COLUMBIA LIBRARIES OFFSITE HEALTH SCIENCES STANDARD HX00031232 r« ^d^^ 2±S_ Columbia ©nitiersittp intfteCtlpuflrtogork CoIIese of ${)2>sictan£t anb ^urstonii Xibrarp Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/definitionhistorOOpfis DEFINITION AND HISTORY OF PSYCHOANALYSIS BY DR. OSKAR PFISTER Pastor and Seminary Teacher in Zurich AND FREUD'S THEORIES OF THE NEUROSES BY DR. EDUARD HITSCHMANN MOFFAT, YARD & COMPANY PUBLISHERS— NEW YORK CoPYRieHT, 1916, BY MOFFAT, YARD & COMPANY Reprinted from "The Peychoanalytic Method," by Dr. Oskar Pfleter Reprinted from "Theories of the Neuroses," by Dr. Ednard Hitschmann o CM ' CHAPTER I DEFINITION AND HISTORY OF PSYCHOANALYSIS Psychoanalysis, as its name denotes, concerns itself with the separation of mental processes into their constituent ele- ments. We might, indeed, conjure up all kinds of harm if we did not at once warn against considering this provisional state- ment as an exact definition. There has been analysis of psychic phenomena since prehis- toric times. The psychologist- who separates the contents of consciousness into its constituent parts and traces them back to their causes, the historian of art who seeks the origin of an important creation, the biographer who is engrossed in the de-- velopment of his hero, the physician who attempts to elucidate the compelling motives of a melancholia, the educator who en- deavors to understand the mental condition of his pupil, in short, everyone who is intent upon penetrating the mental life of others would be, according to the statement heading our train of thought, a psychoanalyst. In reality, not a few repre- sentatives of ancient traditions, in view of the results of the successfully advancing movement which bears the distinctive name, pride themselves that they have already done psycho- analysis for decades. They would be quite right if the meaning of the word was derived by merely splitting it into its parts. The name has, however, gained its content by an historical process, to over- look which would create a fatal confusion. In order to escape the annoying cobwebs and arrive at the correct definition, we have to present in detail how the originator of the name and the very special procedure connoted by the same, reached his theory and technique. We shall see that the criterion of psychoanalysis lies in a special kind of inquiry into the uncon- 1 g THE PSYCHOANALYTIC METHOD scious mental processes which powerfully influence the con- scious life. In the year 1893, Sigmund Freud * published, in collabora- tion with his colleague, Josef Breuer, an epoch-making article entitled "Concerning the Psychic IMechanism of Hysterical Phenomena'* ("tjber den psj^hischen ]\Iechanismus hys- terischer Phanomene"). In order to understand the funda- mental ideas of this short but important work, it is advisable to investigate its connection with the father of the hysteria investigation, J. M. Charcot of Paris (1893). The celebrated director of the Salpetriere was the first person to free hys- terical individuals from the stigma of ridiculousness, earnestly to study and systematically to arrange their sj^mptoms, in doing which, he was also able to demonstrate hysteria in the male sex. Especially important was his discovery, made by researchers on hj'pnotized patients, that the hysterical paraly- ses which appear after severe emotional shock, the socalled traumatic t paralyses, arise from ideas which control the per- sons in moments of special dispositions. The motor disturb- ances may be produced % in hypnosis and even in suggestion. These results at first exercised no effect on therapeutic methods. Charcot remained true to phj^sical and chemical procedures. He advised pressing on the ovarian region at short intervals, under certain circumstances for hours, in order to lessen the severity of the convulsive attacks or indeed to dis- sipate II them. To overcome an hysterical epileptical con- dition, he ordered ether or amyl nitrite.li One of his pupils, Pierre Janet, cured a case of complicated traumatic hysteria by taking the patient in the hypnotic state back to the time when the shock was received and suggesting * Sigmund Freud, born ^lay 6, 185(5, in Freiberg, Moravia, Austria, is to-day Professor of Neurology in tlie University of Vienna. t From '"trauma," wound, thus about: caused by injury. t Sigmund Freud, Sammlung kleiner Schriften zur Neurosenlehre I, p. 12. !| J. M. Charcot, Legons sur les maladies du systeme nerveux, 5tli ed., Paris, Vol. I (1884), pp. 339, 400. HP. 401 f. CHARCOT AND JANET S that the shock was harmless. We will quote the account of this instructive process for the reader 's perusal : ]\Iarie, a girl of nineteen years, suffered upon her admission to the institution from periodic convulsions and deliria. Be- fore the beginning of her menstrual periods, her character changed, she became gloomy and violent and had pains in all her limbs together with nervous disturbances. Barely twenty hours after the onset of the flow, the menstruation would sud- denly cease, a severe chill would shake her whole body and a severe pain slowly ascend from body to throat and the great hysterical crises begin. The violent convulsions were soon succeeded by deliria. Now, the patient uttered cries of terror, meanwhile talking constantly of blood and fire and fleeing to escape the flames, now she played like a child, spoke with her mother and climbed on the stove or furniture. Delirium and convulsions alternated with short intermissions for forty-eight hours. After repeated vomiting of blood, the normal con- dition gradually returned. Between these major monthly at- tacks, Marie had minor muscular contractures, various chang- ing anesthesias (entire loss of sensation) and in particular, complete and constant blindness of the left eye. For seven months the disease resisted all medical pro- cedures. Especially did suggestive measures regarding the menstruation have only bad effects and increased the deliria. The hj^pnotic investigation yielded the following: At the age of thirteen, about twenty hours after the onset of the first menstruation, Marie, impelled by false shame, secretly took a cold bath, by which the flow was suddenly interrupted. At the same time there appeared severe chills and delirium lasting for days. When, after five years, the menstrual periods re- turned, they brought the above described condition with them. Thus, the patient repeated the bath scene monthly without knowing it. The cure did not succeed by the mere hypnotic removal of the fixed idea. Only when the patient in hypnosis had been taken back to the age of thirteen, could the conviction be awakened that the menstrual period would normally come to 4 THE PSYCHOANALYTIC METHOD an end in a course of three days. Immediately, no further periodic disturbances were to be seen in the patient. The cries of terror were explained by the circumstance that ]\Iarie, when sixteen years old, saw an old woman killed by a fall from the stairs. AVith considerable trouble, the girl was shown in artificial sleep that the old woman only stumbled and had not died. The cries ceased from that moment. ]\Iost difficult was the explanation of the hysterical blind- ness. Finally, it was discovered that ]\Iarie, when six years old, had been compelled one day in spite of her outcries, to sleep with a child of similar age which had scrofula on the whole left side of its face. Soon after, ]\Iarie developed the same trouble on the same place. When the scrofula disap- peared, it left behind anesthesia of the left half of the face and blindness of the left eye. Again the girl was taken back to the time of the first shock. The physician pictured the pretty comrade entirely free from scrofula. At the second repetition of the scene, the now convinced patient caressed the imaginary child and upon awakening could see perfectly normally.