Chapter XI: Part 11

A lady of nearly thirty years of age suffered from very severe obsessional symptoms. I might perhaps have been able to help her if my work had not been destroyed by the caprice of fate—perhaps I shall tell you about it later. In the course of a day she would perform the following peculiar obsessive act, among others, several times over. She would run out of her room into the adjoining one, there take up a certain position at the table in the centre of the room, ring for her maid, give her a trivial order or send her away without, and then run back again. There was certainly nothing very dreadful about this, but it might well arouse curiosity. The explanation presented itself in the simplest and most unexceptionable manner, without any assistance on the part of the analyst. I cannot imagine how I could even have suspected the meaning of this obsession or could possibly have suggested an interpretation for it. Every time I had asked the patient, “Why do you do this? What is the meaning of it?” she had answered, “I don’t know.” But one day, after I had succeeded in overcoming a great hesitation on her part, involving a matter of principle, she suddenly did know, for she related the history of the obsessive act. More than ten years previously she had married a man very much older than herself, who had proved impotent on the wedding-night. Innumerable times on that night he had run out of his room into hers in order to make the attempt, but had failed every time. In the morning he had said angrily: “It’s enough to disgrace one in the eyes of the maid who does the beds,” and seizing a bottle of red ink which happened to be at hand he poured it on the sheet, but not exactly in the place where such a mark might have been. At first I did not understand what this recollection could have to do with the obsessive act in question; for I could see no similarity between the two situations, except in the running from one room into the other, and perhaps also in the appearance of the servant on the scene. The patient then led me to the table in the adjoining room, where I found a great mark on the table-cover. She explained further that she stood by the table in such a way that when the maid came in she could not miss seeing this mark. After this, there could no longer be any doubt about the connection between the current obsessive act and the scene of the wedding-night, though there was still a great deal to learn about it.

It was clear, first of all, that the patient identified herself with her husband; in imitating his running from one room into another she acted his part. To keep up the similarity we must assume that she has substituted the table and table-cover for the bed and sheet. This might seem too arbitrary; but then we have not studied dream-symbolism in vain. In dreams a table is very often found to represent a bed. “Bed and board” together mean marriage, so that the one easily stands for the other.

All this would be proof enough that the obsessive act is full of meaning; it _seems_ to be a representation, a repetition of that all-important scene. But we are not bound to stop at this semblance; if we investigate more closely the relation between the two situations we shall probably find out something more, the purpose of the obsessive act. The kernel of it evidently lies in the calling of the maid, to whom she displays the mark, in contrast to her husband’s words: “It’s enough to disgrace one before the servant.” In this way he, whose part she is playing, is _not_ ashamed before the servant, the stain is where it ought to be. We see therefore that she has not simply repeated the scene, she has continued it and corrected it, transformed it into what it ought to have been. This implies something else, too, a correction of the circumstance which made that night so distressing, and which made the red ink necessary: namely, the husband’s impotence. The obsessive act thus says: “No, it is not true, he was not disgraced before the servant, he was not impotent.” As in a dream she represents this wish as fulfilled, in a current obsessive act, which serves the purpose of restoring her husband’s credit after that unfortunate incident.

Everything else which I could tell you about this lady fits in with this, or, more correctly stated, everything else that we know about her points to this interpretation of the obsessive act, in itself so incomprehensible. She had been separated from her husband for years and was trying to make up her mind to divorce him legally. But there would have been no prospect of being free from him in her mind; she forced herself to be true to him. She withdrew from the world and from everyone so that she might not be tempted, and in her phantasies she excused and idealized him. The deepest secret of her illness was that it enabled her to shield him from malicious gossip, to justify her separation from him, and to make a comfortable existence apart from her possible for him. The analysis of a harmless obsessive act thus leads straight to the inmost core of the patient’s disease, and at the same time betrays a great deal of the secret of the obsessional neurosis in general. I am quite willing that you should spend some time over this example, for it unites conditions which cannot reasonably be expected in all cases. The interpretation of the symptom was discovered by the patient herself in a flash, without guidance or interference from the analyst, and it had arisen in connection with an event which did not belong, as it commonly does, to a forgotten period in childhood, but which had occurred in the patient’s adult life and was clear in her memory. All those objections which critics habitually raise against our interpretations of symptoms are quite out of place here. To be sure, we cannot always be so fortunate.

And one thing more! Has it not struck you that this innocent obsessive act leads directly to this lady’s most private affairs? A woman can hardly have anything more intimate to relate than the story of her wedding-night; and is it by chance and without special significance that we are led straight to the innermost secrets of her sexual life? It might certainly be due to the choice I made of this example. Let us not decide this point too quickly; but let us turn to the second example, which is of a totally different nature, and belongs to a very common type, that of rituals preparatory to sleep.

