Introductory lectures on psycho-analysis · Sigmund Freud
TWENTY-FOURTH LECTURE ORDINARY NERVOUSNESS
As a science psycho-analysis is characterized by the methods with which it works, not by the subject-matter with which it deals. These methods can be applied without violating their essential nature to the history of civilization, to the science of religion, and to mythology as well as to the study of the neuroses. Psycho-Analysis aims at and achieves nothing more than the discovery of the unconscious in mental life. The problems of the actual neuroses, in which the symptoms probably arise through direct toxic injury, offer no point of attack for psycho-analysis; it can supply little towards elucidation of them and must leave this task to biological and medical research. Now perhaps you understand better why I chose this arrangement of my material. If I had intended an _Introduction to the Study of the Neuroses_ it would undoubtedly have been correct to begin with the simple forms of (actual) neuroses and proceed from them to the more complicated psychical disorders resulting from disturbances of the Libido. I should have had to collect from various quarters what we know or think we know about the former, and about the latter psycho-analysis would have been introduced as the most important technical means of obtaining insight into these conditions. An _Introduction to Psycho-Analysis_ was what I had undertaken and announced, however; I thought it more important to give you an idea of psycho-analysis than to teach you something about the neuroses; and therefore the actual neuroses which yield nothing towards the study of psycho-analysis could not suitably be put in the foreground. I think too that my choice was the wiser for you, since the radical axioms and far-reaching connections of psycho-analysis make it worthy of every educated person’s interest; the theory of the neuroses, however, is a chapter of medicine like any other.
However, you are justified in expecting that we should take some interest in the actual neuroses; their close clinical connection with the psychoneuroses even necessitates this. I will tell you then that we distinguish three pure forms of actual neurosis: _neurasthenia_, _anxiety-neurosis_ and _hypochondria_. Even this classification has been disputed; the terms are certainly all in use, but their connotation is vague and unsettled. There are some medical men who are opposed to all discrimination in the confusing world of neurotic manifestations, who object to any distinguishing of clinical entities or types of disease, and do not even recognize the difference between actual neuroses and psychoneuroses; in my opinion they go too far, and the direction they have chosen does not lead to progress. The three kinds of neurosis named above are occasionally found in a pure form; more frequently, it is true, they are combined with one another and with a psychoneurotic affection. This fact need not make us abandon the distinctions between them. Think of the difference between the science of minerals and that of ores in mineralogy: the minerals are classified individually, in part no doubt because they are frequently found as crystals, sharply differentiated from their surroundings; the ores consist of mixtures of minerals which have indeed coalesced, not accidentally, but according to the conditions at their formation. In the theory of the neuroses we still understand too little of the process of their development to formulate anything similar to our knowledge of ores; but we are certainly working in the right direction in first isolating from the mass the recognizable clinical elements, which are comparable to the individual minerals.
A noteworthy connection between the symptoms of the actual neuroses and the psychoneuroses adds a valuable contribution to our knowledge of symptom-formation in the latter; the symptom of the actual neurosis is frequently the nucleus and incipient stage of the psychoneurotic symptom. A connection of this kind is most clearly observable between neurasthenia and the transference neurosis known as conversion-hysteria, between the anxiety-neurosis and anxiety-hysteria, but also between hypochondria and forms of a neurosis which we shall deal with later on, namely, paraphrenia (dementia præcox and paranoia). As an example, let us take an hysterical headache or backache. Analysis shows that by means of condensation and displacement it has become a substitutive satisfaction for a whole series of libidinal phantasies or memories; at one time, however, this pain was real, a direct symptom of a sexual toxin, the bodily expression of a sexual excitation. We do not by any means maintain that all hysterical symptoms have a nucleus of this kind, but it remains true that this very often is so, and that all effects (whether normal or pathological) of the libidinal excitation upon the body are specially adapted to serve the purposes of hysterical symptom-formation. They play the part of the grain of sand which the oyster envelopes in mother-of-pearl. The temporary signs of sexual excitation accompanying the sexual act serve the psychoneurosis in the same way, as the most suitable and convenient material for symptom-formation.
There is a similar process of special diagnostic and therapeutic interest. In persons who are disposed to be neurotic without having yet developed a neurosis on a grand scale, some morbid organic condition—perhaps an inflammation, or an injury—very commonly sets the work of symptom-formation in motion; so that the latter process swiftly seizes upon the symptom supplied by reality, and uses it to represent those unconscious phantasies that have only been lying in wait for some means of expression. In such a case the physician will try first one therapy and then the other; will either endeavour to abolish the organic foundation on which the symptom rests, without troubling about the clamorous neurotic elaboration of it; or will attack the neurosis which this opportunity has brought to birth, while leaving on one side the organic stimulus which incited it. Sometimes one and sometimes the other procedure will be found justified by success; no general rules can be prescribed for mixed cases of this kind.
Text from Project Gutenberg, public domain in the United States.