Introductory lectures on psycho-analysis · Sigmund Freud
SEVENTEENTH LECTURE THE MEANING OF SYMPTOMS
In the last lecture I explained to you that clinical psychiatry troubles itself little about the actual form of the individual symptom or the content of it; but that psycho-analysis has made this its starting-point, and has ascertained that the symptom itself has a meaning and is connected with experiences in the life of the patient. The meaning of neurotic symptoms was first discovered by J. Breuer in the study and successful cure of a case of hysteria (1880–82), which has since then become famous. It is true that P. Janet independently reached the same result; in fact, priority in publication must be granted to the French investigator, for Breuer did not publish his observations until more than a decade later (1893–95), during the period of our work together. Incidentally, it is of no great importance to us who made the discovery, for you know that every discovery is made more than once, and none is made all at once, nor is success meted out according to deserts. America is not called after Columbus. Before Breuer and Janet, the great psychiatrist Leuret expressed the opinion that even the delusions of the insane would prove to have some meaning, if only we knew how to translate them. I confess that for a long time I was willing to accord Janet very high recognition for his explanation of neurotic symptoms, because he regarded them as expressions of “_idées inconscientes_” possessing the patient’s mind. Since then, however, Janet has taken up an attitude of undue reserve, as if he meant to imply that the Unconscious had been nothing more to him than a manner of speaking, a makeshift, _une façon de parler_, and that he had nothing “real” in mind. Since then I have not understood Janet’s views, but I believe that he has gratuitously deprived himself of great credit.
Neurotic symptoms then, just like errors and dreams, have their meaning and, like these, are related to the life of the person in whom they appear. This is an important matter which I should like to demonstrate to you by some examples. I can merely assert, I cannot prove, that it is so in every case; anyone observing for himself will be convinced of it. For certain reasons though, I shall not take these examples from cases of hysteria, but from another very remarkable form of neurosis, closely allied in origin to the latter, about which I must say a few preliminary words. This, which we call _the obsessional neurosis_, is not so popular as the widely-known _hysteria_; it is, if I may so express myself, not so noisily ostentatious, behaves more as if it were a private affair of the patient’s, dispenses almost entirely with bodily manifestations and creates all its symptoms in the mental sphere. The obsessional neurosis and hysteria are the two forms of neurotic disease upon the study of which psycho-analysis was first built up, and in the treatment of which also our therapy celebrates its triumphs. In the obsessional neurosis, however, that mysterious leap from the mental to the physical is absent, and it has really become more intimately comprehensible and transparent to us through psycho-analytic research than hysteria; we have come to understand that it displays far more markedly certain extreme features of the neurotic constitution.
The obsessional neurosis[45] takes this form: the patient’s mind is occupied with thoughts that do not really interest him, he feels impulses which seem alien to him, and he is impelled to perform actions which not only afford him no pleasure but from which he is powerless to desist. The thoughts (obsessions) may be meaningless in themselves or only of no interest to the patient; they are often absolutely silly; in every case they are the starting-point of a strained concentration of thought which exhausts the patient and to which he yields most unwillingly. Against his will he has to worry and speculate as if it were a matter of life or death to him. The impulses which he perceives within him may seem to be of an equally childish and meaningless character; mostly, however, they consist of something terrifying, such as temptations to commit serious crimes, so that the patient not only repudiates them as alien, but flees from them in horror, and guards himself by prohibitions, precautions, and restrictions against the possibility of carrying them out. As a matter of fact he never, literally not even once, carries these impulses into effect; flight and precautions invariably win. What he does really commit are very harmless, certainly trivial acts—what are termed the obsessive actions—which are mostly repetitions and ceremonial elaborations of ordinary everyday performances, making these common necessary actions—going to bed, washing, dressing, going for walks, etc.—into highly laborious tasks of almost insuperable difficulty. The morbid ideas, impulses, and actions are not by any means combined in the same proportions in individual types and cases of the obsessional neurosis; on the contrary, the rule is that one or another of these manifestations dominates the picture and gives the disease its name; but what is common to all forms of it is unmistakable enough.
This is a mad disease, surely. I don’t think the wildest psychiatric phantasy could have invented anything like it, and if we did not see it every day with our own eyes we could hardly bring ourselves to believe in it. Now do not imagine that you can do anything for such a patient by advising him to distract himself, to pay no attention to these silly ideas, and to do something sensible instead of his nonsensical practices. This is what he would like himself; for he is perfectly aware of his condition, he shares your opinion about his obsessional symptoms, he even volunteers it quite readily. Only he simply cannot help himself; the actions performed in an obsessional condition are supported by a kind of energy which probably has no counterpart in normal mental life. Only one thing is open to him—he can displace and he can exchange; instead of one silly idea he can adopt another of a slightly milder character, from one precaution or prohibition he can proceed to another, instead of one ceremonial rite he can perform another. He can displace his sense of compulsion, but he cannot dispel it.
