereditary constitution as an aetiological factor. For this variability is an organic factor which operates in an accidental fashion in relation to the constitution and is itself dependent on many influences which might be called accidental - as, for instance, on timely assistance in child-birth. Rank’s theory completely ignores constitutional factors as well as phylogenetic ones. If, however, we were to try to find a place for the constitutional factor by qualifying his statement with the proviso, let us say, that what is really important is the extent to which the individual reacts to the variable intensity of the trauma of birth, we should be depriving his theory of its significance and should be relegating the new factor introduced by him to a position of minor importance: the factor which decided whether a neurosis should supervene or not would lie in a different, and once more in an unknown, field.

Moreover, the fact that while man shares the process of birth with the other mammals he alone has the privilege over them of possessing a special disposition to neurosis is hardly favourable to Rank’s theory. But the main objection to it is that it floats in the air instead of being based upon ascertained observations. No body of evidence has been collected to show that difficult and protracted birth does in fact coincide with the development of a neurosis, or even that children so born exhibit the phenomena of early infantile apprehensiveness more strongly and over a longer period than other children. It might be rejoined that induced labour and births that are easy for the mother may possibly involve a severe trauma for the child. But we can still point out that births which lead to asphyxia would be bound to give clear evidence of the results which are supposed to follow. It should be one of the advantages of Rank’s aetiological theory that it postulates a factor whose existence can be verified by observation. And so long as no such attempt at verification has been made it is impossible to assess the theory’s value.

On the other hand I cannot identify myself with the view that Rank’s theory contradicts the aetiological importance of the sexual instincts as hitherto recognized by psycho-analysis. For his theory only has reference to the individual’s relation to the danger-situation, so that it leaves it perfectly open to us to assume that if a person has not been able to master his first dangers he is bound to come to grief as well in later situations involving sexual danger and thus be driven into a neurosis.

I do not believe, therefore, that Rank’s attempt has solved the problem of the causation of neurosis; nor do I believe that we can say as yet how much it may nevertheless have contributed to such a solution. If an investigation into the effects of difficult birth on the disposition to neurosis should yield negative results, we shall rate the value of his contribution low. It is to be feared that our need to find a single, tangible ‘ultimate cause’ of neurotic illness will remain unsatisfied. The ideal solution, which medical men no doubt still yearn for, would be to discover some bacillus which could be isolated and bred in a pure culture and which, when injected into anyone, would invariably produce the same illness; or, to put it rather less extravagantly, to demonstrate the existence of certain chemical substances the administration of which would bring about or cure particular neuroses. But the probability of a solution of this kind seems slight.

Psycho-analysis leads to less simple and satisfactory conclusions. What I have to say in this connection has long been familiar and I have nothing new to add. If the ego succeeds in protecting itself from a dangerous instinctual impulse, through, for instance, the process of repression, it has certainly inhibited and damaged the particular part of the id concerned; but it has at the same time given it some independence and has renounced some of its own sovereignty. This is inevitable from the nature of repression, which is, fundamentally, an attempt at flight. The repressed is now, as it were, an outlaw; it is excluded from the great organization of the ego and is subject only to the laws which govern the realm of the unconscious. If, now, the danger-situation changes so that the ego has no reason for fending off a new instinctual impulse analogous to the repressed one, the consequence of the restriction of the ego which has taken place will become manifest. The new impulse will run its course under an automatic influence - or, as I should prefer to say, under the influence of the compulsion to repeat. It will follow the same path as the earlier, repressed impulse, as though the danger-situation that had been overcome still existed. The fixating factor in repression, then, is the unconscious id’s compulsion to repeat - a compulsion which in normal circumstances is only done away with by the freely mobile function of the ego. The ego may occasionally manage to break down the barriers of repression which it has itself put up and to recover its influence over the instinctual impulse and direct the course of the new impulse in accordance with the changed danger-situation. But in point of fact the ego very seldom succeeds in doing this: it cannot undo its repressions. It is possible that the way the struggle will go depends upon quantitative relations. In some cases one has the impression that the outcome is an enforced one: the regressive attraction exerted by the repressed impulse and the strength of the repression are so great that the new impulse has no choice but to obey the compulsion to repeat. In other cases we perceive a contribution from another play of forces: the attraction exerted by the repressed prototype is reinforced by a repulsion coming from the direction of difficulties in real life which stand in the way of any different course that might be taken by the new instinctual impulse.

That this is a correct account of fixation upon repression and of the retention of danger-situations that are no longer present-day ones is confirmed by the fact of analytic therapy - a fact which is modest enough in itself but which can hardly be overrated from a theoretical point of view. When, in analysis, we have given the ego assistance which is able to put it in a position to lift its repressions, it recovers its power over the repressed id and can allow the instinctual impulses to run their course as though the old situations of danger no longer existed. What we can do in this way tallies with what can be achieved in other fields of medicine; for as a rule our therapy must be content with bringing about more quickly, more reliably and with less expenditure of energy than would otherwise be the case the good result which in favourable circumstances would have occurred of itself.

We see from what has been said that quantitative– relations - relations which are not directly observable but which can only be inferred - are what determine whether or not old situations of danger shall be preserved, repressions on the part of the ego maintained and childhood neuroses find a continuation. Among the factors that play a part in the causation of neuroses and that have created the conditions under which the forces of the mind are pitted against one another, three emerge into prominence: a biological, a phylogenetic and a purely psychological factor.

