Freud - Complete Works (700 page)

   I do not believe, therefore, that
Rank’s attempt has solved the problem of the causation of
neurosis; nor do I believe that we can say as yet how much it may
nevertheless have
contributed
to such a solution. If an
investigation into the effects of difficult birth on the
disposition to neurosis should yield negative results, we shall
rate the value of his contribution low. It is to be feared that our
need to find a single, tangible ‘ultimate cause’ of
neurotic illness will remain unsatisfied. The ideal solution, which
medical men no doubt still yearn for, would be to discover some
bacillus which could be isolated and bred in a pure culture and
which, when injected into anyone, would invariably produce the same
illness; or, to put it rather less extravagantly, to demonstrate
the existence of certain chemical substances the administration of
which would bring about or cure particular neuroses. But the
probability of a solution of this kind seems slight.

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   Psycho-analysis leads to less
simple and satisfactory conclusions. What I have to say in this
connection has long been familiar and I have nothing new to add. If
the ego succeeds in protecting itself from a dangerous instinctual
impulse, through, for instance, the process of repression, it has
certainly inhibited and damaged the particular part of the id
concerned; but it has at the same time given it some independence
and has renounced some of its own sovereignty. This is inevitable
from the nature of repression, which is, fundamentally, an attempt
at flight. The repressed is now, as it were, an outlaw; it is
excluded from the great organization of the ego and is subject only
to the laws which govern the realm of the unconscious. If, now, the
danger-situation changes so that the ego has no reason for fending
off a new instinctual impulse analogous to the repressed one, the
consequence of the restriction of the ego which has taken place
will become manifest. The new impulse will run its course under an
automatic influence - or, as I should prefer to say, under the
influence of the compulsion to repeat. It will follow the same path
as the earlier, repressed impulse, as though the danger-situation
that had been overcome still existed. The fixating factor in
repression, then, is the unconscious id’s compulsion to
repeat - a compulsion which in normal circumstances is only done
away with by the freely mobile function of the ego. The ego may
occasionally manage to break down the barriers of repression which
it has itself put up and to recover its influence over the
instinctual impulse and direct the course of the new impulse in
accordance with the changed danger-situation. But in point of fact
the ego very seldom succeeds in doing this: it cannot undo its
repressions. It is possible that the way the struggle will go
depends upon quantitative relations. In some cases one has the
impression that the outcome is an enforced one: the regressive
attraction exerted by the repressed impulse and the strength of the
repression are so great that the new impulse has no choice but to
obey the compulsion to repeat. In other cases we perceive a
contribution from another play of forces: the attraction exerted by
the repressed prototype is reinforced by a repulsion coming from
the direction of difficulties in real life which stand in the way
of any different course that might be taken by the new instinctual
impulse.

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   That this is a correct account of
fixation upon repression and of the retention of danger-situations
that are no longer present-day ones is confirmed by the fact of
analytic therapy - a fact which is modest enough in itself but
which can hardly be overrated from a theoretical point of view.
When, in analysis, we have given the ego assistance which is able
to put it in a position to lift its repressions, it recovers its
power over the repressed id and can allow the instinctual impulses
to run their course as though the old situations of danger no
longer existed. What we can do in this way tallies with what can be
achieved in other fields of medicine; for as a rule our therapy
must be content with bringing about more quickly, more reliably and
with less expenditure of energy than would otherwise be the case
the good result which in favourable circumstances would have
occurred of itself.

   We see from what has been said
that
quantitative–
relations - relations which are not
directly observable but which can only be inferred - are what
determine whether or not old situations of danger shall be
preserved, repressions on the part of the ego maintained and
childhood neuroses find a continuation. Among the factors that play
a part in the causation of neuroses and that have created the
conditions under which the forces of the mind are pitted against
one another, three emerge into prominence: a biological, a
phylogenetic and a purely psychological factor.

   The biological factor is the long
period of time during which the young of the human species is in a
condition of helplessness and dependence. Its intra-uterine
existence seems to be short in comparison with that of most
animals, and it is sent into the world in a less finished state. As
a result, the influence of the real external world upon it is
intensified and an early differentiation between the ego and the id
is promoted. Moreover, the dangers of the external world have a
greater importance for it, so that the value of the object which
can alone protect it against them and take the place of its former
intra-uterine life is enormously enhanced. The biological factor,
then, establishes the earliest situations of danger and creates the
need to be loved which will accompany the child through the rest of
its life.

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   The existence of the second,
phylogenetic, factor, is based only upon inference. We have been
led to assume its existence by a remarkable feature in the
development of the libido. We have found that the sexual life of
man, unlike that of most of the animals nearly related to him, does
not make a steady advance from birth to maturity, but that, after
an early efflorescence up till the fifth year, it undergoes a very
decided interruption; and that it then starts on its course once
more at puberty, taking up again the beginnings broken off in early
childhood. This has led us to suppose that something momentous must
have occurred in the vicissitudes of the human species which has
left behind this interruption in the sexual development of the
individual as a historical precipitate. This factor owes its
pathogenic significance to the fact that the majority of the
instinctual demands of this infantile sexuality are treated by the
ego as dangers and fended off as such, so that the later sexual
impulses of puberty, which in the natural course of things would be
ego-syntonic, run the risk of succumbing to the attraction of their
infantile prototypes and following them into repression. It is here
that we come upon the most direct aetiology of the neuroses. It is
a curious thing that early contact with the demands of sexuality
should have a similar effect on the ego to that produced by
premature contact with the external world.

