Introductory lectures on psycho-analysis · Sigmund Freud
TWENTY-FOURTH LECTURE ORDINARY NERVOUSNESS
After such a difficult piece of work as we got through in our last lecture I shall leave the subject for a time and turn to my audience. For I know that you are dissatisfied. You imagined that _Introductory Lectures on Psycho-Analysis_ would be something quite different. You expected illustrations from life instead of theories; you will tell me that the story of the two children, on the ground-floor and in the mansion, revealed something of the causation of neurosis to you, except that it ought to have been an actual fact instead of an invention of my own. Or you will say that, when at the beginning I described two symptoms to you (not also imaginary, let us hope), and unfolded the solution of them and their connection with the lives of the patients, it threw some light on the meaning of symptoms, and you had hoped I would continue in the same way. Instead of doing so I gave you long-drawn-out and very obscure theories which were never complete, and to which I was constantly adding something; I dealt with conceptions which I had not yet introduced to you; I let go of descriptive explanation and took up the dynamic aspect and dropped this again for a so-called economic one; made it difficult for you to understand how many of these technical terms mean the same thing and are only exchanged for one another on account of euphony; I let vast conceptions, such as those of the pleasure and reality principles, and the inherited residue of phylogenetic development, appear, and then instead of explaining anything to you I let them drift away before your eyes out of sight.
Why did I not begin the introduction to the study of the neuroses with what you all know of nervousness, a thing that has long roused your interest, or with the peculiar nature of nervous persons, their incomprehensible reactions to human intercourse and external influences, their excitability, their unreliability, and their inability to do well in anything? Why not lead you step by step from an explanation of the simple everyday forms of nervousness to the problems of the enigmatic extreme manifestations? Indeed, I cannot deny any of this or say that you are wrong. I am not so much in love with my powers of presentation as to imagine that every blemish in it is a peculiar charm. I think myself that I might with advantage to you have proceeded differently, and, indeed, such was my intention. But one cannot always carry through a reasoned scheme; something in the material itself often intervenes and takes possession of one and turns one from one’s first intentions. Even such an ordinary task as the arrangement of familiar material is not entirely subject to the author’s will; it comes out in its own way and one can but wonder afterwards why it happened so and not otherwise.
One of the reasons probably is that my theme, an introduction to psycho-analysis, no longer covers this section dealing with the subject of the neuroses. The introduction to psycho-analysis lies in the study of errors and of dreams; the theory of neurosis is psycho-analysis itself. I do not think that in such a short time I could have given you any knowledge of the material contained in the theory of the neuroses except in this very concentrated form. It was a matter of presenting to you in their proper context the sense and meaning of symptoms, together with the external and internal conditions and mechanisms of symptom-formation. This I attempted to do; it is more or less the core of what psycho-analysis is able to offer to-day. In conjunction with it there was much to be said about the Libido and its development, and something about that of the Ego. You were already prepared by the preliminary lectures for the main principles of our method and for the broad aspects involved in the conceptions of the Unconscious and of repression (resistance). In one of the following lectures you will learn at what point the work of psycho-analysis finds its organic continuation. So far I have not concealed from you that all our results proceed from the study of one single group only of nervous disorders—namely, the transference neuroses; and even so I have traced out the mechanism of symptom-formation only in the hysterical neurosis. Though you will probably have gained no very thorough knowledge and have not retained every detail, yet I hope that you have acquired a general idea of the means with which psycho-analysis works, the problems it has to deal with, and the results it has to offer.
I have ascribed to you a wish that I had begun the subject of the neuroses with a description of the neurotic’s behaviour, and of the ways in which he suffers from his disorder, protects himself against it, and adapts himself to it. This is certainly a very interesting subject, well worth studying, and not difficult to treat; nevertheless there are reasons against beginning with this aspect. The danger is that the Unconscious will be overlooked, the great importance of the Libido ignored, and that everything will be judged as it appears to the patient’s own Ego. Now it is obvious that his Ego is not a reliable and impartial authority. The Ego is after all the force which denies the existence of the Unconscious and has subjected it to repressions; how then can we trust its good faith where the Unconscious is concerned? That which has been repressed consists first and foremost of the repudiated claims of the sexuality; it is perfectly self-evident that we shall never learn their extent and their significance from the Ego’s view of the matter. As soon as the nature of repression begins to dawn upon us we are advised not to allow one of the two contending parties, and certainly not the victorious one, to be judge in the dispute. We are forewarned against being misled by what the Ego tells us. According to its evidence it would appear to have been the active force throughout, so that the symptoms arise by its will and agency; we know that to a large extent it has played a passive part, a fact which it then endeavours to conceal and to gloss over. It is true that it cannot always keep up this pretence—in the symptoms of the obsessional neurosis it has to confess to being confronted by something alien which it must strenuously resist.
