Chapter X: Part 10

The circumstance which calls forth this criticism is essentially related to the effect of displacement, which you have learnt to know as the most powerful instrument in the service of the dream-censorship. With its aid the substitute-formations which we call allusions are created; but these allusions are of a kind not easy to recognize as such; nor is it easy to discover the thought proper by working back from them, for they are connected with it by the most extraordinary and unusual extrinsic associations. But the whole matter throughout concerns things which are meant to be hidden, intended to be concealed: that is exactly the object of the dream-censorship. We must not expect, though, to find something that has been hidden by looking in the very place where it ordinarily belongs. The frontier surveillance authorities nowadays are a good deal more cunning in this respect than the Swiss school authorities; for they are not content with examining portfolios and letter-cases when hunting for documents and plans; but consider the possibility that spies and smugglers may conceal anything compromising about their persons, in places where it is most difficult to detect and where such things certainly do not belong, for example, between the double soles of their boots. If the concealed articles are found there, it is certainly true that they have been “dragged” to light, but they are none the less a very good “find.”

In admitting the possibility that the connection between a latent dream-element and its manifest substitute may appear most remote and extraordinary, sometimes even comical or joking, we are guided by our wide experience of instances in which we did not as a rule find the meaning ourselves. It is often impossible to arrive at such interpretations by our own efforts: no sane person could guess the bridge connecting the two. The dreamer either solves the riddle straightaway by a direct association (_he_ can do it because it is in his mind that the substitute-formation originated); or else he provides so much material that there is no longer any need for special penetration in order to solve it—the solution thrusts itself upon us as inevitable. If the dreamer does not help us in either of these two ways the manifest element in question will remain for ever incomprehensible. Let me give you one more instance of this kind which happened recently. A patient of mine lost her father during the course of the treatment, after which she seized every opportunity to bring him back to life in her dreams. In one of these her father appeared in a certain connection otherwise not applicable and said: “_It is quarter past eleven, it is half past eleven, it is quarter to twelve_.” For the interpretation of this curious detail she could only provide the association that her father was pleased when his older children were punctual at the midday meal. This certainly fitted in with the dream-element, but it threw no light on its origin. The situation which had just been reached in the treatment gave good grounds for the suspicion that a carefully-suppressed critical antagonism to her much loved and honoured father had played a part in this dream. Following out her further associations, apparently quite remote from the dream, she told how she had heard a long discussion of psychological questions on the day before and a relative had said: “Primitive man (_Urmensch_) survives in all of us.” Now a light dawns on us. Here was again a splendid opportunity for her to imagine that her dead father survived, and so in the dream she made him a “clock-man” (_Uhrmensch_), telling the quarters up to the time of the midday meal.

The likeness to a pun in this cannot be ignored, and as a matter of fact it has often happened that a dreamer’s pun has been ascribed to the interpreter; there are yet other examples in which it is not at all easy to decide whether we are dealing with a joke or a dream. But you will remember that the same sort of doubt arose with some slips of the tongue. A man related as a dream that he and his uncle were sitting in the latter’s _auto_ (automobile) and his uncle kissed him. The dreamer himself instantly volunteered the interpretation: it meant “_auto-erotism_” (a term used in our theory of the libido, signifying gratification obtained without any external love-object). Now was this man allowing himself a joke at our expense and pretending that a pun which occurred to him was part of a dream? I do not think so: he really did dream it. But where does this bewildering resemblance between dreams and jokes come from? At one time this question took me somewhat out of my way, for it necessitated my making a thorough investigation into the question of wit itself. This led to the conclusion that wit originates as follows: a preconscious train of thought is for a moment left to a process of unconscious elaboration, from which it emerges in the form of a witticism. While under the influence of the unconscious it is subject to the mechanisms there operative—to condensation and displacement; that is to say, to the same processes as we found at work in the dream-work; and the similarity sometimes found between dreams and wit is to be ascribed to this character common to both. But the unintentional “dream joke” does not amuse us as does an ordinary witticism; a deeper study of wit may show you why this is so. The “dream joke” strikes us as a poor form of wit; it does not make us laugh, it leaves us cold.

Now in this we are following the path of the ancient method of dream-interpretation, which has given us, besides much that is useless, many a valuable example of interpretation upon which we ourselves could not improve. I will tell you a dream of historic importance which is related in slightly different versions by Plutarch and Artemidorus of Daldis, the dreamer being Alexander the Great. When he was laying siege to the city of Tyre, which was putting up an obstinate resistance (B.C. 322), he dreamt one night that he saw a dancing satyr. The dream-interpreter Aristandros, who accompanied the army on its campaigns, interpreted this dream by dividing the word “satyros” into σὰ Τύρος (“Tyre is thine”), and prophesied from this the king’s victory over the city. This interpretation decided Alexander to continue the siege and eventually the city fell. The interpretation, factitious as it seems, was undoubtedly the right one.

