Introductory lectures on psycho-analysis · Sigmund Freud
SIXTEENTH LECTURE PSYCHO-ANALYSIS AND PSYCHIATRY
It pleases me greatly to see you here again to continue our discussions after a year has passed. Last year the subject of my lectures was the application of psycho-analysis to errors and to dreams; I hope this year to lead you to some comprehension of neurotic phenomena which, as you will soon discover, have much in common with both our former subjects. I must tell you before I begin, however, that I cannot concede you the same attitude towards me now as I did last year. Then I endeavoured to make no step without being in agreement with your judgement; I debated a great deal with you, submitted to your objections, in fact, recognized you and your “healthy common-sense” as the deciding factor. That is no longer possible and for a very simple reason. Errors and dreams are phenomena which were familiar to you; one might say you had as much experience of them as I, or could easily have obtained it. The manifestations of neurosis, however, are an unknown region to you; those of you who are not yourselves medical men have no access there except through the accounts I give you; and of what use is the most excellent judgement where there is no knowledge of the subject under debate?
However, do not receive this announcement as though I were going to give these lectures _ex cathedra_ or to demand unconditional acceptance from you. Any such misconception would do me a gross injustice. I do not aim at producing conviction,—my aim is to stimulate enquiry and to destroy prejudices. If owing to ignorance of the subject you are not in a position to adjudicate, then you should neither believe nor reject. You should only listen and allow what I tell you to make its own effect upon you. Convictions are not so easily acquired, or, when they are achieved without much trouble, they soon prove worthless and unstable. No one has a right to conviction on these matters who has not worked at this subject for many years, as I have, and has not himself experienced the same new and astonishing discoveries. Then why these sudden convictions in intellectual matters, lightning conversions, and instantaneous repudiations? Do you not see that the _coup de foudre_, “love at first sight,” proceeds from a very different mental sphere, from the affective one? We do not require even our patients to bring with them any conviction in favour of psycho-analysis or any devotion to it. It would make us suspicious of them. Benevolent scepticism is the attitude in them which we like best. Therefore will you also try to let psycho-analytical conceptions develop quietly in your minds alongside the popular or the psychiatric view, until opportunities arise for them to influence each other and be united into a decisive opinion.
On the other hand, you are not for a moment to suppose that the psycho-analytic point of view which I shall lay before you is a speculative system of ideas. On the contrary, it is the result of experience, being founded either on direct observations or on conclusions drawn from observation. Whether these have been drawn in an adequate or a justifiable manner future advances in science will show; after nearly two and a half decades and now that I am fairly well advanced in years I may say, without boasting, that it was particularly difficult, intense, and all-absorbing work that yielded these observations. I have often had the impression that our opponents were unwilling to consider this source of our statements, as if they looked upon them as ideas derived subjectively which anyone could dispute at his own sweet will. This attitude on the part of my opponents is not quite comprehensible to me. Perhaps it comes from the circumstance that physicians pay so little attention to neurotics and listen so carelessly to what they say that it has become impossible for them to perceive anything in the patients’ communications or to make detailed observations from them.
I will take this opportunity of assuring you that in these lectures I shall make few controversial references, least of all to individuals. I have never been able to convince myself of the truth of the saying that “strife is the father of all things.” I think the source of it was the philosophy of the Greek sophists and that it errs, as does the latter, through the over estimation of dialectics. It seems to me, on the contrary, that scientific controversy, so-called, is on the whole quite unfruitful, apart from the fact that it is almost always conducted in a highly personal manner. Until a few years ago I could boast that I had only once been engaged in a regular scientific dispute, and that with one single investigator, Löwenfeld of Munich. The end of it was that we became friends and have remained so to this day. But I did not repeat the experiment for a very long time because I was not certain that the outcome would be the same.
Now you will surely judge that a refusal of this kind to discuss matters publicly points to a high degree of inaccessibility to criticism, to obstinacy, or, in the polite colloquialism of the scientific world, to “pig-headedness.”[43] My reply to you would be that, should you have arrived at a conviction by means of such hard work, you would also thereby derive a certain right to maintain it with some tenacity. Further, on my own behalf, I can say that in the course of my work I have modified my views on important points, changed them or replaced them by others, and have of course in each case published the fact. What has been the result of this frankness? Some people have ignored my corrections of myself altogether and still to-day criticize me in respect of views which no longer mean the same to me. Others positively reproach me for these changes and declare me to be unreliable on that account. No one who changes his views once or twice deserves to be believed, for it is only too likely that he will be mistaken again in his latest assertions; but anyone who sticks to anything he has once said, or refuses to give way upon it easily enough, is obstinate or pig-headed; is it not so? What is to be done in the face of these self-contradictory criticisms except to remain as one is and behave as seems best to one? This is what I decided to do; and I am not deterred from remodelling and improving my theories in accordance with later experience. I have so far found nothing to alter in my fundamental standpoint and I hope this will never be necessary.
