Freud - Complete Works (51 page)

Studies On Hysteria

262

   This oscillation in intensity on
the part of the hysterical symptom is then repeated every time we
approach a fresh memory which is pathogenic in respect of it. The
symptom, we might say, is on the agenda all the time. If we are
obliged temporarily to drop the thread to which this symptom is
attached, the symptom, too, retires into obscurity, to emerge once
more at a later period of the analysis. This performance goes on
until the working-over of the pathogenic material disposes of the
symptom once and for all.

   In all this, strictly speaking,
the hysterical symptom is not behaving in any way differently from
the memory-picture or the reproduced thought which we conjure up
under the pressure of our hand. In both cases we find the same
obsessionally obstinate recurrence in the patient’s memory,
which has to be disposed of. The difference lies only in the
apparently spontaneous emergence of the hysterical symptoms, while,
as we very well remember, we ourselves provoked the scenes and
ideas. In fact, however, there is an uninterrupted series,
extending from the unmodified
mnemic residues
of affective
experiences and acts of thought to the hysterical symptoms, which
are the
mnemic symbols
of those experiences and
thoughts.

   The phenomenon of hysterical
symptoms joining in the conversation during the analysis involves a
practical drawback, to which we ought to be able to reconcile the
patient. It is quite impossible to effect an analysis of a symptom
at a single stretch or to distribute the intervals in our work so
that they fit in precisely with pauses in the process of dealing
with the symptom. On the contrary, interruptions which are
imperatively prescribed by incidental circumstances in the
treatment, such as the lateness of the hour, often occur at the
most inconvenient points, just as one may be approaching a decision
or just as a new topic emerges. Every newspaper reader suffers from
the same drawback in reading the daily instalment of his serial
story, when, immediately after the heroine’s decisive speech
or after the shot has rung out, he comes upon the words: ‘To
be continued.’ In our own case the topic that has been raised
but not dealt with, the symptom that has become temporarily
intensified and has not yet been explained, persists in the
patient’s mind and may perhaps be more troublesome to him
than it has otherwise been. He will simply have to make the best of
this; there is no other way of arranging things. There are patients
who, in the course of an analysis, simply cannot get free of a
topic that has once been raised and who are obsessed by it in the
interval between two treatments; since by themselves they cannot
take any steps towards getting rid of it, they suffer more, to
begin with, than they did before the treatment. But even such
patients learn in the end to wait for the doctor and to shift all
the interest that they feel in getting rid of the pathogenic
material on to the hours of treatment, after which they begin to
feel freer in the intervals.

Studies On Hysteria

263

   The general condition of patients
during an analysis of this kind also deserves notice. For a time it
is uninfluenced by the treatment and continues to be an expression
of the factors that were operative earlier. But after this there
comes a moment when the treatment takes hold of the patient; it
grips his interest, and thenceforward his general condition becomes
more and more dependent on the state of the work. Every time
something new is elucidated or an important stage in the process of
the analysis is reached, the patient, too, feels relieved and
enjoys a foretaste, as it were, of his approaching liberation.
Every time the work halts and confusion threatens, the psychical
burden by which he is oppressed increases; his feeling of
unhappiness and his incapacity for work grow more intense. But
neither of these things happens for more than a short time. For the
analysis proceeds, disdaining to boast because the patient feels
well for the time being and going on its way regardless of his
periods of gloom. We feel glad, in general, when we have replaced
the spontaneous oscillations in his condition by oscillations which
we ourselves have provoked and which we understand, just as we are
glad when we see the spontaneous succession of symptoms replaced by
an order of the day which corresponds to the state of the
analysis.

   To begin with, the work becomes
more obscure and difficult, as a rule, the deeper we penetrate into
the stratified psychical structure which I have described above.
But once we have worked our way as far as the nucleus, light dawns
and we need not fear that the patient’s general condition
will be subject to any severe periods of gloom. But the reward of
our labours, the cessation of the symptoms, can only be expected
when we have accomplished the complete analysis of every individual
symptom; and indeed, if the individual symptoms are interconnected
at numerous nodal points, we shall not even be encouraged during
the work by partial successes. Thanks to the abundant causal
connections, every pathogenic idea which has not yet been got rid
of operates as a motive for the whole of the products of the
neurosis, and it is only with the last word of the analysis that
the whole clinical picture vanishes, just as happens with memories
that are reproduced individually.