A well-grown clever girl of 19, the only child of her parents, superior to them in education and intellectual activity, was a wild, high-spirited child, but of late years had become very nervous without any apparent cause. She was very irritable, particularly with her mother, was discontented and depressed, inclined to indecision and doubt, finally confessing that she could no longer walk alone through squares and wide streets. We will not go very closely into her complicated condition, which requires at least two diagnoses: agoraphobia and obsessional neurosis; but will turn our attention to the ritual elaborated by this young girl preparatory to going to bed, as a result of which she caused her parents great distress. In a certain sense, every normal person may be said to carry out a ritual before going to sleep, or at least, he requires certain conditions without which he is hindered in going to sleep; the transition from waking life to sleep has been made into a regular formula which is repeated every night in the same manner. But everything that a healthy person requires as a condition of sleep can be rationally explained, and if the external circumstances make any alteration necessary he adapts himself easily to it without waste of time. The morbid ritual on the other hand is inexorable, it will be maintained at the greatest sacrifices; it is disguised, too, under rational motives and appears superficially to differ from the normal only in a certain exaggerated carefulness of execution. On a closer examination, however, it is clear that the disguise is insufficient, that the ritual includes observances which go far beyond what reason can justify and even some which directly contravene this. As the motive of her nightly precautions, our patient declares that she must have silence at night and must exclude all possibility of noise. She does two things for this purpose; she stops the large clock in her room and removes all other clocks out of the room, including even the tiny wrist-watch on her bed-table. Flower-pots and vases are placed carefully together on the writing-table, so that they cannot fall down in the night and break, and so disturb her sleep. She knows that these precautions have only an illusory justification in the demand for quiet; the ticking of the little watch could not be heard, even if it lay on the table by the bed; and we all know that the regular ticking of a pendulum-clock never disturbs sleep, but is more likely to induce it. She also admits that her fear that the flower-pots and vases, if left in their places at night, might fall down of themselves and break is utterly improbable. For some other practices in her ritual this insistence upon silence as a motive is dropped; indeed, by ordaining that the door between her bedroom and that of her parents shall remain half-open (a condition which she ensures by placing various objects in the doorway) she seems, on the contrary, to open the way to sources of noise. The most important observances are concerned with the bed itself, however. The bolster at the head of the bed must not touch the back of the wooden bedstead. The pillow must lie across the bolster exactly in a diagonal position and in no other; she then places her head exactly in the middle of this diamond, lengthways. The eiderdown must be shaken before she puts it over her, so that all the feathers sink to the foot-end; she never fails, however, to press this out and redistribute them all over it again.

I will pass over other trivial details of her ritual; they would teach us nothing new and lead us too far from our purpose. Do not suppose, though, that all this is carried out with perfect smoothness. Everything is accompanied by the anxiety that it has not all been done properly; it must be tested and repeated; her doubts fix first upon one, then another, of the precautions; and the result is that one or two hours elapse before the girl herself can sleep, or lets the intimidated parents sleep.

The analysis of these torments did not proceed so simply as that of the former patient’s obsessive act. I had to offer hints and suggestions of its interpretation which were invariably received by her with a positive denial or with scornful doubt. After this first reaction of rejection, however, there followed a period in which she herself took up the possibilities suggested to her, noted the associations they aroused, produced memories, and established connections until she herself had accepted all the interpretations in working them out for herself. In proportion as she did this she began to relax the performance of her obsessive precautions and before the end of the treatment she had given up the whole ritual. I must also tell you that analytic work, as we conduct it nowadays, definitely excludes any uninterrupted concentration on a single symptom until its meaning becomes fully clear. It is necessary, on the contrary, to abandon a given theme again and again, in the assurance that one will come upon it anew in another context. The interpretation of the symptom, which I am now going to tell you, is therefore a synthesis of the results which, amid the interruptions of work on other points, took weeks and months to procure.

The patient gradually learnt to understand that she banished clocks and watches from her room at night because they were symbols of the female genitals. Clocks, which we know may have other symbolic meanings besides this, acquire this significance of a genital organ by their relation to periodical processes and regular intervals. A woman may be heard to boast that menstruation occurs in her as regularly as clockwork. Now this patient’s special fear was that the ticking of the clocks would disturb her during sleep. The ticking of a clock is comparable to the throbbing of the clitoris in sexual excitation. This sensation, which was distressing to her, had actually on several occasions wakened her from sleep; and now her fear of an erection of the clitoris expressed itself by the imposition of a rule to remove all going clocks and watches far away from her during the night. Flower-pots and vases are, like all receptacles, also symbols of the female genitals. Precautions to prevent them from falling and breaking during the night are therefore not lacking in meaning. We know the very widespread custom of breaking a vessel or a plate on the occasion of a betrothal; everyone present possesses himself of a fragment in symbolic acceptance of the fact that he may no longer put forward any claims to the bride, presumably a custom which arose with monogamy. The patient also contributed a recollection and several associations to this part of her ritual. Once as a child she had fallen while carrying a glass or porcelain vessel, and had cut her finger which had bled badly. As she grew up and learnt the facts about sexual intercourse, she developed the apprehension that on her wedding-night she would not bleed and so would prove not to be a virgin. Her precautions against the vases breaking signified a rejection of the whole complex concerned with virginity and with the question of bleeding during the first act of intercourse; a rejection of the anxiety both that she would bleed and that she would not bleed. These precautions were in fact only remotely connected with the prevention of noise.

