Introductory lectures on psycho-analysis · Sigmund Freud
TWENTY-THIRD LECTURE THE PATHS OF SYMPTOM-FORMATION
In the eyes of the general public the symptoms are the essence of a disease, and to them a cure means the removal of the symptoms. In medicine, however, we find it important to differentiate between symptoms and disease, and state that the disappearance of the symptoms is by no means the same as the cure of the disease. The only tangible element of the disease that remains after the removal of the symptoms, however, is the capacity to form new symptoms. Therefore for the moment let us adopt the lay point of view and regard a knowledge of the foundation of the symptoms as equivalent to understanding the disease. The symptoms—of course we are here dealing with mental (or psychogenic) symptoms, and mental disease—are activities which are detrimental, or at least useless, to life as a whole; the person concerned frequently complains of them as obnoxious to him or they involve distress and suffering for him. The principal injury they inflict lies in the expense of mental energy they entail and, besides this, in the energy needed to combat them. Where the symptoms are extensively developed, these two kinds of effort may exact such a price that the person suffers a very serious impoverishment in available mental energy, which consequently disables him for all the important tasks of life. This result depends principally upon the amount of energy taken up in this way, therefore you will see that “illness” is essentially a practical conception. But if you look at the matter from a theoretical point of view and ignore this question of degree you can very well say that we are all ill, i.e. neurotic; for the conditions required for symptom-formation are demonstrable also in normal persons.
Of neurotic symptoms we already know that they are the result of a conflict arising when a new form of satisfaction of Libido is sought. The two powers which have entered into opposition meet together again in the symptom and become reconciled by means of the _compromise_ contained in symptom-formation. That is why the symptom is capable of such resistance; it is sustained from both sides. We also know that one of the two partners to the conflict is the unsatisfied Libido, frustrated by reality and now forced to seek other paths to satisfaction. If reality remains inexorable, even when the Libido is prepared to take another object in place of that denied, the Libido will then finally be compelled to resort to regression, and to seek satisfaction in one of the organizations it had already surmounted or in one of the objects it had relinquished earlier. The Libido is drawn into the path of regression by the fixations it has left behind it at these places in its development.
Now the path of perversion branches off sharply from that of neurosis. If these regressions do not call forth a prohibition on the part of the Ego, no neurosis results; the Libido succeeds in obtaining a real, although not a normal, satisfaction. But if the Ego, which controls not merely consciousness but also the approaches to motor innervation and hence the realization in actuality of mental impulses, is not in agreement with these regressions, conflict ensues. The Libido is turned off, blocked, as it were, and must seek an escape by which it can find an outlet for its ‘_charge of energy_’ in conformity with the demands of the pleasure-principle: it must elude, eschew the Ego. The fixations upon the path of development now regressively traversed—fixations against which the Ego had previously guarded itself by repressions—offer just such an escape. In streaming backward and re-‘investing’ these repressed ‘positions,’ the Libido withdraws itself from the Ego and its laws; but it also abandons all the training acquired under the influence of the Ego. It was docile as long as satisfaction was in sight; under the double pressure of external and internal privation it becomes intractable and harks back to former happier days. That is its essential unchangeable character.
The ideas to which the Libido now transfers its ‘charge of energy’ belong to the unconscious system and are subject to the special processes characteristic of that system—namely, condensation and displacement. Conditions are thus set up which correspond exactly with those of dream-formation. Just as the latent dream, first formed in the Unconscious out of the thoughts proper, and constituting the fulfilment of an unconscious wish-phantasy, meets with some (pre)conscious activity which exerts a censorship upon it and permits, according to its verdict, the formation of a compromise in the manifest dream, so the ideas to which the Libido is attached (‘libido-representatives’) in the Unconscious have still to contend with the power of the preconscious Ego. The opposition that has arisen against it in the Ego follows it as a ‘_counter__charge_’ and forces it to adopt a form of expression by which the opposing forces also can at the same time express themselves. In this way the symptom then comes into being, as a derivative, distorted in manifold ways, of the unconscious libidinal wish-fulfilment, as a cleverly chosen ambiguity with two completely contradictory significations. In this last point alone is there a difference between dream-formation and symptom-formation; for the preconscious purpose in dream-formation is merely to preserve sleep and to allow nothing that would disturb it to penetrate consciousness; it does not insist upon confronting the unconscious wish-impulse with a sharp prohibiting “No, on the contrary.” It can be more tolerant because a sleeping person is in a less dangerous position; the condition of sleep is enough in itself to prevent the wish from being realized in actuality.