Studies On Hysteria

264

   If a pathogenic memory or a
pathogenic connection which had formerly been withdrawn from the
ego-consciousness is uncovered by the work of the analysis and
introduced into the ego, we find that the psychical personality
which is thus enriched has various ways of expressing itself with
regard to what it has acquired. It happens particularly often that,
after we have laboriously forced some piece of knowledge on a
patient, he will declare: ‘I’ve always known that, I
could have told you that before.’ Those with some degree of
insight recognize afterwards that this is a piece of self-deception
and blame themselves for being ungrateful. Apart from this, the
attitude adopted by the ego to its new acquisition depends in
general on the stratum of analysis from which that acquisition
originates. Things that belong to the external strata are
recognized without difficulty; they had, indeed, always remained in
the ego’s possession, and the only novelty to the ego is
their connection with the deeper strata of pathological material.
Things that are brought to light from these deeper strata are also
recognized and acknowledged, but often only after considerable
hesitations and doubts. Visual memory-images are of course more
difficult to disavow than the memory-traces of mere trains of
thought. Not at all infrequently the patient begins by saying:
‘It’s possible that I thought this, but I can’t
remember having done so.’ And it is not until he has been
familiar with the hypothesis for some time that he comes to
recognize it as well; he remembers - and confirms the fact, too, by
subsidiary links - that he really did once have the thought. I make
it a rule, however, during the analysis to keep my estimate of the
reminiscence that comes up independent of the patient’s
acknowledgement of it. I shall never be tired of repeating that we
are bound to accept whatever our procedure brings to light. If
there is anything in it that is not genuine or correct, the context
will later on tell us to reject it. But I may say in passing that I
have scarcely ever had occasion to disavow subsequently a
reminiscence that has been provisionally accepted. Whatever has
emerged has, in spite of the most deceptive appearance of being a
glaring contradiction, nevertheless turned out to be correct.

Studies On Hysteria

265

   The ideas which are derived from
the greatest depth and which form the nucleus of the pathogenic
organization are also those which are acknowledged as memories by
the patient with greatest difficulty. Even when everything is
finished and the patients have been overborne by the force of logic
and have been convinced by the therapeutic effect accompanying the
emergence of precisely these ideas - when, I say, the patients
themselves accept the fact that they thought this or that, they
often add: ‘But I can’t
remember
having thought
it.’ It is easy to come to terms with them by telling them
that the thoughts were
unconscious
. But how is this state of
affairs to be fitted into our own psychological views? Are we to
disregard this withholding of recognition on the part of patients,
when, now that the work is finished, there is no longer any motive
for their doing so?  Or are we to suppose that we are really
dealing with thoughts which never came about, which merely had a
possibility
of existing, so that the treatment would lie in
the accomplishment of a psychical act which did not take place at
the time? It is clearly impossible to say anything about this -
that is, about the state which the pathogenic material was in
before the analysis - until we have arrived at a thorough
clarification of our basic psychological views, especially on the
nature of consciousness. It remains, I think, a fact deserving
serious consideration that in our analyses we can follow a train of
thought from the conscious into the unconscious (i.e. into
something that is absolutely not recognized as a memory), that we
can trace it from there for some distance through consciousness
once more and that we can see it terminate in the unconscious
again, without this alternation of ‘psychical
illumination’ making any change in the train of thought
itself, in its logical consistency and in the interconnection
between its various parts. Once this train of thought was before me
as a whole I should not be able to guess which part of it was
recognized by the patient as a memory and which was not. I only, as
it were, see the peaks of the train of thought dipping down into
the unconscious - the reverse of what has been asserted of our
normal psychical processes.