One day she divined the central idea of her ritual when she suddenly understood her rule not to let the bolster touch the back of the bed. The bolster had always seemed a woman to her, she said, and the upright back of the bedstead a man. She wished therefore, by a magic ceremony, as it were, to keep man and woman apart; that is to say, to separate the parents and prevent intercourse from occurring. Years before the institution of her ritual, she had attempted to achieve this end by a more direct method. She had simulated fear, or had exploited a tendency to fear, so that the door between her bedroom and that of her parents should not be closed. This regulation was still actually included in her present ritual; in this way she managed to make it possible to overhear her parents; a proceeding which at one time had caused her months of sleeplessness. Not content with disturbing her parents in this way, she at that time even succeeded occasionally in sleeping between the father and mother in their bed. “Bolster” and “bedstead” were then really prevented from coming together. As she finally grew too big to be comfortable in the same bed with the parents, she achieved the same thing by consciously simulating fear and getting her mother to change places with her and to give up to her her place by the father. This incident was undoubtedly the starting-point of phantasies, the effect of which was evident in the ritual.

If the bolster was a woman, then the shaking of the eiderdown till all the feathers were at the bottom, making a protuberance there, also had a meaning. It meant impregnating a woman; she did not neglect, though, to obliterate the pregnancy again, for she had for years been terrified that intercourse between her parents might result in another child and present her with a rival. On the other hand, if the large bolster meant the mother then the small pillow could only represent the daughter. Why had this pillow to be placed diamond-wise upon the bolster and her head be laid exactly in its middle lengthways? She was easily reminded that a diamond is repeatedly used in drawings on walls to signify the open female genitals. The part of the man (the father) she thus played herself and replaced the male organ by her own head. (Cf. Symbolism of beheading for castration.)

Horrible thoughts, you will say, to run in the mind of a virgin girl. I admit that; but do not forget that I have not invented these ideas, only exposed them. A ritual of this kind before sleep is also peculiar enough, and you cannot deny the correspondence, revealed by the interpretation, between the ceremonies and the phantasies. It is more important to me, however, that you should notice that the ritual was the outcome, not of one single phantasy, but of several together which of course must have had a nodal point somewhere. Note, too, that the details of the ritual reflect the sexual wishes both positively and negatively, and serve in part as expressions of them, in part as defences against them.

It would be possible to obtain much more out of the analysis of this ritual by bringing it into its place in connection with the patient’s other symptoms. But that is not our purpose at the moment. You must be content with a reference to an erotic attachment to the father, originating very early in childhood, which had enslaved this girl. It was perhaps for this reason that she was so unfriendly towards her mother. Also we cannot overlook the fact that the analysis of this symptom has again led to the patient’s sexual life. The more insight we gain into the meaning and purpose of neurotic symptoms, the less surprising will this seem.

From two selected examples I have now shown you that neurotic symptoms have meaning, like errors and like dreams, and that they are closely connected with the events of the patient’s life. Can I expect you to believe this exceptionally significant statement on the strength of two examples? No. But can you expect me to go on quoting examples to you until you declare yourselves convinced? Again, no; for in view of the explicit treatment given to each individual case I should have to devote five hours a week for a whole term to the consideration of this one point in the theory of the neuroses. I will content myself therefore with the samples given, as evidence of my statement; and will refer you for more to the literature on the subject, to the classical interpretation of symptoms in Breuer’s first case (hysteria), to the striking elucidations of very obscure symptoms in dementia præcox, so-called, made by C. G. Jung at a time when this investigator was a mere psycho-analyst and did not yet aspire to be a prophet, and to all the subsequent contributions with which our periodicals have been filled since then. Precisely this type of investigation is plentiful. Analysis, interpretation, and translation of neurotic symptoms has proved so attractive to psycho-analysts that in comparison they have temporarily neglected the other problems of the neuroses.