* The method applied by Pierre Janet, although recognized t by Delboeuf and Binet as an effective means of treatment, was not considered a regular method nor established theoret- ically. An accidental discovery, the enormous importance of which its fortunate discoverer himself did not sufficiently appreciate, opened up new paths. In the years 1880-82 the Vieitna physician. Dr. Josef Breuer, was engaged with a famous patientj The girl, aged twenty-one, suffered from severe hysteria, the most important symptom of which consisted of paralysis and anesthesia of the limbs on the right (less often left) side of the body, of squinting, cough and other physical troubles. The walls seemed to be falling on the patient. Two sharply differentiated mental conditions could be noted : * Pierre Janet, L'automatisme psychologique, Paris, 1889, pp. 436- 440. t Freud, Sammlung kleiner Schrifton I, p. 18, 1900. t Breuer & Freud, Studien iiber Hysteria. Leipzig & Vienna, Deu- ticke, 189.5, 2d ed., 1909. BREUER AND FREUD 5 One, almost Jiormal, which was distinguished only by sadness and another, abnormal condition of extreme excitement which was often accompanied by hallucinations. The power of speech disappeared and for two weeks the patient was dumb. One day when she was sitting on her father's bed, she saw a snake which would bite her. In the attempt to ward off the reptile, she noticed that the fingers of her hand changed into snakes with death's heads. From fear, she attempted to pray but could recall only an English child's prayer. From that hour, without noticing it, she spoke only English and no longer understood her mother tongue. In unconsciousness, she murmured some words. When one of these words was kept before her, she phantasied an episode from which she received a certain ease of mind. A year after the death of her father, the two conditions changed so that the patient lived as a normal person in the present but repeated from day to day, in the abnormal state, the events of the preceding year, as the mother could substantiate from a diary she kept. Though this clinical history already affords enough of striking nature, another particularly important circumstance was added. When Breuer had dictated to the hysterical patient in hypnosis what she had whispered in her unconscious state (absence), she gave an account of the whole phantasy from which those words came. It showed that the scattered words were like the flag appearing above a wall, behind which was marching a body of troops bearing it. If the events which had caused the symptom could be successfully drawn out, then the cessation of the pathological phenomenon followed the oral description. For example, the fear of water, the girl traced back to the impression that a dirty little dog had drunk from a glass without her being able to raise any objection. After this memory, the aversion to the drinking of water dis- appeared. The squint and exaggeration of visual objects went back to the circumstance that the girl with tears in her eyes, had brought the clock close to her face in order to tell the time. When the whole story of suffering had been traced back to its 6 THE PSYCHOANALYTIC METHOD causes, her health had also completely and permanently re- turned. From these and similar phenomena, Breuer and Freud, who urged his colleague to publish the material which he had been gathering for more than a decade, drew the following con- clusions: Very many of the hysterical symptoms are occa- sioned by an idea which occurs to the patient with strong affect at a time of sleepiness (166). In case the latter is not conducted along normal mental association paths and, as you might say, distributed, it jumps to abnormal physical and mental paths and produces the hysterical phenomenon. Thus, the h3^sterical individual suffers, as we may say, in great part, from reminiscences. The cure is eft'ected by bringing that reminiscence accompanied by its suitable excitement into consciousness and then allowing it to fade away normally. To put it differently, the pent-up affect is brought into con- sciousness and carried out in speech or removed by medical suggestion; it ''is abreacted." Since Breuer's intelligent patient gave the name of "chimney-sweeping" ("Kamin- fegen") to the talking treatment, which had been tried on her, her fortunate discoverer called the method the "cathartic method" (from KaOaipuv to purify). Its differentiation from that of Janet's lies in the fact that a bit of the patient's past, which is lost to his memory, namely the occasion of the disease, is rendered conscious, and on the other hand, the intentional bringing at the same time of a suggested idea standing in con- tradiction to the pathological idea, is given up. AVe again call attention to the fact that hypnosis and abreaction, the speaking out of a forgotten but affectful traumatic happening which has hurt the mind, now brought back to consciousness, constitute the essential features of the cathartic method. Breuer and Freud presented the views thus gained in a short preliminary publication * and again in the book, ''Studies in Hysteria" ("Studien liber Ilysterie" t) which * Breuer & Freud, tJber den psychischen ^Mechanismus hysterisclier Pliiinomcnc. XiMirolofr. Zentralhlatt, 1803, Xos. 1 & 2. t lA-ijizi*; and Vienna, Deuticke, 2d ed., 1909. (The citations refer to tlie latter edition.) BREUER AND FREUD 7 appeared in 1895. This important work contains in Freud's contributions the fundamental ideas which led to the psycho- analytic method. We will mention the most important: Many hysterical symptoms, for example visions, express sym- bolically ideas which may be found below the threshold of consciousness (51, 157ff.). This idea was once conscious but on account of its painful character, was repressed (99, 145, 235) ; some of its parts, however, still break through into ordinary consciousness (57). All hysteria rests on such re- pression (250) . The content of the repressed idea is of sexual nature (224) and various analogous causes must be present to produce the symptom (63, 229). Hypnosis* can be dis- pensed with (92f.) but the resistance which the patient pre- sents against the repressed ideas being brought into con- sciousness must be overcome by strong pressure (234f.). Al- ready, Freud ventures on the interpretation of dreams, with- out, however, recognizing the importance of these in the treat- ment of hysterical troubles (57). Impressions of earliest childhood are already given attention (115). Also that phe- nomenon to which Freud later, when he had lost faith in the omnipotence of abreaction, ascribed the determining influence in the healing process, the socalled "transference," is in good part outlined. Of this, Freud knew that the patient trans- ferred upon the physician some of the painful ideas emerging from the unconscious during the analysis (266f.), thus, for example, the wish cherished for a kiss from another man would be changed to a similar wish toward the physician. Mit- tenzwey is greatly in error when he believes that Freud's progress beyond Breuer's ideas at this epoch consists merely in the extension of the method to all the neuroses, in the introduction of the term "defence" ("Abwehr") and the exclusively sexual causation of the neuroses, f One peculiarity of the Freudian method may now be * Authors like Forel and Frank (Die Psychanalyse (1909), Munich, Reinhardt) who speak well of psychoanalysis but cling to hypnosis, are adherents of the "cathartic" but not of the psychoanalytic conception. t K. Mittenzwey, Versuch zu einer Darstellung und Kritik der Freud- schen Neurosenlehre. Zeitschrift fiir Pathopsychologie I (1912), p. 413. 