You see that this escape of the Libido under the conditions of conflict is rendered possible by the existence of fixations. The regressive investment (with Libido) of these fixations leads to a circumventing of the repressions and to a discharge—or a satisfaction—of the Libido, in which the conditions of a compromise have nevertheless to be maintained. By this détour through the Unconscious and the old fixations the Libido finally succeeds in attaining to a real satisfaction, though the satisfaction is certainly of an exceedingly restricted kind and hardly recognizable as such. Let me add two remarks on this outcome. First, will you notice how closely connected the Libido and the Unconscious, on the one hand, and the Ego, consciousness, and reality, on the other, show themselves to be, although there were no such connections between them originally; and secondly, let me tell you that all I have said and have still to say on this point concerns the neurosis of hysteria only.
Where does the Libido find the fixations it needs in order to break through the repressions? In the activities and experiences of infantile sexuality, in the component-tendencies and the objects of childhood which have been relinquished and abandoned. It is to them, therefore, that the Libido turns back. The significance of childhood is a double one; on the one hand the congenitally-determined instinct-dispositions are first shown at that time, and secondly, other instincts are then first awakened and activated by external influences and accidental events experienced. In my opinion we are quite justified in laying down this dichotomy. That the innate predisposition comes to expression will certainly not be disputed; but analytic observation even requires us to assume that purely accidental experiences in childhood are capable of inducing fixations of Libido. Nor do I see any theoretical difficulty in this. Constitutional predispositions are undoubtedly the after-effects of the experiences of an earlier ancestry; they also have been at one time acquired; without such acquired characters there would be no heredity. And is it conceivable that the acquisition of characters which will be transmitted further should suddenly cease in the generation which is being observed to-day? The importance of the infantile experiences should not, however, be entirely overlooked, as so often happens, in favour of ancestral experiences or of experiences in adult life; but on the contrary they should be particularly appreciated. They are all the more pregnant with consequences because they occur at a time of uncompleted development, and for this very reason are likely to have a traumatic effect. The work done by Roux and others on the mechanism of development has shown that a needle pricked into an embryonic cell-mass undergoing division results in serious disturbances of the development; the same injury to a larva or a full-grown animal would be innocuous.
The Libido-fixation of an adult, which we have referred to as representing the constitutional factor in the ætiology of the neuroses, may therefore now be divided into two further elements: the inherited predisposition and the predisposition acquired in early childhood. Since a schematic mode of presentation is always acceptable to a student, let us formulate these relations as follows: _Causation of Predisposition + Accidental Neurosis_ = resulting from (_traumatic_) Libido-fixation Experiences ↙ ↘ ———————————— ———————————— ↓ ↓ Sexual Infantile Constitution Experiences (_Ancestral experiences_) The hereditary sexual constitution provides a great variety of predispositions, according as this or that component-impulse, alone or in combination with others, is specially strongly accentuated. Together with the infantile experiences the sexual constitution forms another ‘complemental series,’ quite similar to that already described as being formed out of the predisposition and accidental experiences of an adult. In each series similar extreme cases are met with, and also similar degrees and relationships between the factors concerned. It would be appropriate at this point to consider whether the most striking of the two kinds of Libido-regression (that which reverts to earlier stages of sexual organization) is not predominantly conditioned by the hereditary constitutional factor; but the answer to this question is best postponed until a wider range of forms of neurotic disease can be considered.
Now let us devote attention to the fact that analytic investigation shows the Libido of neurotics to be attached to their infantile sexual experiences. In this light these experiences seem to be of enormous importance in the lives and illnesses of mankind. This importance remains undiminished in so far as the therapeutic work of analysis is concerned; but regarded from another point of view it is easy to see that there is a danger of a misunderstanding here, one which might delude us into regarding life too exclusively from the angle of the situation in neurotics. The importance of the infantile experiences is after all diminished by the reflection that the Libido reverts regressively to them _after_ it has been driven from its later positions. This would lead us towards the opposite conclusion, that the Libido-experiences had no importance at the time of their occurrence, but only acquired it later by regression. You will remember that we discussed a similar alternative before, in dealing with the Oedipus complex.
To decide this point is again not difficult. The statement is undoubtedly correct that regression greatly augments the investment of the infantile experiences with Libido—and with that their pathogenic significance; but it would be misleading to allow this alone to become decisive. Other considerations must be taken into account as well. To begin with, observation shows in a manner excluding all doubt that infantile experiences have their own importance which is demonstrated already during childhood. There are, indeed, neuroses in children too; in their neuroses the factor of displacement backwards in time is necessarily much diminished, or quite absent, the outbreak of illness following immediately upon a traumatic experience. The study of infantile neuroses guards us from many risks of misunderstanding the neuroses of adults, just as children’s dreams gave us the key to comprehension of the dreams of adults. Neurosis in children is very common, far more common than is usually supposed. It is often overlooked, regarded as a manifestation of bad behaviour or naughtiness, and often subdued by the authorities in the nursery; but in retrospect it is always easily recognizable. It appears most often in the form of anxiety-hysteria; we shall learn what that means on another occasion. When a neurosis breaks out in later life analysis invariably reveals it to be a direct continuation of that infantile neurosis, which had perhaps been expressed in a veiled and incipient form only; as has been said, however, there are cases in which the childish nervousness is carried on into lifelong illness without a break. In a few instances we have been able to analyse a child actually in a condition of neurosis; far more often we have had to be satisfied with the retrospective insight into a childhood-neurosis that can be gained through someone who has fallen ill in mature years, a situation in which due corrections and precautions must not be neglected.