Anyone of you who makes the necessary effort to look up this question will certainly be strongly impressed by the wealth of evidential material. But he will also meet with a difficulty. The meaning of a symptom lies, as we have seen, in its connection with the life of the patient. The more individually the symptom has been formed, the more clearly may we expect to establish this connection. Then the task resolves itself specifically into a discovery, for every nonsensical idea and every useless action, of the past situation in which the idea was justified and the action served a useful purpose. The obsessive act of the patient who ran to the table and rang for the maid is a perfect model of this kind of symptom. But symptoms of quite a different type are very frequently seen. They are what we call _typical_ symptoms of a disease, in each case they are practically identical, the individual differences in them vanish or at least fade away, so that it is difficult to connect them with the patient’s life or to relate them to special situations in his past. Let us consider the obsessional neurosis again. The second patient’s ceremonies preparatory to sleep are in many ways quite typical, although showing enough individual features as well to make an “historical” interpretation, so to speak, possible. But all obsessional patients are given to repetitions, to isolating certain of their actions and to rhythmic performances. Most of them wash too much. Those patients who suffer from agoraphobia (topophobia, fear of space), no longer reckoned as an obsessional neurosis but now classified as anxiety-hysteria, reproduce the same features of the pathological picture often with fatiguing monotony. They fear enclosed spaces, wide, open squares, long stretches of road, and avenues; they feel protected if accompanied, or if a vehicle drives behind them, and so on. Nevertheless, on this groundwork of similarity the various patients construct individual conditions of their own, moods, one might call them, which directly contrast with other cases. One fears narrow streets only, another wide streets only, one can walk only when few people are about, others only when surrounded with people. Similarly in hysteria, beside the wealth of individual features there are always plenty of common typical symptoms which appear to resist an easy interpretation on historical lines. Do not let us forget that it is these typical symptoms which enable us to take our bearings in forming a diagnosis. Supposing we do trace back a typical symptom in a case of hysteria to an experience or to a chain of similar experiences (for instance, an hysterical vomiting to a series of impressions of a disgusting nature), it will be confusing to discover in another case of vomiting an entirely dissimilar series of apparently causative experiences. It almost looks as though hysterical patients must vomit, for some unknown reason, and as though the historical factors revealed by analysis were but pretexts, seized upon by an inner necessity, when opportunity offered, to serve its purpose.

This brings us to the discouraging conclusion that although individual forms of neurotic symptoms can certainly be satisfactorily explained by their relation to the patient’s experiences, yet our science fails us for the far more frequent typical symptoms in the same cases. In addition to this, I have not nearly explained to you all the difficulties that arise during a resolute pursuit of the historical meaning of a symptom. Nor shall I do so; for although my intention is to conceal nothing from you and to gloss over nothing, I do not need to confuse you and stupefy you at the outset of our studies together. It is true that our understanding of symptom-interpretation has only just begun, but we will hold fast to the knowledge gained and proceed to overcome step by step the difficulties of the unknown. I will try to cheer you with the thought that it is hardly possible to presume a fundamental difference between the one kind of symptom and the other. If the individual form of symptom is so unmistakably connected with the patient’s experiences, it is possible that the typical symptom relates to an experience which is itself typical and common to all humanity. Other regularly recurring features of a neurosis, such as the repetition and doubt of the obsessional neurosis, may be universal reactions which the patient is compelled to exaggerate by the nature of the morbid change. In short, there is no reason to give up hastily in despair; let us see what more we can find out.

There is a very similar difficulty met with in the theory of dreams, one which I could not deal with in the course of our previous discussions of dreams. The manifest content of dreams is multifarious and highly differentiated individually, and we have shown exhaustively what can be obtained by analysis from this content. But there are also dreams which may in the same way be called _typical_ and occur in everybody, dreams with an identical content, which present the same difficulties to analysis. These are the dreams of falling, flying, floating, swimming, of being hindered, of being naked, and certain other anxiety-dreams; which yield first this, then that, interpretation, according to the person concerned, without any explanation of their monotonous and typical recurrence. But we notice that in these dreams also the common groundwork is embroidered with additions of an individually varying character. Most probably they too will prove to fit in with other knowledge about the dream-life, gained from a study of other kinds of dreams—not by any forcible twist, but by a gradual widening of our comprehension of these things.

EIGHTEENTH LECTURE
FIXATION UPON TRAUMATA: THE UNCONSCIOUS

I said last time that we would take, as a starting-point for further work, the knowledge we have gained already, and not the doubts which it has roused in us. We have not yet even begun to discuss two of the most interesting conclusions arising from the analysis of the two examples.

First: both the patients give the impression that they are “_fixed_” to a particular point in their past, that they do not know how to release themselves from it, and are consequently alienated from both present and future. They are marooned in their illness, as it were; just as in former times people used to withdraw to the cloister to live out their unhappy fate there. In the case of the first patient, it was the marriage to the husband, which in reality had long ago come to an end, that had settled this doom upon her. Her symptoms enabled her to continue her relationship with him; we could perceive in them the voices which pleaded for him, excused him, exalted him, lamented his loss. Although she is young and could attract other men, she has seized upon every possible real and imaginary (magical) precaution that will preserve her fidelity to him. She will not meet strangers, she neglects her appearance; moreover, she cannot readily rise from any chair which she sits upon, and she refuses to sign her name and can give no presents, because no one must have anything which is hers.