8 THE PSYCHOANALYTIC METHOD pointed out : Freud allows his patient to tell without criticism everything which comes into his head while in the physician's presence. AVhere he observes gaps or striking discrepancies, he directs the apperception directly to these points and has the patient give associations to them. The associations thus col- lected, he submits to a method of interpretation which he has developed from many years of experience ; the independent substantiation of this method, no regular analyst can or will avoid. The essential features of Freud's psychoanalj^sis are, in addition to the abandonment of h3^pnosis, an association and interpretation method. In these sentences, w^e have given the characteristics of the psychoanalytic method. It is now high time to give the reader an answer to a ques- tion which must have gradually aroused his impatience. How does all this concern the educator? Professionally, he has nothing to do with hysterical individuals. I cannot better answer the justifiable interpolation than by continuing with my sketch of the history of the development of psycho- analysis. Freud recognized ever more clearly that the processes which produced nervous disturbances are also of highest influence on the mental life of normal individuals and can be equally well studied in them. Without being unfaithful to the med- ical interest, the Vienna neurologist developed a new kind of psychology which penetrated to the unconscious causes of mental performances. He once defined psychoanah'sis as ''the investigation of the unconscious part of the individual mental life."* For a long time astute judges of human nature had asserted that many of the highest performances of the mind were created, not in the laboratory of conscious thinking, feeling and willing, but in the subterranean cham- bers which had often been denominated as the unconscious. Schiller describes this conception in the familiar lines: "As in the air the storm wind blows. One knows not whence it comes or goes, As the spring gushes forth from hidden depths, * Freud, Das Tabu und die Ambivalcnz, Imago I (1912), p. 220. FREUD'S PSYCHOLOGY 9 So comes the poet's song from within And awakes the power of dim emotions Which wonderfully slumber in the heart." * Again Schiller says; ''The unconscious united with dis- cretion makes the poetic artist." t Also, artistic inspiration, religious experience (James, ''Religious Experience," 443f., 461-467), indeed even philo- sophical speculation (Nietzsche) have long ago been traced back to mental processes lying under the threshold of con- sciousness. Freud's investigations not only substantiate these surmises but also afford the proof that the whole conscious mental life, especially on its affective side, is ruled and directed by such subconscious ("subliminal" from limen, threshold) motives. Freud and his pupils are interested, first of all, in the neuroses (popularly, nervous diseases) and mental diseases in which anatomical anomalies are not demonstrable, the socalled func- tional psychoses, then further, in numerous affairs of nor- mal mental functions which had been partly treated cur- sorily as mj^sterious, partly left unobserved. In 1900, ap- peared Freud's "Traumdeutung" | ("Interpretation of Dreams " J ) , the most comprehensive, perhaps also the most important work of the author. He who would judge it, must certainly overcome his aversion to the mysterious title and his resistance to a not unimportant mental product. Further, he cannot avoid the trouble of working over a number of his own or another 's dreams according to Freud 's formula. Oth- erwise, it is obvious that an acceptable scientific judgment cannot be formed. In 1901, appeared Freud's book, " Psychopathology of Everyday Life" ("Zur Psychopathologie des Alltags"|!) on forgetting, errors in speech, superstition and mistakes. In * Compare my article : Anwendungen der Psyclianalyse in der Padagogik und Seelsorge, Imago I (1912), pp. 55-82. t From 0. Eank, Das Inzestmotiv in Dichtung und Sage, p. 1. t Leipzig and Vienna, Deuticke, 2d ed., 1909, 3rd ed., 1911. Also English translation by Brill of New York. il Berlin, Karger, 2d ed., 1907. 10 THE PSYCHOANALYTIC METHOD this work, the writer seeks to prove that the actions mentioned in the subtitle, as well as many other accidental or apparently meaningless acts, frequently come from unconscious motives and owe their origin to the same mechanism which prevails in the dream, neurosis and functional psychosis. In 1905, fol- lowed an extensive investigation of wit and its relation to the unconscious.* In 1907, Freud considered the foundation of religious psychology in his article, "Obsessional Acts and Religious Practices*' ("Zwangshandlungen und Religionsii- bung" t). The same year, pedagogy received its first atten- tion from a psychoanalyst in the open letter on the "Sexual Enlightenment of Children" ("Zur sexuellen Aufkliirung der Kinder"!). These works were followed in 1908 by the first psychoanalytic treatment of a literary work, entitled, "The Delusion and Dreams in W. Jensen's 'Oradiva' " ("Der Wahn und die Triiume in W. Jensen's Gradiva"||). Psy- chology of children which had already been taken as a field for analytic investigation as early as 1905, in "Three Contribu- tions to the Sexual Theory" ("Drei Abhandlungen zur Sex- ualtheorie") received in 1908 the first work specially devoted to the subject in the article "Concerning Infantile Sexual Theories" ("tjber infantile Sexualtheorien" IF). The views set forth there were substantiated in the "Analysis of the Phobia of a Five Year Old Boy" (''Anah^se der Phobic eines fiinfjahrigen Knaben"§). Into the domain of ethics, Freud entered in 1908 with the essay, "Cultural Sexual Morality and ^Modern Nervousness" ("Die kulturelle Sexualmoral und die moderne Nervositiit" **). The psychology of poetry and art received new elucidation in the article, "Poet and Phantasy" * Leipzig and Vienna, Deuticke. t Kleiner Scliriften IF, 122-131. (Originallj^ in the Zeitschrift fiir Religionspsyoliolofrie, I, Part 1.) {Same, pp. 151-158. II mio. TPp. 150-174. § .Talirl)ncli fiir psyclioanalytisclie und psychopatliologische For- schun^^en, I (1910), pp. l-lOf). ** Ivleine Scliriften, IP, pp. 175-190. BEGINNINGS OF PSYCHOANALYSIS 11 C'Der Dichter uud das Phantasieren" (1908) * and in the monograph "A Childhood Reminiscence of Leonardo da Vinci" ("Eine Kindheitserinnerung des Leonardo da Yinci") (1910). t Finally, in 1910, Freud published glimpses into philology in his short article, "Concerning the Contradictory ^Meanings of Primitive Words" ("tJber den Gegensinn der Urworte")4 For a long time no attention was paid to psychoanalysis. Its results called forth some respectful bows but mostly only a shaking of heads. The first persons to second Freud in scientific publications were C. G. Jung,l| psychiatrist in Zurich and his chief, E. Bleuler,^i Professor of Psychiatry and Director of the Cantonal Institute for the Insane. After these two investigators, in spite of the fiercest hostility, recognized the correctness of Freud 's assertions, the movement which had previously been received in dead silence, soon became discussed in the farthest circles. In the spring of 1908, the adherents of the new psychology assembled in Salzburg and arranged for the publication of a periodical journal as an organ for the propagation of their ideas. As a result there has appeared annually in two impressive half -volumes, the '^Jahrbuch flir psychoanalytische und psychopathologische Forschungen" (Yol. I, Part I, 1909) (Yearbook for Psy choanal 3' tic and Fsy- chopathological Investigations). The series of pamphlets de- voted to applied psychology ("Schriften zur angewandten * Kleine Schriften, II, pp. 107-206. t Schriften zur angewandten Seelenkunde, Part 7. t Jalirbuch, Vol. II, pp. 170-184. jl Jung, Ein Fall von hysteriscliem Stupor bei einer Untersuclmngs- gefangenen. Journal f. Psyehologie und Neurologie, Vol. I, 1002, Die psycliologische Bedeutung des Assoziationsexperimentes, xVreliiv f. Krim- inalantlirop. Vol. 22; p. 145. Exper. Beobaelitungen iiber d. Erinner- ungsvermogen. Zbl. f. Nervenheilk. und Psycliiatrie, Year XXVTII (1005), etc. See the index to the literature in the Jahrbuch, Vol. II, pp. 363-375. li Freudsche Mechanismen in der Symptom atologie von Psychosen. Psychiatr.