It is certainly plain sailing enough for anyone who does not heed these warnings against taking the falsifications of the Ego at their face-value; he will escape all the opposition which psycho-analysis has to encounter in accentuating the Unconscious, sexuality, and the passivity of the Ego. He can agree with Alfred Adler that the “nervous character” is the cause of the neurosis, instead of the result; but he will not be in a position to account for a single detail of symptom-formation or a single dream. You will ask: May it not be possible to do justice to the part played by the Ego in nervousness and in symptom-formation without absolutely glaring neglect of the other factors discovered by psycho-analysis? I reply: Certainly it must be possible, and some time or other it will be done; but the work which lies at hand for psycho-analysis is not suited for a beginning at this end. One can, no doubt, predict the point at which this task also will be included. There are neuroses, called by us the _narcissistic_ neuroses, in which the Ego is far more deeply involved than in those we have studied; analytic investigation of these disorders will enable us to estimate impartially and reliably the share taken by the Ego in neurotic disease.
One of the relations the Ego bears to its neurosis is, however, so conspicuous that it was quite appreciable from the beginning. It never seems to be absent; but it is most clearly discernible in a form of disorder which we are far from understanding, the traumatic neurosis. You must know that in the causation and mechanism of all the various different forms of neurosis the same factors are found at work over and over again, only that in one type this factor and in another type that factor is of greatest significance in symptom-formation. It is just the same as with the personnel of a theatrical company, where every member plays a special type of part—hero, confidant, villain, etc; each of them will choose a different piece for his own benefit-performance. Hence, the phantasies which are transformed into the symptoms are nowhere so manifest as in hysteria; the ‘counter-charges’ or reaction-formations of the Ego dominate the picture in the obsessional neurosis; the mechanism which in dreams we called ‘secondary elaboration’ is the prominent feature in the delusions of paranoia, and so on. In the _traumatic neuroses_, especially in those arising from the terrors of war, we are particularly impressed by a self-seeking, egoistic motive, a straining towards protection and self-interest; this alone perhaps could not produce the disease, but it gives its support to the latter and maintains it once it has been formed. This tendency aims at protecting the Ego from the dangers which led by their imminence to the outbreak of illness; nor does it permit of recovery until a repetition of the dangers appear to be no longer possible, or until some gain in compensation for the danger undergone has been received.
The Ego takes a similar interest in the origin and maintenance of all the other forms of neurosis; we have said already that the symptom is supported by the Ego because one side of it offers a satisfaction to the repressing Ego-tendency. More than this, a solution of the conflict by a symptom-formation is the most convenient one, most in accordance with the pleasure-principle; for it undoubtedly spares the Ego a severe and painful piece of internal labour. There are indeed cases in which the physician himself must admit that the solution of a conflict by a neurosis is the one most harmless and most tolerable socially. Do not be astonished to hear then that the physician himself occasionally takes sides with the illness which he is attacking. It is not for him to confine himself in all situations in life to the part of fanatic about health; he knows that there is _other_ misery in the world besides neurotic misery—real unavoidable suffering—that necessity may even demand of a man that he sacrifice his health to it, and he learns that such suffering in one individual may often avert incalculable hardship for many others. Therefore, although it may be said of every neurotic that he has taken ‘_flight into illness_,’ it must be admitted that in many cases this flight is fully justified, and the physician who has perceived this state of things will silently and considerately retire.
But let us continue our discussion without regard to these exceptional cases. In the ordinary way it is apparent that by flight into neurosis the Ego gains a certain internal ‘_advantage through illness_,’ as we call it; under certain conditions a tangible external advantage, more or less valuable in reality, may be combined with this. To take the commonest case of this kind: a woman who is brutally treated and mercilessly exploited by her husband fairly regularly takes refuge in a neurosis, if her disposition admits of it. This will happen if she is too cowardly or too conventional to console herself secretly with another man, if she is not strong enough to defy all external reasons against it and separate from her husband, if she has no prospect of being able to maintain herself or of finding a better husband, and last of all, if she is still strongly attached sexually to this brutal man. Her illness becomes her weapon in the struggle against him, one that she can use for her protection, or misuse for purposes of revenge. She can complain of her illness, though she probably dare not complain of her marriage; her doctor is her ally; the husband who is otherwise so ruthless is required to spare her, to spend money on her, to grant her absence from home and thus some freedom from marital oppression. Whenever this external or ‘accidental’ advantage through illness is at all pronounced, and no substitute for it can be found in reality, you need not look forward very hopefully to influencing the neurosis by your therapy.