With the second patient, the young girl, it is the erotic attachment to the father established in the years before puberty that plays this part in her life. She also has herself perceived that she cannot marry as long as she is so ill. We may suspect that she became so ill in order to be unable to marry and so to remain with her father.

We cannot avoid asking the question how, by what means, and impelled by what motives, anyone can take up such an extraordinary and unprofitable attitude towards life. Provided, that is, that this attitude is a universal character of neurosis and is not a special peculiarity of these two patients. As a matter of fact, this is so; it is a universal trait common to every neurosis, and one of great practical significance. Breuer’s first hysterical patient was _fixated_, in the same way, to the time when her father was seriously ill and she nursed him. In spite of her recovery, she has remained to some extent cut off from life since that time; for although she has remained healthy and active, she did not take up the normal career of a woman. In every one of our patients we learn through analysis that the symptoms and their effects have set the sufferer back into some past period of his life. In the majority of cases it is actually a very early phase of the life-history which has been thus selected, a period in childhood, even, absurd as it may sound, the period of existence as a suckling infant.

The closest analogy to this behaviour in our nervous patients is provided by the forms of illness recently made so common by the war—the so-called _traumatic neuroses_. Of course similar cases had occurred before the war, after railway accidents and other terrifying experiences involving danger to life. The traumatic neuroses are not fundamentally the same as those which occur spontaneously, which we investigate analytically and are accustomed to treat; neither have we been successful so far in correlating them with our views on other subjects; later on I hope to show you where this limitation lies. Yet there is a complete agreement between them on one point which may be emphasized. The traumatic neuroses demonstrate very clearly that a fixation to the moment of the traumatic occurrence lies at their root. These patients regularly reproduce the traumatic situation in their dreams; in cases showing attacks of an hysterical type in which analysis is possible, it appears that the attack constitutes a complete reproduction of this situation. It is as though these persons had not yet been able to deal adequately with the situation, as if this task were still actually before them unaccomplished. We take this attitude of theirs in all seriousness; it points the way to what we may call an _economic_ conception of the mental processes. The term ‘_traumatic_’ has actually no other meaning but this _economic_ one. An experience which we call traumatic is one which within a very short space of time subjects the mind to such a very high increase of stimulation that assimilation or elaboration of it can no longer be effected by normal means, so that lasting disturbances must result in the distribution of the available energy in the mind.

This analogy tempts us also to classify as traumatic those experiences to which our nervous patients seem to be fixated. In this way we should be provided with a simple condition for a neurotic illness; it would be comparable to a traumatic illness and would result from an incapacity to deal with an overpowering affective experience. Indeed, the first formula in which Breuer and I, in 1893–95, reduced our new observations to a theory was expressed very similarly. A case like that of the first patient described, the young woman separated from her husband, fits very well into this description; she had not been able to “get over” the impracticability of her marriage and was still attached to her trauma. But the second case of the young girl who was tied to her father shows us at once that the formula is not comprehensive enough. On the one hand, an infantile adoration of her father by a little girl is such a common experience and so frequently grown out of that the term ‘traumatic’ would lose all its meaning if applied to it; on the other hand, the history of the case shows that this first erotic fixation was gone through by the patient quite harmlessly at the time, to all appearances, and only several years later came to expression in the obsessional neurosis. So we see that there are complications ahead, a considerable variety and number of determining factors in neurosis; but we divine that the traumatic view will not necessarily be abandoned as false, and that it will fit in and have to be co-ordinated properly elsewhere.

Here again we must leave the path we have been following. At the moment it will take us no further, and we have much more to learn before we can find a satisfactory continuation of it. But before leaving the subject of fixation to traumata it should be noted that it is a phenomenon manifested extensively outside the neuroses; every neurosis contains such a fixation, but not every fixation leads to a neurosis, or is necessarily combined with a neurosis, or arises in the course of a neurosis. Grief is a prototype and perfect example of an affective fixation upon something that is past, and, like the neuroses, it also involves a state of complete alienation from the present and the future. But even the lay public distinguishes clearly between grief and neurosis. On the other hand, there are neuroses which may be described as morbid forms of grief.

It does also happen that persons may be brought to a complete standstill in life by a traumatic experience which has shaken the whole structure of their lives to the foundations, so that they give up all interest in the present and the future, and live permanently absorbed in their retrospections; but these unhappy persons do not necessarily become neurotic. Therefore this single feature must not be overestimated as a characteristic of neurosis, however invariable and significant it may be otherwise.

Now let us turn to the second conclusion to be drawn from our analyses; it is one upon which we shall not need to impose any subsequent limitation. With the first patient we have heard of the senseless obsessive act she performed and of the intimate memories she recalled in connection with it; we also considered the relation between the two, and deduced the purpose of the obsessive act from its connection with the memory. But there is one factor which we have entirely neglected, and yet it is one which deserves our fullest attention. As long as the patient continued this performance she did not know that it was in any way connected with the previous experience; the connection between the two things was hidden; she could quite truly answer that she did not know what impulse led her to do it. Then it happened suddenly that, under the influence of the treatment, she found this connection and was able to tell it. But even then she knew nothing of the purpose she had in performing the action, the purpose that was to correct a painful event of the past and to raise the husband she loved in her own estimation. It took a long time and much effort for her to grasp, and admit to me, that such a motive as this alone could have been the driving force behind the obsessive act.