-neurolog. Wochenschrift 1006. Affektivitnt, Suggestibilitiit, Paranoia. Halle, 1000, contributions in the "Diagnostischen Assozia- tionsstudien" edited bv Junsr. 12 THE PSYCHOANALYTIC METHOD Seelenkunde " * ) edited by Freud is constantly growing. The Congress sitting at Niirmberg in 1909 concluded the for- mation of the International Psychoanalytic Association which soon had sections in Vienna, Zurich, Berlin, New York and ^Munich. For the U. S. and Canada, a general American as- sociation Avas founded. Since the ''Yearbook" could not contain the wealth of scientific material, f two new periodicals appeared: In 1910, the " Zentralblatt fiir Psychoanalyse," a medical monthly for mental problems $ and in 1912, the bi- monthly Imago, a journal for the application of psychoanalysis to the mental sciences.] i Since January, 1913, there has ap- peared the "Internationale Zeitschrift fiir arztliche Psycho- analyse" (published by Heller, Vienna, 18 marks a year; edited by Ferenczi and Rank). In November, 1913, appeared the first number of an Ameri- can quarterly devoted to psychoanalj^sis. This is the Psycho- analytic Review, edited by Drs. William A. White of Washing- ton and Smith Ely Jelliffe of New York City. In the first number of Imago, we find a list of all articles in the field of mental sciences published up to the end of 1911. It names almost two hundred articles from the fields of psychology, sexual-, dream-, everyday-, and child-psychology, pedagogy and theory of morals, characterolog}^, biography, *Up to the end of 1912, thirteen parts: 1. Freud, "Gradiva." 2. Riklin, Wunseherfiillung iind Syrabolik in Miirchen. 3. Juno:, Der Tn- lialt der Psycliose. 4. Abraham, Traum und Mythus. 5. Rank, Dor Mythus von der Geburt des Helden. 6. Sadger, Aus d. Liebesleben Xikohius Lenaus. 7. Freud, Fine Kindheitserinnerung des Leonardo da Vinci. 8. Pfister, Die Frtimmigkeit des Grafen L. v. Zinzendorf, !). Graf, Ricli. Wagner im "Fliogondon TTolliindcr." 10. Jones, Das Problem des Hamlet un der Odipus-Komplex. 11. Abraham, Giovanni Segantini. 12. Storfer, Zur Sonderstellung des Vatermordes. 1.5. Rank, Die Lohengrinsage. 14. Jones, Der Alptraum in s. Beziehung zu gew. Formen d. mittelalterl. Aberglaubens. t V^ol. T, 594 pp., Vol. II, 747 pp., Vol. Ill, 857 pp., Vol. IV, Part 1, 606 pp. X Published by Rergmann, Wiesbaden. 18 Marks per year. Edited by W. Stekel. Suspended publication in 1914. II Hugo Heller, Vienna. 15 Marks per year. Edited by H. Sachs and 0. Rank. SPREAD OF PSYCHOANALYSIS 13 esthetics, mythology, religious-, speech-, social- and criminal- psychology. Among pedagogic journals, two have entered the service of psychoanalysis: at the beginning of 1912, the Berner Semi- narbldtter, journal for school reform, organ of the Swiss Pedagogic Association, issued under the auspices of Dr. Ernst Schneider, Director of the Higher Seminary in Bern, in conjunction with Prof. Dr. Oskar Messmer in Rorschach, Dr. Otto von Greyerz in Glarisegg and the author of this book. Some months later, the " ]\Ionatshef te fiir Padagogik und Schulreform" (Vienna) was won by Alfred Adler for psychoanalysis. The first pedagogues who publicly recognized the im- portance of psychoanalysis were Prof. Adolf Ltithi, who in 1910 in the yearbook of the " Unterrichtswesens in der Sweiz^' (page 197) reviewed in most friendly manner my first peda- gogic articles of psychoanalytic nature, further Prof. Dr. E. Meumann,* Prof. Dr. 0. Messmer, t and Dr. P. Haberlin,t Privatdozent of Philosophy in Basel, who had previously, while Seminary Director of the Thurganischen Lehrerbil- dungsanstalt in Kreuzlingen, extensively practiced the new pedagogic method. Pastors who have entered the literary field in favor of psychoanalysis are A. Waldburger || in Ragaz, the Calvinist, Th. Johner,1[ a conservative theologian, and Adolf Keller in Zurich. Two or three years ago the reproach was hurled at the psychoanalyst that aside from Freud and Bleuler, whose im- portance no one disputed, no university teacher had joined the * Meumann, Pildag. Jahresber. 1910, 63rd Year, Leipzig, p. 134. t Messmer, Die Psychoanalyse u. i. pad. Bedeutung. Berner Semin- arblatter, V, Part 9 (1911). ' t Hilberlin, Sexualgespenster. Sexualprobleme, Vol. VIII, pp. 96- 106 (1912). II Waldburger, Psychanalyt. Seelsorge u. Moralpiidagogik. (Prot. Alonatshefte, XIII (1909), pp. 110-114. A defence of my article which appeared in the same journal.) H Johner, Die Psychoanalyse im bernischen Kant. Pfarrverein. Der Kirchenfreund (Basel), XlIv (1910) No. 24. 14, THE PSYCHOANALYTIC METHOD new school. To-day this criticism, which many consider unen- durable, lias already disappeared. A constantly increasing number of high school teachers, in spite of a threatened boy- cott and much derision, have joined the outlawed psychoan- alj'tic association. The following are analysts: the psychi- atrist of Bern University, Prof, von Speyr, the neurologist of Harvard University, Prof, James J. Putnam, a man of wide experience and great philosophical attainments, further, the professors of psychiatry, Ernest Jones (Toronto), Adolf ]\leyer (Baltimore), August Hoch (New York), Davidson (Toronto), Jelliffe (New York), White (Washington). Among the ps}'- chologists is the first college president to acknowledge Freud, the influential founder of experimental religious psychology, G. Stanley Hall; among investigators of speech, P. C. Prescott, Professor of the History of English Literature in New York and II. Sperber in Upsala ; among the representatives of in- ternal medicine, Prof. R. IMorichau-Beauchant in Poitiers. A large number of other investigators, especially in Germany and Switzerland, accept psychoanalysis in its important points. This rapid spread of a theory which had such a tremendous resistance against it, within a very few years, is nothing short of marvelous. In spite of the large number of publications, it is to be re- gretted that the literary w^ork has not kept pace with the practical and theoretical advance. Very many results espe- cially important for pedagogy are scarcely touched upon in psy- choanalytic journals. Of the analytic educational work with pupils, who, without being really ill, still because of inner in- hibitions, make themselves and their families unhappy, there is almost no mention anywhere. How the hitherto unobserved impressions of childhood control the whole later development of the normal individual, even to the peculiarity of his style, his choice of a vocation and of a wife, as well as the most insig- nificant subordinate affairs, finds too little discussion. The enormous loss of love for fellowmen and of power for work which many individuals suffer, mostly without knowing it, as a result of unfavorable educational influences, have not, up to APPLICATION OF PSYCHOANALYSIS 15 the present time, been given their proper weight in the litera- ture. I gave a few examples of this in my article, "Applica- tions of Psychoanalysis in Pedagogy and Pastoral Care" ("Anwendungen der Psychoanalyse in der Piidagogik und Seclsorge" *). I described cases of nntruthfulness, klepto- mania, tormenting of animals, destructive rage, aversion to work, dislike of certain foods, meaningless gestures, portentous corporal punishment, withholding of sexual enlightenment, eccentric gaits, pathological hate, hysterical physical defects as a pedagogic problem, creation of hobgoblins out of the uncon- scious in choice of a husband or wife, unhappy