You will now say that what I have just told you about the ‘advantage through illness’ is all in favour of the view I have rejected, namely, that the Ego itself desires the neurosis and creates it. But just a moment! Perhaps it means merely this: that the Ego is pleased to accept the neurosis which it is in any case unable to prevent, and that if there is anything at all to be made out of it it makes the best of it. This is only one side of the matter. In so far as there is advantage in it the Ego is quite happy to be on good terms with a neurosis, but there are also disadvantages to be considered. As a rule it is soon apparent that by accepting a neurosis the Ego has made a bad bargain. It has paid too heavily for the solution of the conflict; the sufferings entailed by the symptoms are perhaps as bad as those of the conflict they replace, and they may quite probably be very much worse. The Ego wishes to be rid of the pain of the symptoms, but not to give up its advantage through illness; and that is just what it cannot succeed in doing. It appears therefore that the Ego was not quite so actively concerned in the matter throughout as it had thought, and we will keep this well in mind.
If, as physicians, you have much to do with neurotics, you will soon cease to expect that those who complain most bitterly of their illness will be most ready to accept your help and make least difficulty—quite the contrary. You will at all events easily understand that everything which contributes to the advantage through illness reinforces the resistance arising from the repressions, and increases the therapeutic difficulties. And there is yet another kind of advantage through illness, one which supervenes later than that born with the symptom, so to speak. When such a mental organization as the disease has persisted for a considerable time it seems finally to acquire the character of an independent entity; it displays something like a self-preservative instinct; it forms a kind of pact, a _modus vivendi_, with the other forces in mental life, even with those fundamentally hostile to it, and opportunities can hardly fail to arise in which it once more manifests itself as useful and expedient, thus acquiring a _secondary function_ which again strengthens its position. Instead of taking an example from pathology let us consider a striking illustration in everyday life. A capable working-man earning his living is crippled by an accident in the course of his employment; he can work no more, but he gets a small periodical dole in compensation and learns how to exploit his mutilation as a beggar. His new life, although so inferior, nevertheless is supported by the very thing which destroyed his old life; if you were to remove his disability you would deprive him for a time of his means of subsistence, for the question would arise whether he would still be capable of resuming his former work. When a secondary exploitation of the illness such as this is formed in a neurosis we can range it alongside the first and call it a ‘_secondary_ advantage through illness.’
I should like to advise you in a general way not to underestimate the practical importance of the advantage through illness, and yet not to be too much impressed by its theoretical significance. Apart from the exceptions previously recognized, this factor always reminds one of the illustrations of “Intelligence in Animals” by Oberländer in _Fliegende Blätter_. An Arab is riding a camel along a narrow path cut in the side of a steep mountain. At a turn in the path he suddenly finds himself confronted by a lion ready to spring at him. There is no escape; on one side the abyss, on the other the precipice; retreat and flight are impossible; he gives himself up for lost. Not so the camel. He takes one leap with his rider into the abyss—and the lion is left a spectator. The remedies provided by neurosis avail the patient no better as a rule; perhaps because the solution of the conflict by a symptom-formation is after all an automatic process which may show itself inadequate to meet the demands of life, and involves man in a renunciation of his best and highest powers. The more honourable choice, if there be a choice, is to go down in fair fight with destiny.
I still owe you a further explanation of my motive in not taking ordinary nervousness as my starting-point. Perhaps you think I avoided doing so because it would have been more difficult to bring in evidence of the sexual origin of the neuroses in that way; but in this you would be mistaken. In the transference neuroses the symptoms have to be submitted to interpretation before we arrive at this; but in the ordinary forms of what are called the ACTUAL NEUROSES the ætiological significance of the sexual life is a crudely obvious fact which courts notice. I became aware of it more than twenty years ago, as one day I began to wonder why, when we examine nervous patients, we so invariably exclude from consideration all matters concerning their sexual life. Investigations on this point led to the sacrifice of my popularity with my patients, but in a very short time my efforts had brought me to this conclusion: that no neurosis—actual neurosis, I meant—is present where sexual life is normal. It is true that this statement ignores the individual differences in people rather too much, and it also suffers from the indefinite connotation inseparable from the word “normal”; but as a broad outline it has retained its value to this day.