The connection with the scene on the morning after the unhappy bridal-night, and the patient’s own tender feeling for her husband, together, make up what we have called the “meaning” of the obsessive act. But both sides of this meaning were hidden from her, she understood neither the _whence_ nor the _whither_ of her act, as long as she carried it on. Mental processes had been at work in her, therefore, of which the obsessive act was the effect; she was aware in a normal manner of their effect; but nothing of the mental antecedents of this effect had come to the knowledge of her consciousness. She was behaving exactly like a subject under hypnotism whom Bernheim had ordered to open an umbrella in the ward five minutes after he awoke, but who had no idea why he was doing it. This is the kind of occurrence we have in mind when we speak of the existence of _unconscious mental processes_; we may challenge anyone in the world to give a more correctly scientific explanation of this matter, and will then gladly withdraw our inference that unconscious mental processes exist. Until they do, however, we will adhere to this inference and, when anyone objects that in a scientific sense the Unconscious has no reality, that it is a mere makeshift, _une façon de parler_, we must resign ourselves with a shrug to rejecting his statement as incomprehensible. Something unreal, which can nevertheless produce something so real and palpable as an obsessive action!

In the second patient fundamentally the same thing is found. She has instituted a rule that the bolster must not touch the back of the bedstead, and she had to carry out this rule, but she does not know whence it comes, what it means, or to what it owes its strength. Whether she regards it indifferently, or struggles against it, or rages against it, or determines to overcome it, matters not; it will be followed. It must be followed; in vain she asks herself why. It is undeniable that these symptoms of the obsessional neurosis, these ideas and these impulses which arise no man knows where and which oppose such a powerful resistance against all the influences to which an otherwise normal mental life is susceptible, give the impression, even to the patients themselves, of being all-powerful visitants from another world, immortal beings mingling in the whirlpool of mortal things. In these symptoms lies the clearest indication of a special sphere of mental activity cut off from all the rest. They show the way unmistakably to conviction on the question of the unconscious in the mind; and for that very reason clinical psychiatry, which only recognizes a psychology of consciousness, can do nothing with these symptoms except to stigmatize them as signs of a special kind of degeneration. Naturally, the obsessive ideas and impulses are not themselves unconscious, any more than is the performance of the obsessive acts. They would not have become symptoms if they had not penetrated into consciousness. But the mental antecedents of them disclosed by analysis, the connections into which they fit after interpretation, are unconscious, at least until the time when we make the patient conscious of them by the work of the analysis.

Consider now, in addition, that the facts established in these two cases are confirmed in every symptom of every neurotic disease; that always and everywhere the meaning of the symptoms is unknown to the sufferer; that analysis invariably shows that these symptoms are derived from unconscious mental processes which can, however, under various favourable conditions, become conscious. You will then understand that we cannot dispense with the unconscious part of the mind in psycho-analysis, and that we are accustomed to deal with it as with something actual and tangible. Perhaps you will also be able to realize how unfitted all those who only know the Unconscious as a phrase, who have never analysed, never interpreted dreams, or translated neurotic symptoms into their meaning and intention, are to form an opinion on this matter. I will repeat the substance of it again in order to impress it upon you: The fact that it is possible to find meaning in neurotic symptoms by means of analytic interpretation is an irrefutable proof of the existence—or, if you prefer it, of the necessity for assuming the existence—of unconscious mental processes.

But that is not all. Thanks to a second discovery of Breuer’s, for which he alone deserves credit and which seems to me even more far-reaching in its significance than the first, more still has been learnt about the relation between the Unconscious and the symptoms of neurotics. Not merely is the meaning of the symptom invariably unconscious; there exists also a connection of a substitutive nature between the two; the existence of the symptom is only possible by reason of this unconscious activity. You will soon understand what I mean. With Breuer, I maintain the following: Every time we meet with a symptom we may conclude that definite unconscious activities which contain the meaning of the symptom are present in the patient’s mind. Conversely, this meaning must be unconscious before a symptom can arise from it. Symptoms are not produced by conscious processes; as soon as the unconscious processes involved are made conscious the symptom must vanish. You will perceive at once that here is an opening for therapy, a way by which symptoms can be made to disappear. It was by this means that Breuer actually achieved the recovery of his patient, that is, freed her from her symptoms; he found a method of bringing into her consciousness the unconscious processes which contained the meaning of her symptoms and the symptoms vanished.