   The third, psychological, factor
resides in a defect of our mental apparatus which has to do
precisely with its differentiation into an id and an ego, and which
is therefore also attributable ultimately to the influence of the
external world. In view of the dangers of reality, the ego is
obliged to guard against certain instinctual impulses in the id and
to treat them as dangers. But it cannot protect itself from
internal instinctual dangers as effectively as it can from some
piece of reality that is not part of itself. Intimately bound up
with the id as it is, it can only fend off an instinctual danger by
restricting its own organization and by acquiescing in the
formation of symptoms in exchange for having impaired the instinct.
If the rejected instinct renews its attack, the ego is overtaken by
all those difficulties which are known to us as neurotic
ailments.

   Further than this, I believe, our
knowledge of the nature and causes of neurosis has not as yet been
able to go.

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XI

ADDENDA

   In the course of this discussion
various themes have had to be put aside before they had been fully
dealt with. I have brought them together in this chapter so that
they may receive the attention they deserve.

A

MODIFICATIONS OF EARLIER VIEWS

 (
a
)
Resistance and
Anticathexis

   An important element in the
theory of repression is the view that repression is not an event
that occurs once but that it requires a permanent expenditure. If
this expenditure were to cease, the repressed impulse, which is
being fed all the time from its sources, would on the next occasion
flow along the channels from which it had been forced away, and the
repression would either fail in its purpose or would have to be
repeated an indefinite number of times. Thus it is because
instincts are continuous in their nature that the ego has to make
its defensive action secure by a permanent expenditure. This action
undertaken to protect repression is observable in analytic
treatment as
resistance
. Resistance presupposes the
existence of what I have called
anticathexis
. An
anticathexis of this kind is clearly seen in obsessional neurosis.
It appears there in the form of an alteration of the ego, as a
reaction-formation in the ego, and is effected by the reinforcement
of the attitude which is the opposite of the instinctual trend that
has to be repressed - as, for instance, in pity, conscientiousness
and cleanliness. These reaction-formations of obsessional neurosis
are essentially exaggerations of the normal traits of character
which develop during the latency period. The presence of an
anticathexis in hysteria is much more difficult to detect, though
theoretically it is equally indispensable. In hysteria, too, a
certain amount of alteration of the ego through reaction-formation
is unmistakable and in some circumstances becomes so marked that it
forces itself on our attention as the principal symptom. The
conflict due to ambivalence, for instance, is resolved in hysteria
by this means. The subject’s hatred of a person whom he loves
is kept down by an exaggerated amount of tenderness for him and
apprehensiveness about him. But the difference between
reaction-formations in obsessional neurosis and in hysteria is that
in the latter they do not have the universality of a
character-trait but are confined to particular relationships. A
hysterical woman, for instance, may be specially affectionate with
her own children whom at bottom she hates; but she will not on that
account be more loving in general than other women or even more
affectionate to other children. The reaction-formation of hysteria
clings tenaciously to a particular object and never spreads over
into a general disposition of the ego, whereas what is
characteristic of obsessional neurosis is precisely a
spreading-over of this kind - a loosening of relations to the
object and a facilitation of displacement in the choice of
object.

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   There is another kind of
anticathexis, however, which seems more suited to the peculiar
character of hysteria. A repressed instinctual impulse can be
activated (newly cathected) from two directions: from within,
through reinforcement from its internal sources of excitation, and
from without, through the perception of an object that it desires.
The hysterical anticathexis is mainly directed outwards, against
dangerous perceptions. It takes the form of a special kind of
vigilance which, by means of restrictions of the ego, causes
situations to be avoided that would entail such perceptions, or, if
they do occur, manages to withdraw the subject’s attention
from them. Some French analysts, in particular Laforgue, have
recently given this action of hysteria the special name of
‘scotomization’. This technique of anticathexis is
still more noticeable in the phobias, whose interest is
concentrated on removing the subject ever further from the
possibility of the occurrence of the feared perception. The fact
that anticathexis has an opposite direction in hysteria and the
phobias from what it has in obsessional neurosis - though the
distinction is not an absolute one - seems to be significant. It
suggests that there is an intimate connection between repression
and external anticathexis on the one hand and between regression
and internal anticathexis (i.e. alteration in the ego through
reaction-formation) on the other. The task of defence against a
dangerous perception is, incidentally, common to all neuroses.
Various commands and prohibitions in obsessional neurosis have the
same end in view.

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   We showed on an earlier occasion
that the resistance that has to be overcome in analysis proceeds
from the ego, which clings to its anticathexes. It is hard for the
ego to direct its attention to perceptions and ideas which it has
up till now made a rule of avoiding, or to acknowledge as belonging
to itself impulses that are the complete opposite of those which it
knows as its own. Our fight against resistance in analysis is based
upon this view of the facts. If the resistance is itself
unconscious, as so often happens owing to its connection with the
repressed material, we make it conscious. If it is conscious, or
when it has become conscious, we bring forward logical arguments
against it; we promise the ego rewards and advantages if it will
give up its resistance. There can be no doubt or mistake about the
existence of this resistance on the part of the ego. But we have to
ask ourselves whether it covers the whole state of affairs in
analysis. For we find that even after the ego has decided to
relinquish its resistances it still has difficulty in undoing the
repressions; and we have called the period of strenuous effort
which follows after its praiseworthy decision, the phase of
‘working-through’. The dynamic factor which makes a
working-through of this kind necessary and comprehensible is not
far to seek. It must be that after the ego’s resistance has
been removed the power of the compulsion to repeat - the attraction
exerted by the unconscious prototype upon the repressed instinctual
process - has still to be overcome. There is nothing to be said
against describing this factor as the
resistance of the
unconscious
. There is no need to be discouraged by these
emendations. They are to be welcomed if they add something to our
knowledge, and they are no disgrace to us so long as they enrich
rather than invalidate our earlier views - by limiting some
statement, perhaps, that was too general or by enlarging some idea
that was too narrowly formulated.