Freud - Complete Works (49 page)

Studies On Hysteria

251

   In what I have hitherto said the
idea of resistance has forced its way into the foreground. I have
shown how, in the course of our therapeutic work, we have been led
to the view that hysteria originates through the repression of an
incompatible idea from a motive of defence. On this view, the
repressed idea would persist as a memory trace that is weak (has
little intensity), while the affect that is torn from it would be
used for a somatic innervation. (That is, the excitation is
‘converted’.) It would seem, then, that it is precisely
through its repression that the idea becomes the cause of morbid
symptoms - that is to say, becomes pathogenic. A hysteria
exhibiting this psychical mechanism may be given the name
of ‘defence hysteria’.

   Now both of us, Breuer and I,
have repeatedly spoken of two other kinds of hysteria, for which we
have introduced the terms ‘hypnoid hysteria’ and
‘retention hysteria’. It was hypnoid hysteria which was
the first of all to enter our field of study. I could not, indeed,
find a better example of it than Breuer’s first case, which
stands at the head of our case histories. Breuer has put forward
for such cases of hypnoid hysteria a psychical mechanism which is
substantially different from that of defence by conversion. In his
view what happens in hypnoid hysteria is that an idea becomes
pathogenic because it has been received during a special psychical
state and has from the first remained outside the ego. No psychical
force has therefore been required in order to keep it apart from
the ego and no resistance need be aroused if we introduce it into
the ego with the help of mental activity during somnambulism. And
Anna O.’s case history in fact shows no sign of any such
resistance.

   I regard this distinction as so
important that, on the strength of it, I willingly adhere to this
hypothesis of there being a hypnoid hysteria. Strangely enough, I
have never in my own experience met with a genuine hypnoid
hysteria. Any that I took in hand has turned into a defence
hysteria. It is not, indeed, that I have never had to do with
symptoms which demonstrably arose during dissociated states of
consciousness and were obliged for that reason to remain excluded
from the ego. This was sometimes so in my cases as well; but I was
able to show afterwards that the so-called hypnoid state owed its
separation to the fact that in it a psychical group had come into
effect which had previously been split off by defence. In short, I
am unable to suppress a suspicion that somewhere or other the roots
of hypnoid and defence hysteria come together, and that there the
primary factor is defence. But I can say nothing about this.

   My judgement is for the moment
equally uncertain as regards ‘retention hysteria’, in
which the therapeutic work is supposed equally to proceed without
resistance. I had a case which I looked upon as a typical retention
hysteria and I rejoiced in the prospect of an easy and certain
success. But this success did not occur, though the work was in
fact easy. I therefore suspect, though once again subject to all
the reserve which is proper to ignorance, that at the basis of
retention hysteria, too, an element of defence is to be found which
has forced the whole process in the direction of hysteria. It is to
be hoped that fresh observations will soon decide whether I am
running the risk of falling into one-sidedness and error in thus
favouring an extension of the concept of defence to the whole of
hysteria.

Studies On Hysteria

252

   I have dealt so far with the
difficulties and technique of the cathartic method, and I should
like to add a few indications as to the form assumed by an analysis
when this technique is adopted. For me this is a highly interesting
subject, but I cannot expect it to arouse similar interest in
others, who have not yet carried out an analysis of this kind. I
shall, it is true, once more be talking about the technique, but
this time it will be about inherent difficulties for which we
cannot hold the patients responsible and which must be partly the
same in a hypnoid or retention hysteria as in the defence hysterias
which I have before my eyes as a model. I approach this last part
of my exposition with the expectation that the psychical
characteristics which will be revealed in it may one day acquire a
certain value as raw material for the dynamics of ideation.

   The first and most powerful
impression made upon one during such an analysis is certainly that
the pathogenic psychical material which has ostensibly been
forgotten, which is not at the ego’s disposal and which plays
no part in association and memory, nevertheless in some fashion
lies ready to hand and in correct and proper order. It is only a
question of removing the resistances that bar the way to the
material. In other respects this material is known, in the same way
in which we are able to know anything; the correct connections
between the separate ideas and between them and the non-pathogenic
ones, which are frequently remembered, are in existence; they have
been completed at some time and are stored up in the memory. The
pathogenic psychical material appears to be the property of an
intelligence which is not necessarily inferior to that of the
normal ego. The appearance of a second personality is often
presented in the most deceptive manner.

   Whether this impression is
justified, or whether in thinking this we are not dating back to
the period of the illness an arrangement of the psychical material
which in fact was made after recovery - these are questions which I
should prefer not to discuss as yet, and not in these pages. The
observations made during such analyses can in any case be most
conveniently and clearly described if we regard them from the
position that we are able to assume after recovery for the purpose
of surveying the case as a whole.

   As a rule, indeed, the situation
is not as simple as we have represented it in particular cases -
for instance, where there is one symptom only, which has arisen
from one major trauma. We do not usually find a
single
hysterical symptom, but a number of them, partly independent of one
another and partly linked together. We must not expect to meet with
a
single
traumatic memory and a
single
pathogenic
idea as its nucleus; we must be prepared for
successions
of
partial
traumas and
concatenations
of pathogenic
trains of thought. A monosymptomatic traumatic hysteria is, as it
were, an elementary organism, a unicellular creature, as compared
with the complicated structure of such comparatively severe
neuroses as we usually meet with.