In the second place, it would certainly be inexplicable that the Libido should regress so regularly to the time of childhood if there had been nothing there which could exert an attraction upon it. The fixation upon certain stages of development, which we assume, only has meaning if we regard it as attaching to itself a definite amount of libidinal energy. Finally, I may point out that a complemental relationship exists here between the intensity and pathogenic importance of the _infantile_ and of the _later_ experiences, again a similar relationship to that found in the other two series we have already studied. There are cases in which the whole accent of causation falls on the sexual experiences in childhood; cases in which these impressions undoubtedly had a traumatic effect, nothing more than the average sexual constitution and its immaturity being required to supplement them. Then there are others in which all the accent lies on the later conflicts, and the analytic emphasis upon the childhood-impressions seems to be the effect of regression alone. There exist, therefore, the two extremes—‘inhibited development’ and ‘regression’—and between them every degree of combination of the two factors.
This state of things has a certain interest for those looking to pedagogy for the prevention of neuroses by early intervention in the matter of the child’s sexual development. As long as attention is directed mainly to the infantile sexual experiences one would think everything in the way of prophylaxis of later neurosis could be done by ensuring that this development should be retarded and the child secured against this kind of experience. But we know that the conditions causing neurosis are more complicated than this and that they cannot be influenced in a general way by attending to one factor only. Strict supervision in childhood loses value because it is helpless against the constitutional factor; more than this, it is less easy to carry out than specialists in education imagine; and it entails two new risks, which are not to be lightly disregarded. It may accomplish too much; in that it favours an exaggerated degree of sexual repression which is harmful in its effects, and it sends the child into life without power to resist the urgent demands of his sexuality that must be expected at puberty. It therefore remains most doubtful how far prophylaxis in childhood can go with advantage, and whether a changed attitude to actuality would not constitute a better point of departure for attempts to forestall the neuroses.
Let us return to consideration of the symptoms. They yield a satisfaction in place of one lacking in reality; they achieve this by means of a regression of the Libido to a previous time of life, with which regression is indissolubly connected, a reversion to earlier phases in the object-choice or in the organization. We learned some time ago that the neurotic is in some way _tied_ to a period in his past life; we know now that this period in the past is one in which his Libido could attain satisfaction, one in which he was happy. He looks back on his life-story, seeking some such period, and goes on seeking it, even if he must go back to the time when he was a suckling infant to find it according to his recollection or his imagination of it under later influences. In some way the symptom reproduces that early infantile way of satisfaction, disguised though it is by the censorship implicit in the conflict, converted as it usually is into a sensation of suffering, and mingled with elements drawn from the experiences leading up to the outbreak of the illness.
The kind of satisfaction which the symptom brings has much about it which estranges us, quite apart from the fact that the person concerned is unaware of the satisfaction and perceives this that we call satisfaction much more as suffering, and complains of it. This transformation belongs to the mental conflict, by the pressure of which the symptom had to be formed; what was at one time a satisfaction must to-day arouse resistance or horror in him. We are familiar with a simple but instructive instance of such a change of feeling: the same child that sucked milk with voracity from its mother’s breast often shows, some years later, a strong dislike of milk which can with difficulty be overcome by training; this dislike is intensified to the point of horror if the milk or any other kind of liquid containing it has a skin formed upon it. It is possible that this skin calls up reverberations of a memory of the mother’s breast, once so ardently desired; it is true that the traumatic experience of weaning has intervened meanwhile.
There is still something else which makes the symptoms seem remarkable and inexplicable as a means of libidinal satisfaction. They so entirely fail to remind us of all that we are accustomed normally to connect with satisfaction. They are mostly quite independent of an object and thus have given up a relation to external reality. We understand this as a consequence of the rejection of the reality-principle and the return to the pleasure-principle; it is also, however, a return to a kind of amplified auto-erotism, the kind which offered the sexual instinct its first gratifications. In the place of effecting a change in the outer world they set up a change in the body itself; that is, an internal action instead of an external one, an adaptation instead of an activity—from a phylogenetic point of view again a very significant regression. We shall understand this better when we consider it in connection with a new factor yet to be learnt from among those which analytic research has yielded in regard to symptom-formation. Further, we remember that in symptom-formation the same unconscious processes are at work as in dream-formation, namely, condensation and displacement. Like the dream, the symptom represents something as fulfilled, a satisfaction infantile in character; but by the utmost condensation this satisfaction can be compressed into a single sensation or innervation, or by farthest displacement can be whittled away to a tiny detail out of the entire libidinal complex. It is no wonder that we often find it difficult to recognize in the symptom the libidinal satisfaction which we suspect and can always verify in it.