3. I can well imagine that you will be especially impressed on being told that even people who have long studied the interpretation of dreams in the course of their work as psycho-analysts have raised objections to our conception of dreams. It would indeed have been exceptional if so excellent an opportunity for new mistakes had been let slip; and so assertions have been made, due to confusion of ideas and based on unjustifiable generalizations, which are hardly less incorrect than the medical conception of dreams. One of these statements you know already: that dreams deal with attempts at adaptation to the situation at the moment and with the solution of future problems; in other words, that they pursue a “prospective tendency” or aim (A. Maeder). We have already demonstrated that this statement rests upon a confusion between dreams and the latent dream-thoughts and ignores the process of dream-work. If those who speak of this “prospective tendency” mean thereby to characterize the unconscious mental activity to which the latent thoughts belong, then, on the one hand, they tell us nothing new and, on the other hand, the description is not exhaustive; for unconscious mental activity occupies itself with many other things besides preparation for the future. There seems to be a much worse confusion behind the assurance that the “death clause” may be found underlying every dream; I am not quite clear what this formula is intended to mean, but I suspect that behind it the dream is confounded with the whole personality of the dreamer.

An unjustifiable generalization, based on a few striking examples, is contained in the statement that every dream admits of two kinds of interpretation: one of the kind we have described, the so-called “psycho-analytic” interpretation, and the other the so-called “anagogic,” which disregards the instinctive tendencies and aims at a representation of the higher mental functions (H. Silberer); there are dreams of this kind, but you will seek in vain to extend this conception to include even a majority of dreams. After all you have heard, the statement that all dreams are to be interpreted bisexually, as a combination of two tendencies which may be called male and female (A. Adler), will seem to you quite incomprehensible. Here again, single dreams of this sort do of course occur and later on you may learn that their structure is similar to that of certain hysterical symptoms. I mention all these discoveries of new general characteristics of dreams in order to warn you against them, or at least to leave you in no doubt about my own opinion of them.

4. At one time the objective value of research into dreams seemed to be discredited by the fact that patients treated analytically appeared to suit the content of their dreams to the favourite theories of their doctors, one class dreaming mainly of sexual impulses, and another of impulses for mastery, others again even of rebirth (W. Stekel). The force of this observation is weakened by the reflection that people dreamed dreams before there was any such thing as psycho-analytic treatment to influence their dreams and that the patients undergoing treatment nowadays also used to dream before they began it. The actual fact in this supposedly new observation is soon shown to be self-evident and of no consequence for the theory of dreams. The residue from the previous day which gives rise to dreams is a residue from the great interests of waking life. If the physician’s words and the stimuli which he gives have become of importance to the patient they then enter into whatever constitutes the residue and can act as mental stimuli for dream-formation, just like other interests of affective value roused on the preceding day which have not subsided; they operate in the same way as bodily stimuli which affect the sleeper during sleep. Like these other factors inciting dreams, the trains of thought roused by the physician can appear in the manifest dream-content or be revealed in the latent thoughts. We know indeed that dreams can be experimentally produced, or, to speak more accurately, a part of the dream-material can be thus introduced into the dream. In influencing his patients thus the analyst plays a part no different from that of an experimenter, like Mourly Void, who placed in certain positions the limbs of the person upon whom he experimented.

We can often influence what a man shall dream _about_, but never _what_ he will dream; for the mechanism of the dream-work and the unconscious dream-wish are inaccessible to external influence of any sort. We realized, when we were considering dreams arising out of bodily stimuli, that in the reaction to the bodily or mental stimuli brought to bear upon the dreamer the peculiarity and independence of dream-life is clearly seen. The criticism I have just discussed which tends to cast a doubt upon the objectivity of dream investigation is again an assertion based upon confounding, this time confounding dreams with—their material.

I wanted to tell you as much as this about the problems of dreams. You will guess that I have passed over a great deal and will have discovered for yourselves that my treatment of nearly every point has necessarily been incomplete; but this is due to the phenomena of dreams being so closely connected with those of the neuroses. Our plan was to study dreams as an introduction to the study of the neuroses and it was certainly a better one than beginning the other way about; but since dreams prepare us for comprehension of the neuroses, so also can a correctly-formed estimate of dreams be acquired only after some knowledge of neurotic manifestations has been gained.

I do not know how you may think about it, but I can assure you that I do not regret having taken up so much of your interest and of the time at our disposal in the consideration of problems connected with dreams. I know no other way by which one can so speedily arrive at conviction of the correctness of those statements by which psycho-analysis stands or falls. It requires strenuous work for many months, and even years, to demonstrate that the symptoms in a case of neurotic illness have a meaning, serve a purpose, and arise from the patient’s experiences in life. On the other hand, a few hours’ effort may be enough to show these things in some dream which at first seemed utterly confused and incomprehensible, and in this way to confirm all the premises upon which psycho-analysis rests—the existence of unconscious mental processes, the special mechanisms which they obey, and the instinctive propelling forces which are expressed by them. And when we remember how far-reaching is the analogy in the structure of dreams to that of neurotic symptoms and, with that, reflect how rapid is the transformation of a dreamer into a wide-awake, reasonable human being, we acquire an assurance that the neuroses too depend only upon an alteration in the balance of the forces at work in mental life.