So now I have to lay before you the psycho-analytic theory of neurotic manifestations. For this purpose it will be simplest, on account of both the analogy and the contrast, to take an example which links up with the phenomena we have already considered. I will take a ‘symptomatic act’ which I see many people commit in my own consulting-room. The analyst has little to offer to the people who come to a physician’s consulting-room for half-an-hour to recount the lifelong misery of their fate. His deeper comprehension makes it difficult for him to give, as another might, the opinion that there is nothing wrong with them and that they had better take a light course of hydrotherapy. One of our colleagues once replied, with a shrug, when asked how he dealt with consultation patients, that he “fined them so many crowns for ‘wasting the time of the court.’” You will therefore not be surprised to hear that even the busiest psycho-analysts are not much sought after for consultations. I have had the ordinary door between the waiting-room and my consulting-room supplemented by another door and covered with felt. The reason for this is obvious. Now it constantly happens when I admit people from the waiting-room that they omit to close these doors, leaving even both doors open behind them.
When I see this happen, I at once, with some stiffness, request him or her to go back and make good the omission, no matter how fine a gentleman he may be nor how many hours she had spent on her toilet. My action gives the impression of being uncalled-for and pedantic; occasionally too I have found myself in the wrong, when the person turned out to be one of those who cannot themselves grasp a door-handle and are glad when those with them avoid it. But in the majority of cases I was right, for anyone who behaves in this way and leaves the door of a physician’s consulting-room open into the waiting-room belongs to the rabble and deserves to be received with coldness. Now don’t allow yourselves to be biassed before you have heard the rest. This omission on the part of a patient occurs only when he has been waiting alone in the outer room and thus leaves an empty room behind him, never when others, strangers to him, have also been waiting there. In the latter case he knows very well that it is to his own interest not to be overheard while he talks to the physician and he never neglects to close both doors carefully.
Occurring in this way, the patient’s omission is neither accidental nor meaningless, and not even unimportant, for it betrays the visitor’s attitude to the physician. He belongs to that large class who seek those in high places, and wish to be dazzled and intimidated. Perhaps he had made enquiries by telephone at what time he would be most likely to gain admittance and had been expecting to find a crowd of applicants in a queue, as if at the grocer’s in war-time. Then he is shown into an empty room which, moreover, is most modestly furnished, and he is dumbfounded. He must somehow make the physician atone for the superfluous respect he had been prepared to show him; and so he omits to close the doors between the waiting- and the consulting-rooms. He intends this to mean: “Pooh! there is no one here and I daresay there won’t be, however long I stay!” He would behave during the interview in an uncivil and supercilious manner, too, if his presumption were not curbed at the outset by a sharp reminder. In the analysis of this little symptomatic act you find nothing that is not already known to you; namely, the conclusion that it is no accident but has in it motive, meaning, and intention; that it belongs to a mental context which can be specified; and that it provides a small indication of a more important mental process. But above all it implies that the process thus indicated is not known to the consciousness of the person who carries it out; for not one of the patients who left the two doors open would have admitted that he wished to show any depreciation of me by his neglect. Many of them could probably recall a sense of disappointment on entering the empty waiting-room, but the connection between this impression and the succeeding symptomatic act certainly remained outside their consciousness.
Now let us place this little analysis of a symptomatic act by the side of an observation made on a patient. I will choose one which is fresh in my memory, and also because it can be described in comparatively few words. A certain amount of detail is indispensable for any such account. A young officer, home on short leave of absence, asked me to treat his mother-in-law, who was living in the happiest surroundings and yet was embittering her own and her family’s lives by a nonsensical idea. I found her a well-preserved lady, fifty-three years of age, of a friendly, simple disposition, who gave without hesitation the following account of herself. She is most happily married, and lives in the country with her husband who manages a large factory. She cannot say enough of her husband’s kindness and consideration; theirs had been a love-marriage thirty years ago, since when they had never had a cloud, a quarrel, or a moment’s jealousy. Her two children have both married well, but her husband’s sense of duty keeps him still at work. A year before, an incredible and, to her, incomprehensible thing happened. She received an anonymous letter telling her that her excellent husband was carrying on an intrigue with a young girl, and believed it on the spot—since then her happiness has been destroyed. The details were more or less as follows: she had a housemaid with whom she discussed confidential matters, perhaps rather too freely. This young woman cherished a positively venomous hatred for another girl who had succeeded better in life than herself, although of no better origin.