Studies On Hysteria

253

   The psychical material in such
cases of hysteria presents itself as a structure in several
dimensions which is stratified in at least three different ways. (I
hope I shall presently be able to justify this pictorial mode of
expression.) To begin with there is a nucleus consisting in
memories of events or trains of thought in which the traumatic
factor has culminated or the pathogenic idea has found its purest
manifestation. Round this nucleus we find what is often an
incredibly profuse amount of other mnemic material which has to be
worked through in the analysis and which is, as we have said,
arranged in a threefold order.

   In the first place there is an
unmistakable linear chronological order which obtains within each
separate theme. As an example of this I will merely quote the
arrangement of the material in Breuer’s analysis of Anna O.
Let us take the theme of becoming deaf, of not hearing. This was
differentiated according to seven sets of determinants, and under
each of these seven headings ten to over a hundred individual
memories were collected in chronological series (
p. 35
). It was as though we were examining
a dossier that had been kept in good order. The analysis of my
patient Emmy von N. contained similar files of memories though they
were not so fully enumerated and described. These files form a
quite general feature of every analysis and their contents always
emerge in a chronological order which is as infallibly trustworthy
as the succession of days of the week or names of the month in a
mentally normal person. They make the work of analysis more
difficult by the peculiarity that, in reproducing the memories,
they reverse the order in which these originated. The freshest and
newest experience in the file appears first, as an outer cover, and
last of all comes the experience with which the series in fact
began.

Studies On Hysteria

254

   I have described such groupings
of similar memories into collections arranged in linear sequences
(like a file of documents, a packet, etc.) as constituting
‘themes’. These themes exhibit a second kind of
arrangement. Each of them is - I can not express it in any other
way - stratified concentrically round the pathogenic nucleus. It is
not hard to say what produces this stratification, what diminishing
or increasing magnitude is the basis of this arrangement. The
contents of each particular stratum are characterized by an equal
degree of resistance, and that degree increases in proportion as
the strata are nearer to the nucleus. Thus there are zones within
which there is all equal degree of modification of consciousness,
and the different themes extend across these zones. The most
peripheral strata contain the memories (or files), which, belonging
to different themes, are easily remembered and have always been
clearly conscious. The deeper we go the more difficult it becomes
for the emerging memories to be recognized, till near the nucleus
we come upon memories which the patient disavows even in
reproducing them.

   It is this peculiarity of the
concentric stratification of the pathogenic psychical material
which, as we shall hear, lends to the course of these analyses
their characteristic features. A third kind of arrangement has
still to be mentioned - the most important, but the one about which
it is least easy to make any general statement. What I have in mind
is an arrangement according to thought-content, the linkage made by
a logical thread which reaches as far as the nucleus and tends to
take an irregular and twisting path, different in every case. This
arrangement has a dynamic character, in contrast to the
morphological one of the two stratifications mentioned previously.
While these two would be represented in a spatial diagram by a
continuous line, curved or straight, the course of the logical
chain would have to be indicated by a broken line which would pass
along the most roundabout paths from the surface to the deepest
layers and back, and yet would in general advance from the
periphery to the central nucleus, touching at every intermediate
halting-place - a line resembling the zig-zag line in the solution
of a Knight’s Move problem, which cuts across the squares in
the diagram of the chess-board.

Studies On Hysteria

255

   I must dwell for a moment longer
on this last simile in order to emphasize a point in which it does
not do justice to the characteristics of the subject of the
comparison. The logical chain corresponds not only to a zig-zag,
twisted line, but rather to a ramifying system of lines and more
particularly to a converging one. It contains nodal points at which
two or more threads meet and thereafter proceed as one; and as a
rule several threads which run independently, or which are
connected at various points by side-paths, debouch into the
nucleus. To put this in other words, it is very remarkable how
often a symptom is determined in several ways, is
‘overdetermined’.

   My attempt to demonstrate the
organization of the pathogenic psychical material will be complete
when I have introduced one more complication. For it can happen
that there is more than one nucleus in the pathogenic material -
if, for instance, we have to analyse a second outbreak of hysteria
which has an aetiology of its own but is nevertheless connected
with a first outbreak of acute hysteria which was got over years
earlier. It is easy to imagine, if this is so, what additions there
must be to the strata and paths of thought in order to establish a
connection between the two pathogenic nuclei.

   I shall now make one or two
further remarks on the picture we have just arrived at of the
organization of the pathogenic material. We have said that this
material behaves like a foreign body, and that the treatment, too,
works like the removal of a foreign body from the living tissue. We
are now in a position to see where this comparison fails. A foreign
body does not enter into any relation with the layers of tissue
that surround it, although it modifies them and necessitates a
reactive inflammation in them. Our pathogenic psychical group, on
the other hand, does not admit of being cleanly extirpated from the
ego. Its external strata pass over in every direction into portions
of the normal ego; and, indeed, they belong to the latter just as
much as to the pathogenic organization. In analysis the boundary
between the two is fixed purely conventionally, now at one point,
now at another, and in some places it cannot be laid down at all.
The interior layers of the pathogenic organization are increasingly
alien to the ego, but once more without there being any visible
boundary at which the pathogenic material begins. In fact the
pathogenic organization does not behave like a foreign body, but
far more like an infiltrate. In this simile the resistance must be
regarded as what is infiltrating. Nor does the treatment consist in
extirpating something - psychotherapy is not able to do this for
the present - but in causing the resistance to melt and in thus
enabling the circulation to make its way into a region that has
hitherto been cut off.