_PART III_
GENERAL THEORY OF THE NEUROSES

SIXTEENTH LECTURE
PSYCHO-ANALYSIS AND PSYCHIATRY

It pleases me greatly to see you here again to continue our discussions after a year has passed. Last year the subject of my lectures was the application of psycho-analysis to errors and to dreams; I hope this year to lead you to some comprehension of neurotic phenomena which, as you will soon discover, have much in common with both our former subjects. I must tell you before I begin, however, that I cannot concede you the same attitude towards me now as I did last year. Then I endeavoured to make no step without being in agreement with your judgement; I debated a great deal with you, submitted to your objections, in fact, recognized you and your “healthy common-sense” as the deciding factor. That is no longer possible and for a very simple reason. Errors and dreams are phenomena which were familiar to you; one might say you had as much experience of them as I, or could easily have obtained it. The manifestations of neurosis, however, are an unknown region to you; those of you who are not yourselves medical men have no access there except through the accounts I give you; and of what use is the most excellent judgement where there is no knowledge of the subject under debate?

However, do not receive this announcement as though I were going to give these lectures _ex cathedra_ or to demand unconditional acceptance from you. Any such misconception would do me a gross injustice. I do not aim at producing conviction,—my aim is to stimulate enquiry and to destroy prejudices. If owing to ignorance of the subject you are not in a position to adjudicate, then you should neither believe nor reject. You should only listen and allow what I tell you to make its own effect upon you. Convictions are not so easily acquired, or, when they are achieved without much trouble, they soon prove worthless and unstable. No one has a right to conviction on these matters who has not worked at this subject for many years, as I have, and has not himself experienced the same new and astonishing discoveries. Then why these sudden convictions in intellectual matters, lightning conversions, and instantaneous repudiations? Do you not see that the _coup de foudre_, “love at first sight,” proceeds from a very different mental sphere, from the affective one? We do not require even our patients to bring with them any conviction in favour of psycho-analysis or any devotion to it. It would make us suspicious of them. Benevolent scepticism is the attitude in them which we like best. Therefore will you also try to let psycho-analytical conceptions develop quietly in your minds alongside the popular or the psychiatric view, until opportunities arise for them to influence each other and be united into a decisive opinion.

On the other hand, you are not for a moment to suppose that the psycho-analytic point of view which I shall lay before you is a speculative system of ideas. On the contrary, it is the result of experience, being founded either on direct observations or on conclusions drawn from observation. Whether these have been drawn in an adequate or a justifiable manner future advances in science will show; after nearly two and a half decades and now that I am fairly well advanced in years I may say, without boasting, that it was particularly difficult, intense, and all-absorbing work that yielded these observations. I have often had the impression that our opponents were unwilling to consider this source of our statements, as if they looked upon them as ideas derived subjectively which anyone could dispute at his own sweet will. This attitude on the part of my opponents is not quite comprehensible to me. Perhaps it comes from the circumstance that physicians pay so little attention to neurotics and listen so carelessly to what they say that it has become impossible for them to perceive anything in the patients’ communications or to make detailed observations from them. I will take this opportunity of assuring you that in these lectures I shall make few controversial references, least of all to individuals. I have never been able to convince myself of the truth of the saying that “strife is the father of all things.” I think the source of it was the philosophy of the Greek sophists and that it errs, as does the latter, through the over estimation of dialectics. It seems to me, on the contrary, that scientific controversy, so-called, is on the whole quite unfruitful, apart from the fact that it is almost always conducted in a highly personal manner. Until a few years ago I could boast that I had only once been engaged in a regular scientific dispute, and that with one single investigator, Löwenfeld of Munich. The end of it was that we became friends and have remained so to this day. But I did not repeat the experiment for a very long time because I was not certain that the outcome would be the same.

Now you will surely judge that a refusal of this kind to discuss matters publicly points to a high degree of inaccessibility to criticism, to obstinacy, or, in the polite colloquialism of the scientific world, to “pig-headedness.”[43] My reply to you would be that, should you have arrived at a conviction by means of such hard work, you would also thereby derive a certain right to maintain it with some tenacity. Further, on my own behalf, I can say that in the course of my work I have modified my views on important points, changed them or replaced them by others, and have of course in each case published the fact. What has been the result of this frankness? Some people have ignored my corrections of myself altogether and still to-day criticize me in respect of views which no longer mean the same to me. Others positively reproach me for these changes and declare me to be unreliable on that account. No one who changes his views once or twice deserves to be believed, for it is only too likely that he will be mistaken again in his latest assertions; but anyone who sticks to anything he has once said, or refuses to give way upon it easily enough, is obstinate or pig-headed; is it not so? What is to be done in the face of these self-contradictory criticisms except to remain as one is and behave as seems best to one? This is what I decided to do; and I am not deterred from remodelling and improving my theories in accordance with later experience. I have so far found nothing to alter in my fundamental standpoint and I hope this will never be necessary.