marriages as result of psychic traumata of youth, religious abnormalities from similar causes. From these experiences chosen at ran- dom, I drew the conclusion; Countless numbers of persons who bring heart-breaking grief to their parents and other people and cannot help bringing it because they are under neurotic obsessions, can by the aid of analysis be changed into agreeable useful individuals. t The proof for the correctness of this as- sertion which ought to have emphasized the difficulty of the analytic work more strongly, I hope to afford in the present book. Corresponding to the external modifications in the psycho- analytic movement, there are internal changes which are nuich too little noticed by those not intimately associated with it. Many a justifiable reproach from the side of its opponents ap- plies to the analysis as once practiced but not to the present method. It is obvious that so new and penetrating a method of investigation was and is subject to errors. That which once appeared to the astonished gaze of the discoverer as evident certainty, discloses here and there to closer observation oihov causal connections. Where from a number of coincident re- sults, a comprehensive prhiciple was derived, later, contradic- tory observations, setting the earlier formula against a new one, may compel a hypothesis embracing both the old and the newest knowledge. This transition is common to all sciences and it * Imago, I, pp. 56-82 (1912). tP. 77. 16 THE PSYCHOANALYTIC METHOD would not be just to forge weapons against the method from, this adaptation to the progress of experience. I am not at all averse to voicing the opinion that psychoanalytic science has very much to learn and will learn from the observation of earnest pedagogues and any critical co-worker who discloses errors and ambiguities will be most welcome. I shall name some of the most important transformations which the analytic theory and technique has undergone since its inception : The theory that the repression of an affectf ul idea into the unconscious was always accomplished by a pain- ful, shocking experience. The shock or trauma theory was given up in favor of the conception that everything is of im- portance, the repression of ideas or phantasies. Where once the emphasis lay on the sexual trauma, the unconscious attach- ment to the parents was found to be the chief cause of the neuroses and of other conditions of dependence on the uncon- scious which influenced life. The sexual theory, previously the greatest stumbling block, underwent a radical change, since, not only the assertion of the causation of every neurosis in a sexual irritation in the ordinary sense, was abandoned, but also, the term sexuality received a great amplification, so that the poorly oriented reader scarcely understands any longer what the analyst means by the word and strikes wrong interpreta- tions. AYhere at that time, one considered the ''abreaction," the affectf ul ''speaking out," as the healing agent, to-day we know that the transference of repressed wishes upon the analyst, forms, at least in severe cases, an indispensable con- dition of the cure. Where in the first period, the analytic attack was directed at the SA'mptom, now, it is, in a certain sense, neglected, in order to turn all attention to the resistance against analyst and analysis. If at first, one aims only at the elimination of the internal conflict, he presently strives for independent adaptation to reality which comes from the over- coming of the internal two-sidedness, the turning of the patient's mental forces toward reality in accordance with the limitations of his personal peculiarities, and thus rounds out the analytic educational work by assisting conservatively self- CRITICISM OF PSYCHOANALYSIS IT education. Freud's fight against the scientifically and ethi- cally reprehensible ' ' wild psychoanalysis, ' ' * which expects cure from promiscuous sexual gratification without regard to scruples or love, has also raised the moral standing of the analysis. By all these modifications, which are due in only the slight- est measure to hostile criticism, almost entirely to psycho- analytic experience, the agreement with traditional views and especially with prevailing pedagogic ideas, has been essentially increased. In 1907, Isserlin explained: ''If we emphasize the disposition somewhat more and deprive the trauma t of the decisive role which it would play in the causation of hysteria, the contending opinions would have come closely together." t We have seen that the original historical and psychological chasm which seemed unabridgable in the beginning, became narrowed also at other points. He who travels in an unknown land, at first notices the new and strange ; only gradually does the ' ' partout comme chez nous ' ' come into its rights. It would now be my task to describe how the critics met and accompanied the forward march of psychoanalysis. To my satisfaction, Bleuler has performed this necessary task in his discerning article, "Die Psychoanalyse Freuds." The battle raged in the most diverse affective states; from perfect neu- trality to furious insult, to boycott, indeed in one instance, even to denunciation before the public, in which scarcely an insinuation was omitted. As a strange cultural curiosity, one example may be mentioned without anger or intent to complain or apply for the martyr's crown. I can mention it with all the greater equanimity since it only reacted in favor of psycho- analysis. On the 15th of December, 1911, a neurologist in Zurich, specialist in electrotherapy, gave a public lecture in * Freud has from the beginning fought against this with all pos- sible vigor, for example, Kl. Schriften I, p. 109 (1895), pp. 137 ff., 199, 230; II, pp. 14, 34. t M. Isserlin tiber Jungs "Psychologie der Dementia praecox und die Anwendung Freudscher Forschungsmaximen in der Psychopatl)ol- ogie." Zentralblatt fiir Nervenheilkunde u. Psychiatric. 1907, p. 341. t Jahrbueh II, pp. 623-730. 18 THE PSYCHOANALYTIC METHOD which he pictured the objectioiiableness and perversity of psychoanalysis. To this end, he drew a caricature which estranged even non-analysts. In order to show what kind of a business an analysis was, he picked out of Freud's ''Frag- ment of Hysteria- Analysis, " that is, from an article intended only for the medical profession, one of the most delicate por- tions and described to the public, among which were many young boys and girls, how Freud discussed coitus. One can imagine the indignation of some, the joy of others. AVhat would that speaker have said if one had pictured orally to a totally unprepared audience containing many very young in- dividuals, in a voice of moral indignation, the things which that physician did to women and girls in his gynecological practice? And in this, it would not be a question of perversions which would be exposed to the phantasy of persons half -developed sexually. The refusal of a public debate by the analytic side led to a violent contest in the daily press, the end result of which was favorable to psychoanalysis in that the denounced literature was really devoured and the rush to the analysts in- creased wherever possible. Since Bleuler's article in defence of psychoanalysis, there has appeared only one important criticism of psychoanalysis : that of Arthur Kronfeld.