Introductory lectures on psycho-analysis · Sigmund Freud

EIGHTEENTH LECTURE FIXATION UPON TRAUMATA: THE UNCONSCIOUS

I said last time that we would take, as a starting-point for further work, the knowledge we have gained already, and not the doubts which it has roused in us. We have not yet even begun to discuss two of the most interesting conclusions arising from the analysis of the two examples. First: both the patients give the impression that they are “_fixed_” to a particular point in their past, that they do not know how to release themselves from it, and are consequently alienated from both present and future. They are marooned in their illness, as it were; just as in former times people used to withdraw to the cloister to live out their unhappy fate there. In the case of the first patient, it was the marriage to the husband, which in reality had long ago come to an end, that had settled this doom upon her. Her symptoms enabled her to continue her relationship with him; we could perceive in them the voices which pleaded for him, excused him, exalted him, lamented his loss. Although she is young and could attract other men, she has seized upon every possible real and imaginary (magical) precaution that will preserve her fidelity to him. She will not meet strangers, she neglects her appearance; moreover, she cannot readily rise from any chair which she sits upon, and she refuses to sign her name and can give no presents, because no one must have anything which is hers.

With the second patient, the young girl, it is the erotic attachment to the father established in the years before puberty that plays this part in her life. She also has herself perceived that she cannot marry as long as she is so ill. We may suspect that she became so ill in order to be unable to marry and so to remain with her father. We cannot avoid asking the question how, by what means, and impelled by what motives, anyone can take up such an extraordinary and unprofitable attitude towards life. Provided, that is, that this attitude is a universal character of neurosis and is not a special peculiarity of these two patients. As a matter of fact, this is so; it is a universal trait common to every neurosis, and one of great practical significance. Breuer’s first hysterical patient was _fixated_, in the same way, to the time when her father was seriously ill and she nursed him. In spite of her recovery, she has remained to some extent cut off from life since that time; for although she has remained healthy and active, she did not take up the normal career of a woman. In every one of our patients we learn through analysis that the symptoms and their effects have set the sufferer back into some past period of his life. In the majority of cases it is actually a very early phase of the life-history which has been thus selected, a period in childhood, even, absurd as it may sound, the period of existence as a suckling infant.

The closest analogy to this behaviour in our nervous patients is provided by the forms of illness recently made so common by the war—the so-called _traumatic neuroses_. Of course similar cases had occurred before the war, after railway accidents and other terrifying experiences involving danger to life. The traumatic neuroses are not fundamentally the same as those which occur spontaneously, which we investigate analytically and are accustomed to treat; neither have we been successful so far in correlating them with our views on other subjects; later on I hope to show you where this limitation lies. Yet there is a complete agreement between them on one point which may be emphasized. The traumatic neuroses demonstrate very clearly that a fixation to the moment of the traumatic occurrence lies at their root. These patients regularly reproduce the traumatic situation in their dreams; in cases showing attacks of an hysterical type in which analysis is possible, it appears that the attack constitutes a complete reproduction of this situation. It is as though these persons had not yet been able to deal adequately with the situation, as if this task were still actually before them unaccomplished. We take this attitude of theirs in all seriousness; it points the way to what we may call an _economic_ conception of the mental processes. The term ‘_traumatic_’ has actually no other meaning but this _economic_ one. An experience which we call traumatic is one which within a very short space of time subjects the mind to such a very high increase of stimulation that assimilation or elaboration of it can no longer be effected by normal means, so that lasting disturbances must result in the distribution of the available energy in the mind.

This analogy tempts us also to classify as traumatic those experiences to which our nervous patients seem to be fixated. In this way we should be provided with a simple condition for a neurotic illness; it would be comparable to a traumatic illness and would result from an incapacity to deal with an overpowering affective experience. Indeed, the first formula in which Breuer and I, in 1893–95, reduced our new observations to a theory was expressed very similarly. A case like that of the first patient described, the young woman separated from her husband, fits very well into this description; she had not been able to “get over” the impracticability of her marriage and was still attached to her trauma. But the second case of the young girl who was tied to her father shows us at once that the formula is not comprehensive enough. On the one hand, an infantile adoration of her father by a little girl is such a common experience and so frequently grown out of that the term ‘traumatic’ would lose all its meaning if applied to it; on the other hand, the history of the case shows that this first erotic fixation was gone through by the patient quite harmlessly at the time, to all appearances, and only several years later came to expression in the obsessional neurosis. So we see that there are complications ahead, a considerable variety and number of determining factors in neurosis; but we divine that the traumatic view will not necessarily be abandoned as false, and that it will fit in and have to be co-ordinated properly elsewhere.