So now I have to lay before you the psycho-analytic theory of neurotic manifestations. For this purpose it will be simplest, on account of both the analogy and the contrast, to take an example which links up with the phenomena we have already considered. I will take a ‘symptomatic act’ which I see many people commit in my own consulting-room. The analyst has little to offer to the people who come to a physician’s consulting-room for half-an-hour to recount the lifelong misery of their fate. His deeper comprehension makes it difficult for him to give, as another might, the opinion that there is nothing wrong with them and that they had better take a light course of hydrotherapy. One of our colleagues once replied, with a shrug, when asked how he dealt with consultation patients, that he “fined them so many crowns for ‘wasting the time of the court.’” You will therefore not be surprised to hear that even the busiest psycho-analysts are not much sought after for consultations. I have had the ordinary door between the waiting-room and my consulting-room supplemented by another door and covered with felt. The reason for this is obvious. Now it constantly happens when I admit people from the waiting-room that they omit to close these doors, leaving even both doors open behind them. When I see this happen, I at once, with some stiffness, request him or her to go back and make good the omission, no matter how fine a gentleman he may be nor how many hours she had spent on her toilet. My action gives the impression of being uncalled-for and pedantic; occasionally too I have found myself in the wrong, when the person turned out to be one of those who cannot themselves grasp a door-handle and are glad when those with them avoid it. But in the majority of cases I was right, for anyone who behaves in this way and leaves the door of a physician’s consulting-room open into the waiting-room belongs to the rabble and deserves to be received with coldness. Now don’t allow yourselves to be biassed before you have heard the rest. This omission on the part of a patient occurs only when he has been waiting alone in the outer room and thus leaves an empty room behind him, never when others, strangers to him, have also been waiting there. In the latter case he knows very well that it is to his own interest not to be overheard while he talks to the physician and he never neglects to close both doors carefully.

Occurring in this way, the patient’s omission is neither accidental nor meaningless, and not even unimportant, for it betrays the visitor’s attitude to the physician. He belongs to that large class who seek those in high places, and wish to be dazzled and intimidated. Perhaps he had made enquiries by telephone at what time he would be most likely to gain admittance and had been expecting to find a crowd of applicants in a queue, as if at the grocer’s in war-time. Then he is shown into an empty room which, moreover, is most modestly furnished, and he is dumbfounded. He must somehow make the physician atone for the superfluous respect he had been prepared to show him; and so he omits to close the doors between the waiting- and the consulting-rooms. He intends this to mean: “Pooh! there is no one here and I daresay there won’t be, however long I stay!” He would behave during the interview in an uncivil and supercilious manner, too, if his presumption were not curbed at the outset by a sharp reminder.

In the analysis of this little symptomatic act you find nothing that is not already known to you; namely, the conclusion that it is no accident but has in it motive, meaning, and intention; that it belongs to a mental context which can be specified; and that it provides a small indication of a more important mental process. But above all it implies that the process thus indicated is not known to the consciousness of the person who carries it out; for not one of the patients who left the two doors open would have admitted that he wished to show any depreciation of me by his neglect. Many of them could probably recall a sense of disappointment on entering the empty waiting-room, but the connection between this impression and the succeeding symptomatic act certainly remained outside their consciousness.

Now let us place this little analysis of a symptomatic act by the side of an observation made on a patient. I will choose one which is fresh in my memory, and also because it can be described in comparatively few words. A certain amount of detail is indispensable for any such account.