This discovery of Breuer’s was not the result of any speculation but of a fortunate observation made possible by the co-operation of the patient. Now you must not rack your brains to try and understand this by seeking to compare it with something similar that is already familiar to you; but you must recognize in it a fundamentally new fact, by means of which much else becomes explicable. Allow me therefore to express it again to you in other words.

The symptom is formed as a substitute for something else which remains submerged. Certain mental processes would, under normal conditions, develop until the person became aware of them consciously. This has not happened; and, instead, the symptom has arisen out of these processes which have been interrupted and interfered with in some way and have had to remain unconscious. Thus something in the nature of an exchange has occurred; if we can succeed in reversing this process by our therapy we shall have performed our task of dispersing the symptom.

Breuer’s discovery still remains the foundation of psycho-analytic therapy. The proposition that symptoms vanish when their unconscious antecedents have been made conscious has been borne out by all subsequent research; although the most extraordinary and unexpected complications are met with in attempting to carry this proposition out in practice. Our therapy does its work by transforming something unconscious into something conscious, and only succeeds in its work in so far as it is able to effect this transformation.

Now for a rapid digression, lest you should run the risk of imagining that this therapeutic effect is achieved too easily. According to the conclusions we have reached so far, neurosis would be the result of a kind of ignorance, a not-knowing of mental processes which should be known. This would approach very closely to the well-known Socratic doctrine according to which even vice is the result of ignorance. Now it happens in analysis that an experienced practitioner can usually surmise very easily what those feelings are which have remained unconscious in each individual patient. It should not therefore be a matter of great difficulty to cure the patient by imparting this knowledge to him and so relieving his ignorance. At least, one side of the unconscious meaning of the symptom would be easily dealt with in this way, although it is true that the other side of it, the connection between the symptom and the previous experiences in the patient’s life, can hardly be divined thus; for the analyst does not know what the experiences have been, he has to wait till the patient remembers them and tells him. But one might find a substitute even for this in many cases. One might ask for information about his past life from the friends and relations; they are often in a position to know what events have been of a traumatic nature, perhaps they can even relate some of which the patient is ignorant because they took place at some very early period of childhood. By a combination of these two means it would seem that the pathogenic ignorance of the patients might be overcome in a short time without much trouble.

If only it were so! But we have made discoveries that we were quite unprepared for at first. There is knowing and knowing; they are not always the same thing. There are various kinds of knowing, which psychologically are not by any means of equal value. _Il y a fagots et fagots_, as Molière says. Knowing on the part of the physician is not the same thing as knowing on the part of the patient and does not have the same effect. When the physician conveys his knowledge to the patient by telling him what he knows, it has no effect. No, it would be incorrect to say that. It does not have the effect of dispersing the symptoms; but it has a different one, it sets the analysis in motion, and the first result of this is often an energetic denial. The patient has learned something that he did not know before—the meaning of his symptom—and yet he knows it as little as ever. Thus we discover that there is more than one kind of ignorance. It requires a considerable degree of insight and understanding of psychological matters in order to see in what the difference consists. But the proposition that symptoms vanish with the acquisition of knowledge of their meaning remains true, nevertheless. The necessary condition is that the knowledge must be founded upon an inner change in the patient which can only come about by a mental operation directed to that end. We are here confronted by problems which to us will soon develop into the _dynamics_ of symptom-formation.

Now I must really stop and ask you whether all that I have been saying is not too obscure and complicated? Am I confusing you by so often qualifying and restricting, spinning out trains of thought and then letting them drop? I should be sorry if it were so. But I have a strong dislike of simplification at the expense of truth, I am not averse from giving you a full impression of the many-sidedness and intricacy of the subject, and also I believe that it does no harm to tell you more about each point than you can assimilate at the moment. I know that every listener and every reader arranges what is offered him as suits him in his own mind, shortens it, simplifies it, and extracts from it what he will retain. Within certain limits it is true that the more we begin with the more we shall have at the end. So let me hope that, in spite of the elaboration, you will have grasped the essential substance of my remarks concerning the meaning of symptoms, the Unconscious, and the connection between the two. You have probably understood also that our further efforts will proceed in two directions; first, towards discovering how people become ill, how they come to take up the characteristic neurotic attitude towards life, which is a clinical problem; and secondly, how they develop the morbid symptoms out of the conditions of a neurosis, which remains a problem of mental dynamics. The two problems must somewhere have a point of contact.

