Freud - Complete Works (14 page)

   It
might be thought that these psychical conditions which we have laid
down for neuropaths as distinct from hysterics - namely, ignorance
or deliberate overlooking - would necessarily be more favourable
for the production of a false connection than would be the presence
of a split in consciousness, which, after all, withdraws material
for causal connections from consciousness. The split, however, is
rarely a clear cut one. As a rule, portions of the subconscious
complex of ideas intrude into the subject’s ordinary
consciousness, and it is precisely they that provoke this kind of
disturbance. What is usually perceived consciously, as in the
instances I have quoted above, is the general feeling attached to
the complex - a mood of anxiety, it may be, or of grief; and it is
this feeling that, by a kind of ‘compulsion to
associate’, must have a connection found for it with some
complex of ideas which is present in consciousness. (Compare, too,
the mechanism of obsessional ideas, described in two papers,
1894
a
and 1895
c
.)

   Not
long ago I was able to convince myself of the strength of a
compulsion of this kind towards association from some observations
made in a different field. For several weeks I found myself obliged
to exchange my usual bed for a harder one, in which I had more
numerous or more vivid dreams, or in which, it may be, I was unable
to reach the normal depth of sleep. In the first quarter of an hour
after waking I remembered all the dreams I had had during the
night, and I took the trouble to write them down and try to solve
them. I succeeded in tracing all these dreams back to two factors:
(1) to the necessity for working out any ideas which I had only
dwelt upon cursorily during the day - which had only been touched
upon and not finally dealt with; and (2) to the compulsion to link
together any ideas that might be present in the same state of
consciousness. The senseless and contradictory character of the
dreams could be traced back to the uncontrolled ascendancy of this
latter factor.

   It
is a quite regular thing for the mood attaching to an experience
and the subject-matter of that experience to come into different
relations to the primary consciousness. This was shown in the case
of another patient, Frau Cäcilie M., whom I got to know far
more thoroughly than any of the other patients mentioned in these
studies. I collected from her very numerous and convincing proofs
of the existence of a psychical mechanism of hysterical phenomena
such as I have put forward above. Personal considerations
unfortunately make it impossible for me to give a detailed case
history of this patient, though I shall have occasion to refer to
it from time to time. Frau Cäcilie had latterly been in a
peculiar hysterical state. This state was certainly not a unique
one, though I do not know if it has hitherto been recognized. It
might be called a ‘hysterical psychosis for the payment of
old debts’. The patient had experienced numerous psychical
traumas and had spent many years in a chronic hysteria which was
attended by a great variety of manifestations. The causes of all
these states of hers were unknown to her and everyone else. Her
remarkably well-stocked memory showed the most striking gaps. She
herself complained that it was as though her life was chopped in
pieces. One day an old memory suddenly broke in upon her clear and
tangible and with all the freshness of a new sensation. For nearly
three years after this she once again lived through all the traumas
of her life - long-forgotten, as they seemed to her, and some,
indeed, never remembered at all - accompanied by the acutest
suffering and by the return of all the symptoms she had ever had.
The ‘old debts’ which were thus paid covered a period
of thirty-three years and made it possible to discover the origins,
often very complicated, of all her abnormal states. The only way of
relieving her was to give her an opportunity of talking off under
hypnosis the particular reminiscence which was tormenting her at
the moment, together with all its accompanying load of feelings and
their physical expression. When I was prevented from doing so, so
that she was obliged to say these things to a person in whose
presence she felt embarrassed, it sometimes happened that she would
tell him her story quite calmly and would subsequently, in
hypnosis, produce for me all the tears, all the expressions of
despair, with which she would have wished to accompany her recital.
For a few hours after a purgation of this kind during hypnosis she
used to be quite well and on the spot. After a short interval the
next reminiscence of the series would break its way in. But this
reminiscence would be preceded some hours earlier by the mood which
was proper to it. She would become anxious or irritable or
despairing without ever suspecting that this mood did not belong to
the present moment but to the state to which she would next be
subject. During this transition period she would habitually make a
false connection to which she would obstinately cling until her
next hypnosis. For instance, she once greeted me with the question
: ‘Am I not a worthless person? Is it not a sign of
worthlessness that I said to you what I did yesterday?’ What
she had actually said to me the day before did not in fact seem to
me to justify this damning verdict. After a short discussion, she
clearly recognized this; but her next hypnosis brought to light a
recollection of an occasion, twelve years earlier, which had
aroused severe self-reproaches in her - though, incidentally, she
no longer subscribed to them in the least.

Studies On Hysteria

66

   I then got her to tell me the
history of her pains in the leg. She began in the same way as
yesterday and then went on with a long series of instances of
experiences, alternately distressing and irritating, which she had
had at the same time as her pains in the leg and the effect of
which had each time been to make them worse, even to the point of
her having bilateral paralysis of the legs with loss of sensation
in them. The same was true of the pains in her arm. They too had
come on while she was nursing someone who was ill, at the same time
as the ‘neck-cramps’. Concerning the latter, I only
learnt that they succeeded some curious restless states accompanied
by depression which had been there previously. They consist in an
‘icy grip’ on the back of the neck, together with an
onset of rigidity and a painful coldness in all her extremities, an
incapacity to speak and complete prostration. They last from six to
twelve hours. My attempts to show that this complex of symptoms
represented a recollection failed. I put some questions to her with
a view to discovering whether her brother, while she was nursing
him during his delirium, had ever caught hold of her by the neck;
but she denied this. She said she did not know where these attacks
came from.¹

  
¹
On subsequent reflection, I cannot help
thinking that these ‘neck cramps’ may have been
determined organically and have been analogous to migraine. In
medical practice we come across a number of conditions of this kind
which have not been described. These show such a striking
resemblance to the classical attack of hemicrania that we are
tempted to extend the concept of the latter and to attach only
secondary importance to the localization of the pain. As we know,
many neuropathic women very often have hysterical attacks (spasms
and deliria) along with an attack of migraine. Every time I
observed a ‘neck-cramp’ in Frau Emmy it was accompanied
by an attack of delirium.