A young officer, home on short leave of absence, asked me to treat his mother-in-law, who was living in the happiest surroundings and yet was embittering her own and her family’s lives by a nonsensical idea. I found her a well-preserved lady, fifty-three years of age, of a friendly, simple disposition, who gave without hesitation the following account of herself. She is most happily married, and lives in the country with her husband who manages a large factory. She cannot say enough of her husband’s kindness and consideration; theirs had been a love-marriage thirty years ago, since when they had never had a cloud, a quarrel, or a moment’s jealousy. Her two children have both married well, but her husband’s sense of duty keeps him still at work. A year before, an incredible and, to her, incomprehensible thing happened. She received an anonymous letter telling her that her excellent husband was carrying on an intrigue with a young girl, and believed it on the spot—since then her happiness has been destroyed. The details were more or less as follows: she had a housemaid with whom she discussed confidential matters, perhaps rather too freely. This young woman cherished a positively venomous hatred for another girl who had succeeded better in life than herself, although of no better origin. Instead of going into service, the other young woman had had a commercial training, been taken into the factory and, owing to vacancies caused by the absence of staff on service in the field, had been promoted to a good position. She lived in the factory, knew all the gentlemen, and was even addressed as “Miss.” The other one who had been left behind in life was only too ready to accuse her former schoolmate of all possible evil. One day our patient and her housemaid were discussing an elderly gentleman who had visited the house and of whom it was said that he did not live with his wife but kept a mistress. Why, she did not know, but she suddenly said: “I cannot imagine anything more awful than to hear that my husband had a mistress.” The next day she received by post an anonymous letter in disguised handwriting which informed her of the very thing she had just imagined. She concluded—probably correctly—that the letter was the handiwork of her malicious housemaid, for the woman who was named as the mistress of her husband was the very girl who was the object of this housemaid’s hatred. Although she at once saw through the plot and had seen enough of such cowardly accusations in her own surroundings to place little credence in them, our patient was nevertheless prostrated by this letter. She became terribly excited and at once sent for her husband to overwhelm him with reproaches. The husband laughingly denied the accusation and did the best thing he could. He sent for the family physician (who also attended the factory), and he did his best to calm the unhappy lady. The next thing they did was also most reasonable. The housemaid was dismissed, but not the supposed mistress. From that time on the patient claims to have repeatedly brought herself to a calm view of the matter, so that she no longer believes the contents of the letter; but it has never gone very deep nor lasted very long. It was enough to hear the young woman’s name mentioned, or to meet her in the street, for a new attack of suspicion, agony, and reproaches to break out.

This is the clinical picture of this excellent woman’s case. It did not require much experience of psychiatry to perceive that, in contrast to other neurotics, she described her symptoms too mildly—as we say, dissimulated them—and that she had never really overcome her belief in the anonymous letter.

Now what attitude does a psychiatrist take up to such a case? We know already what he would say to the symptomatic act of a patient who does not close the waiting-room doors. He explains it as an accident, without interest psychologically, and no concern of his. But he cannot continue to take up this attitude in regard to the case of the jealous lady. The symptomatic action appears to be unimportant; the symptom calls for notice as a grave matter. Subjectively it involves intense suffering, and objectively it threatens to break up a family; its claim to psychiatric interest is therefore indisputable. First the psychiatrist tries to characterize the symptom by some essential attribute. The idea with which this lady torments herself cannot be called nonsensical in itself; it does happen that elderly husbands contract relationships with young women. But there is something else about it that is nonsensical and incomprehensible. The patient has absolutely no grounds, except the anonymous letter, for supposing that her loving and faithful husband belongs to this category of men, otherwise not so uncommon. She knows that this communication carries no proof, she can explain its origin satisfactorily; she ought therefore to be able to say to herself that she has no grounds for her jealousy and she does even say so, but she suffers just as much as if she regarded her jealousy as well-founded. Ideas of this kind that are inaccessible to logic and the arguments of reality are unanimously described as _delusions_. The good lady suffers therefore, from a _delusion of jealousy_. That is evidently the essential characteristic of the case.

Having established this first point, our psychiatric interest increases. When a delusion cannot be dissipated by the facts of reality, it probably does not spring from reality. Where else then does it spring from? Delusions can have the most various contents; why is the content of it in this case jealousy? What kind of people have delusions, and particularly delusions of jealousy? Now we should like to listen to the psychiatrist, but he leaves us in the lurch here. He considers only one of our questions. He will examine the family history of this woman and will _perhaps_ bring us the answer that the kind of people who suffer from delusions are those in whose families similar or different disorders have occurred repeatedly. In other words, this lady has developed a delusion because she had an hereditary predisposition to do so. That is certainly something; but is it all that we want to know? Is it the sole cause of her disease? Does it satisfy us to assume that it is unimportant, arbitrary, or inexplicable that one kind of delusion should have been developed instead of another? And are we to understand the proposition—that the hereditary predisposition is decisive—also in a negative sense; that is, that no matter what experiences and emotions life had brought her she was destined some time or other to produce a delusion? You will want to know why scientific psychiatry gives no further explanation. And I reply: “Only a rogue gives more than he has.” The psychiatrist knows of no path leading to any further explanation in such a case. He has to content himself with a diagnosis and, in spite of wide experience, with a very uncertain prognosis of its future course.