At that time I got so far as to be able to establish particular connections between certain forms of nervousness and certain injurious sexual conditions; I do not doubt that I could repeat these observations to-day if I still had similar material for investigation. I noticed often enough that a man who contented himself with some kind of incomplete sexual satisfaction, e.g. with manual masturbation, would suffer from a definite type of actual neurosis, and that this neurosis would promptly give way to another form if he adopted some other equally unsatisfactory form of sexual life. I was then in a position to infer the change in his mode of sexual life from the alteration in the patient’s condition; and I learnt to abide stubbornly by my conclusions until I had overcome the prevarications of my patients and had compelled them to give me confirmation. It is true that they then thought it advisable to seek other physicians who would not take so much interest in their sexual life.
It did not escape me at that time either that sexuality was not always indicated as the cause of a neurosis; one person certainly would fall ill because of some injurious sexual condition, but another because he had lost his fortune or recently sustained a severe organic illness. The explanation of these variations was revealed later, when insight was obtained into the interrelationships suspected between the Ego and the Libido; and the further this subject was explored the more satisfactory became our insight into it. A person only falls ill of a neurosis when the Ego loses its capacity to deal in some way or other with the Libido. The stronger the Ego the more easily can it accomplish this task; every weakening of the Ego, from whatever cause, must have the same effect as an increase in the demands of the Libido; that is, make a neurosis possible. There are yet other and more intimate relations between the Ego and the Libido, which I shall not go into now as we have not yet come to them in the course of our discussions. The most essential and most instructive point for us is that the fund of energy supporting the symptoms of a neurosis, in every case and regardless of the circumstances inducing their outbreak, is provided by the Libido, which is thus put to an abnormal use.
Now I must point out to you the decisive difference between the symptoms of the _actual neuroses_ and those of the _psychoneuroses_, with the first group of which (the transference neuroses) we have hitherto been so much occupied. In both the actual neuroses and the psychoneuroses the symptoms proceed from the Libido; that is, they are abnormal ways of using it, substitutes for satisfaction of it. But the symptoms of an actual neurosis—headache, sensation of pain, an irritable condition of some organ, the weakening or inhibition of some function—have no ‘meaning,’ no signification in the mind. Not merely are they manifested principally in the body, as also happens, for instance with hysterical symptoms, but they are in themselves purely and simply physical processes; they arise without any of the complicated mental mechanisms we have been learning about. They really are, therefore, what psychoneurotic symptoms were for so long held to be. But then, how can they be expressions of the Libido which we have come to know as a force at work in the mind? Now, really, the answer to that is very simple. Let me resurrect one of the very first objections ever made against psycho-analysis. It was said that the theories were an attempt to account for neurotic symptoms by psychology alone and that the outlook was consequently hopeless, since no illness could ever be accounted for by psychological theories. These critics were pleased to forget that the sexual function is not a purely mental thing, any more than it is merely a physical thing. It affects bodily life as well as mental life. Having learnt that the symptoms of the psychoneuroses express the mental consequences of some disturbance in this function, we shall not be surprised to find that the actual neuroses represent the direct somatic consequences of sexual disturbances.
Clinical medicine gives us a useful hint (recognized by many different investigators) towards comprehension of the actual neuroses. In the details of their symptomatology, and also in the peculiarity by which all the bodily systems and functions are affected together, they exhibit an unmistakable similarity with pathological conditions resulting from the chronic effect or the sudden removal of foreign toxins—i.e. with states of intoxication or of abstinence. The two groups of affections are brought still closer together by comparison with conditions like Basedow’s disease[49] that have also been found to result from poisoning, not, however, from poisons derived externally, but from such as arise in the internal metabolism. In my opinion these analogies necessitate our regarding the neuroses as the effects of disturbances in the sexual metabolism, due either to more of these sexual toxins being produced than the person can dispose of, or else to internal and even mental conditions which interfere with the proper disposal of these substances. Assumptions of this kind about the nature of sexual desire have found acceptance in the mind of the people since the beginning of time; love is called an “intoxication,” it can be induced by “potions”—in these ideas the agency at work is to some extent projected on to the outer world. We find occasion at this point to remember the erotogenic zones, and to reflect upon the proposition that sexual excitation may arise in the most various organs. Beyond this the subject of ‘sexual metabolism’ or the ‘chemistry of sexuality’ is an empty chapter: we know nothing about it, and cannot even determine whether to assume two kinds of sexual substances, to be called ‘male’ and ‘female,’ or to content ourselves with _one_ sexual toxin as the agent of all the stimuli effected by the Libido. The edifice of psycho-analytic doctrine which we have erected is in reality but a superstructure, which will have to be set on its organic foundation at some time or other; but this foundation is still unknown to us.
Text from Project Gutenberg, public domain in the United States.