   As
regards the pains in her arm and leg, I am of opinion that what we
have here is the not very interesting and correspondingly common
case of determination by chance coincidence. She had pains of this
kind while she was in an agitated state nursing her sick brother;
and, owing to her exhaustion, she felt them more acutely than
usual. These pains, which were originally associated only
accidentally with those experiences, were later repeated in her
memory as the somatic symbol of the whole complex of associations.
I shall be able below to give several more examples in confirmation
of this process. It seems probable that in the first instance these
pains were rheumatic; that is to say, to give a definite sense to
that much misused term, they were of a kind which resides
principally in the muscles, involves a marked sensitiveness to
pressure and modification of consistency in the muscles, is at its
most severe after a considerable period of rest and immobilization
of the extremity (i.e. in the morning), is improved by practising
the painful movement and can be dissipated by massage. These
myogenic pains, which are universally common, acquire great
importance in neuropaths. They themselves regard them as nervous
and are encouraged in this by their physicians, who are not in the
habit of examining muscles by digital pressure. Such pains provide
the material of countless neuralgias and so-called sciaticas, etc.
I will only refer briefly here to the relation of these pains to
the gouty diathesis. My patient’s mother and two of her
sisters suffered very severely from gout (or chronic rheumatism).
Some part of the pains which she complained of at the time of the
treatment may, like her original pains, have been of contemporary
origin. I cannot tell, since I had no experience then in forming a
judgement of this state of the muscles.

Studies On Hysteria

67

  
Evening
. - She was in very
good spirits and showed a great sense of humour. She told me
incidentally that the affair of the lift was not as she had
reported it. The proprietor had only said what he did in order to
give an excuse for the lift not being used for downward journeys.
She asked me a great many questions which had nothing pathological
about them. She has had distressingly severe pains in her face, in
her hand on the thumb side and in her leg. She gets stiff and has
pains in her face if she sits without moving or stares at some
fixed point for any considerable time. If she lifts anything heavy
it brings on pains in her arm. - An examination of her right leg
showed fairly good sensibility in her thigh, a high degree of
anaesthesia in the lower part of the leg and in the foot and less
in the region of the buttock and hip.

   In hypnosis she informed me that
she still occasionally has frightening ideas, such as that
something might happen to her children, that they might fall ill or
lose their lives, or that her brother, who is now on his honeymoon,
might have an accident, or his wife might die (because the
marriages of all her brothers and sisters had been so short). I
could not extract any other fears from her. I forbade her any need
to be frightened when there was no reason for it. She promised to
give it up ‘because you ask me to’. I gave her further
suggestions for her pains, her leg, etc.

  
May 16
. - She had slept
well. She still complained of pains in her face, arms and legs. She
was very cheerful. Her hypnosis yielded nothing. I applied a
faradic brush to her anaesthetic leg.

  
Evening
. - She gave a
start as soon as I came in. ‘I’m so glad you’ve
come,’ she said, ‘I am so frightened.’ At the
same time she gave every indication of terror, together with
stammering and
tic
. I first got her to tell me in her waking
state what had happened. Crooking her fingers and stretching out
her hands before her, she gave a vivid picture of her terror as she
said: 'An enormous mouse suddenly whisked across my hand in
the garden and was gone in a flash; things kept on gliding back
wards and forwards.’ (An illusion from the play of shadows?)
‘A whole lot of mice were sitting in the trees. - Don’t
you hear the horses stamping in the circus? - There’s a man
groaning in the next room; he must be in pain after his operation.
- Can I be in Rügen? Did I have a stove there like
that?’ She was confused by the multitude of thoughts crossing
one another in her mind and by her efforts to sort out her actual
surroundings from them. When I put questions to her about
contemporary things, such as whether her daughters were here, she
could make no answer.

Studies On Hysteria

68

   I tried to disentangle the
confusion of her mind under hypnosis. I asked her what it was that
frightened her. She repeated the story of the mouse with every sign
of terror, and added that as she went down the steps she saw a
dreadful animal lying there, which vanished at once. I said that
these were hallucinations and told her not to be frightened of
mice; it was only drunkards who saw them (she disliked drunkards
intensely). I told her the story of Bishop Hatto. She knew it too,
and listened to it with extreme horror. - ‘How did you come
to think of the circus?’ I went on to ask. She said that she
had clearly heard the horses stamping in their stables near-by and
getting tied up in their halters, which might injure them. When
this happened Johann used to go out and untie them. I denied that
there were stables near-by or that anyone in the next room had
groaned. Did she know where she was? She said she knew now, but had
thought earlier that she was in Rügen. I asked her how she got
on to this memory. They had been talking in the garden, she said,
of how hot it was in one part of it, and all at once the thought
had come to her of the shadeless terrace in Rügen. Well then,
I asked, what were her unhappy memories of her stay in Rügen?
She produced a series of them. She had had the most frightful pains
there in her legs and arms; when she was out on excursions there
she had several times been caught in a fog and lost her way; twice,
while she was on a walk, a bull had come after her, and so on. How
was it that she had had this attack to-day? - How (she answered)?
She had written a great many letters; it had taken her three hours
and had given her a bad head. - I could assume, accordingly, that
her attack of delirium was brought on by fatigue and that its
content was determined by associations from such things as the
shadeless place in the garden, etc. I repeated all the lessons I
have been in the habit of giving her and left her composed to
sleep.