Here again we must leave the path we have been following. At the moment it will take us no further, and we have much more to learn before we can find a satisfactory continuation of it. But before leaving the subject of fixation to traumata it should be noted that it is a phenomenon manifested extensively outside the neuroses; every neurosis contains such a fixation, but not every fixation leads to a neurosis, or is necessarily combined with a neurosis, or arises in the course of a neurosis. Grief is a prototype and perfect example of an affective fixation upon something that is past, and, like the neuroses, it also involves a state of complete alienation from the present and the future. But even the lay public distinguishes clearly between grief and neurosis. On the other hand, there are neuroses which may be described as morbid forms of grief. It does also happen that persons may be brought to a complete standstill in life by a traumatic experience which has shaken the whole structure of their lives to the foundations, so that they give up all interest in the present and the future, and live permanently absorbed in their retrospections; but these unhappy persons do not necessarily become neurotic. Therefore this single feature must not be overestimated as a characteristic of neurosis, however invariable and significant it may be otherwise.

Now let us turn to the second conclusion to be drawn from our analyses; it is one upon which we shall not need to impose any subsequent limitation. With the first patient we have heard of the senseless obsessive act she performed and of the intimate memories she recalled in connection with it; we also considered the relation between the two, and deduced the purpose of the obsessive act from its connection with the memory. But there is one factor which we have entirely neglected, and yet it is one which deserves our fullest attention. As long as the patient continued this performance she did not know that it was in any way connected with the previous experience; the connection between the two things was hidden; she could quite truly answer that she did not know what impulse led her to do it. Then it happened suddenly that, under the influence of the treatment, she found this connection and was able to tell it. But even then she knew nothing of the purpose she had in performing the action, the purpose that was to correct a painful event of the past and to raise the husband she loved in her own estimation. It took a long time and much effort for her to grasp, and admit to me, that such a motive as this alone could have been the driving force behind the obsessive act.

The connection with the scene on the morning after the unhappy bridal-night, and the patient’s own tender feeling for her husband, together, make up what we have called the “meaning” of the obsessive act. But both sides of this meaning were hidden from her, she understood neither the _whence_ nor the _whither_ of her act, as long as she carried it on. Mental processes had been at work in her, therefore, of which the obsessive act was the effect; she was aware in a normal manner of their effect; but nothing of the mental antecedents of this effect had come to the knowledge of her consciousness. She was behaving exactly like a subject under hypnotism whom Bernheim had ordered to open an umbrella in the ward five minutes after he awoke, but who had no idea why he was doing it. This is the kind of occurrence we have in mind when we speak of the existence of _unconscious mental processes_; we may challenge anyone in the world to give a more correctly scientific explanation of this matter, and will then gladly withdraw our inference that unconscious mental processes exist. Until they do, however, we will adhere to this inference and, when anyone objects that in a scientific sense the Unconscious has no reality, that it is a mere makeshift, _une façon de parler_, we must resign ourselves with a shrug to rejecting his statement as incomprehensible. Something unreal, which can nevertheless produce something so real and palpable as an obsessive action!

In the second patient fundamentally the same thing is found. She has instituted a rule that the bolster must not touch the back of the bedstead, and she had to carry out this rule, but she does not know whence it comes, what it means, or to what it owes its strength. Whether she regards it indifferently, or struggles against it, or rages against it, or determines to overcome it, matters not; it will be followed. It must be followed; in vain she asks herself why. It is undeniable that these symptoms of the obsessional neurosis, these ideas and these impulses which arise no man knows where and which oppose such a powerful resistance against all the influences to which an otherwise normal mental life is susceptible, give the impression, even to the patients themselves, of being all-powerful visitants from another world, immortal beings mingling in the whirlpool of mortal things. In these symptoms lies the clearest indication of a special sphere of mental activity cut off from all the rest. They show the way unmistakably to conviction on the question of the unconscious in the mind; and for that very reason clinical psychiatry, which only recognizes a psychology of consciousness, can do nothing with these symptoms except to stigmatize them as signs of a special kind of degeneration. Naturally, the obsessive ideas and impulses are not themselves unconscious, any more than is the performance of the obsessive acts. They would not have become symptoms if they had not penetrated into consciousness. But the mental antecedents of them disclosed by analysis, the connections into which they fit after interpretation, are unconscious, at least until the time when we make the patient conscious of them by the work of the analysis.