* In its depth of thought, neutral reserve and repeatedly, indeed, in its honest admiration of Freud, it places all other discussions in the shade. Still, jit is one wnth its pretlecessors in that it does not trouble itself in the least about the fundamental facts underlying psychoanalysis and avoids a priori empiric tests. The hypotheses and theories which Freud and his pupils have' been compelled to believe from the phenomena observed, it puts under the head of "general psychological foundations" and thus stands the whole system on its head. How would a representation of the Wundtian psychology work, which began, say with the principle of the * tjber die psycliolooigclipn Theorion Freiuls und verwandte An- 8chauunf;en," Archiv fiir die gesamte Psycholo<;ie, Vol. XXII (1011), pp. 130-24.S. While this hook was in press, an excellent, anticriticism against Kronfeld hy Gaston Kosenstein appeared (Jahrhuch IV (1013), pp. 741-798). CRITICS 19 aim of heterogony, and from there went backwards but was promptly silent every time Wundt disclosed a psychological fact determined empirically or proposed an experiment? The effect would plainly be similar to that in a cinematographic production if a dramatic scene was produced backwards by reversing the film. All causal connections would be destroyed, the whole would be incomprehensible. So proceeds Kronfeld with the analysis. Also the most everyday observations, for example, the transposition of an affect from one idea to an- other, he denies without going to the trouble of a test. Like all the hostile critics, Kronfeld seems to suffer from a strange fear of the facts, an ''ontophobia." Hence his industry, his learning and his sharpsightedness serve no purpose, the dis- cussion is hopeless though one would gladly meet so chivalrous an opponent. In the following statements, I shall give careful attention to the voices of the critics. Especially shall I consider the expres- sions of Alt, Aschaffenburg, O. Binswanger, Dubois, O. Fischer, F. W. Foerster, Friedlander, Heilbronner, Hoche, Janet, Isserlin, Klien, Kraepelin, Kronfeld, Lehmann, jMendel, j\1o11, Naeke, Oppenheim, Morton Prince, Siemerling, Skliar, Vogt, Wiegandt, Ziehen. I hope that no important argument of these opponents will escape me. The mockers among the op- ponents, I would ask to recall that old sajdng which Goethe gives in his ''Faust": "We are accustomed to men jeering at that which they do not understand." The many other authors who, after proving for themselves, have broken lances in favor of the violently opposed theory, should be considered with the same precision. If the objection be raised that pedagogy ought to wait in silence until the physicians have solved the problem of psycho- analysis, two facts should be remembered : psychoanalysis is also important for normal individuals ; these are of no concern to the physician but of much concern to the educator. Fur- ther, this professional quarrel of the physicians may not be settled for decades ; meanwhile, however, the great new educa- tional problems are waiting and can no longer be put off. The 20 THE PSYCHOANALYTIC METHOD scientifically trained pedagogue is just as good an expert in re- gard to the child 's mind and the influencing of this function as the physician is for the sick child. Therefore, the teacher has a right to his own judgment and the stimulating encourage- ment of Freud as well as all other competent analysts can only strengthen him in his undertaking. From our historical sketch, we may now derive the definition : Psychoanalysis is a scientifically grounded method devoted to neurotic and mentally deranged persons, as w^ell as to normal individuals, w^hich seeks by the collection and interpretation of associations, with the avoidance of suggestion and hypnosis, to investigate and influence the instinctive forces and content of mental life lying below the threshold of consciousness. Whether or not the claims expressed in this definition are justified, we have now to determine. FREUD'S THEORY OF THE NEUROSES CHAPTER I GENERAL THEORY OF THE NEUROSES Freud's Field of Work. General Pathology. Clas- sification of the Neuroses. Course of Development of Freud's Theory of the Neuroses. General Etiology. Role of Sexuality and of Heredity. The Psychosexual Constitution. The Cultural Sexual Morality. Refer- ence to the Therapy. The field of Freud's work comprises the neuroses in the narrower sense as well as certain closely related psychoses, such as paranoia, acute hallucinatory confusion, etc. Formerly, numer- ous clinical pictures were included in the term neuroses from which many have been separated by the progress of the study of the blood-forming organs, for example, Basedow's disease and tetany, w^hile on the other hand, others have been classified as infections, for example, chorea. Thus, the term neuroses has now been limited to neurasthenia, hysteria and the compulsion or 2 FREUD'S THEORY OF THE NEUROSES obsessional neurosis (Zwangsneurose). Accord- ing to Freud's opinion, the neuroses deserve the name sexual-neuroses, since for these clinical pic- tures the chief etiological factors may be proven to lie in the psychosexual sphere. In the field of neurasthenia, the Freudian investigation has yielded a classification of great theoretical im- portance and practical significance. In a classi- cal study,^ Freud has separated from the vague term neurasthenia the "anxiety-neurosis" and further sharply marked off a symptom-complex as real or true neurasthenia. He calls these tv^o clinical pictures true neuroses because their cause lies in the present abnormal condition of the sexual function of the individual and in oppo- sition to these he calls hysteria and the obsessional neurosis, psychoneuroses.^ In these latter, the real causative factors in contrast to those of the true neuroses belong not to the actual sexual life but to a long past period of life in early child- hood. Further, these infantile experiences and impressions ^vhich only later become actively pathogenic turn out to belong without exception to the erotic life which is generally though er- roneously believed to be completely negligible in i"uber die Bercclitigung, von der Neurasthenic einen be- stimmten Symptomenkoniplex als 'Angstneurose' abzutrennen,'* Lit. No. 4. 2 In the following presentation, neurasthenia and hysteria will be used as the best known examples of their kind. GENERAL THEORY OF NEUROSIS 3 the child. Thus in every case of neurosis, a sex- ual etiology was revealed; in neurasthenia, the agencies were of a physical nature, in the psychoneuroses, of an infantile nature. A second essential difference between these two groups of nervous maladies is to be sought in the fact that in the true neuroses the disturbances (symptoms) may find expression in physical or mental mani- festations which seem to be of a toxic nature ; they are similar to the phenomena accompanying an excess or deficiency of certain nerve poisons. These neuroses, formerly grouped mostly under nem^asthenia, can be produced by certain inju- rious influences of the sexual life without any necessary hereditary predisposition; indeed the form of the malady corresponds to the kind of injurious influence so that frequently one can infer the special sexual etiology merely from the clinical picture presented. With the psychoneu- roses on the other hand, the influence of heredity is more important, the original cause less evident. A special method of investigation which will be described later as psycho-analysis has, however, allowed the fact to be recognized that the symp- toms of the disorders (hysteria, obsessional neurosis, etc.) are psychogenic, depending on the activity of unconscious (repressed) idea-com- plexes. This same method has also recognized these complexes and shown them to be universally 4 FREUD'S THEORY OF THE NEUROSES of a sexual erotic content; they arise from the sexual needs of individuals ungratified in the broadest sense of the word and afford them a kind of substitute gratification. Tlie value of the theoretical distinction between the toxic (true) neuroses and the psychogenic neuroses is not diminished by the fact that in most nervous persons disturbances due to both sources may be observed. Such mixed cases are very frequent; thus, the obsessional neurosis is often associated