This capacity for displacing all the symptoms, involving radical alteration of their original forms, is a main characteristic of the disease; it is, moreover, striking that in this condition the ‘_opposite-values_’ (_polarities_) pervading mental life appear to be exceptionally sharply differentiated. In addition to compulsions of both positive and negative character, doubt appears in the intellectual sphere, gradually spreading until it gnaws even at what is usually held to be certain. All these things combine to bring about an ever-increasing indecisiveness, loss of energy, and curtailment of freedom; and that although the obsessional neurotic is originally always a person of a very energetic disposition, often highly opinionated, and as a rule intellectually gifted above the average. He has usually attained to an agreeably high standard of ethical development, is over-conscientious, and more than usually correct. You may imagine that it is a sufficiently arduous task to find one’s bearings in this maze of contradictory character-traits and morbid manifestations. At the moment our aim is merely to interpret some symptoms of this disease.
Perhaps in view of our previous discussions you would like to know what present-day psychiatry has to offer concerning the obsessional neurosis; it is but a miserable contribution, however. Psychiatry has given names to the various compulsions; and has nothing more to say about them. It asserts instead that persons exhibiting these symptoms are “degenerate.” That is not much satisfaction to us; it is no more than an estimate of their value, a condemnation instead of an explanation. We are intended, I suppose, to conclude that deterioration from type would naturally produce all kinds of oddities in people. Now, we do believe that people who develop such symptoms must be somewhat different in type from other human beings; but we should like to know whether they are more “degenerate” than other nervous patients, than hysterical or insane people. The characterization is clearly again much too general. One may even doubt whether it is justified at all when one learns that such symptoms occur in men and women of exceptional ability who have left their mark on their generation. Thanks to their own discretion and the untruthfulness of biographers we usually learn very little of an intimate nature about our exemplary great men; but it does happen occasionally that one of them is a fanatic about truth like Émile Zola,[46] and then we hear of the many extraordinary obsessive habits from which he suffered throughout life.
Psychiatry has got out of this difficulty by dubbing these people “_dégénerés superieurs_.” Very well; but psycho-analysis has shown that these extraordinary obsessional symptoms can be removed permanently, like the symptoms of other diseases, and as in other people who are not degenerate. I myself have frequently succeeded in doing so. I shall only give you two examples of analysis of obsessional symptoms; one is an old one, but I have never found a better; and one is a recent one. I shall limit myself to these two because an account of this kind must be very explicit and go into great detail. A lady of nearly thirty years of age suffered from very severe obsessional symptoms. I might perhaps have been able to help her if my work had not been destroyed by the caprice of fate—perhaps I shall tell you about it later. In the course of a day she would perform the following peculiar obsessive act, among others, several times over. She would run out of her room into the adjoining one, there take up a certain position at the table in the centre of the room, ring for her maid, give her a trivial order or send her away without, and then run back again. There was certainly nothing very dreadful about this, but it might well arouse curiosity. The explanation presented itself in the simplest and most unexceptionable manner, without any assistance on the part of the analyst. I cannot imagine how I could even have suspected the meaning of this obsession or could possibly have suggested an interpretation for it. Every time I had asked the patient, “Why do you do this? What is the meaning of it?” she had answered, “I don’t know.” But one day, after I had succeeded in overcoming a great hesitation on her part, involving a matter of principle, she suddenly did know, for she related the history of the obsessive act.
More than ten years previously she had married a man very much older than herself, who had proved impotent on the wedding-night. Innumerable times on that night he had run out of his room into hers in order to make the attempt, but had failed every time. In the morning he had said angrily: “It’s enough to disgrace one in the eyes of the maid who does the beds,” and seizing a bottle of red ink which happened to be at hand he poured it on the sheet, but not exactly in the place where such a mark might have been. At first I did not understand what this recollection could have to do with the obsessive act in question; for I could see no similarity between the two situations, except in the running from one room into the other, and perhaps also in the appearance of the servant on the scene. The patient then led me to the table in the adjoining room, where I found a great mark on the table-cover. She explained further that she stood by the table in such a way that when the maid came in she could not miss seeing this mark. After this, there could no longer be any doubt about the connection between the current obsessive act and the scene of the wedding-night, though there was still a great deal to learn about it.
