LITMIR.BIZ

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it is conscious.^[273] The superiority of character of the hysterical is indicated by the fact that the conflict between their ideas of right and the bent of their inclinations is often an element in the constitution of the hysterical state. Breuer and Freud are prepared to assert that the hysterical are among "the flower of humanity," and they refer to those qualities of combined imaginative genius and practical energy which characterized St. Theresa, "the patron saint of the hysterical."

To understand the position of Breuer and Freud we may start from the phenomenon of "nervous shock" produced by physical traumatism, often of a very slight character. Charcot had shown that such "nervous shock," with the chain of resulting symptoms, is nothing more or less than hysteria. Breuer and Freud may be linked on to Charcot at this point. They began by regarding the most typical hysteria as really a psychic traumatism; that is to say, that it starts in a lesion, or rather in repeated lesions, of the emotional organism. It is true that the school of Charcot admitted the influence of moral shock, especially of the emotion of fear, but that merely as an "agent provocateur," and with a curious perversity Gilles de la Tourette, certainly reflecting the attitude of Charcot, in his elaborate treatise on hysteria fails to refer to the sphere of the sexual emotions even when enumerating the "agents provocateurs."^[274]

      The influence of fear is not denied by Breuer and Freud, but they have found that careful psychic analysis frequently shows that the shock of a commonplace "fear" is really rooted in a lesion of the sexual emotions. A typical and very simple illustration is furnished in a case, recorded by Breuer, in which a young girl of seventeen had her first hysterical attack after a cat sprang on her shoulders as she was going downstairs. Careful investigation showed that this girl had been the object of somewhat ardent attentions from a young man whose advances she had resisted, although her own sexual emotions had been aroused. A few days before, she had been surprised by this young man on these same dark stairs, and had forcibly escaped from his hands. Here was the real psychic traumatism, the operation of which merely became manifest in the cat. "But in how many cases," asks Breuer, "is a cat thus reckoned as a completely sufficient causa efficiens?"

In every case that they have investigated Breuer and Freud have found some similar secret lesion of the psychic sexual sphere. In one case a governess, whose training has been severely upright, is, in spite of herself and without any encouragement, led to experience for the father of the children under her care an affection which she refuses to acknowledge even to herself; in another, a young woman finds herself falling in love with her brother-in-law; again, an innocent girl suddenly discovers her uncle in the act of sexual intercourse with her playmate, and a boy on his way home from school is subjected to the coarse advances of a sexual invert. In nearly every case, as Freud eventually found reason to believe, a primary lesion of the sexual emotions dates from the period of puberty and frequently of childhood, and in nearly every case the intimately private nature of the lesion causes it to be carefully hidden from everyone, and even to be unacknowledged by the subject of it. In the earlier cases Breuer and Freud found that a slight degree of hypnosis is necessary to bring the lesion into consciousness, and the accuracy of the revelations thus obtained has been tested by independent witness. Freud has, however, long abandoned the induction of any degree of hypnosis; he simply tries to arrange that the patient shall feel absolutely free to tell her own story, and so proceeds from the surface downwards, slowly finding and piecing together such essential fragments of the history as may be recovered, in the same way he remarks, as the archæologist excavates below the surface and recovers and puts together the fragments of an antique statue. Much of the material found, however, has only a symbolic value requiring interpretation and is sometimes pure fantasy. Freud now attaches great importance to dreams as symbolically representing much in the subject's mental history which is otherwise difficult to reach.^[275] The subtle and slender clues which Freud frequently follows in interpreting dreams cannot fail sometimes to arouse doubt in his readers' minds, but he certainly seems to have been often successful in thus reaching latent facts in consciousness. The primary lesion may thus act as "a foreign body in consciousness." Something is introduced into psychic life which refuses to merge in the general flow of consciousness. It cannot be accepted simply as other facts of life are accepted; it cannot even be talked about, and so submitted to the slow usure by which our experiences are worn down and gradually transformed. Breuer illustrates what happens by reference to the sneezing reflex. "When an irritation to the nasal mucous membrane for some reason fails to liberate this reflex, a feeling of excitement and tension arises. This excitement, being unable to stream out along motor channels, now spreads itself over the brain, inhibiting other activities. … In the highest spheres of human activity we may watch the same process." It is a result of this process that, as Breuer and Freud found, the mere act of confession may greatly relieve the hysterical symptoms produced by this psychic mechanism, and in some cases may wholly and permanently remove them. It is on this fact that they founded their method of treatment, devised by Breuer and by him termed the cathartic method, though Freud prefers to call it the "analytic" method. It is, as Freud points out, the reverse of the hypnotic method of suggestive treatment; there is the same difference, Freud remarks, between the two methods as Leonardo da Vinci found for the two technical methods of art, per via di porre and per via di levare; the hypnotic method, like painting, works by putting in, the cathartic or analytic method, like sculpture, works by taking out.^[276]

      It is part of the mechanism of this process, as understood by these authors, that the physical symptoms of hysteria are constituted, by a process of conversion, out of the injured emotions, which then sink into the background or altogether out of consciousness. Thus, they found the prolonged tension of nursing a near and dear relative to be a very frequent factor in the production of hysteria. For instance, an originally rheumatic pain experienced by a daughter when nursing her father becomes the symbol in memory of her painful psychic excitement, and this perhaps for several reasons, but chiefly because its presence in consciousness almost exactly coincided with that excitement. In another way, again, nausea and vomiting may become a symbol through the profound sense of disgust with which some emotional shock was associated. Then the symbol begins to have a life of its own, and draws hidden strength from the emotion with which it is correlated. Breuer and Freud have found by careful investigation that the pains and physical troubles of hysteria are far from being capricious, but may be traced in a varying manner to an origin in some incident, some pain, some action, which was associated with a moment of acute psychic agony. The process of conversion was an involuntary escape from an intolerable emotion, comparable to the physical pain sometimes sought in intense mental grief, and the patient wins some relief from the tortured emotions, though at the cost of psychic abnormality, of a more or less divided state of consciousness and of physical pain, or else anæsthesia. In Charcot's third stage of the hysterical convulsion, that of "attitudes passionnelles," Breuer and Freud see the hallucinatory reproduction of a recollection which is full of significance for the origin of the hysterical manifestations.

The final result reached by these workers is clearly stated by each writer. "The main observation of our predecessors," states Breuer,^[277] "still preserved in the word 'hysteria,' is nearer to the truth than the more recent view which puts sexuality almost in the last line, with the object of protecting the patient from moral reproaches. Certainly the sexual needs of the hysterical are just as individual and as various in force as those of the healthy. But they suffer from them, and in large measure, indeed, they suffer precisely through the struggle with them, through the effort to thrust sexuality aside." "The weightiest fact," concludes Freud,^[278] "on which we strike in a thorough pursuit of the analysis is this: From whatever side and from whatever symptoms we start, we always unfailingly reach the region of the sexual life. Here, first of all, an etiological condition of hysterical states is revealed. … At the bottom of every case of hysteria—and reproducible by an analytical effort after even an interval of long years—may be found

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