I shall not go further into this to-day; but as our time is not yet up I propose to draw your attention to another characteristic of our two analyses; namely, _the memory gaps or amnesias_, again a point which only later will appear in its full significance. You have heard that the task of the psycho-analytic treatment can be summed up in this formula: everything pathogenic in the Unconscious must be transferred into consciousness. Now you will be perhaps astonished to hear that another formula may be substituted for that one: all gaps in the patient’s memory must be filled in, his amnesias removed. It amounts to the same thing; which means that an important connection is to be recognized between the development of the symptoms and the amnesias. If you consider the case of the first patient analysed you will, however, not find this view of amnesia justified; the patient had not forgotten the scene from which the obsessive act is derived; on the contrary, it was vivid in her memory, nor is there any other forgotten factor involved in the formation of her symptom. The situation is quite analogous, although less clear, in the second case, the girl with the obsessional ceremonies. She, too, had not really forgotten her behaviour in former years, the fact that she had insisted upon the open door between her parents’ bedroom and her own, and that she had turned her mother out of her place in the parents’ bed; she remembered it quite clearly, although with hesitation and unwillingness. What is remarkable about it is that the first patient, although she had carried out her obsessive act such a countless number of times, had not _once_ been reminded of its similarity to the scene after the wedding-night, nor did this recollection ever occur to her when she was directly asked to search for the origin of her obsessive act. The same thing is true in the case of the girl, where not merely the ritual, but the situation which gave rise to it, was repeated identically every evening. In neither case was there really an amnesia, a lapse of memory; but a connection, which should have existed intact and have led to the reproduction, the recollection, of the memory, had been broken. This kind of disturbance of memory suffices for the obsessional neurosis; in hysteria it is different. This latter neurosis is usually characterized by amnesias on a grand scale. As a rule the analysis of each single hysterical symptom leads to a whole chain of former impressions, which upon their return may be literally described as having been hitherto forgotten. This chain reaches, on the one hand, back to the earliest years of childhood, so that the hysterical amnesia is seen to be a direct continuation of the infantile amnesia which hides the earliest impressions of our mental life from all of us. On the other hand, we are astonished to find that the most recent experiences of the patient are liable to be forgotten also, and that in particular the provocations which induced the outbreak of the disease or aggravated it are at least partially obliterated, if not entirely wiped out, by amnesia. From the complete picture of any such recent recollection important details have invariably disappeared or been replaced by falsifications. It happens again and again, almost invariably, that not until shortly before the completion of an analysis do certain recollections of recent experiences come to the surface, which had managed to be withheld throughout it and had left noticeable gaps in the context.

These derangements in the capacity to recall memories are, as I have said, characteristic of hysteria, in which disease it also happens even that states occur as symptoms (the hysterical attacks) without necessarily leaving a trace of recollection behind them. Since it is otherwise in the obsessional neurosis, you may infer that these amnesias are part of the psychological character of the hysterical change and are not a universal trait of neurosis in general. The importance of this difference will be diminished by the following consideration. Two things are combined to constitute the meaning of a symptom; its _whence_ and its _whither_ or _why_; that is, the impressions and experiences from which it sprang, and the purpose which it serves. The _whence_ of a symptom is resolved into impressions which have been received from without, which were necessarily at one time conscious, and which may have become unconscious by being forgotten since that time. The _why_ of the symptom, its tendency, is however always an endo-psychic process, which may possibly have been conscious at first, but just as possibly may never have been conscious and may have remained in the Unconscious from its inception. Therefore it is not very important whether the amnesia has also infringed upon the _whence_, the impressions upon which the symptom is supported, as happens in hysteria; the _whither_, the tendency of the symptom, which may have been unconscious from the beginning, is what maintains the symptom’s dependence upon the Unconscious, in the obsessional neurosis no less strictly than in hysteria.

By thus emphasizing the unconscious in mental life we have called forth all the malevolence in humanity in opposition to psycho-analysis. Do not be astonished at this and do not suppose that this opposition relates to the obvious difficulty of conceiving the Unconscious or to the relative inaccessibility of the evidence which supports its existence. I believe it has a deeper source. Humanity has in the course of time had to endure from the hands of science two great outrages upon its naïve self-love. The first was when it realized that our earth was not the centre of the universe, but only a tiny speck in a world-system of a magnitude hardly conceivable; this is associated in our minds with the name of Copernicus, although Alexandrian doctrines taught something very similar. The second was when biological research robbed man of his peculiar privilege of having been specially created, and relegated him to a descent from the animal world, implying an ineradicable animal nature in him: this transvaluation has been accomplished in our own time upon the instigation of Charles Darwin, Wallace, and their predecessors, and not without the most violent opposition from their contemporaries. But man’s craving for grandiosity is now suffering the third and most bitter blow from present-day psychological research which is endeavouring to prove to the “ego” of each one of us that he is not even master in his own house, but that he must remain content with the veriest scraps of information about what is going on unconsciously in his own mind. We psycho-analysts were neither the first nor the only ones to propose to mankind that they should look inward; but it appears to be our lot to advocate it most insistently and to support it by empirical evidence which touches every man closely. This is the kernel of the universal revolt against our science, of the total disregard of academic courtesy in dispute, and the liberation of opposition from all the constraints of impartial logic. And besides this, we have been compelled to disturb the peace of the world in yet another way, as you will soon hear.

NINETEENTH LECTURE
RESISTANCE AND REPRESSION