Now can psycho-analysis do better than this? Yes, certainly I hope to show you that even in such an obscure case as this it is possible to discover something which makes closer comprehension possible. First, I shall ask you to notice this incomprehensible detail; that the anonymous letter on which her delusion is founded was positively provoked by the patient herself, by her saying to the scheming housemaid the day before that nothing could be more awful than to hear that her husband had an intrigue with a young woman. She first put the idea of sending the letter into the servant’s mind by this. So the delusion acquires a certain independence of the letter; it existed beforehand as a fear—or, as a wish?—in her mind. Besides this, the further small indications revealed in the bare two hours of analysis are noteworthy. The patient responded very coldly, it is true, to the request to tell me her further thoughts, ideas, and recollections, after she had finished her story. She declared that nothing came to her mind, she had told me everything; and after two hours the attempt had to be given up, because she announced that she felt quite well already and was certain that the morbid idea would not return. Her saying this was naturally due to resistance and to the fear of further analysis, In these two hours she had let fall some remarks, nevertheless, which made a certain interpretation not only possible but inevitable, and this interpretation threw a sharp light on the origin of the delusion of jealousy. There actually existed in her an infatuation for a young man, for the very son-in-law who had urged her to seek my assistance. Of this infatuation she herself knew nothing or only perhaps very little; in the circumstances of their relationship it was easily possible for it to disguise itself as harmless tenderness on her part. After what we have already learnt it is not difficult to see into the mind of this good woman and excellent mother. Such an infatuation, such a monstrous, impossible thing, could not come into her conscious mind; it persisted, nevertheless, and unconsciously exerted a heavy pressure. Something had to happen, some sort of relief had to be found; and the simplest alleviation lay in that mechanism of displacement which so regularly plays its part in the formation of delusional jealousy. If not merely she, old woman that she was, were in love with a young man, but if only her old husband too were in love with a young mistress, then her torturing conscience would be absolved from the infidelity. The phantasy of her husband’s infidelity was thus a cooling balm on her burning wound. Of her own love she never became conscious; but its reflection in the delusion, which brought such advantages, thus became compulsive, delusional and conscious. All arguments against it could naturally avail nothing; for they were directed only against the reflection, and not against the original to which its strength was due and which lay buried out of reach in the Unconscious.

Let us now piece together the results of this short, obstructed psycho-analytic attempt to understand this case. It is assumed of course that the information acquired was correct, a point which I cannot submit to your judgement here. First of all, the delusion is no longer senseless and incomprehensible; it is sensible, logically motivated, and has its place in connection with an affective experience of the patient’s. Secondly, it has arisen as a necessary reaction to another mental process which has itself been revealed by other indications; and it owes its delusional character, its quality of resisting real and logical objections, to this relation with this other mental process. It is something desired in itself, a kind of consolation. Thirdly, the fact that the delusion is one of jealousy and no other is unmistakably determined by the experience underlying the disease. You will also recognize the two important analogies with the symptomatic act we analysed; namely, the discovery of the sense or intention behind the symptom and the relation of it to something in the given situation which is unconscious.

This does not, of course, answer all the questions arising out of this case. On the contrary, it bristles with further problems, some of which have not yet proved soluble at all, while others cannot be solved owing to the unfavourable circumstances met with in this case. For instance, why does this happily-married lady fall in love with her son-in-law, and why does relief come to her in the form of this kind of reflection, this projection of her own state of mind on to her husband, when other forms of relief were also possible? Do not think that it is idle and uncalled-for to propound these questions. We have already a good deal of material at hand to provide possible answers. The patient had come to that critical time of life which brings a sudden and unwelcome increase of sexual desire to a woman; that may have been sufficient in itself. Or there may have been an additional reason, in that the sexual capacity of her excellent and faithful husband may have been for some years insufficient for the still vigorous woman’s needs. Observation has taught us that it is just such men, whose fidelity is thus a matter of course, who treat their wives with particular tenderness and are unusually considerate of their nervous ailments. Neither is it unimportant, moreover, that the object of this abnormal infatuation should be her daughter’s young husband. A strong erotic attachment to the daughter, with its roots in the individual sexual constitution of the mother, often manages to maintain itself in such a transformation. I may perhaps remind you in this connection that the relation between mother-in-law and son-in-law has from time immemorial been regarded by mankind as a particularly sensitive one, which among primitive races has given rise to very powerful taboos and precautions.[44] On the positive as well as on the negative side it frequently exceeds the limits regarded as desirable in civilized society. Of these three possible factors, whether one of them has been at work in the case before us, or two of them, or whether all three together have taken part, I cannot tell you; though only because the analysis of the case could not be continued beyond the second hour.