It was clear, first of all, that the patient identified herself with her husband; in imitating his running from one room into another she acted his part. To keep up the similarity we must assume that she has substituted the table and table-cover for the bed and sheet. This might seem too arbitrary; but then we have not studied dream-symbolism in vain. In dreams a table is very often found to represent a bed. “Bed and board” together mean marriage, so that the one easily stands for the other. All this would be proof enough that the obsessive act is full of meaning; it _seems_ to be a representation, a repetition of that all-important scene. But we are not bound to stop at this semblance; if we investigate more closely the relation between the two situations we shall probably find out something more, the purpose of the obsessive act. The kernel of it evidently lies in the calling of the maid, to whom she displays the mark, in contrast to her husband’s words: “It’s enough to disgrace one before the servant.” In this way he, whose part she is playing, is _not_ ashamed before the servant, the stain is where it ought to be. We see therefore that she has not simply repeated the scene, she has continued it and corrected it, transformed it into what it ought to have been. This implies something else, too, a correction of the circumstance which made that night so distressing, and which made the red ink necessary: namely, the husband’s impotence. The obsessive act thus says: “No, it is not true, he was not disgraced before the servant, he was not impotent.” As in a dream she represents this wish as fulfilled, in a current obsessive act, which serves the purpose of restoring her husband’s credit after that unfortunate incident.
Everything else which I could tell you about this lady fits in with this, or, more correctly stated, everything else that we know about her points to this interpretation of the obsessive act, in itself so incomprehensible. She had been separated from her husband for years and was trying to make up her mind to divorce him legally. But there would have been no prospect of being free from him in her mind; she forced herself to be true to him. She withdrew from the world and from everyone so that she might not be tempted, and in her phantasies she excused and idealized him. The deepest secret of her illness was that it enabled her to shield him from malicious gossip, to justify her separation from him, and to make a comfortable existence apart from her possible for him. The analysis of a harmless obsessive act thus leads straight to the inmost core of the patient’s disease, and at the same time betrays a great deal of the secret of the obsessional neurosis in general. I am quite willing that you should spend some time over this example, for it unites conditions which cannot reasonably be expected in all cases. The interpretation of the symptom was discovered by the patient herself in a flash, without guidance or interference from the analyst, and it had arisen in connection with an event which did not belong, as it commonly does, to a forgotten period in childhood, but which had occurred in the patient’s adult life and was clear in her memory. All those objections which critics habitually raise against our interpretations of symptoms are quite out of place here. To be sure, we cannot always be so fortunate.
And one thing more! Has it not struck you that this innocent obsessive act leads directly to this lady’s most private affairs? A woman can hardly have anything more intimate to relate than the story of her wedding-night; and is it by chance and without special significance that we are led straight to the innermost secrets of her sexual life? It might certainly be due to the choice I made of this example. Let us not decide this point too quickly; but let us turn to the second example, which is of a totally different nature, and belongs to a very common type, that of rituals preparatory to sleep. A well-grown clever girl of 19, the only child of her parents, superior to them in education and intellectual activity, was a wild, high-spirited child, but of late years had become very nervous without any apparent cause. She was very irritable, particularly with her mother, was discontented and depressed, inclined to indecision and doubt, finally confessing that she could no longer walk alone through squares and wide streets. We will not go very closely into her complicated condition, which requires at least two diagnoses: agoraphobia and obsessional neurosis; but will turn our attention to the ritual elaborated by this young girl preparatory to going to bed, as a result of which she caused her parents great distress. In a certain sense, every normal person may be said to carry out a ritual before going to sleep, or at least, he requires certain conditions without which he is hindered in going to sleep; the transition from waking life to sleep has been made into a regular formula which is repeated every night in the same manner. But everything that a healthy person requires as a condition of sleep can be rationally explained, and if the external circumstances make any alteration necessary he adapts himself easily to it without waste of time.
The morbid ritual on the other hand is inexorable, it will be maintained at the greatest sacrifices; it is disguised, too, under rational motives and appears superficially to differ from the normal only in a certain exaggerated carefulness of execution. On a closer examination, however, it is clear that the disguise is insufficient, that the ritual includes observances which go far beyond what reason can justify and even some which directly contravene this. As the motive of her nightly precautions, our patient declares that she must have silence at night and must exclude all possibility of noise. She does two things for this purpose; she stops the large clock in her room and removes all other clocks out of the room, including even the tiny wrist-watch on her bed-table. Flower-pots and vases are placed carefully together on the writing-table, so that they cannot fall down in the night and break, and so disturb her sleep. She knows that these precautions have only an illusory justification in the demand for quiet; the ticking of the little watch could not be heard, even if it lay on the table by the bed; and we all know that the regular ticking of a pendulum-clock never disturbs sleep, but is more likely to induce it.