Studies On Hysteria

266

   I have finally to discuss yet
another topic, which plays an undesirably large part in the
carrying out of cathartic analyses such as these. I have already
admitted the possibility of the pressure technique failing, of its
not eliciting any reminiscence in spite of every assurance and
insistence. If this happens, I said, there are two possibilities:
either, at the point at which we are investigating, there is really
nothing more to be found - and this we can recognize from the
complete calmness of the patient’s facial expression; or we
have come up against a resistance which can only be overcome later,
we are faced by a new stratum into which we cannot yet penetrate -
and this, once more, we can infer from the patient’s facial
expression, which is tense and gives evidence of mental effort. But
there is yet a third possibility which bears witness equally to an
obstacle, but an external obstacle, and not one inherent in the
material. This happens when the patient’s relation to the
physician is disturbed, and it is the worst obstacle that we can
come across. We can, however, reckon on meeting it in every
comparatively serious analysis.

   I have already indicated the
important part played by the figure of the physician in creating
motives to defeat the psychical force of resistance. In not a few
cases, especially with women and where it is a question of
elucidating erotic trains of thought, the patient’s
co-operation becomes a personal sacrifice, which must be
compensated by some substitute for love. The trouble taken by the
physician and his friendliness have to suffice for such a
substitute. If, now, this relation of the patient to the physician
is disturbed, her co-operativeness fails, too; when the physician
tries to investigate the next pathological idea, the patient is
held up by an intervening consciousness of the complaints against
the physician that have been accumulating in her. In my experience
this obstacle arises in three principal cases.

   (1) If there is a personal
estrangement - if, for instance, the patient feels she has been
neglected, has been too little appreciated or has been insulted, or
if she has heard unfavourable comments on the physician or the
method of treatment. This is the least serious case. The obstacle
can easily be overcome by discussion and explanation, even though
the sensitiveness and suspiciousness of hysterical patients may
occasionally attain surprising dimensions.

Studies On Hysteria

267

   (2) If the patient is seized by a
dread of becoming too much accustomed to the physician personally,
of losing her independence in relation to him, and even of perhaps
becoming sexually dependent on him. This is a more important case,
because its determinants are less individual. The cause of this
obstacle lies in the special solicitude inherent in the treatment.
The patient then has a new motive for resistance, which is
manifested not only in relation to some particular reminiscence but
at every attempt at treatment. It is quite common for the patient
to complain of a headache when we start on the pressure procedure;
for her new motive for resistance remains as a rule unconscious and
is expressed by the production of a new hysterical symptom. The
headache indicates her dislike of allowing herself to be
influenced.

   (3) If the patient is frightened
at finding that she is transferring on to the figure of the
physician the distressing ideas which arise from the content of the
analysis. This is a frequent, and indeed in some analyses a
regular, occurrence. Transference on to the physician takes place
through a
false connection
. I must give an example of this.
In one of my patients the origin of a particular hysterical symptom
lay in a wish, which she had had many years earlier and had at once
relegated to the unconscious, that the man she was talking to at
the time might boldly take the initiative and give her a kiss. On
one occasion, at the end of a session, a similar wish came up in
her about me. She was horrified at it, spent a sleepless night, and
at the next session, though she did not refuse to be treated, was
quite useless for work. After I had discovered the obstacle and
removed it, the work proceeded further; and lo and behold: the wish
that had so much frightened the patient made its appearance as the
next of her pathogenic recollections and the one which was demanded
by the immediate logical context. What had happened therefore was
this. The content of the wish had appeared first of all in the
patient’s consciousness without any memories of the
surrounding circumstances which would have assigned it to a past
time. The wish which was present was then, owing to the compulsion
to associate which was dominant in her consciousness, linked to my
person, with which the patient was legitimately concerned; and as
the result of this
mésalliance
- which I describe as
a ‘false connection’ - the same affect was provoked
which had forced the patient long before to repudiate this
forbidden wish. Since I have discovered this, I have been able,
whenever I have been similarly involved personally, to presume that
a transference and a false connection have once more taken place.
Strangely enough, the patient is deceived afresh every time this is
repeated.