Instead of going into service, the other young woman had had a commercial training, been taken into the factory and, owing to vacancies caused by the absence of staff on service in the field, had been promoted to a good position. She lived in the factory, knew all the gentlemen, and was even addressed as “Miss.” The other one who had been left behind in life was only too ready to accuse her former schoolmate of all possible evil. One day our patient and her housemaid were discussing an elderly gentleman who had visited the house and of whom it was said that he did not live with his wife but kept a mistress. Why, she did not know, but she suddenly said: “I cannot imagine anything more awful than to hear that my husband had a mistress.” The next day she received by post an anonymous letter in disguised handwriting which informed her of the very thing she had just imagined. She concluded—probably correctly—that the letter was the handiwork of her malicious housemaid, for the woman who was named as the mistress of her husband was the very girl who was the object of this housemaid’s hatred.
Although she at once saw through the plot and had seen enough of such cowardly accusations in her own surroundings to place little credence in them, our patient was nevertheless prostrated by this letter. She became terribly excited and at once sent for her husband to overwhelm him with reproaches. The husband laughingly denied the accusation and did the best thing he could. He sent for the family physician (who also attended the factory), and he did his best to calm the unhappy lady. The next thing they did was also most reasonable. The housemaid was dismissed, but not the supposed mistress. From that time on the patient claims to have repeatedly brought herself to a calm view of the matter, so that she no longer believes the contents of the letter; but it has never gone very deep nor lasted very long. It was enough to hear the young woman’s name mentioned, or to meet her in the street, for a new attack of suspicion, agony, and reproaches to break out. This is the clinical picture of this excellent woman’s case. It did not require much experience of psychiatry to perceive that, in contrast to other neurotics, she described her symptoms too mildly—as we say, dissimulated them—and that she had never really overcome her belief in the anonymous letter.
Now what attitude does a psychiatrist take up to such a case? We know already what he would say to the symptomatic act of a patient who does not close the waiting-room doors. He explains it as an accident, without interest psychologically, and no concern of his. But he cannot continue to take up this attitude in regard to the case of the jealous lady. The symptomatic action appears to be unimportant; the symptom calls for notice as a grave matter. Subjectively it involves intense suffering, and objectively it threatens to break up a family; its claim to psychiatric interest is therefore indisputable. First the psychiatrist tries to characterize the symptom by some essential attribute. The idea with which this lady torments herself cannot be called nonsensical in itself; it does happen that elderly husbands contract relationships with young women. But there is something else about it that is nonsensical and incomprehensible. The patient has absolutely no grounds, except the anonymous letter, for supposing that her loving and faithful husband belongs to this category of men, otherwise not so uncommon. She knows that this communication carries no proof, she can explain its origin satisfactorily; she ought therefore to be able to say to herself that she has no grounds for her jealousy and she does even say so, but she suffers just as much as if she regarded her jealousy as well-founded. Ideas of this kind that are inaccessible to logic and the arguments of reality are unanimously described as _delusions_. The good lady suffers therefore, from a _delusion of jealousy_. That is evidently the essential characteristic of the case.
Having established this first point, our psychiatric interest increases. When a delusion cannot be dissipated by the facts of reality, it probably does not spring from reality. Where else then does it spring from? Delusions can have the most various contents; why is the content of it in this case jealousy? What kind of people have delusions, and particularly delusions of jealousy? Now we should like to listen to the psychiatrist, but he leaves us in the lurch here. He considers only one of our questions. He will examine the family history of this woman and will _perhaps_ bring us the answer that the kind of people who suffer from delusions are those in whose families similar or different disorders have occurred repeatedly. In other words, this lady has developed a delusion because she had an hereditary predisposition to do so. That is certainly something; but is it all that we want to know? Is it the sole cause of her disease? Does it satisfy us to assume that it is unimportant, arbitrary, or inexplicable that one kind of delusion should have been developed instead of another? And are we to understand the proposition—that the hereditary predisposition is decisive—also in a negative sense; that is, that no matter what experiences and emotions life had brought her she was destined some time or other to produce a delusion? You will want to know why scientific psychiatry gives no further explanation. And I reply: “Only a rogue gives more than he has.” The psychiatrist knows of no path leading to any further explanation in such a case. He has to content himself with a diagnosis and, in spite of wide experience, with a very uncertain prognosis of its future course.