with neurasthenia, anxiety-neu- rosis with hysteria (compare later ^'anxiety- hysteria") . In all these cases, a mixed and com- bined etiology in the sense explained later is found without exception. While it was just now stated that those two great groups of diseases were the original field of Freud's work, it must be emphasized that for about fifteen years Freud has not had opportunity to contiime his investigation of the true neuroses, hence this part of the theory has not experienced a further expansion. The important progress which the comprehension of the nature of the psychoneurotic troubles has made in the mean- time will jjlace their relation to the true neuroses in a somewhat different light and it will probably necessitate a revision in this field in the near fu- ture. The more limited field of Freud's work is constituted by the psychoneurotic forms, espe- GENERAL THEORY OF NEUROSIS 5 cially hysteria and the obsessional neurosis, and it is exceedingly instructive to follow the steps in the development of the nucleus of the Freud- ian doctrine if one wishes to appreciate the full extent and value of his theory of the etiological significance of the psychosexual agencies for the neuroses. As a pupil of Charcot in Paris in 1885-1886, Freud received important incentives to investi- gation.^ Prominent among these was the step by which Charcot surpasssed the level of his orig- inal conception of hysteria and assured himself the fame of being the first to explain this enig- matical malady, a fact of great significance for the further investigations in this field. While Char- cot was engaged in the study of the hysterical paralyses which follow dreams the idea came to him to reproduce these paralyses artificially and to this end he made use of hysterical patients whom he brought into the somnambulistic state by hypnosis. He succeeded in proving that these paralyses may be the result of ideas which have 3 Compare Freud's obituary notice on Charcot, Lit. No. 23. While lecturer in Vienna University, Freud translated into Ger- man the most important works of his French master, J. M. Char- cot, "Poliklinische Vortrage," School-year 1887-88. "Neue Vorlesungen iiber die Krankheiten des Nervensystems, indesondere liber Hysteric." H. Bernheim, "Die Suggestion und ihre Heil- wirkung." "Neue Studien iiber Hypnotismus Suggestion, und Psychotherapie." Collected by the press of F. Deuticke, Vienna and Leipzic. 6 FREUD'S THEORY OF THE NEUROSES gained the mastery of the patient's brain in mo- ments of special disposition. Thus was the mech- anism of an hysterical symptom elucidated for the first time and this incomparably beautiful piece of clinical investigation enabled Charcot's pupil, P. Janet, to pave the way for a deeper penetration into the peculiar psychic processes of hysteria. This example was followed by Breuer and Freud who succeeded in sketching a psychological theory of hysteria in their jointly published ''Studies in Hysteria" ( 1895) . In the years 1880-1882, Breuer had observed a note- worthy case of hysteria which, in so-called hypnoidal states, revealed to the attending phy- sician those psychic-traumatic experiences which had brought about the individual hysterical symptom. Thereby appeared the entirely new and surprising fact that the individual hysterical symptoms disappear when the memory of the event which caused them is successfully brought to clear consciousness, at the same time arousing its accompanying effect and having the patient describe the event in all possible detail and give the effect expression in words. Following this classical observation of Breuer's, as you might say the first psycho-analysis, Freud applied the ca- thartic method to a series of cases with success. Breuer and Freud arrived at conclusions which permitted of bridging the gap between the trau- GENERAL THEORY OF NEUROSIS 7 matic hysteria of Charcot and the general non- traumatic variety. Their conception was that the hysterical symptoms are the continued activ- ities of mental traumas, the accompanying effects of which have heen separated by special conditions from the conscious mental processes and are ac- cordingly in a position to attain an abnormal path to bodily innervation (conversion). The terms "pent-up effect," "conversion,'' "to abre- act" sum up the characteristics of this view. It showed these painful experiences "repressed into the unconscious," the effects of the original idea not abreacted as "pent-up"; only by the complete expression of this idea in words could the patho- genic activity of the old memory be broken. If the requisite conditions for conversion are not at hand in a person, then the idea separated from its effect may remain separated from all associations in consciousness; the emotion thus set free may become attached to other not unbearable ideas and these from this false association become obses- sions in the broader sense of the term (substitu- tion). Hysteria and obsessional neurosis are thus both to be considered as cases of unsuccessful defense. In the further investigation of the psycho- neuroses to which Freud now devoted himself ex- clusively, he found upon a more detailed study of the causative psychic traumas from which the 8 FREUD'S THEORY OF THE NEUROSES hysterical symptoms were supposed to be derived that these original scenes which had appeared to possess etiological importance must sometimes be absolved from being the determining factor and the traumatic force which occasioned the disease. The "traumatic experience" thus lost its supreme importance and Freud found through continued analytic work in the associated memories of the patient that no symptom of an hysteric could arise solely from an actual experience, but that in every case a memory awakened by association of an earlier traumatic experience usually belonging to the time of puberty, which had not at that time caused trouble, cooperated in the causation of the symptom. A furtlier result of this later analytic work was the discovery that from whatever case or whatever symptom one wished to start, he finally came without exception to the field of sexual experience. Herewith was revealed for the first time an etiological condition of an hyster- ical symptom. ^ But experiences recovered with so much trouble, extracted from the mass of old memories, seemingly the final traumatic events, although they had the two characteristics of sexuality and puberty in common, proved themselves to be very disparate and of different value so that further investigation was demanded. It was finally revealed that behind the sexual erotic events of GENERAL THEORY OF NEUROSIS 9 puberty are still more far-reaching experiences of infantile life, which are also of sexual content but of far more uniform kind than the previously revealed scenes occurring at puberty. These in- fantile experiences evince their effect in only the slightest degree at the time when they happen; far more important is the later effect, which finds expression only in later periods of maturity. Since these infantile experiences of sexual con- tent can produce a psychic effect only by the aid of the memory, here is revealed the insight that hysterical symptoms never arise without the co- operation of the memory. Hysterical patients suffer from "reminiscences." At the bottom of every case of hysteria are found one or more events of premature sexual experience which be- long to earliest youth; these may be reproduced in memory by persevering analytic work even after decades have intervened. At that time, these traumatic experiences were erroneously limited to neurotics; it soon became evident, however, that such experiences w^ere often consciously re- membered by individuals who remained perfectly healthy afterwards, hence the specific etiological agent in the causation of the neurotic symptoms