I perceive now that I have been speaking entirely of things which you were not yet prepared to understand. I did so in order to carry out the comparison between psychiatry and psycho-analysis. But I may ask you one thing at this point: Have you observed anything in the nature of a contradiction between the two? Psychiatry does not employ the technical methods of psycho-analysis, neglects any consideration of the content of the delusion, and in pointing to heredity gives us but a general and remote ætiology instead of first disclosing the more specific and immediate one. But is any contradiction or opposition contained in this? Is not the one rather a supplement to the other? Is the hereditary factor inconsistent with the importance of experience and would they not both work together most effectively? You will admit that there is nothing essential in the work of psychiatry which could oppose psycho-analytic researches. It is therefore the psychiatrists who oppose it, and not psychiatry itself. Psycho-Analysis stands to psychiatry more or less as histology does to anatomy; in one, the outer forms of organs are studied, in the other, the construction of these out of the tissues and constituent elements. It is not easy to conceive of any contradiction between these two fields of study, in which the work of the one is continued in the other. You know that nowadays anatomy is the basis of the scientific study of medicine; but time was when dissecting human corpses in order to discover the internal structure of the body was as much a matter for severe prohibition as practising psycho-analysis in order to discover the internal workings of the human mind seems to-day to be a matter for condemnation. And, presumably at a not too distant date, we shall have perceived that there can be no psychiatry which is scientifically radical without a thorough knowledge of the deep-seated unconscious processes in mental life.

There may be some of you who perhaps are friendly enough towards psycho-analysis, often attacked as it is, to wish that it would justify itself in another direction also, that is, therapeutically. You know that psychiatric therapy has hitherto been unable to influence delusions. Can psycho-analysis do so perhaps, by reason of its insight into the mechanism of these symptoms? No, I have to tell you that it cannot; for the present, at any rate, it is just as powerless as any other therapy to heal these sufferers. It is true that we can understand what has happened to the patient; but we have no means by which we can make him understand it himself. You have heard that I could not continue the analysis of this delusion beyond the first preliminaries. Would you then maintain that analysis of such cases is undesirable because it remains fruitless? I do not think so. It is our right, yes, and our duty, to pursue our researches without respect to the immediate gain effected. The day will come, where and when we know not, when every little piece of knowledge will be converted into power, and into therapeutic power. Even if psycho-analysis showed itself as unsuccessful with all other forms of nervous and mental diseases as with delusions, it would still remain justified as an irreplaceable instrument of scientific research. It is true that we should not be in a position to practise it; the human material on which we learn lives, and has its own will, and must have its own motives in order to participate in the work; and it would then refuse to do so. I will therefore close my lecture for to-day by telling you that there are large groups of nervous disturbances for which this conversion of our own advance in knowledge into therapeutic power has actually been carried out; and that with these diseases, otherwise so refractory, our measures yield, under certain conditions, results which give place to none in the domain of medical therapy.

SEVENTEENTH LECTURE
THE MEANING OF SYMPTOMS

In the last lecture I explained to you that clinical psychiatry troubles itself little about the actual form of the individual symptom or the content of it; but that psycho-analysis has made this its starting-point, and has ascertained that the symptom itself has a meaning and is connected with experiences in the life of the patient. The meaning of neurotic symptoms was first discovered by J. Breuer in the study and successful cure of a case of hysteria (1880–82), which has since then become famous. It is true that P. Janet independently reached the same result; in fact, priority in publication must be granted to the French investigator, for Breuer did not publish his observations until more than a decade later (1893–95), during the period of our work together. Incidentally, it is of no great importance to us who made the discovery, for you know that every discovery is made more than once, and none is made all at once, nor is success meted out according to deserts. America is not called after Columbus. Before Breuer and Janet, the great psychiatrist Leuret expressed the opinion that even the delusions of the insane would prove to have some meaning, if only we knew how to translate them. I confess that for a long time I was willing to accord Janet very high recognition for his explanation of neurotic symptoms, because he regarded them as expressions of “_idées inconscientes_” possessing the patient’s mind. Since then, however, Janet has taken up an attitude of undue reserve, as if he meant to imply that the Unconscious had been nothing more to him than a manner of speaking, a makeshift, _une façon de parler_, and that he had nothing “real” in mind. Since then I have not understood Janet’s views, but I believe that he has gratuitously deprived himself of great credit.

Neurotic symptoms then, just like errors and dreams, have their meaning and, like these, are related to the life of the person in whom they appear. This is an important matter which I should like to demonstrate to you by some examples. I can merely assert, I cannot prove, that it is so in every case; anyone observing for himself will be convinced of it. For certain reasons though, I shall not take these examples from cases of hysteria, but from another very remarkable form of neurosis, closely allied in origin to the latter, about which I must say a few preliminary words. This, which we call _the obsessional neurosis_, is not so popular as the widely-known _hysteria_; it is, if I may so express myself, not so noisily ostentatious, behaves more as if it were a private affair of the patient’s, dispenses almost entirely with bodily manifestations and creates all its symptoms in the mental sphere. The obsessional neurosis and hysteria are the two forms of neurotic disease upon the study of which psycho-analysis was first built up, and in the treatment of which also our therapy celebrates its triumphs. In the obsessional neurosis, however, that mysterious leap from the mental to the physical is absent, and it has really become more intimately comprehensible and transparent to us through psycho-analytic research than hysteria; we have come to understand that it displays far more markedly certain extreme features of the neurotic constitution.