Consider now, in addition, that the facts established in these two cases are confirmed in every symptom of every neurotic disease; that always and everywhere the meaning of the symptoms is unknown to the sufferer; that analysis invariably shows that these symptoms are derived from unconscious mental processes which can, however, under various favourable conditions, become conscious. You will then understand that we cannot dispense with the unconscious part of the mind in psycho-analysis, and that we are accustomed to deal with it as with something actual and tangible. Perhaps you will also be able to realize how unfitted all those who only know the Unconscious as a phrase, who have never analysed, never interpreted dreams, or translated neurotic symptoms into their meaning and intention, are to form an opinion on this matter. I will repeat the substance of it again in order to impress it upon you: The fact that it is possible to find meaning in neurotic symptoms by means of analytic interpretation is an irrefutable proof of the existence—or, if you prefer it, of the necessity for assuming the existence—of unconscious mental processes.

But that is not all. Thanks to a second discovery of Breuer’s, for which he alone deserves credit and which seems to me even more far-reaching in its significance than the first, more still has been learnt about the relation between the Unconscious and the symptoms of neurotics. Not merely is the meaning of the symptom invariably unconscious; there exists also a connection of a substitutive nature between the two; the existence of the symptom is only possible by reason of this unconscious activity. You will soon understand what I mean. With Breuer, I maintain the following: Every time we meet with a symptom we may conclude that definite unconscious activities which contain the meaning of the symptom are present in the patient’s mind. Conversely, this meaning must be unconscious before a symptom can arise from it. Symptoms are not produced by conscious processes; as soon as the unconscious processes involved are made conscious the symptom must vanish. You will perceive at once that here is an opening for therapy, a way by which symptoms can be made to disappear. It was by this means that Breuer actually achieved the recovery of his patient, that is, freed her from her symptoms; he found a method of bringing into her consciousness the unconscious processes which contained the meaning of her symptoms and the symptoms vanished.

This discovery of Breuer’s was not the result of any speculation but of a fortunate observation made possible by the co-operation of the patient. Now you must not rack your brains to try and understand this by seeking to compare it with something similar that is already familiar to you; but you must recognize in it a fundamentally new fact, by means of which much else becomes explicable. Allow me therefore to express it again to you in other words. The symptom is formed as a substitute for something else which remains submerged. Certain mental processes would, under normal conditions, develop until the person became aware of them consciously. This has not happened; and, instead, the symptom has arisen out of these processes which have been interrupted and interfered with in some way and have had to remain unconscious. Thus something in the nature of an exchange has occurred; if we can succeed in reversing this process by our therapy we shall have performed our task of dispersing the symptom. Breuer’s discovery still remains the foundation of psycho-analytic therapy. The proposition that symptoms vanish when their unconscious antecedents have been made conscious has been borne out by all subsequent research; although the most extraordinary and unexpected complications are met with in attempting to carry this proposition out in practice. Our therapy does its work by transforming something unconscious into something conscious, and only succeeds in its work in so far as it is able to effect this transformation.

Now for a rapid digression, lest you should run the risk of imagining that this therapeutic effect is achieved too easily. According to the conclusions we have reached so far, neurosis would be the result of a kind of ignorance, a not-knowing of mental processes which should be known. This would approach very closely to the well-known Socratic doctrine according to which even vice is the result of ignorance. Now it happens in analysis that an experienced practitioner can usually surmise very easily what those feelings are which have remained unconscious in each individual patient. It should not therefore be a matter of great difficulty to cure the patient by imparting this knowledge to him and so relieving his ignorance. At least, one side of the unconscious meaning of the symptom would be easily dealt with in this way, although it is true that the other side of it, the connection between the symptom and the previous experiences in the patient’s life, can hardly be divined thus; for the analyst does not know what the experiences have been, he has to wait till the patient remembers them and tells him. But one might find a substitute even for this in many cases. One might ask for information about his past life from the friends and relations; they are often in a position to know what events have been of a traumatic nature, perhaps they can even relate some of which the patient is ignorant because they took place at some very early period of childhood. By a combination of these two means it would seem that the pathogenic ignorance of the patients might be overcome in a short time without much trouble.