could not lie in this circumstance. By a penetrating investigation of the sexual life of the first years of childhood this note- worthy and very instructive error was exposed 10 FREUD'S THEORY OF THE NEUROSES and by a deepened insight into the constitutional factors, overcome. Freud had previously re- vealed in the "Drei Abhandlungen zur Sexual- theorie" ^ the whole polymorj^hous fullness of the normal infantile sexual life with its germs of disease and abnormality. Thereby infantilism of sexuality took the place of the originally over- rated infantile sexual traumas. And as the sex- ual experiences of childhood reported by patients turned out repeatedly to be the products of later- formed phantasies from the eroticism of puberty concerning earlier childhood, the importance of the preponderating erotic phantasy-life for the breaking out of a neurosis came to the fore- ground. When Freud had finally succeeded in analyzing a child-neurosis in state of formation there was revealed the decisive influence of the family constellation on the content and intensity of the child's affections as well as for the later possibilities of development. The nature and degree of the psychic fixation of the growing child on the parents and brothers and sisters, as well as on the related problems of birth and procreation, disclose themselves more and more clearly as the essential nuclear complex of the neuroses. To the formation of a neurosis from this nuclear complex, which is also present in normal indi- 4 Translation by Brill in Monograph Series of Journal of Ner- vous and Mental Disease. GENERAL THEORY OF NEUROSIS 11 viduals, belong in exquisite fashion, besides quan- titative transgressions, a hereditary predisposition which Freud has described in a narrower sense as the psychosexual constitution. In this decisive importance of the instinctive hfe and its psycho- sexually conditioned disharmonies there has been attained a provisional ultimate source for the later formation of the neurosis. When Freud appeared on the scene, heredity constituted the most important presupposition of the neurosis. He could thus with justice ap- ply himself at first to the exciting agencies ; in this connection, he has not overlooked but repeatedly called attention to the fact that besides the a^en- cies in the psychosexual field, the etiology of the neuroses may be conditioned both by inheritance and by a special constitution and that the neu- roses, like all other diseases, have complex causes. Though more recently the theory of an hereditary j)redisposition has undergone a certain abridg- ment, still there is no doubt that there are neuro- pathic families in which an hereditary taint can be clearly traced.^ Freud thus assumes that the he- c Freud has emphatically pointed out more than once that in more than half of his cases of severe hysteria, obsessional neu- rosis, etc., treated by psychotherapy, syphilis in the father before marriage was to be proven. Not that the later neurotic children bore physical signs of hereditary lues but that in these cases the abnormal psycho-sexual constitution could be observed as the last offshoot of luetic inheritance. 12 FREUD'S THEORY OF THE NEUROSES redity finds expression in a peculiar psychosexual constitution of the individual which asserts itself in an abnormally strong and many-sided instinc- tive life and a consequent sexual precocity. This renders difficult the later desirable subjection of the sexual instinct to the higher mental powers, its adaptation to the prevailing cultural demands and strengthens the obsessional character which the psychic representation of this instinct lays claim to. This early and excessive development of the sexual instinct brought about by constitu- tional conditions can only be counteracted by an abnormal amount of efferent repressive effort (sexual repression) ; the psychological analysis shows further how to solve the contradictory mysteriousness of hysteria by the perception of two opposing forces, a too severe sexual absti- nence and an excessive sexual need. The occa- sion for the onset of the disease in the hysterically disposed person arises when, on account of the progressive internal maturing process or of ex-» ternal events, the real sexual demands earnestly assert themselves. Between the compulsion of the instinct and the opposing force of sexual denial, the way is prepared for the malady, which does not solve the conflict but seeks to escape it by changing the libidinous strivings into symp- toms. The manifold varieties and the different possibilities of development of such an abnormal GENERAL THEORY OF NEUROSIS 13 psychosexual constitution Freud has explained in detail in his "Drei Ahhandlungen zur Sexual- theorie." Added to the hereditary and constitu- tional prerequisite conditions of the neurosis, there are many premature sexual experiences and activities which act as agencies favoring its out- break ; the importance of these could have been so long overlooked only because so much more at- tention has been directed to that long past period of the lifetimes of the ancestors, namely heredity, than to that long past period in the history of the individual, namely, early childliood. Freud has done a great service in calling attention to the early seduction of children by other children or adults and the abnormal reaction to these experi- ences as a result of an especial susceptibility to these impressions. "The greatest effect will be produced by the neurosis when constitution and experience combine toward the same end/' An outspoken constitution may be able to escape by the impressions of life, a sufficient shock in life may bring about the neurosis in an average con- stitution." ^ Besides the admitted share of true 6 The admission that there may be such a combination of dif- ferent causes instead of the assertion of one set of causes is a peculiarity of the Freudian theory of the neuroses which never fails to emphasize the variety of causes and in no way conducts itself in a one-sided dogmatic fashion as it is reproached with doing. 7 Lit. No. 20. 14 FREUD'S THEORY OF THE NEUROSES heredity, Freud has revealed a pseudo-heredity in the influence of an environment of nervous peo- ple, namely the nervous parents, and has shown that there is a nearer way than heredity for nerv- ous parents to transmit their disturbances to their children. "It is one of the surest signs of a later neurosis when a child shows itself insatiable in its demands for caresses from the parents and, on the other hand, it is just the neuropathic parents who tend to exhibit unbounded affection and by their fondling predispose the disposition of the child to a neurotic outbreak at the earliest possible moment." ^ Thus upon more careful analysis, what appears to be hereditary transmission re- solves itself into the effect of powerful infantile influences. From a higher point of view, it is observed that our present-day cultural standard of sexual morality, which imposes so many inju- ries and restrictions on a natural life, is an im- portant factor in the causation of nervous dis- eases, especially the true neuroses. Cultural, indeed still more frequently, material agencies often place insurmountable obstacles in the way of a normal sexual life, which is necessary as a protection against neurasthenic and anxiety- neurotic troubles, for in this connection it is found that nothing else is necessary for a cure except the correction of the inadequate sexual gratifica- tion. JNIuch more difficult is the treatment of the GENERAL THEORY OF NEUROSIS 15 psychoneuroses ; for the healing of these a very comphcated ps^^chological technique has been perfected, which will be explained later; in cer- tain particulars this is still undergoing deepen- ing and refinement. 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