Now can psycho-analysis do better than this? Yes, certainly I hope to show you that even in such an obscure case as this it is possible to discover something which makes closer comprehension possible. First, I shall ask you to notice this incomprehensible detail; that the anonymous letter on which her delusion is founded was positively provoked by the patient herself, by her saying to the scheming housemaid the day before that nothing could be more awful than to hear that her husband had an intrigue with a young woman. She first put the idea of sending the letter into the servant’s mind by this. So the delusion acquires a certain independence of the letter; it existed beforehand as a fear—or, as a wish?—in her mind. Besides this, the further small indications revealed in the bare two hours of analysis are noteworthy. The patient responded very coldly, it is true, to the request to tell me her further thoughts, ideas, and recollections, after she had finished her story. She declared that nothing came to her mind, she had told me everything; and after two hours the attempt had to be given up, because she announced that she felt quite well already and was certain that the morbid idea would not return.
Her saying this was naturally due to resistance and to the fear of further analysis, In these two hours she had let fall some remarks, nevertheless, which made a certain interpretation not only possible but inevitable, and this interpretation threw a sharp light on the origin of the delusion of jealousy. There actually existed in her an infatuation for a young man, for the very son-in-law who had urged her to seek my assistance. Of this infatuation she herself knew nothing or only perhaps very little; in the circumstances of their relationship it was easily possible for it to disguise itself as harmless tenderness on her part. After what we have already learnt it is not difficult to see into the mind of this good woman and excellent mother. Such an infatuation, such a monstrous, impossible thing, could not come into her conscious mind; it persisted, nevertheless, and unconsciously exerted a heavy pressure. Something had to happen, some sort of relief had to be found; and the simplest alleviation lay in that mechanism of displacement which so regularly plays its part in the formation of delusional jealousy. If not merely she, old woman that she was, were in love with a young man, but if only her old husband too were in love with a young mistress, then her torturing conscience would be absolved from the infidelity. The phantasy of her husband’s infidelity was thus a cooling balm on her burning wound. Of her own love she never became conscious; but its reflection in the delusion, which brought such advantages, thus became compulsive, delusional and conscious. All arguments against it could naturally avail nothing; for they were directed only against the reflection, and not against the original to which its strength was due and which lay buried out of reach in the Unconscious.
Let us now piece together the results of this short, obstructed psycho-analytic attempt to understand this case. It is assumed of course that the information acquired was correct, a point which I cannot submit to your judgement here. First of all, the delusion is no longer senseless and incomprehensible; it is sensible, logically motivated, and has its place in connection with an affective experience of the patient’s. Secondly, it has arisen as a necessary reaction to another mental process which has itself been revealed by other indications; and it owes its delusional character, its quality of resisting real and logical objections, to this relation with this other mental process. It is something desired in itself, a kind of consolation. Thirdly, the fact that the delusion is one of jealousy and no other is unmistakably determined by the experience underlying the disease. You will also recognize the two important analogies with the symptomatic act we analysed; namely, the discovery of the sense or intention behind the symptom and the relation of it to something in the given situation which is unconscious.
This does not, of course, answer all the questions arising out of this case. On the contrary, it bristles with further problems, some of which have not yet proved soluble at all, while others cannot be solved owing to the unfavourable circumstances met with in this case. For instance, why does this happily-married lady fall in love with her son-in-law, and why does relief come to her in the form of this kind of reflection, this projection of her own state of mind on to her husband, when other forms of relief were also possible? Do not think that it is idle and uncalled-for to propound these questions. We have already a good deal of material at hand to provide possible answers. The patient had come to that critical time of life which brings a sudden and unwelcome increase of sexual desire to a woman; that may have been sufficient in itself. Or there may have been an additional reason, in that the sexual capacity of her excellent and faithful husband may have been for some years insufficient for the still vigorous woman’s needs. Observation has taught us that it is just such men, whose fidelity is thus a matter of course, who treat their wives with particular tenderness and are unusually considerate of their nervous ailments.
Ideas discussed in this chapter
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