She also admits that her fear that the flower-pots and vases, if left in their places at night, might fall down of themselves and break is utterly improbable. For some other practices in her ritual this insistence upon silence as a motive is dropped; indeed, by ordaining that the door between her bedroom and that of her parents shall remain half-open (a condition which she ensures by placing various objects in the doorway) she seems, on the contrary, to open the way to sources of noise. The most important observances are concerned with the bed itself, however. The bolster at the head of the bed must not touch the back of the wooden bedstead. The pillow must lie across the bolster exactly in a diagonal position and in no other; she then places her head exactly in the middle of this diamond, lengthways. The eiderdown must be shaken before she puts it over her, so that all the feathers sink to the foot-end; she never fails, however, to press this out and redistribute them all over it again. I will pass over other trivial details of her ritual; they would teach us nothing new and lead us too far from our purpose. Do not suppose, though, that all this is carried out with perfect smoothness. Everything is accompanied by the anxiety that it has not all been done properly; it must be tested and repeated; her doubts fix first upon one, then another, of the precautions; and the result is that one or two hours elapse before the girl herself can sleep, or lets the intimidated parents sleep.
The analysis of these torments did not proceed so simply as that of the former patient’s obsessive act. I had to offer hints and suggestions of its interpretation which were invariably received by her with a positive denial or with scornful doubt. After this first reaction of rejection, however, there followed a period in which she herself took up the possibilities suggested to her, noted the associations they aroused, produced memories, and established connections until she herself had accepted all the interpretations in working them out for herself. In proportion as she did this she began to relax the performance of her obsessive precautions and before the end of the treatment she had given up the whole ritual. I must also tell you that analytic work, as we conduct it nowadays, definitely excludes any uninterrupted concentration on a single symptom until its meaning becomes fully clear. It is necessary, on the contrary, to abandon a given theme again and again, in the assurance that one will come upon it anew in another context. The interpretation of the symptom, which I am now going to tell you, is therefore a synthesis of the results which, amid the interruptions of work on other points, took weeks and months to procure.
The patient gradually learnt to understand that she banished clocks and watches from her room at night because they were symbols of the female genitals. Clocks, which we know may have other symbolic meanings besides this, acquire this significance of a genital organ by their relation to periodical processes and regular intervals. A woman may be heard to boast that menstruation occurs in her as regularly as clockwork. Now this patient’s special fear was that the ticking of the clocks would disturb her during sleep. The ticking of a clock is comparable to the throbbing of the clitoris in sexual excitation. This sensation, which was distressing to her, had actually on several occasions wakened her from sleep; and now her fear of an erection of the clitoris expressed itself by the imposition of a rule to remove all going clocks and watches far away from her during the night. Flower-pots and vases are, like all receptacles, also symbols of the female genitals. Precautions to prevent them from falling and breaking during the night are therefore not lacking in meaning. We know the very widespread custom of breaking a vessel or a plate on the occasion of a betrothal; everyone present possesses himself of a fragment in symbolic acceptance of the fact that he may no longer put forward any claims to the bride, presumably a custom which arose with monogamy. The patient also contributed a recollection and several associations to this part of her ritual. Once as a child she had fallen while carrying a glass or porcelain vessel, and had cut her finger which had bled badly. As she grew up and learnt the facts about sexual intercourse, she developed the apprehension that on her wedding-night she would not bleed and so would prove not to be a virgin. Her precautions against the vases breaking signified a rejection of the whole complex concerned with virginity and with the question of bleeding during the first act of intercourse; a rejection of the anxiety both that she would bleed and that she would not bleed. These precautions were in fact only remotely connected with the prevention of noise.
One day she divined the central idea of her ritual when she suddenly understood her rule not to let the bolster touch the back of the bed. The bolster had always seemed a woman to her, she said, and the upright back of the bedstead a man. She wished therefore, by a magic ceremony, as it were, to keep man and woman apart; that is to say, to separate the parents and prevent intercourse from occurring. Years before the institution of her ritual, she had attempted to achieve this end by a more direct method. She had simulated fear, or had exploited a tendency to fear, so that the door between her bedroom and that of her parents should not be closed. This regulation was still actually included in her present ritual; in this way she managed to make it possible to overhear her parents; a proceeding which at one time had caused her months of sleeplessness. Not content with disturbing her parents in this way, she at that time even succeeded occasionally in sleeping between the father and mother in their bed. “Bolster” and “bedstead” were then really prevented from coming together. As she finally grew too big to be comfortable in the same bed with the parents, she achieved the same thing by consciously simulating fear and getting her mother to change places with her and to give up to her her place by the father. This incident was undoubtedly the starting-point of phantasies, the effect of which was evident in the ritual.
Ideas discussed in this chapter
Text from Project Gutenberg, public domain in the United States.