I have indicated that we have still to learn of a new element; it is really something most surprising and bewildering. You know that from analysis of symptoms we arrive at a knowledge of the infantile experiences to which the Libido is fixated and out of which the symptoms are made up. Now the astonishing thing is that these scenes of infancy are not always true. Indeed, in the majority of cases they are untrue, and in some cases they are in direct opposition to historical truth. You will see that this discovery is more likely than any other to discredit either the analysis which leads to such results, or the patient, upon whose testimony the analysis and comprehension of the neuroses as a whole is built up. There is besides this still something utterly bewildering about it. If the infantile experiences brought to light by the analysis were in every case real we should have the feeling that we were on firm ground; if they were invariably falsified and found to be inventions and phantasies of the patient’s we should have to forsake this insecure foothold and save ourselves some other way.
But it is neither one thing nor the other; for what we find is that the childhood-experiences reconstructed or recollected in analysis are on some occasions undeniably false, while others are just as certainly quite true, and that in most cases truth and falsehood are mixed up. So the symptoms are thus at one minute reproductions of experiences which actually took place and which one can credit with an influence on the fixation of the Libido; and at the next a reproduction of phantasies of the patient’s to which, of course, it is difficult to ascribe any ætiological significance. It is hard to find one’s way here. We may perhaps find our first clue in a discovery of a similar kind, namely, that the meagre childish recollections which people have always, long before analysis, consciously preserved can be falsified in the same way, or at least can contain a generous admixture of truth and falsehood; evidence of error in them is nearly always plainly visible, and so we have at least the reassurance that not the analysis, but the patient in some way, must bear the responsibility for this unexpected disappointment.
After a little reflection we can easily understand what it is that is so bewildering in this matter. It is the depreciation of reality, the neglect of the difference between reality and phantasy; we are tempted to be offended with the patient for taking up our time with invented stories. According to our way of thinking heaven and earth are not farther apart than fiction from reality, and we value the two quite differently. The patient himself, incidentally, takes the same attitude when he is thinking normally. When he brings forward the material that leads us to the wished-for situations (which underlie the symptoms and are formed upon the childhood-experiences), we are certainly in doubt at first whether we have to deal with reality or with phantasies. Decision on this point becomes possible later by means of certain indications, and we are then confronted with the task of making this result known to the patient. This is never accomplished without difficulty.
If we tell him at the outset that he is now about to bring to light the phantasies in which he has shrouded the history of his childhood, just as every race weaves myths about its forgotten early history, we observe to our dissatisfaction that his interest in pursuing the subject further suddenly declines—he also wishes to find out facts and despises what is called “imagination.” But if we leave him to believe until this part of the work has been carried through that we are investigating the real events of his early years, we run the risk of being charged with the mistake later and of being laughed at for our apparent gullibility. It takes him a long time to understand the proposal that phantasy and reality are to be treated alike and that it is to begin with of no account whether the childhood-experiences under consideration belong to the one class or to the other. And yet this is obviously the only correct attitude towards these products of his mind. They have indeed also a kind of reality; it is a fact that the patient has created these phantasies, and for the neurosis this fact is hardly less important than the other—if he had really experienced what they contain. In contrast to _material_ reality these phantasies possess _psychical_ reality, and we gradually come to understand that _in the world of neurosis_ PSYCHICAL REALITY _is the determining factor_.
Among the occurrences which continually recur in the story of a neurotic’s childhood, and seem hardly ever absent, are some of particular significance which I therefore consider worthy of special attention. As models of this type I will enumerate: observation of parental intercourse, seduction by an adult, and the threat of castration. It would be a great mistake to suppose that they never occur in reality; on the contrary, they are often confirmed beyond doubt by the testimony of older relatives. Thus, for example, it is not at all uncommon for a little boy, who is beginning to play with his penis and has not yet learnt that he must conceal such activities, to be threatened by parents or nurses that his member or his offending hand will be cut off. Parents will often admit the fact on being questioned, since they imagine that such intimidation was the right course to take; many people have a clear conscious recollection of this threat, especially if it took place in later childhood. If the mother or some other woman makes the threat she usually shifts the execution of it to someone else, indicating that the father or the doctor will perform the deed.
Text from Project Gutenberg, public domain in the United States.