The biological factor is the long period of time during which the young of the human species is in a condition of helplessness and dependence. Its intra-uterine existence seems to be short in comparison with that of most animals, and it is sent into the world in a less finished state. As a result, the influence of the real external world upon it is intensified and an early differentiation between the ego and the id is promoted. Moreover, the dangers of the external world have a greater importance for it, so that the value of the object which can alone protect it against them and take the place of its former intra-uterine life is enormously enhanced. The biological factor, then, establishes the earliest situations of danger and creates the need to be loved which will accompany the child through the rest of its life.

The existence of the second, phylogenetic, factor, is based only upon inference. We have been led to assume its existence by a remarkable feature in the development of the libido. We have found that the sexual life of man, unlike that of most of the animals nearly related to him, does not make a steady advance from birth to maturity, but that, after an early efflorescence up till the fifth year, it undergoes a very decided interruption; and that it then starts on its course once more at puberty, taking up again the beginnings broken off in early childhood. This has led us to suppose that something momentous must have occurred in the vicissitudes of the human species which has left behind this interruption in the sexual development of the individual as a historical precipitate. This factor owes its pathogenic significance to the fact that the majority of the instinctual demands of this infantile sexuality are treated by the ego as dangers and fended off as such, so that the later sexual impulses of puberty, which in the natural course of things would be ego-syntonic, run the risk of succumbing to the attraction of their infantile prototypes and following them into repression. It is here that we come upon the most direct aetiology of the neuroses. It is a curious thing that early contact with the demands of sexuality should have a similar effect on the ego to that produced by premature contact with the external world.

The third, psychological, factor resides in a defect of our mental apparatus which has to do precisely with its differentiation into an id and an ego, and which is therefore also attributable ultimately to the influence of the external world. In view of the dangers of reality, the ego is obliged to guard against certain instinctual impulses in the id and to treat them as dangers. But it cannot protect itself from internal instinctual dangers as effectively as it can from some piece of reality that is not part of itself. Intimately bound up with the id as it is, it can only fend off an instinctual danger by restricting its own organization and by acquiescing in the formation of symptoms in exchange for having impaired the instinct. If the rejected instinct renews its attack, the ego is overtaken by all those difficulties which are known to us as neurotic ailments.

Further than this, I believe, our knowledge of the nature and causes of neurosis has not as yet been able to go.0

XI ADDENDA

In the course of this discussion various themes have had to be put aside before they had been fully dealt with. I have brought them together in this chapter so that they may receive the attention they deserve.

AMODIFICATIONS OF EARLIER VIEWS

(a) Resistance and Anticathexis

An important element in the theory of repression is the view that repression is not an event that occurs once but that it requires a permanent expenditure. If this expenditure were to cease, the repressed impulse, which is being fed all the time from its sources, would on the next occasion flow along the channels from which it had been forced away, and the repression would either fail in its purpose or would have to be repeated an indefinite number of times. Thus it is because instincts are continuous in their nature that the ego has to make its defensive action secure by a permanent expenditure. This action undertaken to protect repression is observable in analytic treatment as resistance. Resistance presupposes the existence of what I have called anticathexis. An anticathexis of this kind is clearly seen in obsessional neurosis. It appears there in the form of an alteration of the ego, as a reaction-formation in the ego, and is effected by the reinforcement of the attitude which is the opposite of the instinctual trend that has to be repressed - as, for instance, in pity, conscientiousness and cleanliness. These reaction-formations of obsessional neurosis are essentially exaggerations of the normal traits of character which develop during the latency period. The presence of an anticathexis in hysteria is much more difficult to detect, though theoretically it is equally indispensable. In hysteria, too, a certain amount of alteration of the ego through reaction-formation is unmistakable and in some circumstances becomes so marked that it forces itself on our attention as the principal symptom. The conflict due to ambivalence, for instance, is resolved in hysteria by this means. The subject’s hatred of a person whom he loves is kept down by an exaggerated amount of tenderness for him and apprehensiveness about him. But the difference between reaction-formations in obsessional neurosis and in hysteria is that in the latter they do not have the universality of a character-trait but are confined to particular relationships. A hysterical woman, for instance, may be specially affectionate with her own children whom at bottom she hates; but she will not on that account be more loving in general than other women or even more affectionate to other children. The reaction-formation of hysteria clings tenaciously to a particular object and never spreads over into a general disposition of the ego, whereas what is characteristic of obsessional neurosis is precisely a spreading-over of this kind - a loosening of relations to the object and a facilitation of displacement in the choice of object.

There is another kind of anticathexis, however, which seems more suited to the peculiar character of hysteria. A repressed instinctual impulse can be activated (newly cathected) from two directions: from within, through reinforcement from its internal sources of excitation, and from without, through the perception of an object that it desires. The hysterical anticathexis is mainly directed outwards, against dangerous perceptions. It takes the form of a special kind of vigilance which, by means of restrictions of the ego, causes situations to be avoided that would entail such perceptions, or, if they do occur, manages to withdraw the subject’s attention from them. Some French analysts, in particular Laforgue, have recently given this action of hysteria the special name of ‘scotomization’. This technique of anticathexis is still more noticeable in the phobias, whose interest is concentrated on removing the subject ever further from the possibility of the occurrence of the feared perception. The fact that anticathexis has an opposite direction in hysteria and the phobias from what it has in obsessional neurosis - though the distinction is not an absolute one - seems to be significant. It suggests that there is an intimate connection between repression and external anticathexis on the one hand and between regression and internal anticathexis (i.e. alteration in the ego through reaction-formation) on the other. The task of defence against a dangerous perception is, incidentally, common to all neuroses. Various commands and prohibitions in obsessional neurosis have the same end in view.

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