The obsessional neurosis[45] takes this form: the patient’s mind is occupied with thoughts that do not really interest him, he feels impulses which seem alien to him, and he is impelled to perform actions which not only afford him no pleasure but from which he is powerless to desist. The thoughts (obsessions) may be meaningless in themselves or only of no interest to the patient; they are often absolutely silly; in every case they are the starting-point of a strained concentration of thought which exhausts the patient and to which he yields most unwillingly. Against his will he has to worry and speculate as if it were a matter of life or death to him. The impulses which he perceives within him may seem to be of an equally childish and meaningless character; mostly, however, they consist of something terrifying, such as temptations to commit serious crimes, so that the patient not only repudiates them as alien, but flees from them in horror, and guards himself by prohibitions, precautions, and restrictions against the possibility of carrying them out. As a matter of fact he never, literally not even once, carries these impulses into effect; flight and precautions invariably win. What he does really commit are very harmless, certainly trivial acts—what are termed the obsessive actions—which are mostly repetitions and ceremonial elaborations of ordinary everyday performances, making these common necessary actions—going to bed, washing, dressing, going for walks, etc.—into highly laborious tasks of almost insuperable difficulty. The morbid ideas, impulses, and actions are not by any means combined in the same proportions in individual types and cases of the obsessional neurosis; on the contrary, the rule is that one or another of these manifestations dominates the picture and gives the disease its name; but what is common to all forms of it is unmistakable enough.

This is a mad disease, surely. I don’t think the wildest psychiatric phantasy could have invented anything like it, and if we did not see it every day with our own eyes we could hardly bring ourselves to believe in it. Now do not imagine that you can do anything for such a patient by advising him to distract himself, to pay no attention to these silly ideas, and to do something sensible instead of his nonsensical practices. This is what he would like himself; for he is perfectly aware of his condition, he shares your opinion about his obsessional symptoms, he even volunteers it quite readily. Only he simply cannot help himself; the actions performed in an obsessional condition are supported by a kind of energy which probably has no counterpart in normal mental life. Only one thing is open to him—he can displace and he can exchange; instead of one silly idea he can adopt another of a slightly milder character, from one precaution or prohibition he can proceed to another, instead of one ceremonial rite he can perform another. He can displace his sense of compulsion, but he cannot dispel it. This capacity for displacing all the symptoms, involving radical alteration of their original forms, is a main characteristic of the disease; it is, moreover, striking that in this condition the ‘_opposite-values_’ (_polarities_) pervading mental life appear to be exceptionally sharply differentiated. In addition to compulsions of both positive and negative character, doubt appears in the intellectual sphere, gradually spreading until it gnaws even at what is usually held to be certain. All these things combine to bring about an ever-increasing indecisiveness, loss of energy, and curtailment of freedom; and that although the obsessional neurotic is originally always a person of a very energetic disposition, often highly opinionated, and as a rule intellectually gifted above the average. He has usually attained to an agreeably high standard of ethical development, is over-conscientious, and more than usually correct. You may imagine that it is a sufficiently arduous task to find one’s bearings in this maze of contradictory character-traits and morbid manifestations. At the moment our aim is merely to interpret some symptoms of this disease.

Perhaps in view of our previous discussions you would like to know what present-day psychiatry has to offer concerning the obsessional neurosis; it is but a miserable contribution, however. Psychiatry has given names to the various compulsions; and has nothing more to say about them. It asserts instead that persons exhibiting these symptoms are “degenerate.” That is not much satisfaction to us; it is no more than an estimate of their value, a condemnation instead of an explanation. We are intended, I suppose, to conclude that deterioration from type would naturally produce all kinds of oddities in people. Now, we do believe that people who develop such symptoms must be somewhat different in type from other human beings; but we should like to know whether they are more “degenerate” than other nervous patients, than hysterical or insane people. The characterization is clearly again much too general. One may even doubt whether it is justified at all when one learns that such symptoms occur in men and women of exceptional ability who have left their mark on their generation. Thanks to their own discretion and the untruthfulness of biographers we usually learn very little of an intimate nature about our exemplary great men; but it does happen occasionally that one of them is a fanatic about truth like Émile Zola,[46] and then we hear of the many extraordinary obsessive habits from which he suffered throughout life.

Psychiatry has got out of this difficulty by dubbing these people “_dégénerés superieurs_.” Very well; but psycho-analysis has shown that these extraordinary obsessional symptoms can be removed permanently, like the symptoms of other diseases, and as in other people who are not degenerate. I myself have frequently succeeded in doing so.

I shall only give you two examples of analysis of obsessional symptoms; one is an old one, but I have never found a better; and one is a recent one. I shall limit myself to these two because an account of this kind must be very explicit and go into great detail.