If only it were so! But we have made discoveries that we were quite unprepared for at first. There is knowing and knowing; they are not always the same thing. There are various kinds of knowing, which psychologically are not by any means of equal value. _Il y a fagots et fagots_, as Molière says. Knowing on the part of the physician is not the same thing as knowing on the part of the patient and does not have the same effect. When the physician conveys his knowledge to the patient by telling him what he knows, it has no effect. No, it would be incorrect to say that. It does not have the effect of dispersing the symptoms; but it has a different one, it sets the analysis in motion, and the first result of this is often an energetic denial. The patient has learned something that he did not know before—the meaning of his symptom—and yet he knows it as little as ever. Thus we discover that there is more than one kind of ignorance. It requires a considerable degree of insight and understanding of psychological matters in order to see in what the difference consists. But the proposition that symptoms vanish with the acquisition of knowledge of their meaning remains true, nevertheless. The necessary condition is that the knowledge must be founded upon an inner change in the patient which can only come about by a mental operation directed to that end. We are here confronted by problems which to us will soon develop into the _dynamics_ of symptom-formation.

Now I must really stop and ask you whether all that I have been saying is not too obscure and complicated? Am I confusing you by so often qualifying and restricting, spinning out trains of thought and then letting them drop? I should be sorry if it were so. But I have a strong dislike of simplification at the expense of truth, I am not averse from giving you a full impression of the many-sidedness and intricacy of the subject, and also I believe that it does no harm to tell you more about each point than you can assimilate at the moment. I know that every listener and every reader arranges what is offered him as suits him in his own mind, shortens it, simplifies it, and extracts from it what he will retain. Within certain limits it is true that the more we begin with the more we shall have at the end. So let me hope that, in spite of the elaboration, you will have grasped the essential substance of my remarks concerning the meaning of symptoms, the Unconscious, and the connection between the two. You have probably understood also that our further efforts will proceed in two directions; first, towards discovering how people become ill, how they come to take up the characteristic neurotic attitude towards life, which is a clinical problem; and secondly, how they develop the morbid symptoms out of the conditions of a neurosis, which remains a problem of mental dynamics. The two problems must somewhere have a point of contact.

I shall not go further into this to-day; but as our time is not yet up I propose to draw your attention to another characteristic of our two analyses; namely, _the memory gaps or amnesias_, again a point which only later will appear in its full significance. You have heard that the task of the psycho-analytic treatment can be summed up in this formula: everything pathogenic in the Unconscious must be transferred into consciousness. Now you will be perhaps astonished to hear that another formula may be substituted for that one: all gaps in the patient’s memory must be filled in, his amnesias removed. It amounts to the same thing; which means that an important connection is to be recognized between the development of the symptoms and the amnesias. If you consider the case of the first patient analysed you will, however, not find this view of amnesia justified; the patient had not forgotten the scene from which the obsessive act is derived; on the contrary, it was vivid in her memory, nor is there any other forgotten factor involved in the formation of her symptom. The situation is quite analogous, although less clear, in the second case, the girl with the obsessional ceremonies.

She, too, had not really forgotten her behaviour in former years, the fact that she had insisted upon the open door between her parents’ bedroom and her own, and that she had turned her mother out of her place in the parents’ bed; she remembered it quite clearly, although with hesitation and unwillingness. What is remarkable about it is that the first patient, although she had carried out her obsessive act such a countless number of times, had not _once_ been reminded of its similarity to the scene after the wedding-night, nor did this recollection ever occur to her when she was directly asked to search for the origin of her obsessive act. The same thing is true in the case of the girl, where not merely the ritual, but the situation which gave rise to it, was repeated identically every evening. In neither case was there really an amnesia, a lapse of memory; but a connection, which should have existed intact and have led to the reproduction, the recollection, of the memory, had been broken. This kind of disturbance of memory suffices for the obsessional neurosis; in hysteria it is different. This latter neurosis is usually characterized by amnesias on a grand scale.

As a rule the analysis of each single hysterical symptom leads to a whole chain of former impressions, which upon their return may be literally described as having been hitherto forgotten. This chain reaches, on the one hand, back to the earliest years of childhood, so that the hysterical amnesia is seen to be a direct continuation of the infantile amnesia which hides the earliest impressions of our mental life from all of us. On the other hand, we are astonished to find that the most recent experiences of the patient are liable to be forgotten also, and that in particular the provocations which induced the outbreak of the disease or aggravated it are at least partially obliterated, if not entirely wiped out, by amnesia. From the complete picture of any such recent recollection important details have invariably disappeared or been replaced by falsifications. It happens again and again, almost invariably, that not until shortly before the completion of an analysis do certain recollections of recent experiences come to the surface, which had managed to be withheld throughout it and had left noticeable gaps in the context.

Text from Project Gutenberg, public domain in the United States.

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